Association between wasting and food insecurity among children under five years: findings from Nepal demographic health survey 2016

Background Wasting is a consequence of food insecurity, inappropriate dietary practices, and inadequate caring and feeding practices. The present study assessed association between wasting and household food insecurity among under 5 years old children, along with other socio-demographic characteristics. Methods This study is a secondary analysis of the Nepal Demographic and Health Survey 2016. The survey is cross-sectional in design with use of standardized tools. The sampling frame used is an updated version of the frame from the 2011 National Population and Housing Census. The participants were children under 5 years of age (n = 2414). Logistic regression was carried out to identify the odds of being wasted for children belonging to different levels of food insecure households using odds ratio and 95% confidence intervals. Results The prevalence of wasting increased with the level of food insecurity, from mild (9.4%) to moderate (10.8%) and to severe (11.3%). The highest proportions of wasted children were in Province 2 (14.3%), from rural areas (10.1%), born to mothers with no education (12.4%) and from a richer quintile (11.3%). Children belonging to severe food insecure households had 1.36 (95%CI 0.72–2.57) adjusted odds of being wasted and those belonging to mild food insecure and moderately food insecure households had 0.98 (95%CI 0.64-1.49) and 1.13 (95%CI 0.65–1.97) odds of being wasted respectively. Province 1 (AOR 2.06, 95%CI 1.01–4.19) and Province 2 (AOR 2.45, 95%CI 1.22–4.95) were significantly associated with wasting. Conclusion Considering the increment in childhood wasting as per level of food insecurity, an integrated intervention should be developed in Nepal that, 1. addresses improving knowledge and behavior of community people with respect to diet and nutrition; 2. reduce the problem of food insecurity through agricultural interventions

The family as a determinant of stunting in children living in conditions of extreme poverty: a case-control study

BACKGROUND: Malnutrition in children can be a consequence of unfavourable socioeconomic conditions. However, some families maintain adequate nutritional status in their children despite living in poverty. The aim of this study was to ascertain whether family-related factors are determinants of stunting in young Mexican children living in extreme poverty, and whether these factors differ between rural or urban contexts. METHODS: A case-control study was conducted in one rural and one urban extreme poverty level areas in Mexico. Cases comprised stunted children aged between 6 and 23 months. Controls were well-nourished children. Independent variables were defined in five dimensions: family characteristics; family income; household allocation of resources and family organisation; social networks; and child health care. Information was collected from 108 cases and 139 controls in the rural area and from 198 cases and 211 controls in the urban area. Statistical analysis was carried out separately for each area; unconditional multiple logistic regression analyses were performed to obtain the best explanatory model for stunting. RESULTS: In the rural area, a greater risk of stunting was associated with father's occupation as farmer and the presence of family networks for child care. The greatest protective effect was found in children cared for exclusively by their mothers. In the urban area, risk factors for stunting were father with unstable job, presence of small social networks, low rate of attendance to the Well Child Program activities, breast-feeding longer than six months, and two variables within the family characteristics dimension (longer duration of parents' union and migration from rural to urban area). CONCLUSIONS: This study suggests the influence of the family on the nutritional status of children under two years of age living in extreme poverty areas. Factors associated with stunting were different in rural and urban communities. Therefore, developing and implementing health programs to tackle malnutrition should take into account such differences that are consequence of the social, economic, and cultural contexts in which the family lives

Internal validity of a household food security scale is consistent among diverse populations participating in a food supplement program in Colombia

Objective: We assessed the validity of a locally adapted Colombian Household Food Security Scale (CHFSS) used as a part of the 2006 evaluation of the food supplement component of the Plan for Improving Food and Nutrition in Antioquia, Colombia (MANA – Plan Departamental de Seguridad Alimentaria y Nutricional de Antioquia). Methods: Subjects included low-income families with pre-school age children in MANA that responded affirmatively to at least one CHFSS item (n = 1,319). Rasch Modeling was used to evaluate the psychometric characteristics of the items through measure and INFIT values. Differences in CHFSS performance were assessed by area of residency, socioeconomic status and number of children enrolled in MANA. Unidimensionality of a scale by group was further assessed using Differential Item Functioning (DIF). Results: Most CHFSS items presented good fitness with most INFIT values within the adequate range of 0.8 to 1.2. Consistency in item measure values between groups was found for all but two items in the comparison by area of residency. Only two adult items exhibited DIF between urban and rural households. Conclusion: The results indicate that the adapted CHFSS is a valid tool to assess the household food security of participants in food assistance programs like MANA

Application of ordinal logistic regression analysis in determining risk factors of child malnutrition in Bangladesh

<p>Abstract</p> <p>Background</p> <p>The study attempts to develop an ordinal logistic regression (OLR) model to identify the determinants of child malnutrition instead of developing traditional binary logistic regression (BLR) model using the data of Bangladesh Demographic and Health Survey 2004.</p> <p>Methods</p> <p>Based on weight-for-age anthropometric index (Z-score) child nutrition status is categorized into three groups-severely undernourished (< -3.0), moderately undernourished (-3.0 to -2.01) and nourished (≥-2.0). Since nutrition status is ordinal, an OLR model-proportional odds model (POM) can be developed instead of two separate BLR models to find predictors of both malnutrition and severe malnutrition if the proportional odds assumption satisfies. The assumption is satisfied with low p-value (0.144) due to violation of the assumption for one co-variate. So partial proportional odds model (PPOM) and two BLR models have also been developed to check the applicability of the OLR model. Graphical test has also been adopted for checking the proportional odds assumption.</p> <p>Results</p> <p>All the models determine that age of child, birth interval, mothers' education, maternal nutrition, household wealth status, child feeding index, and incidence of fever, ARI & diarrhoea were the significant predictors of child malnutrition; however, results of PPOM were more precise than those of other models.</p> <p>Conclusion</p> <p>These findings clearly justify that OLR models (POM and PPOM) are appropriate to find predictors of malnutrition instead of BLR models.</p

Household and community socioeconomic and environmental determinants of child nutritional status in Cameroon

BACKGROUND: Undernutrition is a leading cause of child mortality in developing countries, especially in sub-Saharan Africa. We examine the household and community level socioeconomic and environmental factors associated with child nutritional status in Cameroon, and changes in the effects of these factors during the 1990s economic crisis. We further consider age-specific effects of household economic status on child nutrition. METHODS: Child nutritional status was measured by weight-for-age (WAZ) and height-for-age (HAZ) z-scores. Data were from Demographic and Health Surveys conducted in 1991 and 1998. We used analysis of variance to assess the bivariate association between the explanatory factors and nutritional status. Multivariate, multilevel analyses were undertaken to estimate the net effects of both household and community factors. RESULTS: Average WAZ and HAZ declined respectively from -0.70 standard deviations (SD), i.e. 0.70 SD below the reference median, to -0.83 SD (p = 0.006) and from -1.03 SD to -1.14 SD (p = 0.026) between 1991 and 1998. These declines occurred mostly among boys, children over 12 months of age, and those of low socioeconomic status. Maternal education and maternal health seeking behavior were associated with better child nutrition. Household economic status had an overall positive effect that increased during the crisis, but it had little effect in children under 6 months of age. Improved household (water, sanitation and cooking fuel) and community environment had positive effects. Children living in the driest regions of the country were consistently worst off, and those in the largest cities were best off. CONCLUSION: Both household and community factors have significant impact on child health in Cameroon. Understanding these relationships can facilitate design of age- and community-specific intervention programs