Access of Households to Arable Land and Nutritional Status of Children Aged 6–59 Months in Rural Areas of South Kivu, Case of the Health Zone of Minova, Eastern DRC

Already knowing enough about the determinants of malnutrition, this study set itself the objective of verifying the influence of access to arable land on the nutritional status of children aged 6 to 59 months in a rural Health Zone of the DRC in South Kivu (Minova) with very high prevalence of malnutrition (62% CM and 7.1% AM). A cross-sectional quantitative study conducted on a representative sample of 424 children aged 6 to 59 months selected using the Lynch formula by probabilistic stratum sampling; using a structured questionnaire. Malnutrition (acute and chronic) assessed on the basis of WHO growth standards served as the dependent variable and access to arable land considered according to the FAO definition was the main independent variable. Chi-square or Ficher tests were used to compare proportions and logistic regressions were used to determine the factors associated with malnutrition; the significance threshold set at 5%. The frequency of less than 3 meals per day and the low socio-economic level of households were associated with chronic malnutrition (p-value 0.046 and 0.007). Exclusive breastfeeding and unimproved source of drinking water were associated with acute malnutrition. Finally, no statistically significant association was found between access to arable land and the nutritional status of children aged 6 to 59 months. How land production and household incomes are allocated for other needs would also be part of the problem

Association between diagnostic criteria for severe acute malnutrition and hospital mortality in children aged 6-59 months in th eastern Democratic Republic of Congo: the Lwiro cohort study

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Follow-up of a historic cohort of children treated for severe acute malnutrition between 1988 and 2007 in Eastern Democratic Republic of Congo

Background: It is well documented that treatment for severe acute malnutrition (SAM) is effective. However, little is known about the long-term outcomes for children treated for SAM. We sought to trace former SAM patients 11 to 30 years after their discharge from hospital, and to describe their longer-term survival and their growth to adulthood. Methods A total of 1,981 records of subjects admitted for SAM between 1988 and 2007 were taken from the archives of Lwiro hospital, in South Kivu, DRC. The median age on admission was 41 months. Between December 2017 and June 2018, we set about identifying these subjects (cases) in the health zones of Miti-Murhesa and Katana. For deceased subjects, the cause and year of death were collected. A Cox proportional hazards multivariate regression analysis was used to identify the death-related factors. For the cases seen, age- and gender-matched community controls were selected for a comparison of anthropometric indicators. Results: A total of 600 subjects were traced, and 201 subjects were deceased. Of the deceased subjects, 65·6% were under 10 years old at the time of their death. Of the deaths, 59·2% occurred within 5 years of discharge from hospital. The main causes of death were malaria (14·9%), kwashiorkor (13·9%), respiratory infections (10·4%), and diarrhoeal diseases (8·9%). The risk of death was higher in subjects with SAM, MAM combined with CM, and in male subjects, with HRs* of 1·83 (p = 0·043), 2.35 (p = 0·030) and 1.44 (p = 0·013) respectively. Compared with their controls, the cases had a low weight (-1·7 kg, p = 0·001), short height [sitting (-1·3 cm, p = 0·006) and standing (-1·7 cm, p = 0·003)], short legs (-1·6 cm, p = 0·002), and a small mid-upper arm circumference (-3·2mm, p = 0·051). There was no difference in terms of BMI, thoracic length, or head and thoracic circumference between the two groups. Conclusion: SAM during childhood has lasting negative effects on growth to adulthood. In addition, these adults have characteristics that may place them at risk of chronic non-communicable diseases later in lif

Severe acute malnutrition in childhood, chronic diseases, and human capital in adulthood in the Democratic Republic of Congo: the Lwiro Cohort Study

Background Little is known about the long-term outcome of children treated for severe acute malnutrition (SAM) after nutritional rehabilitation. Objectives To explore the association between SAM in childhood, noncommunicable diseases (NCDs), and low human capital in adulthood. Methods We identified 524 adults (median age: 22 y) who were treated for SAM during childhood in Eastern Democratic Republic of Congo between 1988 and 2007. They were compared with 407 community unexposed age- and sex-matched subjects with no history of SAM. The variables of interest were cardiometabolic risk markers for NCDs and human capital. For the comparison, we used linear and logistic regressions to estimate the association between SAM in childhood and the risk of NCDs and ordinal logistic regression for the human capital. Results Compared with unexposed subjects, the exposed participants had a higher waist circumference [1.2 (0.02, 2.3) cm; P = 0.015], and a larger waist-to-height ratio [0.01 (0.01, 0.02) cm; P < 0.001]. On the other hand, they had a smaller hip circumference [−1.5 (−2.6, −0.5) cm; P = 0.021]. Regarding cardiometabolic markers for NCDs, apart from a higher glycated hemoglobin (HbA1c) [0.4 (0.2, 0.6); P < 0.001], no difference was observed in other cardiometabolic markers for NCD between the 2 groups. Compared with unexposed participants, exposed participants had a higher risk of metabolic syndrome (crude OR: 2.35; 95% CI: 1.22, 4.54; P = 0.010) and visceral obesity [adjusted OR: 1.44 (1.09, 1.89); P = 0.001]. The prevalence of hypertension, diabetes, overweight, and dyslipidaemia was similar in both groups. Last, the proportion of malnutrition survivors with higher socioeconomic status level was lower. Conclusion SAM during childhood was associated with a high risk of NCDs and lower human capital in adulthood. Thus, policymakers and funders seeking to fight the global spread of NCDs in adults in low-resource settings should consider the long-term benefit of reducing childhood SAM as a preventive measure to reduce the socioeconomic burden attributable to NCDs

Effects of probiotics and synbiotics on diarrhea in undernourished children: Systematic review with meta-analysis

BACKGROUND : Undernutrition predisposes children to a greater incidence and duration of diarrhea. No review and meta-analysis have yet been conducted to assess effectiveness of probiotics and synbiotics in undernourished children. AIMS : To assess the effectiveness of probiotics and synbiotics on diarrhea in undernourished children. METHODS : Randomized, double-blind, placebo-controlled trials evaluating the effects of probiotics and synbiotics on diarrhea in undernourished children were searched from 1990 to May 2020. Recommendations of the Cochrane Handbook and the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement were followed. RESULTS : The systematic review identified 15 trials with 6986 patients. The meta-analysis revealed that treatment with probiotic or synbiotic reduced significantly both the duration of diarrhea [Weighted mean difference (WMD) = −1.05 day, 95% CI (−1.98, −0.11)] and the hospital stay duration [Standard mean difference (SMD) = −2.87 days, 95% CI (−5.33, −0.42)], especially in specific patient subsets. In both groups, similar rates of vomiting and nutritional recovery were observed. No probiotics or synbiotics-related adverse effects were reported. Subgroup analyses showed that probiotic and synbiotic treatment were more effective in reducing risk of diarrhea in outpatients [Risk ratio (RR) = 0.86, 95%CI (0.75–0.98)]. CONCLUSION : This meta-analysis supports the potential beneficial roles of probiotics and synbiotics on diarrhea in undernourished children

Association between diagnostic criteria for severe acute malnutrition and hospital mortality in children aged 6–59 months in the eastern Democratic Republic of Congo: the Lwiro cohort study

Background: Few studies have assessed the relationship between weight-for-height (WHZ) and mid-upper arm circumference (MUAC) with hospital mortality considering confounders. The particularity of MUAC for age (MUACZ) is less documented. Objective: This study aims to investigate this relationship in a region endemic for severe acute malnutrition (SAM). Methods: This is a retrospective cohort based on a database of children admitted from 1987 to 2008 in South Kivu, eastern DRC. Our outcome was hospital mortality. To estimate the strength of the association between mortality and nutritional indices, the relative risk (RR) with its 95% confidence interval (95% CI) was calculated. In addition to univariate analyses, we constructed multivariate models from binomial regression. Results: A total of 9,969 children aged 6 to 59 months were selected with a median age of 23 months. 40.9% had SAM (according to the criteria WHZ < -3 and/or MUAC<115 mm and/or the presence of nutritional edema) including 30.2% with nutritional edema and 35.2% had both SAM and chronic malnutrition. The overall hospital mortality was 8.0% and was higher at the beginning of data collection (17.9% in 1987). In univariate analyses, children with a WHZ < -3 had a risk almost 3 times higher of dying than children without SAM. WHZ was more associated with in-hospital mortality than MUAC or MUACZ. Multivariate models confirmed the univariate results. The risk of death was also increased by the presence of edema. Conclusion: In our study, WHZ was the indicator more associated with hospital death compared with MUAC or MUACZ. As such, we recommend that all criteria shall continue to be used for admission to therapeutic SAM programs. Efforts should be encouraged to find simple tools allowing the community to accurately measure WHZ and MUACZ.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Infant and Young Child Feeding Practices and Nutritional Status in Two Health Zones of South Kivu, Eastern Democratic Republic of Congo: A Community-Based Study

Background: In DRC, childhood undernutrition remains a serious public health concern. Internationally recommended infant and young child feeding (IYCF) practices may improve child nutritional status. This study aimed to describe IYCF practices, factors associated with inappropriate complementary feeding, and infant’s nutritional status. Methods: A community-based cross-sectional study including 1,009 mother-infant pair was conducted in August 2019 in 32 health areas (16 in rural health zone and 16 in urban one) of South Kivu, Democratic Republic of Congo (DRC), among mothers who had infants under 24 months of age. Infant’s nutritional status was assessed using WHO Anthro plus software. To describe IYCF practices, we used the indicators recommended by the WHO. To study the factors associated with inappropriate complementary feeding practices, we performed univariable and multiple logistic regression analyzes. The data was analyzed in SPSS version 25. Results: The prevalence of early initiation of breastfeeding and exclusive breastfeeding up to 6 months of age was 73.7% and 42.2% respectively. Of the 746 infants aged 6–23.9 months, 246 (32.3%) received appropriate complementary feeding. Of the 997 infants who had valid anthropometric parameters, 416 (41.7%) were well-nourished, 374 (37.5%) were undernourished and 207 (20.8%) were overweight. Multivariable logistic regression analysis revealed that residence in rural area [Adjusted Odds Ratio (AOR): 2.38 (95% Confidence Interval (CI): 1.49, 3.78)], nonattendance at postnatal care (AOR 1.63; 95% CI 1.12, 2.96), low household socioeconomic (AOR 1.72; 95% CI 1.14, 2.59) and low maternal education (AOR 1.83; 95% CI 1.20, 2.77) were factors associated with inappropriate complementary feeding. Mothers with inappropriate complementary feeding practices were 6.88 times more likely to have undernourished infants than their counterparts (AOR 6.88; 95% CI 1.24, 18.37). Conclusion: Findings from this study provide strong evidence, both of association between inappropriate complementary feeding and undernutrition, and of the double burden of malnutrition with the co-existence of under- and overnutrition in the infant population in South Kivu. Interventions should focus on both preventing undernutrition and overweight to promote child well-being

Minimum acceptable diet among children aged 6–23 months in South Kivu, Democratic Republic of Congo: a community-based cross-sectional study

Background: Suboptimal child nutrition remains the main factor underlying child undernutrition in Democratic Republic of Congo (DRC). This study aimed to assess the prevalence of minimum acceptable diet and associated factors among children aged 6–23 months old. Methods: Community-based cross-sectional study including 742 mothers with children aged 6–23 months old was conducted in 2 Health Zones of South Kivu, Eastern DRC. WHO indicators of Infant and Young Child Feeding (IYCF) regarding complementary feeding practices were used. Logistic regression analysis was used to quantify the association between sociodemographic indicators and adequate minimum acceptable diet for both univariate and multivariate analysis. Results: Overall, 33% of infants had minimum acceptable diet. After controlling for a wide range of covariates, residence urban area (AOR 2.39; 95% CI 1.43, 3.85), attendance postnatal care (AOR 1.68; 95% CI 1.12, 2.97), education status of mother (AOR 1.83; 95% CI 1.20, 2.77) and household socioeconomic status (AOR 1.72; 95% CI 1.14, 2.59) were factors positively associated with minimum acceptable diet. Conclusion: Actions targeting these factors are expected to improve infant feeding practices in South Kivu

Association between severe acute malnutrition in childhood and hematological disorders in adulthood: the Lwiro follow-up study in the Eastern Democratic Republic of the Congo.

BACKGROUND: Despite growing evidence on the short-term deleterious effects of severe acute malnutrition (SAM) in childhood on hematopoiesis, little is known about the long-term hematological effects of SAM in low-income countries (LICs). Our study explored the association between childhood SAM and hematological disorders in adults 11 to 30 years after post-SAM nutritional rehabilitation. METHODS: This follow up study investigated 97 adults (mean age 32 years) treated for SAM during childhood in eastern Democratic Republic of the Congo (DRC) between 1988 and 2007. Participants were compared to 97 aged- and sex-matched adult controls living in the same community with no history of SAM. Outcomes of interest were hematological characteristics and disorders in adulthood, assessed by various biological markers. Logistic and linear regression models were used to estimate the association between SAM in childhood and risk of hematological abnormalities. RESULTS: Compared to the unexposed, the exposed had higher mean white blood cells (/μl) [+ 840 (179 to 1501), p = 0.013], neutrophils [+ 504 (83 to 925), p = 0.019] and platelets (*103) [11.9 (8.1 to 17.9), p = 0.038] even after adjustment for food consumption in adulthood. No difference was observed in red blood cells (RBC), hemoglobin and erythrocytes parameters. With regard to the risk of hematological disorders, in contrast to the unexposed, exposed subjects had a risk of leukocytosis approximately three times higher [adjusted OR (95% CI): 2.98 (1.01 to 8.79), p = 0.048]. No difference was observed in terms of anemia, leukopenia, increased platelets and thrombocytopenia between the 2 groups. CONCLUSION: Adults with a history of SAM in childhood have hematological characteristics that would be markers associated with chronic low-grade inflammatory or infectious diseases in an environment with no nutritional transition. Larger cohort studies with bone marrow analyses could provide further understanding of the impact of SAM on the overall hematological profile in adult life