International Journal of Child Health and Nutrition

119-130

Authors: Mbeugué Thiam, Adama Diouf, Ousseynou Baba Coly, Saliou Diombo Kébé, Ousmane Diongue, Abdou Badiane, Mane Hélène Faye, Papa Mamadou Dit Doudou Sylla, Nicole Idohou-Dossou, Jean Michel Medoc

Background: Despite micronutrient supplementation and food fortification strategies carried out for decades, micronutrient deficiencies remain prevalent among children under 5 years old in rural area in Senegal. The OR4FOOD project was implemented as a preventive and long-term approach to reduce malnutrition through biofortification. Objective: We aimed to assess the baseline dietary intakes and nutritional status of the mother-child (6-23 months old) pairin a rural community in Senegal. Methods:Dietary intakes were assessed using dietary recall questionnaires and weight food records. All foods and beverages consumed from waking to bedtime were quantified, and nutrient intakes were calculated. The nutritional status was measured by anthropometry. Results: Results showed that77.2% of children had low dietary diversity score. Only 18% of them received an appropriate complementary feeding according to the minimum acceptable diet. Cereals and legumes were among the most consumed food groups, whereas orange-fleshed sweet potato (OFSP) and animal food products were rarely consumed. Median dietary intakes of iron, zinc, and vitamin A were lower than the recommended dietary allowances. Acute malnutrition and stunting affected 14.6% and 16.9% of children, respectively. Overall, 20.8% of mothers were underweighted, and overweight/obesity affected 23.1% of them.Conclusion: Malnutrition remains prevalent in rural areas of Senegal and affects both mothers and children. Furthermore, their nutrient requirements were not covered by the diet. Millet and cowpea being widely consumed, optimizing their iron and zinc content through biofortification and the introduction of OFSP might improve micronutrient intakes and would be promising strategies to prevent child malnutrition

142-151

Authors: Mahmut Kılıç, Tuğba Uçak Ozan

This study aims to reveal the relationship between the academic success of the students and the duration of breastfeeding, parental attitude, and other variables. This cross-sectional study was conducted among 9th-grade high school students in 2019. A total of 501 students and their families participated in the research. Academic success in order of importance in multivariable linear regression analysis, the increase in the education level of the father, the preparation for the exam, the increase in the protective and democratic parental attitude, the shortening of the first walking age, and the increase in the maternal age increase the high school exam score. Breastfeeding duration and authoritarian parental attitudes were not found to be statistically significant. The protective and democratic attitude of the parents, the high level of father education, and early walking positively affect academic success, while the breastfeeding duration is insignificant.

161-170

Authors: Abebe Ferede, Tefera Belachew, Muluemebet Abera

Background: To improve the iodine status and growth of children was not documented in Ethiopia. This study aimed to determine the effects of nutrition behavior communication change (BCC) on improving iodine status and growth of children 6 to 59 months. Methods: A community cluster randomized trial with a single treatment arm was conducted from February 2018 to April 2020. “Kebeles” [lower administrative units] were randomly assigned to either the intervention or the control cluster. Mothers and their paired children were randomly selected from kebeles. Anthropometry data and urine samples were collected at baseline and end-line surveys. Percentile rank and Independent t-test were used to determine the difference between arms. Finally, Generalized Estimating Equation (GEE) is used to isolate independent predictors. Results: At baseline, 97.83 % (n = 812) mothers/ caregivers and paired children were enrolled for the trial study, but at the end-line, 88.05% (n =715) of children completed the intervention. Iodine deficiency prevalence was higher (11.82%, n = 96) at baseline and reduced to 6.15 % (n =44) at the end-line. The growth defect among children was 41 %( n = 332) at the baseline and declined to 28.67 %( n=205) at the end-line, while among interventions reduced by more than two times (39% to 12.81%). At the baseline, the median UIC among the intervention group was 106.0µg/L and increased to 207.190µg/L. The prevalence of iodine deficiency among intervention was 14.29% (n = 58) at the baseline and lowered to 3.45% (n=14) at the end-line, but a slight increment observed among control from 9.36% to 9.71% at end-line. The end-line median UIC was very high (210.56µg/L ± 150 compared to the baseline median UIC (107µg/L ± 8.66). Most (43.6%) of the intervention group found in the 4th and 5th percentile ranks factions of UIC by Height (Ht) mean differences. Being an intervention group increased Ht by 10.85cm (β =10.85, Std. E = 0.33). Likewise, for 1µg/l UIC change a 1cm (β = 1.0, p = <0.05) Ht change predicted at the end-line. Conclusions: Findings from this trial enhance nutrition behavior communication to improve the iodine status and growth of young children in the community. Longitudinal studies are needed to determine the level of iodine deficiency disorders in the community

178-186

Authors: Magdalene E. Odunvbun, Anthony O. Atimati, Gold I. Osueni

Background: Nigeria has the highest burden of sickle cell anaemia (SCA) in Africa. Patients with SCA present with life-long complications in addition to growth failure. With comprehensive care, patients with SCA have improved survival and well-being, with some studies reporting overnutrition. This study aims to assess nutritional status and sociodemographic determinants in children with SCA. Methods: A descriptive cross-sectional study was carried out among children aged 1-16years attending the paediatric SCA clinics and their sex and age-matched controls. Anthropometric measurements were carried out to determine their nutritional status, and the data obtained were analyzed using SPSS software. The sociodemographic and relevant clinical information was obtained using a semi-structured questionnaire. Results: The majority (86%) of the children with SCA had normal height and weight, but the mean weight, weight for age z-score (WAZ), body mass index z-score (BMIZ) and height for age z-score (HAZ) were significantly lower than the HbAA controls. The mean WAZ was significantly higher in children from high socioeconomic class (SEC) and those whose mothers had tertiary education than those from lower educational statuses. Similarly, the mean HAZ was significantly higher in children from high SEC, tertiary maternal education and younger children. Conclusion: Most children with SCA have normal nutritional status despite significantly lower nutritional indicators compared to children with HbAA genotype. Higher educational status of mothers and SEC were associated with a significantly higher nutritional status among the subjects

60-71

Authors: David J. Farbo, Deborah J. Rhea

Introduction: Obesity has continued to rise in recent years due to a lack of physical activity. The school environment contributes to this problem as opportunities for physical activity are eliminated for more classroom time. Recess, defined as unstructured, outdoor play, can increase MVPA and improve current obesity trends. This study aimed to examine body fat category shift differences in children who received 40-60 minutes and those who received 30 minutes. A secondary purpose was to examine differences by district, sex, grade, and race across both groups since they received more than the national average for recess. Methods:Students in 2nd-5th grade (7-11 years old) (N=393) were selected from schools serving as an intervention (N=190) or control school (N=203) in a larger longitudinal intervention titled Let’s Inspire Innovation N’ Kids (LiiNK). Bio-electrical impedance analysis was used to categorize students as either underfat, healthy, overfat, or obese. These categories were then used to determine if students shifted a category between pre and post-measurements. Results: At least 30 minutes of recess was significantly associated with a body fat shift in 2nd graders and females. Additionally, the percentage of obese students did not change over the school year. There was no association between the group, sex, or race. Conclusion: Due to this study occurring during COVID-19, it is hard to make definitive conclusions on the effects of increased recess time on obesity. However, some positive trends are pointing towards recess as a successful method of preventing a rise in childhood obesity

80-97

Authors: Venus S. Kalami, Laurie C. Miller, Lynne Ausman, Beatrice Rogers

Background:Micronutrient status, body composition, gastrointestinal (GI) functioning, and neurological functioning are important facets of pediatric nutrition and health. When studied in low- and middle-income countries (LMIC), information about these elements is usually obtained via standardized surveys and traditional anthropometry. While convenient, these evaluations offer limited information that may be prone to error and bias. However, a variety of underutilized objective measurement tools exist which can promote a more objective, comprehensive, and deeper understanding of these aspects of pediatric nutrition and health in LMIC. Objective: Identify field-friendly, relatively low-cost, and portable tools that provide objective measurements of micronutrient status, body composition, GI functioning, and neurological functioning in young children. Methods: A narrative review of the literature was conducted to assess the state-of-the-art field-friendly research tools targeting micronutrient status, body composition, GI functioning, and neurological functioning in children in LMIC.Results:A number of field-friendly tools addressing the domains of micronutrient status, GI health, body composition, and neurological functioning were identified. While many tools remain to be fully validated, these tools have yet to be used to their full potential in field-based pediatric nutrition and health research in LMICs. Conclusions: More robust, field-friendly assessment methods will help to refine knowledge on the state of pediatric health of vulnerable children in LMIC. Such awareness could contribute to the design of interventions, programs and policies, and further research

110-118

Authors: Mehreen Qadri, Lubna Ansari Baig, Zaeema Ahmer, Aimen Asim, Syed Moin Aly

Objective: To validate the WHO recommended Mid-Upper Arm Circumference (MUAC) cut-offs for acute malnutrition screening in children younger than five in Karachi, Pakistan. Methods: A cross-sectional study was conducted, including an anthropometric examination following WHO guidelines. Height was measured using Stadiometer and Infantometer. The link between MUAC and Weight-for-Height-Z score (WHZ) for different cut-offs of MUAC for Moderate Acute Malnutrition (MAM) and Severe Acute Malnutrition (SAM) was shown using Receiver Operator Characteristics (ROC) curves and the Youden index. Sensitivity and specificity of MUAC <11.5 cm and ≥11.5 to <12.5cm were determined using WHZ scores of -3 Standard Deviation (SD) and ≥-3 to <-2 SD for SAM and MAM, respectively. Results: Among 499 children, as per WHZ score, 9.6% and 27.1% had SAM and MAM, respectively, whereas according to MUAC, 6.4% and 3.6% had MAM and SAM, respectively. At the maximum value of the Youden index of 55.6%, an optimum cut-off of 12.7cm for screening of SAM with MUAC was found compared to the recommended cut-off of 11.5cm. Similarly, at the maximum value of the Youden index of 57.7%, an optimum cut-off of 13.9cm for screening of MAM with MUAC was found compared to the recommended cut-off of 12.5cm. Conclusion: The current MUAC cut-off of WHO for screening SAM and MAM cases captures only a small percentage of children under five. This needs to be revised to capture children with acute malnutrition for timely treatment in Pakistan.

1-10

Authors: Kyaw Zin Latt, Yelda Turkmenoglu, Alper Kacar, Ahmet Irdem, Hasan Dursun

The relationship between urinary stone disease and nutrition in infants is not well known. This study investigates the relationship between breast milk, formula and supplementary foods, vitamin D usage, and family stone history with urinary system stones in children aged 3-24 months. The study included 100 infants aged 3-24 months of age with urinary tract stones and 40 healthy infants with similar age and gender as the control group. Sixty of the patients were boys, and 40 were girls; the control group consisted of 26 boys and 16 girls. There was no significant difference in only breastfeeding, breastfeeding plus formula, and formula feeding in the patients and controls. Positive family history of urolithiasis was significantly higher in the patients compared to the controls (p=0.04). While breastfeeding duration time was negatively correlated with spot urine calcium to creatinine ratio in children exclusively breastfed infants. No direct effect of nutrition type and vitamin D usage on stone formation was found in infants. It has been shown that stone formation in this age group is associated with a family history of stones. In this study, the duration of breastfeeding is negatively correlated with the spot urinary calcium to creatinine ratio.

25-29

Authors: Ayalew Kassaw, Abebe Gebere Mariam, Alemi Kebede, Fassikaw Kebede

Vaccination is the epicenter of preventive care for good children's health outcomes in each nation. Nevertheless, a number of factors have been hindering the attainment of targets from providing complete vaccination in different nations. This study aims to assess predictors of immunizations in 12-23 months aged children in Abobo District, Gambela regions southwest Ethiopia. Method: A community-based cross-sectional study was employed in 436 pairs of mothers to children aged 12–23 months from 12 marches---27 April 2019. The study participant was recruited by multistage-sampling were used for each kebele. Data were entered into Epi-Data version 3.1 after cleaning and coded, exported to STATA/SE-14/R logistic regression analysis. Variables with P-value <0.25 in bivariate logistic regression were transported into multivariable logistic regression. A variable with 95%CI in AOR was used as claim predictors for the dropout rate. Results: The overall dropout rate of immunization from completion was found 25.8% (95%CI: 21.5--30.2). Factors like mothers did not attend ANC (AOR= 4.59, 95% CI: 2.58, 7.84), being home delivery (AOR=6.46, 95% CI: (3.5--- 11.4), postponed last immunization scheduled (AOR=3.44, 95% CI: 1.98---5.97), children ill during measles vaccine (AOR=1.83, 95% CI: (1.02---3.28), Mothers refused ≥30 minutes for vaccine service waiting (AOR=3.58, 95% CI: (1.99, 6.44) were significantly associated with immunization dropout out. Conclusion: The immunization dropout rate was unacceptable and higher compared to WHO reference (<10%). Home delivery postponed measles vaccine, child illness, ANC status Service refusal ≥30 minutes waiting for the vaccine were independently associated with dropout

42-48

Authors: Suleyiman Hassen Ali, Eskinder Wolka, Misgan Legesse Liben

Introduction: Globally, iron deficiency is estimated to be responsible for half of all anemia cases. The reduction of iron deficiency anemia in pregnant women relies largely on their adherence to IFA supplementation. This study aimed to assess the factors associated with adherence to IFA supplementation among women attending antenatal checkups at health centers in Borena district, Ethiopia. Methods: Institution-based cross-sectional study design was conducted on 348 pregnant women. The data were analyzed using SPSS version 20. Variables with a p-value of ≤0.2 in the univariable logistic regression analysis were included in the multivariable analysis. Adjusted odds ratio with 95% confidence interval was reported, and variables with p<0.05 were considered statistically significant. Result: A total of 340 pregnant women were enrolled. The study revealed that 45.6% (95% CI: 40.27, 50.92%) of women adhered to the IFA supplement use. Women of husbands with primary education [AOR: 1.95; 95% CI: 1.07, 3.57] and who had taken IFA for two months [AOR: 2.81; 95% CI: 1.37, 5.79] were positively associated with adherence to IFA supplementation. However, women with a previous history of abortion [AOR: 0.16; 95% CI: 0.50, 0.53], who had disease other than anemia [AOR: 0.48; 95% CI: 0.28-0.79] and lack of family support [AOR: 0.12; 95% CI: 0.04, 0.39] were less likely to adhere to the supplement. Conclusion: This study revealed that nearly nine in twenty women adhered to the IFA supplement. Therefore, strengthening nutritional counseling, health education, and information on iron-folic acid supplementation in a health institution is important to improve adherence.

130-147

Authors: Nèmanan R. Ninamou, Jérémie B. Dupuis, Noël-Marie Zagré, Mamady Daffé, Sonia Blaney

Water provision to infants under six months of age (IU6M) can hamper exclusive breastfeeding (EBF). Understanding factors and their relationships influencing this practice is needed to tailor EBF promotion programs. Using a validated questionnaire, this study aims to identify pathways in which individual factors and the environment interact to affect the provision of water in addition to breast milk among 300 mothers of IU6M. Our finding shows that 75% of mothers intended to provide water in addition to breast milk to their IU6M and that about 60% reported doing it. Results of the final path show that the subjective norm/SN (β = 0.432, p < 0.001), the attitude (β= 0.349, p < 0.001), and to a lesser extent the perceived control/PC (β = 0.141, p = 0.005) predict the intention of mothers to provide water in addition to breast milk to their IU6M. The environment scores predict the attitude (β = 0.210, p = 0.001) and the SN (β = 0.284, p< 0.001). Having the mother practicing early breastfeeding initiation at birth positively predicted the PC score (β = 0.157, p = 0.017) and predicted an increasing score of SN (β = 0.221, p = 0.003). Even though predicting the final behavior is complex, this research provides directions to nutrition education programs to tailor their content to the context and be more efficient in reducing the proportion of women providing water to their IU6M, hence contributing to the improvement of EBF.

154-161

Authors: Allico Mousso Jean Maurel, Agbo Adouko Edith, Séri Kipré Laurent, Boyvin Lydie, Kouamé Christophe, Yapi Houphouët Félix, Djaman Allico Joseph

The objective of this work was to study the impact of food diversification based on sweet potato, soybean, and cowpea on the prognostic inflammatory and nutritional index (PINI) in school-aged children in the Nawa region. This study took place from October 2017 to May 2018 among 240 pupils aged 6 to 12, divided into four groups of 60. Four types of meals were proposed: rice with tomato soup and fish (group 1), sweet potato porridge enriched with green soybeans (group 2), sweet potato porridge enriched with white cowpea (group 3), or sweet potato porridge accompanied by white cowpea with green soybeans (group 4). There were three blood samples: before eating meals (phase 0), the end of the first trimester (phase 1), and the end of the second trimester (phase 2). Blood assay for C-reactive protein (CRP), orosomucoid, albumin, and prealbumin was performed using COBAS c311 analyzer. PINI was calculated. Groups 3 and 4 showed a slight increase in albumin values (42.24 ± 0.95 g/L and 41.51 ± 1.71 g/L, respectively) compared to group 1. CRP decreased from phase 1 for group 1 (2.06 ± 0.26 mg/L) and group 4 (2.38 ± 0.36 mg/L). Orosomucoid increased insignificantly (p > 0.05) in group 3 (0.74 ± 0.04 g/L) and group 4 (0.71 ± 0.04 g/L). PINI was reduced by 0.37 (group 1), 0.36 (group 2), 0.46 (group 3) and 0.44 (group 4). Food diversification based on sweet potato and white cowpea has a positive impact on PINI in more than 80% of pupils

80-87

Authors: Teresia Mbogori, James Muriuki

Objective: To identify the demographic, social, and economic determinants of malnutrition in Kenya's children aged 0-23 months.Methods: Data from the Kenya Demographic and Health Survey (KDHS), a nationally representative cross-sectional study conducted in 2014/2015, were used in this study. Data from children 0-23 months old with complete information on weight, height, age, and sex were used for analysis. Height for Age Z scores (HAZ), Weight for Height Z scores (WHZ), and BMI for age Z scores (BAZ) was determined using WHO guidelines to determine the nutritional status of the children. Chi-square statistics were used to determine the relationship between social-economic status and place of residence indicators and the nutritional status of the children. Significance was set at p <0.05.Results: Among all participating (n=7578), 22.7% were stunted (HAZ < -2), 6.2% were wasted (WHZ < -2), and 6.1% were either overweight or obese (BAZ > 2). Wasting and stunting were significantly higher in children from rural areas, poorer wealth index, and mothers with no education. In contrast, children from urban areas, the richest wealth index category, and mothers with secondary or higher education were significantly more likely to be overweight or obese. Conclusion: Current and future policies and programs to curb malnutrition in Kenya need to target specific needs of children based on their social-economic status, area of residence, and other demographic characteristics that were identified as determinants of child malnutrition instead of using a general approach

105-115

Authors: Beyhan Özge Yersel, Lugen Ceren Gunes, Ender Durualp

The aim of this descriptive study was to examine the views of parents with children between the ages of 3-6 on their children's daily life activities during the pandemic. The study sample was composed of 65 parents, among whom 60 were mothers, and five were fathers, who were selected with the snowball method and who had children between the ages of 3-6 and voluntarily participated in the study. The data were collected through the General Information Form and the Family Interview Form, which were developed in line with expert opinions. The collected data were analyzed using percentage and frequency values. The findings suggested that, during the pandemic, the children's family relationships were positively affected; the duration of using technological tools increased; the children started to wash their hands more carefully; and duration of activities, such as drawing and chores, and plays increased. It was also found that the children mostly preferred piece assembly games; their physical movement needs were not fully satisfied; and there was no change in their health conditions, self-care skills, diet, sleep patterns, interactive book reading, and purposes of using technology. In line with the findings, parents, experts were given specific recommendations.

121-129

Authors: Yenefenta Wube Bayleyegne

Background: Stunting is a well-established child health indicator of chronic malnutrition related to environmental and socio-economic circumstances. In Ethiopia, childhood stunting is the most widely prevalent among children under the age of five years. Objective: To estimate the prevalence of stunting and model the determinants of stunting prevalence among children under age five in Ethiopia. Methods: Data were extracted from 2016 EDHS, and samples of 8487 children under age five were used in this study. The sample was selected using a two-stage stratified sampling process, and a multilevel logistic regression model was used to determine the factors associated with childhood stunting in Ethiopia. Results: This study revealed that the prevalence of stunting among children under age five years in Ethiopia was around 39.39%. The multilevel binary logistic regression analysis was performed to investigate the variation of predictor variables of stunting prevalence among children under age five. Accordingly, it has been identified that the ages of the child above 12 months, male gender, children from poor households, and no mother education significantly affect the prevalence of stunting in Ethiopia. It is found that variances related to the random term were statistically significant, implying a variation in the prevalence of stunting across Ethiopia's regional states. Conclusion: The current study confirmed that the prevalence of stunting among children under aged five years in Ethiopia was a severe public health problem. Therefore, governmental or stakeholders should pay attention to all the significant factors mentioned in this study's analysis.