Post-natal factors such as failure to complete or not being up-to-date on immunizations as per the national immunization schedule (OR=2.2; 95% CI: 0.77.2) and human immunodeficiency virus (HIV) sero-exposure (OR=1.4; 95% CI: 0.63.5) and delayed developmental milestones (OR=18.9; 95% CI: 4.187.5) also increased the odds of developing under-nutrition. Mother not having attended ante-natal clinic (OR=7.9; 95% CI: 1.541.2), deworming (OR=0.8; 95% CI: 0.41.2), and pre-lacteal feeding (OR=1.8; 95% CI: 1.13.0) were associated with under-nutrition. Addis Ababa: Addis Ababa University College of health sciences; 2014. Federal government websites often end in .gov or .mil. Setting: This study was set at Sebokeng, Kopanong and Heidelberg hospitals, Sedibeng district, South Africa. e-Library of Evidence for Nutrition Actions (eLENA). This includes 155 countries withnational data sources (e.g. However, we gave strict attention to the study procedures, including the process of training the research team and workers at the hospital, standardization of anthropometric measurements, and close and supportive supervision throughout the field activities to minimize biases. BMJ Glob Health. The proposed method has important characteristics, including non-linear time trends, regional trends, country-specific trends, covariate data and a heterogeneous error term. The use of statistical models at country level is important to enable comparisons across countries at the same year, filling in the gaps. Accessibility This was important in order to alert the reader, via footnotes, to instances where estimates for some regions and years should be interpreted with caution due to low population coverage (defined as less than 50 per cent). !function(e,i,n,s){var t="InfogramEmbeds",d=e.getElementsByTagName("script")[0];if(window[t]&&window[t].initialized)window[t].process&&window[t].process();else if(!e.getElementById(n)){var o=e.createElement("script");o.async=1,o.id=n,o.src="https://e.infogram.com/js/dist/embed-loader-min.js",d.parentNode.insertBefore(o,d)}}(document,0,"infogram-async"); The interaction between undernutrition and infection can create a potentially lethal cycle of worsening illness and deteriorating nutritional status. statement and 2016. In 2022 globally, 45.0 million children under five were wasted of which 13.7 million were severely wasted. Continued breastfeeding and child growth in the second year of life: a prospective cohort study in western Kenya. Any child aged 659months attending the hospital as an inpatient or outpatient whose anthropometric measurements are appropriate for their age with z-scores between -2SD and+2SD [9]. Of the cases, 84% (79/94) were under-nourished. A WHOUNICEFLancet Commission, Assessing progress towards SDG2: Trends and patterns of multiple malnutrition in young children under 5 in West and Central Africa, Prevalence and major contributors of child malnutrition in developing countries: Systematic review and meta-analysis, Past drivers of and priorities for child undernutrition in South Asia: A mixed methods systematic review protocol. In 2022, three regions had very high stunting prevalence, with approximately one third of children affected. For this reason, uncertainty intervals are needed to enhance trend interpretability in terms of the caution level employed. We conducted a hospital-based case-control study and as such, its findings cannot be generalized to the entire population of under-five children in Western Kenya. Other studies carried out in Burundi and Uganda also had similar findings [12, 13]. Desyibelew HD, Bayih MT, Baraki AG, Dadi AF. Number of under-fives falling below minus 2 standard deviations (moderate and severe) and minus 3 standard deviations (severe) from the median. Stunting refers to a child who is too short for his or her age. This finding was similar to another study carried out in Kenya in 2009 [28]. Bethesda, MD 20894, Web Policies These estimates do not account for the impact of COVID-19, but the pandemic is expected to exacerbate all forms of malnutrition due to worsening household income especially in the vulnerable population, constraints in the availability and affordability of nutritious food, disruptions in essential nutrition services, and reduced physical activity. The key findings 2021 Edition includes global and regional trends and, for the first time, country-level estimates are also presented, with a summary of the enhanced methodology for deriving country-level model-based estimates for stunting and overweight. As such, lack of formal education could mean no formal employment and by extension no regular source of income to provide for their families. Prevalence thresholds for wasting, overweight and stunting in children under 5 years. This has also been shown in other Sub-Saharan African countries [30]. Among those that were under-nourished, by assessing the WHZ score, 20% (16/79) were wasted while 9% (7/79) were severely wasted. The participants who were born preterm (OR=2.0; 95% CI: 0.67.4) and those with low birth weight (OR=2.8; 95% CI: 1.26.2) had higher odds of under-nutrition compared to term babies and those with normal birth weights. 2010;8:10516. The global prevalence-based estimates of 45.4 million children under 5 affected by wasting and 13.6 million affected by severe wasting in 2020 should therefore be viewed as an underestimate of the number of children affected and in need of treatment that year. This study aimed to identify factors associated with malnutrition in children aged < 5 years in western Kenya. Hyun P. The impact of nutritional status and longitudinal recovery of motor and cognitive milestones in internationally adopted children. Malnutrition is the intake of an insufficient, surplus or disproportionate amount of energy and/or nutrients [].Malnutrition is a significant global public health burden with greater concern among children under five years [].In an attempt to address this global challenge of malnutrition, the World Health Organization (WHO) member states recently signed into effect a . 2019) developed by the JME Working Group in partnership with the University of South Carolina. Article Springer Nature. de Onis M, Blossner M, Borghi E, Morris R, Frongillo EA. This finding was similar to other studies [28]. Malnutrition amongst children under the age of 5 years is a result of a complex interaction of availability, accessibility, and utilisation of food and healthcare services. These indices are measured and compared as standard deviation units (Z-scores) from the median of the reference population.6 Children with under-nutrition were also shown to be more likely to have delayed developmental milestones. Das JK, Salam RA, Saeed M, Kazmi FA, Bhutta ZA. There are currently no joint global or regional estimates for these combined conditions, but UNICEF has a country-level dataset with country level estimates, where re-analysis was possible. For the first time in 2021, the JME also includes country-level modelled estimates for stunting and overweight based on updated methodology (Mclain et al. Article Exclusive breastfeeding for 6months as recommended by the WHO was also widely practiced with 72% (271/375) of the participants parents adhering to this guideline. In contrast, the giving of pre-lacteal feeds adversely affected nutritional status and predisposed the children to under-nutrition. Geneva: World Health Organization; 2014 (http://who.int/nutrition/publications/globaltargets2025_policybrief_wasting/en/). Cookies policy. All authors helped with the interpretation of the results, read, critically reviewed and approved the final manuscript. Deepti D. A community-based study on growth and development of under-five children in an Urbanized Village of South Delhi. Middle East and North Africa had the highest overweight prevalence in 2022 with 10.3 per cent affected, followed by Latin America and Caribbean at 8.6%. The indicators stunting, wasting, overweight and underweight are used to measure nutritional imbalance; such imbalance results in either undernutrition (assessed from stunting, wasting and underweight) or overweight. Obese children and adolescents are likely to suffer from both short-term and long-term health consequences, the most significant being: Underweight - Weight is easy to measure; hence, this is the indicator for which most data have been collected in the past. The first edition of the JME was released in 2012 and provided estimates for stunting, wasting, severe wasting, underweight and overweight, as well as a detailed description of the methodology (UNICEF & WHO, 2012). As started in the 2014 edition, a separate exercise was conducted to assess population coverage for the modelled global and regional estimates. WHO, UNICEF. As such, proper education on feeding practices during post-natal period should be enhanced. The key findings report for the 2021 edition of the JME presents country data, a countrys share of the global burden, and progress assessment towards 2030 targets for the first time. Male gender was also positively associated with over-nutrition. PubMedGoogle Scholar. (2018). For the MUAC cut-points to determine whether a child was under- or over-nourished, we used the cut-points of any child with MUAC <126mm was classified under-nourished [8]. This can be done by providing job aids to providers to help them talk to parents about adherence to key recommended practices such as appropriate feeding, continuous auditing of patient outcomes, and better use of data for improved decision-making should be implemented at these facilities. World Health Organization (WHO) - global database on child growth and malnutrition. Independent Oversight and Advisory Committee, Levels and trends in child malnutrition: UNICEF/WHO/The World Bank Group joint child malnutrition estimates: key findings of the 2021 edition. Under-nutrition impairs a childs immunity, which can lead to recurrent infections, and impaired physical and cognitive development [3]. This approach can address therapeutic feeding, social assessment of the family to identify and address contributing factors.19 It also provides an opportunity to primary health care workers for counselling on appropriate feeding, care, and demonstration and practice of food hygiene.30 Early identification and prevention of low birthweight are part of basic antenatal care programmes in South Africa. United Nations Childrens Fund, World Health Organization, The World Bank. Using the HAZ score among the under-nourished, 46% (36/79) were stunted while 38% (30/79) were severely stunted. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Stunting is largely irreversible, especially the first 1000 days from conception have adverse effects in childs life.28 It has a major influence on the physical and cognitive development of a child.29, According to UNICEF, WHO and World Bank Group 2020 report, an estimated 144 million children under the age of 5 suffer from stunting, globally. 427451. Anthropometric measures and their technical errors are another limitation because it can result in misclassification of childrens nutritional status. Proper pre-natal care, child feeding practices and deworming programs should be enhanced to reduce pediatric malnutrition. 2004), applying population weights for children under 5 years of age from The United Nations World Population Prospects, 2019 Revision. Source: de Onis, M., et al. Of the cases, 84% (79/94) were under-nourished and 16% (15/94) over-nourished. In contrast, for overweight, about half of all countries have experienced no progress or are worsening. During the interviews informed oral consent was obtained from parents/legal guardians of all study participants after explaining the objectives of the study. Gudu, E., Obonyo, M., Omballa, V. et al. Overall, these two regions account for just over 2 out of 5 children affected by overweight in the world. For univariable analysis, we calculated odds ratios (OR), 95% confidence intervals (CI), chi-square statistics and p-values. Provider advocacy and better health education to parents should be intensified in the region for better outcomes. Received 2021 Jun 22; Accepted 2021 Aug 24. However, the exact mechanism of this link has not yet been clearly described. 1999;354(9195):20415. China, Hong Kong Special Administrative Region, China, Macao Special Administrative Region, Saint Helena, Ascension and Tristan da Cunha. The purpose of these consultations was to explain the updated methodology for stunting and overweight estimates to national governments; to ensure the estimates included all recent and relevant country data for stunting, wasting and overweight; and to engage with and receive feedback from national governments on the estimates. This could be because younger children are more likely to receive more attention and feeding effort from their parents as compared to older children. These estimates of prevalence and numbers affected for child stunting, overweight, wasting and severe wasting are derived for the global population as well as by regional groupings of United Nations (UN) regions and sub-regions, Sustainable Development Goals (SDG), UNICEF, WHO and World Bank regions, as well as World Bank country-income group classifications. Before 2017. We conducted a hospital-based unmatched case-control study between May and June 2017. Methods This paper is part of a bigger study, conducted in 2017 using a mixed methods . Map of Busia County, Western Kenya showing the constituent sub-counties including Teso South sub-county. The average number of children <5years visiting the outpatient section of the child welfare clinic daily was used as a sampling frame. Limited or poor access to education, healthcare services, infrastructure and poor hygienic environment are other nutritional sensitive factors that adversely affect the children under the age of 5-year nutritional status.6,16 Global nutrition targets 2025: stunting policy brief. Data sharing is not applicable to this article as no new data were created or analysed in this study. All data generated or analyzed during this study are available upon request to the corresponding author. The hospital in conjunction with Busia County Government should organize for regular outreach to the community targeting pregnant and lactating mothers, strengthen deworming programs for children >1year and all children with delayed developmental milestones. These three indicators are also included in WHO's Global reference list of 100 core health indicators. The sampling occurred via the data entered into the MoH Child Health Logbook, which would have each presenting childs age, MUAC, and other information indicative of over-, under-, or at-level nutrition. It has resulted in high levels of persistent undernutrition amongst the lower income population potentially because of high levels of food insecurity at the household level.10 The following interventions might be considered to overcome the complex issue of malnutrition amongst children under the age of 5 years.26,33, The community-based management of malnutrition enables community healthcare workers to identify and initiate treatment for children with malnutrition before they become seriously ill.22 This helps in the early detection of severe acute malnutrition in the community and the provision of management for those without medical complications.19 Ready-to-use therapeutic foods or other nutrient-dense foods are part of community-based strategies.23 Active community-based surveillance by community healthcare workers is the key to nutritional counselling, early identification and management of malnutrition.30 This approach provides an opportunity for a primary health care worker to understand the context of malnutrition that assists in the preparation of energy-dense child foods using locally available, culturally acceptable, and affordable food items.23 The community-based management of malnutrition can prevent both short-term and long-term consequences of childhood malnutrition.10, The health facility-based strategy is being used in the management of acute malnutrition with medical complications. Causes of malnutrition. Public health nutrition, 22(1), 175-179. For overweight, the covariate data consisted of linear and quadratic socio-demographic index (SDI)**, and data source type. 2017. 3.1 Explanation as to why trends are shown for stunting and overweight but only most current estimate for wasting and severe wasting: The JME on wasting and severe wasting are based on national-level prevalence data alone and thus do not reflect the cumulative cases (incidence) that occur over the course of a year (Isanaka et al 2021). Therefore, consistent follow-up of pregnant mothers from the antenatal period and post-natal care of the children <5years needs to be enhanced. The dataset you are about to download is licensed under a Creative Commons Attribution 3.0 IGO license. Measures were taken to assure collected data were properly stored and secured and only accessible to the investigators. Anthropometric data was analyzed using WHO Anthro software version 3.2.2 (WHO Anthro) to assess nutritional indicators like weight-for-length/weight-for-height (wasting), weight-for-age (underweight or overweight), length-for-age/height-for-age (stunting), MUAC-for-age, and HC-for-age. (http://www.who.int/childgrowth/publications/en/). de Onis M, Borghi E, Arimond M, Webb P, Croft T, Saha K et al. Read more Data Nutritional status Build your own dataset Proper infant and young child feeding practices and deworming should be emphasized. Stunting, wasting and overweight in children aged under 5 years are included as primary outcome indicators in the core set of indicators for the Global Nutrition Monitoring Framework to monitor progress towards reaching Global Nutrition Targets 1, 4 and 6. However, current systematic reviews show little benefit is derived from mass deworming. Malnutrition in children under the age of 5 years in a primary health care setting S Afr Fam Pract (2004). (UNICEF, New York; WHO, Geneva; The World Bank, Washington, DC; 2012). Tzioumis E, Adair LS. Constance G. Childhood overweight and obesity among Kenyan pre-school children: association with maternal and early child nutritional factors. For the estimates presented in the 2021 edition of the JME, joint UNICEF-WHO country consultations were conducted from November 2020 to January 2021. Momberg DJ, Ngandu BC, Voth-Gaeddert LE, et al.. Water, sanitation and hygiene (WASH) in sub-Saharan Africa and associations with undernutrition, and governance in children under five years of age: A systematic review. Since the prevalence data are collected infrequently (every 3 to 5 years) in most countries and measure wasting at one point in time, it is not possible to capture the rapid fluctuations in wasting over the course of a given year or to adequately account for variations in seasons across survey years. As of the latest review closure on 31 January 2021, the primary source dataset contained 997 data sources from 157 countries and territories, with nearly 80 per cent of children living in countries with at least one data point on stunting, wasting and overweight that is less than 5 years old. In 2022, 22.3 per cent, or more than one in five children under age 5 worldwide had stunted growth. Improving estimates of the burden of severe wasting: analysis of secondary prevalence and incidence data from 352 sites. doi:10.1136/bmjgh-2020-004342. Sory DI, Sory D, Nfanly C, Ibrahima D, Mamoudou BE, Moussa C, et al. Child growth is internationally recognized as an important indicator of nutritional status and health in populations. Overweight increases the risk of diet-related noncommunicable diseases later in life. The other limitation was that since it was a casecontrol study, which means it cannot establish the relationship between exposure and disease. Pattern of malnutrition in children under the age of 5 years. This is a new development over the last couple of decades that needs to be further explored to halt and decrease the burden of cases of over-nutrition. The quality of the models was quantified with model-fit criteria that balance the complexity of the model with the closeness of the fit to the observed data. Among the same group, using WAZ score, 39% (31/79) were underweight while 29% (23/79) were severely underweight. Licensee: AOSIS. These children should therefore be followed up more closely. Global nutrition targets 2025: wasting policy brief. official website and that any information you provide is encrypted Primary healthcare providers play a vital role in screening, early identification, appropriate referral and integrated management of malnutrition in children under the age of 5 years. Onyango AW, Esrey SA, Krammer MS. What are the consequences and implications? All variables removed from the model when a backward stepwise method was performed and those known to be potential cofounders or factors associated with malnutrition from previous studies were tested for confounding, any of the mentioned variables that had a more than ten percentage change (>10%) between the crude and adjusted odds ratio was considered as a confounder. The wasting and severe wasting prevalence data from national data sources described in se section 2.1 above were used to generate the regional and global estimates for the year 2020 using the JME sub-regional multi-level model (UNICEF & WHO, 2012, de Onis et al. Malnutrition rates in children under 5 years In Nigeria, 37 per cent of children, or 6 million children, are stunted (chronically malnourished or low height for age), more than half of them severely. In terms of the targets, at country level, the greatest progress is being made towards the stunting target, with nearly two-thirds of countries seeing at least some progress. Nutrition-sensitive factors include food insecurity . Stunting is a chronic form of malnutrition that results from prolonged non-adherence to proper dietary requirements to meet the bodys physiological needs. More than half of all children affected by wasting live in Southern Asia and Asia as a whole is home to more than three-quarters of all children suffering from severe wasting. These parts of the JME are described in more detail below. The sample size was calculated using statistical software Epi Info version 7.2.0. human immunodeficiency virus [HIV], Tuberculosis [TB], etc. Measures of child malnutrition are used to track development progress. Wasting demonstrates an acute undernutrition status that measures body mass with height and describes the current nutritional status of a child.6 It usually indicates recent and severe weight loss because of unavailability of enough food and infectious diseases, such as diarrhoea. A total of 94 cases and 281 controls were recruited. (2018). If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. A backward elimination stepwise method was used to identify independent factors associated with malnutrition. That said, overall trends are positive. This could be because the community being a patriarchal society, the fathers control the familys resources. This work is licensed under the Creative Commons Attribution License. The study population consisted of all children <5years attending the child welfare clinic and the outpatient clinic within the hospital during the study period. Statistics in Medicine 38:1002-1012, 2019. Methods We conducted a hospital-based unmatched case-control study between May and June 2017. This study aimed to identify factors associated with malnutrition in children aged <5years in western Kenya. The uncertainty intervals for the new JME method have been tested and validated with various data types. Thus, regional estimates for these indicators are only reported for the latest year (2022). Correspondence to For height/length, children <2years were measured lying down (recumbent length) while those who were>=2years were measured standing up. The regional and global figures for stunting and overweight are now also based on these country model outputs, while they remain based on the previously applied sub-regional model for wasting and severe wasting (UNICEF & WHO, 2012). Overweight - Childhood obesity is associated with a higher probability of obesity in adulthood, which can lead to a variety of disabilities and diseases, such as diabetes and cardiovascular diseases. It is an indicator of linear growth retardation and cumulative growth deficits in children because of chronic malnutrition.5 Stunting is usually associated with low socio-economic conditions, poor maternal health and nutritional status, inappropriate feeding and frequent hospital admissions in early life.15 Linear growth is a strong predictor of morbidity, mortality and learning capability during later life. Childhood nutrition is an integral component of a multifocal relationship with health, economic, social developments, and political system of the country. Organization, W.H. An official website of the United States government. Fanzo J, Hawkes C, Udomkesmalee E, Afshin A, Allemandi L, Assery O, Baker P, Battersby J, Bhutta Z, Chen K, Corvalan C. Global Nutrition Report. 382, no. WHO. Children at risk for developmental delay can be recognized by stunting, being underweight, ill health, little maternal schooling or high gravidity. Nearly half of all deaths in children under 5 are attributable to undernutrition; undernutrition puts children at greater risk of dying from common infections, increases the frequency and severity of such infections, and delays recovery. At the household level, age, gender, geographical area, level of maternal education, family income, household size, food security and healthcare access are important factors that had a significant association with child malnutrition.18,19 Malnutrition is an economic problem at the household level, which is accompanied by poverty, disturbed family structure, and ignorance of health and wellness of children. Prevalence thresholds for wasting, overweight and stunting in children under 5 years. For more information about how to calculate country-level AARR, please click here to read a technical note. Cite this article. The lack of incidence data for wasting and severe wasting is a main reason why the JME does not present annual trends for these forms of malnutrition. Under-nutrition is a major cause of morbidity and mortality especially, in low-to-middle-income (LMIC) countries. Read more about them in our Privacy Policy. 2014 Kenya Demographic and Health Survey. In this study, we outlined the types of malnutrition amongst children, the causes of malnutrition intervention at the primary health care level and some recommendations to alleviate childhood malnutrition in South Africa. Food Nutr Bull. Variables with p-value 0.05 were statistically significant. Under-five wasting and severe wasting are highly sensitive to change. 2015;5:749. The thresholds were developed in relation to standard deviations (SD) of the normative WHO Child Growth Standards. Infant and young child feeding practices also affected nutritional status of the participants. AA. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Independent Oversight and Advisory Committee, http://who.int/nutrition/publications/globaltargets2025_policybrief_stunting/en/, http://who.int/nutrition/publications/globaltargets2025_policybrief_wasting/en/, http://www.who.int/nutrition/publications/operational-guidance-GNMF-indicators/en/, https://www.who.int/healthinfo/indicators/2018/en/, http://www.who.int/childgrowth/publications/en/, https://www.who.int/nutrition/publications/anthropometry-data-quality-report/en/, http://www.who.int/nutgrowthdb/estimates/en/, http://who.int/nutrition/global-target-2025/en/, http://www.who.int/elena/global-targets/en, http://www.who.int/elena/global-targets/en/#stunting, http://www.who.int/elena/global-targets/en/#childhoodoverweight, http://www.who.int/elena/global-targets/en/#wasting, cardiovascular diseases, mainly heart disease and stroke, musculoskeletal disorders, especially osteoarthritis and.
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