Women's social power, child nutrition and poverty in Mali

While the macro-level association between poverty and child malnutrition is well-established, the concept of 'poverty' and its operationalization in terms of measures of socioeconomic status shed little or no light on the mechanisms through which malnutrition is created and/or prevented. This paper investigates a woman's social power, one such mechanism that may mediate the impact of poverty on childhood nutrition. This micro-level factor is examined using survey data on 402 children 5 years of age and younger and their 261 Fulbe mothers in rural Mali. A conceptual model of social power is developed and used to test the hypothesis that a mother's social power can predict her child's nutritional status.     

Reducing child malnutrition in Tanzania. Combined effects of income growth and program interventions.

Malnutrition is associated with an inadequate diet, poor health and sanitation services and inadequate care for young children. A combination of income growth and nutrition interventions are therefore suggested to adequately tackle this issue [Haddad, L., Alderman, H., Appleton, S., Song, L., Yohannes, Y., 2003. Reducing child malnutrition: how far does income growth take us? World Bank Econ. Rev., 17, 107-131.], yet evidence to support this claim is often not available, especially for African settings. This paper evaluates the joint contribution of income growth and nutrition interventions towards the reduction of malnutrition. Using a four round panel data set from northwestern Tanzania we estimate the determinants of a child's nutritional status, including household income and the presence of nutrition interventions in the community. The results show that better nutrition is associated with higher income, and that nutrition interventions have a substantial beneficial effect. Policy simulations make clear that if one intends to halve malnutrition rates by 2015 (the MDG objective), income growth will have to be complemented by large scale program interventions.     

A case-control study of maternal knowledge of malnutrition and health-care-seeking attitudes in rural South India.

INTRODUCTION: In India, approximately 20 percent of children under the age of four suffer from severe malnutrition, while half of all the children suffer from undernutrition. The contributions of knowledge and attitudes of nutrition-conscious behaviors of the mothers to childhood malnutrition has been unclear. The purpose of this study was to explore maternal knowledge of the causes of malnutrition, health-care-seeking attitudes and socioeconomic risk factors in relation to children''s nutritional status in rural south India. METHODS: A case-controlled study was conducted in a rural area in Tamil Nadu, India. Thirty-four cases and 34 controls were selected from the population of approximately 97,000 by using the local hospital''s list of young children. A case was defined as a mother of a severely malnourished child under four years of age. Severe malnutrition was defined as having less than 60 percent of expected median weight-for-age. A control had a well-nourished child and was matched by the location and the age of the child. Interviews obtained: (1) socioeconomic information on the family, (2) knowledge of the cause of malnutrition and (3) health-care-seeking attitudes for common childhood illnesses, including malnutrition. RESULTS: Poor nutritional status was associated with socioeconomic variables such as sex of the child and father''s occupation. Female gender (OR = 3.44, p = .02) and father''s occupation as a laborer (OR = 2.98, p = .05) were significant risk factors for severe malnutrition. The two groups showed a significant difference in nutrition-related knowledge of mild mixed malnutrition (OR = 2.62, p = .05). No significant difference was apparent in health-care-seeking attitudes. Based on their traditional beliefs, the mothers did not believe that medical care was an appropriate intervention for childhood illnesses such as malnutrition or measles. DISCUSSION: The results suggested that the gender of the child and socioeconomic factors were stronger risk factors for malnutrition than health-care availability and health-care-seeking attitudes. The father''s occupation was a more accurate indicator for malnutrition than household income. These results suggest a need for intensive nutritional programs targeted toward poor female children and their mothers.     

The Bacon Chow study: Genetic analysis of physical growth in assessment of energy–protein malnutrition

Estimates of the prevalence of energy–protein malnutrition almost universally employ physical growth measurements. In this study we focus on this disease and the role of body size of relatives as mediators of responses in individuals to one type of nutrition intervention: supplementation of pregnant and lactating women. In this study, initiated by Dr. Bacon Chow and others in 1967, during gestation of a first infant a mother was untreated, while during the lactation of the first infant and the gestation and lactation of a second infant she was treated with either a calorie supplement or a placebo. Supplement–placebo group differences were sought in sibling and mother–child correlations in growth from birth to 30 months, in order to assess the role of heredity as a mediator of supplement effects. There were 108 pairs of siblings whose mothers had received a high-calorie–high-protein supplement as described above and 105 pairs of siblings whose mothers had received a placebo. Among the latter, sibling correlations for most measurements are statistically significant at birth, and of the same magnitude seen in previous studies (～0.5), while among supplemented siblings, birth correlations are unusually low and often insignificant. The sibling correlations in Rohrer's index (wt/L³) differed the most between groups (p < 0.01). Group differences in the sibling correlation tended to disappear over the first 2.5 years of life. Correlations between mothers and their second children in subscapular skinfold tended to be higher in the supplemented than in the placebo group, birth to 30 months. In both supplement groups mother–second child correlations for body weight were higher than mother–first child correlations, suggesting the occurrence of secular changes in the environment unconnected with the treatment. The results suggest that: (1) genetic analysis of components of anthropometric variation may be a more sensitive method than the more conventional comparison of group means in detecting supplement effects; and (2) infant relative weight (Rohrer index), particularly the addition of subcutaneous fat, may be more affected by maternal supplementation than growth in weight or length alone.     

Socioeconomic disparities and the familial coexistence of child stunting and maternal overweight in guatemala

The double burden of malnutrition, defined here as households with a stunted child and an overweight mother (SCOM), is a growing problem in Guatemala. We explored the magnitude of SCOM and the identification of socio-economic factors associated with this malnutrition duality. From the 2000 Living Standards Measurement Study from Guatemala, we obtained a sample of 2492 households with pairs of children 6–60 months and their mothers (18–49 years) and estimated the prevalence of SCOM. Economic characteristics of this sample were assessed with the Concentration Index (CI). Results revealed higher prevalence of child stunting, but a lower prevalence of maternal overweight among the poor compared to the rich households. Economic inequality in child stunting was greater than economic inequality in maternal overweight (CI = ?0.22 vs. +0.14). SCOM pairs were more prevalent among the poor and middle SES groups as compared to the rich households. A multivariate logistic regression model showed that SCOM was more likely to occur in households from the middle consumption quintile than in those from the first quintile (odds ratio = 1.7). The findings reported here add new insights into the complex phenomenon observed in households with both extremes of the malnutrition continuum, and support the need for the identification of economic, social and biological interventions aimed at, on the one hand, the prevention of this duality of the malnutrition in those households where it is still non-existent, and on the other hand, to deter or correct the economic, social and biological environments where those mother–child dyads are already affected by such phenomena.     

Geography and culture matter for malnutrition in Bolivia

The prevalence of health problems and malnutrition in Bolivia is exceptionally high, even in comparison to other underdeveloped countries. This study analyzes the relationship between a two measures of child health--height-for-age and weight-for-age z-scores--and a set of physical and cultural determinants of child nutrition, including mother's characteristics, household assets and access to public services. The ultimate aim is to identify the most important determinants of child health and to measure the relative impact of each factor on the height and weight z-scores. A sequential strategy was adopted in order to estimate a two-equation linear model with correlated error terms. A major finding points to geographical and cultural variables as main causes of nutritional status and highlights the role of mother's anthropometrical characteristics. This study uses data on over 3000 children gathered from a Demographic and Health Survey (DHS).     

Maternal grandmothers improve nutritional status and survival of children in rural Gambia

Hypotheses for the evolution of human female life-history characteristics have often focused on the social nature of human societies, which allows women to share the burden of childcare and provisioning amongst other members of their kin group. We test the hypothesis that child health and survival probabilities will be improved by the presence of kin using a longitudinal database from rural Gambia. We find that the only kin to improve the nutritional status of children significantly (apart from mothers) are maternal grandmothers, and that this is reflected in higher survival probabilities for children with living maternal grandmothers. There is also evidence that the reproductive status of the maternal grandmother influences child nutrition, with young children being taller in the presence of non-reproductive grandmothers than grandmothers who are still reproductively active. Paternal grandmothers and male kin, including fathers, have negligible impacts on the nutritional status and survival of children.     

Brazilian mothers' beliefs, attitudes and practices related to child weight status and early feeding within the context of nutrition transition

With the rapid pace of the nutrition transition worldwide, understanding influences of child feeding practices within a context characterized by the co-existence of overweight and undernutrition in the same population has increasing importance. This qualitative study describes Brazilian mothers' child feeding practices and their perceptions of their association with child weight status and explores the role of socioeconomic, cultural and organizational factors on these relationships. Forty-one women enrolled in the Family Health/Community Health Workers Programme were selected from rural, urban, coastal and indigenous areas in Ceara State, north-east Brazil, to participate in four focus group discussions. Content analysis identified fourteen emergent themes showing mothers' child feeding practices in this setting were influenced by economic resources, mothers' immediate social support networks (e.g. neighbours and family members) and participation in nutrition assistance programmes. Child malnutrition was the most common nutritional concern; nevertheless, mothers were aware of the negative health consequences of obesity but misunderstood its causes (e.g. foods filled with fat would make a person fat; others thought that birth control pills and stimulants given to children were causes of obesity); several reported their own struggles with overweight. Food assistance programmes emerged as an important influence on children's dietary adequacy, especially among mothers describing dire economic situations. The findings have implications for targeting food assistance as well as health and nutrition education strategies in low-income families undergoing the nutrition transition in north-east Brazil.     

Infant and child mortality in India in the last two decades: a geospatial analysis

BACKGROUND: Studies examining the intricate interplay between poverty, female literacy, child malnutrition, and child mortality are rare in demographic literature. Given the recent focus on Millennium Development Goals 4 (child survival) and 5 (maternal health), we explored whether the geographic regions that were underprivileged in terms of wealth, female literacy, child nutrition, or safe delivery were also grappling with the elevated risk of child mortality; whether there were any spatial outliers; whether these relationships have undergone any significant change over historical time periods. METHODOLOGY: The present paper attempted to investigate these critical questions using data from household surveys like NFHS 1992-1993, NFHS 1998-1999 and DLHS 2002-2004. For the first time, we employed geo-spatial techniques like Moran's-I, univariate LISA, bivariate LISA, spatial error regression, and spatiotemporal regression to address the research problem. For carrying out the geospatial analysis, we classified India into 76 natural regions based on the agro-climatic scheme proposed by Bhat and Zavier (1999) following the Census of India Study and all estimates were generated for each of the geographic regions. RESULT/CONCLUSIONS: This study brings out the stark intra-state and inter-regional disparities in infant and under-five mortality in India over the past two decades. It further reveals, for the first time, that geographic regions that were underprivileged in child nutrition or wealth or female literacy were also likely to be disadvantaged in terms of infant and child survival irrespective of the state to which they belong. While the role of economic status in explaining child malnutrition and child survival has weakened, the effect of mother's education has actually become stronger over time.     

Developmental and nutritional determinants of pregnancy outcome among teenagers

To investigate the determinants of low birth weight in infants born to adolescent mothers, we studied the obstetric population attended at the Maternity Hospital of Lima, Peru. From this population, 1256 gravidas, ranging in age from 12 to 25 years, volunteered to participate in this study. Anthropometric and biochemical measurements were used to evaluate the nutritional status and physiological maturity of the mother and newborn. For analytical reasons the young teenaged mothers (less than 15 years) were classified as either still-growing or having completed their growth, depending on their height relative to their parents' height. Similarly, the young teenagers were classified as either gynecologically immature or gynecologically mature depending on whether their gynecological age was less than or greater than 2 years. Our results indicate that young still-growing teenagers, even when matched for nutritional status, have smaller newborns than adult mothers. The data also demonstrate that maternal gynecological age per se does not affect prenatal growth. As inferred from multivariate analyses, it appears that the reduction in birth weight among young teenagers can be explained in part by a decreased net availability of nutrients resulting from the competition for nutrients between the mother's growth needs and the growth needs of her fetus and by an inability of the teenage placenta to maintain placental function adequately for active fetal growth.     

Complexities in Research on Fathering: Illustrations from the Tufts Study of Young Fathers

Theory and research suggest that the transition to parenthood is a major life transition, and that adaptation to the parenting role is influenced by a complex set of factors, including the relationship with the child's mother, family of origin, and how the father is situated within sociocultural contexts. The father–]mother relationship is particularly important for men making the transition to fatherhood. This study examined patterns of fathering among young fathers (15–24 years) and investigated how fathers' relationships with the mothers of their young children (infants and toddlers) were related to fathering. In general, higher quality father–mother relationships were related to greater father involvement with children; when mothers were perceived as barriers to involved fathering fathers also had less accurate and adaptive parenting knowledge, attitudes, and behavior. Person-centered analyses revealed quite complex relations between father–mother relationships and father–child interaction. One pattern showed strong positive father–mother relationships associated with a disengaged pattern of father–child interaction, while another pattern showed sensitive and positive father–child engagement in the context of negative or distant father–mother relationships. Four patterns of association between fathering and mother–father relationships were demonstrated. Results highlight the complexity of understanding fathering and family relationships among young fathers.     

Child nutrition in the transition from nomadic pastoralism to settled lifestyles: individual, household, and community-level factors

The research reported here examines child nutrition in a population that is currently experiencing a transition in subsistence, shifting from nomadic pastoralism to a variety of settled lifestyles. We investigate the range of nutritional consequences of settlement both within and between communities by examining individual, household, and community-level predictors of child nutritional status. Data are drawn from the Rendille Demographic and Health Survey, which contains anthropometric data from 1,088 children ages 6 months to 10 years, as well as socioeconomic data from 640 households drawn from one nomadic and four economically and ecologically diverse settled communities. Comparisons allow us to test the widely held assumption that settlement results in nutritional improvements. The examination of individual and household-level factors highlights several important influences on child nutrition. We find a complex interaction between gender and birthorder, whereby firstborn sons have significantly higher weight-for-height scores than other children, potentially reflecting preference under a system of primogeniture. We also find a complex interaction between defacto female-headed households, where males are absent for over half of the year, and economic status. Young children from poor female-headed households have significantly lower weight-for-height than other children, possibly due to the fact that these households are amongst the poorest in the entire community. However, young children from economically sufficient female-headed households actually fare better than their counterparts in male headed households, suggesting that in households with any discretionary resources, female heads prioritize food acquisition relative to other concerns. Finally, our comparison of child nutritional status across communities, while controlling for individual and household-level variation, does not support the contention that settlement is associated with nutritional improvements. Rather, the effect of community, and its associated changes in subsistence and lifestyle, results in either no nutritional changes, or in the case of young children in the lowland desert community of Korr, diminished nutritional status. Our results underscore the importance of considering variation in sample composition and socioeconomic status when performing community comparisons, and highlight the central role of women in influencing the nutritional welfare of their families.     

Psychological Adjustment of Obese Youth Presenting for Weight Management Treatment

Objective: To determine the prevalence of psychological maladjustment in clinic‐based treatment‐seeking obese children and adolescents (BMI ≥ 95th percentile) and the degree to which maternal, demographic, and youth factors correlate to the youths’ psychological adjustment. Research Methods and Procedures: Anthropometrics, demographics (race, sex, insurance status), measures of youth psychological adjustment (self‐ and mother‐report; Behavior Assessment System for Children), and maternal self‐report of psychological distress (Symptom Checklist 90‐Revised) were collected from 121 obese children and adolescents (55% white, 45% black) and their mothers. Results: Approximately one‐third of youths self‐reported some psychological maladjustment, but two‐thirds of youth were described by their mothers as experiencing some degree of psychological maladjustment. Adjustment difficulties were specific to social functioning, low self‐esteem, and internalizing symptoms. Forty‐one percent of mothers of child participants and 56% of mothers of adolescent participants reported clinically significant psychological distress. Youth self‐report and mother‐report of youths’ psychological difficulties were often most strongly associated with mothers’ level of psychological distress and/or family socioeconomic status rather than to youth characteristics (e.g., percent overweight, race). Discussion: Psychological maladjustment levels among obese youth and their mothers were higher in this clinic‐based sample than in treatment research‐based samples. Present correlate findings extended to obese adolescents and reaffirm a potent association between youth self‐report of their own psychological adjustment and their mother's level of psychological distress. Demographic characteristics and youth weight status were not consistent correlates of youths’ psychological functioning. Findings have implications for the translation of empirically supported pediatric obesity interventions to clinic‐based treatment samples.     

Millennium Development Goal Four and Child Health Inequities in Indonesia: A Systematic Review of the Literature

Introduction

Millennium Development Goal (MDG) 4 calls for reducing mortality of children under-five years by two-thirds by 2015. Indonesia is on track to officially meet the MDG 4 targets by 2015 but progress has been far from universal. It has been argued that national level statistics, on which MDG 4 relies, obscure persistent health inequities within the country. Particularly inequities in child health are a major global public health challenge both for achieving MDG 4 in 2015 and beyond. This review aims to map out the situation of MDG 4 with respect to disadvantaged populations in Indonesia applying the Social Determinants of Health (SDH) framework. The specific objectives are to answer: Who are the disadvantaged populations? Where do they live? And why and how is the inequitable distribution of health explained in terms of the SDH framework?

Methods and Findings

We retrieved studies through a systematic review of peer-reviewed and gray literature published in 1995-2014. The PRISMA-Equity 2012 statement was adapted to guide the methods of this review. The dependent variables were MDG 4-related indicators; the independent variable “disadvantaged populations” was defined by different categories of social differentiation using PROGRESS. Included texts were analyzed following the guidelines for deductive content analysis operationalized on the basis of the SDH framework. We identified 83 studies establishing evidence on more than 40 different determinants hindering an equitable distribution of child health in Indonesia. The most prominent determinants arise from the shortcomings within the rural health care system, the repercussions of food poverty coupled with low health literacy among parents, the impact of low household decision-making power of mothers, and the consequences of high persistent use of traditional birth attendants among ethnic minorities.

Conclusion

This review calls for enhanced understanding of the determinants and pathways that create, detain, and overcome inequities in child health in resource constraint settings like Indonesia and the promotion of actionable health policy recommendations and tailored investments.     

Effectiveness of out-of-home day care for disadvantaged families: randomised controlled trial

Objective To assess the effects of providing daycare facilities for young children on the health and welfare of disadvantaged families.Design Randomised controlled trial. Eligible children from the application list to a daycare facility were randomly allocated to receive a daycare place or not.Setting Early Years daycare centre in Borough of Hackney, London.Participants 120 mothers and 143 eligible children (aged between 6 months and 3.5 years).Intervention A place at the centre, which provided high quality day care. Control families used other child care that they secured for themselves.Main outcome measures Maternal paid employment, household income, child health and development.Results At 18 months'' follow up, 67% of intervention group mothers and 60% of control group mothers were in paid employment (adjusted risk ratio 1.23 (95% confidence interval 0.99 to 1.52)), but were no more likely to have a weekly household income of above £200 (risk ratio 0.88 (0.70 to 1.09)). Intervention group children had more otitis media with effusion (risk ratio 1.74 (1.02 to 2.96)) and used more health services (1.58 (1.05 to 2.38)), but both estimates were imprecise.Conclusion The provision of child day care may have increased maternal employment, but it did not seem to increase household income. The results suggest that providing day care may be insufficient as a strategy to reduce poverty. The study shows how random allocation can be used to ration and evaluate interventions where demand exceeds supply.     

Child health,its dynamic interaction with nutrition and health memory – Evidence from Senegal

Child malnutrition is pervasive in developing countries and anthropometric measures such as weight-for-height and height-for-age have proven reliable indicators of short term malnutrition and stunting. Rather than studying these indicators separately, we look at their interaction and carve out child health dynamics. Considering height-for-age a child's health stock and weight-for-lagged height a proxy for nutritional inputs, we develop a child health production function that features self-productivity of past health stocks and contemporaneous nutritional inputs. We test the model on a Senegalese panel of 271 children between 0 and 5 years employing dynamic panel methods to control for endogeneity in the production function. In line with previous evidence, we find that children can partially catch-up from malnutrition spells. Yet, child health stocks also deplete quickly and need constant updating in the form of nutrition. This demonstrates the importance of health memory and that malnutrition cannot be fought with snapshot interventions. Consequently, sustainable nutrition interventions have to be long term and yield higher returns the earlier they reach children.     

Nutrition, infection and child growth in Papua New Guinea

Growth patterns of populations in Papua New Guinea (PNG) have traditionally shown considerable variation, with the greatest difference lying between coastal and highland populations. While genetic differences in explaining these patterns cannot be excluded, the generally poor growth relative to western growth references is largely due to the complex interactive effects of undernutrition and infection. The effects of diet, nutrition and infection on the nutritional status of a child vary with age, the general disease ecology and the type and extent of exposure to it, patterns of infant and young child feeding, and types of food consumed. There are two possible ways in which the relationship between undernutrition and infection can begin; one in which poor nutritional status leads to impaired immunocompetence and reduced resistance to infection, and the other in which exposure to infectious disease can lead to a range of factors that reduce food intake, absorption of nutrients, or increase nutrient requirements. In PNG prior to, and at early stages of modernisation, primary malnutrition is likely to have been the usual initiating factor in the onset of growth faltering due to undernutrition-infection interactions. However, the possibility that infection may have been the initiating event in some societies cannot be excluded. This would have happened by way of early dietary supplementation of infants with foods of minor nutritional significance, which could have acted as a vehicle for the introduction of infectious disease to the child. With modernisation and adoption of primary health care principles, earlier supplementation of infant diet than was previously the case became common in PNG. This has lead to general improvements in growth and nutritional status. However, in populations where undernutrition is still common, infection has become more important than primary malnutrition as the initiator of growth faltering due to undernutrition-infection interactions.     

Fermented foods, feeds, and beverages

World population reached 5 billion people in 1986 and is expected to rise to 6 particularly severe in parts of Africa, particularly Ethiopia. Hunger and malnutrition accompany the poverty that is characteristic of the masses of the people in the developing world. Even in the United States, one of the most affluent countries, there has been a considerable increase in the number of homeless people including mothers and children living in the streets or in substandard housing. The indigenous fermented foods and beverages already consumed for centuries by hundreds of millions of the world's masses can be used in many cases to improve and extend the world's food and nutrition supply at a relatively low cost. Fermented foods, feeds and beverages are getting ever increasing attention particularly in the developing world and also in the developed world. This paper summarizes activities and advances related to fermented foods, feeds, and beverages over the past several years.     

Migration,Remittances and Nutrition Outcomes of Left-Behind Children: A National-Level Quantitative Assessment of Guatemala

Historically, Guatemalans have suffered high rates of poverty and malnutrition while nearly ten percent of their population resides abroad. Many Guatemalan parents use economic migration, mainly international migration to the United States, as a means to improve the human capital prospects of their children. However, as this investigation shows, the timing of migration events in relation to left-behind children’s ages has important, often negative and likely permanent, repercussions on the physical development of their children. To illustrate these dynamics, this investigation uses an instrumental variables framework to disentangle the countervailing effects of Guatemalan fathers’ absences due to migration from concomitant remittances on left-behind children’s growth outcomes. Based on national-level data collected in 2000, the investigation reveals that the international migration of a father in the previous year is correlated with a 22.1% lower length/height-for-age z-score for the average left-behind child aged ≤ 3. In contrast, the receipt of remittance income has no influence on the physical stature of a child, which may indicate that migrant fathers with young children are not able to achieve economic success soon enough during their ventures abroad to fully ameliorate the harmful effects caused by their absences.     

Maternal BMI and country of birth as indicators of childhood obesity in children of Mexican origin

Objective: The goal of this study was to evaluate the relationship between maternal and childhood BMI at baseline in a group of 5‐ to 18‐year‐old children and their mothers, all of whom were of Mexican origin, low socioeconomic status, and enrolled in a cohort study in Houston, TX. Research Methods and Procedures: Using data from 438 mother‐child dyads residing in the same household, we completed logistic regression analyses to determine maternal factors associated with the child being overweight or at‐risk‐for‐overweight, after adjusting for the child's gender, age, and level of physical activity and other maternal confounders. Results: Almost one‐half of the boys and girls (47% and 44%, respectively) were either overweight or at‐risk‐for‐overweight. Obese mothers were twice as likely to have an overweight and/or at‐risk‐for‐overweight child compared with normal‐weight mothers. Women born in the U.S. were twice as likely to have an overweight and/or at‐risk‐for‐overweight child compared with women born in Mexico. In addition, women with less than a high school education were twice as likely to have an overweight child compared with their more educated peers. Discussion: The high prevalence of overweight or at‐risk‐for‐overweight among Mexican‐origin children of low socioeconomic status suggests a continued need to develop and implement culturally sensitive preventive interventions for this minority population. Our data also suggest a need to tailor such interventions particularly for children of obese mothers and those born in the U.S.