Anthropometric indicators of nutritional status, socioeconomic factors and mortality in hospitalized children in Addis Ababa

The influence of some household and maternal variables on three anthropometric nutritional status indices of hospitalized children in Addis Ababa, Ethiopia, are examined. On admission, only 30% of these children can be classified as being of a normal overall nutritional status. There are no significant differences in weight-for-age of hospitalized children between those residing in Addis Ababa and those residing in the rural areas. Income and father's occupation appear to be the major household factors influencing the level of two of the three indices (weight-for-age and weight-for-height). Length of last closed birth interval and, to a lesser degree, maternal age appear to have significant effects on all three nutritional status indices. Upon admission to hospital, children who will in the end survive their hospital stay are on average nutritionally normal or in a mild state of malnutrition, whereas children who will die during their stay arrive in a moderate or severe state of malnutrition. The degree of malnutrition is positively related to the risk of mortality in respiratory disease patients.     

Selective mortality and the anthropometric status of children in low- and middle-income countries

Despite a close relationship between the childrens’ anthropometric status and mortality rates, the highest mortality rates are concentrated in sub-Saharan Africa, while the lowest anthropometric indicators, in particular the height-for-age z-scores, are concentrated in South Asia. This discrepancy should, however, be expected to decrease when one accounts for the survivorship bias, i.e. selective mortality. We analyse whether the survivorship bias can explain these observed differences in three standard anthropometric indicators (stunting, underweight and wasting) by using individual data of children from six waves of Demographic and Health Surveys for a large cross-section of 37 low- and middle-income countries between 1991 and 2016. We use both a matching approach and semi-parametric regression to estimate the values for the anthropometric status of deceased children. The results are twofold: first, both methods reveal that the imputed values for the anthropometric indicators are, on average, between 0.10 and 0.25 standard deviations lower than the observed anthropometric indicators. Second, since the share of deceased children in our sample is below ten per cent, the contribution of the anthropometric status of deceased children to overall anthropometric indicators is small and therefore only influences it marginally.     

Untangling genetic influences on smoking,body mass index and longevity: a multivariate study of 2464 Danish twins followed for 28 years

A multivariate twin study was conducted in order to evaluate to what extent smoking, BMI and longevity are influenced by common genetic factors. The study was based on a 28-year follow-up of a sample of 2464 Danish twins who were born in the period 1890–1920 and who answered a questionnaire, including requests for information on smoking status, height and weight, in 1966. By 1994, approximately 2/3 of the sample had died. To compensate for the right-censoring, age at death was imputed for twins who were still alive by using survival analysis; all living subjects were more than 73 years old (mean 80 years, SD 5) in 1994. Proportions of covariance resulting from genetic and environmental factors in common and unique to the three traits were estimated from covariance matrices using the structural equation model approach. The study found no evidence for a substantial impact of common genetic factors on smoking, BMI and longevity. This suggests that only a small fraction of the genetic influences on longevity is mediated via a genetic influence on smoking and BMI and, furthermore, that it is unlikely that the associations between smoking and mortality and between BMI and mortality are confounded by common genetic factors. Received: 20 May 1996 / Revised: 21 May 1996     

Costs of Inaction on Maternal Mortality: Qualitative Evidence of the Impacts of Maternal Deaths on Living Children in Tanzania

Background

Little is known about the interconnectedness of maternal deaths and impacts on children, beyond infants, or the mechanisms through which this interconnectedness is established. A study was conducted in rural Tanzania to provide qualitative insight regarding how maternal mortality affects index as well as other living children and to identify shared structural and social factors that foster high levels of maternal mortality and child vulnerabilities.

Methods and Findings

Adult family members of women who died due to maternal causes (N = 45) and key stakeholders (N = 35) participated in in-depth interviews. Twelve focus group discussions were also conducted (N = 83) among community leaders in three rural regions of Tanzania. Findings highlight the widespread impact of a woman’s death on her children’s health, education, and economic status, and, by inference, the roles that women play within their families in rural Tanzanian communities.

Conclusions

The full costs of failing to address preventable maternal mortality include intergenerational impacts on the nutritional status, health, and education of children, as well as the economic capacity of families. When setting priorities in a resource-poor, high maternal mortality country, such as Tanzania, the far-reaching effects that reducing maternal deaths can have on families and communities, as well as women’s own lives, should be considered.     

Multivariate analysis of infant and child mortality in Java and Bali

The data used in this analysis come from the 1976 Indonesian Fertility Survey, part of the World Fertility Survey. The data are examined 3 times, fitting them to models which include different combinations of independent variables. The dependent variables are: 1) the proportion of children born between 5 and 15 years before the survey who died before their 1st birthday, for infant mortality; and 2) among those alive on their 1st birthday, the proportions who died before reaching their 5th birthday, for child mortality. The figures indicate that the chance of dying for children who were 1st born, born shortly after a previous child, whose previous sibling had died, who lived in rural areas, or had parents who were young and with little education, was greater than for children without these characteristics. In all 3 models used, the greatest net effects are attributed to the survival of a preceding sibling or the length of the preceding interval. Birth order does not have a significant gross effect on infant mortality, but the net effects are significant because of the control on maternal age. Education of both parents has significant effects, but these are overshadowed in magnitude by the demographic variables. Maternal education has a greater influence in determining differences in child mortality than was found for infant mortality. Father's education also has a significant independent effect, but mainly for 1st births. It is uncertain whether these variables are measuring the effect of schooling as such, or other characteristics such as economic status or various social roles adopted by people with different levels of education. The variables distinguishing urban from rural status shows significant gross effects which are greatly reduced when controls for other variables are introduced in the model which includes all births. That is to say, the difference in the survival chances of a child in the city is more a function of the education of its parents, and the associated demographic variables than city residence as such. Access to medical services is quite probably the main element in these differences. The findings are weakened to some extent by the lack of satisfactory data on household economic status which might have provided a better base for indirectly discerning the effects of nutrition and sanitation on mortality at young ages.     

Nutritional status and mortality of highland children in Nepal: Impact of sociocultural factors

This study investigates the nutritional status of native children in the highlands of Nepal (1,700–3,000 m) and explores the relationship between child mortality and surviving children's nutritional status. A random sample of 145 households from 11 villages in the Koshi Hill Zone in east Nepal was surveyed, and the nutritional status of the 438 children <14 years of age living in these households was assessed by means of anthropometry. We found a severe growth retardation in the Nepalese children compared to lowland reference groups as well as to highland children from the Andes. Child mortality and altitude are not significantly different between higher (Brahman and Chetri) and lower (Baisya and Sudra) caste households. A lower caste status and higher altitude of the household is associated with a significantly better nutritional status in offspring. In multiple regression analyses, improved nutritional status in children is significantly associated with lower caste (P = 0.001), higher altitude (P = 0.009), and less crowding (P = 0.001) but not with sibling mortality (P = 0.11). We thus conclude that nutritional status of children in households in the highlands of Nepal is associated with the household's socioeconomic status and altitude but not with mortality among siblings. © 1996 Wiley-Liss, Inc.     

Impact of social class on body fatness among rural pre-school Bengalee Hindu children of Arambagh, West Bengal, India

Body composition is a useful marker for assessing the adiposity of an individual. The amount of body fat (BF) differs with age, sex, environmental conditions and genotype, and is a good indicator of the health and nutritional status of a community. As the subcutaneous fat serves as a reservoir for energy during nutritional deprivation, lower BF in comparison with other studies indicates a lower energy intake by those children, who are affected by their lower socio-economic status. The objective of the present study was to evaluate the impact of socio-economic class, after allowing for sex and age, on body fatness among rural pre-school children of Bengalee Hindu ethnicity of Arambagh, West Bengal, India. The present study was undertaken at 20 Integrated Child Development Services (ICDS) scheme centers in Bali Gram Panchayat, Arambagh, Hooghly District of West Bengal, India. A total of 1012 boys and girls (aged 2-6 years) living in these areas were studied. The children were classified into two groups based on their social class: Schedule Castes (SC) and Non-Schedule Castes (NSC). In general, SC comprise socio-economically and educationally deprived individuals. Three-way analysis of variance was used to assess the effect of ethnicity on mid-upper arm circumference (MUAC) and sum of skinfolds (SS), allowing for age and sex. There was an increasing age trend in both these variables in both sexes in the two groups. All three factors had a significant effect on MUAC, whereas only age and social class had a significant impact on SS. In the case of MUAC, only one second order interaction (sex-age) was significant. In conclusion, we found that after controlling for age and sex, children belonging to the SC group had lower body fatness. These results implied that they were under more nutritional stress. There was also some evidence that at the early ages, girls belonging to the SC group probably received inadequate nutrition and as a result had lower body fat.     

Child mortality, social status, and fertility in India

The incidence of child mortality in relation to the social status and fertility of Indian women was investigated on the assumptions that: 1) the higher the social status, the lower the child mortality rate; and 2) the lower the child mortality rate, the lower the family size. 311 married women in Chandigarh were grouped into 4 status categories: (1) higher educated working women (95); (2) higher educated nonworking women (75); (3) less educated nonworking women (75); and (4) less educated working women (66). The 311 women gave birth to a total of 1075 children (960 living and 115 who had died, mostly between the ages 0-5 years). Percentage of children living (89%) was different for each status category: 93% for category 1; 92% for category 2; 91% for category 3; and 81% for category 4. When analyzed by proportion of women who had lost children in each status category, the relationship between child mortality and social status confirmed the assumption that the higher the social status, the lower the mortality. In category 1, 87% had not experienced any child mortality in their family; in category 2, the figure was 77%; category 3, 72%; and category 4, 48%. The findings also confirmed the other assumption that the lower the mortality rate, the lower the fertility (Table 2).     

Determinants of nutritional status of pre-school children in India

The aim of this paper is to assess the spatial distribution of nutritional status of children of less than three years through Z-scores of weight-for-age, height-for-age and weight-for-height using data collected by the National Family Health Survey (NFHS-2, 1998-99), India. The nutritional status of pre-school children was regressed on different socio-demographic factors after eliminating the effect of age. The data show that there are gender differences and spatial variations in the nutritional status of children in India. Gender difference is not very pronounced and almost disappears when the effects of age and socio-demographic variables are removed. The spatial difference, especially the rural-urban difference, was found to be very large and decreased substantially when the effects of age and socioeconomic variables were removed. However, the differences were not close to zero. All the variables were found to affect significantly the nutritional status of children. However, the literacy of mothers did not affect height-for-age significantly. The weight-for-age and height-for-age scores showed a dismal picture of the health condition of children in almost all states in India. The worst affected states are Bihar, Madhya Pradesh, Orissa and Uttar Pradesh. Assam and Rajasthans are also lagging behind. Weight-for-height scores do not give a clear picture of state-wise variation. Goa, Kerala and Punjab are the three most developed states in India and also have the lowest percentages of underweight children according to the Z-scores. Along with these three states come the north-eastern states where women are well educated. Thus overall development, enhancement of level of education and low gender inequality are the key factors for improvement in the health status of Indian children.     

Causes of Early Childhood Deaths in Urban Dhaka,Bangladesh

Data on causes of early childhood death from low-income urban areas are limited. The nationally representative Bangladesh Demographic and Health Survey 2007 estimates 65 children died per 1,000 live births. We investigated rates and causes of under-five deaths in an urban community near two large pediatric hospitals in Dhaka, Bangladesh and evaluated the impact of different recall periods. We conducted a survey in 2006 for 6971 households and a follow up survey in 2007 among eligible remaining households or replacement households. The initial survey collected information for all children under five years old who died in the previous year; the follow up survey on child deaths in the preceding five years. We compared mortality rates based on 1-year recall to the 4 years preceding the most recent 1 year. The initial survey identified 58 deaths among children <5 years in the preceding year. The follow up survey identified a mean 53 deaths per year in the preceding five years (SD±7.3). Under-five mortality rate was 34 and neonatal mortality was 15 per thousand live births during 2006–2007. The leading cause of under-five death was respiratory infections (22%). The mortality rates among children under 4 years old for the two time periods (most recent 1-year recall and the 4 years preceding the most recent 1 year) were similar (36 versus 32). The child mortality in urban Dhaka was substantially lower than the national rate. Mortality rates were not affected by recall periods between 1 and 5 years.     

Treading water: The long-term impact of the 1998 flood on nutrition in Bangladesh

Bangladesh was hit by the worst flood in over a century in the summer of 1998. Although many households were able to smooth consumption expenditure, not everyone was able to maintain adequate calorie consumption. As a consequence, the nutritional status of children in households that were more severely exposed to the flood deteriorated. We use a three round panel data set to investigate which households were better protected from longer term nutritional crises, and whether the health of flood-exposed children recovered to the level of those who were not exposed. The evidence suggests that children exposed to the flood were adversely affected by the shock to their health and did not recover within the survey period. The results also suggest that ex ante government programs were more effective than ex post interventions to protect the heath of children from the impact of the flood.     

Sibling mortality correlation in Kenya

This paper examines whether infant and child mortality risks among successive siblings are closely correlated, and if so, whether the survival status of the preceding child is an important factor affecting infant and child mortality in Kenya. The data were drawn from the 1988/89 Kenya Demographic and Health Survey. Logistic regression was used as the major method of data analysis. The results show that both infant and child mortality rates are significantly higher among subsequent children whose preceding siblings had died in infancy than for those whose preceding sibling had survived through infancy. The effect of the survival status of the preceding child on infant mortality was statistically strong, even after a large number of control variables were taken into account. However, its effect on child mortality appears to be spurious since it was rendered statistically insignificant when just a few control variables were introduced into the analysis. The results provide empirical evidence that infant and child mortality risks among successive siblings are closely correlated in Kenyan families, and that the effect of the survival status of the preceding child is important in determining infant mortality but not child mortality.     

Effects of HIV Infection on the Metabolic and Hormonal Status of Children with Severe Acute Malnutrition

Background

HIV infection occurs in 30% of children with severe acute malnutrition in sub-Saharan Africa. Effects of HIV on the pathophysiology and recovery from malnutrition are poorly understood.

Methods

We conducted a prospective cohort study of 75 severely malnourished Ugandan children. HIV status/CD4 counts were assessed at baseline; auxologic data and blood samples were obtained at admission and after 14 days of inpatient treatment. We utilized metabolomic profiling to characterize effects of HIV infection on metabolic status and subsequent responses to nutritional therapy.

Findings

At admission, patients (mean age 16.3 mo) had growth failure (mean W/H z-score −4.27 in non-edematous patients) that improved with formula feeding (mean increase 1.00). 24% (18/75) were HIV-infected. Nine children died within the first 14 days of hospitalization; mortality was higher for HIV-infected patients (33% v. 5%, OR = 8.83). HIV-infected and HIV-negative children presented with elevated NEFA, ketones, and even-numbered acylcarnitines and reductions in albumin and amino acids. Leptin, adiponectin, insulin, and IGF-1 levels were low while growth hormone, cortisol, and ghrelin levels were high. At baseline, HIV-infected patients had higher triglycerides, ketones, and even-chain acylcarnitines and lower leptin and adiponectin levels than HIV-negative patients. Leptin levels rose in all patients following nutritional intervention, but adiponectin levels remained depressed in HIV-infected children. Baseline hypoleptinemia and hypoadiponectinemia were associated with increased mortality.

Conclusions

Our findings suggest a critical interplay between HIV infection and adipose tissue storage and function in the adaptation to malnutrition. Hypoleptinemia and hypoadiponectinemia may contribute to high mortality rates among malnourished, HIV-infected children.     

Airport noise exposure and the postnatal growth of children

To determine whether chronic exposure to airport noise affects children, a study was conducted of the physical growth of children, aged 5-13 years, from two communities, one exposed to airport noise (n = 148) and another, not exposed (n = 102). Ten standard anthropometric measurements were made according to U.S. Health Examination Survey guidelines, and information on the social and biological characteristics of each family was collected in interviews. Hotelling's T2-tests were performed comparing the noise-exposed and nonnoise-exposed samples. There was no significant difference between the sample for measurements of social and biological characteristics of the families (including socioeconomic status and maternal reproductive history). Parental anthropometrics differed significantly (T2 = 24.32, P = 0.0001) as did child anthropometrics (T2 = 21.01, P = 0.032). For the child anthropometrics, noise-exposed children's slightly smaller measures of body bulk, together with their larger facial breadths, contributed to the significant T2. When the entire sample (n = 250) was analyzed by multiple linear regression, noise exposure was a significant predictor only of male triceps and subscapular skinfolds. For these two variables, and most other anthropometrics, however, the beta coefficients were negative for both sexes. In order to include information on the covariance structure among all variables, a canonical correlation analysis was performed. Noise exposure loaded negatively on the third canonical variate and was paired with positively loaded measures of body bulk. Taken together, the three analyses suggest that while there is some evidence for a slight effect of airport noise on measures of body bulk for males in this sample, most measures of postnatal growth for both males and females were unaffected by the noise levels experienced.     

Differences in nutritional outcomes between Brazilian white and black children

This paper analyzes whether differences in nutritional outcomes between white and black children are related to disparities in socioeconomic status and how improvements in nutritional indicators for each racial group over time are associated with changes in household income, parent's education and other socioeconomic attributes. According to the results, the gap in anthropometric measures would be substantially reduced if black and white children had similar characteristics. Evidence also shows that better economic and social attributes explain only a small part of the large improvement in nutritional measures verified between 2002-2003 and 2008-2009 for both racial groups.     

Vitamin A supplements and mortality related to measles: a randomised clinical trial.

One hundred and eighty children admitted with measles were randomly allocated to receive routine treatment alone or with additional large doses of vitamin A (200,000 IU orally immediately and again the next day). Baseline characteristics of the two groups were virtually identical for age, severity of measles, and vitamin A and general nutritional states. In 91% of the children serum vitamin A concentrations were less than 0.56 mumol/l. Of the 88 subjects given vitamin A supplements, six (7%) died; of the 92 controls, 12 (13%) died (p = 0.13). This difference in mortality was most obvious for children aged under 2 years (one death out of 46 children receiving supplements versus seven deaths out of 42 controls; p less than 0.05) and for cases complicated by croup or laryngotracheobronchitis. Mortality was several times higher in marasmic than in better nourished children, regardless of study allocation (p less than 0.01).     

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.     

Response of bone and enamel formation to nutritional supplementation and morbidity among malnourished Guatemalan children

The effects of changes in nutritional and health status upon bone and enamel development are examined in a sample of 63 rural Guatemalan children (24 females, 39 males). The number of ossified hand-wrist centers at 3 years and the number of linear enamel hypoplasias (LEH) in ～0–3 year zones of developing teeth were used to monitor the response of bone mineralization and enamel matrix formation to illness and nutritional supplementation. Numbers of ossified centers and LEH were compared across sex, supplementation, and morbidity groups. Enamel matrix secretion responded positively to increased supplementation. Children who received less than 34.25 kcal/day in supplement had more LEH than those who received more supplement. No differences in ossification status were found between supplementation groups. These data suggest that enamel formation may be more sensitive to changes in nutritional status than is bone mineralization. Disruptions of bone and enamel formation were both associated with frequent illness. Children who were ill more than 3.6% of the time had more LEH and fewer ossified hand-wrist centers than children who were less frequently ill. Conclusions regarding relative environmental sensitivity must take into account the specific aspects of dental and skeletal development examined. © 1993 Wiley-Liss, Inc.     

Malnutrition and child mortality: are socioeconomic factors important?

The influences of household economic condition, maternal education, sex, and nutritional status of children on mortality were examined using multivariate analytical techniques. Weights of around 1700 children aged 2 60 months in five villages of Matlab, Bangladesh, were taken during the first half of 1981. The children were followed for 18 months and their survival was recorded. The severely malnourished children had a risk of death nine times that of their counterparts with better nutritional status. Female children had a higher risk of death than the males. Mother's education and economic condition of household also showed negative relationships with the risk of death, but the effect of mother's education was modified by economic condition and sex of the children.     

Biocultural Factors in School Achievement for Mopan Children in Belize

Mayan children in Belize face a number of challenges to school success. Their families are the poorest of the poor, and the Mopan children in this study exhibit poor growth and poor school achievement. But a direct relationship between growth and school achievement was evident only for current nutritional status, not for nutritional history. A combination of quantitative and qualitative data revealed that school achievement for these Mopan children may relate more to family attributes and attitudes than to health and nutritional status. The strongest predictors of school achievement were father's literacy and grade level in school.