Undernutrition among the tribal children in India: tribes of Coastal, Himalayan and Desert ecology

The purpose of the present cross-sectional investigation was to assess the nutritional condition in children of three tribal communities namely Dhodia, Kinnaura and Bhil, which belong to Coastal, Himalayan and Desert ecology, respectively, in India. A total of 989 tribal children in the age group 0-1 years through 5+ years (below 6 years) was examined. There were 306 Dhodia children (164 boys and 142 girls), 327 Kinnaura children (177 boys and 150 girls) and 356 Bhil children (168 boys and 188 girls) out of 989 subjects. Crown-heel length was measured using infantometer with the child lying supine, height with Martin's anthropometer and body weight using standard weighing machine. Body mass index (BMI) was subsequently computed. 'Z' score was undertaken to obtain comprehensive pictures of undernutrition in terms of wasting, stunting and underweight in these communities. The chi2-test test was also undertaken to compare nutritional indicators by the sexes. It was observed that maximum wasting (85.3%), stunting (86.6%) and underweight (93.3%) was recorded in Kinnaura girls, who belong to Himalayan ecology. The results revealed also that so far as wasting and stunting was concerned, the situation was worst for desert dwelling Bhil, where only 7.3% wasted and 5.6% stunted pre-school children fall in between -1 SD to < or = median as compared to 11.7% wasted and 18.3% stunted pre-school children in Dhodia and 11.3% wasted and 15.3% stunted pre-school children in Kinnaura, who fall in the same category (-1 SD to < or = median). It was important to note that the prevalence of undernutrition in terms of wasting, stunting and underweight was similar in both the sexes (chi2(2) = 1.745, p > 0.05). The findings of the present study revealed the widespread prevalence of undernutrition among the children of Dhodia, Kinnaura and Bhil tribal communities and highlight a need for an integrated approach towards improving the child health as well as the nutritional status in these areas.     

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.     

Implication of new WHO growth standards on identification of risk factors and estimated prevalence of malnutrition in rural Malawian infants

Background

The World Health Organization (WHO) released new Child Growth Standards in 2006 to replace the current National Center for Health Statistics (NCHS) growth reference. We assessed how switching from the NCHS to the newly released WHO Growth Standards affects the estimated prevalence of wasting, underweight and stunting, and the pattern of risk factors identified.

Methodology/Principal Findings

Data were drawn from a village-informant driven Demographic Surveillance System in Northern Malawi. Children (n = 1328) were visited twice at 0–4 months and 11–15 months. Data were collected on the demographic and socio-economic environment of the child, health history, maternal and child anthropometry and child feeding practices. Weight-for-length, weight-for-age and length-for-age were derived in z-scores using the two growth references. In early infancy, prevalence estimates were 2.9, 6.1, and 8.5 fold higher for stunting, underweight, and wasting respectively using the WHO standards compared to NCHS reference (p<0.001 for all). At one year, prevalence estimates for wasting and stunting did not differ significantly according to reference used, but the prevalence of underweight was half that with the NCHS reference (p<0.001). Patterns of risk factors were similar with the two growth references for all outcomes at one year although the strength of association was higher with WHO standards.

Conclusions/Significance

Differences in prevalence estimates differed in magnitude but not direction from previous studies. The scale of these differences depends on the population''s nutritional status thus it should not be assumed a priori. The increase in estimated prevalence of wasting in early infancy has implications for feeding programs targeting lactating mothers and ante-natal multiple micronutrients supplementation to tackle small birth size. Risk factors identified using WHO standards remain comparable with findings based on the NCHS reference in similar settings. Further research should aim to identify whether the young infants additionally diagnosed as malnourished by this new standard are more appropriate targets for interventions than those identified with the NCHS reference.     

Physical growth and nutritional status of Tsimane' Amerindian children of lowland Bolivia

This study examines patterns of growth and nutritional status of indigenous Tsimane' children under 9 years of age (n = 199 boys and 210 girls), based on a cross-sectional sample from 58 villages from the Beni Deparment of lowland Bolivia. Compared with US children, Tsimane' children are quite short, with linear growth tracking at or below the US 5th centile in both sexes. The prevalence of low height-for-age ("stunting;" HA Z-scores 相似文献   

Soil-transmitted helminth infection,anemia, and malnutrition among preschool-age children in Nangapanda subdistrict,Indonesia

BackgroundSoil-transmitted helminth (STH) infections are still prevalent in Indonesia, with roughly one-third of infected population being preschool-age children (PSC), which are generally at higher risk of morbidity such as malnutrition and anemia. This study aimed to investigate the association of STH infections with nutritional status and anemia among PSC in Nangapanda subdistrict, Ende, East Nusa Tenggara.MethodsA cross-sectional survey involving PSC ranging from 12 to 59 months old from Nangapanda subdistrict, Ende district, East Nusa Tenggara was performed. Socio-demographic, breastfeeding, and complementary feeding information was obtained from structured questionnaires, while nutritional and anemia status was determined from anthropometry and hemoglobin measurements, respectively. Anthropometric z-scores were calculated based on the World Health Organization 2006 standards and stool samples were examined using Kato-Katz method.ResultsA total of 393 PSC randomly selected from 22 villages were examined. The prevalence of underweight, stunting, wasting, and anemia were 33.1%, 40.2%, 17.1%, and 60.3%, respectively. STH infection, predominated by Ascaris lumbricoides, was found in 160 (58.8%) PSC. Single STH infection, but not multiple infection, was independently associated with a lower risk of anemia (odds ratio [OR] 0.320, 95% confidence interval [CI]: 0.126–0.809, p = 0.016). Similar association with anemia was also found on mild STH infection (OR 0.318 [95% CI: 0.114–0.887], p = 0.029). On the other hand, younger children were found to have a higher risk of anemia and stunting. None of the examined variables were independently associated with underweight and wasting.ConclusionSTH infection as well as anemia and malnutrition were prevalent in this region. However in this study, current STH infections seemed to have minimal negative impact on children’s nutritional status.     

Comparison of the Nutritional Status of Overseas Refugee Children with Low Income Children in Washington State

Introduction

The extent that the dual burden of undernutrition and overnutrition affects refugee children before resettlement in the US is not well described.

Objective

To describe the prevalence of wasting, stunting, overweight, and obesity among refugee children ages 0–10 years at their overseas medical screening examination prior to resettlement in Washington State (WA), and to compare the nutritional status of refugee children with that of low-income children in WA.

Methods

We analyzed anthropometric measurements of 1047 refugee children ages 0–10 years old to assess their nutritional status at the overseas medical screening examination prior to resettlement in WA from July 2012—June 2014. The prevalence estimates of the nutritional status categories were compared by country of origin. In addition, the nutritional status of refugee children age 0–5 years old were compared to that of low-income children in WA from the Center for Disease Control and Prevention’s Pediatric Nutrition Surveillance System.

Results

A total of 982 children were eligible for the study, with the majority (65%) from Somalia, Iraq and Burma. Overall, nearly one-half of all refugee children had at least one form of malnutrition (44.9%). Refugee children ages 0–10 years were affected by wasting (17.3%), stunting (20.1%), overweight (7.6%) and obesity (5.9%). Among children 0–5 years old, refugee children had a significantly higher prevalence of wasting (14.3% versus 1.9%, p<0.001) and stunting (21.3% versus 5.5%, p<0.001), and a lower prevalence of obesity (6.2% versus 12.9%, p<0.001) than low-income children in WA.

Conclusion

The dual burden of under- and over-nutrition among incoming refugee children as well as their overall difference in prevalence of nutritional status categories compared to low-income children in WA provides evidence for the importance of tailored interventions to address the nutritional needs of refugee children.     

Physical growth of children under five years of age in Nchelenge,Zambia: Results from a district survey

This study focuses on the physical growth of children aged 0–60 months in Nchelenge District, northeast Zambia. By means of a two-stage clustered and random sampling method, 193 households were selected. Weight, height, and mid-upper-arm circumference (MUAC) of children 0–60 months were measured. Underweight, stunting, and wasting were defined as weight for age, height for age, and weight for height (W/H), respectively, ≤2 z scores below the median of the National Center for Health Statistics (NCHS) reference population. Among 250 children, prevalence rates of 30% underweight, 69.2% stunting, and 4.4% wasting were found, with the highest rates at age 12–<24 months. Prevalence of stunting, underweight, and wasting in children aged 0–<6 months and 6–<12 months suggested that a substantial proportion of infants were premature and/or small for gestational age. The literature suggests that prematurity and intrauterine growth retardation may be quite common in Africa, and this may have important implications for the interpretation of growth data and under nutrition rates. Use of the MUAC < 125 mm as an indicator of wasting resulted in higher estimates of wasting compared to W/H ≤ −2 z scores, and seemed unsuitable as a screening test for wasting in this Zambian population. © 1996 Wiley-Liss, Inc.     

Parasite risk factors for stunting in grade 5 students in a community of extreme poverty in Peru

Malnutrition in school-age children is common in developing countries and includes both stunting and underweight. Stunting, which represents a chronic state of nutritional stress, leads to adverse health, educational and cognitive effects. Although much research is focused on preschool-age children, recent studies show both the high prevalence of stunting and the effectiveness of interventions in school-age children. The objectives of the current study were to determine the risk factors for stunting only, and stunting and underweight. A survey was conducted in 1074 grade 5 children (mean age 10 years) from 17 schools in Belen, Peru, a community of extreme poverty. Prevalence of underweight and stunting were 10.5 and 34.5%, respectively, co-prevalence was 9.3%. Based on multivariable logistic regression analyses, significant independent risk factors (odds ratio: OR) for stunting and underweight were: age (per 1 year increment) (OR=1.55; 95% confidence interval (CI): 1.33, 1.81); diarrhoea in the last week (OR=1.96; 95% CI: 1.17, 3.29) and hookworm infection (OR=1.74; 95% CI: 1.05, 2.86). Significant independent risk factors for stunting only were: age (per 1 year increment) (OR=1.51; 95% CI: 1.35, 1.70); anaemia (OR=1.98; 95% CI: 1.26, 3.11); and moderate and heavy Trichuris and Ascaris co-infection (OR=1.95; 95% CI: 1.35, 2.82). Our results indicate a high prevalence of stunting, in addition to other adverse health indicators, in the study population. Due to the interrelation between many of these health and nutrition problems, interventions at both the school and community levels, including de-worming, feeding programs and health and hygiene education, are needed to reduce malnutrition in this and other similar populations living in conditions of extreme poverty.     

Effect of number of rooms and sibs on nutritional status among rural Bengalee preschool children from eastern India

In developing countries including rural India, undernutrition among preschool children is one of the main barriers of the national development. However, there exists scanty information on the prevalence of underweight and stunting and their socio-demographic predictors among preschool children in India and West Bengal. The aim of the present study was to investigate the prevalence of underweight and stunting and the impact of two socio-demographic indicators, namely number of living rooms (NLR) and number of sibs (NS), on them among 1-5 year old Bengalee rural preschool children of Integrated Child Development Services (ICDS) Centres. This cross sectional study was undertaken at 30 randomly selected ICDS centre of Chapra Block, Nadia District, West Bengal, India. A total of 673 children, aged 1-5 years were studied. The overall (age and sex combined) rates of underweight and stunting were 54.40% and 39.20%, respectively. NLR was significantly associated with the prevalence of underweight (chi2 = 4.34, df = 1, p < 0.05) and stunting (chi2 = 8.98, df = 1, p < 0.01) among girls. Similarly, NS had a significant association with prevalence of underweight (chi2 = 10.29, df = 1, p < 0.001) and stunting (chi2 = 5.42, df = 1, p < 0.05) among girls. Girls with < 2 NLR had significant higher risk of being underweight (OR = 1.64, C.I = 1.30-2.62) or stunted (OR=2.23, C.I = 1.31-3.80) than those with > or = 2 NLR. Moreover, girls with > or = 3 NS had significant higher rate of underweight (OR = 2.03, CI = 1.32-3.146) or stunting (OR = 1.69, C.I = 1.09-2.63) than those with < 3 sibs. Logistic regression analyses also revealed that both NLR as well as NS were strong predictors of underweight (NLR: Wald = 4.30, p < 0.05; NS: Wald = 8.74, p < 0.001) and stunting (NLR: Wald = 10.17, p < 0.001; NS: Wald = 5.38, p < 0.05) among girls. Gender discrimination could be a likely cause for this sex difference in the impact of NRL and NS. Moreover, logistic regression were also undertaken with underweight and stunting status (yes/ no) as dependent variables and NLR and NS (combined) as independent variables to identify their effects, when considered together, on undernutrition. Results showed that NS had significant impact on underweight (Wald = 8.28, p < 0.001) rather than NLR among girls. Results also demonstrated that NLR had significant impact on stunting (Wald = 6.874, p < 0.01) rather than NS.     

Growth and nutritional status of Tibetan children at high altitude

Growth and development are clearly affected by high-altitude exposure to hypoxia, nutritional stress, cold or a combination of these factors. Very little research has been conducted on the growth and nutritional status of children living on the Tibetan Plateau. The present study evaluated the environmental impact on human growth by analyzing anthropometric characteristics of Tibetan children aged 8-14, born and raised above 4000 m altitude on the Himalayan massif in the prefecture of Shegar in Tibet Autonomous Region. Data on anthropometric traits, never measured in this population, were collected and the nutritional status was assessed. A reference data set is provided for this population. There was no evidence of wasting but stunting was detected (28.3%). Children permanently exposed to the high-altitude environment above 4000 m present a phenotypic form of adaptation and a moderate reduction in linear growth. However, it is also necessary to consider the effects of socioeconomic deprivation.     

Nutritional status in two Mbyá-Guaraní communities from Misiones (Argentina)

Growth and nutritional status of children and adults in two Mbyá-Guaraní communities from Argentina, was assessed. Height, weight, sitting height, upper arm circumference, triceps and subscapular skinfold were measured on 120 individuals aged from 2 to 60 between March and May, 2001. Data were transformed to z-scores using United States references (NHANES I and NHANES II). A z-score of less than -2 was used as the cut-off point to determine the prevalence of stunting and wasting respectively. Mean z-scores for weight, height, and upper arm circumference lie below the reference (0 > Z > -3), while in sitting height ratio and muscular area for females they were above the US standard (0 < Z < 2). Skinfold thicknesses and muscular area for males were similar to the reference (2 > Z > -1). Our findings are in agreement with others South American Indian research that the prevalence of stunting (36.7%) is significantly higher than wasting (1.8%). The presence of parasitic infections and nutritional environment previously described in this population could be related to the short stature.     

Soil-transmitted helminth infections and nutritional indices among Filipino schoolchildren

BackgroundSoil-transmitted helminth (STH) infections are still prevalent among schoolchildren in the Philippines. We evaluated the risk factors associated with STH and the relationship between STH and nutritional indices among schoolchildren aged 9–10 years in Laguna province, the Philippines.MethodsWe used the baseline data from 40 schools enrolled in a randomised controlled trial of the Magic Glasses Philippines health education package. Data on demographic and socio-economic variables, and STH related knowledge, attitudes and practices, were obtained through a questionnaire. Stool samples were collected and assessed for STH egg presence using the Kato-Katz technique. Haemoglobin levels and height and weight of study participants were also determined. The generalized estimating equations approach was used to construct logistic regression models to assess STH-associated risk factors, and the association between any STH infection and anaemia, child stunting, wasting and being underweight. The trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12616000508471).FindingsAmong 1,689 schoolchildren, the prevalence of any STH was 23%. The prevalence of anaemia, stunting, being underweight and wasting was 13%, 20.2%, 19% and 9.5%, respectively. Age, socio-economic status, rural/urban classification of schools and knowledge of STH were significant risk factors for acquiring a STH infection. Moreover, infections with any STH were significantly associated with stunting (P = <0.001) and being underweight (P = <0.003), but not wasting (P = 0.375) or anaemia (P = 0.462) after controlling for confounding covariates.ConclusionThe study findings emphasise the need for sustainable deworming in tandem with other measures such as the provision of health education, improvements in sanitation and hygiene, and nutritional programs in order to control STH infections and improve morbidity outcomes in schoolchildren.Trial registrationAustralian New Zealand Clinical Trials Registry (ACTRN12616000508471).     

A Comparative Study on Nutritional Status and Body Composition of Urban and Rural Schoolchildren from Brandsen District (Argentina)

The purpose of this study was to analyze whether nutritional status and body composition varies according to the environment of residence (urban or rural) of children in the Brandsen district (Argentina). Weight, height, arm circumference and tricipital and subscapular skinfolds were performed in 1368 schoolchildren aged 3 to 14. NHANES III reference was used to estimate nutritional status -underweight, stunting, wasting, overweight, and obesity- and to evaluate body composition -deficit and excess of adipose (DA, EA) and muscular (DM, EM) tissues of the arm-. Central fat distribution (CFD) was estimated using the subscapular-tricipital index. A structured questionnaire was implemented to evaluate socio-environmental characteristics. Nutritional categories based on body size and body composition were compared between urban and rural areas of residence using Chi-squared tests (χ2). The results indicated for the total sample: 1.1% underweight, 6.9% stunting, 0.4% wasting, 12.1% overweight, 9.7% obesity, 22.0% DM, 2.5% EM, 0.1% DA, 17.6% EA, and 8.5% CFD. Significant differences between urban and rural areas were found only for CFD. The socio-environmental analysis showed that while access to public services and housing quality was significantly better in the urban area, a considerable number of city households lived under deficient conditions, lacked health insurance and had low socioeconomic level. Fifty-three percent of the undernourished children had DM without urban-rural significant differences, and none of them showed DA. In the overweight plus obesity group, 62.8% presented EA, 6.4% EM, 4.7% DM, and 22.8% CFD. The highest percentages of DM and CFD were recorded in rural areas (p = 0.00). We conclude that the child population shows the “double burden” of malnutrition. The environment of residence does not promote any differentiation in the nutritional status. Nevertheless, the increment of central adiposity and, in some cases of muscle deficit in rural children, suggests a consumption of unbalanced diet.     

Paradoxical malnutrition in mother-child pairs: Untangling the phenomenon of over- and under-nutrition in underdeveloped economies

As economic development and urbanization proceed globally, the coexistence of under- and over-nutrition within the same household, sometimes termed ‘paradoxical’ or ‘dual burden’ malnutrition is increasingly being reported. We used Demographic and Health Survey data sets from 18 lower and middle income countries to explore paradoxical forms of malnutrition (maternal overweight with child underweight or stunting) in mother-child pairs. Multinomial logistic regression was used to estimate the odds of discordant pairs after adjusting for a number of important covariates. Several factors were significantly associated with an increased relative odds of discordant mother-child pairs, including working in subsistence agriculture, low levels of maternal education, more siblings in the household, and relative household poverty. However, many of these factors also predicted other combinations of poor nutritional status in mother-child pairs. We conclude that it is difficult to identify any specific factors that elevate risk above and beyond those that predict risk of maternal over-nutrition or child under-nutrition. Based on these analyses, it appears that paradoxical weight status between mothers and children can be best understood as a consequence of rapid secular increases in maternal weight, rather than a distinct nutritional condition with a discrete etiology.     

Extreme levels of underweight and stunting among pre-adolescent children of low socioeconomic class from Madhyamgram and Barasat, West Bengal, India

A cross-sectional study on 1206 children (788 boys, 618 girls) aged 1-12 years, belonging to low socioeconomic status, of Barasat and Madhyamgram, West Bengal, India, was undertaken to investigate age and sex variations in height and weight. It also evaluated the levels of underweight and stunting among them. Anthropometric measurements included weight and height. Weight-for-age (WA) and height-for-age (HA) <-2 z-scores were used to evaluate underweight (UW) and stunting (ST), respectively, following the National Center for Health Statistics (NCHS) Guidelines. Results showed that boys aged 4 and 11 years were significantly heavier than girls of corresponding ages. Boys aged 7 years were significantly taller than girls of the same age. Significant (p < 0.001) age differences existed in mean weight and height in boys (weight: F = 336.762; height: F = 565.160) as well as girls (weight: F = 275.320; height = 498.715). Results also revealed that the mean z-scores of WA (WAZ) and HA (HAZ) were less than (negative values) those of NCHS for both sexes at all ages. The overall (age combined) rate of UW was 60.4% and 51.3%; while that of ST was 51.7% and 48.4%, in boys and girls, respectively. Based on World Health Organization classification of severity of malnutrition, the prevalence of UW and ST were very high (> or = 30%) in both sexes. In conclusion, this study demonstrated that the prevalence of UW and ST were very high among the subjects. Since the nutritional status of the subjects is not satisfactory, there is need for immediate supplementary nutrition.     

Association between age at menarche and early-life nutritional status in rural Bangladesh

Age at menarche is associated with anthropometry in adolescence. Recently, there has been growing support for the hypothesis that timing of menarche may be set early in life but modified by changes in body size and composition in childhood. To evaluate this, a cohort of 255 girls aged <5 years recruited in 1988 were followed up in 2001 in Matlab, Bangladesh. The analysis was based on nutritional status as assessed by anthropometry and recalled age at menarche. Data were examined using lifetable techniques and the Cox regression model. The association between nutritional status indicators and age at menarche was examined in a multivariate model adjusting for potential confounding variables. Censored cases were accounted for. The median age at menarche was 15.1 years. After controlling for early-life predictors (birth size, childhood underweight, childhood stunting) it appeared that adolescent stunting stood out as the most important determinant of age at menarche. Adolescent stunting still resonates from the effect of stunting in early childhood (OR respectively 2.63 (p<0.01 CI: 1.32-5.24) and 8.47 (p<0.001 CI: 3.79-18.93) for moderately and severely stunted under-fives as compared with the reference category). Birth size was not a significant predictor of age at menarche. It is concluded that age at menarche is strongly influenced by nutritional status in adolescence, notably the level of stunting, which is in turn highly dependent on the level of stunting in early childhood. A 'late' menarche due to stunting may be detrimental for reproductive health in case of early childbearing because of the association between height and pelvic size.     

Socioeconomic transition and physical growth of Tupí-Mondê Amerindian children of the Aripuan? Park, Brazilian Amazon

Anthropometric assessment of nutritional status is reported for three Tupí-Mondê-speaking groups from Rond?nia and Mato Grosso, Brazil. This region of the Amazon basin is experiencing rapid development through government-oriented colonization. The Gavi?o, Suruí, and Zoró had their first contacts with Brazilian national society at different times, and the nature and degree of their participation in regional markets varies. Height, weight, sitting height, subischial leg length, upper arm circumference, triceps skin-fold thickness, and upper arm muscle and fat areas are reported for children 0-10.9 years of age. Like other Amazonian Amerindians, Tupí-Mondê children are short for their age but normal or above normal in weight for height with respect to the National Center for Health Statistics reference. Hence stunting levels are high (55.4%) and wasting levels are low (0.8%). There are also deficits in body composition parameters, especially in upper arm circumference and estimated muscle and fat areas. We interpret the results as evidence of suboptimal nutritional status, reflecting the interaction between poor diet and infectious and parasitic diseases. The Gavi?o, with the longest period of contact, present the lowest level of stunting. This finding is attributed to the use of cash income from rubber tapping and nut gathering to purchase of food items and health care. Differences in height between the three groups are mostly due to leg length, instead of sitting height, reinforcing the idea that environmental conditions can alter body proportions.     

Is Economic Growth Associated with Reduction in Child Undernutrition in India?

Background

Economic growth is widely perceived as a major policy instrument in reducing childhood undernutrition in India. We assessed the association between changes in state per capita income and the risk of undernutrition among children in India.

Methods and Findings

Data for this analysis came from three cross-sectional waves of the National Family Health Survey (NFHS) conducted in 1992–93, 1998–99, and 2005–06 in India. The sample sizes in the three waves were 33,816, 30,383, and 28,876 children, respectively. After excluding observations missing on the child anthropometric measures and the independent variables included in the study, the analytic sample size was 28,066, 26,121, and 23,139, respectively, with a pooled sample size of 77,326 children. The proportion of missing data was 12%–20%. The outcomes were underweight, stunting, and wasting, defined as more than two standard deviations below the World Health Organization–determined median scores by age and gender. We also examined severe underweight, severe stunting, and severe wasting. The main exposure of interest was per capita income at the state level at each survey period measured as per capita net state domestic product measured in 2008 prices. We estimated fixed and random effects logistic models that accounted for the clustering of the data. In models that did not account for survey-period effects, there appeared to be an inverse association between state economic growth and risk of undernutrition among children. However, in models accounting for data structure related to repeated cross-sectional design through survey period effects, state economic growth was not associated with the risk of underweight (OR 1.01, 95% CI 0.98, 1.04), stunting (OR 1.02, 95% CI 0.99, 1.05), and wasting (OR 0.99, 95% CI 0.96, 1.02). Adjustment for demographic and socioeconomic covariates did not alter these estimates. Similar patterns were observed for severe undernutrition outcomes.

Conclusions

We failed to find consistent evidence that economic growth leads to reduction in childhood undernutrition in India. Direct investments in appropriate health interventions may be necessary to reduce childhood undernutrition in India. Please see later in the article for the Editors'' Summary     

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.     

Burden of Giardia duodenalis Infection and Its Adverse Effects on Growth of Schoolchildren in Rural Malaysia

Background

Giardia duodenalis infection and malnutrition are still considered as public health problems in many developing countries especially among children in rural communities. This study was carried out among Aboriginal (Orang Asli) primary schoolchildren in rural peninsular Malaysia to investigate the burden and the effects of Giardia infection on growth (weight and height) of the children.

Methods/Findings

Weight and height of 374 children aged 7–12 years were assessed before and after treatment of Giardia infection. The children were screened for Giardia parasite using trichrome staining technique. Demographic and socioeconomic data were collected via face-to-face interviews using a pre-tested questionnaire. Overall, 22.2% (83/374) of the children were found to be infected with Giardia. Nutritional status of children was assessed and the results showed that the mean weight and height were 23.9 kg (95% CI = 23.3, 24.5) and 126.6 cm (95% CI = 125.6, 127.5), respectively. Overall, the prevalence of severe underweight, stunting and wasting were 28.3%, 23.8% and 21.0%, respectively. Multiple linear regression analyses showed sex, Giardia infection and household monthly income as the significant determinants of weight while sex and level of mother''s education were the significant determinants of height. Weight and height were assessed at 3 and 6 months after treatment of Giardia infection. It was found that Giardia infection has a significant association with the weight of children but not with height.

Conclusions/Significance

This study reveals high prevalence of Giardia infection and malnutrition among Aboriginal children in rural Malaysia and clearly highlights an urgent need to identify integrated measures to control these health problems in the rural communities. Essentially, proper attention should be given to the control of Giardia infection in Aboriginal communities as this constitutes one of the strategies to improve the nutritional status of Aboriginal children.