evidence-based blog of Filippo Dibari

Posts Tagged ‘underweight’

Association between economic growth and early childhood undernutrition: evidence from 121 Demographic and Health Surveys from 36 low-income and middle-income countries

In Under-nutrition on April 2, 2014 at 5:06 pm

by  Sebastian Vollmer, Kenneth Harttgen, Malavika A Subramanyam, Jocelyn Finlay, Stephan Klasen, S V Subramanian

The Lancet Global Health. Volume 2, Issue 4, April 2014, Pages e225–e234




Economic growth is widely regarded as a necessary, and often sufficient, condition for the improvement of population health. We aimed to assess whether macroeconomic growth was associated with reductions in early childhood undernutrition in low-income and middle-income countries.


We analysed data from 121 Demographic and Health Surveys from 36 countries done between Jan 1, 1990, and Dec 31, 2011. The sample consisted of nationally representative cross-sectional surveys of children aged 0–35 months, and the outcome variables were stunting, underweight, and wasting. The main independent variable was per-head gross domestic product (GDP) in constant prices and adjusted for purchasing power parity. We used logistic regression models to estimate the association between changes in per-head GDP and changes in child undernutrition outcomes. Models were adjusted for country fixed effects, survey-year fixed effects, clustering, and demographic and socioeconomic covariates for the child, mother, and household.


Sample sizes were 462 854 for stunting, 485 152 for underweight, and 459 538 for wasting. Overall, 35·6% (95% CI 35·4–35·9) of young children were stunted (ranging from 8·7% [7·6–9·7] in Jordan to 51·1% [49·1–53·1] in Niger), 22·7% (22·5–22·9) were underweight (ranging from 1·8% [1·3–2·3] in Jordan to 41·7% [41·1–42·3] in India), and 12·8% (12·6–12·9) were wasted (ranging from 1·2% [0·6–1·8] in Peru to 28·8% [27·5–30·0] in Burkina Faso). At the country level, no association was seen between average changes in the prevalence of child undernutrition outcomes and average growth of per-head GDP. In models adjusted only for country and survey-year fixed effects, a 5% increase in per-head GDP was associated with an odds ratio (OR) of 0·993 (95% CI 0·989–0·995) for stunting, 0·986 (0·982–0·990) for underweight, and 0·984 (0·981–0·986) for wasting. ORs after adjustment for the full set of covariates were 0·996 (0·993–1·000) for stunting, 0·989 (0·985–0·992) for underweight, and 0·983 (0·979–0·986) for wasting. These findings were consistent across various subsamples and for alternative variable specifications. Notably, no association was seen between per-head GDP and undernutrition in young children from the poorest household wealth quintile. ORs for the poorest wealth quintile were 0·997 (0·990–1·004) for stunting, 0·999 (0·991–1·008) for underweight, and 0·991 (0·978–1·004) for wasting.


A quantitatively very small to null association was seen between increases in per-head GDP and reductions in early childhood undernutrition, emphasising the need for direct health investments to improve the nutritional status of children in low-income and middle-income countries.

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Ground-breaking Book release: “The Road to Good Nutrition” – by multiple “very special” writers

In Over-nutrition, Under-nutrition on October 5, 2013 at 12:49 pm




Eggersdorfer M.
Kraemer K.
Ruel M.
Van Ameringen M.
Biesalski  H.K.
Bloem M.
Chen J.
Lateef A.
Mannar V.

Some of the chapters are free for downloading here.


(from the Karger’s web site)

This is a work of advocacy, whose prime objective is to inform people about the relationship between nutrition security and public health. It draws on the thinking and experience of a selected number of experts in the field of nutrition and public health. Collating up-to-the-minute information in a clear and accessible way, the book forms a ‘one-stop information source’, and paves the way for further, science-led publications in this field. ‘The Road to Good Nutrition’ puts the topic of nutrition security on the agenda of policy-makers, academics, private sector organizations and civil society, as well as of organizations dedicated to the nutrition space. It is also of interest to the educated lay reader who is generally well informed in matters of health, nutrition and sustainability.
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Predictors of stunting, wasting and underweight among Tanzanian children born to HIV-infected women

In Under-nutrition on October 24, 2012 at 7:52 am

McDonald CMKupka RManji KPOkuma JBosch RJAboud SKisenge RSpiegelman DFawzi WWDuggan CP.

Eur J Clin Nutr. 2012 Oct 3


Background/Objectives: Children born to human immunodeficiency virus (HIV)-infected women are susceptible to undernutrition, but modifiable risk factors and the time course of the development of undernutrition have not been well characterized.

The objective of this study was to identify maternal, socioeconomic and child characteristics that are associated with stunting, wasting and underweight among Tanzanian children born to HIV-infected mothers, followed from 6 weeks of age for 24 months.

Subjects/Methods: Maternal and socioeconomic characteristics were recorded during pregnancy, data pertaining to the infant’s birth were collected immediately after delivery, morbidity histories and anthropometric measurements were performed monthly. Multivariate Cox proportional hazards methods were used to assess the association between potential predictors and the time to first episode of stunting, wasting and underweight.

Results: A total of 2387 infants (54.0% male) were enrolled and followed for a median duration of 21.2 months. The respective prevalence of prematurity (<37 weeks) and low birth weight (<2500 g) was 15.2% and 7.0%; 11.3% of infants were HIV-positive at 6 weeks. Median time to first episode of stunting, wasting and underweight was 8.7, 7.2 and 7.0 months, respectively. Low maternal education, few household possessions, low infant birth weight, child HIV infection and male sex were all independent predictors of stunting, wasting and underweight. In addition, preterm infants were more likely to become wasted and underweight, whereas those with a low Apgar score at birth were more likely to become stunted.

Conclusions: Interventions to improve maternal education and nutritional status, reduce mother-to-child transmission of HIV, and increase birth weight may lower the risk of undernutrition among children born to HIV-infected women.

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Development, acceptability, and nutritional characteristics of a low-cost, shelf-stable supplementary food product for vulnerable groups in Kenya

In Uncategorized, Under-nutrition on October 15, 2012 at 8:14 am

 Kunyanga, Catherine; Imungi, Jasper; Okoth, Michael; Vadivel, Vellingiri; Biesalski, Hans Konrad

Food & Nutrition Bulletin, Volume 33, Number 1, March 2012 , pp. 43-52(10)


Background. Food-based approaches have been advocated as the best strategies to curb hunger and malnutrition in developing countries. The use of low-cost, locally available, nutritious foods in the development of supplementary foods has been recommended.

 Objective. To develop low-cost food supplements using different traditionally processed local foods, consisting of cereals, legumes, nuts, fish, and vegetables, to meet the nutrient requirements for vulnerable groups in Kenya.

 Methods. Four food supplements were developed and evaluated by taste panel procedures. The product containing amaranth grain, pigeon pea, sweet potato, groundnuts, and brown sugar was found to be the most acceptable supplement. Evaluation of nutritional composition, shelf-life, and cost analysis of the acceptable supplement was carried out to assess if it could satisfactorily provide more than 50% of the Recommended Dietary Allowances (RDAs) of the basic nutrients for vulnerable groups.

 Results. The acceptable supplement contained 453.2 kcal energy, 12.7 g crude protein, 54.3 g soluble carbohydrates, 20.8 g crude fat, and 10.1 g crude fiber per 110 g. The micronutrient contents were 93.0 mg calcium, 172.4 mg magnesium, 2.7 mg zinc, 5.7 mg iron, 0.8 mg vitamin B1, 0.2 mg vitamin B2, 7.9 mg niacin, 100 μg folic acid, and 140 μg retinol equivalent per 110 g. The supplement also contained 21% total essential amino acid in addition to appreciable levels of palmitic, stearic, oleic, linoleic, and α-linolenic fatty acids. The shelf-life study showed that it could be stored in different packaging materials (polythene bags, gunny bags, and kraft paper) at 26°C without deleterious effects on its chemical composition for up to 4 months. Cost analysis of the supplement indicated that the product could be competitively sold at US$0.812/kg (KES 65.50/kg).

 Conclusions. Locally available indigenous foods can be used in the formulation of acceptable, low-cost, shelf-stable, nutritious supplementary foods for vulnerable groups.

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Undernutrition among Kenyan children: contribution of child, maternal and household factors

In Under-nutrition on May 7, 2012 at 7:45 am

Constance A Gewa and Nanette Yandell

Public Health Nutrition June 2012 15 : pp 1029-1038  


Objective To examine the contribution of selected child-, maternal- and household-related factors to child undernutrition across two different age groups of Kenyan under-5s.

“Design Demographic and Health Survey data, multistage stratified cluster sampling methodology.

“Setting Rural and urban areas of Kenya.

“Subjects A total of 1851 children between the ages of 0 and 24 months and 1942 children between the ages of 25 and 59 months in Kenya.

“Results Thirty per cent of the younger children were stunted, 13 % were underweight and 8 % were wasted. Forty per cent of the older children were stunted, 17 % were underweight and 4 % were wasted. Longer breast-feeding duration, small birth size, childhood diarrhoea and/or cough, poor maternal nutritional status and urban residence were associated with higher odds of at least one form of undernutrition, while female gender, large birth size, up-to-date immunization, higher maternal age at first birth, BMI and education level at the time of the survey and higher household wealth were each associated with lower odds of at least one form of undernutrition among Kenyan children. The more proximal child factors had the strongest impact on the younger group of children while the intermediate and more distal maternal and household factors had the strongest impact on child undernutrition among the older group of children.

“Conclusions The present analysis identifies determinants of undernutrition among two age groups of Kenyan pre-school children and demonstrates that the contribution of child, maternal and household factors on children’s nutritional status varies with children’s age.”

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