Rotavirus vaccination and stunting: Secondary Data Analysis from the Peruvian Demographic and Health Survey

Rotavirus infection is the leading cause of acute diarrhea in children and is preventable with a vaccine. Malnutrition increases the risk for the development of enteric and respiratory diseases, but also diarrhea increases the risk for stunting, having a negative effect in height-for-age Z score (HAZ). Therefore, Rotavirus can be considered as one of the contributing factors to stunting. The objective was to determine if vaccination against rotavirus was associated with changes in HAZ of children aged 6–60 months. We analyzed the data of Demographic and Health Survey (DHS) 2015–2017 for Peru, which is a nationwide representative. We fitted linear regression models controlling for complex sampling. The vaccine coverage was close to 75.5%, and the mean HAZ was −0.76 standard deviations. After adjusting by demographic, health, and household characteristics, children who received rotavirus vaccine, had a mean HAZ 0.06 standard deviations higher than children who did not receive it. Additionally, BCG vaccination, a higher education level of the mother, a higher wealth index, and treating water for drinking were positively associated with HAZ. On the other hand, we found low birth weight, lack of flush toilet, and altitude higher than 2500 m above sea level negatively associated with HAZ. Rotavirus vaccine is associated with better anthropometric measurements.     

Sanitation,financial incentives and health spillovers: A cluster randomised trial

Poor sanitation and its consequent negative health outcomes continue to plague the developing world. Drawing on the finding that financial subsidies have changed behaviour in other health contexts, we conducted a clustered randomised trial in 160 villages in Lao PDR to evaluate the effectiveness of combining financial incentives with Community-Led Total Sanitation (CLTS), a widely-conducted behaviour change program. Villages were randomly allocated to four groups, all of which received CLTS but differed in the type of subsidy offered (none, household, village or both). Using data from a random sample of households with young children and village administrative data, we show that household incentives increased sanitation take-up among the poor, whereas a village incentive increased take-up primarily among the non-poor. Improved sanitation produced positive health spillovers - a 10 percentage point increase in village sanitation coverage decreased the probability of childhood stunting by 3 percentage points.     

Continuation of linear growth failure and its association with cognitive ability are not dependent on initial length‐for‐age: a longitudinal study from 6 months to 11 years of age

Aim: To examine linear growth and its association with cognitive ability at age 11 years among full‐term singletons with varying degree of stunting or without stunting at age 6 months. Methods: A total of 1516 Filipino term‐born singletons were followed bimonthly from age 6 to 24 months and took cognitive and academic achievement tests at 11 years. The tests were factor‐analysed to give a summary cognitive ability score. Linear regression was used to examine associations and adjust for covariates. Results: Mean height‐for‐age Z‐score (HAZ) was ?1.0 at age 6 months and ?2.4 at 24 months. HAZ at 6 months, change in HAZ from 6 to 24 months and change in HAZ from 24 months to 11 years were positively associated with cognitive ability at 11 years (each p < 0.001). The association was seen in all categories of HAZ at 6 months. Conclusion: In this setting where linear growth retardation was common, association between linear growth after age 6 months and cognitive ability in adolescence was not dependent on initial HAZ. Prevention of growth stunting may benefit all children regardless of their initial HAZ.     

Body size and growth: The significance of chronic malnutrition among the Casiguran Agta

Primary objective: The Agta are a short statured, hunter–gatherer population who have been living under demographic and environmental stress. This article shows the influence of these factors and the resulting nutritional deficiency on the anthropometric measurements and mortality of Agta individuals.

Research design: The joint analysis of cross-sectional measurements of Agta children and adults and of the mortality schedules in this population aims to stress the influence of environmental pressures on the ongoing evolution of short stature.

Methods and procedures: Recumbent length, height, weight, mid-upper arm circumference, and triceps skinfolds were taken using standard methods from a total of 253 Agta individuals. Exact or nearly exact ages were taken from a long-term demographic database. z-Scores and growth curves were calculated using the NutStat program and 2000 CDC reference. Mortality schedules are from published material, improved through interviews in the field.

Main outcomes and results: Agta individuals are both short and thin when compared to other populations. Thirty-four per cent of the adults are under-nourished, while 17% of the children are wasted, according to international standards. A major and delayed peak of mortality in early infancy overlaps with a period of average decrease in body length in relation to the reference.

Conclusion: Demographic indicators of poor health-related quality of life are consistent with slowed patterns of growth observed, stressing the importance of environmental pressure in maintaining the short stature of the Agta population.     

Iron-Folic Acid Supplementation During Pregnancy Reduces the Risk of Stunting in Children Less Than 2 Years of Age: A Retrospective Cohort Study from Nepal

The aim of the study was to investigate the effect of antenatal iron-folic acid (IFA) supplementation on child stunting in Nepalese children age <2 years. A retrospective cohort study design was used, in which a pooled cohort of 5235 most recent live births 2 years prior to interview from three Nepal Demographic and Health Surveys (2001, 2006 and 2011) was analysed. The primary outcome was stunting in children age <2 years. The main exposure variable was antenatal IFA supplementation. Multivariate Poisson regression analysis was performed. In our sample, 31% and 10% of Nepalese children age <2 years were stunted and severely stunted, respectively. The adjusted relative risk of being stunted was 14% lower in children whose mothers used IFA supplements compared to those whose mothers did not use (aRR = 0.86, 95% CI = 0.77–0.97). Additionally, the adjusted relative risk of being stunted was significantly reduced by 23% when antenatal IFA supplementation was started ≤6 months with ≥90 IFA supplements used during pregnancy (aRR = 0.77, 95% CI = 0.64–0.92). Antenatal IFA supplementation significantly reduced the risk of stunting in Nepalese children age <2 years. The greatest impact on the risk reduction of child stunting was when IFA supplements were started ≤6 months with ≥90 supplements were used.     

Nutritional status of children during and post-global economic crisis in China

Objective To describe the impact of the global economic crisis on the nutritional status of children in China during and after the crisis.Methods Data from 1990 to 2010 were sourced from the National Food and Nutrition Surveillance System.Approximately 16 000 children under 5 years old were selected using a stratified random cluster method from 40 surveillance sites.Anthropometric and hemoglobin measurements for children under 5 were conducted.Nutritional status was determined according to WHO child growth ...     

The World Health Organization child growth standards: expected implications for clinical and epidemiological research

In 2006 and 2007, the World Health Organization (WHO) released two sets of child growth standards (World Health Organization, WHO Child Growth Standards. Methods and development. Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age. WHO, Geneva, 2006; World Health Organization, WHO Child Growth Standards: Methods and Development. Head circumference-for-age, arm circumference-for-age, triceps skinfold-for-age and subscapular skinfold-for-age. WHO, Geneva, 2007) to replace the National Center for Health Statistics references (Hamill et al., National Center for Health Statistics, Vital and Health Statistics Series 11, No 165, 1977) as an international tool for growth and nutritional assessment. This paper explores the scope of implications for future anthropometric research, highlighting foreseeable effects on the choice of research questions, choice of nutritional indices, training of measurers, and issues of internal and external validity of research results. The conclusion drawn is that the introduction of the WHO child growth standards is expected to have wide implications for growth and nutrition research. The full scope of this effect will gradually become clear while researchers, similar to health care workers, make the transition to using the new standards, re-evaluate results of past approaches, and explore the uses and functional validity of the standards, including those for indices that were not previously available.     

Determinants of linear growth and predictors of severe stunting during infancy in rural Malawi

Stunting is common among children under 5 y of age in sub-Saharan Africa. Several risk factors have been associated with poor growth but few studies have prospectively addressed the development of linear growth faltering and stunting during the first year of life. The present study was designed to analyse typical growth among rural Malawian infants, focusing particularly on the impact of birth size, adherence to feeding guidelines and morbidity in the development of severe stunting during infancy. A community-based cohort of 613 singleton newborns was prospectively followed by monthly home visits. Data were collected on the children's socioeconomic background, maternal size and weight gain during pregnancy, birth events, morbidity, breastfeeding and complementary feeding, growth and mortality. Univariate and multivariate analyses were used to determine associations between predictor variables and poor linear growth. The proportions of stunted infants (Height-for-age Z-score 3 32) at 3, 6 and 9 mo of age were 27%, 51%, and 63%, respectively. At 1 y of age, over two-thirds (71%) of the infants were at least moderately (HAZ 3 32) and 31% severely stunted (HAZ 3 33). Conclusion: The strongest predictor of severe stunting at 12 mo of age was small birth size. Other variables independently associated with this outcome included inappropriate complementary feeding, high morbidity, maternal short stature, male gender, and home delivery. Faltering of linear growth started soon after birth and continued throughout infancy. Interventions increasing birth size could have a significant role in the prevention of early childhood stunting. The ideal strategy should also emphasize the importance of appropriate infant feeding and decreasing the number of illness episodes amongst the infants.     

Adolescent nutrition in a rural community in Bangladesh

The objective of this study was to assess the nutritional status of adolescent boys and girls in a rural community in Bangladesh. Between December 1996 and January 1997, a cross-sectional survey was carried out in 803 households, each containing at least one adolescent, sampled consecutively from four purposely-selected villages in Rupganj Thana, Narayanganj district. Initially, the guardians of 1483 healthy and unmarried 10–17 year old adolescents (51% boys and 49% giris) were interviewed about family structure and socio-economic status. Out of these children, 906 (47% boys and 53% girls) from 597 households were weighed, had their height and MUAC measured and were clinically examined. Blood was then collected from 861 adolescents for haemoglobin estimation. The median monthly income per person in these 597 families was approximately Taka 554 (US $12). Twenty seven per cent of the household heads were labourers, 21% were solvent farmers, 14% ran small scale businesses and 6% were unemployed. Sixty seven per cent of adolescents were thin (defined as BMI < 5th centile of WHO recommended reference) with 75% boys and 59% girls being affected. The percentage of thin adolescents fell from 95% at age 10 years to 12 % at age 17 years. The prevalence of stunting (height for age < 3rd centile NCHS/WHO) was 48% for both boys and girls and rose from 34% at age 10 to 65% at age 17. On clinical examination angular stomatitis was present in 46%, 27% nad glossitis, 38% had pallor, 11% ha’d dental caries, 3.2% had an conspicuously enlarged thyroid and 2.1% had eye changes of vitamin A deficiency. According to INACG (International Nutritional Anaemia Consultative Group, 1985) cut-off values, 94% of the boys and 98% of the girls were anaemic. We conclude that rural Bangladesh adolescents suffer from high rates of malnutrition and almost universal anaemia. Nutritional interventions to target this population are urgently required.