Child behavior problems: Prevalence and correlates in rural minority areas of China

BACKGROUND: Ethnicity may possibly associate with different maternal child-rearing practices and child developmental problems. The aim of this study was to better understand epidemiological features and correlates of child behavior problems in a large sample of children in economically disadvantaged rural minority areas of China and to provide reference data for subsequent intervention of child developmental problems. METHODS: A total of 1222 rural mother-child pairs belonging to Hani, Yi, Hui, Miao and Han were drawn from four economically disadvantaged minority counties in Yunnan Province of China. Well-trained investigators completed child physical examination and measurements (height and weight) in village clinics and interviews of mothers at respondents' homes using a structured questionnaire. RESULTS: Child behavior problems were prevalent in children aged 2-6 years: 71.4% for temper tantrums; 48.2% for swearing; 36.0% for nocturnal bed-wetting; 29.9% for disobedience; 29.5% for difficulty initiating sleep; and 17.0% for picky eating. Child behavior problems significantly differed across Hani, Yi, Hui, Miao and Han ethnic groups. Logistic regression indicated that ethnicity of Hui compared with Han, younger children, prenatal risk factors, being a twin, ineffective child-rearing behaviors such as pampering, corporal punishment, swaddling, family disagreement among child-rearing contributed independently to the risk for child behavior problems. CONCLUSIONS: The child behavior problems were prevalent in children aged 2-6 years in rural minority children of China. Ineffective family child-rearing practices increase risk for child behavior problems.     

Risk factors for low Kaup index among children in rural ethnic minority areas of Yunnan, China

BACKGROUND: The general living standard and health level have been greatly improved in China. But the result of a significant change in a child's growth level has not been reported in the Yunnan rural minority area. The aim of this study was to identify the risk factors for low Kaup index in the Dai peoples' autonomous region to construct a better health service system in rural minority areas. METHODS: A total of 1173 mother-child pairs were selected in 36 villages of the Dai peoples' autonomous region. Sampled mothers were interviewed using a structured questionnaire. Sampled children were measured for weight and height. RESULTS: In total, 36.1% of the candidate group was under weight, 12.0% was wasting, and 30.8% had stunted growth. A child's gender (odds ratio; OR, 1.42; 95% confidence interval; 95% CI, 1.07-1.88), existence of a weaning food (OR, 0.35; 95% CI, 0.26-0.46), grasp of the cause of the child's malnutrition (OR, 1.82; 95% CI, 1.16-2.89), positiveness to information on better nutrition (OR, 2.97; 95% CI, 1.07-8.18), coincidence of the child-rearing plan between parents (OR, 3.15; 95% CI, 1.12-4.11), and existence of a doctor who can consult about child-rearing (OR, 3.17; 95% CI, 1.22-8.22) indicated significant relationships to the low value of a child's Kaup index. CONCLUSION: The mother's child-rearing behavior and social support were identified as risk factors. An offer of effective and abundant information to mothers, and the existence of professionals with whom mothers can consult immediately, were required to construct a better health system in the target area.     

Exploring the impact of water,sanitation and hygiene (WASH), early adequate feeding and access to health care on urban–rural disparities of child malnutrition in China

To explore the effects of UNICEF-suggested modifiable factors, that is, water, sanitation and hygiene (WASH), early adequate feeding and health care on child malnutrition, and to examine the extent to which each factor contributes to urban–rural disparities of child malnutrition in China. Pooling two waves of regionally representative survey data from Jilin, China, in 2013 and 2018, we report on urban–rural relative risks (RRs) in the prevalence of child stunting, wasting and overweight. We employ Poisson regression to examine the effects of urban–rural setting and the three modifiable factors on the prevalence of each malnutrition outcome, that is, stunting, wasting and overweight. We perform mediation analyses to estimate the extent to which each modifiable factor could explain the urban–rural disparities in each malnutrition outcome. The prevalence of stunting, wasting and overweight were 10.9%, 6.3% and 24.7% in urban, and 27.9%, 8.2% and 35.9% in rural Jilin, respectively. The rural to urban crude RR was 2.55 (95% confidence interval [CI]: 1.92–3.39) for stunting, while the corresponding RRs for wasting and overweight were 1.31 (95% CI: 0.84–2.03) and 1.45 (95% CI: 1.20–1.76), respectively. The rural to urban RR for stunting reduced to 2.01 (95% CI: 1.44–2.79) after adjusting for WASH. The mediation analyses show that WASH could mediate 23.96% (95% CI: 4.34–43.58%) of the urban–rural disparities for stunting, while early adequate feeding and health care had no effects. To close the persistent urban–rural gap in child malnutrition, the specific context of rural China suggests that a multi-sectoral approach is warranted that focuses on the sanitation environment and other wider social determinants of health.     

Prevalence and correlates of stunting among primary school children in rural areas of southern Pakistan

Protein-energy malnutrition is one of the leading causes of childhood morbidity and mortality in developing countries. The purpose of the present study was to measure the prevalence of stunting and its correlates among school children aged 6-12 years in the rural areas of southern Pakistan. We selected 1915 children aged 6-12 years enrolled in 32 primary schools in rural Sindh, Pakistan. Trained community health workers conducted child height and weight measurements and collected information from the parents. The Z-scores for the distribution of height-for-age, weight-for-age, and weight-for-height relative to those of National Center for Health Statistics/Center of Disease Control and prevention (NCHS/CDC) reference population were calculated. Out of 1915 children, 300 (16.5 per cent) were stunted. Female children compared to males were more likely to be stunted (prevalence ratio (PR) = 1.26; 95 per cent confidence interval (CI): 1.02-1.53). Children older than 7 years were more likely to be stunted (PR, 1.40; CI, 1.14-1.72). Fathers who were working as government employees (PR, 1.71; CI, 1.05-2.79), shopkeepers (PR, 2.00; CI, 1.22-3.26) and farmers (PR, 1.43; CI, 0.93-2.22) were more likely to have children who were stunted when compared to landlords. In rural areas of southern Pakistan, sex of child, age of the child, and father's occupation may be considered as important risk factors for stunting among school children aged 6-12 years.     

Prevalence and correlates of stunting among children in rural Pakistan

BACKGROUND: Protein-energy malnutrition remains an important underlying cause of death among preschool children in Pakistan. The present study aimed to estimate the prevalence of stunting and its correlates and to explore the role of sex bias in remote rural villages of south Pakistan. METHODS: We selected 1878 children less than 3 years of age through stratified random sampling from 64 villages having the number of children enrolled proportionate to the size of each village, in rural Sindh, Pakistan. Trained investigators completed child physical measurements and a maternal interview. The Z-scores for the distribution of height-for-age (stunting) and weight-for-height (wasting) were estimated relative to those of the National Center for Health Statistics/Center for Disease Control (NCHS/CDC) reference population. RESULTS: A total of 483 (26%) of the 1878 children were wasted, 977 (55%) were stunted and 259 (15%) were both wasted and stunted. Mothers who were illiterate were more likely to have children who were stunted (odds ratio (OR) = 1.27, 95% confidence interval (CI) 1.11-1.61). Fathers who earn less than Rs. 1000 (US $20) per month (OR = 1.35, 95% CI 1.12-1.66) were more likely to have children who were stunted. Children living in an overcrowded house were more likely to be stunted (OR = 1.44, 95% CI 1.18-1.75). Male children compared to females were equally likely to be stunted (57 vs 55%, OR 1.03, 95% CI 0.86-1.25). CONCLUSIONS: In this region of lower Sindh, stunting is more common than wasting. Female illiteracy, poor household income and overcrowding are important risk factors for stunting. The prevalent belief that in rural Pakistan, parents pay attention to feeding male children at the cost of female children is not proven by these data.     

Maternal child-rearing behaviors and correlates in rural minority areas of Yunnan, China

An epidemiological survey of maternal child-rearing behaviors was conducted in the rural minority areas of Yunnan, China. An interview of 2019 rural mothers of Hani, Yi, Hui, Miao, and Han and 544 urban mothers with children younger than 7 years of age showed that 51.7% of these rural mothers placed their infants in swaddling clothes. In the rural sample, exclusive breastfeeding occurred at frequency rates of 76.7% and 34.2% during 3 and 6 months postpartum, respectively. Maternal training and playing behaviors were reported less frequently, whereas physical punishment for children's misbehavior was more commonly found in the child-rearing behavior of rural mothers. Maternal child-rearing behaviors differed significantly among ethnic groups as well as between urban and rural areas. Maternal child-rearing behaviors were significantly associated with maternal education level, family type, family income, maternal age at delivery, and number of children in the family. Children's gender had no significant association with maternal child-rearing behaviors.     

Epidemiologic correlates of malnutrition in rural areas of Kolar

The extent of malnutrition was determined in 252 children aged 6 months to 3 1/2 years; and its association with 16 variables grouped into four clusters was investigated: (1) home environment, (2) personal characteristics of children, (3) feeding and cultural practices of children, and (4) morbidity pattern. Least malnutrition was found in the age group 6 months to 1 year. More girls were malnourished than boys. In the case of boys, if the mother looked after the child, there was less malnutrition, while in the girls though the findings were similar, the differences were not significant. Of those boys who had a history of passing worms in their stools, a significantly larger proportion were malnourished as compared to those who did not have such a history. The overall prevalence of malnutrition as judged by weight for age was 70 per cent and by weight for actual height 84 per cent. Retardation, determined by height as a percentage of expected height was 66.4 per cent. The study illustrates the use of simple survey methods and epidemiological techniques which could be used by medical officers or public health nurses in rural areas.     

Polyunsaturated fatty acids in erythrocyte and plasma lipids of children with severe protein–energy malnutrition

The fatty acid composition of plasma cholesterol esters, plasma phospholipids, erythrocyte phosphatidylcholine and erythrocyte phosphatidylethanolamine was investigated in severely malnourished Nigerian children with kwashiorkor (n = 12) and marasmus (n = 32). Normally nourished children from the same area (n = 23) served as controls. The malnourished children showed a significant reduction of highly polyunsaturated fatty acids in cholesterol esters, phospholipids and phosphatidylcholine. No differences between the groups were found in erythrocyte phosphatidylethanolamine. Children with kwashiorkor had lower levels of linoleic acid metabolites and docosahexaenoic acid than marasmic children. The results suggest that the kwashiorkor syndrome is associated with impaired desaturation and elongation of PUFA and/or increased lipid peroxidation.     

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??Objective??To use the modified pediatric malnutrition risk screening tool to investigate the prevalence of malnutrition in hospitalized children and assess the clinical effectiveness of the screening tool??to provide the basis for nutritional assessment and reasonable nutrition support. Methods??Choose hospitalized children in Xinhua Hospital Affiliated to Shanghai Jiao Tong University of Medicine from August 2014 to September 2015 as the investigation subjects. The modified pediatric malnutrition risk screening tool was used to further explore the relationship between results of nutritional risk screening and the clinical outcome. Results??The screening results showed that the total incidence of malnutrition in 2632 hospitalized children was 53.2%. The younger the hospitalized children were??the higher the incidence of malnutrition risk was??χ2??59.89??P??0.05??. There was statistical difference among children with different diseases in incidence of malnutrition risk??χ2??425.12??P??0.05????and the incidence of malnutrition was higher in the alimentary system disease group??70.1%?? and hematological malignancies group??86.7%?? than in other disease groups. In the absence of nutritional support??the lengthof hospital stay of children with malnutrition was significantly longer??Z??-9.293??P??0.05????and there was a significant difference in the outcome of the disease??χ2??4.937??P??0.05????the incidence of complications during hospitalization had a rising trend??but the difference was not statistically significant??χ2??2.203??P??0.05??. Conclusion??The results suggest that the modified pediatric malnutrition risk screening tool can effectively screen out the risk of malnutrition in hospitalized children?? with better clinical predictability.     

Individual, household, programme and community effects on childhood malnutrition in rural India

The children living in rural areas of India disproportionately suffer from malnutrition compared with their urban counterparts. The present article analyses the individual, household, community and programme factors on nutritional status of children in rural India. Additionally, we consider the random variances at village and state levels after introducing various observed individual-, household- and programme-level characteristics in the model. A multilevel model is conducted using data from the National Family and Health Survey 2. The results show that maternal characteristics, such as socio-economic and behavioural factors, are more influential in determining childhood nutritional status than the prevalence of programme factors. Also, it was found that individual factors show evidence of state- and village-level clustering of malnutrition.     

Factors associated with acute malnutrition among children 6‐59 months in rural Mozambique

Factors associated with acute malnutrition are complex and wide‐ranging particularly in developing countries. In Mozambique, contextual factors associated to children acute malnutrition are yet to be fully investigated and the evidences used to better inform prevention programme. The objective of this study is to identify key factors associated with acute malnutrition among 6‐ to 59‐month‐old children living in nine districts in rural Mozambique assessed in the 2018 seasonal nutrition assessment. We analysed Standardized Monitoring and Assessment for Relief and Transition (SMART) nutrition survey data of 1,116 children from three districts and rapid nutrition assessment (RNA) data of 3,884 children from six districts of Mozambique. We used a multiple logistic regression analysis to respond to the research question. Experiencing diarrhoea [odds ratio (OR) = 4.54; P = 0.001] was the only variable associated with acute malnutrition from the SMART survey dataset, whereas in the RNA, fever (OR = 3.0; P = 0.000) access to sanitation (OR = 0.118; P = 0.037), experiencing shock in the household (OR = 0.5; P = 0.020), diarrhoea (OR = 2.41; P = 0.001) and cough (OR = 1.75; P = 0.030) were the variables with significant association to acute malnutrition. We believe that the findings were influenced by the proportion of acute malnutrition in each survey type. Study findings confirm the association between acute malnutrition and child's health outcomes that are generally linked to poor living conditions and independent effects of shocks. This highlights the need for policy and programme to implement integrated, cross‐sectoral approaches to tackling child acute malnutrition, particularly addressing community level conditions such as water and sanitation.     

Prevalence and behavioural correlates of enuresis in young children

Objectives:   Previous studies based on clinical samples report that enuresis in children is associated with behavioural problems and reduced self-esteem, but the relationship between behavioural problems and enuresis remains controversial. This population-based study investigated the prevalence and behavioural correlates of enuresis in a group of preparatory school children.
Methods:   This cross-sectional survey involved 356 parents and their children aged 5–7 years, all residents of Istanbul, Turkey. Parents completed the Child Behaviour Checklist and socio-demographic data form (response rate: 90%). Fifty-three children with enuresis were compared with 303 non-symptomatic children. Differences in the mean scores and the percentages of children falling beyond pre-selected clinical thresholds were compared between the groups.
Results:   The prevalence of enuresis was 14.9%, and enuresis was more frequent among boys. Children with enuresis were reported by their parents to have greater social problems and higher total problem scores than control children ( P  = 0.019, P  = 0.048, respectively). However, there were no differences in the percentages of children falling beyond pre-selected clinical thresholds between the groups.
Conclusions:   Children with enuresis had higher mean scores for total and social behavioural problems than controls; however, clinically relevant behavioural problems did not show differences between the groups. Given the inconsistent research findings across studies, longitudinal research and outcome studies could help determine whether there is a causal relationship between psychopathology and enuresis.     

Serum,zinc and copper levels in children with protein energy malnutrition

Serum zinc and copper were measured by atomic absorption spectrophotometry in 58 children (3 months-5 years); of these, 46 children had protein energy malnutrition (PEM), and 12 children served as controls. The levels of serum zinc and copper were found to be significantly low in children with severe malnutrition (grades III and IV PEM). There was a significant positive correlation between serum zinc and height-for-age (r=0.8809, p<0.001). Serum copper was found low only in children exhibiting marked linear growth retardation (height-for-age <85% of the normal). Hypoalbuminemia (serum albumin <2.5 g/dl), and anemia (hemoglobin ≤8.0 g/dl) in malnourished children were associated with significant decline in serum zinc and copper levels, respectively.     

Echocardiographic evaluation of cardiac functions and left ventricular mass in children with malnutrition

OBJECTIVE: This study was undertaken to assess the left ventricular mass (LV Mass) and systolic and diastolic functions of the left ventricle in children with protein energy malnutrition (PEM). METHODOLOGY: Thirty children, aged between 2 months and 2 years with PEM (four kwashiorkor, seven marasmic- kwashiorkor, 19 marasmus), and 17 healthy, age-matched children, using Doppler echocardiography were studied. RESULTS: The mean LV Mass in the patients was lower than that in the controls (14.5 +/- 5.2 vs 19.8 +/- 4.7 g, P < 0.05). However, the LV Mass/body surface area was not different in the patients with PEM and in the control group (52 +/- 9.2 vs 53.9 +/- 8.2g/m(2), P > 0.05), indicating that LV Mass was reduced in proportion to decrease in body size in malnutrition. Left ventricular septal and posterior wall thickness in PEM were also lower than that in the controls, and the most significant reduction in the LV Mass, septal and posterior wall thickness were found in the kwashiorkor group. Cardiac output was reduced in proportion to decrease in body size in the patient group (1.6 +/- 0.5 vs 2.1 +/- 0.8 L/min, P < 0.05), therefore cardiac index was not significantly different between the patients and the control subjects (5.9 +/- 1.4 vs 5.7 +/- 1.6 L/min/m(2), P > 0.05). Systolic function indices including ejection fraction, fractional shortening, and diastolic function indices were not significantly different in the groups. CONCLUSIONS: We demonstrated that LV Mass and cardiac output were reduced in proportion to decrease in body size in patients with PEM, and LV systolic and diastolic functions were preserved in atrophic hearts.     

Malnutrition improvement for infants under 18 months old of Dai minority in Luxi, China

BACKGROUND: Child malnutrition and thiamine deficiency remain a matter of public concern in Dai children under 5 years old in Southwest areas of China. The aim of the present study was to understand the status and correlates of malnutrition and thiamine deficiency in Dai children under 18 months old in Yunnan, China, and to explore an effective intervention for improving their nutritional status and decreasing the prevalence of malnutrition and thiamine deficiency in Dai children. METHODS: Well-trained investigators completed a baseline evaluation survey, including questionnaire survey by maternal interviews, child physical measurements, lab examination of thiamine, and group discussions in a cross-sectional study. An intervention plan was constructed by a group consisting of the city governor, government officers, maternal and child health workers, community leaders, and villagers etc. A comprehensive community-based intervention was carried out for 352 children born after July 2001 and their mothers or caregivers in half of the baseline survey villages by the end of 2003. The intervention included participatory intervention, community nutrition education, child growth monitoring and distributing thiamine to new mothers just before or after delivery. RESULTS: The baseline evaluation survey in 2000 indicated that the prevalence of moderate and severe protein-energy malnutrition was 19.5% for underweight, 16.4% for stunting, and 6.7% for wasting, respectively. With increasing age, the prevalence increased, peaking at 12-15 months. The prevalence of underweight in girls was higher than in boys. A total of 10.5% of children suffered from thiamine deficiency, and 5.7% of the children were insufficient in thiamine supply. Low Kaup target (<25%) was significantly associated with lack of guidance by doctors, lack of nutrition knowledge, lack of knowledge of causes of malnutrition and local culture food taboos. The status of child nutrition has been improved significantly since the intervention measure implementation. The change of prevalence of underweight children aged 6-17 months prior to and after the intervention was significant: 20.5% before and 13.7% after the intervention in infants aged 6-11 months, and 39.0% before and 26.4% after the intervention in young children aged 12-17 months. Prevalence of girls was higher than that of boys. Some women began to eat vegetables and pork from the market, which were forbidden by the culture food taboos. There is no case report of child thiamine deficiency in project villages. CONCLUSION: The prevalence of moderate and severe protein-energy malnutrition is high in Dai infants and young children. However, based on the local situation, participatory community-based comprehensive nutrition intervention effectively reduces the prevalence of child malnutrition and thiamine deficiency. It is highlighted that population nutritional intervention can produce better results with participation at a community level.     

Infant feeding,growth monitoring and the double burden of malnutrition among children aged 6 months and their mothers in KwaZulu-Natal,South Africa

South Africa has a documented high prevalence of stunting and increasing obesity in children as well as obesity in adults. The double burden of malnutrition, which can be on an individual-, household- or population level, has implications for both health and the economic development of a community and country. This paper describes a large-scale survey (N = 774) of infant feeding, growth monitoring and anthropometry among mother and child pairs aged 6 months of age in KwaZulu-Natal (KZN), South Africa, conducted between January and August 2017. Among children, a large increase in the prevalence of stunting and obesity was seen between birth and 6 months of age increasing from 9.3% to 21.7% and 4.0% to 21.0%, respectively. 32.1% of the mothers were overweight [body mass index (BMI): 25.0–29.9] and 28.4% had obesity grade 1 (BMI: 30–<40). Although most mothers (93%; 563/605) initiated breastfeeding, the introduction of other foods started early with 17.6% (56/319) of the mothers having started giving other fluids or food to their child within the first month. At 6 months 70.6% (427/605) children were still breastfed and 23.5% were exclusively breastfed. In addition, we found that length measurements were done less frequently than weight measurements between birth and 6 months, on average 2.2 (SD: 1.3) versus 5.8 (SD: 1.5) times. Moreover, there is a need for improvement of health worker training and understanding regarding anthropometric measurements when assessing malnutrition in children in the clinics. Early detection and improved infant feeding practices are key in preventing both stunting and obesity in children.