Dietary diversity is associated with child nutritional status: evidence from 11 demographic and health surveys

Simple indicators reflecting diet quality for young children are needed both for programs and in some research contexts. Measures of dietary diversity are relatively simple and were shown to be associated with nutrient adequacy and nutritional status. However, dietary diversity also tends to increase with income and wealth; thus, the association between dietary diversity and child nutrition may be confounded by socioeconomic factors. We used data from 11 recent Demographic and Health Surveys (DHS) to examine the association between dietary diversity and height-for-age Z-scores (HAZ) for children 6-23 mo old, while controlling for household wealth/welfare and several other potentially confounding factors. Bivariate associations between dietary diversity and HAZ were observed in 9 of the 11 countries. Dietary diversity remained significant as a main effect in 7 countries in multivariate models, and interacted significantly with other factors (e.g., child age, breast-feeding status, urban/rural location) in 3 of the 4 remaining countries. Thus, dietary diversity was significantly associated with HAZ, either as a main effect or in an interaction, in all but one of the countries analyzed. These findings suggest that there is an association between child dietary diversity and nutritional status that is independent of socioeconomic factors, and that dietary diversity may indeed reflect diet quality. Before dietary diversity can be recommended for widespread use as an indicator of diet quality, additional research is required to confirm and clarify relations between various dietary diversity indicators and nutrient intake, adequacy, and density, for children with differing dietary patterns.     

Socioeconomic inequalities and vaccination coverage: results of an immunisation coverage survey in 27 Brazilian capitals, 2007-2008

BACKGROUND: Since 1988, Brazil's Unified Health System has sought to provide universal and equal access to immunisations. Inequalities in immunisation may be examined by contrasting vaccination coverage among children in the highest versus the lowest socioeconomic strata. The authors examined coverage with routine infant immunisations from a survey of Brazilian children according to socioeconomic stratum of residence census tract. METHODS: The authors conducted a household cluster survey in census tracts systematically selected from five socioeconomic strata, according to average household income and head of household education, in 26 Brazilian capitals and the federal district. The authors calculated coverage with recommended vaccinations among children until 18 months of age, according to socioeconomic quintile of residence census tract, and examined factors associated with incomplete vaccination. RESULTS: Among 17?295 children with immunisation cards, 14?538 (82.6%) had received all recommended vaccinations by 18 months of age. Among children residing in census tracts in the highest socioeconomic stratum, 77.2% were completely immunised by 18 months of age versus 81.2%-86.2% of children residing in the four census tract quintiles with lower socioeconomic indicators (p<0.01). Census tracts in the highest socioeconomic quintile had significantly lower coverage for bacille Calmette-Guérin, oral polio and hepatitis B vaccines than those with lower socioeconomic indicators. In multivariable analysis, higher birth order and residing in the highest socioeconomic quintile were associated with incomplete vaccination. After adjusting for interaction between socioeconomic strata of residence census tract and household wealth index, only birth order remained significant. CONCLUSIONS: Evidence from Brazilian capitals shows success in achieving high immunisation coverage among poorer children. Strategies are needed to reach children in wealthier areas.     

Socioeconomic determinants of nutritional status of children in Lao PDR: effects of household and community factors

The prevalence of undernutrition among Lao children is among the highest in the region. However, the determinants of childhood undernutrition in Laos have not been fully analyzed. This paper, using the dataset of the Lao Multiple Indicator Cluster Survey 3, which is a nationally-representative sample in Laos, investigated the effects of socioeconomic factors at both household and community levels on the nutritional status of children. In the estimation, a multilevel linear model with random-intercepts was used for estimating the determinants of child anthropometric indices. The empirical results revealed that children from households in southern Laos and from ethnic minority groups were less-nourished. Level of education of parents, attitudes of mothers towards domestic violence, assets of household, local health services, and the condition of sanitation and water were considered to be important determinants of nutritional status of children. The pattern of growth-faltering in children by age was identified. Children aged 12-59 months were less-nourished than those aged 0-11 months. The empirical results were consistent with the collective household model which incorporates a decision-making process within the household. Since there is scarce evidence about the predictors of childhood undernutrition in Laos, the findings of this study will serve as a benchmark for future research.     

Environmental tobacco smoke exposure in children: household and community determinants.

To determine the most important sources of environmental tobacco smoke exposure to young children, the authors studied the associations among urinary cotinine, reported household smoking habits, and socioeconomic variables in 575 schoolchildren aged 6-11 y. The school children were among a population of prodigious smokers in Cape Town, South Africa. Eighty percent of the children were exposed to environmental tobacco smoke. Maternal smoking, which was adjusted for creatinine, accounted for 21.8% of the variation in urinary cotinine--more than all other sources combined. The male parent and other household smokers accounted for 12.7% of the variation, and socioeconomic indicators explained an additional 4.8%. By defining the ecological variable of smoking prevalence per school, the authors estimated a "community" contribution of 3.3%. The relative importance of different sources of smoke should be taken into account in the prevention of environmental tobacco smoke exposure in young children. Most importantly, of all the sources of environmental tobacco smoke, mothers' smoking habits had the greatest impact on exposure to children.     

Female autonomy and child nutritional status: the extended-family residential unit in Amman, Jordan

This study explores the hypothesis that the mother's position within household power relations--her autonomy with respect to other household members--influences her ability to provide for the health of her children. We argue that in the context of the Arab Middle East, a woman's structural position within the household is a good indicator of her relative autonomy: if she is the daughter-in-law in a vertically extended residential unit, she has less autonomy than if she is head or co-head of household. Our analysis is based on data collected from 1341 households in 1985 as a part of the Follow-up Health and Population Assessment of four urban settlements in Amman, Jordan. They include measures of the child's weight and age, plus a variety of socioeconomic factors. We analyze the effect of the mother's autonomy on child nutritional status within a multiple regression framework that controls for rival hypotheses. In particular, we investigate whether it is the availability of other potential child-care substitutes, particularly the grandmother, that influences child nutrition rather than household structure. We also look at household income, mother's education, the area of residence, and the child's sex. Our results show a strong negative influence associated with having a mother whose autonomy in the household is low. This effect does not disappear when mother's age and education, and household size and composition are taken into consideration. Nor is it a proxy for the higher household incomes characteristic of extended-family residential units with their multiple earners.     

Household smoking and respiratory disease in under-five children

Environmental tobacco smoke is an important respiratory tract irritant in young children. To identify factors associated with respiratory disease and determine the main source of smoking exposure in the household, a cross-sectional study of 2,037 children who were immunized in primary health care clinics was conducted (in a sample of 10 out of 38 clinics with 200 children each). Parents answered a questionnaire about children's birth, passive smoking, former and current respiratory morbidity, socio-demographic characteristics, and living conditions. Analysis was based on hierarchical logistic regression. Prevalence of respiratory symptoms was 59.9% for children who live with smokers. Asthma and bronchitis showed the strongest association with smoking. In multivariate logistic regression, the following variables remained associated with asthma/bronchitis: socioeconomic status (OR = 2.93; 95%CI: 1.57-5.45), maternal schooling (OR = 1.46; 95%CI: 1.08-1.98)] and occupation (OR = 1.68; 95%CI: 1.04-2.74), neighborhood (OR = 1.47; 95%CI: 1.06-2.02), child's age (OR = 3.38; 95%CI: 2.31-4.95) and sex (OR = 1.46; 95%CI: 1.09-1.94), breastfeeding (OR = 1.66; 95%CI: 1.15-2.40), and household smoking (OR = 1.58; 95%CI: 1.18-2.11). Children with lower socioeconomic status and exposed to household smoking showed increased risk of respiratory disease.     

The relationship between socioeconomic status and household smoking patterns in Canada

Abstract This report uses data from a 1986 Labour Force Survey (LFS) smoking supplement to examine the relationship between education and smoking prevalence within Canadian households and the influence of parental smoking behavior on the smoking behavior of their children. The sample was a national probability sample of 14,469 households and 30,000 respondents. Over one in two (54%) Canadian children are exposed to the presence of at least one adult smoker in the household. Parents and children within lower socioeconomic groups are more likely to be regular smokers than their counterparts in upper socioeconomic groups. Children in lower socioeconomic households are three times more likely to be exposed to a family environment in which both parents smoke than children in upper socioeconomic level households. At all socioeconomic levels, there is a gradient in the smoking prevalence among youth and young adults according to parental smoking behavior. The patterns of smoking within households suggest the possibility of increasing divergence in smoking rates between socioeconomic groups. The findings are discussed in terms of epidemiological and health promotion implications.     

Household economic strategies and nutritional anthropometry of women in American Samoa and highland Bolivia

This study compares findings from research projects involving different genetic, environmental, and cultural contexts: a study of lifestyle and health from American Samoa (ASLS) and the Bolivian project. Reproduction and Ecology in Provincia Aroma (REPA). This paper presents analyses of varying economic strategies and their association with nutritional status indicators in each population. The ASLS sample includes 66 Samoan women and the REPA sample includes 210 Aymara women. Principle components analysis of household economic resources within each sample extracted two significant factors: one represents modernizing influences including education and occupational status, and the other represents ethnographically salient traditional economic behavior. The traditional pattern includes adding household members in Samoa and selling agricultural products in Bolivia. This analysis places each woman along two continua, traditional and modern, based on her household mobilization of economic resources, permitting an understanding of the patterns underlying household economic behavior that is not possible in univariate analyses of socioeconomic variables. For the Bolivian women the strategy involving more education and higher occupational status was associated with higher measures of several nutritional status indicators, including body mass index, arm muscle area, and peripheral skinfolds. But among the Samoan women, where substantial obesity was the norm, there were no significant differences in anthropometric measurements based on economic strategies. These data argue for the importance of directly measuring the potential consequences of variation in household economic strategies rather than merely inferring such, and of assessing ethnographically relevant aspects of household economic production rather than limiting analyses to non-context-specific economic indicators such as income. This focus on household strategy is likely to be fruitful especially where economic and nutritional conditions are marginal. The findings from Bolivia also support efforts in developing countries to improve girls' education, and thereby occupational prospects, as a means to improve their health status as women.     

Nutrition in agricultural development: Intensive dairy farming by rural smallholders

This study concerns the introduction of intensive dairy farming among rural smallholders in Kilifi District, Kenya. Household surveys were conducted among dairy farmers, dairy customers and a comparison sample from rural locations. Dairy farmers were better off than the rural sample as regards household income, food production, food consumption and nutritional status of young children. These differences resulted from the dairy activities but also from greater involvement in crop cultivation and off‐farm employment.

Local milk purchases by dairy customers were mostly by wealthier households with wage employment. They had higher incomes and higher food consumption than the rural sample, and the children in these households had better nutritional status. Further analysis confirms a positive relation between milk consumption and nutritional status of children, independent of household income, energy intake and level of education. Other notable findings were the high incomes from off‐farm employment of dairy farmers; regular dairy customers are chiefly households with wage employment; milk consumption among the rural population was very low.

The results cast doubt on the importance of intensive dairy production as a means of livelihood for resource‐poor households and the importance of milk as a means to improve nutritional status of children in low‐income households.     

Influence of family structure on health among youths with diabetes

Type 1 diabetes mellitus is a chronic metabolic disorder and is one of the most common chronic diseases in childhood. The study discussed in this article examined the extent to which family structure is significantly associated with health in youths with Type 1 diabetes. A convenience sample of 155 children with diabetes and their mothers completed face-to-face interviews; multiple regression analyses were conducted. Findings demonstrated that family structure remains a significant predictor of youths' health when statistically controlling for race, child's age, family socioeconomic status, and adherence. Social workers in outpatient medical settings are in a unique position to develop family-oriented strategies targeting this neglected area of primary care.     

Measuring rural women's work and class position

On the basis of experience gained in researching the economic roles of rural women in a national level study in Colombia and in a regional level study in Peru, some of the methodological problems of measuring rural women's economic participation by sample survey are considered. The specific objective of the sample surveys was to quantify the existing sexual division of labor among the peasant population. The rural household was the unit of analysis, and the focus of measurement was the division of labor by sex in such activities as daily maintenance, household production, and income-generating activitives pursued outside the household. The focus of the survey questionnaire is on the sexual division of labor, but it necessarily must be related to another series of socioeconomic or cultural variables for analysis. The selection of these variables needs to be derived from the hypotheses guiding the study, yet much attention must be given to narrowing the range of inquiry. The time constraint on the length of the questionnaire requires that certain choices be made in terms of the complementary variables to be included. The most important problem in the design of a representative sample survey is the selection of the population to be sampled. The choice of population needs to be compatible with the theoretical framework. Since the interest was to measure the sexual division of labor in terms of class formation, the sample had to be representative of the different class strata in the rural areas. The measurement of access to means of production ideally should be quantitative and qualitative. The choice of the population to be sampled is also constrained by the available data base, a particular problem in rural areas.     

Health and nutritional status of infants in a population of the Center-Western region of Brazil]

OBJECTIVE: To evaluate the nutritional status of infants who reside in the city of Campo Grande, State of Mato Grosso do Sul, Brazil. METHODS: The method used was that of a cross sectional household study by means of an anthropometric social survey, sampling 652 children from 0 to 59 months of age. RESULTS: A low prevalence of nutritional deficit, excepting that of height-for-age, starting in the first year of life, was found. The nutritional status proved to be influenced by the socioeconomic conditions, especially concerning per capita family income. Nearly all children started breast-feeding but were weaned during the first month. Exclusive breast-feeding is of short duration and soon replaced by infant formula. The survey of mother-child assistance demonstrated an excellent coverage of prenatal care, but inadequacy in the follow-up of the child's health at all income levels. CONCLUSIONS: The need to carry out changes in the approach to preventive actions and in the monitoring of the nutritional situation of the children, concerning the problems identified in this study in order to allow for the development of differential actions in the nutritional field has been identified.     

Periods of child growth up to age 8 years in Ethiopia,India, Peru and Vietnam: Key distal household and community factors

Recent research has demonstrated some growth recovery among children stunted in infancy. Less is known about key age ranges for such growth recovery, and what factors are correlates with this growth. This study characterized child growth up to age 1 year, and from ages 1 to 5 and 5 to 8 years controlling for initial height-for-age z-score (HAZ), and identified key distal household and community factors associated with these growth measures using longitudinal data on 7266 children in the Young Lives (YL) study in Ethiopia, India, Peru and Vietnam. HAZ at about age 1 year and age in months predicted much of the variation in HAZ at age 5 years, but 40–71% was not predicted. Similarly, HAZ at age 5 years and age in months did not predict 26–47% of variation in HAZ at 8 years. Multiple regression analysis suggests that parental schooling, consumption, and mothers' height are key correlates of HAZ at about age 1 and also are associated with unpredicted change in HAZ from ages 1 to 5 and 5 to 8 years, given initial HAZ. These results underline the importance of a child's starting point in infancy in determining his or her growth, point to key distal household and community factors that may determine early growth in early life and subsequent growth recovery and growth failure, and indicate that these factors vary some by country, urban/rural designation, and child sex.     

Sociocultural practices influencing under five nutritional status in an urban community in Osun State, Nigeria

Three hundred and forty four preschool children from Ilare district of Ife Central Local Government Area of Osun State, Nigeria were assessed for nutritional status using selected and sensitive anthropometric techniques. The sociocultural practices of the parents were also examined. Approximately 53.8% and 54.7% of the children were identified to be malnourished and stunted respectively. The socioeconomic situation of the family was identified to have a significant influence on the child's nutritional status. Female children were observed not to be as adequately nourished as their male counterparts. However parity and food taboo had no significant influence on the child's nutritional status. The need for improvement in the socioeconomic status of the family and education of the community on the importance of female nutrition are discussed.     

Deterioration in the nutritional status of young children and their mothers in Brazzaville, Congo, following the 1994 devaluation of the CFA franc

The effects of the January 1994 devaluation of the African Financial Community (CFA) franc on the nutritional situation of the populations concerned has been little documented. We report in this article on two nutritional cross-sectional surveys that were conducted before and after this devaluation (1993 and 1996) in two districts of Brazzaville, Congo. The surveys involved a representative sample of 4206 households with a child aged 4-23 months. Complementary feeding practices and the anthropometric indices of the children and their mothers were compared, adjusting for changes in household socioeconomic characteristics. The results show a decline in the quality of the first complementary foods offered to the infants, i.e. less frequent use of special transitional foods and imported complementary flours (of higher nutritional quality), and preparation of less nutritious local gruels. Overall, the nutritional situation had deteriorated, with greater levels of stunting and wasting among children, mothers with lower body mass index, and infants with reduced birth weights. Increased food prices would appear to be the direct cause of the decreased quality in complementary feeding, but factors other than the devaluation have also had an impact on household welfare. The influence of these factors on nutritional-status is discussed.     

Does material disadvantage explain the increased risk of adverse health,educational, and behavioural outcomes among children in lone parent households in Britain? A cross sectional study

OBJECTIVE: To test the hypothesis that material disadvantage explains the increased risk among children and young people of adverse health, educational, and behavioural problems associated with living in lone parent households in Britain STUDY DESIGN: Secondary analysis of a cross sectional survey of a representative sample of British households with children and youthMain outcomes: Parent reported fair/poor health, longstanding illness and disability, statement of special educational needs, suspension and/or expulsion from school, and in trouble with the police. PARTICIPANTS: Data were available on 15 636 (8049 boys and 7587 girls) aged 0-18 years in 8541 households in the third sweep (2001) of the British government's families and children study RESULTS: Lone parenthood was associated with increased risk of health and educational problems, and antisocial behaviour among boys and girls in a logistic regression model adjusting for child's age alone. Adding age of main carer, number of dependent children, and child's rank in the household made little difference to the associations. Addition of housing tenure, household hardship index, and an interaction term for lone parenthood and hardship eliminated the relation with lone parenthood for all outcomes except parent reported health among girls. Similar results were obtained for households headed by lone parents for at least a year. An interaction effect of lone parenthood with hardship for parent reported health and statement of special educational needs was noted. CONCLUSION: Adverse effects of lone parenthood on health, education, and antisocial behaviour were apparently explained by material disadvantage in this cross sectional sample of British households with children and youth.     

Ecological correlates of dietary consumption and nutritional status in highland and coastal Ecuador

This paper investigates the patterns of variation in food availability and nutritional status among small‐scale farmers from highland and coastal regions of Ecuador. Dietary adequacy is greater among households of the highland sample and appears to be associated with higher consumption of foods from subsistence production. Energy consumption is marginal in the coastal sample where farmers are involved in the production of coffee as a cash crop. Households on the coast rely on inexpensive market foods and obtain less than a quarter of their energy from home‐produced items. Early childhood growth is poor in both regions. In the highland sample, older children have relatively better nutritional status, whereas nutritional status declines in the older cohorts of the coastal sample. Children's nutritional status (weight‐for‐age and weight‐for‐height) is correlated with household dietary adequacy in the highland sample; in the coastal group, per capita income is the strongest correlate of nutritional status. These results highlight important differences in the correlates of dietary consumption and nutritional status among small‐scale producers in two distinct farming systems.     

家庭社会经济状况对婴幼儿认知发育的影响

目的:研究反映家庭社会经济状况的主要因素家庭年人均可支配收入和双亲文化程度对婴幼儿的认知应物测验/临床语言和听力进程量表(Cognitive Adaptive Test/Clinical Linguistic and Auditory Milestone Scale,CAT/CLAMS)发育商(DQ)的影响。方法:采用CAT/CLAMS对上海市4~36个月常模婴幼儿进行测试,计算各婴幼儿CAT/CLAMS语言能DQ、应物能DQ及认知能DQ。同时调查家庭年人均可支配收入和双亲文化程度。采用非参数统计的方法比较组间差异。结果:家庭年人均可支配收入对婴幼儿CAT/CLAMS的3种DQ均有极显著影响(P<0.01);母亲文化程度对婴幼儿CAT/CLAMS的应物能和认知能这两种DQ有显著的影响(P<0.05);父亲文化程度对婴幼儿CAT/CLAMS的3种DQ均无明显影响。结论:社会经济状况对婴幼儿的发育具有明显的促进作用;对婴幼儿尤其是对低收入、母亲低学历家庭的婴幼儿进行发育监测十分必要。     

Nutritional Status of Children below Five Years in Malaysia: Anthropometric Analyses from the Third National Health and Morbidity Survey III (NHMS, 2006)

The Third National Health and Morbidity Survey (NHMS III) was conducted in 2006 on a nationally representative sample of population in Malaysia. Over 21,000 children aged 0-17.9 years were measured for body weight and stature according to the protocol of the World Health Organization. This article describes the nutritional status of children aged 0-59.9 months. Mean z score for weightfor-age (WAZ), height-for-age (HAZ) and BMI-for-age were compared with the z-scores tables of the WHO standards. The overall prevalence of underweight and stunting of the children were 12.9% and 17.2% respectively. These levels included 2.4% severe underweight and 6.0% severe stunting. In terms of z scores, the age group of 0-5.9 months showed the best nutritional status with mean WAZ of -0.33 (95%CI: -0.52, 0.15) and -0.40 (-0.57, 0.24) for boys and girls respectively, while mean HAZ was 0.64 (0.38, 0.89) for boys and 0.76 (0.54, 0.98) for girls. Mean HAZ and WAZ status was least satisfactory after about 6 months, suggesting a faltering in growth rate at an age that coincides with dependence on complementary feeding. Prevalence of overweight based on BMI-for-age for the sexes combined was 6.4%, while that based on WAZ was 3.4%. The NHMS III results indicate that Malaysian children have better nutritional status compared to children under 5 years in neighbouring countries. In order to meet the targets set in the National Plan of Nutrition (2006-2015), more effective intervention programmes are needed to accelerate the reduction of underweight and stunting, and to arrest the rise of overweight in young children.     

Factors for Accessing a Medical Home Vary Among CSHCN from Different Levels of Socioeconomic Status

Purpose The purpose of this research study was to identify factors that are associated with receiving care in a medical home for children with special health care needs (CSHCN) and to identify how these factors vary among different socioeconomic levels. Methods Data were obtained from the National Survey of Children with Special Health Care Needs, 2000–2002. Access to a medical home was derived using an algorithm. This survey analysis also included demographic characteristics, geographical location of household, severity of condition, and social factors. Multiple logistic regression models were constructed for socioeconomic status (SES) levels defined by federal poverty level (FPL): <133%; 133–199%; 200–299%; ≥300%. Results Age group was significant in all but the 200–299% of FPL stratum. Severity of condition was significant in all strata. Race was significant in all but the ≥300% stratum. Maternal education was borderline significant in the lowest and highest strata. Insurance type/status was significant in all but the 133–199% of FPL stratum. Geographical location was significant in the lowest and highest strata. The language of the interview was only significant in the lowest stratum. The relationship of the respondent to the child was significant in the middle two strata. The total number of adults in the household was significant in the highest stratum, and the total number of children in the household was significant in the 200–299% of FPL stratum. Conclusions Factors affecting access to a medical home differed among socioeconomic groups. Future research should explore the CSHCN population by income groups to better serve this population.