Indicators for assessing breastfeeding practices. Please note that some children can suffer from more than one form of malnutrition such as stunting and overweight or stunting and wasting. Momberg DJ, Ngandu BC, Voth-Gaeddert LE, et al.. Water, sanitation and hygiene (WASH) in sub-Saharan Africa and associations with undernutrition, and governance in children under five years of age: A systematic review. Among those that were under-nourished, by assessing the WHZ score, 20% (16/79) were wasted while 9% (7/79) were severely wasted. 2021 Sep 7;63 . PLoS Negl Trop Dis. Anthropometric measures and their technical errors are another limitation because it can result in misclassification of childrens nutritional status. Factors associated with malnutrition in children <5years in western Kenya: a hospital-based unmatched case control study. For height/length, children <2years were measured lying down (recumbent length) while those who were>=2years were measured standing up. Vollmer S, Harttgen K, Kupka R, Subramanian SV. Child malnutrition under the age of 5 years has a great influence on the cultural, social, economic and community food practices. Feeding practices such as bottle with nipple feeding, breastfeeding within thirty minutes of delivery, exclusive breast feeding for 6months and cessation of breastfeeding at 2years were also assessed during the study. Some administrative data sources (e.g., from surveillance systems) are also included where population coverage is high. A participant was classified as stunted if HAZ score was <2SD and severely stunted if HAZ score was <3SD. 2016. For the MUAC cut-points to determine whether a child was under- or over-nourished, we used the cut-points of any child with MUAC <126mm was classified under-nourished [8]. Childhood nutrition is an integral component of a multifocal relationship with health, economic, social developments, and political system of the country. Proper pre-natal care, child feeding practices and deworming programs should be enhanced to reduce pediatric malnutrition. The mortality risk is increased in children who are even mildly underweight, and the risk is even greater in severely underweight children. This means that 1 in 4 children suffer from chronic under-nutrition. 2015;5:749. Aim: The aim of this study was to determine the prevalence and factors associated with malnutrition among under-5-year-old hospitalised children. We conducted a hospital-based unmatched case-control study between May and June 2017. The purpose of these consultations was to explain the updated methodology for stunting and overweight estimates to national governments; to ensure the estimates included all recent and relevant country data for stunting, wasting and overweight; and to engage with and receive feedback from national governments on the estimates. The global prevalence-based estimates of 45.4 million children under 5 affected by wasting and 13.6 million affected by severe wasting in 2020 should therefore be viewed as an underestimate of the number of children affected and in need of treatment that year. Stunting (height-for-age) in a child is defined as too short for his or her age with a height-for-age Z-score less than 2 s.d. The dataset you are about to download is licensed under a Creative Commons Attribution 3.0 IGO license. J Health Popul Nutr. The new standards should be used in future assessments of child nutritional status. China, Hong Kong Special Administrative Region, China, Macao Special Administrative Region, Saint Helena, Ascension and Tristan da Cunha, Access the technical notes for country consultations, Access the PowerPoint presentation (UN regions), Access the PowerPoint presentation (UNICEF regions). In turn, this affects economic productivity at the national level. Controls were children aged 659months with age-appropriate anthropometric measurements. These estimates do not account for the impact of COVID-19, but the pandemic is expected to exacerbate all forms of malnutrition due to worsening household income especially in the vulnerable population, constraints in the availability and affordability of nutritious food, disruptions in essential nutrition services, and reduced physical activity. We also found that lack of parental formal education was linked to development of under-nutrition with paternal illiteracy being shown to have a greater influence. Children at risk for developmental delay can be recognized by stunting, being underweight, ill health, little maternal schooling or high gravidity. e-Library of Evidence for Nutrition Actions (eLENA). Proper pre-natal care, child feeding practices and deworming programs should be enhanced. PDF Hunger Hotspots: FAOWFP early warnings on acute food insecurity, June The JME dataset of country estimates requires the collection of national data sources that contain information on child malnutrition, specifically that collected data on the height, weight and age of children under 5, which can be used to generate national-level prevalence estimates for stunting, wasting, severe wasting and overweight. and 2 s.d.) Recommendations for data collection, analysis and reporting on anthropometric indicators in children under 5 years old. Another limitation of the study was that the study relied on participants self-reported data, which was prone to recall bias and social desirability bias and interviewer bias due to the retrospective tracking of information beyond the advantages of case control study. (2018). 2021;6(3):e004342. 1999;354(9195):20415. Primary health care is the entry point for the fulfilment of community healthcare needs. More than 7 million children under the age of 5 remain malnourished and in need of urgent nutrition support, and over 1.9 million children are at risk of dying from severe malnutrition. We also acknowledge Alupe Sub-County Hospital and Busia County Government. Onyango AW, Esrey SA, Krammer MS. In 2022, three regions had very high stunting prevalence, with approximately one third of children affected. Improving estimates of the burden of severe wasting: analysis of secondary prevalence and incidence data from 352 sites. Background: Malnutrition is a significant risk factor for ill health among children under 5 years of age and the consequences are significant. from the median of the reference population. This condition is a composite extraction of both stunting and wasting, that is, an underweight child may be stunted, wasted or both.30, Overweight refers to a child whose weight-for-height Z-score is above two standard deviations (+2 s.d.) Children <5years who are prone to recurrent infectious diseases such as diarrheal illnesses, respiratory tract infections, tuberculosis and malaria often have under-nutrition as a co-morbidity [5]. Obasohan PE, Walters SJ, Jacques R, Khatab K. A scoping review of the risk factors associated with anaemia among children under five years in sub-Saharan African countries. Under-nutrition also contributes to about 35,000 deaths among children <5years each year in Kenya [4]. Males were 57% (54/94) of cases and 49% (137/281) of controls. Springer Nature. The rise of the overweight epidemic has been because of greater access to processed foods, along with lower levels of physical activity.2, Severe acute malnutrition (SAM) is a severe form of malnutrition defined as weight-for-height/weight-for-length, with a Z-score of 3 s.d. This study aimed to identify factors associated with malnutrition in children aged < 5 years in western Kenya. household surveys) included in the JME country dataset described in section 2.1 above. It has resulted in high levels of persistent undernutrition amongst the lower income population potentially because of high levels of food insecurity at the household level.10 The following interventions might be considered to overcome the complex issue of malnutrition amongst children under the age of 5 years.26,33, The community-based management of malnutrition enables community healthcare workers to identify and initiate treatment for children with malnutrition before they become seriously ill.22 This helps in the early detection of severe acute malnutrition in the community and the provision of management for those without medical complications.19 Ready-to-use therapeutic foods or other nutrient-dense foods are part of community-based strategies.23 Active community-based surveillance by community healthcare workers is the key to nutritional counselling, early identification and management of malnutrition.30 This approach provides an opportunity for a primary health care worker to understand the context of malnutrition that assists in the preparation of energy-dense child foods using locally available, culturally acceptable, and affordable food items.23 The community-based management of malnutrition can prevent both short-term and long-term consequences of childhood malnutrition.10, The health facility-based strategy is being used in the management of acute malnutrition with medical complications. Since its inception, the JME outputs have comprised a harmonized country-level dataset of primary data (e.g., national estimates based on household surveys), as well as regional and global model-based estimates. Data sharing is not applicable to this article as no new data were created or analysed in this study. 3.3 Prevalence thresholds for wasting, overweight and stunting in children under 5 years. Expressed on a scale of 0 to 1, SDI is a composite average of the rankings of the incomes per capita, average educational attainment, and fertility rates of all areas in the Global Burden of Disease study. 2017. Birth weight and childhood obesity: a 12-country study. Clark H, Coll-Seck AM, Banerjee A, et al.. A future for the worlds children? PubMedGoogle Scholar. World Health Organization (WHO) - global database on child growth and malnutrition. This could be because they require more nutrients for catch-up growth which if not provided in adequate quantities leave them vulnerable to develop under-nutrition. The prevalence of underweight in children aged 5 years and younger attending primary health care clinics in the Mangaung area, Free State, All children surviving and thriving: Re-envisioning UNICEFs conceptual framework of malnutrition. Map source: Commission on Revenue Allocation-Kenya. NIH Public Access. statement and Figure 2 demonstrates the theoretical framework for the causes of malnutrition under the age of 5 years. Malnutrition is a health condition resulting from eating food that contains either insufficient or too many calories, carbohydrates, vitamins, proteins or minerals.1,2 It is a state of under- or overnutrition, evidenced by a deficiency or an excess of essential nutrients.3 Good nutrition is the basic need for children to thrive, grow, learn, play and participate. Christian P, Lee S. Risk of childhood undernutrition related to small-for-gestational age and preterm birth in low- and middle-income countries. The key findings 2021 Edition includes global and regional trends and, for the first time, country-level estimates are also presented, with a summary of the enhanced methodology for deriving country-level model-based estimates for stunting and overweight. Cases were defined as children aged 659months with either z-score for weight-for-height2SD or+2SD; weight-for-age2SD or+2SD; or height-for-age2SD. from the median of the reference population. As of the latest review closure on 31 January 2021, the primary source dataset contained 997 data sources from 157 countries and territories, with nearly 80 per cent of children living in countries with at least one data point on stunting, wasting and overweight that is less than 5 years old. Malnutrition in children under the age of 5 years in a primary health In 2022, more than half of all children affected by wasting lived in South Asia and nearly one quarter in sub-Saharan Africa, with similar proportions for children affected by severe wasting. The average number of children <5years visiting the outpatient section of the child welfare clinic daily was used as a sampling frame. (PDF) Determinants of Malnutrition in Children Under Five Years in To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. from the median of the reference population and the mid-upper-arm circumference of < 115 mm with bilateral nutritional oedema.31 Based on the current WHO guidelines, childhood malnutrition is broadly categorised into acute and chronic malnutrition. While the 2023 edition of the UNICEF-WHO-World Bank Group Joint Malnutrition Estimates shows that stunting prevalence has been declining since the year 2000, more than one in five 148.1 million children under 5 were stunted in 2022, and at least 45.0 million suffered from wasting at any given point of time in the year. That said, overall trends are positive. Geneva: World Health Organization; 2017 (http://www.who.int/nutrition/publications/operational-guidance-GNMF-indicators/en/). AA. Additional work is ongoing to update methods for wasting and severe wasting for which available data are not as stable as for stunting and overweight. 2014;35(2):16778. 2004), was used to generate the global and regional estimates for wasting and severe wasting. This article followed all ethical standards for research without any direct contact with human or animal subjects. The authors used oral consent to accommodate the low literacy rates in the populations served by this hospital in Alupe. This questionnaire was adapted from a survey sheet used in Guinea [11]. Revisiting Alma-Ata: What is the role of primary health care in achieving the Sustainable Development Goals? Interventions by global target. UNICEF-WHO-The World Bank: Joint child malnutrition estimates - levels and trends.(http://www.who.int/nutgrowthdb/estimates/en/). Read more about them in our Privacy Policy. This finding was similar to other studies [28]. Introduction. 2010;51(6):6529. Public health nutrition, 22(1), 175-179. Yiga, P. E. T. E. R. (2016). It also includes 49 countries with modelled estimates generated fordevelopment of regional and globalaggregates but for which country modelled estimates are not shown because they did not have any household surveys in the JME country dataset or because the modelled estimates remained pending final review at the time of publication. Addis Ababa: Addis Ababa University College of health sciences; 2014. Gilbert H. An investigation on factors associated with malnutrition among underfive children in Nakaseke and Nakasongola districts, Uganda. Delayed developmental milestones (AOR=13.9; 95% CI: 2.868.6); low birth weight (AOR=3.3; 95% CI: 1.47.6), and paternal lack of formal education (AOR=4.9; 95% CI: 1.318.9) were independently associated with under-nutrition. The other limitation was that since it was a casecontrol study, which means it cannot establish the relationship between exposure and disease. The percentage of children with a low height-for-age (stunting) reflects the cumulative effects of undernutrition and infections since birth, and even before birth. Correspondence to Statistics in Medicine 38:1002-1012, 2019. Geneva: World Health Organization; 1991. Different methods were applied to generate regional and global estimates for stunting and overweight compared to wasting and severe wasting for the 2021 edition of the JME as described below. As started in the 2014 edition, a separate exercise was conducted to assess population coverage for the modelled global and regional estimates. For the estimates presented in the 2021 edition of the JME, joint UNICEF-WHO country consultations were conducted from November 2020 to January 2021. Van den Broeck J, Willie D, Younger N. The World Health Organization child growth standards: expected implications for clinical andepidemiological research. In short, results from the new country-level model were used to generate the regional and global estimates for stunting and overweight, while the JME sub-regional multi-level model (UNICEF & WHO, 2012, de Onis et al. On 1 April 2016, the United Nations General assembly declared a decade of action on nutrition to address all forms of malnutrition by 2025.11 The Sustainable Development Goal (SDG)-2 (end hunger, achieve food security and improve nutrition), SDG-3 (ensure healthy lives and promote well-being for all ages) and the Global strategy for Womens, Childrens and Adolescents health also set the relevant nutritional outcome targets by 2030.12,13, Despite the ample support from the United Nations International Childrens Emergency Fund (UNICEF), World Health Organization (WHO) and World Bank towards achieving nutritional freedom, we are still far from the world without malnutrition.14 The WHO report published in March 2020 revealed insufficient progress towards the World Health Assembly targets set for 2025 and the SDG set for 2030.7 According to the WHO 2020 report, about 144 million children under 5 years have stunted growth, 47 million children are wasted and 14.3 million are severely wasted, whilst 38.3 million are overweight or obese.6 According to the 2016 South Africa Demographic and Health Survey (SADHS), the prevalence rate of wasting was found to be 2.5% and underweight was 6%, whilst the stunting rate remained high at 27.0% amongst children under 5 years.15 Around 45% of deaths reported amongst children under the age of 5 years are linked to undernutrition.6. The weight was measured using electronic digital weighing scale (Seca). We carried out unconditional logistic regression with variables that had p-values of <0.2 at univariable analysis. The final model after testing for all biologically and statistically plausible interactions had only variables with p-value 0.05. Under-nutrition is a major cause of morbidity and mortality especially, in low-to-middle-income (LMIC) countries. They show that children found to be worm infested are the ones that gain weight more significantly compared to non-worm infested children [15, 16]. There were 375 participants (94 cases and 281 controls), with median age of 16months (IQR 10, 22), and 51% (191/375) male. This form of malnutrition results from energy intakes from food and beverages that exceed childrens energy requirements. Das JK, Salam RA, Saeed M, Kazmi FA, Bhutta ZA. Effectiveness of interventions for managing acute malnutrition in children under five years of age in, Effectiveness of interventions for managing acute malnutrition in children under five years of age in low-income and middle-income countries: A systematic review and meta-analysis, Management of severe acute malnutrition in children under 5 years through the lens of health care workers in two rural South African hospitals, An assessment of the integrated nutrition programme for malnourished children aged six months to five years at primary healthcare facilities in Mangaung, Free State, South Africa, S Afr Fam Pract (2004). The Kenya Demographic Health Survey 2014 reports that 26% of children <5years are stunted, 4% are wasted, and 11% are underweight. Shally A, Peto R, Pande V. Effects of deworming on malnourished preschool children in India. Modelled country estimates were also produced for an additional 49 countries, used solely for generation of regional and global aggregates. Developing a model for prevention of malnutrition among children under Where microdata are available, the JME uses estimates that have been recalculated to adhere to the global standard definition (UNICEF & WHO, 2019). Variables with p-value 0.05 were statistically significant. UNICEF-WHO-The World Bank Joint child malnutrition estimates. Isanaka S, Andersen CT, Cousens S, et al. (Each patient was de-identified by a unique code to ensure their privacy and maintenance of confidentiality.). Background Serious consequences leading to the increase of infectious diseases and mortality of children justifies the importance of interventions for eradication of malnutrition. The devastating effects of stunting can last a lifetime and even affect the next generation. Food Nutr Bull. 2019) developed by the JME Working Group in partnership with the University of South Carolina. Public health nutrition, 22(1), 175179. We would like to appreciate the participants whose data were used in this study. The dataset you are about to download is licensed under a Creative Commons Attribution 3.0 IGO license. A systematic review and meta-analysis of observational studies. Factors associated with malnutrition in children <5years in western Kenya: a hospital-based unmatched case control study, https://doi.org/10.1186/s40795-020-00357-4, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. Your US state privacy rights, WHO. This study was based on patient records, thus consent for publication was not applicable. Prevention of malnutrition among children under 5 years old in - PLOS Wasting is also affected by seasonality, meaning that prevalence may vary greatly between the pre-harvest season (which is often associated with food shortages, heavy rains and related diseases that can affect nutrition status) and the post-harvest season (which is often associated with higher food availability and weather patterns that are less likely to cause disease). Neonatal mortality associated with the referral of low birth weight newborns to the Institute of Child Nutrition and Health (INSE). This research work received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. J Biosoc Sci. The key findings report for the 2021 edition of the JME presents country data, a countrys share of the global burden, and progress assessment towards 2030 targets for the first time. 2013;42:134055. contributed equally to the design and implementation of the research, to the analysis of the results and to the writing of the manuscript. The indicators stunting, wasting, overweight and underweight are used to measure nutritional imbalance; such imbalance results in either undernutrition (assessed from stunting, wasting and underweight) or overweight. Multipliers of this very low level (rounded to 2.5%) set the basis to establish subsequent thresholds. Mass drug administration in east African schools. Open J Pediatrics. Taylor R. Deworming school children in developing countries. There are currently no joint global or regional estimates for these combined conditions, but UNICEF has a country-level dataset with country level estimates, where re-analysis was possible. Malnutrition is one of the main causes of death in children under 5 years of age and one of the most common factors threatening children's life and health. Unlike adults, the nutritional status of children is directly influenced by maternal health during pre-pregnancy, pregnancy and breastfeeding. Int J Obes Suppl. https://doi.org/10.1186/s40795-020-00357-4, DOI: https://doi.org/10.1186/s40795-020-00357-4. Organization, W.H. 2023 BioMed Central Ltd unless otherwise stated. 2009;24751. Global nutrition targets 2025: childhood overweight policy brief. A WHOUNICEFLancet Commission, Assessing progress towards SDG2: Trends and patterns of multiple malnutrition in young children under 5 in West and Central Africa, Prevalence and major contributors of child malnutrition in developing countries: Systematic review and meta-analysis, Past drivers of and priorities for child undernutrition in South Asia: A mixed methods systematic review protocol. It should be noted that because of the differences between the old reference population and the new standards, prevalence estimates of child anthropometry indicators based on these two references are not readily comparable. UNICEF, Progress for children, in UNICEF. low weight-for-height), indicating acute weight loss or stunting, or both. A child who is moderately or severely wasted has an increased risk of death, buttreatment ispossible. Koetaan D, Smith A, Liebenberg A, et al.. 2017;36(1):27. Poor nutrition in the first 1,000 days of a childs life can also lead to stunted growth, which is associated with impaired cognitive ability and reduced school and work performance. 2018)and have been used for development of prevalence-based maps. Under-five wasting and severe wasting are highly sensitive to change. Outcomes of childhood malnutrition under the age of 5 years. Of the cases, 84% (79/94) were under-nourished and 16% (15/94) over-nourished. Federal government websites often end in .gov or .mil. This finding was similar to another study carried out in Kenya in 2009 [28]. Overweight - Childhood obesity is associated with a higher probability of obesity in adulthood, which can lead to a variety of disabilities and diseases, such as diabetes and cardiovascular diseases. This includes 155 countries withnational data sources (e.g. The recovery rate from severe acute malnutrition among under-five years of children remains low in sub-Saharan Africa. This could be because the community being a patriarchal society, the fathers control the familys resources. Global and regional estimates for all years from 2000 to 2020 were derived as the respective country averages weighted by the countries under-5 population from The United Nations World Population Prospects, 2019 Revision, using model-based estimates for 204 countries. For this reason, uncertainty intervals are needed to enhance trend interpretability in terms of the caution level employed. Children who came from households in urban areas and those who came from families with higher average monthly income had higher odds of over-nutrition.

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