Adolescence (10–19 years) is a critical period of rapid growth and development with increased nutritional needs. Adolescent girls are particularly vulnerable to anaemia and malnutrition due to growth, menstrual blood loss, gender inequalities, early pregnancy and limited access to health services. Globally, undernutrition, micronutrient deficiencies and anaemia coexist with rising overweight and obesity. In India, the CNNS 2016–18 reported substantial levels of stunting, thinness and anaemia among adolescents, with about 40% of adolescent girls affected by anaemia. This article reviews the nutritional status, dietary practices, determinants and major nutrition programmes for adolescent girls in India. The evidence highlights the need for a life-course and multisectoral approach integrating nutritious diets, micronutrient interventions, health services, education and gender-responsive strategies.
Chronic aflatoxins exposure may impair immune function, but evidence in African children is limited. We assessed their association with hepatitis B surface antibody (Anti-HBs) levels in Rwandan children receiving nutritional support for malnutrition recovery or prevention. A total of 216 children aged 7–59 months were enrolled, including 70 malnutrition cases and 146 controls. Anti-HBs concentrations were measured using the ARCHITECT System (Abbott Diagnostics), and aflatoxins (AFB1, AFB2, AFG1, AFG2 and AFB1-lysine) were quantified by liquid chromatography-tandem mass spectrometry (LC–MS/MS). Anti-HBs levels were highly variable (median = 84.8 IU/ml, IQR 14.0–283.4). Serum analysis for AFB1-lysine revealed a mean concentration of 23.43 ± 5.76 pg/mg albumin, while none of the samples showed detectable levels of AFB1, AFB2, AFG1, or AFG2 above the limit of detection. In unadjusted analyses, no significant differences in Anti-HBs or aflatoxin levels were observed between cases and controls (Mann–Whitney U, p = 0.452 and p = 0.119, respectively) or between sexs (t-test, p = 0.642 and p = 0.352). Age was not correlated with aflatoxin levels (r = 0.06, p = 0.556). In multivariable linear regression analyses adjusting for age, place of residence, socioeconomic status, and sex, nutritional status emerged as a significant determinant of Anti-HBs levels. Specifically, the control group had higher Anti-HBs levels than the case group (β = 0.573, 95% CI 0.076–1.070, p = 0.024), while aflatoxin exposure showed no independent association with Anti-HBs levels (β = − 0.003, 95% CI − 0.031–0.025, p = 0.832). These findings suggest that, in this population, nutritional status rather than chronic aflatoxins burden, is the primary determinant of Anti-HBs response, highlighting the importance of targeted nutritional interventions to support immune protection in children.
The early 2020s have been shaped by ‘polycrisis’ – global public health crises, climate disasters, political and economic instability – which has reversed or stalled decades of progress in human development, and which has disproportionately affected children. Children are at least twice as likely as adults to live in poverty, and even brief instances of hardship in a child’s life can have lifelong developmental consequences. Although poverty is traditionally measured using monetary methods, these measures often miss what is most important for children. Child poverty is different from adult poverty because children lack agency and rely on public goods, such as schools and health clinics, and a child whose household may not be counted as income-poor can still lack access to adequate food, safe drinking water, shelter, schooling, or healthcare, among other essential resources. This thesis examines child poverty, vulnerability, and exclusion across different low- and middle-income contexts, revealing how 1) measurement choices determine who is considered poor; 2) interconnected and overlapping deprivations can reinforce each other and harm children’s development; 3) early, integrated and context-specific interventions are necessary to protect vulnerable children and safeguard their lifelong potential. It does this through four separate but interconnected research papers, and using large, nationally representative household survey datasets. The first assesses three multidimensional poverty measurement frameworks, and how they each identify different shares of children as poor in Uganda, demonstrating how technical and conceptual measurement choices are crucial in deciding who is identified as poor. The second investigates how overlapping deprivations in essential dimensions like nutrition, health, sanitation, water and housing are associated with child stunting (a signifier of a child’s physical growth being held back over a long period of time) among children in Cambodia, showing that children who faced fewer than three deprivations were significantly less likely to be stunted. The third investigates the relationship between maternal educational achievement and the extent to which it protects against child stunting across fourteen Sub-Saharan African countries, finding that when the mother achieved higher levels of schooling, children generally were less likely to be stunted, but other deprivations, as well as intergenerational, biological and contextual factors, also mattered. The last study examines how disability intersects with other disadvantages such as rurality and poverty in Viet Nam, to create barriers to school completion, digital access, and overall child well-being. The research suggests that policies aiming to break intergenerational cycles of poverty should holistically support children across all dimensions of their well-being, instead of addressing only one need at a time, and be implemented early in their life and adapted to their needs across different ages. Policies should also be adapted to the local conditions, instead of applying “one-size-fits-all” metrics. Evidence to inform policies should also be based on measurement tools that are chosen carefully and whose choices and limitations are stated openly, because the answer to the question, “which children are poor?”, depends on these choices. Inclusive future research and policy design should consider longitudinal and qualitative lenses, and treat vulnerable children with dignity and empathy, ensuring that applied frameworks actively remove the structural, environmental, and social barriers that keep them excluded.
Abstrak: Pemanfaatan Kartu Menuju Sehat (KMS) yang belum optimal dapat menghambat pemantauan pertumbuhan balita dan penyampaian informasi pertumbuhan kepada keluarga. Kegiatan pengabdian kepada masyarakat ini bertujuan meningkatkan kapasitas kader dalam pengisian dan pemanfaatan KMS sebagai instrumen pendukung deteksi dini gangguan pertumbuhan serta memperkuat pemahaman ibu balita terhadap hasil pemantauan pertumbuhan. Kegiatan melibatkan 24 kader melalui pelatihan, edukasi, praktik, dan pendampingan langsung pada pelayanan posyandu. Evaluasi pengetahuan dilakukan menggunakan pre-test dan post-test yang masing-masing terdiri dari 15 pertanyaan, sedangkan keterampilan diamati selama praktik pengisian dan interpretasi KMS. Rata-rata skor pengetahuan meningkat dari 60,5% pada pengukuran awal menjadi 82% setelah kegiatan, dengan peningkatan sebesar 22,5%. Observasi selama pendampingan menunjukkan antusiasme kader dan meningkatnya pemahaman mengenai fungsi KMS dalam pencatatan serta pemantauan pertumbuhan anak. Pendekatan pendampingan berbasis praktik memberikan pengalaman langsung bagi kader dalam menerapkan KMS pada pelayanan posyandu.Abstract: Suboptimal utilization of the Growth Monitoring Card (KMS) may hinder the routine monitoring of child growth and the delivery of growth-related information to families. This community service activity aimed to strengthen cadres’ capacity to complete and utilize the KMS as a supporting instrument for early detection of growth disorders and to improve mothers’ understanding of child growth monitoring. The program involved 24 community health cadres through training, health education, practical sessions, and direct mentoring during integrated health post (posyandu) services. Knowledge was assessed using pre-test and post-test measures, each consisting of 15 questions, while practical skills were observed during KMS completion and growth-chart interpretation. The mean knowledge score increased from 60.5% at baseline to 82% after the intervention, representing an increase of 22.5%. Observations during the mentoring process indicated high cadre engagement and improved understanding of the role of the KMS in documenting and monitoring child growth. Practice-based mentoring provided cadres with direct experience in applying KMS procedures during posyandu services.
Maxsi Irmanto, Anneke Yacob, Syaharuddin Nur et al.
ABSTRAK Stunting merupakan kondisi gagal tumbuh dalam balita akibat kekurangan gizi kronis, yang dapat memengaruhi perkembangan fisik dan kognitif anak. Di Posyandu Bougenvelle, pelaksanaan program “Zero New Stunting” menghadapi berbagai kendala, seperti keterlambatan pencatatan data dan kurangnya standar pemberian asupan gizi. Penelitian ini merancang sistem berbasis Internet of Things (IoT) untuk memonitoring dan pemberian rekomendasi asupan gizi balita yang berisiko stunting. Sistem terdiri dari perangkat keras berupa sensor tinggi badan (VL53L1X) dan berat badan (Load Cell serta modul HX711) yang terintegrasi dengan mikrokontroler ESP8266, serta sistem berbasis web yang menyimpan dan menimpilkan riwayat data pertumbuhan. Sistem ini juga menghitung Z index Score untuk klasifikasi status gizi dan mengirim rekomendasi asupan protein melalui WhatsApp. Metode pengembangan yang digunakan adalah prototype, yang memungkinkan penyesuaian sistem secara iteratif berdasarkan kebutuhan pengguna. Hasil implementasi menunjukan bahwa sistem dapat membantu meningkatkan akurasi data dan mempermudah proses evaluasi serta pemantauan pertumuhan balita oleh tenaga Kesehatan dan Orang tua. ABSTRACT Stunting is a condition of growth failure in toddlers caused by chronic malnutrition, which affects children's physical and cognitive development. In Posyandu Bougenvelle, the “Zero New Stunting” program faces challenges such as delayed data recording and lack of standardized nutritional intake guidelines. This research designs an Internet of Things (IoT)-based system for monitoring and recommending nutritional intake for toddlers at risk of stunting. The system consists of hardware using height (VL53L1X) and weight (Load Cell and Modul HX711) sensors integrated with an ESP8266 microcontroller, as well as a web-based platform to store and display growth history data. The system also calculates Z-scores to classify nutritional status and sends daily protein intake recommendations via WhatsApp. The prototype development method was used to allow iterative adjustments based on user feedback. Implementation results indicate the system improves data accuracy and facilitates growth monitoring and evaluation by healthcare workers and parents.
Abstract Background Undernutrition remains a leading driver of child mortality and morbidity in low- and middle-income countries, yet surveillance and case management in Pakistan still rely largely on infrequent surveys and paper-based registers that cannot track nutritional status in real time. The private sector, where most Pakistani households seek care, has been largely excluded from nutrition programming. We describe the development and early implementation of Mazboot Bunyad, a digital nutrition registry embedded within an integrated nutrition–immunization programme at private provider clinics in high-risk, low-income settlements of Karachi. Methods The Android application and web dashboard used in this implementation study were designed through a participatory process using the AHEAD framework, in consultation with provincial health authorities, immunization staff, and community nutrition worker. The system used QR-linked child records, an embedded digital decision-support system that classified children by mid-upper arm circumference and has automated follow-up reminders. The tool was deployed across 33 clinics, and routinely collected programme data, a preliminary analysis of data from 1 July to 31 December 2024 were retrospectively reviewed. Results During the period of 6 months, the Mazboot Bunyad application was used to screen and enroll 8,406 children aged 6–59 months. Field teams used the embedded Digital Decision Support System (DDSS) to classify children aged 6–59 months in real-time. Of these, 71.4% were classified as normal, 22.3% as moderately acutely malnourished (MAM), and 6.2% as severely acutely malnourished (SAM). The largest share of enrollments was among children aged 13–24 months (40.5%). Male children represented a slightly larger share of total enrollments (52.2%), but SAM burden was higher among females (7.3%) compared to males (5.3%). Supervisory teams used the dashboard to identify defaulters, monitor stock availability, and follow case recovery timelines. Conclusions Early implementation of Mazboot Bunyad highlighted opportunities for enhanced nutritional surveillance using real-time tracking, but also challenges such as supply chain gaps that could affect the overall implementation. These offer valuable lessons for scaling digital tools in real world settings across Pakistan and other LMICs.
Shifa Salman Habib, Ammarah Ali, Muhammad Fazal Hussain Qureshi et al.
Background. Stunting and wasting drive child mortality and are central to Sustainable Development Goal target 2.2. In 2025, 24.0% of Bangladeshi children under five were stunted and 12.9% wasted, meeting the national stunting target but missing the 8% wasting target. We compared where the two occur and tested whether environmental factors explain the patterns. Methods. We linked the 2025 Bangladesh Multiple Indicator Cluster Survey to cluster GPS locations and environmental data. Moran's I tested clustering and Getis-Ord Gi* found hotspots across 64 districts and 3,144 clusters. We tested whether six environmental and access factors explained the hotspots, estimated what share of affected children each hotspot list reached, and used a joint model to compare factor associations between outcomes. Results. Stunting clustered by region (district Moran's I 0.21, P=0.002), with a north-eastern hotspot centred on Sylhet and Sunamganj. Six environmental factors together removed this clustering (I −0.01, P=0.45) and about 60% of between-district variation (95% CI 28 to 84), more than rainfall alone, with the gain over generic regional terms uncertain. Wasting showed no clear regional clustering (I 0.05, P=0.17), and district stunting and wasting rates were unrelated (r −0.01). Stunting hotspot districts held 5.9% of wasted children, the same as their 5.9% population share. Children with both conditions (902 cases) did not cluster. Altitude and rainfall related differently to stunting than to wasting (all P<0.004), but altitude associations were sensitive to how altitude was modelled. Conclusion. Stunting in Bangladesh is concentrated in the north-east, and six environmental and access factors together account for much of this, though no single factor, including rainfall, does. Wasting shows no clear regional pattern. A stunting hotspot list reached no more wasted children than population share, so surveillance may need both measures, with finer-scale data for wasting.
S.M. Ashraf Ul Hoque, Khairul Islam, Mohammad Khalid Hasan et al.
Paediatric nutrition directly influences survival, clinical outcomes, and long-term health, and is particularly of significance in India with one of the world's largest child populations. This symposium, hosted by St. John's National Academy of Health Sciences as part of an ICMR-funded Centre for Advanced Research initiative, convened national and international experts spanning from clinical nutrition and public health. Day 1 focused on the management of intestinal failure and the life-saving role of parenteral and enteral nutrition, highlighting global best practices, surgical advances, and the need to strengthen multidisciplinary nutrition support teams in India. Day 2 shifted to maternal and child nutrition at the community level, addressing breastfeeding challenges, complementary feeding, stunting, and government program strategies. Together, the sessions underscored that nutrition for vulnerable children requires continuous care supported by technology, coordinated systems, and policy. The symposium laid the foundation for sustained annual engagement to strengthen paediatric nutrition systems in India.
Shalini Gajanan Hegde, Greeshma Mulakatte, Alekia Uscoicar et al.
Somalia records one of the highest global burdens of child wasting and stunting, with approximately 1.7–1.85 million children under five estimated to be affected by acute malnutrition annually during 2022–2025, including approximately 421,000–513,550 children with severe acute malnutrition. For over two decades, the dominant policy response has been community-based management of acute malnutrition (CMAM), a curative intervention that treats clinical endpoints rather than underlying drivers. Despite meeting international cure-rate standards, CMAM alone cannot address the food insecurity, water, sanitation and hygiene (WASH), microbial and parasitic infectious diseases, health-system, and climatic drivers that perpetuate malnutrition. This paper integrates recent Somali survey, programme-evaluation, and administrative data to show that the national burden of acute malnutrition has remained high despite continued treatment scale-up, with stunting falling only 9.7 percentage points over 24 years, relapse after discharge remaining a documented challenge, and nationally representative Somalia-specific estimates of CMAM treatment coverage remaining unavailable. Diagnostic discordance between screening tools leaves an unknown share of wasted children undetected, and persistent sex- and region-based disparities highlight structural gaps. Ending child malnutrition in Somalia requires rebalancing investment from an emergency, treatment-centred paradigm toward integrated, multisectoral strategies combining therapeutic feeding with WASH investment, maternal and infant feeding support, primary health-care strengthening, climate-resilient livelihoods, and shock-responsive social protection. We propose four policy shifts: sustaining CMAM while addressing diagnostic gaps, mandating nutrition-sensitive financing, institutionalizing relapse prevention, and expanding anticipatory financing. These shifts require governance reforms and multi-year donor commitment to address the determinants of child nutrition in Somalia comprehensively.
Background Anemia and malnutrition are major contributors to child morbidity and mortality in Sub-Saharan Africa, particularly in West Africa where their prevalence remains high due to multifaceted socio-economic and environmental factors. Malnutrition, as defined by WHO, includes both undernutrition and overnutrition and is linked to increased risk of non-communicable diseases. Anemia, characterized by low hemoglobin levels, impairs oxygen transport and is associated with developmental delays and increased mortality in children. Given their interrelated nature, a joint modeling approach is essential to understand shared risk factors and inform targeted interventions. Methods This study analyses pooled DHS data from Gabon, Gambia, Liberia, Mauritania, and Nigeria to identify determinants of anemia and malnutrition. Malnutrition is measured using the Composite Index of Anthropometric Failure (CIAF), which integrates stunting, underweight, and wasting for a comprehensive assessment. A copula-based geo-additive joint model is employed to simultaneously examine both conditions, accounting for spatial variation and interdependence. This approach offers a novel framework for informing policy and improving child health outcomes in West Africa. Results Key predictors of malnutrition and anemia were identified across five West African countries. Malnutrition risk was significantly associated with maternal education, water source, household wealth, child age, gender, and feeding practices. Notably, children from households using non-bottled water sources and those given milk were at higher risk. Several water-source categories were positively associated with malnutrition relative to bottled/sachet water; however, these associations may reflect socioeconomic and residential differences in the reference group and warrant cautious, non-causal interpretation. Anemia risk was significantly lower among urban children and those whose mothers had higher education. Fortified food and egg consumption were protective against anemia, while poverty and poor water sources increased risk. These findings highlight distinct and overlapping determinants of both conditions. Conclusion This study highlights the complex interplay of socioeconomic, environmental, and dietary factors influencing malnutrition and anemia among children in West Africa. Key predictors include maternal education, household wealth, water source, and feeding practices, with notable geographic variation. Addressing these challenges requires integrated, multisectoral strategies focused on improving maternal education, access to safe water, dietary diversity, and poverty reduction. Geographically targeted interventions and strengthened health systems are essential.
