Background Child undernutrition remains a major public health concern and creates health-related inequalities in developing countries, with long-term consequences for human development deficits. Most of these early studies were conducted using conventional econometric techniques; however, understanding the complex, multi-level determinants of undernutrition may require more advanced analytical methods. Methods This study, PC algorithm is used for Structural Learning-Based Bayesian Networks [SL-BN] (a graphical model based on directed acyclic graph with joint and conditional associations)—which is conceptually different than the weight-based networks, to examine the macro- and micro-level determinants of child undernutrition in Pakistan. Macro-level analysis combines historical nutrition policy evaluation (critical discourse) with WDI and UNDP data (2000–2022), spanning the MDG and SDG eras. Micro-level analysis draws on the Pakistan Demographic and Health Survey (PDHS 2017–18) to identify socioeconomic drivers of child malnutrition and nutritional inequalities. Results In micro analysis, the SL-BN network structure identifies household-level determinants—such as poor wealth status, rural residence, poor environmental conditions, low maternal education, and diarrhea—as key drivers of child undernutrition. Inequality is stark, with malnutrition disproportionately concentrated among the poorest. However, the SL-BN findings and critical assessment of nutritional policies and programs found that low investment in human development, foreign dependency on health, poverty, inflation, and a history of inconsistent nutritional policies to combat hunger and undernutrition are the fundamental issues at the macro level in Pakistan. Conclusion The study concluded that the underlying micro level determinants of child undernutrition in Pakistan cannot overcome without long-term targeted policies at macro level.
Introduction: Low birth weight, defined as a weight below 2500 grams in live newborns, is a fundamental indicator of maternal and child health and a predictor of neonatal morbidity and mortality with consequences throughout the entire life course. Objective: To comprehensively describe the current state of knowledge on low birth weight, covering its epidemiology, pathophysiological mechanisms, maternal risk factors, and strategies for detection, management, and prevention. Methods: A narrative literature review was conducted through searches in PubMed/MEDLINE, SciELO, LILACS, and Google Scholar, using the Health Sciences Descriptors (DeCS) and Medical Subject Headings (MeSH) “low birth weight infant,” “premature birth,” “fetal growth retardation,” and “risk factors,” complemented with clinical practice guidelines and technical documents from the World Health Organization. Development: Low birth weight affects 14.7% of live births worldwide and arises from two pathophysiological pathways—prematurity and intrauterine growth restriction—driven by largely modifiable maternal nutritional, metabolic, toxic, and infectious determinants. Antenatal ultrasound and Doppler surveillance, together with standardized neonatal care protocols, help mitigate its immediate and long-term complications. Conclusions: Low birth weight is a critical factor for neonatal survival and human development. Translating the accumulated scientific knowledge into scalable preventive strategies is necessary to achieve the reduction targets set by the World Health Organization.
Maikro Osvaldo Chávez Moya, Leodanis Hernández Cabrera, Laura Beatriz Fernández Feitó et al.
Early marriage is a social issue that can affect the continuity of education, psychological readiness, reproductive health, and the family's ability to carry out parenting functions. Therefore, educational efforts that involve teenagers and the social environment comprehensively are needed. This community service activity aims to increase the knowledge, understanding, and awareness of teenagers and the social environment about preventing early marriage in Ranokomea Village, West Poleang District, Bombana Regency. The activity implementation methods include observation and coordination with the village government, delivering material by two resource persons, interactive discussions, and evaluation through a Focus Group Discussion (FGD). The first resource person from the Poleang Barat District Office of Religious Affairs (KUA) provided education on laws, age limits, and marriage purposes based on regulations. The second speaker, an officer from the Poleang Barat District Family Planning (KB) office, gave a talk about couple’s mental readiness, women’s reproductive health, preparedness for parenthood, parenting, and preventing stunting in toddlers. The activity results showed that participants had a better understanding of the consequences of early marriage and the importance of being ready before starting a family. Participants also showed enthusiasm by actively joining in discussions and focus group discussions (FGDs), especially on topics like marriage laws, reproductive health, mental readiness, and child-rearing. This activity shows that preventing early marriage requires a multidimensional and collaborative approach that integrates legal, psychological, reproductive health, parenting, and social support aspects. Ongoing education and guidance are needed so that increased knowledge can turn into changes in people's attitudes and behavior when it comes to preventing early marriage.
Arafat Mallapiseng, Sismayani Sismayani, Rahmat Hidayat et al.
Abstrak: Stunting masih menjadi permasalahan gizi pada balita yang memerlukan penguatan intervensi berbasis masyarakat. Kader posyandu berperan strategis dalam mendukung pemenuhan gizi balita, namun keterbatasan pengetahuan tentang pola pangan Beragam, Bergizi Seimbang, dan Aman (B2SA) serta teknologi pengolahan pangan lokal dapat menghambat penyediaan Pemberian Makanan Tambahan (PMT). Kegiatan ini bertujuan meningkatkan pengetahuan kader Posyandu Matahari Desa Purwokerto Wetan mengenai stunting dan pencegahannya, B2SA, pemanfaatan pangan lokal, serta teknologi pengolahan pangan untuk PMT. Kegiatan menggunakan pendekatan Community-Based Participatory Research (CBPR) melalui sosialisasi, pelatihan, praktik, monitoring, dan evaluasi. Pengetahuan diukur menggunakan pre-test dan post-test. Hasil menunjukkan peningkatan pengetahuan tentang stunting dari 80% menjadi 90%, B2SA dari 60% menjadi 90%, pemanfaatan pangan lokal dari 78% menjadi 98%, dan teknologi pengolahan PMT dari 80% menjadi 92%. Rata-rata pengetahuan meningkat dari 74,5% menjadi 92,5%. Kegiatan ini meningkatkan kapasitas kader dalam mendukung pemanfaatan pangan lokal sebagai PMT untuk pencegahan stunting.Abstract: Stunting remains a major nutritional problem among children under five, requiring stronger community-based interventions. Posyandu cadres play a strategic role in supporting children's nutritional needs; however, limited knowledge of Diverse, Nutritious, Balanced, and Safe (B2SA) food patterns and local food processing technology may hinder the provision of supplementary food (PMT). This community service activity aimed to improve the knowledge of Posyandu Matahari cadres in Purwokerto Wetan Village regarding stunting prevention, B2SA, local food utilization, and food processing technology for PMT. The activity applied a Community-Based Participatory Research (CBPR) approach through socialization, training, hands-on practice, monitoring, and evaluation. Knowledge was assessed using pre- and post-tests. Results showed increased knowledge of stunting prevention from 80% to 90%, B2SA from 60% to 90%, local food utilization from 78% to 98%, and food processing technology for PMT from 80% to 92%. Overall knowledge increased from 74.5% to 92.5%. The activity strengthened cadres’ capacity to utilize local food as PMT to support stunting prevention.
Background & Objective: Children with a history of Low Birth Weight (LBW) are at greater risk of undernutrition compared to those without such a history. This vulnerability is associated with incomplete organ development and weakened immune systems, making them more susceptible to infectious diseases. The objective of this study was to evaluate the effectiveness of oral stimulation in improving the sucking reflex in LBW infants.Materials & Methods: A quasi-experimental design with pre-test and post-test control groups was conducted involving 25 infants diagnosed with LBW. The intervention consisted of oral stimulation with one finger for 5 minutes followed by 1 minute of breastfeeding in the intervention group, while the control group received standard Neonatal Intensive Care Unit (NICU) unit procedures. Oral stimulation was administered twice daily for 14 days, with permission to continue beyond this period. Reflex assessment was then performed. The Wilcoxon Signed Rank Test was used for statistical analysis.Results: Baseline characteristics indicated that most infants were preterm (66%), classified as LBW (72%), and male (62%). Statistical analysis revealed significant improvement in the sucking reflex in both the intervention group (P<0.001) and the control group (P=0.001). However, the intervention group demonstrated a higher post-test mean score (1.25) compared to the control group (0.73). Comparison of Post-Test Sucking Reflex Scores yielded a p-value of 0.002, indicating a significant difference between groups.Conclusion: Oral stimulation effectively enhances the rooting-sucking reflex in LBW infants. These findings suggest that periodic oral stimulation can be implemented to support the rooting-sucking reflex in this vulnerable population.
Parida Hanum, Siti Arofah Siregar, Debi Novita Siregar et al.
Over the past two decades, malnutrition has evolved into a complex global health challenge. More than 2 billion people are affected by micronutrient deficiencies [1], 2.5 billion adults are overweight or living with obesity [2], and more than 150 million children under the age of five are stunted [3,4]. Increasing attention is also being given to the double and triple burdens of malnutrition, in which undernutrition coexists with overnutrition and, in some contexts, micronutrient deficiencies within the same population, household, or individual [5]. Key drivers of this changing nutrition profile include the global shift towards ultra-processed foods, early-life metabolic programming, poverty, and food insecurity [6,7].In response to the coexistence of malnutrition crises, global health authorities and governments have promoted double-duty actions: policies and interventions designed to address undernutrition and overnutrition simultaneously [8]. These efforts are increasingly linked to universal health coverage, improved diet quality, and broader food-system transformation [7]. Additional strategies include fortification and biofortification, school health programs, regulatory frameworks, and restrictions on the marketing of unhealthy foods [9]. Despite these efforts, current evidence suggests that the world remains off track to meet nutrition-related Sustainable Development Goal targets by 2030 [4,10]. However, understanding the dynamics of malnutrition is useful only when responses are applied equitably, effectively, and in ways that reflect population needs [11].The key goals of this special issue in Frontiers of Public Health and Nutrition: The Dynamics in Global Malnutrition Uncovered, are to assess demographic and economic shifts, examine the effects of trade on food systems, and explore integrated responses. Drawing on public health, nutrition, and global health perspectives, the issue aims to develop practical, future-focused solutions to malnutrition. This special issue brings together 10 original articles, research perspectives, and a systematic review to explain these complex and interconnected challenges.Collectively, the selected papers examine global malnutrition as a complex public health challenge shaped by place, time, biology, household conditions, food systems, and social inequality. Across the papers, the central message is that malnutrition cannot be understood or addressed through isolated indicators or broad national averages alone. Instead, effective prevention and response require attention to when children become vulnerable, where risk is concentrated, which groups are most affected, and how overlapping nutritional, social, and health-system factors interact.Agudelo-Ibáñez et al. [12] demonstrate the value of spatiotemporal analysis for identifying deaths due to malnutrition among children under five in Colombia between 2015 and 2023. Their work shows that knowing the location, timing, and population distribution of malnutrition-related mortality is essential for targeting interventions, allocating limited resources, detecting high-risk areas early, and monitoring progress. Similarly, Moran-Herrera et al. [13] approach child nutritional risk as a multidimensional and spatially uneven phenomenon. By combining anthropometric indicators using Zscore matrices and multivariate spatial methods, this approach provides a reproducible framework for identifying provinces where children face coexisting forms of nutritional vulnerability. Socioeconomic inequalities are examined by Tan et al. [14], who show that child undernutrition in Pakistan is concentrated among poorer households, with wealth, maternal education, and region explaining much of the observed inequality. Together, these studies highlight the importance of spatial surveillance and equity-sensitive planning in directing public health action toward communities with the greatest need.Betha et al. [15] add a life-course perspective by analyzing longitudinal data from the LIFE birth cohort in rural Southern India. Their findings show that malnutrition emerges early in childhood, especially during the first three years of life, and is particularly significant among girls and children with low birth weight. This reinforces the need for preventive approaches beginning at birth, rather than waiting until severe malnutrition becomes visible. Makwela and Mashaba [16] extend this prevention focus to the complementary feeding period from 6 to 23 months, a critical developmental window in which inadequate feeding practices may lead to stunting, wasting, and micronutrient deficiencies. Their scoping review of 109 manuscripts and over one million caregiverchild pairs identify caregiver knowledge, maternal education, household resources, cultural practices, food affordability, and access to health services as key determinants. Their findings support locally tailored programs rather than uniform interventions.At a global level, Peng et al. [17] report substantial reductions in iodine and vitamin A deficiencies among children between 1990 and 2021, but little progress in dietary iron deficiency, particularly in populations with a low sociodemographic index. Tan's [18] systematic review and meta-analysis broaden the discussion by showing how childhood malnutrition often overlaps with rickets, anaemia, iron deficiency, vitamin A deficiency, infections, poverty, poor diet quality, and limited healthcare access. This study underscores the public health importance of integrating multiple deficiencies into a unified nutrition model, particularly in areas where anaemia and micronutrient deficiencies are common. Octavia and Nirmala [19] further expand the framework by examining Indonesia's triple burden of malnutrition from a Gene-to-Plate food-system perspective, with reference to Peru and South Africa. They argue that weakened food systems, declining nutrient quality, biodiversity loss, and limited dietary diversity contribute to persistent malnutrition, while locally rooted food systems and coordinated multisectoral action can support sustainable improvements and advance SDGs 2 and 3.The remaining studies demonstrate that malnutrition rarely occurs in isolation. Li et al. [20] quantify the burden of diarrhoeal disease, malaria, measles, respiratory infections, and tuberculosis among children with growth failure, highlighting important differences by age and country and a possible future increase in malaria burden. Cui et al. [21] extend this perspective to adults with cancer and comorbidities, showing substantial overlap between malnutrition, frailty, and sarcopenia. Together, these articles position malnutrition as a multidimensional condition shaped by food systems, social inequalities, early-life exposures, infectious disease, micronutrient disorders, and chronic illness.Overall, these papers converge on the need for evidence-informed, locally grounded, multisectoral strategies that connect early-life prevention, spatial targeting, micronutrient integration, caregiver support, and food-system reform to reduce childhood malnutrition more effectively.The contributions to this research topic demonstrate that malnutrition is not a single condition with a single cause or solution. It is shaped by interconnected food-system failures, socioeconomic and territorial inequalities, early-life exposures, micronutrient deficiencies, infectious diseases, and chronic conditions operating across the life course.Addressing these challenges requires integrated, equity-focused action. Nutrition policies must use disaggregated evidence to identify populations being left behind, strengthen early-life interventions, embed nutrition within routine healthcare, and ensure that food systems deliver affordable, accessible, and nutritious diets. Doubleand triple-duty interventions offer an important way forward but must be contextspecific, adequately financed, and supported by multisectoral governance and robust monitoring.With 2030 approaching, fragmented and incremental responses are no longer sufficient. The priority must shift from documenting the multiple burdens of malnutrition to transforming the systems and inequalities that create and sustain them.
Phillips Edomwonyi Obasohan, Joseph Peprah Mensah, Robert Akparibo
Indonesia has made progress in reducing child stunting, but current policy and surveillance systems largely identify children only after anthropometric growth deficits have occurred. This approach overlooks the accumulation of biological, infection, nutritional, and caregiving risks that precede measurable stunting. This study develops a Child Stunting Risk Index (CSRI) using the 2023 Indonesian Health Survey to support early and preventive risk prioritization among children aged 0–59 months. The CSRI is designed as a concurrent vulnerability screening tool rather than a diagnostic measure or an estimator of stunting prevalence. The formative index combines age-eligible proximal indicators within two dimensions: biological/infection risks and nutrition/care risks. Indicators are aggregated using nested equal weighting, subject to minimum data-coverage requirements. Risk categories are determined using a sample-relative traffic-light classification and assessed through leave-one-out known-group validation against established child growth risk markers. Among 82,678 children with valid scores, the weighted mean CSRI was 0.126 (12.56 on a 0–100 scale), with mean indicator coverage of 96.45%. Overall, 25.64% of children were classified as having high or very high risk. Risk was highest among children aged 6–23 months and in Maluku-Papua, Sumatra, and Sulawesi. Higher scores were consistently observed among children exposed to low birth weight, prematurity, incomplete immunization, inadequate dietary diversity, limited growth monitoring, and suboptimal breastfeeding and feeding practices. Theoretically, the study extends stunting assessment from outcome-based measurement to a multidimensional vulnerability framework. Practically, the CSRI provides a scalable tool for targeting preventive interventions before growth failure becomes observable.
Didi Nuryadin, Didit Welly Udjianto, Gita Astyka Rahmanda et al.
Early-life nutrition shapes lifelong health, yet the long-term consequences of childhood overnutrition, particularly on musculoskeletal aging, remain unclear. Here, we show that neonatal overfeeding acts as a developmental insult that accelerates age-related sarcopenia in both sexes. Using different mouse models, early overnutrition shortens lifespan and exacerbates late-life muscle atrophy, accompanied by metabolic dysfunction. Mechanistically, neonatal overfeeding disrupts goblet cell development, leading to persistent mucus barrier defects and consequently reduced Akkermansia muciniphila (A. muciniphila) colonization during aging. Fecal microbiota transplantation transfers the sarcopenic phenotype, implicating gut dysbiosis in disease propagation. Loss of A. muciniphila reduces acetate production, impairs muscle mitochondrial function at least in part via suppressed GPR43 signaling, and aggravates sarcopenia. Conversely, A. muciniphila reconstitution or acetate supplementation restores mitochondrial homeostasis and improves muscle performance in aged mice. These findings reveal a developmental origin of age-related sarcopenia and define a gut-muscle axis linking early-life overnutrition to muscle aging, highlighting the preventive potential of optimizing early nutrition to support healthy aging. Here, the authors demonstrate that neonatal overfeeding in mice shortens lifespan and accelerates late-life muscle loss. This originates from persistent gut mucus defects and depleted Akkermansia muciniphila, revealing a targetable developmental origin for sarcopenia.
International migration from Nepal has important implications for older parents who remain at home. While remittances can improve household financial conditions, older parents may also experience changes in physical assistance, emotional well-being, family relationships, and access to health services. This article presents a narrative review of empirical research, demographic census data, legislation, and policy frameworks to examine these dimensions of well-being among older parents affected by migration. The analysis is guided by the life course perspective, intergenerational solidarity theory, transnational care circulation, and the relational model of well-being. The findings indicate that financial support can contribute to household well-being but cannot fully replace physical presence and everyday assistance. The review also identifies gaps in coordination between migration policies and policies for older people, particularly where family care arrangements change following adult children’s migration. The article highlights the role of social work in individual assessment, community-based case management, and policy practice at the local, provincial, and federal levels. Strengthening professional social work services and connecting migration policies to social protection for older people can help improve access to services and respond to the changing needs of older parents in Nepal.
Introduction Maternal nutrition is fundamental to the health of mothers and children. Over the years, the Indian government introduced several programs and policies to support women’s nutrition during pregnancy and improve maternal and child health outcomes. However, significant contextual differences remain in service provisions and access across states. This study explores expert perspectives on factors that impact the implementation and reach of maternal nutrition services in India. Methods The study was conducted in two phases. The first phase consisted of contextual mapping through desk review of policy documents, government reports, published literature, and descriptive secondary data from NFHS-4 and NFHS-5 to map maternal nutrition indicators and provide contextual evidence. In the second phase, fifteen national- and state-level experts from across policy, implementation, and research fields were purposively selected for semi-structured interviews. Following this, interviews were transcribed, coded and analyzed using a reflexive thematic analysis. Results The desk review indicated that maternal nutrition programs in India are implemented through multiple local and centralized institutions and show substantial variation across states. State-specific initiatives to strengthen maternal nutrition were identified in 35 of the 36 Indian states and union territories. Qualitative findings complemented the desk review. Thematic analysis of expert interviews indicated that despite numerous maternal nutrition programmes in effect in India, effective implementation was constrained by three interconnected mechanisms: weak governance and health system capacity to translate policy into consistent frontline practice; fragmented monitoring systems that limit routine, data-driven course correction; and sociocultural norms that impact household decision-making and the reach and acceptability of maternal nutrition services. Discussion Experts emphasized that strengthening implementation within existing government programmes, rather than introducing additional schemes, is central to improving maternal nutrition services and, ultimately, maternal health outcomes in India.
Sukirti Chandra, Avilasha Ghosh, Himani Sharma et al.
