The Waorani are a recently contacted indigenous group inhabiting oil extraction territories in the Amazon. This study aimed to analyse the prevalence of stunting and explore its association with health determinants in Waorani children under 5 years of age. A cross-sectional study was conducted with 102 children. Mothers were surveyed about biological, socioeconomic, environmental and health service determinants. Bivariate, multivariate and weight-adjusted logistic regression models were performed. A total of 39.2% of the children exhibited stunting. Health determinants such as male sex (OR = 2.73, 95% CI: 1.63-4.64), short maternal stature (OR = 4.96, 95% CI: 2.38-10.84), child age (OR = 1.04, 95% CI: 1.02-1.05), reduced dietary diversity (OR = 2.37, 95% CI: 1.27-4.53) were associated with a higher prevalence of stunting. Prenatal care was also associated with stunting (OR = 1.59, 95% CI: 1.16-2.21, for two or more checkups), with a potential reverse causality effect. Tall birth height (OR 0.28, 95% CI: 0.13-0.57) was associated with a lower prevalence of stunting. No socioeconomic differences were found related to stunting. The health determinants model may have limitations in socioeconomically homogeneous populations. Stunting prevention policies should take this model into account, contextualised to the specific territory.
María F. Rivadeneira, Andrea Bravo-Díaz, José Cóndor et al.
Abstract Infants’ motor development is influenced by genetic and environmental factors. The objective of this study is to investigate whether there are differences in the age of gross motor skill development between cohorts observed over a 30-year period, and if these differences are observed among children born during the COVID-19 pandemic. The analysis included 1348 children (613 girls and 735 boys).The data comes from three cohorts. The first cohort consists of children born in the years 1992–1997, the second born in the years 2003–2008, and the third of children born just before and during the COVID-19 pandemic, in the years 2019–2022. In each cohort, parents were invited to complete a survey questionnaire concerning the gross motor development of their children. Furthermore, the respondents were asked about the type of infant feeding in the first months of life (breastfeeding versus formula feeding) and the parents’ educational level. Multiple regression analysis was used to identify the factors influencing the age at which gross motor development milestones are reached. The Kruskal-Wallis test showed significant differences in the age at which children began independent sitting (H = 168.91, p < 0.001), independent standing (H = 91.83, p < 0.001) and independent walking (H = 66.94, p < 0.001) between children born in the three cohorts. The multiple regression model showed that the factors negatively correlated with the age at which children can sit independently are the cohorts 1992–1997 and 2003–2008 compared with the cohort 2019–2022 (Beta = -0.372; p < 0.001 and Beta = -0.236; p < 0.001, respectively), formula feeding compared with breastfeeding (Beta = 0.054; p = 0.049) and the mother’s secondary education level compared with higher education (Beta = -0.085; p = 0.021). Furthermore, factors negatively correlated with the age of independent standing are cohorts from 1992 to 1997 and 2003–2008 vs. 2019–2022 (respectively Beta = -0.268; p < 0.001 and Beta = -0.166; p < 0.001). The same factors are negatively correlated with the age of independent walking – years 1992–1997 vs. 2019–2022 (Beta = -0.280; p < 0.001) and years 2003–2008 vs. 2019–2022 (Beta = -0.189; p < 0.001). In central Poland, in one of the country’s largest cities (Lodz) the shift in the age at which infants reach the stages of gross motor development – significantly later attainment of motor developmental milestones – intensifies with every decade, which may not be without consequences for children’s proper growth and development. For this reason, further research is needed to identify which environmental factors have a significant impact on infants’ gross motor development.
Anna Opoka, Joanna Nieczuja-Dwojacka, Paulina Pruszkowska‐Przybylska et al.
Micronutrient deficiencies in children are common, often coexisting and subclinical, yet remain underrecognized.This expert consensus aims to provide an integrated framework for pediatric bone health, emphasizing multi-nutrient interactions and strategies to support adequate bone accrual and peak bone mass during growth.This consensus was developed using a modified Delphi methodology involving a multidisciplinary panel of 23 experts.A structured review of the literature was conducted to synthesize evidence on nutritional determinants, bone biology, and clinical management.Consensus statements were developed and subjected to a single-round anonymized Delphi voting process, with agreement defined as ≥75%.This expert consensus highlights the potential burden of dietary inadequacy and subclinical deficiency of key micronutrients, including vitamin D, calcium, magnesium, and zinc.Evidence supports a systems-based model of bone health, emphasizing the interdependence of structural minerals, regulatory cofactors, and hormonal pathways.A life-course approach was identified as essential, with critical windows during early life and adolescence.The panel recommends risk-based screening, comprehensive clinical assessment, and a context-specific approach to nutritional management that considers multiple nutrient and lifestyle factors for prevention and management.Practical guidance on formulation, dosing considerations, and implementation strategies is also provided.Pediatric bone health may benefit from a comprehensive, multi-nutrient and multi-mineral framework that complements assessment and management of individual nutrient deficiencies and is aligned with underlying physiology.Adoption of riskbased, life-course strategies and context-specific nutritional interventions may support skeletal health, while high-quality clinical studies are needed to establish the effects of multi-nutrient interventions on bone outcomes and fracture risk.
Poor environmental sanitation in coastal areas is closely associated with environmentally related diseases and malnutrition among under-five children, but participatory interventions are rarely evaluated at the household level. Therefore, this study aimed to implement and evaluate a family-centered adaptation of the Participatory Hygiene and Sanitation Transformation (PHAST) method in Medan Belawan District, Indonesia. A Participatory Action Research (PAR) design engaged 30 households with children under five years of age. Qualitative interview and observation data were triangulated with descriptive pre- and post-intervention sanitation indicators and anthropometric data to validate the thematic evidence. The results from the baseline assessment showed inadequate sanitation conditions, including unsafe toilets, open wastewater channels, as well as poor hygiene and waste management. Following the intervention, all families stored water and food in covered containers, 83.3% disposed of waste daily, and 50% performed actions such as closing toilet holes and cleaning up scattered waste. The intervention increased household environmental awareness, strengthened shared family responsibility for sanitation, and produced measurable improvements in sanitation practices. This reduced the risk of environmentally related diseases, and malnutrition remains a plausible, unmeasured downstream benefit. In conclusion, the adaptation appears feasible and acceptable for strengthening household sanitation ownership in low-resource coastal communities, warranting further evaluation of its longer-term health impact.
Evi Naria, Indra Chahaya, Rusmalawaty Rusmalawaty et al.
Introduction: The high rate of stunting in East Nusa Tenggara Province is related to patriarchal cultural practices that affect decision-making patterns in households. The dominance of fathers in determining aspects of child nutrition and health has an impact on the fulfillment of children's rights, especially in North Central Timor Regency. Purposes of the Research: This study aims to analyze the relationship between patriarchal culture and stunting and assess the role of the Child Protection Law in efforts to overcome it. Methods of the Research: This study uses a descriptive normative-empirical legal research method with a qualitative approach through non-participatory observations, direct interviews, and normative studies of the Child Protection Law. Results Main Findings of the Research: The results of the study showed a significant relationship between patriarchal culture and the increase in stunting rates in Noemuti District, North Central Timor Regency. The main findings included maternal dependence on husbands' decisions, low discipline in children's feeding time since pregnancy and breastfeeding, and the phenomenon of double burdens experienced by mothers. These conditions have an impact on the non-optimal fulfillment of child nutrition and health. The Child Protection Law has the potential to be used as a normative, imperative, and repressive instrument through socialization and enforcement of the obligations of parents, especially fathers (in patriarchal culture), in ensuring the fulfillment of children's rights.
Ellon Belwan Cornelius Mau, Yanto Melkianus Paulus Ekon, Adriani Rafael et al.
Abstrak: Anemia pada balita masih menjadi masalah kesehatan masyarakat yang signifikan, terutama di wilayah dengan tingkat sosial ekonomi menengah ke bawah. Prevalensi anemia anak balita cenderung menunjukkan kenaikan dari tahun ke tahun. Dampak terhadap kematian dan kualitas sumber daya manusia di masa mendatang akibat kejadian anemia, mendorong pemerintah untuk melakukan penanganan yang lebih optimal. Tujuan pengabdian dilakukan untuk meningkatkan pengetahuan dan keterampilan mitra mengenai pemanfaatan hati ayam sebagai sumber protein hewani untuk mencegah anemia pada balita. Metode pengabdian dilakukan melalui penyuluhan, pelatihan, dan pendampingan. Mitrra sasaran pada kegiatan ini yaitu kader posyandu Sarinita sejumlah 20 orang. Evaluasi kegiatan dilaksanakan dengan melakukan pretest dan posttest melalui kuesioner dan lembar observasi dengan jumlah pertanyaan 10 butir mengenai pengetahuan tentang anemia balita, pengukuran antropometri, dan keterampilan mengolah hati ayam menjadi cemilan stik. Hasil pretest peserta sebelum dilakukan kegiatan pengabdian ini menunjukkan sebanyak 60% peserta memiliki pengetahuan rendah dan 100% peserta tidak terampil membuat cemilan kerupuk stik hati ayam. Hasil posttest melalui kuesioner dan lembar observasi menunjukkan bahwa terjadi peningkatan pengetahuan dan keterampilan pada peserta yakni pengetahuan kategori tinggi sebesar 75% dan 100% peserta terampil membuat kerupuk stik hati ayam.Abstract: Anemia among children under five remains a significant public health issue, particularly in areas with low-to-middle socioeconomic status. The prevalence of anemia in this age group has shown a tendency to rise over the years. The potential impact of anemia on mortality and the future quality of human resources has prompted the government to seek more optimal interventions. This community service activity aimed to enhance the partners' knowledge and skills regarding the use of chicken liver as a source of animal protein to prevent anemia in children under five. The activity was conducted through health education, training, and mentoring. The target partners consisted of 20 participants from the Sarinita group.The activity was evaluated using pre-tests and post-tests—administered via questionnaires and observation sheets—comprising 10 questions covering knowledge of anemia in toddlers, anthropometric measurements, and skills in processing chicken liver into snack sticks. Pre-test results indicated that 60% of participants had low knowledge, and none possessed the skills to make chicken liver snack sticks. Post-test results demonstrated an improvement in both knowledge and skills: 75% of participants reached the high-knowledge category, and all participants became skilled in making chicken liver snack sticks.
Nurqalbi SR, Husnul Khatimah, Nurjannah Supardi et al.
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.
