ABSTRACT We analyse the effect of women's empowerment and access to sanitation on health outcomes using panel data from 115 developing economies between 2000 and 2022. This study adopts a panel data approach and estimation techniques capable of handling cross‐sectional dependency and endogeneity issues. The results based on the Lewbel two‐stage least squares method indicate that, on average, women's political empowerment, measured with women's civil liberties, women's civil society participation, and women's political participation, significantly improves population health outcomes measured with life expectancy and maternal, infant and under‐five mortality. The findings also show that access to sanitation services significantly enhances life expectancy and maternal and child health outcomes. The study further demonstrates that women's political empowerment positively moderates the impact of sanitation on health outcomes, suggesting that in countries with better (higher) women's political empowerment, sanitation essentially leads to better health outcomes and vice versa. The results are consistently robust across different econometric techniques but differ across geopolitical regions. The outcome of the study is important to public health policies, as it underscores that policies that enhance gender inclusivity in the political sphere and access to sanitation services would be valuable for improving population health outcomes in developing countries.
Alex Opoku Acheampong, Eric Evans Osei Opoku, Janet Dzator
Background. Famine-like conditions resulting from the 2022 Russian invasion of Ukraine have created an acute humanitarian crisis with serious long-term metabolic health implications. Drawing on the Developmental Origins of Health and Disease (DOHaD) framework and historical evidence from the Holodomor (1932–1933), this review examines the emerging association between war-induced nutritional deprivation and type 2 diabetes mellitus (T2DM) in Ukraine between 2022 and 2024. Materials and methods. This narrative review synthesized data from national health records, regional hospital reports, humanitarian organization assessments (World Food Programme, UNICEF, Médecins Sans Frontières), birth cohort studies from three Ukrainian perinatal centers, and peer-reviewed literature on famine-related metabolic outcomes. Sources were identified through PubMed, Scopus, Web of Science, and Embase databases as well as official reports from the Ukrainian Ministry of Health and international humanitarian agencies. Results. Hospitals in eastern and southern regions reported a 25–30 % increase in newly diagnosed adult-onset T2DM between mid-2022 and late 2023. Up to 80 % of diabetic patients in conflict-affected zones were forced to self-fund medications due to healthcare system collapse. Preliminary birth cohort data (n = 1,500+) from three perinatal centers revealed elevated HOMA-IR scores, reduced C-peptide levels, and early signs of metabolic syndrome in infants by 12 months of age. Case studies from Mariupol documented gestational diabetes mellitus incidence exceeding 40 % and body mass index drops of 3–6 kg/m2 in pregnant women. In Kharkiv, screening programs identified a 45 % increase in pre-diabetes cases and elevated fasting glucose in children aged 5–10 years. Biological mechanisms identified include impaired pancreatic β-cell development, activation of the thrifty phenotype, chronic low-grade inflammation, HPA axis dysregulation, and mitochondrial dysfunction — all driven by prenatal and early-life undernutrition. Conclusions. The convergence of famine, chronic psychosocial stress, and healthcare collapse has accelerated T2DM onset and created conditions for a generational metabolic epidemic in Ukraine. Urgent, long-term public health strategies integrating nutritional rehabilitation, early metabolic screening, and mental health support are required to prevent a chronic disease crisis in future decades.
Христина Козловська, Alina Urbanovych, Федір Ланюш
Undernutrition and infectious diseases pose a double threat to child survival, especially in areas with a high malnutrition burden and low vaccination coverage. In this study, we evaluated whether distributing preventive small-quantity lipid-based nutrient supplements (SQ-LNS) alongside routine immunization services may increase vaccine uptake in a pediatric, pragmatic, cluster-randomized controlled trial in northern Nigeria. Twenty geographically defined clusters across two Local Government Areas were randomized 1:1 to the NutriVax strategy (intervention) or standard National Program of Immunization (NPI) services (control). NutriVax provided a monthly ration of SQ-LNS to children aged 6-23 months after routine NPI delivery at primary healthcare centers. The primary outcome was coverage of the first dose of measles-containing vaccine (MCV1) verified by vaccination card among children aged 12-23 months, assessed in an endline population-based household cross-sectional survey 12 months after conducting a similar baseline survey. The endline survey included 1,604 children (801 control, 803 NutriVax); 48% of children surveyed in intervention clusters had ever received SQ-LNS. The odds of receiving card-verified MCV1 were two times higher in the NutriVax arm than in the control arm (odds ratio = 2.08, 95% confidence interval (CI): 1.30-3.35, P = 0.004). The difference-in-differences, cluster conditional analysis indicated a 20.1 percentage-point (pp) increase in MCV1 coverage from baseline (95% CI: 13.7-26.5 pp, P < 0.0001) relative to the control arm. Co-delivering SQ-LNS with routine immunization substantially improved card-verified MCV1 uptake, supporting a scalable strategy to make progress toward targets set by the World Health Organization's Immunization Agenda 2030 in similar settings. ClinicalTrials.gov identifier: NCT06387511 .
Cécile Cazes, Baba Waru Goni, Delphine Gabillard et al.
Clear socio-demographic pattern is observed in the emergence and transition of the double burden of malnutrition at community level. However, co-existence of underweight and overweight problems in the same household appears to be perplexing, being associated with completely diverse factors. Hence, this study examines the prevalence and progression of underweight child/overweight mother (UCOM) and stunted child/overweight mother (SCOM) pairs in India across selected socio-economic and demographic factors. Mother-child pairs from NFHS-3 (2005-06), NFHS-4 (2015-16) and NFHS-5 (2019-21) were analysed, which comprised of mothers aged 15–49 years and children aged 1–4 years. The Asian population-specific Body Mass Index classification (WHO, 2004) was used for evaluating maternal nutritional status. Children having Z-scores lower than two SD below the average for weight-for-age and height-for-age were considered to measure underweight and stunting respectively. Descriptive analysis show that prevalence of UCOM and SCOM pairs have doubled in India between 2005 and 2021, which is indeed concerning. Even though household level double burden of malnutrition is closely associated with factors determining maternal overweight, the rural-urban and rich-poor gap have reduced, signalling towards trickling down of overweight problems towards rural and underprivileged sections. The results from the logistic regression analyses across three NFHS rounds, demonstrate that nutrition transition is effective primarily among adult population. The rise in UCOM and SCOM proportions across socio-culturally and economically diverse states of India demands researchers and policy makers must delve deeper into the issue focusing upon intra-household dynamics and child feeding practices leading to such paradoxical mother-child nutritional pairs.
Angan Sengupta, Sneh Shrivastava, Bikram Barman et al.
Soil-transmitted helminth infections remain an important public health problem among children in sub-Saharan Africa. This study assessed the prevalence of these infections among pupils attending two primary schools in Bonny and Finima communities, Bonny Local Government Area, Rivers State, Nigeria. Stool samples were examined using the formalin–ether concentration technique to recover helminth eggs and cysts.
Nkeiruka Adaeze Chijioke, peter ulim-ujuo-ushang Ikor, Ikechukwu Chijioke
Child malnutrition is a major health issue in Nigeria, particularly in rural areas like Bayelsa State. This study compares the nutritional status of under-five children and caregivers in Agudama-Epie (a UNICEF-intervened community) and Amasoma (a non-intervened community). Using a cross-sectional design, data was collected from 202 caregiver-child pairs through questionnaires and anthropometric measurements following WHO standards. Results showed malnutrition was prevalent in both communities, but lower in Agudama-Epie, with better hygiene, diet diversification, and feeding habits. Stunting, wasting, and underweight rates were relatively lower in Agudama-Epie. In contrast, Amasoma had higher malnutrition rates linked to poor breastfeeding, low dietary variety, inadequate sanitation, and increased disease burden. The study also found malnutrition is a dual burden, with underweight and overweight cases coexisting in families, reflecting a mix of BMI patterns among caregivers. The study concludes that government and NGO nutrition interventions can reduce undernutrition among under-five children. Sustainability requires combined efforts in caregiver education, poverty reduction, and environmental health enhancement. These findings highlight the importance of targeted interventions to address malnutrition in vulnerable communities.
Young children require optimal nutritional intake, including through the selection of safe and nutritious snacks at childcare centers. Snacks that are visually appealing in terms of color, shape, and taste do not necessarily guarantee safety or nutritional quality; therefore, educating caregivers and those supervising the children is essential. This community service activity aimed to enhance the knowledge, awareness, and skills of caregivers regarding the selection and provision of snacks that are safe, nutritious, and suited to children's needs. The activity was conducted at the Sahabat Hati Childcare Center on June 26, 2026, employing educational, participatory, and demonstrative approaches that included briefings, discussions, practical snack identification exercises, and an introduction to food labeling. Evaluation was carried out using pre-tests and post-tests to measure changes in participants' knowledge. The results showed that the average participant knowledge score rose from 49% in the pre-test to 91% in the post-test, representing an increase of 42 percentage points. The most significant improvements were observed in the understanding that appealing snacks are not necessarily healthy and in the recognition of harmful food colorings, with each area showing a 50-percentage-point increase. This activity successfully improved participants' knowledge regarding healthy snack selection and is expected to support the formation of healthy eating habits and efforts to prevent nutritional issues, including stunting.
Siti Masdah, Nita Putriasti Mayarestya, Ayu Diana Meilantika et al.
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.
