Abstract The introduction of salt iodization is associated with improved health and socioeconomic outcomes, but is not yet universally adopted and not always sustained. Using a quasi-experimental event study with difference-in-differences over space and time, we quantify the impacts of iodine deficiency in utero and infancy on childhood mortality and later academic achievement in Ethiopia, comparing cohorts born just before and after the May 1998 border closure that interrupted access to iodized salt. Rural children with fewer months of early-life exposure to iodized salt scored lower on standardized secondary-school exams, especially in districts with low environmental iodine, with excess deaths emerging in infancy and persisting through early childhood. These findings reveal the long-term benefits of salt iodization for health and education, especially for people with low intake of iodine from environmental sources.
Abstract Background Iron and zinc deficiencies are a major public health concern among children aged 6-24 months in Northern Uganda, particularly in the Acholi sub-region. These deficiencies are largely linked to complementary foods prepared from inadequately processed local ingredients with high anti-nutritional factors, which impair micronutrient absorption. This study investigated the effect of malting on broken rice-iron-rich beans composite flour, focusing on sensory properties, nutrient composition, bioavailability, and anti-nutritional content. Methods Nine formulations (four malted, four unmalted, and one control) were analyzed. Sensory evaluations were conducted with 124 mothers of children aged 6-24 months. Proximate composition, micronutrient content, and anti-nutritional factors were determined in the laboratory. Data were analyzed using two-way ANOVA at p ≤ 0.05. Results For children aged 6-11 months, the most preferred formulation was composite F (30% unmalted beans: 70% rice), while composite C (40% malted beans: 60% rice) was most acceptable for 12-24 months. Composite A (30% malted beans: 70% rice) and G (40% unmalted beans: 60% rice) recorded moisture contents of 2.3% and 3.0%, respectively, with G being significantly higher (p ≤ 0.05). Composite E (30% unmalted beans: 70% rice) showed the highest water absorption capacity, while malting reduced oil absorption capacity and bulk density. Ash content was higher in malted samples (A = 1.45%, C = 2.28%) than unmalted (E = 1.52%, G = 1.76%). Carbohydrate levels were consistent but highest in the control (100% rice = 91.71%). Protein digestibility was higher in malted samples (A = 33.16%, C = 12.35%), while zinc bioavailability was highest in C (4.14%). Malting increased zinc, calcium, iron, magnesium, potassium, and fiber, and reduced phytate and trypsin inhibitors, though polyphenols and tannins slightly increased. Conclusions Malting improved nutritional quality, functional properties, and acceptability of complementary foods. Composite A is suitable for 6-11 months, and composite C for 12-24 months. Promoting iron-rich bean composites through caregiver education and early childhood feeding programs could enhance nutrient intake, support growth, and prevent micronutrient deficiencies.
Christopher Atibo, Sunday Mark Oyet, Christopher Muggaga et al.
Abstract Background According to the United Nations, the third Sustainable Development Goal, ‘Ensure Healthy Lives and Promote Well-Being at All Ages’, set numerous targets on child and maternal health. Universal health insurance is broadly seen as a solution to fulfil these targets. West Africa is known to have the most severe maternal mortality and under-five mortality rates in the world. This review seeks to understand whether health insurance provides increased access to services for mothers and children in this region. Methods The protocol for this review is registered in the International Prospective Register of Systematic Reviews database (CRD42020203859). A search was conducted in the MEDLINE Complete, Embase, CINAHL Complete and Global Health databases. Eligible studies were from West African countries. The population of interest was mothers and children and the outcome of interest was the impact of health insurance on access to services. Data were extracted using a standardized form. The primary outcome was the impact of health insurance on the rate of utilization and access to services. The Joanna Briggs Institute Critical Appraisal Tool was used for methodological assessment. Results Following screening, we retained 49 studies representing 51 study settings. In most study settings, health insurance increased access to child and maternal health services. Other determinants of access were socio-economic factors such as wealth and education. Conclusions Our findings suggest that health insurance may be a viable long-term strategy to alleviate West Africa's burden of high maternal and child mortality rates. An equity lens must guide future policy developments and significant research is needed to determine how to provide access reliably and sustainably to services for mothers and children in the near and long term.
Protein-energy malnutrition (PEM) remains a significant public health issue among children in many parts of Kenya. This study aimed to utilize locally available sorghum, pearl millet, and pigeon peas to develop a protein-rich complementary flour blend that could contribute to efforts to improve the nutritional quality of complementary foods for young children in Tharaka Nithi County, Kenya. The study employed a nested experimental design with pigeon pea level (0, 15, 30, 45, and 60% of the total flour blend) as the main factor and sorghum level (0, 20, and 40% of the remaining flour after pigeon pea addition) nested within each pigeon pea level to evaluate protein content and in vitro protein digestibility of flour blends. An additional factor, storage period (days), was included to assess selected storage quality indicators of the millet-based flour blends during storage. Formulated flour blends were then analysed for protein content, protein digestibility, yeast and mold counts, titratable acidity, and pH. The results revealed that the addition of pigeon peas significantly (p < 0.001) increased the protein content and the digestibility of the flour blends. The average relative humidity and temperature during storage were 55.5% and 25.2 °C, respectively. The addition of pigeon peas to the blends significantly (p < 0.002) increased the titratable acidity of the composite flour blends. The initial mean yeast and mold count was 2.439 ± 0.147 Log CFU/g, which was below the East African Community recommended safety limit for millet flour (4 Log CFU/g). The yeast and mold count slightly increased during storage in the first 16 days, followed by a significant decrease, reaching 1.052 Log CFU/g by day 45. These findings demonstrate the potential of pigeon peas, sorghum, and millet as locally available ingredients for the development of nutritionally improved complementary foods.
Catherine Nzisa Mwangangi, Jackin Njagi Nanua, Willy Kiboi et al.
Introduction: Anemia, defined as a low level of hemoglobin in the blood, is a sign of inadequate nutrition as well as poor health in children. It affects about 269 million (39.8%) children under the age of five worldwide and it is a significant risk factor for poor health and nutrition in children. The main aim of this study was to assess the prevalence and contributing factors of anemia among children aged 6–59 months in Eastern Africa. Methods: The research was conducted between 2010 and 2023 across ten East African countries. To identify potential factors associated with anemia, a multilevel logistic regression model was used. Results: The prevalence of anemia in Eastern Africa was 54.26%, with the highest in Tanzania (70.32%) and the lowest in Rwanda (36.64%). A multilevel multivariable logistic regression model revealed that factors like child age in months 12-23 (AOR = 0.623; 95% CI: 0.581-0.669), female (AOR = 0.914; 95% CI: 0.880-0.949), stunted (AOR =1.289; 95% CI: 1.234-1.347), underweight (AOR = 1.232; 95% CI: 1.163-1.306), two under-five children (AOR=1.068; 95% CI: 1.023- 1.116), 2-3 birth order (AOR=1.096; 95% CI:1.034-1.162), having fever (AOR=1.410; 95% CI: 1.343-1.481), having diarrhea (AOR=1.066; 95% CI: 1.009-1.125), vitamin A supplementation (AOR =0.899; 95% CI: 0.863-0.937), primary educated mother (AOR=0.819; 95% CI: 0.775-0.865), anemic mother (AOR =1.844; 95% CI: 1.768-1.923), toilet facility (AOR = 0.879; 95% CI = 0.835-0.926), middle wealth index (AOR =0.876; 95% CI: 0.830-0.925), mother had occupation (AOR=0.930;95%CI: 0.892-0.971) and high community poverty (AOR = 1.047; 95% CI: 1.006-1.089) were significantly associated with anemia in Eastern Africa. Conclusion: The prevalence of anemia among children aged 6–59 months was still high in the region, indicating a continuing public health concern. Child age, sex, nutritional status (stunting and underweight), recent illness (feverand diarrhea), maternal education, anemia status, and occupation, household wealth, toilet facilities, vitamin A supplementation, and community poverty levels have statistically significant association with anemia. These findings underscore the urgent need for comprehensive interventions targeting both child nutrition and broader socio-economic and environmental determinants to effectively reduce the burden of anemia in the region.
Denekew Bitew Belay, Nigussie Adam Birhan, Tilahun Yemanu Birhan et al.
ABSTRACT Infant undernutrition is linked to cognitive deficits and reduced future economic productivity. This makes mitigating its effects on neurodevelopment an important health priority. The gut microbiome is hypothesised to influence host physiology, including brain function, through the production of microbial metabolites such as the short-chain fatty acids (SCFAs). However, direct epidemiological evidence linking SCFAs to infants’ cognitive development remains scarce in low-resourced settings. This study aimed to assess the association between SCFA concentrations and infants’ (6 to 23 months) cognitive development at a tertiary hospital in Northern Ghana. This age- and sex-matched case-control study included 132 infants admitted with severe acute malnutrition and 132 healthy counterparts. Cognitive development was assessed using the Ages and Stages Questionnaire-3. Infant faecal SCFAs (acetate, propionate, butyrate) were quantified via Gas Chromatography-Mass Spectrometry. Associations between SCFAs and atypical cognitive development were analysed using conditional logistic regression, adjusting for covariates. The prevalence of atypical cognitive development was 18.2%. The mean age of infants was 14.92 ± 5.13 months. In the adjusted models, each unit increase in acetate (AOR = 0.88, 95% CI: 0.82-0.95), propionate (AOR = 0.75, 95% CI: 0.63-0.87), and butyrate (AOR = 0.72, 95% CI: 0.60-0.87) was associated with 12%, 25% and 28% significantly reduced likelihood of atypical cognitive development, respectively (p < 0.001 for all). This study provides evidence that SCFAs may influence cognitive development among infants. Effective strategies are urgently needed to specifically enhance SCFA production among undernourished infants. Such strategies may include continued breastfeeding, diversified dietary intake, or targeted prebiotic supplementation.
Hammond Yaw Addae, Charles Apprey, Alexander Kwarteng
Introduction: In Tanzania, prevalence exceeds 30% and is unevenly distributed across geographical areas. The observed distribution may reflect unobserved contextual factors; however, little literature applies Bayesian multilevel generalised linear mixed (B-MGLM) models, which can account for them. This study aimed to model the determinants of stunting, controlling for contextual factors at both the region and enumeration area levels. Methods: This was a secondary data analysis using four recent Tanzania Demographic and Health Surveys (TDHS) datasets. We studied 7,492, 6,806, 8,929, and 4,797 under-five children in TDHS 2004/5, 2010, 2015/16, and 2022, respectively. We used B-MGLM models to evaluate the determinants of stunting. We used the deviance information criterion to compare the models. Results: About 41.4%, 34.1%, and 28.96% of under-five children were stunted in 2010, 2015/16, and 2022, respectively. Controlling for other factors in the model, a unit increase in MPI increased the odds of stunting by 10% [AOR = 1.1; 95% CI: 1.1, 1.2], while a unit increase in WAMI reduced the odds of stunting by 64% [AOR=0.36; 95% CI: 0.3, 0.4] in 2015/16 and 2010, respectively. Other interesting results were that children with multiple births had 17% [AOR=0.83; 95% CI: 0.7, 0.9] lower odds and 68% [AOR=1.68; 95% CI: 1.5, 1.9] higher odds of stunting in 2004/5 and 2010, respectively. Conclusion: Stunting is associated with individual and contextual factors. Critical efforts should focus on the availability of items that form WAMI and MPI, with greater emphasis on elements that form WAMI because of its consistent negative relationship with stunting across the two surveys. Nutrition education should target working mothers and households with food insecurity.
Edwin Musheiguza, Tukae Mbegalo, Justine N. Mbukwa
Background: Routine childhood immunisation is central to child survival in Nigeria, yet coverage and completion vary across settings and over time. Facility-level evidence is needed to assess programme performance during disruption and recovery. Objectives: This study reviewed routine childhood immunisation coverage and dropout rates at the University of Port Harcourt Teaching Hospital (UPTH), a tertiary hospital in South-South Nigeria, from 2022 to 2025, identified vaccines with consistently high uptake, and assessed schedule completion between Penta1-Penta3 and BCG-measles. Methods: A retrospective descriptive analysis was conducted using routine immunisation registers from the Family Health Clinic, UPTH. All children aged 0-23 months vaccinated between January 2022 and December 2025 were included. Administrative coverage rates were calculated for each antigen, and monthly dropout rates were estimated for Penta1-Penta3 and BCG-measles. Results: A total of 37,685 immunisation visit records were reviewed. Male children accounted for 17,570 (46.6%) visit records, while female children accounted for 20,115 (53.4%). Administrative coverage estimates were generally high but varied over time, with a decline in 2023, an increase in 2024, and a subsequent reduction in 2025. Vaccines administered at birth and at 6 weeks of age, including BCG, OPV0, HBV0, Penta1, and PCV1, consistently had the highest uptake. In contrast, vaccines administered later in infancy, including rotavirus vaccine, inactivated polio vaccine (IPV), measles vaccine, yellow fever vaccine, and meningococcal A conjugate vaccine (MenA), showed greater variability. Penta1–Penta3 dropout rates were slightly above the recommended threshold in 2022, improved in 2023, and increased in 2024, while BCG–measles dropout rates remained high and fluctuated throughout the study period. Conclusion: Facility administrative immunisation coverage estimates at UPTH remained generally high, although completion across the schedule was inconsistent, particularly for rotavirus, inactivated polio, measles, yellow fever, and meningococcal A conjugate vaccines. Strengthening follow-up systems and defaulter-tracking may improve completion rates.
Introduction Household food security and food preparation practices are shaped by social roles, caregiving responsibilities, and economic conditions. We examined everyday household food practices in Timor-Leste within systems of caregiving, authority, and resource constraints, and their implications for household food security and child feeding. Methods We conducted an exploratory qualitative study from August to October 2025 using semi-structured, in-depth interviews with mothers who had caregiving responsibilities for children in their households across urban Dili and the rural municipalities of Ainaro and Ermera. Data were analysed using a hybrid deductive–inductive thematic approach. A total of 34 mothers participated in the study. Results Food practices were organised through women’s caregiving roles, household decision-making, and economic constraints. Women coordinated everyday food work and maintained food adequacy even under financial strain. Food allocation followed a hierarchy but remained flexible, with children prioritised during periods of scarcity. Neighbourhood sharing functioned as an informal redistribution system shaped by reciprocity and social obligation. Ceremonial obligations reinforced social cohesion but introduced financial pressure. Meal frequency and food choices were shaped by income stability, while caregiving authority determined the prioritisation of limited resources. Food knowledge was transmitted intergenerationally, and diets combined traditional staples with selected market foods. Discussion Household food practices in Timor-Leste are shaped by caregiving roles, social relationships, and economic constraints, with implications for household food security and child feeding. These findings identify caregiving, food allocation, and adaptive responses to resource constraints as household processes potentially relevant to child nutrition vulnerability. Interventions that recognise women’s central roles in everyday food management, stabilise income, and build on reciprocal systems may support household food security and child feeding.
Md Abu Sayeed, Lesy Careca Atok, Salvador Amaral et al.
This study examines emergent gender issues in the analysis of newspaper coverage of maternal and child healthcare (MCH) in Nigeria over a one-year period. MCH is a major challenge in Nigeria as the country is among the highest contributors to maternal and child mortalities globally. Even though this pattern has wider implication to society at large, it may be regarded as being more relevant to women. Premised on gender bias and journalistic norms hypotheses, the study combines content analysis and in-depth interviews (IDI) to determine the dominant gender leading in the newspaper coverage of such a womencentred issue, and underlying reasons for the dominance. The study thus examines the dominant gender of journalists, and other voices projected in the newspaper reports on the issues. It also compares views of male and female health journalists for possible differences of opinion regarding media coverage of MCH. The study finds male dominance amongst journalists and voices quoted in the coverage of MCH issues and related stories, though there was minimal influence of gender in the overall coverage of issues. The study thus deviates from the media gender studies attributing underrepresentation of women in the media to gender bias; noting that gender imbalance is often rooted in journalistic norms pervading media operations.
