ABSTRACT This study examines the impact of ethnic diversity on child health in Ghana using nationally representative panel data. We assess whether greater community‐level ethnic heterogeneity is associated with poorer child health outcomes and explore poverty and access to prenatal care as potential mechanisms. To address endogeneity, we employ an instrumental variable strategy using historical regional ethnic diversity. The results show that higher ethnic heterogeneity is significantly associated with worse child health, particularly in rural areas, with poverty and limited prenatal care access identified as key mediating channels. These findings underscore the importance of poverty reduction and improved maternal healthcare provision in ethnically diverse communities.
BACKGROUND: Severe acute malnutrition (SAM) is diagnosed based on bilateral edema, mid‑upper arm circumference (MUAC), and/or weight‑for‑height z‑score (WHZ). These criteria do not fully overlap and may identify children with distinct biological and clinical profiles. Understanding how children with SAM identified by different criteria differ in body composition during outpatient therapeutic program (OTP) treatment may help inform treatment and post‑discharge practices. METHODS: We conducted a prospective cohort study of children aged 6-59 months with uncomplicated SAM admitted by MUAC only (MUAC group), WHZ only (WHZ group), or combined MUAC and WHZ criteria (Combined group) in Aweil Centre, South Sudan. Anthropometry, triceps skinfold thickness, and bioelectrical impedance analysis were collected at admission (n = 194) and discharge (n = 127). Fat mass (FM), fat‑free mass (FFM), fat mass index (FMI), fat‑free mass index (FFMI), total body water percentage (TBW), and phase angle (PhA) were assessed. Between‑group differences and within‑child changes were analyzed using linear mixed effects models adjusted for age and sex. RESULTS: At admission, children in the MUAC and Combined groups were younger and more stunted, with the Combined group showing the most severe deficits across anthropometry, FMI, and PhA. During treatment, the WHZ group exhibited the fastest recovery, with predominantly FFM accretion (82% of weight gain) and the largest increases in FFMI. In contrast, the MUAC group accumulated mainly FM (78% of weight gain) with minimal FFM gain and a decline in PhA, while the Combined group showed mixed FM and FFM recovery patterns. CONCLUSIONS: Children admitted for outpatient SAM treatment by MUAC, WHZ, or combined criteria appeared to follow different recovery trajectories despite meeting standard anthropometric discharge thresholds. Body‑composition and impedance indicators suggested heterogeneity in tissue gain patterns and vulnerability profiles across admission groups, particularly in the MUAC and Combined groups. While exploratory, these findings suggest that anthropometric recovery alone may not uniformly capture the full recovery pattern across SAM admission groups, warranting the need for longitudinal studies evaluating whether body-composition differences at discharge predict subsequent clinical outcomes and post-discharge vulnerability.
Gabriele Rossi, Rachel M. Creighton, Patricia Ayebazibwe et al.
BACKGROUND: Children with sickle cell anemia (SCA) in low-income settings are at risk of severe malnutrition, but optimal nutritional management has not been established. We evaluated an intensified ready-to-use therapeutic food (RUTF) regimen in children with persistent severe malnutrition after initial treatment and assessed whether early change in body mass index z-score (BMIZ) was prognostic of later resolution of severe malnutrition. PROCEDURE: Children aged 5-12 years with SCA and BMIZ less than -3.0 after 12 weeks of supplemental RUTF received higher intensity, weight-based RUTF plus hydroxyurea through Week 24. We examined whether the change in BMIZ from baseline to Week 4 was associated with the resolution of severe malnutrition (BMIZ ≥-3.0) by Week 12 or, among extension participants, by Week 24. RESULTS: Of 108 children, 66 (61%) entered the extension. During Weeks 12-24, 11 of 66 (17%) achieved resolution, increasing the cumulative proportion with BMIZ ≥-3.0 from 39% (42/108) at Week 12 to 49% (53/108) by Week 24. Greater improvement in BMIZ from baseline to Week 4 was associated with higher odds of resolution by Week 12 or, among extension participants, by Week 24 (OR 12.38; p < 0.001), whereas older age was associated with lower odds of resolution (OR 0.72; p = 0.006). Among extension participants, higher Week-12 BMIZ was associated with higher odds of Week-24 resolution (OR 14.44; p = 0.039). CONCLUSIONS: In children with SCA and severe malnutrition, early BMIZ improvement in this small, single-arm extension was associated with later resolution of severe malnutrition, and may help risk-stratify children who need earlier reassessment or alternative management, a prognostic signal that warrants prospective testing rather than an immediate change in practice.
Safiya Gambo, Shehu Umar Abdullahi, Hassan Adam Murtala et al.
Stunting in children less than five years of age is widespread in Sub-Saharan Africa. We aimed to: (i) evaluate how the prevalence of stunting has changed by socio-economic status and rural/urban residence, and (ii) assess inequalities in children’s diet quality and access to maternal and child health care. We used data from nationally representative demographic and health- and multiple indicator cluster-surveys (DHS and MICS) to disaggregate the stunting prevalence by wealth quintile and rural/urban residence. The composite coverage index (CCI) reflecting weighed coverage of eight preventive and curative Reproductive, Maternal, Neonatal, and Child Health (RMNCH) interventions was used as a proxy for access to health care, and Minimum Dietary Diversity Score (MDDS) was used as a proxy for child diet quality. Stunting significantly decreased over the past decade, and reductions were faster for the most disadvantaged groups (rural and poorest wealth quintile), but in only 50% of the countries studied. Progress in reducing stunting has not been accompanied by improved equity as inequalities in MDDS (p < 0.01) and CCI (p < 0.001) persist by wealth quintile and rural-urban residence. Aligning food- and health-systems’ interventions is needed to accelerate stunting reduction more equitably.
Background: Child growth stunting, defined as a height-for-age z-score (HAZ) below −2 SD based on World Health Organization standards, remains a major global public health challenge, affecting approximately 149 million children under five worldwide. Progress has stalled well short of the World Health Assembly target of a 40% reduction by 2030. Objective: This literature review synthesizes current evidence on the epidemiology, determinants, biological mechanisms, consequences, and interventions related to child stunting. Methods: A structured search of Scopus, PubMed, and Google Scholar covering 2010 to 2026 retrieved 3,412 records, of which 265 peer-reviewed studies and agency reports met the eligibility criteria and were thematically synthesized. Results: Global stunting prevalence declined from 33% in 2000 to 22% in 2020, although substantial disparities persist, particularly in South Asia and sub-Saharan Africa. Stunting is driven by multifactorial determinants, including inadequate dietary intake, recurrent infections, food insecurity, poor water, sanitation, and hygiene (WASH), inadequate childcare practices, poverty, and limited education. Environmental enteric dysfunction (EED) has emerged as an important mechanism linking poor sanitation to impaired growth. Conclusion: Evidence suggests that integrated multisectoral interventions combining nutrition-specific and nutrition-sensitive approaches are more effective than single-sector strategies. This review contributes an integrated synthesis linking cellular-level mechanisms to multisectoral policy design, explaining why single-sector programs may reach a ceiling. Acceleration requires sustained political commitment, adequate financing, and context-specific delivery.
Engkus Kusnadi, Sri Ramdaniati, Bambang Budi Raharjo et al.
Background: Exposure to cigarette smoke indoors remains a concern among children in developing countries. Smoking poses serious health risks to children, as no safe level of secondhand smoke exposure exists. Family sociocultural determinants play a crucial role in shaping household smoking behaviors, thereby influencing children’s respiratory health and nutritional status. However, evidence remains fragmented and incomprehensively mapped. Objective: This study aimed to map evidence on family sociocultural determinants of household tobacco smoke exposure and their association with respiratory disorders and stunting among children aged 0–59 months in developing countries. Methods: This scoping review searched PubMed, ScienceDirect, Wiley Online Library, and Google Scholar for original studies published in English between 2015 and 2025 in developing countries. Eligible studies involved children aged 0–59 months or their caregivers/households exposed to cigarette smoke and examined family sociocultural determinants of smoking related to respiratory and nutritional outcomes. Irrelevant studies were excluded, and data were descriptively analyzed. Results: Eleven articles were included: 10 country-specific and 1 multi-country study, representing 9 unique countries. Country-specific studies were from India (4), Indonesia (2), South Africa (1), Albania (1), Malaysia (1), and Turkey (1), while the multi-country study included Cambodia, Indonesia, Lao PDR, and Timor-Leste. Studies showed that family sociocultural determinants influence children's exposure to secondhand smoke and increase the risk of respiratory disorders and stunting. Evidence on family-based interventions remains limited. Conclusion: Family sociocultural determinants shape tobacco smoke exposure and its adverse effects on children’s respiratory and nutritional health. These findings support culturally appropriate health promotion strategies and community midwifery policies.
Pascoela da Costa de Jesus Xavier, Dewi Rokhanawati, Ismarwati Ismarwati
Abstract In the fight against malnutrition, Burkina Faso has developed a Multisectoral Nutrition Strategic Plan (MNSP). This study was conducted to assess the plan’s potential impact on reducing mortality and chronic malnutrition among children under five, using mathematical modeling through the Lives Saved Tool (LiST). Two projections were developed. The first, MNSP, included the strategic plan interventions, namely complementary feeding, age-appropriate breastfeeding practices, and prevention of malaria in pregnancy. The second, MNSP +, included the MNSP interventions, along with additional interventions such as zinc supplementation for children and WASH interventions. The results showed that under-five mortality would decline from 85.4 to 80.6 deaths per 1000 live births under MNSP, and from 85.4 to 73.6 deaths per 1000 live births under MNSP + . The findings also showed that complementary feeding under the MNSP projection would prevent 80% of chronic malnutrition cases, while zinc supplementation under the MNSP + projection would prevent 46% of cases. The projected cost of the interventions modeled in LiST for this study is estimated at $447,431,001 for MNSP and $557,768,209 for MNSP + over the five-year implementation period. Overall, the LiST analysis showed that both MNSP and MNSP + interventions would have a significant impact on chronic malnutrition and under-five mortality in Burkina Faso, with a greater impact observed under MNSP + .
Natacha Kere, Youssouf Keita, Ella W. R. Compaore et al.
Objectives: The study aims to determine socio-demographic characteristics and assess awareness of risk factors of severe acute malnutrition (SAM) among parents of children admitted to stabilisation centres in Northern Nigeria. Material and Methods: A descriptive cross-sectional study was conducted between September and December 2025 across Federal Medical Centre Nguru (Yobe State) and three centres in Zamfara State (Talata Mafara, Gusau, Shinkafi). Structured questionnaires were administered to 408 parents of children aged 6–59 months diagnosed with SAM. Socio-demographic data, parental awareness of SAM risk factors and anthropometric measurements were collected. Data were analysed using the Statistical Package for the Social Sciences version 25, with Chi-square and logistic regression applied to test associations, and a p < 0.05 was considered statistically significant. Results: The mean age of the children with SAM recruited was 23.9 ± 10.8 months; More than half (56.6%) were male. Nearly three-fifths of the mothers of the children were aged 14–29 years (57.6%), while fathers were older (mean 44.0 ± 11.0 years). Polygamous families predominated (71.3%), with the majority (71.3%) residing in rural areas. Nearly half (48.5%) reported displacement due to insecurity. Fathers were predominantly peasant farmers (75%), while 87.1% of mothers were housewives. Formal education was lacking in 55.4% of fathers and 55.5% of mothers. Socio-economic classification revealed 96.3% belonged to the lower class. Awareness of the link between antenatal care and SAM prevention was significantly higher among urban parents (odds ratio = 13.9; 95% confidence interval [CI]: 8.3–23.3; p < 0.001). Parents of children with chronic illnesses demonstrated greater awareness of SAM risk compared to those with recent illnesses ( p < 0.001). Conclusion: Parents of children admitted with SAM in Northern Nigeria are predominantly of low socioeconomic status, rural residence and limited formal education. Awareness of risk factors associated with SAM is significantly influenced by the place of abode and type of illness. Strengthening maternal education, improving antenatal care utilisation and targeted community-based awareness programs are essential to reduce the SAM burden.
Mikailu Abubakar Jangebe, Abdulhakeem Hamza, Sunday Ochapa Onazi et al.
Anchored in Grossman’s health production framework, this study examines how socioeconomic, institutional, environmental, and demographic conditions are associated with population health in developing countries. Population health is measured through three complementary indicators—life expectancy, infant mortality, and maternal mortality—to capture broader survival conditions, early-life vulnerability, and maternal health risks. Using panel data for 90 developing countries from 2002 to 2018, the study estimates country fixed-effects models and uses Driscoll–Kraay standard errors to strengthen inference in the presence of heteroskedasticity, autocorrelation, and cross-sectional dependence. Additional robustness checks are conducted using Panel-Corrected Standard Errors, Feasible Generalized Least Squares, and winsorized specifications. The results show that human capital, government effectiveness, and population density are consistently associated with higher life expectancy and lower infant and maternal mortality, and that these coefficient signs remain stable across robustness checks. Economic misery is associated with lower life expectancy and higher mortality in the baseline models, although its significance weakens in some sensitivity tests. Government health expenditure and educational attainment are generally associated with more favorable health outcomes, but their estimates are less stable after winsorization. Ecological footprint yields mixed associations across the three health indicators, while political stability produces unstable and, in some cases, counterintuitive coefficients. Overall, the findings suggest that population health in developing countries is associated more consistently with human capability and institutional effectiveness than with health expenditure alone.
Tahsin Tabassum Ahmed, Md. Golam Kibria, Mohammad Ridwan et al.
We examine the effect of racial diversity on child stunting and underweight in post-apartheid South Africa, which has a strong history of systemic racial segregation. Using five waves of longitudinal data from the National Income Dynamics Survey (NIDS), and employing instrumental variable and propensity score matching methods, we find that racial diversity significantly reduces child stunting and underweight. This result is consistent across alternative measures of racial diversity, child stunting and underweight, and is also robust to different endogeneity-correction methods. The negative effect of racial diversity on child stunting and underweight is more pronounced among children under 5 years of age. Further analyses highlight increased employment opportunities, food expenditure per capita and financial inclusion as important channels through which racial diversity decreases stunting and underweight. We discuss the policy implications of these findings.
Isaac Koomson, Clifford Afoakwah, Martinson Ankrah Twumasi
