Well-child care for newborns and infants (birth to 12 months) allows clinicians to identify any abnormalities in growth and development, administer vaccinations, and provide anticipatory guidance. History should focus on feeding, stooling, and sleeping. Trends in infant growth over time should be observed. Infants require a comprehensive physical examination to assess for normal development. Caregivers should be counseled on vaccination practices and their importance for disease prevention with adherence to standard schedules. Vaccine hesitancy should be addressed. Clinicians should review or perform routine newborn screenings for critical congenital heart disease, genetic conditions, hearing, hyperbilirubinemia, and neonatal opioid withdrawal syndrome. The birthing person should be screened for perinatal mood disorders through the infant's first 6 months of life. Families should be screened for social determinants of health and offered community resources to help with identified areas of need. Caregivers should be educated on infant nutrition, including breastfeeding and introduction of solid foods. Many infants may benefit from vitamin D and iron supplementation. Safety should be discussed with caregivers, including rear-facing car seats, water safety, and avoiding infant walkers. Caregivers should be counseled on normal infant sleep patterns and safe sleep.
Katherine Turner, Jessica E Barnes, Leigh Morrison et al.
The introduction of food textures in a child's first 2 years of life plays a vital role in growth, nutrition, and feeding development. However, the absence of a standardized texture framework for studying texture progression limits both pediatric feeding research and the ability to diagnose pediatric feeding disorder (PFD) based on age-appropriate expectations. To address this gap, authors Delaney and Goday proposed data sharing from the Nestlé Feeding Infant-Toddler Study (FITS) to explore texture progression and define age-appropriate texture expectations. In response, Nestlé assembled a multidisciplinary panel of feeding experts to create standardized textures but did not provide financial or nonfinancial assistance for this study. This panel integrated literature on global guidelines, texture classification systems, the International Dysphagia Diet Standardization Initiative, food properties, and developmental research. Through an iterative process, they developed a framework with standardized definitions based on food properties. The framework categorizes food textures into five main groups: liquids, purees, mashed solids, chewable solids, and combination foods. These categories are based on food properties (flow rate/cohesiveness, moisture content, firmness, particle size, and particle distribution) and oral motor skills (biting, chewing, tongue force, and tongue control). Each category is further divided into three subcategories. The texture category is determined by how the food is prepared and presented, rather than its original form. This property-based framework offers flexibility in classifying foods based on preparation and presentation, making it ideal for coding existing data and supporting at-home data collection. By establishing a standardized language for food textures, the framework will help fill gaps in normative data, assist in PFD diagnostics, and support future research and clinical applications.
Amy L Delaney, Sarah Staskiewicz, Suzanne Evans Morris et al.
Background The double burden of malnutrition (DBM), where undernutrition and overnutrition coexist, is a new paradigm in the global nutritional landscape. With an increasing rate of obesity and a gradual decline in undernutrition, India is currently experiencing this public health challenge. At the household level, among mother-child pairs, this disparity in nutritional status is becoming evident. Objective To assess the prevalence and patterns of the double burden of malnutrition among mother-child dyads and to determine the factors associated with this condition. Method In this observational, cross-sectional study, the nutritional status (double burden of malnutrition) of 360 mothers and their children (aged 0 - 23 months) from a rural community of West Bengal, India, was assessed. Data were collected via interviews using a pre-tested, semi-structured questionnaire and through standard anthropometric measurements. The collected data were subsequently analyzed using SPSS (Version 25). Result The findings showed that 16.1% of the mother-child pairs had double burden of malnutrition, the highest being the pair of overweight/obese mother-stunted children (10%). Mother's education (aOR 4.19, CI 1.65-10.62), food-insecure households (aOR 3.27, CI 1.51-9.16), and lower socio-economic class (aOR 2.70, CI 1.09-6.67) were found to be significantly associated with the presence of double burden of malnutrition among participants. Conclusion The double burden of malnutrition among mother-child dyads can be seen as a dual nutrition challenge that needs to be addressed with paramount importance. This contrasting form of malnutrition claims a renewed focus and program intervention through the equity-focused policies of Double Duty Action.
Objective: The aim of this study was to assess complementary feeding practices and dietary diversity in relation to the nutritional status of children under five attending health facilities in the Thabazimbi sub-district, Limpopo Province. Methods: A cross-sectional study was conducted among 409 mother-child pairs. Data on socio-demographics, feeding practices, and anthropometry were collected using validated tools. Nutritional status was assessed using WHO growth standards, and dietary diversity was evaluated using WHO infant and young child feeding (IYCF) indicators and a 24 h dietary recall. Associations were analyzed using prevalence ratios in STATA 18. Results: Among 409 children (median age: 18 months, IQR: 12-24), 38% were stunted, 13% were underweight, 5% were thin, and 17% were overweight/obese. Exclusive breastfeeding was reported in 27%, and only 24% met the minimum dietary diversity (DDS ≥ 4). Complementary feeding practices varied significantly by maternal age, with mixed feeding more common among older mothers and younger mothers more likely to receive feeding advice (p = 0.001). Stunting was associated with being a boy (PR = 1.27; 95% CI: 1.00-1.61), age > 24 months (PR = 0.33; 95% CI: 0.16-0.65), and DDS ≥ 4 (PR = 0.72; 95% CI: 0.52-0.99). Underweight was more prevalent among boys (PR = 2.40; 95% CI: 1.40-4.11), but less likely in children with DDS ≥ 4 (PR = 0.43; 95% CI: 0.20-0.92) and those from spouse-headed households (PR = 0.33; 95% CI: 0.13-0.87). Thinness was associated with DDS ≥ 4 (PR = 2.70; 95% CI: 1.13-6.45) and age 12-24 months (PR = 2.80; 95% CI: 1.02-7.64). Overweight/obesity was linked to age 12-24 months (PR = 1.94; 95% CI: 1.25-3.03) and household income > ZAR 15,000 (PR = 4.09; 95% CI: 2.33-7.17). Conclusions: Complementary feeding and dietary diversity deficits contribute significantly to the dual burden of malnutrition in rural Limpopo, highlighting the need for targeted, context-specific nutrition interventions.
Tshilidzi Mafhungo, Lindiwe Priscilla Cele, Mmampedi Mathibe et al.
INTRODUCTION: Maternal high-risk fertility behaviors (HRFBs) represent a multifaceted bio-demographic factor with profound implications for child health. Maternal HRFBs raise the risk of undernutrition in children under the age of five, rendering them more susceptible to stunting and wasting. When estimating the impact of HRFBs on child malnutrition using an observational study such as the Demographic and Health Survey (DHS), it's important to consider the potential for selection bias and the effect of confounding variables. To address this, we employed propensity score-matched (PSM) analysis to more accurately estimate the true impact of maternal HRFBs on children's nutritional status. METHODS: Secondary data analysis of 161,179 children under the age of five was conducted based on the 26 Sub-Saharan Africa DHS data (2015-2023). To estimate the maternal HRFBs on children's nutritional status, We employed propensity score matching (PSM) with a logistic model using the 'psmatch2 ate' STATA command to estimate the Average Treatment Effect (ATE) for the population, the treated group (ATT), and the untreated group (ATU). We assessed the quality of matching both statistically and graphically. Additionally, we conducted a sensitivity analysis to test the robustness of the PSM estimates, using the Mantel-Haenszel (MH) test statistic. RESULTS: More than two-thirds of (57.14, 95%CI: 56.90, 57.39) mothers had a high-risk fertility behavior. In SSA the prevalence of stunting, wasting, and being underweight among under-five children was 30.58% (95%CI: 76.30, 76.72), 6.74% (95%CI: 6.62, 6.86) and 16.70% (95%CI: 16.52, 16.88), respectively. The difference in the Average Treatment Effect (ATE) of maternal HRFBs on stunting, wasting, and underweight was 2.00, 0.30, and 2.19%, respectively. The Average Treatment Effect on the Treated group (ATT) showed a 2.12% increased risk of stunting, a 0.24% decreased risk of wasting, and a 2.68% increased risk of underweight. These estimates remained robust to hidden bias and demonstrated good matching quality. CONCLUSION: These results indicate the necessity of public health interventions aimed at enhancing maternal and child health by promoting family planning services, educating young mothers, and providing support to women with high parity.
BACKGROUND: Due to its immediate and long-term implications for population health and socioeconomic advancement, children’s nutritional status is especially crucial. It is the main reason for morbidity and mortality in children under five. Therefore, this study aimed to investigate predictors for under-nutrition indices among under-five children in West Africa. METHOD: The study was conducted in 14 countries in West Africa. A weighted total sample of 35,162 under-five children was included. Considering the impact of other predictors such as maternal, child, and socioeconomic variables, a multilevel multivariate partial proportional ordinal logistic regression model was conducted to analyze the relationship between stunting, wasting and underweight. RESULT: Among the participants in the study, approximately 27.7% were stunted, with 17.9% moderately stunted and 10.8% severely stunted. Additionally, about 18.6% (13.3% moderately and 5.3% severely) were underweight, and 9% (6.7% moderately and 2.3% severely) were wasted. More than half of the children (51.1%) were male, and 36.6% lived in urban areas. Compared to singleton children, a child with multiple birth types was 2.701, 3.740, and 1.777 times more likely to be stunted, underweight, and wasted, respectively. CONCLUSION: The findings in the current study revealed a direct correlation among underweight status, wasting, and stunting. Furthermore, even when ignoring the effects of other independent variables, underweight was found to serve as a composite measure of stunting and wasting when examining the link between these three indicators. The results identified several common predictors significantly associated with all three undernourishment indices. Therefore, governments and non-governmental organizations should prioritize public health interventions aimed at improving parental education and increasing antenatal care visits to enhance the nutritional status of under-five children. More attention should be given to improving healthcare delivery at health facilities and homes, promoting children’s health education, and ensuring access to clean drinking water sources.
BACKGROUND: There is regional variation in the incidence of stunting, the most common of which occurs in Amhara, the largest share of which is in Ethiopia. However, evidence on the magnitude of stunting and its determinants in children under five years of age is inadequate. The objective of the current review is to identify, appraise, and review systematically and to analyze the pooled effect of stunting among children under the age of five in Ethiopia. MATERIALS AND METHODS: The protocol of this review is registered in PROSPERO with registration number CRD42023323568 (https://www.crd.york.ac.uk). To combine the search results, we used reference management software (Endnote V-X7.2) and removed duplicates. For the meta-analysis, the Joanna Briggs Institute (JBI)-Meta-Analysis of Statistics Assessment and Review Instrument (MAStARI) was used for the critical appraisal of the studies. The data were categorized after extraction, sorted by quality score, and entered into STATA V14 for analysis. Cochrane's Q statistic (chi-square), I 2, and p values were used to check for heterogeneity in the studies' outcomes. RESULTS: A total of 27 potentially eligible articles containing 32,448 under-five children were identified and included. The prevalence of stunting ranged from Eastern Hararghe (12.45%), the least prevalent to the highest prevalence, in the Tigray and Northwest regions (56.65%). Based on the meta-analysis, the overall pooled incidence of stunting was 40.30% (CI: 37.11-43.49 at 95% CI). The pooled effect size of twenty-seven studies showed that male children were 1.13 times more likely to have a risk of stunting than females (RR = 1.13, CI 1.01-1.26 @95%). DISCUSSION AND CONCLUSIONS: Childhood stunting was significantly associated with the age of the child, child weight at birth, mother BMI, diarrhea episodes, deprivation of colostrum, and duration of breastfeeding. The issue of gender can be solved considering that breastfeeding duration was the lowest for daughters, as their parents were trying for a son. Finally, women's education is an alternative mechanism and sustainable strategy for overcoming the burden of childhood stunting. SYSTEMATIC REVIEW REGISTRATION: [http://www.library.UCSF.edu], identifier [CRD42023323568].
Teshome Bekele Elema, Fetene Nega, Jemal Mohammed Ali et al.
The effective development of health programs requires the practical application of evidence-based strategies, equitable financial allocation, and the integration of operational research into public health actions. These elements are essential for attaining measurable improvements in healthcare systems and population well-being. By aligning research-driven approaches with policy implementation, we can accelerate progress toward achieving Sustainable Development Goal 3 (SDG-3) targets. This study aimed to engage in an in-depth, evidence-based quantitative and qualitative analysis of National Family Health Survey (NFHS) datasets, as well as a category and sub-category-wise comparability assessment of health indicators. Each round of the NFHS outcomes was analyzed for its application towards programmatic development, implementation, and evaluation. Studies analyzed were representative of each of the studied categories, i.e., demography, maternal health, child health, and behavioral pattern. Literature published under the subheads demography (159), maternal health (286), child health (318), and behavioral pattern (94) and indexed on PubMed Central were analyzed for inferential patterned study. This was followed by the outcome comparability and Strength-Weakness-Opportunity-Challenges (SWOC) analysis of trends, emphasis, and applicability. This trend analysis was quantitatively and qualitatively analyzed. There was a deviation in sub-criterion identification over various rounds, posing challenges to the use of NFHS data with multiple, varied, and rich resources available for healthcare and support. The lowest expected decline per round compared to their previous rounds in stunting, wasting, and unmet need for family planning was -2.5%, -4.3%, and 1%, respectively. In contrast, the lowest increase per round for female sterilization and antenatal care (ANC) was +1.3% and +1%, respectively. Strengths include the quality of data, sub-categorization over NFHS rounds, use of new tools for assessments, and elimination of some parameters. Weakness was illustrated through unsynchronized conduct of rounds, viz., 6, 7, 10, and 5 years' time gap observed in NFHS-1, 2, 3, 4, and 5, respectively. Opportunity of using data for national development initiatives and fulfilling Sustainable Development Goal-3 can be availed to benefit the healthcare-deprived masses. Threats include intrinsic limitations of data collection, processes of outcome measures for addressing upgradation needs, especially of Reproductive, Maternal, Neonatal, Child Health + Adolescents (RMNCH+A), National Programme for Prevention and Control of Non-Communicable Disease (NPNCD), and national nutrition programs. The policy development, programmatic design, intervention implementation, effectiveness assessment, and National Health Program evaluation need stronger, consecutive, and appropriate evidence datasets for public health action. The felt need of public health intervention can be augmented significantly by using NFHS datasets over time while ensuring adaptable, flexible, and resource-friendly mechanisms of action. Triangulating NFHS datasets, programmatic needs, and financial allocations will hence help create user-friendly public health networks.
Lalima Gupta, Raghvendra Gumashta, Rajendra Mahor et al.
BACKGROUND: Malnutrition is still a major global public health issue, especially in Sub-Saharan Africa (SSA), where millions of children suffer from stunting, a chronic form of the disease. In addition to limiting physical growth, stunting also impedes social and cognitive development, which frequently has long-term effects. Stunting is still incredibly common in SSA, with notable regional variations, despite international efforts to address hunger. Moreover, no studies have been conducted to assess the spatial distribution of stunting at the SSA level. Therefore, to pinpoint high-burden areas and guide focused treatments; this study intends to investigate the spatial distribution of stunting among breastfeeding children in SSA. METHODS: The demographic and Health Survey data from 31 SSA nations were used for this study. The investigation included a total of 174,586 breastfeeding children. Stunting clustering and geographic patterns were evaluated using Geographic Information Systems and spatial analytic methods such as Getis-Ord Gi* and Global Moran's I. Stunting prevalence in unsampled areas was predicted using spatial interpolation (Kriging techniques). For the participants, descriptive statistics were calculated. RESULT: Stunting prevalence in SSA varied from 17.63% to 53.68%, with Madagascar (39.43%), Burundi (42.40%), and the Democratic Republic of the Congo (53.68%) having the highest rates. Significant clustering of stunting was found by spatial analysis (Moran's I: 0.639, p < 0.001), with hotspots primarily located in Central and Eastern Africa, such as Ethiopia, and the Democratic Republic of the Congo. In Southern Africa, cold locations like Namibia and South Africa were found to have lower stunting rates. CONCLUSION: The significant regional variability in the prevalence of stunting among nursing children in SSA was highlighted by this study. In order to address underlying variables including poverty, food insecurity, and limited access to healthcare, the findings highlighted the necessity of region-specific public health initiatives. To lessen the burden of stunting and its long-term effects, improved geospatial surveillance systems are crucial for locating high-risk locations and directing the distribution of resources.
BACKGROUND: Undernutrition is linked to decreased survival in childhood cancer. However, its global impact remains unclear, and childhood cancer is not recognised as a high-risk factor in WHO nutrition guidelines. This systematic review quantifies the prevalence and clinical outcomes of undernutrition among children with cancer in low-income and middle-income countries (LMICs), highlighting the global burden and impact on children with cancer. METHODS: Ovid Medline, EMBASE, Cochrane and Web of Science databases were searched until September 2024. Key search terms included "developing countries", "neoplasm", "child" and "undernutrition". LMICs were classified by the World Bank data. Undernutrition was defined by the WHO and includes wasting, stunting and underweight. FINDINGS: Data from 21 646 children across 88 studies in 23 countries revealed prevalence rates ranging from 6.1% in China to 88.4% in South Africa. Nutritional assessments predominantly relied on weight-based indicators (57.0%), with mid-upper arm circumference used in 17.0% and combined methods in 27.0%. Older children (>5 years) showed a trend towards higher undernutrition prevalence rates compared with younger children. Undernutrition was associated with deteriorating outcomes in 7 out of 11 studies (p<0.05). INTERPRETATION: Our findings show the substantial burden of undernutrition among children with cancer in LMICs. Childhood cancer should be recognised as a high-risk factor in international nutrition guidelines, in order to promote equitable care and improve survival rates. Targeted intervention studies are needed, supporting the WHO's goal of 60% survival for common and curable childhood cancer types by 2030.
Nthongase Makamo, Sterre Schoon, Nmazuo Ozuah et al.
