BACKGROUND: Undernutrition, which includes stunting, wasting, and underweight, is a global problem, especially among children of low- and middle-income countries. To our knowledge, this study is first of its type from Afghanistan. Its main objectives were to estimate the prevalence and associated risk factors of stunting, wasting/thinness, and underweight among urban primary school children in Kandahar city of Afghanistan.
METHODS: This school-based cross-sectional study was conducted among 1205 primary school children aged 6-12 years during a period of six months (October 2022-March 2023). Anthropometric measurements and other data were collected from all the participants. Data were analyzed by using descriptive statistics, Chi square test (using crude odds ratio or COR), and multivariate logistic regression (using adjusted odds ratio or AOR).
RESULTS: Among the 1205 enrolled government school students, 47.4%, 19.5%, and 25.6% had stunting, wasting/thinness, and underweight, respectively. Statistically significant factors associated with stunting were age group 6-9 years (AOR 1.3, 95% CI 1.1-1.7), being girl (AOR 2.3, 95% CI 1.8-3.0), poverty (AOR 2.2, 95% CI 1.5-3.2), large family (AOR 3.0, 95% CI 2.4-3.9), illiterate mother (AOR 1.6, 95% CI 1.0-2.6), jobless head of the family (AOR 3.3, 95% CI 2.3-4.8), and skipping breakfasts (AOR 1.7, 95% CI 1.2-2.3). Main factor associated with wasting/thinness were age group 6-9 years (AOR 30.5, 95% CI 11.8-78.7), skipping breakfasts (AOR 22.9, 95% CI 13.9-37.8), and history of sickness during the past two weeks (AOR 17.0, 95% CI 6.6-43.8). Also, main factors associated with underweight were age group 6-9 years (AOR 2.6, 95% CI 1.6-4.1), skipping breakfasts (AOR 2.6, 95% CI 1.8-3.6), and poor sanitation (AOR 1.9, 95% CI 1.1-3.2).
CONCLUSIONS: Stunting, wasting/thinness, and underweight are highly prevalent among primary school children (both girls and boys) in Kandahar city. It is recommended that local government (Afghanistan Ministry of Education and Ministry of Public Health) with the help of international organizations and donor agencies should implement comprehensive school-based feeding programs especially for girls. Health and nutrition education programs should be conducted with emphasis on nutrition of children aged 6-9 years as well as importance of healthy breakfast and good sanitation.

Background Childhood immunization programs in underdeveloped nations can improve children\'s growth and nutritional status and prevent growth delays while protecting against infectious diseases and meeting growth norms. This study aimed to assess the impact of vaccination status on the anthropometric indices of children aged 12-18 months at an Expanded Programme on Immunization vaccination center and compare the anthropometric indices of growth in children with complete and incomplete vaccination statuses. Methodology This study was conducted at the rural health center in Kala Shah Kaku, Pakistan, from November 2023 to December 2023. Children aged 12-18 months were enrolled and their vaccination status was recorded. Height and weight were measured using World Health Organization growth charts. The data were analyzed using descriptive statistics and chi-square and Fisher\'s exact tests. A p-value <0.05 was considered statistically significant. Results The mean age of the 110 children who visited the vaccination site for this study was 16.36 months ± 2.415. There were 28 (25.5%) stunted children. In the study, 17.6 (16%) participants were underweight, and 15.95 (14.5%) were wasted. Of the children, 79% had received all recommended vaccinations. A statistically significant (p < 0.05) association was found between vaccination and nutritional status. Conclusions This study emphasizes the significance of vaccination in promoting child health and nutrition, reducing stunting risk, and ensuring equitable access to vaccination services and comprehensive healthcare interventions. This can help mitigate the malnutrition burden and promote optimal growth, contributing to global health and development goals.

UNASSIGNED: Globally, five million children under the age of five died in 2021. Asia and African countries contributed to 69% and 27.2% of wasting, respectively. In Ethiopia, out of 901 (10.1%) under-five children, 632 (8.1%) were found to be moderately wasted, and 269 (3.0%) were severely wasted. The purpose of this study was to assess the prevalence of wasting and its associated factors among children between the ages of 6 and 59 months in Habro Woreda, Oromia, Eastern Ethiopia.
UNASSIGNED: A community-based cross-sectional study was conducted in Habro Woreda from 25 August to 20 September 2020. In total, 306 participants were included in this study through a systematic sampling technique. Data were collected using a pretested structured questionnaire through a face-to-face interview, entered into EpiData version 3.1, and analyzed using SPSS version 25. Predictors were assessed using a multivariate logistic regression analysis model and reported using an adjusted odds ratio (AOR) with a 95% confidence interval (CI). Statistical significance was set at p < 0.05.
UNASSIGNED: Overall, the prevalence of wasting among children aged 6-59 months in the Habro district was 28%, with a 95% confidence interval [26.5, 32.2%]. Factors such as mothers illiterate [AOR = 3.4; 95% CI: 1.14-10.47], households without latrines [AOR = 2.91; 95% CI: 1.33-6.37], food-insecure households [AOR = 4.11; 95% CI: 1.87-9], households that did not receive home visits [AOR = 4.2; 95% CI: 1.92-9.15], did not eat a variety of food [AOR = 7.44; 95% CI: 2.58-21.45], sick children after discharge from the program [AOR = 6.55; 95% CI: 2.85-15.02], readmitted children [AOR = 3.98; 95% CI: 1.43-15.07], and wasting 3.42 [AOR = 3.42; 95% CI: 1.24-9.45] were factors statistically associated with outcome variables.
UNASSIGNED: This study noted that the prevalence of wasting among children aged 6-59 months following discharge from the Outpatient Therapeutic Program remains high. Educational status of the mother, availability of a latrine, separate kitchen in the household, household food insecurity, household dietary diversity, home visit, and admission type were significantly associated with wasting of children after discharge from the outpatient therapeutic program. Therefore, efforts that target these factors should be maximized to reduce the occurrence of wasting among children aged 6-59 months after discharge from the outpatient therapeutic program.

UNASSIGNED: Variety and adequacy of intake of food are required to meet the nutritional needs of the children. Due to poverty/illiteracy, poor families depend on a single food group that is, cereals. Due to the pandemic also, the nutrition of the growing children is affected.
UNASSIGNED: To know the effect of quantity and quality of diet on the nutritional status of under-five children.
UNASSIGNED: This study had 270 children aged between 1 and 4 years registered at Anganwadi as study participants. Information on sociodemographic variables, quantity of calories and proteins consumed, quality of diet, and anthropometry of children was collected. Percentages and paired t-tests were used to find the difference between nutritional status and diet at different intervals, which was found to be statistically significant (P < 0.05).
UNASSIGNED: In our study, we found that as the quantity and quality of diet improved nutritional status, especially weight for age, body mass index (BMI) for age Z score also improved. There was a significant difference between calories consumed at the baseline, 6 months and 1 year with P < 0.05. Protein intake was significant between baseline and six months with P < 0.005.
UNASSIGNED: Our study found a high percentage of undernutrition and wasting in the under-five population when diet was not sufficient in quality and quantity. As the quality and quantity of diet improved nutritional status also improved.

UNASSIGNED: Wasting occurs when the body\'s nutritional needs are unmet due to insufficient intake or illness. It represents a significant global challenge, with approximately 45 million infants and children under 5 years of age suffering from wasting in 2022.
UNASSIGNED: A cluster-randomized, controlled, non-inferiority trial was conducted in three regions of Ethiopia. A non-inferiority margin of 15%, along with a recovery rate of 90% and a minimum acceptable recovery rate of 75%, were considered alongside an intra-cluster correlation coefficient of 0.05 and an anticipated loss to follow-up of 10% in determining the total sample size of 1,052 children. Children with severe acute malnutrition (SAM) in the simplified group received two sachets of ready-to-use therapeutic food (RUTF) daily, while the standard group received RUTF based on their body weight. For moderate acute malnutrition (MAM) cases, the simplified group received one sachet of RUTF, whereas the standard group received one sachet of ready-to-use supplementary food daily. A non-parametric Kaplan-Meir curve was utilized to compare the survival time to recovery.
UNASSIGNED: A total of 1,032 data points were gathered. For SAM cases, the average length of stay was 8.86 (±3.91) weeks for the simplified protocol and 8.26 (±4.18) weeks for the standard protocol (P = 0.13). For MAM cases, the average length of stay was 8.18 (±2.96) weeks for the simplified approach and 8.32 (±3.55) weeks for the standard protocol (P = 0.61). There was no significant difference (P = 0.502) observed between the simplified protocol [8 weeks, interquartile range (IQR): 7.06-8.94] and the standard protocol [9 weeks (IQR: 8.17-9.83)] among children with SAM on the median time to cure. There was no significant difference (P = 0.502) in the time to cure between the simplified approach [8 weeks (IQR: 7.53-8.47)] and the standard protocol [8 weeks (IQR: 7.66-8.34)] among children with MAM. The survival curves displayed similarity, with the log-rank test not showing significance (P > 0.5), indicating the non-inferiority of the simplified approach for cure time.
UNASSIGNED: The findings showed that the simplified and standard protocols demonstrated no significant differences in terms of the average duration of stay and time required for recovery.
UNASSIGNED: https://pactr.samrc.ac.za/, Identifier (PACTR202202496481398).

BACKGROUND: Poor sanitation and/or open defecation are a significant public health problem in Ethiopia, where access to improved sanitation facilities is still limited. There is a growing body of literature about the effect of open defecation on children\'s linear growth failure. However, very few studies about the effects of open defecation on child anemia exist. In this study, we examine whether childhood undernutrition (i.e. stunting, wasting, and underweight) mediates the relationship between open defecation and childhood anemia in children aged 6-59 months in Ethiopia.
METHODS: We used pooled Ethiopia Demographic and Health Survey data (2005-2016) comprising 21,918 (weighted data) children aged 6-59 months. Anemia was defined as an altitude-adjusted hemoglobin (Hb) level of less than 11 g/deciliter (g/dl) for children under 5 years. Childhood undernutrition was assessed using height-for-age Z-scores (HAZ), weight-for-age Z-scores (WAZ), and weight-for-height Z-scores (WHZ) for stunting, wasting, and underweight respectively. Mediation effects were calculated using the bootstrap and the indirect effect was considered significant when the 95% bootstrap confidence intervals (95% CI) did not contain zero. Moreover, separate multilevel regression analyses were used to explore the statistical association between open defecation and child anemia, after adjusting for potential confounders.
RESULTS: Our analysis revealed that nearly half (49.6%) of children aged 6 to 59 months were anemic, 46.8% were stunted, 9.9% were wasted, and 29.5% were underweight. Additionally, 45.1% of children belonged to households that practiced open defecation (OD). Open defecation was associated with anemia (AOR: 1.28; 95% CI: 1.18-1.39) and it positively predicted anemia with direct effect of β = 0.233, p < 0.001. Childhood undernutrition showed a partial mediating role in the relationship between OD and anemia. Analyzing the indirect effects, results revealed that child undernutrition significantly mediated the relationship between open defecation and anemia (stunting (βindirect = 0.014, p < 0.001), wasting (βindirect = 0.009, p = 0.002), and underweight (βindirect = 0.012, p < 0.001)). When the mediating role of child undernutrition was accounted for, open defecation had a positive impact on anemia with a total effect of βtotal = 0.285, p < 0.001.
CONCLUSIONS: Open defecation showed a significant direct effect on anemia. Child undernutrition remarkably mediated the relationship between OD and anemia that further magnified the effect. This finding has an important programmatic implication calling for strengthened, accelerated and large-scale implementation of strategies to end open defecation and achieve universal access to sanitation in Ethiopia.

Worldwide, nearly 45 million children under the age of 5 years were affected by wasting in 2022. Ethiopia has been challenged by disasters increasing the caseload of children with wasting. This study aimed to determine the effect of a simplified approach on recovery of children with acute malnutrition as compared with the standard protocol. A cluster randomized, controlled, noninferiority trial was carried out in three regions of Ethiopia from December 4, 2021, to July 30, 2022. A total of 58 clusters (health posts) were randomized into intervention and control groups. Children with SAM in the intervention groups received two sachets of Ready-to-Use Therapeutic Food (RUTF), whereas children in the control groups received RUTF based on their body weight. Children with moderate acute malnutrition (MAM) received one sachet of RUTF and one sachet of Ready-to-Use Supplementary Food (RUSF) daily in the intervention and control groups, respectively. Per protocol (PP) and intention-to-treat analysis were used to compare recovery at a noninferiority margin of 15%. Data were collected from 55 health posts and 1032 children. In the PP analysis, the recovery rate of children with wasting among the simplified group (97.8%) was noninferior to the standard protocol group (97.7%), p = 0.399. The RUTF cost per treatment of child with SAM was 56.55 USD for the standard versus 42.78 USD for the simplified approach. The simplified approach is noninferior to the standard protocol in terms of recovery and has a lower cost of RUTF. Further study is recommended to assess the effectiveness of the simplified approach in emergency contexts.

Diet quality in childhood and adolescence can affect health outcomes such as physical and cognitive growth and preventing chronic diseases in adulthood. This study aimed to evaluate the relationship between diet quality using the modified youth healthy eating index (MYHEI) with socioeconomic factors and nutrition status in 7-12-year-old children in Iran. This descriptive-cross-sectional study was performed on 580 students in Zabol, Iran, selected through multistage cluster sampling. The diet was assessed through the 168-item food frequency questionnaire (FFQ) and eating behaviors. Then, the MYHEI scoring system was used to calculate the diet quality. In addition, we used the WHO growth indices, such as weight to age, height to age, and body mass index (BMI) to age ratios, to evaluate nutrition status. The mean total MYHEI score in children was 56.3 ± 11.2. Among children with the highest MYHEI score quartile, the number of girls was significantly higher than boys (p = 0.001). The prevalence of underweight, stunting, and wasting was 25.3%, 17.4%, and 21.7%, respectively. The prevalence of underweight (OR: 2.2; 95% CI  1.26, 3.90, p = 0.001) and stunting (OR: 3.2; 95% CI   1.65, 6.14, p = 0.006) were significantly lower in the higher MYHEI score quartile compared to the lower quartile. The overall diet quality of most children should be modified. Therefore, to improve the children\'s health and nutrition status, it is necessary to perform nutritional interventions such as training and promotional programs, especially in schools.

BACKGROUND: Undernutrition among children younger than 5 years is a subtle indicator of a country\'s health and economic status. Despite substantial macroeconomic progress in India, undernutrition remains a significant burden with geographical variations, compounded by poor access to water, sanitation, and hygiene services.
OBJECTIVE: This study aimed to explore the spatial trends of child growth failure (CGF) indicators and their association with household sanitation practices in India.
METHODS: We used data from the Indian Demographic and Health Surveys spanning 1998-2021. District-level CGF indicators (stunting, wasting, and underweight) were cross-referenced with sanitation and sociodemographic characteristics. Global Moran I and Local Indicator of Spatial Association were used to detect spatial clustering of the indicators. Spatial regression models were used to evaluate the significant determinants of CGF indicators.
RESULTS: Our study showed a decreasing trend in stunting (44.9%-38.4%) and underweight (46.7%-35.7%) but an increasing prevalence of wasting (15.7%-21.0%) over 15 years. The positive values of Moran I between 1998 and 2021 indicate the presence of spatial autocorrelation. Geographic clustering was consistently observed in the states of Madhya Pradesh, Jharkhand, Odisha, Uttar Pradesh, Chhattisgarh, West Bengal, Rajasthan, Bihar, and Gujarat. Improved sanitation facilities, a higher wealth index, and advanced maternal education status showed a significant association in reducing stunting. Relative risk maps identified hotspots of CGF health outcomes, which could be targeted for future interventions.
CONCLUSIONS: Despite numerous policies and programs, malnutrition remains a concern. Its multifaceted causes demand coordinated and sustained interventions that go above and beyond the usual. Identifying hotspot locations will aid in developing control methods for achieving objectives in target areas.

Introduction The adverse effects of the coronavirus disease 2019 (COVID-19) pandemic on maternal and reproductive health extend beyond the immediate morbidity and mortality attributed directly to the disease. Pandemic-induced disruptions in the healthcare, social and economic infrastructures can exacerbate the already high burden of childhood undernutrition in India. Method A cross-sectional study was conducted in a selected district of the central Indian province of Madhya Pradesh. Data was collected from eligible children born during the COVID-19 pandemic (February 2020 to December 2021) who visited a selected tertiary care hospital for routine immunization during the study period. Weight-for-length, weight-for-age, and length-for-age were compared with reference values to obtain corresponding z-scores. Children with z-scores two standard deviations below the reference values were considered wasting, underweight and stunting, respectively. Descriptive statistics were employed to summarise the sociodemographic characteristics of participants. The association of sociodemographic, nutritional, and pregnancy-related factors with the z-scores were assessed via unpaired t-test and ANOVA. Result The studied 147 children were in the age group of nine to 29 months, of which 61 (58.1%) were males. Forty-two (28.6%) were found to be underweight, 22 (14.9%) had wasting and 51 (34.7%) were stunted. These prevalences were comparable to the estimates of the National Family Health Survey 2019-2021 (NFHS-5) for Madhya Pradesh and lower than the NFHS-4 (2015-2016), showing no discernible effect of being born during the pandemic on growth indicators. However, mothers\' employment and family income were independent predictors of stunting whereas gestational age at birth, maternal education, and prolonged breastfeeding were all substantially linked with wasting in this study. Conclusion This study adds to the evidence base by reporting the prevalence of stunting, wasting and underweight along with their determinants in central India among children born during the COVID-19 pandemic. Our data did not reflect the expected increase in child malnutrition due to the COVID-19 pandemic-related disruptions in healthcare, social and economic infrastructure. Future research should incorporate the lessons learnt from our study to design a population-based study of under-five children and compare the prevalence of undernutrition in pandemic-born versus non-pandemic-born children.