BACKGROUND: In low/middle-income countries, most nutritional assessments use the latest weights, without reference to growth trajectory.
OBJECTIVE: This study explores whether velocity, in addition to the latest weight, improves the prediction of wasting, stunting or mortality in the first two years of life.
METHODS: We analysed a combined data set with weight and height data collected monthly in the first year of 3447 children from Pakistan, Malawi, South Africa, with height and survival recorded till 24 months. The main exposures were weight-for-age z-score (WAZ) at the end of each 2-month period and weight velocity-for-age z-score (WVZ2) across that period. The outcomes were wasting, stunting or all-cause mortality in the next 1-2 months. As a sensitivity analysis, we also used WVZ over 6 months (WVZ6), with matching WAZ. Cox proportional hazard models with repeated growth measures were used to study the association between exposures and mortality. Mixed Poisson models were used for stunting and wasting.
RESULTS: Children who were already stunted or wasted were most likely to remain so. WVZ2 was associated with a lower risk of subsequent stunting (RR 0.95; 95% CI 0.93-0.96), but added minimal prediction (difference in AUC = 0.004) compared to a model including only WAZ. Similarly, WVZ2 was associated with wasting (RR 0.74; 95% CI 0.72-0.76) but the prediction was only marginally greater than for WAZ (difference in AUC = 0.015). Compared to WAZ, WVZ6 was less predictive for both wasting and stunting. Low WVZ6 (but not WVZ2) was associated with increased mortality (HR 0.75, 95% CI 0.67-0.85), but added marginal only prediction to a model including WAZ alone (difference in C = 0.015).
CONCLUSIONS: The key anthropometric determinant of impending wasting, stunting, and mortality appears to be how far below the normal range the child\'s weight is, rather than how they reached that position.

BACKGROUND: Malnutrition among adolescents is a major public health issue. This problem is particularly pressing in Sudan, an African country where there is scarce published data on the nutritional status of adolescents. In this study, we aimed to assess the nutritional status of adolescents in eastern Sudan.
METHODS: A community-based cross-sectional survey was carried out in Gadarif, eastern Sudan. A questionnaire was used to collect sociodemographic data, and the anthropometric measurements (weight and height) of adolescent participants were recorded. Height-for-age and body mass index-for-age Z-scores were calculated using the WHO anthropometric standards. Binary and multivariate multinomial regression analyses were performed.
RESULTS: A total of 388 adolescents were included in this survey, 207 (53.4%) were female, and 181 (46.6%) were male. The median (interquartile) age was 13.9 (12.0-16.0) years. The results showed that a total of 29 (7.5%), 93 (24.0%), 33 (8.5%), and 16 (4.1%) adolescents were stunted, thin, overweight, and obese, respectively. None of the investigated factors (age, sex, parents\' education levels, and occupation) were associated with stunting. In the multivariate multinomial analysis, the male sex was associated with thinness (OR = 2.41, 95.0% CI = 1.47-3.94). Moreover, adolescents whose mothers had an education lower than secondary level were at a lower risk of overweight/obesity (OR = 0. 0.35, 95.0% CI = 0. 0.35).
CONCLUSIONS: While both undernutrition and overnutrition exist in eastern Sudan, undernutrition is more common. Male sex and mothers\' education levels are associated with malnutrition.

BACKGROUND: The main cause of growth and development delays remains unknown, but it can occur as an interaction between genetic, environmental, and socio-economic factors.
OBJECTIVE: The aim of the study was to investigate the prevalence and social determinants of growth and developmental delays among children aged under five years in Qazvin, Iran.
METHODS: A cross-sectional study was conducted between January 2019 to December 2020 with participation of 1800 mothers with children aged 4-60 months who were referred to comprehensive health centers in Qazvin city, Iran. Structural and intermediate social determinants of health were assessed including: parents and children socio-demographic characteristics, families\' living and economic status, parents\' behavioral factors, household food security, mother\'s general health, and perceived social support. Children\'s growth was assessed based on their anthropometric assessment and their development was assessed using their age-specific Ages and Stages Questionnaire. Data were analyzed using univariable and multivariable logistic regression models using SPSS software version 24 and Stata version 14.
RESULTS: The prevalence of developmental problems in each domain were 4.28% for personal and social delay, 5.72% for gross motor delay, 6.5% for communication delay, 6.72% for fine motor delay, and 8% for problem-solving delay. The prevalence of weight growth delays was 13.56% and height growth delays was 4.66%. Communication, gross motor, and problem-solving delays were higher among children whose fathers\' smoked cigarettes. Fine motor delays were lower among mothers with education status of high school diploma and university degree vs. the under diploma group. Personal and social delay was significantly higher among families with fair economic status and lower among children when their fathers were employed (vs. unemployed). Weight and height growth delays were higher among mothers who had experienced pregnancy complications and household food insecure families, respectively.
CONCLUSIONS: There are different predictors of growth and developmental delay problems among Iranian children aged under five years including fathers\' smoking, families\' economic status, and household food insecurity as well as history of mothers\' pregnancy complications. The present study\'s findings can be used to screen for at-risk of growth and developmental delays among children and could help in designing and implementation of timely interventions.

The prevalence of short stature among prepubertal children in China is relatively high. Early identification of the cause and timely intervention can bring greater benefits to children with short stature. This paper provides an overview of early diagnosis, intervention measures, and personalized medication dosage for prepubertal short stature children, aiming to provide references for clinical doctors.
我国青春期前儿童矮身材的发生率较高。尽早明确病因，及时进行干预，可为矮身材儿童带来更好的获益。该文对青春期前矮身材儿童的早期诊断、干预措施、个体化用药剂量等进行了概述，以期为临床医生提供参考。.

OBJECTIVE: The study aimed to explore mothers\' perceptions for timely introduction of complementary feeding through interviews with 2-12-month-old infants\' mothers in Ghana.
METHODS: Qualitative descriptive research with 16 semi-structured interviews with mothers attending the Child Welfare Clinic at Ejisu Hospital was conducted from June 2022 to May 2023. The study was guided by the Declaration of Helsinki, and all participants were instructed about informed consent for the study. Interviews and analysis were guided by Theory of Planned Behavior. NVivo 1.5 was used throughout the coding procedure. This study was conducted after the approval from St. Luke\'s International University.
RESULTS: Four themes were revealed: (1) attitude toward the behavior based on the mothers\' experience raising children, (2) attitude toward the behavior influenced by subjective norm (grandmothers\' recommendation), (3) attitude toward the behavior influenced by perceived behavioral control (difficulty in continuing breastfeeding), and (4) mothers who are worried about underweight despite timely introduction of complementary feeding. Attitudes toward the behavior were influenced by mothers\' experiences raising children and grandmothers\' recommendations. Surroundings disruptive of breastfeeding also influenced attitudes toward intentions and behavior. Moreover, some mothers suffered from underweight even if they introduce complementary feeding at an optimal time.
CONCLUSIONS: Supporting to continue breastfeeding and conducting re-education for grandmothers is a key recommendation for midwives and pediatric nurses. Moreover, pediatric nurses are required to further enhance not only health education regarding the timing of initiating complementary feeding but also support after the introduction.

AbstractMorning Report is a time-honored tradition where physicians-in-training present cases to their colleagues and clinical experts to collaboratively examine an interesting patient presentation. The Morning Report section seeks to carry on this tradition by presenting a patient\'s chief concern and story, inviting the reader to develop a differential diagnosis and discover the diagnosis alongside the authors of the case. This report examines the story of a 15-month-old with faltering growth and short stature. Using questions, physical examination, and testing, an illness script for the presentation emerges. As the clinical course progresses, the differential is refined until a diagnosis is made.

BACKGROUND: Malaysia faces the threat of a double burden of malnutrition where undernutrition and overweight (including obesity) coexist in the same population. This study aimed to determine the anthropometric assessment among children and adolescents aged 5 to 17 years and its association with socio-demographic factors.
METHODS: Data were extracted from the National Health and Morbidity Survey conducted in 2019. This cross-sectional survey applied a two-stage stratified sampling design. Socio-demographic characteristics were obtained. Weight and height were measured, age- and sex-specific standard scores for height and BMI were calculated to establish individual\'s anthropometric assessment. Having either stunting or thinness was considered undernutrition, while being overweight (including obesity) was considered overnutrition. If someone had undernutrition and/or overnutrition, they were classified as having malnutrition. The prevalence was determined using complex sampling analysis, while the association was assessed through logistic regression. The analysis included a total of 3,185 respondents.
RESULTS: The prevalence of stunting, thinness, overweight and obesity among the respondents aged 5 to 17 years was 12.7%, 10.0%, 15.0% and 14.8%, respectively. The overall prevalence of malnutrition was 48.3%. Respondents residing in rural had 1.35 times more likelihood of experiencing undernutrition [AOR = 1.35, 95% CI (1.04, 1.77)] compared to their urban counterparts. Boys exhibited a greater likelihood of being overweight and obese than girls [AOR = 1.40, 95% CI (1.13, 1.73)]. Respondents aged 10 to 14 years were 1.37 times more likely to be overnutrition than those aged 5 to 9 years old [AOR = 1.37, 95% CI (1.09, 1.73)].
CONCLUSIONS: There is growing evidence of the increasing prevalence of coexistence of undernutrition along with overweight and obesity among children and adolescents in Malaysia. Moving forward, greater initiatives and efforts are required to formulate strategies for planning and implementing programs and policies to expedite progress in improving nutrition.

Treatment outcomes for different causes of childhood dwarfism vary widely, and there are no studies on the economic burden of treatment in relation to outcomes. This paper compared the efficacy and healthcare costs per unit height of recombinant human growth hormone (rhGH) for the treatment of growth hormone deficiency (GHD) and idiopathic short stature (ISS) with a view to providing a more cost-effective treatment option for children. We retrospectively analyzed 117 cases (66 cases of GHD and 51 cases of ISS) of short-stature children who first visited Weifang People\'s Hospital between 2019.1 and 2022.1 and were treated with rhGH for 1 to 3 years to track the treatment effect and statistically analyzed by using paired t tests, non-parametric tests, and chi-square tests, to evaluate the efficacy of rhGH treatment for GHD and ISS children and the medicinal cost. The annual growth velocity (GV) of children with GHD and ISS increased the fastest during 3 to 6 months after treatment and then gradually slowed down. The GV of the GHD group was higher than that of the ISS group from 0 to 36 months after treatment (P < .05 at 3, 6, 9, and 12 months); the height standard deviation scores (HtSDS) of the children in the GHD and ISS groups increased gradually with the increase of the treatment time, and the changes in the height standard deviation scores (ΔHtSDS) of the GHD group were more significant than those of the ISS group (P < .05 at 3, 6, 9, and 12 months). (2) The medical costs in the pubertal group for a 1-cm increase in height were higher than those of children in the pre-pubertal group at the same stage (3 to 24 months P < .05). The longer the treatment time within the same group, the higher the medical cost of increasing 1cm height. RhGH is effective in treating children with dwarfism to promote height growth, and the effect on children with GHD is better than that of children with ISS; the earlier the treatment time, the lower the medical cost and the higher the comprehensive benefit.

BACKGROUND: Growth retardation and short final height is a common complication of chronic kidney disease (CKD) beginning in childhood, with profound deleterious effects on quality of life, mental health, and social achievement. Despite optimal treatments of causative factors for growth retardation in children with CKD, more than 50% of patients reach end-stage renal failure with a height >2 SD below the mean, and most do not demonstrate \"catch-up\" growth after receiving a kidney transplant. Four decades ago, recombinant human growth hormone (rhGH) treatment was introduced after studies showed increased growth velocity and improved height SDS in uremic subjects. Since then, an abundance of published data showed significant improvements in health-related quality of life, and most studies revealed no significant adverse effects. Clinical practice guidelines recommended rhGH treatment in CKD Stages 3-5D and after transplantation. Despite these guidelines, this therapy remained underutilized. Most commonly cited barriers to the implementation of rhGH treatment were the need for daily injections, financial challenges, physicians\' unfamiliarity with guidelines, and fear of adverse events.
CONCLUSIONS: rhGH has been shown to improve growth and final height in short children with CKD, with minimal adverse effects. Despite data of its successful use generated over 3 decades, this treatment is underutilized. More judicious utilization of the treatment should emphasize educating patients, their care givers, and members of the multidisciplinary treating team. Additional studies are needed to assess the longer-term rhGH treatment in larger cohorts of patients, leading to additional supportive data and clearer recommendations.

BACKGROUND: Epidemiological and nutritional modifications are causing an increase in stunting in many low- and middle-income countries (LMIC), which will eventually result in juvenile diseases and mortality. Therefore, this study aimed to identify the influential factors contributing to stunting among under-five children in Cambodia.
METHODS: A secondary dataset consisting of 3268 under-five children was extracted from the latest Cambodian Demographic and Health Survey (CDHS)-2021/2022 dataset. The Chi-square test and Boruta algorithm were used for covariate selection, and logistic regression approaches were used to determine the influence of demographic, socioeconomic and other factors on the presence of stunting.
RESULTS: Findings revealed that about 21% of under-five children were stunted, and the prevalence of stunting was higher in rural areas than in urban areas. The prevalence of child stunting was lower in families with highly educated parents. A child whose father had a secondary education had 0.71 times lower (adjusted odds ratio [AOR]: 0.71, 95% CI: 0.520-0.969) chance of stunting than a child whose father had no education. Findings revealed that Ratnak Kiri, Mondul Kiri, Stung Treng, Pursat and Kampot had a greater prevalence of stunting than other places, ranging from 27.11% to 35.70%, whereas Banteay Meanchey, Phnom Penh and Kandal had the lowest rates, ranging from 12.80% to 16.00%. Results of the Boruta algorithm and logistic regression suggested that under-five stunting is significantly influenced by factors such as the child\'s age, size at birth, mother\'s age at first birth, mother\'s body mass index (BMI), father\'s educational status, cooking fuel, and wealth index.
CONCLUSIONS: It is necessary to take initiatives for reducing the prevalence of stunted children prioritising the identified factors that ultimately help to reduce the burden of child health. The authors believed that the findings of this study will be helpful for policymakers in designing the appropriate policies and actions to achieve the Sustainable Development Goals (SDGs) by reducing stunting among under-five children in Cambodia.