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Household food access and child malnutrition: results from the eight-country MAL-ED study.

Psaki S, Bhutta ZA, Ahmed T, Ahmed S, Bessong P, Islam M, John S, Kosek M, Lima A, Nesamvuni C, Shrestha P, Svensen E, McGrath M, Richard S, Seidman J, Caulfield L, Miller M, Checkley W, for MALED Network Investigato - Popul Health Metr (2012)

Bottom Line: In pooled regression analyses, a 10-point increase in food access insecurity score was associated with a 0.20 SD decrease in height-for-age Z score (95% CI 0.05 to 0.34 SD; p = 0.008).A likelihood ratio test for heterogeneity revealed that this relationship was consistent across countries (p = 0.17).Such a measure could be used to direct interventions by identifying children at risk of illness and death related to malnutrition.

View Article: PubMed Central - HTML - PubMed

Affiliation: Fogarty International Center, National Institutes of Health, Bethesda, USA. wcheckl1@jhmi.edu.

ABSTRACT

Background: Stunting results from decreased food intake, poor diet quality, and a high burden of early childhood infections, and contributes to significant morbidity and mortality worldwide. Although food insecurity is an important determinant of child nutrition, including stunting, development of universal measures has been challenging due to cumbersome nutritional questionnaires and concerns about lack of comparability across populations. We investigate the relationship between household food access, one component of food security, and indicators of nutritional status in early childhood across eight country sites.

Methods: We administered a socioeconomic survey to 800 households in research sites in eight countries, including a recently validated nine-item food access insecurity questionnaire, and obtained anthropometric measurements from children aged 24 to 60 months. We used multivariable regression models to assess the relationship between household food access insecurity and anthropometry in children, and we assessed the invariance of that relationship across country sites.

Results: Average age of study children was 41 months. Mean food access insecurity score (range: 0-27) was 5.8, and varied from 2.4 in Nepal to 8.3 in Pakistan. Across sites, the prevalence of stunting (42%) was much higher than the prevalence of wasting (6%). In pooled regression analyses, a 10-point increase in food access insecurity score was associated with a 0.20 SD decrease in height-for-age Z score (95% CI 0.05 to 0.34 SD; p = 0.008). A likelihood ratio test for heterogeneity revealed that this relationship was consistent across countries (p = 0.17).

Conclusions: Our study provides evidence of the validity of using a simple household food access insecurity score to investigate the etiology of childhood growth faltering across diverse geographic settings. Such a measure could be used to direct interventions by identifying children at risk of illness and death related to malnutrition.

No MeSH data available.


Related in: MedlinePlus

Box-percentile plots of weight-for-height (WHZ) by country; 2009–10.
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Figure 3: Box-percentile plots of weight-for-height (WHZ) by country; 2009–10.

Mentions: Overall, 42% (ranging from 8% to 55%) of children were stunted, and 6% (range from 0% to 17%) were wasted (Figures 2 and 3). HAZ in India and Brazil were shifted toward the highest values, with approximately 35% of Brazilian children and 30% of Indian children measuring above the WHO standard mean. In the remaining six sites, approximately 50% of each population was stunted, and in Bangladesh all children were below the WHO standard mean in height. On average, a much smaller proportion of children in these sites experienced growth faltering as assessed by WHZ. In both South Africa and Tanzania, where over 50% of the sample children were stunted, none of them were wasted. In contrast, in India, where about 22% of children were stunted (fewer than most sites), a similar proportion (17%) were wasted (more than most sites). Stunting was significantly associated with infant age, water source, sanitation facility, mother’s education, and people per room. Wasting was associated with water source and people per room. Low food access security was significantly associated with sex of the child, mother’s education, ownership of a bank account, and people per room. Wasting and stunting were only weakly correlated with each other (r = −0.02; p < 0.001), but stunting was directly associated with inadequate water and sanitation facilities (Table 2). To further explore these relationships, we controlled for the same set of SES indicators in our regression models (Table 3). The final models for the relationship between food access insecurity and child malnutrition (HAZ and WHZ) retained the SES indicators that remained statistically significant, i.e. water source, mother’s education, and people per room. This model was more parsimonious, and the relationship of interest remained consistent between models.


Household food access and child malnutrition: results from the eight-country MAL-ED study.

Psaki S, Bhutta ZA, Ahmed T, Ahmed S, Bessong P, Islam M, John S, Kosek M, Lima A, Nesamvuni C, Shrestha P, Svensen E, McGrath M, Richard S, Seidman J, Caulfield L, Miller M, Checkley W, for MALED Network Investigato - Popul Health Metr (2012)

Box-percentile plots of weight-for-height (WHZ) by country; 2009–10.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3584951&req=5

Figure 3: Box-percentile plots of weight-for-height (WHZ) by country; 2009–10.
Mentions: Overall, 42% (ranging from 8% to 55%) of children were stunted, and 6% (range from 0% to 17%) were wasted (Figures 2 and 3). HAZ in India and Brazil were shifted toward the highest values, with approximately 35% of Brazilian children and 30% of Indian children measuring above the WHO standard mean. In the remaining six sites, approximately 50% of each population was stunted, and in Bangladesh all children were below the WHO standard mean in height. On average, a much smaller proportion of children in these sites experienced growth faltering as assessed by WHZ. In both South Africa and Tanzania, where over 50% of the sample children were stunted, none of them were wasted. In contrast, in India, where about 22% of children were stunted (fewer than most sites), a similar proportion (17%) were wasted (more than most sites). Stunting was significantly associated with infant age, water source, sanitation facility, mother’s education, and people per room. Wasting was associated with water source and people per room. Low food access security was significantly associated with sex of the child, mother’s education, ownership of a bank account, and people per room. Wasting and stunting were only weakly correlated with each other (r = −0.02; p < 0.001), but stunting was directly associated with inadequate water and sanitation facilities (Table 2). To further explore these relationships, we controlled for the same set of SES indicators in our regression models (Table 3). The final models for the relationship between food access insecurity and child malnutrition (HAZ and WHZ) retained the SES indicators that remained statistically significant, i.e. water source, mother’s education, and people per room. This model was more parsimonious, and the relationship of interest remained consistent between models.

Bottom Line: In pooled regression analyses, a 10-point increase in food access insecurity score was associated with a 0.20 SD decrease in height-for-age Z score (95% CI 0.05 to 0.34 SD; p = 0.008).A likelihood ratio test for heterogeneity revealed that this relationship was consistent across countries (p = 0.17).Such a measure could be used to direct interventions by identifying children at risk of illness and death related to malnutrition.

View Article: PubMed Central - HTML - PubMed

Affiliation: Fogarty International Center, National Institutes of Health, Bethesda, USA. wcheckl1@jhmi.edu.

ABSTRACT

Background: Stunting results from decreased food intake, poor diet quality, and a high burden of early childhood infections, and contributes to significant morbidity and mortality worldwide. Although food insecurity is an important determinant of child nutrition, including stunting, development of universal measures has been challenging due to cumbersome nutritional questionnaires and concerns about lack of comparability across populations. We investigate the relationship between household food access, one component of food security, and indicators of nutritional status in early childhood across eight country sites.

Methods: We administered a socioeconomic survey to 800 households in research sites in eight countries, including a recently validated nine-item food access insecurity questionnaire, and obtained anthropometric measurements from children aged 24 to 60 months. We used multivariable regression models to assess the relationship between household food access insecurity and anthropometry in children, and we assessed the invariance of that relationship across country sites.

Results: Average age of study children was 41 months. Mean food access insecurity score (range: 0-27) was 5.8, and varied from 2.4 in Nepal to 8.3 in Pakistan. Across sites, the prevalence of stunting (42%) was much higher than the prevalence of wasting (6%). In pooled regression analyses, a 10-point increase in food access insecurity score was associated with a 0.20 SD decrease in height-for-age Z score (95% CI 0.05 to 0.34 SD; p = 0.008). A likelihood ratio test for heterogeneity revealed that this relationship was consistent across countries (p = 0.17).

Conclusions: Our study provides evidence of the validity of using a simple household food access insecurity score to investigate the etiology of childhood growth faltering across diverse geographic settings. Such a measure could be used to direct interventions by identifying children at risk of illness and death related to malnutrition.

No MeSH data available.


Related in: MedlinePlus