Prevalence and determinants of undernutrition among under-five children residing in urban slums and

rural area, Maharashtra, India: a community-based cross-sectional study

Abstract
Background: Undernutrition among under five children in India is a major public health
problem. Despite India's growth in the economy, the child mortality rate due to undernutrition is
still high in both urban and rural areas. Studies that focus on urban slums are scarce. Hence the
present study was carried out to assess the prevalence and determinants of undernutrition in
children under five in Maharashtra, India.
Methods: A community-based cross-sectional study was conducted in 16 randomly selected
clusters in two districts of Maharashtra state, India. Data were collected through house to house
survey by interviewing mothers of under five children. Total 2929 mothers and their 3671 under
five children were covered. Multivariate logistic regression analysis was carried out to identify
the determinants of child nutritional status seperately in urban and rural areas.
Results: The mean age of the children was 2.38 years (±SD 1.36) and mean age of mothers was
24.25 years (± SD 6.37). Overall prevalence of stunting among children under five was 45.9%,
wasting was 17.1 and 35.4% children were underweight. Prevalence of wasting, stunting and
underweight were more seen in an urban slum than a rural area. In the rural areas exclusive
breast feeding (p < 0.001) and acute diarrhea (p = 0.001) were associated with wasting, children
with birth order 2 or less than 2 were associated with stunting and exclusive breast feeding (p <
0.05) and low maternal education were associated with underweight. Whereas in the urban
slums exclusive breast feeding (p < 0.05) was associated with wasting, sex of the child (p < 0.05)
and type of family (p < 0.05) were associated with stunting,and low income of the family (p <
0.05) was associated with underweight.
Conclusions: Factors like sex of the child, birth order,exclusive breast feeding,economic status
of the family, type of family,acute diarrhea and maternal education have influence on nutritional
status of the child. Improvement of maternal education will improve the nutritional status of the
child. Strategies are needed to improve the economic status of the community.
CITATION:Murarkar, S., Gothankar, J., et al (2020). Prevalence and determinants of undernutrition
among under-five children residing in urban slums and rural area,Maharashtra, India: a
community-based cross-sectional study. BMC public health, 20(1), 1559.
https://doi.org/10.1186/s12889-020-09642-0

Background: Child malnutrition is a major public

health problem in developing countries. Therefore,
the aim of this study was to estimate
Prevalence and determinants of undernutrition among children
under 5-year-old in rural areas: A cross-sectional survey in North
Sudan

Abstract
Background: Child malnutrition is a major public health problem in developing countries. Therefore, the aim of this
study was to estimate the prevalence of undernutrition among children <5 years in River Nile state (RNS) in North
Sudan. Subjects and methods: A cross-sectional household survey was done in four localities in RNS. Using
Multistage Cluster sampling, 1635 under 5 years' children had participated. Pretested questionnaire and
anthropometric measures were used during data collection. The analysis was done using SPSS software program
version 21 and World Health Organization (WHO) Anthro 2005 software. Indices were reported in z-scores and
compared with the WHO 2005 reference population to determine the nutritional status of children. Results: Among
1,447 surveyed children, the prevalence of stunting, underweight, and wasting were 42.5%, 32.7%, and 21%,
respectively. Stunting was highest among the 48-60 months of age group (82.5%). Boys had poorer indicators of
undernutrition in comparison to girls. Geographically stunting was more prevalent in Berber locality. Infectious
diseases (gastroenteritis and respiratory symptoms) and incomplete vaccination were significantly associated with
wasting (P = 0.007, P = 0.013, and P = 0.008). Poor socioeconomic status (P = 0.043), poorer household sanitation (P
= 0.022), large family size, lack of family spacing, and infants weaned suddenly were regarded as risk factors for
undernutrition. Conclusion: There was a high prevalence of undernutrition in the 4th and 5th year of life in RNS
population, with significant gender imbalance. Our survey highlighted the importance of urgent need to improve child
health in this region.

Sulaiman AA, Bushara SO, Elmadhoun WM,

Noor SK, Abdelkarim M, Aldeen IN, et al.
Prevalence and determinants
of undernutrition among children under 5-year-
old in rural areas:
A cross-sectional survey in North Sudan. J
Family Med Prim Care
2018;7:104-10
Sulaiman AA, Bushara SO, Elmadhoun WM,
Noor SK, Abdelkarim M, Aldeen IN, et al.
Prevalence and determinants
of undernutrition among children under 5-year-
old in rural areas:
A cross-sectional survey in North Sudan. J
Family Med Prim Care
2018;7:104-10
Sulaiman AA, Bushara SO, Elmadhoun WM, Noor SK, Abdelkarim M, Aldeen IN, et al. Prevalence and
determinants of undernutrition among children under 5-year-old in rural areas: A cross-sectional survey
in North Sudan. J Family Med Prim Care 2018;7:104-10

Nutritional Status and Effect of Maternal Employment among Children

Aged 6-59 Months in Wolayta Sodo Town, Southern Ethiopia: A Cross-
sectional Study

Abstract
Background: Childhood malnutrition remains common in many parts of the world; the
magnitude of worldwide stunting, underweight and wasting in children under five years
of age were 24.7 %, 15.1 % and 7.8 %, respectively. More than 150 million children under
the age of five years in the developing world are malnourished. Ethiopia is one of the
countries in sub-Saharan Africa with the highest rates of malnutrition. In Ethiopia, 44.4%
and 9.7% of children under-five years old were stunted and wasted, respectively. This
study was aimed to assess nutritional status and effect of maternal employment among
children aged 6-59 months.
Methods: A cross-sectional study was conducted in Wolayta Sodo Town, Southern
Ethiopia. Socio-demographic characteristics, child feeding and healthcare seeking
practice of mothers, and child's anthropometric status were assessed. Probability
proportional to size sampling approach was used to select a sample of 316 mothers
having children aged 6-59 months. The study was ethically approved by Institutional
Review Board of Health Science College, Hawasa University.
Result: The overall result revealed that the prevalence of stunting was 22.2%, of which
21.8% and 22.6% were in children of employed and unemployed mothers, respectively.
Low-weight-for age was 10.8% for children of employed mothers and 13.4% for children
of unemployed mothers. Wasting was 8.8% and 10.8% for children of employed and
unemployed mothers, respectively. There was no statistically significant association
between maternal employment and nutritional status of their children. However, chronic
malnutrition (stunting) was influenced by being educated mother (OR: 0.37) child age
group of 24-59 months (OR: 0.36) and households' fifth wealth quintile (OR: 0.28).
Conclusion: Low prevalence of stunting was observed. Stunting is a public health
concern in the study area. Furthermore, stunting is significantly influenced by mothers'
education, household wealth and child age. However, maternal employment was not
statistically associated with child nutritional status. Thus, nutritional intervention
initiatives should focus on improving household food security, maternal education and
agricultural diversification.
Eshete, H., Abebe, Y., Loha, E., Gebru, T., & Tesheme, T. (2017). Nutritional Status and Effect of
Maternal Employment among Children Aged 6-59 Months in Wolayta Sodo Town, Southern
Ethiopia: A Cross-sectional Study. Ethiopian journal of health sciences, 27(2), 155–162.
https://doi.org/10.4314/ejhs.v27i2.8
Factors influencing undernutrition among children under 5 years from cocoa-growing
communities in Bougainville

Abstract
Half the children under the age of 5 years in Papua New Guinea (PNG) are
undernourished, more than double the global average with rural areas
disproportionately affected. This study examines factors associated with stunting,
wasting and underweight in cocoa growers’ children (<5 years) in the
Autonomous Region of Bougainville (ARoB), using data from a comprehensive
2017 cross-sectional livelihoods survey. Sixteen independent predictors for
stunting, wasting and underweight were selected based on the UNICEF
Conceptual Framework of Determinants of Undernutrition. We used multilevel
logistic mixed regression models to measure the association of the explanatory
variables with stunting, wasting and underweight. At the household level, the
adjusted OR (aOR) of stunting (aOR=1.71,95% CI 1.14 to 2.55) and underweight
(aOR=2.11, 95% CI 1.16 to 3.82) increased significantly among children from
households with unimproved toilet facilities. The aOR for underweight also
increased among children from households without access to clean drinking
water (aOR=1.97, 95% CI 1.19 to 3.29). Short maternal stature was significantly
associated with child stunting, the odds increased as maternal height decreased
(from 150 to <155 cm, aOR=1.52, 95% CI 1.02 to 2.26) (<150 cm, aOR=2.37,
95% CI 1.29 to 4.35). At the individual level, the odds of a child being
underweight increased with birth order (second born, aOR=1.92, 95% CI 1.09 to
3.36; third born, aOR=6.77, 95% CI 2.00 to 22.82). Compared with children less
than 6 months, children aged 6–23 months and 24–59 months had a higher odds
of being stunted (aOR=3.27, 95% CI 1.57 to 6.78 and aOR=2.82, 95% CI 1.40 to
5.67) and underweight (aOR=4.83, 95% CI 1.36 to 17.24 and aOR=4.59, 95% CI
1.29 to 16.26). No variables were found to be significant for wasting.
Interventions that simultaneously target key life stages for women and children
and the underlying social and environmental determinants are required for
sustained improvements to undernutrition.

Hall J, Walton M, Van Ogtrop F, et al
Factors influencing undernutrition among children under 5 years from cocoa-
growing communities in Bougainville
BMJ Global Health 2020;5:e002478.

Effects of malnutrition on child development: Evidence from a backward district of India

Abstract
Background
In India, under-nutrition among the poor children imposes greater burden in
rural areas. Particularly rural children are more vulnerable to malnutrition
because they receive foods having low nutritional values along with
discriminatory distribution of food within the household. Also in early childhood
due to lack of appropriate care they suffer from recurrent infections and
multiple diseases either causing delayed development or fatal effect. The
demographic and socio-economic factors influence the nutritional status and
neuro-development of the vulnerable children.
Methods
The aim of present study is to assess the nutritional status of developmentally
challenged children of less than five years through Z-scores of height-for-age,
weight-for-height and weight-for-age by demographic characteristics in a
backward district of the state of West Bengal, India. Indices of nutritional
status are calculated based on the WHO Child Growth Standards.
Result & conclusion
It has been observed that there are gender differences and age group
variations in the nutritional status of children who are developmentally
challenged. Under-nutrition is a major problem with vulnerable children in rural
area who suffer from developmental delay.

Partha De Nandita Chattopadhyay Published:February 13,

2019DOI:https://doi.org/10.1016/j.cegh.2019.01.014

Peanuts, Aflatoxins and Undernutrition in Children in

Sub-Saharan Africa

Abstract
Peanuts (Arachis hypogaea) is an important and affordable source of protein in most of
Sub-Saharan Africa (SSA) and a popular commodity and raw material for peanut butter,
paste and cooking oil. It is a popular ingredient for foods used at the point of weaning
infants from mother’s milk. It is at this critical point that childhood undernutrition occurs
and the condition manifests as stunting, wasting and growth restriction and accounts for
nearly half of all deaths in children under five years of age in SSA. Undernutrition is
multi-factorial but weaning foods contaminated with microbiological agents (bacteria and
fungi) and natural toxins have been shown to play a big part. While peanuts may
provide good nutrition, they are also highly prone to contamination with mycotoxigenic
fungi. The high nutritive value of peanuts makes them a perfect substrate for fungal
growth and potential aflatoxin contamination. Aflatoxins are highly carcinogenic and
mutagenic mycotoxins. This article reviews the nutritional value and aflatoxin
contamination of peanuts, the role they play in the development of childhood
malnutrition (including the different theories of aetiology) and immunological problems in
children. We also discuss the control strategies that have been explored and advocacy
work currently taking shape in Africa to create more awareness of aflatoxins and thus
combat their occurrence with the goal of reducing exposure and enhancing trade and
food safety. 

Mupunga I, Mngqawa P, Katerere DR. Peanuts, Aflatoxins and Undernutrition in

Children in Sub-Saharan Africa. Nutrients. 2017; 9(12):1287.
https://doi.org/10.3390/nu9121287

Local
Undernutrition in the Philippines : Scale, Scope, and
Opportunities for Nutrition Policy and
Programming
For nearly 30 years, the rates of both wasting and stunting in the Philippines have
been nearly flat. For 2019, the rate of stunting among children under five years of
age (28.8 percent) was only slightly lower than in 2008 (32 percent)—the prevalence
of underweight in 2019 was 19 percent and that of wasting was 6 percent. Based on
the World Health Organization’s classification of undernutrition rates, the stunting
prevalence of children in the Philippines is of “very high” public health significance.
The Philippines’ 29 percent stunting rate places it fifth among countries in the East
Asia and Pacific region, and among the top 10 countries globally. The Philippines’
high levels of childhood undernutrition can lead to a staggering loss of the country’s
human and economic potential. The burden on the Philippines’ economy brought
by childhood undernutrition was estimated at US$4.4 billion, or 1.5 percent of the
country’s GDP, in 2015. Undernutrition robs Filipino children of their chance at a
bright future. When viewed through the lens of the World Bank’s Human Capital
Index (HCI), the country’s 2020 HCI score of 0.52 predicts that the future
productivity of children born today will be 48 percent below what they might
achieve if they were to enjoy complete education and full health. Undernutrition in
the Philippines: Scale, Scope, and Opportunities for Nutrition Policy and
Programming presents a comprehensive, analytical work on this topic. It provides
evidence of why it is critical that the government of the Philippines prioritize
tackling this persistent challenge. The report assesses the determinants and causes
of childhood undernutrition and reviews current policies and programs directed at
addressing this problem. Based on these analyses, the report provides
recommendations of how national policies and programs can be strengthened to
reduce the high rates of undernutrition in the country. It sets out to inform the
debate on the causes and potential solutions of undernutrition while identifying
high-priority policies and policy commitments for action.

Citation
“Mbuya, Nkosinathi V.N.; Demombynes, Gabriel; Piza, Sharon Faye A.; Adona, Ann Jillian
V.. 2021.  Undernutrition in the Philippines : Scale, Scope, and Opportunities for
Nutrition Policy and Programming.  International Development in Focus;.  Washington,
DC: World Bank. © World Bank.
https://openknowledge.worldbank.org/handle/10986/35530 License: CC BY 3.0 IGO.”

LOCAL RRL
A Case Study on Undernutrition among Children under Five Years of Age in Barangay Calumpang,
Nagcarlan, Laguna

Abstract
Background. In 2020, Barangay Calumpang, a 2nd class municipality in Nagcarlan, Laguna recorded the
highest prevalence of undernutrition among children under five years of age out of the 52 barangays.

Objectives. This study was undertaken to describe the factors possibly causing undernutrition among
children under five years of age in Barangay Calumpang and provide key recommendations to improve
their nutritional status.

Methods. The study used a descriptive research design wherein secondary data from the 2020 Barangay
Management Information System (BMIS) and Operation Timbang (OPT) 2021 was merged to extract the
children's data. The Statistical Package for the Social Sciences (SPSS) was used for the principal
component analysis (PCA) and creation of the wealth index. The children’s nutrition situation and profile
were also cross-tabulated.

Results. We included 28 children. Undernutrition was more prevalent in boys than girls. Most of the
children had improved water sources, sanitation facilities, and waste disposal methods. The wealth
index showed that half of the subjects were in the lower quintiles, and all were partially immunized. The
most prevalent forms of undernutrition were severe underweight (36%) and severe stunting (39%).
Other forms of undernutrition were also present in the barangay, such as underweight (14%) and severe
wasting (14%). There was also a prevalence of 11% for both stunting and wasting.

Conclusion. Undernutrition was more frequent in boys, lower quintile households (stunting), and
partially immunized children. Conducting gender-targeted nutrition programs, developing nutrition-
focused livelihood programs, increasing awareness on the advantages of immunization, and promoting
proper infant and child feeding practices were some of the recommendations given to improve the
nutritional status of children under five.

Lanorio MCL, Salvo RST, Barrion ASA, Maneja MCP. A Case Study on Undernutrition among Children
under Five Years of Age in Barangay Calumpang, Nagcarlan, Laguna. Acta Med Philipp [Internet].
2022Mar.8 [cited 2022Oct.28];. Available from:
https://actamedicaphilippina.upm.edu.ph/index.php/acta/article/view/3970

Dietary risk factors of physical growth of Filipino school-aged

children

ABSTRACT
Background: Adequate nutrition during childhood is essential to promote child growth and
development.

Objective: The study evaluated the relationship of habitual nutrient intake and protein
adequacy to the prevalence of child malnutrition.

Methods: Data were derived from a nationally representative sample of children aged 6–12
years. Two nonconsecutive day 24-h dietary recalls (24hR) were collected to estimate the
individual food intake. PC-SIDE version 1.0 software (Software for Intake Distribution
Estimation) was used to estimate the habitual intake of key nutrients accounting for
between- and within-person differences in dietary intake. The 2007 WHO Protein
Digestibility Corrected Amino Acid Score (PDCAAS) method was used to measure the
protein quality or the utilizable protein intake. The nutritional status of the participants is
reflected in the weight-for-age, height-for-age, and body mass index (BMI)-for-age z-scores
using the WHO Growth Reference Standard (WHO, 2007).

Results: Undernourished school-aged children were found to have high protein

inadequacy. Higher consumption of grains and cereal products, meat, and high-quality
protein foods was associated with a lower risk of stunting. Higher intake of milk and milk
products, grains and cereal products, high-quality protein foods, calcium, riboflavin, and
vitamin C was associated with a lower risk of underweight. Higher consumption of grains
and cereal products, riboflavin, thiamine, and fiber was associated with a lower risk of
wasting. On the contrary, higher consumption of meat, milk and milk products, grains and
cereal products, high-quality protein foods, and vitamin C was associated with a higher risk
of obesity. Furthermore, linear growth of children was found to be associated with high-
quality protein foods, calcium, vitamin B12, vitamin C, and vitamin D.

Conclusions: Malnutrition among Filipino children is influenced by nutrient intakes.

However, the existence of malnutrition among children may be specifically attributed to the
quality of protein consumed. Therefore, the study suggests that nutrition interventions and
policies focusing on child malnutrition should improve not just the quantity but also the
quality of protein sources consumed by children to aid in proper growth and development.

Angeles-Agdeppa I., Nakamura T., Sugita M., Bangan Toledo M., Castillo Sampaga P., & Taruc
Zamora J. A. (2022). Dietary risk factors of physical growth of Filipino school-aged
children. Food & Nutrition Research, 66. https://doi.org/10.29219/fnr.v66.7873
Under-stunting the Child Nutrition Problem in the Philippines: Determining the Nutritional
Status and Severity of Undernutrition among Children Aged 0-5 years old using Binary Logistic
Regression, and Adjacent-Categories Logit Models
ABSTRACT In the Philippines, undernutrition is a multifaceted issue that can be affected by basic
causes at the social level, underlying causes at the household level, and immediate causes as
illustrated in the UNICEF conceptual framework for undernutrition. Undernutrition may restrict
an individual’s physical and intellectual capacity, which may negatively impact the economy. In
this study, household characteristics, maternal factors, and individual traits were considered.
The data was obtained from the 2013 National Nutrition Survey of the DOST-FNRI. This study
utilized a logistic regression model to understand the factors that may affect the occurrence of
stunting among children aged 0 to 5 years. Adjacent-categories logit model was also used to
determine the significant factors that influence their severity. Results show that older children
and male children are more likely to be undernourished. Larger households tend to have more
undernourished children with higher severity, while children coming from households
belonging to higher wealth quintiles are less likely to be stunted or be at-risk of being stunted.
Nutrition programs should also be complemented with educational programs since higher
educational attainment among mothers affects knowledge and practices on child care.
Furthermore, livelihood programs should be strengthened to improve maternal employment,
and, consequently, raise household income. The models on stunting did not only uncover its
determinants but also the factors at various levels of severity.

Alcantara, John Michael Mirabueno, Claudine Gabrielle Narrajos, Tommy

Jairushttps://psa.gov.ph/sites/default/files/5.2.2%20Determining%20the%20Nutritional
%20Status%20and%20Severity%20of%20Undernutrition%20Among%20Children%20Aged
%200-5%20Years%20Old%20Using%20Binary%20L.pdf?
fbclid=IwAR2kxy6XVZZN5dhpP0Tf8v4jksgdye5tyYSDnZjElkp8hyEZFSHgRAA-1v8

Nutrition in the new normal

By Dr. Pilar “Lalay” Ramos Jimenez

July 17, 2022

https://www.manilatimes.net/2022/07/17/opinion/columns/nutrition-in-the-new-normal/1851208?
fbclid=IwAR2akqdK_U6q1k5nMFziLnRls7VrTzOBNzYhX6gUrAHHc0c5KHD3-2MaUJI
JULY is the Philippines' national nutrition month, and it aims to raise greater awareness among Filipinos
about malnutrition prevention and the importance of healthy eating habits. This celebration began 48
years ago after the creation of the National Nutrition Council (NNC) through the issuance of Presidential
Decree 491 in June 1974. The NNC was given the responsibility of supervising, coordinating and
evaluating the country's nutrition program for all government and private agencies. It also spearheads the
nationwide nutrition campaign with annual themes that promote healthy diets that are essential for human
growth and development. This year's theme is "New normal na nutrisyon, sama-samang gawan ng
solusyon!" (New normal nutrition, together we find solutions!). This theme, according to the NNC, "calls
for strengthened nutrition interventions and solidarity toward nutrition improvement as the country shifts
toward living with the Covid-19 virus." Prior to the pandemic, what was the nutritional status in the
country, especially among children younger than 5 years old?

Let us draw from the Food and Nutrition Research Institute (FNRI) pre-pandemic National Nutrition
Survey (NNS) results from 1989 to 2019 (the June 2021 World Bank (WB) comprehensive report noted
that in the past three decades, there is almost no improvement in the prevalence of undernutrition in the
Philippines). The 2019 FNRI NNS showed that 1 in 3 children (29 percent) below 5 years old were
stunted, or "small in size for their age." Nineteen percent were underweight or below the expected weight
for their age, while 6 percent of children under 5 years of age were identified as "wasted," or underweight
for their height. The Philippines "ranked fifth among countries in the East Asia and Pacific region with
the highest prevalence of stunting and is among the 10 countries globally with the highest number of
stunted children," indicating that stunting is a major public health issue in our country.

Stunting is the most important indicator of child malnutrition because it is the result of prolonged
undernutrition. This occurs in the first 1,000 days of human life (i.e., from conception until the age of 2),
because if the height growth and brain development were not achieved during this period, it is, according
to the June 2021 World Bank report, "irrecoverable and is associated with measurable negative
consequences for health, impaired cognitive development, reduced earnings in adulthood and increased
risk of developing chronic diseases."

There are also disparities in the prevalence of stunting among children below five years old across
Philippine regions (2015 FNRI NNS). The poorer regions and those which are populated by indigenous
people and Moros, tend to have higher prevalence of stunting. The Bangsamoro Autonomous Region in
Muslim Mindanao (BARMM) had the highest number of stunted children (45 percent), followed by
Mimaropa (41 percent), Bicol Region (40 percent), Western Visayas (40 percent) and Soccsksargen (40
percent). Five of the top 10 regions with high proportions of stunted young children were from Mindanao.
Aside from BARMM and Soccsksargen, the three areas are Zamboanga Peninsula, Northern Mindanao
and Caraga.

  

The 2019 NNS showed that many under 5-year-old children also suffer from "hidden hunger," a type of
malnutrition that is triggered by lack of important vitamins and minerals (micronutrients) in the diet
particularly Vitamin A, iron, zinc, folic acid and iodine. One fifth of pregnant women suffers from
anemia.