Prevalence and determinants of stunting in a conflict-ridden border region in Armenia - a cross-sectional study
Tóm tắt
Despite global efforts, stunting remains a public health problem in several developing countries. The prevalence of stunting among 0- to 5-year-old children in Armenia has increased from 17% in 2000 to 19% in 2010. A baseline study was conducted among preschool children in Berd, a region near the northeastern border of Armenia that has experienced intermittent military tension for over 20 years. We conducted a cross-sectional study including 594 children aged 6-month- 6 years old and their caregivers in our analysis, to assess the prevalence and determinants of stunting. We calculated the anthropometric measurements and hemoglobin levels of children; analyzed children’s stool and conducted a survey with children’s caregivers. We employed the hierarchical logistic regression model to explore the predictors of stunting among 25–72 months old children and multivariable logistic regression models to investigate the predictors of stunting among 6–24 months old children. Individual and residence level variables were included in the models including anemia, minimum dietary diversity, mothers’ height, the overall duration of breastfeeding, birthweight, child’s history of diarrhea and mean socio-economic score. The prevalence of stunting was significantly higher among the 6–24 months old children (13.3%) compared to the children aged 25–72 months old (7.8%). We did not find any differences in the prevalence of stunting by place of residence in either age group. The 6–24 months old children who consumed at least four food groups during the previous day (minimum dietary diversity) had 72% lower odds of being stunted (p < 0.05). Each kilogram increase in birthweight was associated with 76% lower odds of being stunted (OR = 0.24, p < 0.01). Mother’s height significantly decreased the odds of stunting among the children 25–72- months old (OR = 0.86, p < 0.001). BMI was also a significant predictor of stunting among both age-groups. The study results highlight the significance of mother’s height, birthweight, and adequate complementary feeding to reduce stunting. Further studies are needed to determine the possible association of anemia and stunting with the ongoing conflict in the region, as well as socioeconomic conditions and food insecurity in the region.
Tài liệu tham khảo
Ghobarah HA, Huth P, Russet B. Civil wars kill and maim people-long after the shooting stops. Am Pol Sci Rev. 2003;97(2):189–202.
Roberts L, Lafta R, Garfield R, Khudhairi J, Burnham G. Mortality before and after the 2003 invasion of Iraq: cluster sample survey. Lancet (Lond Engl). 2004;364(9448):1857–64.
Coghlan B, Brennan RJ, Ngoy P, Dofara D, Otto B, Clements M, et al. Mortality in the Democratic Republic of Congo: a nationwide survey. Lancet (Lond Engl). 2006;367(9504):44–51.
Ghazi HF, Mustafa J, Aljunid S, Isa Z, Abdalqader MA. Malnutrition among 3 to 5 years old children in Baghdad city, Iraq: a cross-sectional study. J Health Popul Nutr. 2013;31(3):350–5.
Guerrero-Serdán G. The effects of the war in Iraq on nutrition and health: an analysis using anthropometric outcomes of children: Royal Holloway College, University of London; 2009.
Unicef. Malnutrition a silent threat emerging among Syrian refugee children in Lebanon: UNICEF; 2015.
Gordon B, Mackay R, Rehfuess E. Inheriting the world: the atlas of Children's Healthand the environment: World Health Organization 2004.
de Onis M, Borghi E, Blössner M. Levels & Trends in child malnutrition 2012. Report No.: 978 92 4 150451 5.
United Nations. The sustainable development goals report 2016. Report No.: 978-92-1-101284-2.
World Health Organization. Nutrition 2014.
Borja JB. The impact of early nutrition on health: key findings from the Cebu longitudinal health and nutrition survey (CLHNS). Malays J Nutr. 2013;19(1):1–8.
Broilo MC, Louzada ML, de Lourdes DM, Stenzel LM, Vitolo MR. Maternal perception and attitudes regarding healthcare professionals’ guidelines on feeding practices in the child's first year of life. J Pediatr (Rio J). 2013;89(5):485–91.
Deshmukh PR, Sinha N, Dongre AR. Social determinants of stunting in rural area of Wardha, Central India. Med J Armed Forces India. 2013;69(3):213–7.
Gyorkos TW, Maheu-Giroux M, Casapia M, Joseph SA, Creed-Kanashiro H. Stunting and helminth infection in early preschool-age children in a resource-poor community in the Amazon lowlands of Peru. Trans R Soc Trop Med Hyg. 2011;105(4):204–8.
Lawan UM, Amole GT, Jahum MG, Sani A. Age-appropriate feeding practices and nutritional status of infants attending child welfare clinic at a teaching Hospital in Nigeria. J Family Community Med. 2014;21(1):6–12.
National Statistical Service, Ministry of Health, O. C. Macro. Armenian demographic and health survey 2010.
Bukusuba J, Kaaya AN, Atukwase A. Predictors of Stunting in Children Aged 6 to 59 Months: A Case-Control Study in Southwest Uganda. Food and nutrition bulletin. 2017;38(4):542–53. doi:10.1177/0379572117731666.
Rannan-Eliya RP, Hossain SM, Anuranga C, Wickramasinghe R, Jayatissa R, Abeykoon AT. Trends and determinants of childhood stunting and underweight in Sri Lanka. Ceylon Med J. 2013;58(1):10–8.
Rohner F, Woodruff BA, Aaron GJ, Yakes EA, Lebanan MA, Rayco-Solon P, et al. Infant and young child feeding practices in urban Philippines and their associations with stunting, anemia, and deficiencies of iron and vitamin a. Food Nutr Bull. 2013;34(2 Suppl):S17–34.
Simeon DT, Grantham-McGregor SM, Callender JE, Wong MS. Treatment of Trichuris trichiura infections improves growth, spelling scores and school attendance in some children. J Nutr. 1995;125(7):1875–83.
Talapalliwar MR, Garg BS. Nutritional status and its correlates among tribal children of Melghat, Central India. Indian J Pediatr. 2014;81(11)1151–57.
Udoh EE, Amodu OK. Complementary feeding practices among mothers and nutritional status of infants in Akpabuyo area, Cross River state Nigeria. Springer Plus. 2016;5(1):2073. doi: 10.1186/s40064-016-3751-7.
Esfarjani F, Roustaee R, Mohammadi F, Esmaillzadeh A. Determinants of stunting in school-aged children of tehran, iran. Int J Prev Med. 2013;4(2):173–9.
Mukhopadhyay K, Louis D, Mahajan G, Mahajan R. Longitudinal growth and post-discharge mortality and morbidity among extremely low birth weight neonates. Indian Pediatr. 2014;51(9):723–6.
Przyrembel H. Timing of introduction of complementary food: short- and long-term health consequences. Ann Nutr Metab. 2012;60(Suppl 2):8–20. doi:10.1159/000336287.
Underwood BA, Hofvander Y. Appropriate timing for complementary feeding of the breast-fed infant. A review. Acta Paediatr Scand Suppl. 1982;294:1–32.
Hanieh S, Ha TT, De Livera AM, Simpson JA, Thuy TT, Khuong NC, et al. Antenatal and early infant predictors of postnatal growth in rural Vietnam: a prospective cohort study. Arch Dis Child. 2014;
Boylan S, Mihrshahi S, Louie JCY, Rangan A, Salleh HN, Md Ali HI et al. Prevalence and Risk of Moderate Stunting Among a Sample of Children Aged 0-24 Months in Brunei. Maternal and child health journal. 2017;21(12):2256–66. doi:10.1007/s10995-017-2348-2.
Ndukwu CI, Egbuonu I, Ulasi TO, Ebenebe JC. Determinants of undernutrition among primary school children residing in slum areas of a Nigerian city. Niger J Clin Pract. 2013;16(2):178–83. doi:10.4103/1119-3077.110142.
Hovhannisyan L, Demirchyan A, Petrosyan V. Estimated prevalence and predictors of undernutrition among children aged 5-17 months in Yerevan. Armenia Public Health Nutr. 2014;17(5):1046–53.
USA Embassy in Republic of Armenia. Increased tension in border areas. 2014.
Armenian News Tert am. Border tensions not something new in Tavush, says regional governor 2014.
Civilnet. Azerbaijani infiltration attempt in Tavush, reports of casualties 2015.
Wagstaff A. Child health on a dollar a day: some tentative cross-country comparisons. Soc Sci Med. 2003;57(9):1529–38. doi:10.1016/S0277-9536(02)00555-5.
Cattaneo A, Timmer A, Bomestar T, Bua J, Kumar S, Tamburlini G. Child nutrition in countries of the commonwealth of independent states: time to redirect strategies? Public Health Nutr. 2008;11(12):1209–19.
Daniel WW, Cross CL. Biostatistics: a Foundation for Analysis in the health sciences. New York: Wiley; 1999.
Pourhoseingholi MA, Vahedi M, Rahimzadeh M. Sample size calculation in medical studies. Gastroenterol Hepatol. 2013;6(1):14–7.
Andresen E, Bilukha OO, Menkir Z, Gayford M, Kavosa M, Wtsadik M, et al. Notes from the field: malnutrition and elevated mortality among refugees from South Sudan - Ethiopia, June-July 2014. MMWR Morb Mortal Wkly Rep. 2014;63(32):700–1.
Deribew A, Alemseged F, Tessema F, Sena L, Birhanu Z, Zeynudin A, et al. Malaria and under-nutrition: a community based study among under-five children at risk of malaria, south-west Ethiopia. PLoS One. 2010;5(5):e10775.
Food and Drug Administration United States of America. Substantially equivalent 510(k) device information. Food and drug Administrarion United States of America. 2009.
Morris LD, Osei-Bimpong A, McKeown D, Roper D, Lewis SM. Evaluation of the utility of the HemoCue 301 haemoglobinometer for blood donor screening. Vox Sang. 2007;93(1):64–9.
Montresor A, Crompton DWT, Hall A, Bundy DAP, Savioli L. Guidelines for the evaluation of soil-transmitted helminthiasis and schistosomiasis at community level. Geneva: World Health Organization | Division of Control of Tropical Diseases; 1998.
World Health Organization. Training manual of diagnosis of intestinal parasites: World Health Organization; 2004.
World Health Organization. Indicators for assessing infant and young child feeding practices World Health Organization: Dept. of Child and Adolescent Health and Development; 2007.
Report of a W. H. O. Expert Committee. Physical status: the use and interpretation of anthropometry. Geneva: World Health Organization; 1995.
World Health Organization. Haemoglobin concentrations for thediagnosis of anaemia and assessment of severity. Geneva: World Health Organziation; 2011.
Hosmer D, Lemeshow S. Applied logistic regression. New York: Wiley-Interscience; 2000.
Gat-Yablonski G, Pando R, Phillip M. Nutritional catch-up growth. World Rev Nutr Diet. 2013;106:83–9.
Mosby's Medical D. catch-up growth 2015.
Marriott BP, White A, Hadden L, Davies JC, Wallingford JC. World Health Organization (WHO) infant and young child feeding indicators: associations with growth measures in 14 low-income countries. Matern Child Nutr. 2012;8(3):354–70.
Zongrone A, Winskell K, Menon P. Infant and young child feeding practices and child undernutrition in Bangladesh: insights from nationally representative data. Public Health Nutr. 2012;15(9):1697–704.
Cobayashi F, Augusto RA, Lourenco BH, Muniz PT, Cardoso MA. Factors associated with stunting and overweight in Amazonian children: a population-based, cross-sectional study. Public Health Nutr. 2014;17(3):551–60.
Correia LL, Silva AC, Campos JS, Andrade FM, Machado MM, Lindsay AC, et al. Prevalence and determinants of child undernutrition and stunting in semiarid region of Brazil. Rev Saude Publica. 2014;48(1):19–28.
Pedraza DF, Menezes TN. Risk factors of stunting in preschool children: a case-control study. Cien Saude Colet. 2014;19(5):1495–502.
Bates K, Gjonça A, Leone T. Double burden or double counting of child malnutrition? The methodological and theoretical implications of stuntingoverweight in low and middle income countries. J Epidemiol Community Health. 2017; doi:10.1136/jech-2017-209008.
Fernald LC, Neufeld LM. Overweight with concurrent stunting in very young children from rural Mexico: prevalence and associated factors. Eur J Clin Nutr. 2007;61(5):623–32. doi:10.1038/sj.ejcn.1602558.
Mamabolo RL, Alberts M, Steyn NP, Delemarre-van de Waal HA, Levitt NS. Prevalence and determinants of stunting and overweight in 3-year-old black South African children residing in the Central Region of Limpopo Province, South Africa. Public Health Nutr 2005;8(5):501-508.
Pettifor JM. Combined stunting and overweight in young children – a paradox? S Afr J Clin Nutr. 2006;19(3):98–100.
Said-Mohamed R, Bernard JY, Ndzana AC, Pasquet P. Is overweight in stunted preschool children in Cameroon related to reductions in fat oxidation, resting energy expenditure and physical activity? PLoS One. 2012;7(6):e39007. doi:10.1371/journal.pone.0039007.
Felisbino-Mendes MS, Villamor E, Velasquez-Melendez G. Association of maternal and child nutritional status in Brazil: a population based cross-sectional study. PLoS One. 2014;9(1):e87486.
Keino S, Plasqui G, Ettyang G, van den Borne B. Determinants of stunting and overweight among young children and adolescents in sub-Saharan Africa. Food Nutr Bull. 2014;35(2):167–78.
Chesire EJ, Orago AS, Oteba LP, Echoka E. Determinants of under nutrition among school age children in a Nairobi peri-urban slum. East Afr Med J. 2008;85(10):471–9.
Wamani H, Åstrøm AN, Peterson S, Tumwine JK, Tylleskär T. Boys are more stunted than girls in sub-Saharan Africa: a meta-analysis of 16 demographic and health surveys. BMC Pediatr. 2007;7:17. doi:10.1186/1471-2431-7-17.
Elsmen E, Hansen Pupp I, Hellstrom-Westas L. Preterm male infants need more initial respiratory and circulatory support than female infants. Acta Paediatr. 2004;93(4):529–33.
Kilbride HW, Daily DK. Survival and subsequent outcome to five years of age for infants with birth weights less than 801 grams born from 1983 to 1989. J Perinatol: official journal of the California Perinatal Association. 1998;18(2):102–6.
Demirchyan A, Petrosyan V, Sargsyan V, Hekimian K. Predictors of stunting among children aged 0-59 months in a rural region of Armenia: a case-control study. J Pediatr Gastroenterol Nutr. 2015;
Ikeda N, Irie Y, Shibuya K. Determinants of reduced child stunting in Cambodia: analysis of pooled data from three demographic and health surveys. Bull World Health Organ. 2013;91(5):341–9.
Paudel R, Pradhan B, Wagle RR, Pahari DP, Onta SR. Risk factors for stunting among children: a community based case control study in Nepal. Kathmandu Univ Med J (KUMJ). 2012;10(39):18–24.
Richard SA, Black RE, Gilman RH, Guerrant RL, Kang G, Lanata CF, et al. Catch-up growth occurs after diarrhea in early childhood. J Nutr. 2014;144(6):965–71.