thesis title about malnutrition

78 Malnutrition Essay Topic Ideas & Examples

🏆 best malnutrition topic ideas & essay examples, 👍 simple & easy malnutrition essay titles, 🎓 good research topics about malnutrition, ❓ research question about malnutrition.

Malnutrition: Major Risk Factors and Causes The normal functioning of body organs is something that requires an adequate amount of mineral salts, fluids, and nutrients that are derived from different food materials. The purpose of this paper, therefore, is to analyze […]
Healthy Nutrition: Case Study of Malnutrition Sofia’s possible malnutrition might be owing to her demanding schedule and lack of prenatal care, which is an important part of a healthy pregnancy.
Malnutrition in Hospitalized Patients: Intended and Potential Outcomes Furthermore, there is a chance that the patients will be able to determine malnutrition at its early stages and inform nurses about the problem. As a result, a rise in the number of positive patient […]
Malnutrition in South Africa: Public Health Policy The global food systems are highly dysfunctional, creating malnutrition crises in certain parts of the world which are the primary cause of death and disease.
Malnutrition: Criteria and Description of Statement of the Problem Between adequate nutrition programs and malnutrition primary prevention programs, what approach is the most effective to enhance children’s development? What are the dissimilarities between adequate nutrition programs and malnutrition primary prevention programs?
Obesity and Malnutrition: Who Is at Fault I would like to note that in both the interview and the article Nestle states that malnutrition is not only the responsibility of the consumers.
Child Malnutrition in the GCC Countries Countries which have faired badly in the recent past include Kuwait and Qatar which saw an increase in their child malnutrition rates from 5% in the 1990s to 10% in the mid-2000s.
Child Malnutrition: Term Definition Majority of the people in the globe specifically in the rural areas do not have access to safe drinking water and most of them lack the access of good sanitation.
The Issues of Malnutrition and the Healing Process The issues of malnutrition and the healing process are regarded in lots of journals and scientific literature. The nutritional status of the patient previous to and after a surgical procedure is significant for speedy and […]
Integrated Nursing Practice Addressing Malnutrition The benefits of the specified intervention include an opportunity to reduce the extent of stress experienced by the patient and create the basis for the future patient education.
Malnutrition in Children as a Global Health Issue The peculiarity of this initiative is not to support children and control their feeding processes but prevent pediatric malnutrition even before a child is born.
Early Enteral Nutrition to Prevent Malnutrition The choice of the method depends on the state of a patient, his/her disease, and the peculiarities of the health problem that should be solved at the moment.
Accelerating Progress Toward Reducing Child Malnutrition in India
Addressing Chronic Malnutrition Through Multi-Sectoral, Sustainable Approaches
Addressing the Double Burden of Malnutrition in ASEAN
Battle Against Starvation and Malnutrition
Behaviors Associated With Child Malnutrition
Childhood Malnutrition and Schooling in the Terai Region of Nepal
Chronic Malnutrition and Its Effects on Children
Closing the Rural-Urban Gap in Child Malnutrition: Evidence From Paraguay
Child Malnutrition and Antenatal Care: Evidence From Three Latin American Countries
Combating Child Chronic Malnutrition and Anemia in Peru
Death From Stroke During the Danish Malnutrition Period 1999-2007
Comparing Peri-Urban Versus Rural Poverty and Child Malnutrition Reduction
Deforestation and Household- And Individual-Level Double Burden of Malnutrition in Sub-Saharan Africa
Combining Insights From Quantile and Ordinal Regression: Child Malnutrition in Guatemala
Child Malnutrition and Poverty: The Case of Pakistan
Developing Countries Suffer From Poverty and Malnutrition
Diets, Malnutrition, and Disease: The Indian Experience
Child Malnutrition and Mortality in China and Vietnam in a Comparative Perspective
Effects of Parental Education on Malnutrition Among Children in Brazil
How Hunger and Malnutrition Influence the Health and Development of Communities
Child Malnutrition and the Provision of Water and Sanitation in the Philippines
Linking Economic Growth and Child Malnutrition in Egypt
Economic Growth, Poverty, and Malnutrition in India
Child Malnutrition, Social Development, and Health Services in the Andean Region
Ending Malnutrition: From Commitment to Action
Environmental Factors and Children’s Malnutrition in Ethiopia
Children’s Malnutrition and Horizontal Inequalities in Sub-Saharan Africa
Difference Between Undernutrition and Malnutrition
The Impact of Public Expenditure on Child Malnutrition in Peru
Factors Affecting the Prevalence of Malnutrition
Fetal Malnutrition and Academic Success: Evidence From Muslim Immigrants in Denmark
Fighting Poverty and Child Malnutrition: On the Design of Foreign Aid Policies
Factors Influencing the Occurrence of Malnutrition Health and Social Care
An Opportunity to Minimize Malnutrition and Hunger in Developing Countries
Geography and Culture Matter for Malnutrition in Bolivia
Household and Community HIV/AIDS Status and Child Malnutrition in Sub-Saharan Africa
Hunger and Malnutrition Are a Problem Everywhere
Identifying Risk Factors for Severe Childhood Malnutrition by Boosting Additive Quantile Regression
Inequality, Hunger, and Malnutrition: Power Matters
Hunger, Malnutrition and Millennium Development Goals: What Can Be Done
What Happens to Your Body Durimg Malnutrition?
What Causes Malnutrition?
What Is the Treatment for Malnutrition?
How Long Does It Take To Recover From Malnutrition in Adults?
How Do Doctors Test for Malnutrition?
What Is the Largest Reason for Malnutrition?
How Do Doctors Diagnose Malnutrition?
How Long Can You Live With Malnutrition?
Which Medicine Is Best for Malnutrition?
What Drugs Cause Malnutrition?
Can Blood Test Detect Malnutrition?
What Bloodwork Shows Malnutrition?
What Are the Most Common Signs of Malnutrition?
How Is Malnutrition Best Managed?
What Social Factors Cause Malnutrition?
What Are the Long Term Effects of Malnutrition?
What Are Immediate Cause of Malnutrition?
What Is the Best Way for Early Detection of Malnutrition?
What Are the Complications of Malnutrition?
How Is Severe Malnutrition Diagnosed?
What Infection Causes Malnutrition?
What Are the Diseases Caused by Malnutrition?
How Is Malnutrition Treated in Adults?
How Does Malnutrition Affect the Brain in Adults?
Can You Get Brain Damage From Malnutrition?
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Empirical studies of factors associated with child malnutrition: highlighting the evidence about climate and conflict shocks

Original Paper
Open access
Published: 21 May 2020
Volume 12 , pages 1241–1252, ( 2020 )

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Molly E. Brown ORCID: orcid.org/0000-0001-7384-3314 1 ,
David Backer 2 ,
Trey Billing 2 ,
Peter White 3 ,
Kathryn Grace 4 ,
Shannon Doocy 5 &
Paul Huth 2

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Children who experience poor nutrition during the first 1000 days of life are more vulnerable to illness and death in the near term, as well as to lower work capacity and productivity as adults. These problems motivate research to identify basic and underlying factors that influence risks of child malnutrition. Based on a structured search of existing literature, we identified 90 studies that used statistical analyses to assess relationships between potential factors and major indicators of child malnutrition: stunting, wasting, and underweight. Our review determined that wasting, a measure of acute malnutrition, is substantially understudied compared to the other indicators. We summarize the evidence about relationships between child malnutrition and numerous factors at the individual, household, region/community, and country levels. Our results identify only select relationships that are statistically significant, with consistent signs, across multiple studies. Among the consistent predictors of child malnutrition are shocks due to variations in climate conditions (as measured with indicators of temperature, rainfall, and vegetation) and violent conflict. Limited research has been conducted on the relationship between violent conflict and wasting. Improved understanding of the variables associated with child malnutrition will aid advances in predictive modeling of the risks and severity of malnutrition crises and enhance the effectiveness of responses by the development and humanitarian communities.

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1 Introduction

Malnutrition is preventable, yet remains a major public health challenge. This condition affects one in five children and contributes to nearly half of all deaths during childhood globally (Black et al. 2013 ). Children who have poor nutrition during their first 1000 days of life attain lower levels of education and have lower work capacity and productivity as adults. Malnourished children also face increased likelihoods of being overweight, of developing chronic illnesses such as cardiovascular disease, diabetes and cancer, and of suffering from mental health issues later in life (Haddad et al. 1994 ; Hoddinott et al. 2013 ). After having suffered of malnutrition during early childhood, girls face increased likelihoods of having children that are born too early or underweight (UNSCN 2010 ).

Given the serious repercussions for survival, health, and well-being, anticipating and addressing the circumstances under which children become malnourished is vital. Various development and humanitarian interventions focus on fostering healthy communities where children are better protected and able to recover from nutrient deficits (Collins et al. 2006 ). To facilitate those interventions, assessments of food security conducted by organizations such as the Famine Early Warning Systems Network (FEWS NET) and the Integrated Food Security Phase Classification (IPC) initiative have sought to project the future status of at-risk countries and issue alerts about impending and ongoing crises months in advance, aiming to ensure enough lead time for the coordination and implementation of appropriate responses (Brown et al. 2007 ; Funk et al. 2019 ; IPC 2012 ). Assessments that focus on early warning have advantages relative to relying on measuring the prevalence of malnutrition in a community, which can detect a crisis only after it emerges (Maxwell et al. 2020 ). Assessments such as FEWS NET and IPC, however, do not gauge, much less substantiate, associations between malnutrition at an individual level and relevant factors. Statistically modelling these empirical relationships is integral to detecting vulnerabilities, diagnosing their sources, and directing assistance.

In this article, we consolidate what has been learned from published studies that used statistical analysis of empirical data to examine relationships between malnutrition among children and a large array of individual-, household-, community-, regional- and national-level variables. Our literature review is guided by two main questions: (1) Which variables were consistently associated with child malnutrition? (2) What types of quantitative empirical data and statistical methods have been used to analyse the nature of the relationship between these variables and child malnutrition? Answering these questions results in a summary of drivers of malnutrition, clarifies the strengths and limitations of existing studies, and suggests potential directions for further research, which may include a formal meta-analysis.

Our review considers studies in which the outcomes of interest included at least one of three major indicators of malnutrition, formalized in international standards (WHO 2020 ). Wasting (low weight for height) indicates an acute decline in nutritional status experienced by a normally well-nourished child. This decline usually involves rapid and substantial weight loss. Stunting (low height for age), by contrast, indicates a chronic, long-term nutritional deficit, the effects of which are potentially irreversible (Kennedy et al. 2015 ). Children who suffer wasting regularly over time may also develop stunting (Hoddinott et al. 2008 ). Underweight (low weight for age), on the other hand, can reflect wasting, stunting, or both (WHO 2010 ).

The breadth of our review provides a more expansive picture of the findings from the empirical research about malnutrition, according to statistical modelling of quantitative data. In the process, we can compare the state of knowledge about factors associated with the different indicators of malnutrition. Our expectation is that the findings of the review will improve awareness of which factors yield consistent findings and emphasize how particular relationships can vary across different measures of malnutrition.

At the same time, we have a specific interest in the variables associated with wasting. The acute nature of this condition presents a distinct challenge in practice. Prompt, effective interventions, with the potential to mitigate the risk of wasting, depend on the existence of reliable guidance about factors that tend to be associated with changes in individuals’ nutritional status in the short term. Insights from such a review may help inform interventions that are focused on reversing weight loss trajectories in children before malnutrition becomes a persistent condition.

Finally, we spotlight the role of external shocks experienced by individuals, households and communities, especially those caused by exposures to environmental and societal forces. Disasters due to climate extremes (e.g., drought) and violent conflict (e.g., civil war) are regularly attributed as the primary causes – acting independently and in interaction – of crises such as famines resulting in prevalence spikes in the rate of acute malnutrition. The urgency of understanding the role of these shocks has been magnified as complex emergencies are becoming more common and lasting longer (Lautze and Raven-Roberts 2006 ; Young et al. 2004 ). Policies resulting in timely action are needed to reduce the impact of these crises on children, families, and the communities in which they live (Ghobarah et al. 2003 ; Hillbruner and Moloney 2012 ).

We start by presenting the methods we used to isolate and code relevant studies that were included in our review. Next, we summarize the results of our review. In the concluding section, we discuss the results in the context of the broader literature, with particular attention to studies about the relationship between malnutrition and climate extremes, conflict events, and their interactions.

We conducted a search of the American Economic Association’s EconLit database in January 2019. EconLit indexes six types of materials: journal articles, books, book chapters, dissertations, working papers, and book reviews. The coverage features nearly 1 million articles from over 1000 journals published in 74 countries, dating from 1969 to the present ( https://www.aeaweb.org/econlit/content ). Many of the topics covered by the material indexed in EconLit relate to child malnutrition, including Health and Economic Development (JEL code I15), Health and Inequality (JEL code I14), Health, Government Policy, and Regulation (JEL code I16), Welfare, Wellbeing and Poverty (JEL code I3), Fertility, Family Planning, Child Care, Children, and Youth (JEL code J13), Agricultural Economics (JEL code Q1), and Renewable Resources and Conservation (JEL code Q2) (see http://www.aeaweb.org/econlit/jelCodes.php for a complete list of topics covered by EconLit). We sought to identify articles indexed by EconLit that quantitatively assess potential factors, with explicit statistical tests, in relation to child malnutrition. We therefore conducted separate searches using “malnutrition,” “wasting,” “wasted,” “stunting,” “stunted,” “underweight,” and “undernourishment” as key words. In addition, we paired each of these key words with “child” when conducting searches. In total, the searches yielded a set of 688 articles.

Within this set, we then selected articles relevant to our review. We therefore searched for any mentions of “child wast*” (166 articles), “child stunt*” (104 articles), and “child under*” (39 articles) in the article titles and abstracts. Certain articles referenced multiple search terms. We thus selected 209 potentially relevant articles. Finally, we scanned the titles and abstracts of these remaining articles with the following criteria:

use of quantitative and/or numerically coded qualitative data within a statistical analysis.

dependent variable(s) in the analysis must be some variant(s) of child malnutrition.

testing of statistical relationship between child malnutrition and one or more independent variables.

Some of the reasons for excluding articles include:

article not published in an English-language academic journal (for reasons of feasibility in conducting the review).

title and/or abstract indicating that the study is unrelated to our review (e.g., food waste).

title and/or abstract indicating that the study is peripheral to our objective (e.g., global narratives regarding child health).

title and/or abstract not mentioning quantitative data analysis.

quantitative analysis referred to in abstract concerning adult malnutrition Articles evaluating adult nutrition (e.g., of the mother during pregnancy) as a factor for child malnutrition were retained.

quantitative analysis referred to in title and/or abstract concerning not concerning relationships between child nutrition prevalence and any of its factors.

quantitative analysis referred to in the title and/or abstract considering child malnutrition as an independent, and not a dependent variable.

Our approach using the inclusion and exclusion criteria yielded a sample of 61 articles from EconLit.

We further augmented the sample with 29 articles from beyond the EconLit database. These additional articles: (1) cited articles from the EconLit sample, (2) were cited by those articles, and/or (3) involved authors of those articles. All the additional articles satisfied the inclusion and exclusion criteria stated above. The final sample therefore consists of a total of 90 articles (see supplementary Table S 1 for details).

2.1 Coding of article variables

Information pertaining to each article was coded according to the following: the data used (location, timing, panel vs. cross-section, sample size); statistical methods of analysis; and the dependent and independent variables considered. Only the main statistical results in a given article were coded; other results (e.g., exploratory subgroup tests, robustness checks, and sensitivity analyses) were not included. Dependent variables were grouped into three categories: wasting (W, continuous weight-for-height z-score and/or binary indicator for wasted), stunting (S, continuous height-for-age z-score and/or binary indicator for stunted), and underweight (U, continuous weight-for-age z-score and/or binary indicator for underweight) (de Onis and Blössner 2003 ). Each combination of a dependent variable and an independent variable in a given article was coded with both the sign and the level of reported statistical significance of the relationship as evaluated in the analysis. Most of the reviewed studies focus on the sign of relationships; few studies pay close attention to the magnitude of effect sizes. P -values were not always reported in all articles, reflecting differences in standards across journals and fields. The coding categorized each relationship as significant if the p value was smaller than or equal to 0.05. These instances were marked as 1. All other instances were marked as 0. The coding also noted instances of p -values less than (or equal to) 0.01 and 0.001 (supplementary materials; (Finlay and Agresti 1986 )). Supplementary Table S 2 provides a list of all variables reported in all 90 reviewed articles, along with their reported statistical significance.

Across the sample of reviewed studies, more than 300 independent variables were found. Independent variables about the same factor, even if operationalized differently, were consolidated into a factor category to facilitate comparison across studies (Phalkey et al. 2015 ). Supplementary Table S 3 lists all variables analysed in the reviewed studies that comprise our factor categories, and which papers they came from.

The findings of the studies included in our review enabled each factor to be characterized as follows:

Risk factor – a majority of reviewed studies examining a given type of malnutrition report a significant ( p ≤ 0.05) positive relationship with the independent variables (i.e., a greater extent or probability of malnutrition as a function of increasing values of the independent variable).

Mitigating factor – a majority of reviewed studies examining a given type of malnutrition report a significant (p ≤ 0.05) negative relationship with the independent variables (i.e., a lower extent or probability of malnutrition as a function of increasing values of the independent variable).

Inconclusive factor – a majority of studies examining a given type of malnutrition report either an inconsistent sign of the relationship with the independent factor, or a relationship that is not statistically significant ( p > 0.05).

In order to facilitate comparison and the policy and other practical applications of the analysis, factors were grouped according to the scale they concern: child, household, region/community, or country (Smith et al. 2005 ).

Relationships between a given type of malnutrition and a given factor may have been evaluated in only one study. While all relationships appearing in the main statistical analysis of each study were coded and documented (Table S2 ), only factors evaluated in multiple studies were reported in the results. All studies were treated equally, regardless of scope, scale of the analysis, magnitude of effect sizes, and level of significance reported. The results of the analysis offer a general summary and mapping of results to capture patterns in the existing research. No statistical assessment of the importance of factors across publications (“effect size” in the meta-analysis literature) is provided in the interest of reflecting the broadest possible sample of studies.

Wasting and underweight have been studied less often than stunting (Table 1 ). Just over 34% of the reviewed studies modelled wasting. Slightly more studies operationalized this outcome with a binary variable (whether or not children were wasted, as a status based on exceeding a given threshold) than with a z-score (extent of deviation from international standards, along a continuous scale that captures a spectrum of outcomes in a process of becoming undernourished). Under 5% of the reviewed articles used both operationalizations of wasting in their analysis. Similarly, underweight appeared in 34% of the reviewed studies. In these studies, the operationalization was most often a z-score, rather than a binary variable. Meanwhile, 81% of the articles used stunting as a dependent variable; a z-score was most common for stunting as well.

3.1 Factors evaluated as affecting child nutrition

A total of 49 factors were evaluated in relation to wasting, stunting, and/or underweight by multiple studies (Fig. 1 ). This list includes 12 factors measured at the individual level; 25 factors measured at the household level (including five factors pertaining to mothers); eight factors measured at the region/community level; and four factors measured at the country level (Table S3 ). Analysis of disaggregated data at the individual and/or household level featured in 89% of the reviewed articles. Most analyses did not include any covariates measured at the regional/community or country levels (e.g., (Ekbrand and Halleröd 2018 )). Thus, fewer articles are available with which to evaluate the consistency of relationships of factors at the regional/community and country levels than at the individual and household levels. Of the 49 factors, 18 have been evaluated by multiple studies in relation to each of the three standard measures of child malnutrition (Fig. 1 ). The subsequent presentation of results is restricted to instances of prevailing evidence of statistically significant relationships indicating risk factors or mitigating factors, according to a majority of relevant reviewed studies.

Summary of results from statistical analyses of relationships between indicators of child malnutrition and: a child-specific factors, b household-level factors, c region/community-level factors, and d country-level factors. Note: We limit the results reflected in this figure to factors that are evaluated in the main statistical analyses reported in at least two of the 90 reviewed articles. Details of which study was included in each factor can be found in Supplementary Table S 3

Eight of the 12 factors measured at the level of individual children exhibited statistically significant relationships for the following factors: child’s sex and age, if they were a multiple at birth (twin, triplet, etc.), and diarrhea status (Fig. 1a ). Seven of the 10 factors evaluated in relation to stunting exhibited statistically significant associations. These associations identified five risk factors: child’s sex and age, their birth order, if they were a multiple at birth, and short birth interval. Two mitigating factors were also identified: if a professionally trained assistant was present at the birth and if Vitamin A supplements had been used. The results indicated that two of the four factors evaluated in relation to underweight were statistically significant risk factors: child’s age and if they were a multiple at birth. According to our review, therefore, all three anthropometric measures of malnutrition were associated with two individual-level risk factors: age and multiple at birth.

Of the 25 household-level factors, just four of the 17 factors exhibited statistically significant associations: mother’s education, mother’s BMI, wealth/assets, and access to a health care center (Fig. 1b ). All were evaluated as being mitigating factors. Eleven of the 25 factors evaluated in relation to stunting yielded statistically significant associations. The relationships identified three risk factors: rural, indigenous, and altitude. In addition, eight mitigating factors were identified: mother’s education, father’s education, mother’s BMI, mother’s height, pregnancy care, wealth/assets, quality of household materials, and food aid or supplemental feeding. Five of the 13 factors evaluated in relation to underweight yielded statistically significant associations. Only one relationship identified a risk factor: rural residence. Four mitigating factors were also identified: mother’s education, mother’s BMI, wealth/assets, and quality of toilet. According to our review, therefore, all three anthropometric measures were associated with three household-level risk factors: mother’s education (either years of education or specific levels relative to no education), mother’s BMI, and wealth/assets (encompassing different indices).

The eight factors measured at the region/community level is split between measuring features of the environment, including climate conditions, and features related to conflict (Fig. 1c ). Wasting had a statistically significant association with excessive rainfall as a risk factor and growing season rainfall as a mitigating factor. Stunting had a statistically significant association with extreme temperatures as a risk factor. Underweight only exhibited a statistically significant association with drought as a risk factor. Several of the reviewed studies analysed vegetation quality, employing either the normalized difference vegetation index (NDVI) or the enhanced vegetation index (EVI), with varying operationalizations. In particular, vegetation quality during the previous growing season has been evaluated in multiple studies of both wasting and stunting, yielding findings that vary by context. Statistically significant associations were observed between stunting and three factors that reflect distinctive operationalizations of the role of conflict. Conflict in the surrounding region, conflict exposure (days or months), and whether a child was born during a conflict were all identified as risk factors for stunting.

At the country level, national per capita GDP was identified as a mitigating factor for wasting, stunting, and underweight (Fig. 1d ). Female education (encompassing national rates of female literacy and female secondary enrolment) was identified as a mitigating factor for stunting and underweight. Both the national average female-to-male life expectancy ratio and the dietary energy supply per capita were identified as mitigating factors for underweight.

3.2 Statistical methods

About 60% of the reviewed studies employed standard variations of multivariate regression techniques, such as linear, generalized linear (e.g., logit), or multilevel models. Only 5% of studies used explicit multilevel statistical techniques, modelling simultaneously the relationships between malnutrition and covariates at the individual, household, and regional/community levels (e.g., (Ekbrand and Halleröd 2018 )). Other studies that did not estimate multilevel models instead included covariates aggregated to higher levels, introduced dummy variables for geographic regions, or adjusted for within-spatial-unit correlation via clustered standard errors (e.g., (Rashad and Sharaf 2018 )). Five articles used quantile regression, which fits a model through quantiles of the dependent variable, rather than the mean (e.g., (Asfaw 2018 )). This approach has the advantage of allowing for heterogeneous treatment effects for different segments of the distribution of child malnutrition. For example, a given factor may exhibit a stronger association with weight-for-height z-scores for children who are undernourished (i.e., the left tail of the distribution), relative the association observed for children whose nutrition status is near the center of the distribution.

A majority of reviewed studies relied on cross-sectional analysis of either data from single surveys or a pooled dataset comprising multiple cross-sectional surveys. Just five of the studies capitalized on panel data involving repeated waves of data collection for the same children or households over time. The remaining studies employed a diversity of approaches, including time-series analysis of repeated cross-sections of countries or subnational regions. Among the reviewed studies, the most common source of malnutrition measures was Demographic and Health Survey (DHS) data (27 studies). Five of the reviewed studies used Living Standards and Measurements Survey (LSMS) data. The remaining studies employed other country-specific surveys, with India’s National Family Health Survey (4 studies) and Ethiopia’s Rural Household Survey (2 studies) featuring in multiple cases.

In terms of causal identification strategies, 17% of the reviewed studies directly leveraged the availability of data collected from repeated measurement over time, estimating either unit-level fixed effects or difference-in-differences models (e.g., (Lucas and Wilson 2013 )). A further 9% of articles featured an instrumental variables strategy (e.g., (Yamano et al. 2005 )) and another 6% of articles resorted to matching techniques (e.g., propensity score) to control for selection bias and minimize problems of sample imbalance. The remaining studies exhibited a variety of other approaches, including decomposition analysis (Block et al. 2004 ; Rodriguez 2016 ) and a regression discontinuity design (Ali and Elsayed 2018 ).

Among the reviewed studies, attention to the temporal relationship between malnutrition and potential factors was limited and uneven, constraining the ability to ascertain any general patterns. The lack of such examination of the impact of climate and conflict shocks is especially conspicuous. A common approach has been to measure deviations in conditions during the survey period relative to long-run average conditions, within a suitable sub-national geographic area surrounding the survey cluster. The implicit assumption is that the deviations in conditions exert a contemporaneous impact on malnutrition. Select studies used models specifying factors with time lags. For example, Johnson and Brown (Johnson and Brown 2014 ) tested one- and two-year lagged measures of shocks in vegetation, but the results of these estimations were not presented because the observed effects were not statistically significant. Kinyoki et al. ( 2016 ) tested lags measures of conflict during the three months prior to survey and the period from 3 to 12 months prior to the survey, finding that both variables have statistically significant associations with wasting and stunting. Howell et al. (Howell et al. 2018 ) tested yearly lagged values of conflict days and deaths in an analyses of stunting and wasting. Another approach in studies that have modelled the effects of conflict shocks on child malnutrition is cohort analysis. The effect of the shock is gauged based on birth timing relative to the shock, evaluating how the “during” shock cohort differs from the “before” shock and “after” shock cohorts (Grace et al. 2015 ).

3.3 Geographical coverage

Nearly 80% of the reviewed studies focused on a single country or even just one sub-national geographic area within a country. The country that features the most often was India, in 13% of the studies. Ethiopia was second (10%), followed by Guatemala and Kenya (6% each). Nineteen of the reviewed studies (21%) analysed data from multiple countries. The studies with the most extensive geographic scope covered 166 countries (Smith and Haddad 2015 ), 63 countries (Smith and Haddad 2001 ), and 41 countries (Kimenju and Qaim 2016 ). The analysis in each of these studies was conducted at the country level.

The shortage of comparative analysis within individual studies, the limited scope of geographic coverage among multiple studies that examined the same factors, and the lack of comparability of the studies that did examine the same factors in different country settings restricts understanding of the generalizability of observed relationships. Of interest, no comparative studies have been conducted to analyse the consistency of the relationship between child malnutrition and conflict across multiple country settings.

4 Discussion and conclusions

We conducted a review of 90 studies involving statistical analyses of empirical data to examine relationships of child malnutrition to factors measured at the individual, household, regional/community and national levels. Our main purpose was to consolidate understanding about the tendencies of findings to date and the design and extent of existing research. A main strength of our review was the wide scope, with respect to the number of studies included, the multiple measures of malnutrition reflected in the analyses reported in these studies, and the volume of factors evaluated in those analyses. The review by Phalkey et al. (Phalkey et al. 2015 ) takes a similar approach on fewer (15) studies and considered seven categories (agriculture, crops, weather, livelihood, demographics, morbidity, and diet). These categories were simply reported statistically significant, or not (Phalkey et al. 2015 ). The present review achieves a broader coverage of the literature, includes description of risk and mitigating factors, and highlights possible differences in relationships across the types of malnutrition. The approach used in the present review departs from a formal meta-analytical approach (Borenstein et al. 2011 ). Our approach allowed us to include a large number of studies, irrespective of statistical designs, choice of variables, and modelling approaches. Meta-analysis published elsewhere will be useful in confirming trends reported here.

Specifically, our review reveals that wasting is understudied as a measure of child malnutrition. Instead, far more attention has been paid to stunting. Another main observation is that many of the factors evaluated in relation to the different types of child malnutrition yielded inconclusive results or were not analysed in multiple studies. According to the prevailing evidence, select factors were associated with all three types of child malnutrition: age of child and multiple births are risk factors, while mother’s education, mother’s BMI, household wealth/assets, and national GDP per capita are mitigating factors. A single factor is associated with both wasting and stunting (child’s sex as a categorical variable) and two factors with both stunting and underweight (rural household, national female education level), while 23 factors are associated with only one of the types of malnutrition.

Previous research summarising determinants of child nutritional status identified factors similar to those in our review. For example, Smith et al. (Smith et al. 2005 ) list a number of individual- and household-level factors that seem important to nutritional status, including whether the child has had diarrhoea, mother’s education, mother’s nutritional status, feeding practices, sanitary conditions, wealth, and medical care. Many of these factors exhibit significant associations in the studies included in our review, which identifies other risk and mitigating factors as well.

The present review explicitly captures findings about the role of climate and conflict conditions, while other recent reviews about child malnutrition overlook these conditions (Jones et al. 2013 ; Leroy et al. 2015 ; (Wrottesley et al. 2015 )). Among the studies we reviewed, climate conditions are widely included in analyses, most often measured with indicators of precipitation, temperature, and vegetation. Measures of conflict conditions – activity in the surrounding region, extent of exposure, and birth during an affected period – are also included more selectively in analyses (Akresh et al. 2012 ; Delbiso et al. 2017 ). The prevailing evidence indicates that climate shocks involving excessive rainfall, extreme temperatures, and drought are among the risk factors for wasting, stunting, and underweight, respectively, while conflict emerged as a risk factor for stunting. Additional relationships between certain types of malnutrition and certain forms of external shocks may exist, but the evidence from our review is either inconclusive or only reflects single studies (Table S2 ).

Our results are consistent with existing research showing that climate-related shocks, such as droughts or floods, are detrimental to food security, especially of rural populations (Table S3 ) (Cooper et al. 2019 ; Douxchamps et al. 2016 ; Grace et al. 2014 ; Murali and Afifi 2014 ). Our review reveals that excessive rainfall is a risk factor and growing season rainfall is a mitigating factor. Excessive rainfall represents an extreme event, with the potential for natural disasters (e.g., floods) that can be damaging to health, well-being, and economic production. By comparison, growing season rainfall captures conditions during critical periods of agricultural productivity, when above-average precipitation logically tends to be beneficial to food security (Cooper et al. 2019 ; Funk et al. 2008 ). Another study found that households located in regions that experienced a drier-than-average year reported one more month of food insecurity than households experiencing wetter-than-average years (Niles and Brown 2017 ). Our review also found that stunting was associated with both extremely cold temperatures (Skoufias and Vinha 2012 ) and extremely hot temperatures (Jacoby et al. 2014 ) as risk factors. Other existing studies suggest that high temperatures and heat waves tend to be important for understanding food security (Phalkey et al. 2015 ; Bain et al. 2013 ; Grace et al. 2012 ). In addition, we found that the results for vegetation quality differ across countries. For example, Johnson and Brown (Johnson and Brown 2014 ) find vegetation quality during the previous growing season to be a statistically significant mitigating factor for wasting in Mali, but not Benin, Burkina Faso, or Guinea, while Shively et al. (Shively et al. 2015 ) did not find a statistically significant relationship between wasting and this factor in Nepal.

In comparison to the literature using climate variables, analyses of relationships between child malnutrition and conflict shocks are limited in number. Foundations for such studies exist in the literature about the effect of conflict on food security and public health. For example, Akresh et al. ( 2011 , (Akresh et al. 2012 )) and Bundervoet et al. ( 2009 ) showed that children in conflict-affected settings exhibit signs of stunting, with similar effects for children born before or during wartime. These results, however, have not translated into interventions that take advantage of data on climate and conflict, despite the increasing availability of sources with granular detail (Dunn 2018 ; Jones et al. 2010 ; Raleigh et al. 2010 ). Our review also highlights the lack of attention in existing research to the relationship between conflict and wasting. We view this gap as warranting attention given the acute nature of this type of malnutrition, which could plausibly be influenced by the sort of shock that conflict represents.

Another important consideration is that climate and conflict shocks can coincide – and influence one another. These potential intersections and interactions suggest possible causal pathways of child malnutrition. Multiple theories address the impact of climate shocks on the emergence of armed conflict, which cannot be decisively established (Hsiang and Burke 2014 ). Food security and nutrition may also be a key mediating factors in the nexus between climate and conflict. For example, Buhaug et al. (Buhaug et al. 2015 ) model a process in which climate shocks cause in a first stage to an increase of local food prices, which then lead to conflict during a second stage. They find evidence of a strong climate impact at the first stage, but a weak and inconsistent one at the second stage. Their argument is that the effect of food prices on conflict is likely conditional on local “socioeconomic and political contexts.” This explanation is consistent with findings of studies on the relationship between food prices and urban unrest (Berazneva and Lee 2013 ; Hendrix and Haggard 2015 ).

Our review indicates that empirical research evaluating the joint effects of environmental and political conditions on risks of malnutrition unfortunately remains the exception (Fig. 1 and Tables S 2 and S 3 ). Few studies on malnutrition have considered both climate and conflict simultaneously. A meta-analysis of nutrition surveys in Ethiopia from 2000 to 2017 concluded that droughts increase the prevalence of wasting, but the impact of conflict is less certain (Delbiso et al. 2017 ). Other research suggests that the effects of climate extremes and conflict should exacerbate one another, pushing conditions beyond a tipping point and contributing to complex emergencies. In the famines of the twentieth Century caused primarily by drought or flood, concurrent conflict often served to escalate the environmental crisis and exacerbate mortality (Devereux 2000 ). This finding is consistent with Sen’s (Sen 1981 ) seminal argument that no famines with exclusively natural causes have been observed in the modern era. Sen (Sen 1981 ) argues that contemporary societies should be able to respond more effectively to potential famines caused by droughts or other natural events, except when hampered by failures in social, economic, and political institutions. Crises arising with one type of shock may be eased by stored food or relief supplies, whereas the coincidence of both types of shocks undermines those responses. For example, conflict blocked aid from reaching populations at risk of malnutrition amid droughts in Ethiopia during the 1980s and in Somalia in 2011 (Hillbruner and Moloney 2012 ; Maxwell and Fitzpatrick 2012 ). More generally, conflict diminishes the capacity of households and communities to cope with other stresses and shocks (Raleigh et al. 2015 ).

Among the main challenges to achieving improvements in the detailed, rigorous analysis of relationships between child malnutrition and conflict is the availability of data. Surveys that serve as the source of data on nutrition are conducted in conflict-affected areas. The insecure nature of these conditions, however, can make data collection less frequent, extensive, and reliable, reducing their scope, scale, and quality. Also, the relevant surveys rarely collect information about direct conflict exposure at the individual or household level. Instead, studies that evaluate conflict as a factor usually resort to making inferences from analysis using event data. These data offer consistent precision of georeferencing of events only to the level of first- or at best second-order administrative divisions (Raleigh et al. 2010 ), rather than specific point locations or even small areas. Appropriately integrating these data on conflict into analysis requires a multilevel modelling approach (Gelman and Hill 2006 ), which can account for potential influences at the regional level, as well as other levels (individual, household, community). Such an approach can be complemented by reasonable theoretical arguments that children residing within regions experiencing conflict (and possibly affected neighbouring regions) are more vulnerable to suffering effects on malnutrition, through various causal pathways. Given that the direct exposure to conflict events is not measured, compounded by events being infrequent in most settings, the evaluated relationships are likely to be difficult to detect. Encountering such difficulties in the analysis of climate factors is less likely because of the greater geographic granularity of the available data, a more balanced distribution of conditions, and clearer, more direct pathways of influence of local conditions on individuals and households.

Ultimately, examining the state of knowledge about factors associated with acute and chronic child malnutrition holds the potential to help advance an ongoing agenda of scientific inquiry with practical applications that have important real-world consequences. Recent technological developments in mobile devices and remote sensing, communications coverage (including cell phone and Internet networks), and the ability to transmit large amounts of information rapidly improve the potential of designing and implementing more timely protective interventions (GSMA 2015 ). Considerable opportunities exist for identifying where, when, how, and why proven policy and public health interventions should be implemented (Collins et al. 2006 ), especially to gauge the local impact of climate and conflict shocks. Our review contributes to capabilities of isolating intervention points in ways that can improve strategies (Wrottesley et al. 2015 ; Walker et al. 2015 ). Further evidence from studies spanning multiple countries and time periods is needed to bolster the foundations for designing interventions (Dilley 2000 ). Pertinent data are increasingly available, including from sources (e.g., the World Food Program’s Food Aid Information System) that can be used to study the effectiveness of international aid and humanitarian assistance in relation to vulnerabilities to malnutrition.

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Brown, M.E., Backer, D., Billing, T. et al. Empirical studies of factors associated with child malnutrition: highlighting the evidence about climate and conflict shocks. Food Sec. 12 , 1241–1252 (2020). https://doi.org/10.1007/s12571-020-01041-y

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PhD thesis- Nutrition Economics. Disease-related malnutrition and the economic health care value of medical nutrition

Summary Without nutrition life is not possible. Already in the womb sufficient nutrition is needed for the embryo to evolve. From that time we have to eat and drink every day to provide our body with the nutrients needed to meet the requirements to prevent illness as well as to manage metabolic stress situations. Disease, injury, trauma or surgery are examples of such stress situations in which there is an increased need for specific nutrients to strengthen the functioning of our immune system and recovery among others. Malnutrition, meaning under‐nutrition (lack of nutrients) in health care also known as disease related malnutrition (DRM) in this thesis, is leading to health impairment associated with high health care costs. DRM is one of the most important indications for the use of medical nutrition, which is a special food indicated to be used in the total treatment of patients. It comprises parenteral (intravenous) as well as enteral (via gastro‐intestine) nutrition. The latter...

Factors affecting malnutrition in children and the uptake of interventions to prevent the condition

Edem m. a. tette.

Department of Community Health, School of Public Health, University of Ghana, P.O. Box 4236, Accra, Ghana

Princess Marie Louis Children’s Hospital (PML), P.O. Box GP 122, Accra, Ghana

Eric K. Sifah

Edmund t. nartey.

World Health Organisation Collaborating Centre for Advocacy and Training in Pharmacovigilance, Centre for Tropical Clinical Pharmacology & Therapeutics, School of Medicine and Dentistry, University of Ghana, P. O. Box GP 4236, Accra, Ghana

Malnutrition is a major cause of child morbidity and mortality. There are several interventions to prevent the condition but it is unclear how well they are taken up by both malnourished and well nourished children and their mothers and the extent to which this is influenced by socio-economic factors. We examined socio-economic factors, health outcomes and the uptake of interventions to prevent malnutrition by mothers of malnourished and well-nourished in under-fives attending Princess Marie Louise Children's Hospital (PML).

An unmatched case control study of malnourished and well-nourished children and their mothers was conducted at PML, the largest facility for managing malnutrition in Ghanaian children. Malnourished children with moderate and severe acute malnutrition were recruited and compared with a group of well-nourished children attending the hospital. Weight-for-height was used to classify nutritional status. Record forms and a semi-structured questionnaire were used for data collection, which was analysed with Stata 11.0 software.

In all, 182 malnourished and 189 well-nourished children and their mothers/carers participated in the study. Children aged 6–12 months old formed more than half of the malnourished children. The socio-demographic factors associated with malnutrition in the multivariate analysis were age ≤24 months and a monthly family income of ≤200 GH Cedis. Whereas among the health outcomes, low birth weight, an episode of diarrhoea and the presence of developmental delay were associated with malnutrition. Among the interventions, inadequate antenatal visits, faltering growth and not de-worming one's child were associated with malnutrition in the multivariate analysis. Immunisation and Vitamin A supplementation were not associated with malnutrition. Missed opportunities for intervention were encountered.

Poverty remains an important underlying cause of malnutrition in children attending Princess Marie Louise Children’s Hospital. Specific and targeted interventions are needed to address this and must include efforts to prevent low birthweight and diarrhoea, and reduce health inequalities. Regular antenatal clinic attendance, de-worming of children and growth monitoring should also be encouraged. However, further studies are needed on the timing and use of information on growth faltering to prevent severe forms of malnutrition.

Malnutrition is regarded as the most important risk factor for illness and death globally and it is associated with 52.5 % of all deaths in young children [ 1 – 4 ]. According to UNICEF, WHO and the World Bank, out of the 161 million under-fives estimated to be stunted globally in 2013, over a third resided in Africa [ 5 ]. In addition, about one-third of the 51 million under-fives who were wasted and the 99 million who were underweight were also from Africa [ 5 ]. Furthermore, although there has been a global decline in underweight from 25 % to 15 %, Africa has experienced the smallest relative decrease in prevalence going from 23 % in 1990 to 17 % by 2013 [ 5 ].

In children, low birth weight, feeding problems, diarrhoea, recurrent illness, measles, pertussis, and chronic disease among others increase the risk of malnutrition [ 6 – 8 ]. These factors vary from locality to locality and children under five years are most at risk. Social factors also have an influence on malnutrition and in the 1990’s, malnutrition was associated with young mothers and low maternal socio-economic status at Princess Marie Louise Children’s Hospital (PML) [ 6 ].

The consequences of malnutrition are many and have been extensively documented [ 2 – 4 , 8 , 9 ]. It includes increased risk of infection, death, and delayed cognitive development, leading to low adult incomes, poor economic growth and intergenerational transmission of poverty [ 9 ]. Children with malnutrition have reduced ability to fight infection and are more likely to die from common diseases such as malaria, respiratory infections and diarrhoeal diseases [ 2 – 4 , 8 ]. Children who are born with low birth weight and have intrauterine growth retardation, are at increased risk of morbidity and mortality, and other forms of malnutrition compared to healthy infants. They also tend to develop non-communicable diseases such as diabetes and hypertension in adult life [ 10 ]. Interventions for reducing malnutrition must therefore begin before birth.

Reproductive Health Services provide the settings for political strategies that can reduce low birth weight by enhancing birth spacing and reducing teenage pregnancy [ 11 – 13 ]. Maternal malnutrition, low gestational weight gain, weight loss due to illness, medical conditions during pregnancy such as malaria, hypertension, smoking, drug and alcohol use, increase the risk of low birth weight [ 10 ]. Antenatal care provides the setting to identify and treat such high-risk pregnancies and it offers nutritional and educational interventions which can promote healthy eating habits, hygienic practices and lifestyle changes to reduce low birth weight [ 10 ]. Thus low birth weight can be a measure of success in preventing malnutrition during pregnancy through antenatal care.

Promotion of breastfeeding, appropriate complementary feeding, vitamin A supplementation and case management of malnutrition are most effective at preventing malnutrition or its effects [ 11 , 14 ]. De-worming programmes and conditional cash transfer have been reported to be effective only in specific situational context, while there is little evidence for the effectiveness of interventions such as growth monitoring. Intervention such as immunization and education on clean hygienic practices and nutritional counselling at post-natal and child welfare clinics can also prevent malnutrition [ 15 ].

Repeated attacks of diarrhoea and infections leads to weight loss and compromise a child’s nutritional status [ 1 , 15 ]. This in turn makes the child vulnerable to infections and further weight loss, eventually leading to severe malnutrition unless the cycle is broken. Thus recurrent diarrhoea and sickness episodes reflect the effectiveness of health interventions to prevent and manage diarrhea and infections, and hence prevent malnutrition.

Ghana has several policies and programmes to reduce malnutrition [ 16 , 17 ]. This includes reproductive health interventions such as antenatal and postnatal care and interventions contained in the Under Fives Child Health Programme. The latter includes promotion of breast feeding, appropriate complementary feeding, growth monitoring, Vitamin A supplementation and immunisation. Others are regular de-worming and strategies for feeding children with special nutritional requirements such as infants of mothers with HIV infection or AIDS [ 17 ]. The programme also provides information on appropriate treatment of childhood illnesses such as diarrhoeal diseases [ 11 , 14 , 17 ].

In recent times there has been renewed interest in preventing malnutrition however there is insufficient data on the uptake of these health interventions and the factors which affect them. According to UNICEF the main causes of childhood malnutrition can be categorized into three main underlying factors which are; household food insecurity, inadequate care and unhealthy household environment, and lack of health care services [ 18 ]. These in turn are affected by income, poverty, employment, dwelling, assets, remittances, pensions and transfers which are also determined by socio-economic and political factors.

Interventions to prevent malnutrition must target these underlying causes. Thus we examined social factors, health outcomes and the uptake of interventions to prevent malnutrition by mothers of malnourished and well-nourished children under the age of five years attending PML.

Study design

An unmatched case–control study was conducted at the Princess Marie Louise Children’s Hospital in Accra. Cases were defined as children under the age of 5 years with either Moderate Acute Malnutrition (MAM- a weight for height Z score of ≥ −3SD to < − 2 SD) or Severe Acute Malnutrition (SAM-a weight for height Z score of < − 3 SD with or without bilateral pitting oedema). The controls were children under the age of 5 years with well-nourished nutritional status (a weight for height Z scores > − 2SD). The study was part of a larger study which also examined feeding practices, maternal, social, medical and biologic factors associated with malnutrition. We present here the extent of exposure of these children and their mothers to selected health interventions that prevent the malnutrition and the socio-demographic and health outcomes affecting them.

Study setting

Princess Marie Louise Children’s Hospital is the largest centre dedicated to treating children with malnutrition in the country. The hospital is a 74 bed children’s hospital situated in the commercial centre of the capital, Accra. It provides both primary care and specialized paediatric services for patients brought in by their parents and referrals from health facilities in other parts of Accra and from other regions. In 2012, there were 157 admissions for MAM and SAM at PML with a mortality rate of 11.7 % as reported by the Dietetic unit. The WHO protocol informs case management at the hospital.

Study population

Patients with malnutrition were identified initially by measuring the Mid Upper Arm Circumference (MUAC) as this is the main measurement used for admitting and identifying patients with SAM and MAM in Ghanaian nutritional rehabilitation centres. Those with Severe Acute malnutrition (SAM), a weight for height Z score of < − 3 SD with or without bilateral pitting oedema (WHO) and Moderate Acute Malnutrition (MAM), a weight for height Z score of ≥ −3SD to < − 2 SD (WHO) were included as cases [ 19 , 20 ]. Patients with a weight for height Z scores > − 2SD presenting with other conditions were included as controls.

Children who met MUAC criteria but did not meet weight for height criteria or had missing weight or height measurements were excluded from the study. Children with chronic diseases which have an influence on nutritional status, including congenital heart disease, renal failure, sickle cell disease or liver disease and their mothers were also excluded from both study groups. Also excluded were children who had been in the nutritional rehabilitation programme for more than 7 days and their mothers. Children who were severely ill were also excluded until they were stable, if this was within the 7 days.

Purposive sampling was used in this study. We recruited consecutive patients with MAM and SAM admitted to the malnutrition ward or referred to the nutritional rehabilitation unit into the study between 9 th January and 10 th June 2013 who met weight-for height and other inclusion criteria, and gave consent. A comparative group of children attending PML who were being seen or treated for conditions other than malnutrition were recruited from the out-patients department and from the general paediatric wards if they had a weight-for-height z score of < −2SD, met inclusion criteria and gave consent. These were classified as controls but were not matched by age or sex to the cases.

We had some challenges recruiting controls especially from the general wards as many of those screened did not meet the criteria for being “well nourished”. Thus we extended the time of recruitment of the comparison group to 10 th September 2013 due to difficulty obtaining suitable controls and because of an industrial action which reduced patient attendance.

Measurements and data collection

A Class III infant scale (Seca 334) was used to measure the children’s weight. A Seca 417 measuring board was used to measure length while height measurements were done using a Leicester height measure. These were recorded to the nearest millimetre. MUAC and head circumference were done using non-stretch tape measures. Research personnel making these measurements were trained in standardized techniques for performing these measurements. A Royal College of Paediatrics and Child Health training video clip was used as part of the training.

Weight-for-height measures wasting or acute malnutrition and can be expressed as a z-score which is the number of standard deviations or Z-scores below or above the reference mean or median value [ 21 ]. The Mid-Upper Arm Circumference (MUAC) is the arm circumference taken at the midpoint between the tip of the shoulder (acromium process) and the tip of the elbow (olecranon process). Both measurements measure wasting or acute malnutrition but correlation between them is often poor. MUAC is better predictor of mortality, easier and less cumbersome to perform and therefore is recommended for use in community-based screening [ 22 ].

A semi-structured questionnaire and a data record form were used to collect the information on the child’s profile. The information collected included data on the child’s age, sex, birth weight and birth order, maturity and problems at birth, child development, HIV status, chronic illness, illness episodes and diarrhoeal episodes over the past year. Information on nutritional status, sources of nutrition advice, growth pattern, immunisation status and preventive interventions such as de-worming, vitamin A supplementation and antenatal and postnatal visits was also obtained.

Information on faltering growth was obtained from the Child Health Record and in this study it was defined as a fall off the growth curve through two or more centile spaces on the growth chart. At the time, adequacy of antenatal visits was defined as 4 or more antenatal visits and postnatal visits as two or more postnatal visits.

Statistical analysis

The data were entered into a Microsoft Access (Microsoft Corporation, Redmond, Washington) and analysed using Stata 11.0® (College Station, Texas 77845 USA). Classification of malnutrition using weight for length/height measurements was done using the WHO Anthro for personal computers, version 3.2.2, 2011. Frequencies and means were computed. The results were presented using tables, graphs with statistical inference. Both univariate and multivariate analysis were done to determine factors associated with malnutrition with the variables grouped under socio-economic and demographic factors, health outcomes and uptake of interventions. Variables significant at p < 0.2 in the univariate analysis were entered into the final multivariate analysis model. Statistical significance was accepted at a 5 % probability level, i.e. a p -value of less than 0.05.

Ethical approval was sought and obtained from the University of Ghana Medical School’s Ethical and Protocol Review Committee [Protocol Identification Number: MS-Et/M.8-P.5.8/2011-2012]. Ethical approval was also obtained from the Ghana Health Service Ethical Review Committee [Protocol Identification Number GHS-ERC 05/07/2012]. Written consent was obtained from the mothers/guardians of the children using consent forms which were signed or thumb printed.

Description of the study participants

Table 1 shows the socio-economic and demographic description of the study participants. A total of 371 children participated in the study involving 182 malnourished children and 189 well-nourished children and their mothers. Female children constituted 52.7 % ( n = 96) and 47.6 % ( n = 90) of the malnourished and well-nourished groups respectively. More than half of the malnourished children were in the 6 months to 12 months age group with a median age of 11 months in the malnourished group. Or over 40 % of both groups were aged between 12 and 24 months. A total 86.0 % ( n = 154) of mothers of malnourished children were educated and 93.5 % ( n = 174) of mothers of well-nourished children were also educated. An assessment of the occupational status indicated that 18.1 % ( n = 33) and 7.9 % ( n = 15) of mothers of malnourished children and well-nourished children respectively were unemployed. Family income levels were >200 GH Cedis in 63.2 % ( n = 115) and 87.8 % ( n = 166) in malnourished and well-nourished children respectively.

Socio-economic and demographic characteristics of 371 children and their mother's (caregivers) attending PML hospital in Accra, Ghana

1 1.00$ = 2.00GH Cedis

Table 2 provides a description of the health outcomes of the study participants. A vast majority of the study participants recruited were out-patients comprising 72 % of the malnourished group and 90.5 % of the well-nourished group. There were four (4) cases of Kwashiorkor (oedematous SAM). Low birth weight was recorded in 13.9 % ( n = 23) and 5.9 % ( n = 10) of malnourished and well-nourished children respectively with developmental delay present in 15.9 % ( n = 29) of malnourished children.

Health outcomes of 371 children attending PML hospital in Accra, Ghana

Table 3 is a description of uptake of interventions of the study participants. Inadequate number of antenatal visits (20.9 %, n = 38) and postnatal visits of less than two (27.5 %, n = 50) were reported in mothers of malnourished children. Only 6.6 % ( n = 12) of malnourished children were de-wormed in the last six months compared with 20.6 % ( n = 39) of well-nourished children. Assessment of the child health record booklet indicated that faltering growth had occurred in 77.2 % ( n = 71 and 19.5 % ( n = 24) of malnourished and well-nourished children respectively (Table 3 ). The proportion of mothers who had received breastfeeding and nutritional counselling was high in both study groups (93.4 % in malnourished group and 99.5 % in well-nourished group) (Table 3 ). Whereas the delivery room was reported as the commonest setting for nutritional counselling by mothers of malnourished children (39.3 %, n = 57), the child health record book was reported as the commonest source by mothers of well-nourished children (35.4 %, n = 62). The uptake of BCG vaccines was high (99.4 %) in both the malnourished group and the well-nourished group. The pentavalent vaccine was taken by 97.1 % ( n = 167) of the malnourished children and 98.2 % ( n = 164) of the well-nourished children (Table 3 ).

Uptake of interventions of 371 children and their mother's (caregivers) attending PML hospital in Accra, Ghana

Socio-economic and demographic factors associated with malnutrition

Table 4 shows the socio-economic and demographic factors associated with malnutrition in the study participants. Gender, mother's educational status and mother's occupational status were not associated with malnutrition in the multivariate analysis ( p > 0.05) (Table 4 ). Children who were 24 months and below had higher odds of being malnourished compared with those of 25–59 months (Adjusted OR = 4.13 [95 % CI, 1.64-10.40], p = 0.003). Similarly, family income levels of ≤200 GH Cedis was associated with higher odds of malnutrition compared with income levels of >200 GH Cedis (Adjusted OR = 4.23 [95 % CI, 2.41-7.44], p < 0.001).

Socio-economic and demographic factors associated with malnutrition in 371 children attending PML hospital in Accra, Ghana

1 1.00$ = 2.00GH Cedis; 2 Varibales with p < 0.2 in the univariate analysis were entered into the multivariate analysis model; OR = Odds ratio; CI = Confidence interval

Heath outcomes associated with malnutrition

Table 5 shows the health outcomes associated with the uptake of interventions. In the multivariate analysis, children who had low birth weight (Adjusted OR, 2.65 [95 % CI, 1.09-6.45], p = 0.032) or showed evidence of developmental delay (Adjusted OR, 12.09 [95 % CI, 2.68-54.57], p = 0.001) were associated with higher odds of malnutrition (Table 5 ). Similarly, children with an episode of diarrhoea (within the last 6 months) had a higher odds of malnutrition (Adjusted OR, 2.23 [95 % CI, 1.36-3.66], p = 0.002).

Health outcomes associated with malnutrition in 371 children attending PML hospital in Accra, Ghana

1 1.00$ = 2.00GH Cedis; 2 Varibales with p < 0.2 in the univariate analysis were entered into the multivariate analysis model in addition to age category and family income level; OR = Odds ratio; CI = Confidence interval

Uptake of interventions to prevent malnutrition

Table 6 shows the uptake of reproductive health and child health interventions that prevent malnutrition including antenatal and postnatal care, de-worming, breastfeeding and nutrition counselling, growth monitoring and immunisation. In the multivariate analysis, the inadequate or lack of antenatal visits was marginally associated with malnutrition (Adjusted OR, 4.31 [95 % CI, 1.01-19.12], p = 0.049), whereas the number of postnatal visits was not ( p > 0.05). The odds of being malnourished was 8.47 times higher in children who had not been de-wormed (in the last six months) compared with children had been de-wormed (Adjusted OR, 8.47 [95 % CI, 1.99-36.01], p = 0.004) (Table 6 ). Faltering growth recorded during growth monitoring was also associated with an increased odds of a child being malnourished (Adjusted OR, 21.40 [95 % CI, 8.74-52.41], p < 0.001) in the multivariate analysis (Table 6 ). There was no significant difference between the uptake of the three immunisation vaccines or Vitamin A by children who were malnourished and those who were well-nourished ( p > 0.05) (Table 6 ).

Uptake of interventions associated with malnutrition in 371 children attending PML hospital in Accra, Ghana

1 1.00$ = 2.00GH Cedis; 2 Varibales with p < 0.2 in the univariate analysis were entered into the multivariate analysis model in addition to age category and family income level; 3 Not estimable due to coll inearity; OR = Odds ratio; CI = Confidence interval

A total of 80 of the children have had one episode of diarrhoea comprising 26.4 % of malnourished children and 16.9 % of well-nourished children. Two or more episodes of diarrhoea were reported by 40.7 % of the cases and 23.3 % of the controls. Eleven malnourished children (6.0 %) had 4 or more episodes of diarrhoea compared with 2.1 % ( n = 4) of the well-nourished children.

Socio-economic and demographic factors

In this study more than half of the malnourished children were in the 6 months to 12 months age group (Table 1 ). Since this coincides with the weaning period, it may well be that inappropriate weaning or complementary feeding practices may have been a major contributor to this finding [ 3 , 14 ]. A similar pattern was found in a study of admissions of children under the age of five years with protein energy malnutrition in Enugu, Nigeria [ 23 ]. The study on malnutrition at PML in the 1990’s differs in methodology from our study as the researchers specifically targeted children between 8 and 36 months. The average age then was around 14 months for underweight and 17 months for severe malnutrition [ 6 ].

We found that an age of 24 months or less was associated with malnutrition in the multivariate analysis. It is well known that this age group is most vulnerable to malnutrition and its effects [ 24 ]. At the same time the age group provides a window of opportunity for intervening to reduce the effects of malnutrition hence the emergence of the Scaling Up Nutrition (SUN) movement which aims at mitigating nutritional problems during pregnancy, and in this age group [ 24 , 25 ]. It is a country-led process which brings organizations together to support nations to implement nutrition interventions in their national plans through multidisciplinary working.

A monthly family income of ≤200 GH Cedis (≤100 USD) was associated with malnutrition in the multivariate analysis reiterating the importance of poverty in the aetiology of malnutrition in this setting [ 26 ]. This is similar to a previous study in Ghana which found that economic inequality is strongly associated with chronic under - nutrition. It is also similar to a study in Nigeria which found that maternal monthly income < $20, monthly household food expenditure of < $55 was associated with malnutrition [ 26 ]. In contrast, the educational status of mothers and their occupational status in this study were only significantly associated with malnutrition in the univariate analysis and not in the multivariate analysis. The researchers in Nigeria also found that malnutrition was significantly. associated with education below secondary level in a univariate but not in multivariate analysis of its determinants [ 27 ]. They also found that residence in a one room apartment, higher birth order and incomplete immunization of the child were significantly associated with malnutrition in that study consequently, they suggested a multidisciplinary approach for preventive strategies just as the SUN movement has done [ 27 ]. We did not find an association between immunisation status and malnutrition possibly because immunisation rates were similar in both groups and was high. It could be that making a health service such as immunisations readily accessible reduces the effects of poverty and health inequalities.

Although poverty can exert its influence on all three arms of the UNICEF conceptual frame work of underlying causes of malnutrition, it has a major effect on household food security [ 28 ]. Food security is determined by several factors including food prices, agricultural practices, climate change and market forces among others [ 29 ]. There was a gradual increase in the number of people worldwide who were underweight from 1990, peaking in 2008. This was worsened by the global recession in 2008 and 2009 which particularly affected the urban poor. It led to price hikes in food, limiting food consumption and causing a shift to less balanced diets. It also left less resources for buying goods and services to ensure hygienic practices, health and well being [ 29 ]. Suggestions have been made to counteract this by promoting agricultural growth, measures to reduce extreme market volatility, and expansion of social protection and child nutrition action particularly nutrition sensitive interventions [ 29 – 31 ].

In response to this call, there have been several studies exploring the use of social protection measures such as cash transfers to mitigate the effects of poverty on malnutrition in childhood and some have been particularly successful as reported in a study in Niger [ 32 ]. This study found that preventive distributions of supplementary food and cash transfer were better at preventing MAM and SAM than either of these measures alone. However, it is not clear how this can be sustained in the long term. In any case it is rewarding to note that there are plans to ensure that strong social protection measures are enshrined in the upcoming sustainable development goals.

Health outcomes

The results of the study showed that low birth weight, having an episode of diarrhoea within the last 6 months and the presence of developmental delay were all associated with malnutrition in the multivariate analysis. Similar findings have been reported by other studies [ 3 , 6 , 23 ]. On the other hand, although having been admitted to hospital within the past one year was associated with malnutrition in the univariate analysis, the association was not statistically significant in the multivariate analysis. There was also no relationship between sickness episodes and malnutrition unlike the study by Maleta et al. [ 33 ] in Malawi which found that malnutrition was associated with frequent illness episodes in infancy. It is possible that we may have found an association if we had focussed on infancy as they did.

Diarrhoeal diseases are generally more frequent and tend to be more severe in malnourished children because of the association between malnutrition and infection [ 1 – 3 ]. In this study, 40.7 % of the malnourished children had two or more episodes of diarrhoea compared to 23.3 % of the controls. This suggests that efforts to control diarrhoea are important for effective prevention of malnutrition. This must include providing effective advice on feeding during diarrhoea episodes and adequate follow up after each episode. It is also important that protocols exist for investigating and managing children who have relapsed after previous treatment for diarrhoea to exclude underlying medical conditions [ 23 ]. Developmental delay was more prevalent in malnourished children and associated with increased odds of being malnourished. Malnutrition often causes developmental delay however malnutrition can also be precipitated in feeding difficulties due to a chronic neurological problem [ 9 ]. It appears this association was more of an effect rather than a cause of malnutrition in most of the children. However eight (8) out of the 29 malnourished children with developmental delay were reported to have had problems at birth and one (1) had a chronic neurological condition, cerebral palsy which could have precipitated the delay in data not presented here. Early intervention will ensure that these children make the most of their developmental potential to reduce the effect of malnutrition [ 30 , 34 , 35 ].

Uptake of interventions

The study found that inadequate/lack of antenatal care was associated with malnutrition in the multivariate analysis although the association was marginal. This implies that mothers of malnourished children were less likely to have had adequate health contacts through antenatal visits. The present result is similar to a study in three Latin American countries which found only a weak association between antenatal care and reduction in the level of child malnutrition and some variations between countries [ 10 ]. They attributed these findings to differences in the quality of care and health inequalities.

Antenatal care provides opportunities for nutritional counselling which mothers of well nourished children may have benefited from and it has been shown to be effective if there is food security [ 11 , 13 , 14 ]. It is also worthy to note that the mothers of malnourished children reported the delivery room to be the main setting for nutritional counselling, whereas mothers of well nourished children reported the child health record books as their main source of nutritional advice. The study also shows that mothers of well nourished children were more likely to de-worm their children every 6 months. Regular de-worming of children has been reported to be a useful intervention for preventing malnutrition in some settings and this appears to be one [ 11 , 14 ]. Furthermore, a majority of the mothers reported that they had nutritional counselling or advise from the health service which is one of the interventions expected in a national plan [ 16 , 17 , 24 ]. The delivery room is an important setting for counselling mothers on early initiation of breast feeding [ 36 ].

Since maternity care is free in all government health institutions, pregnant women should be encouraged to access antenatal care and the health serivice should engage those mothers who miss out through home visiting. However a more specific and targeted approach will be needed. Vitamin A supplementation was not associated with malnutrition even in the univariate analysis. Although Vitamin A reduces child mortality, it is not known to affect anthropometric measurements [ 14 ].

Growth faltering occurred in both groups; however it was significantly more common in children with malnutrition and was still significant after multivariate analysis. This is not an unexpected finding. We encountered some incomplete records which are most likely because most mothers come for growth monitoring only when their child’s immunisations are due. They used to stop at 9 months after the measles immunisation but more recently this has gone up to 18 months since the second dose of measles was introduced. Additional clinic visits may be necessary to pick up and monitor children who are faltering between the ages of 9 and 18 months and above. The usefulness of these visits needs to be established first since growth monitoring has been used in several intervention programmes with mixed results [ 11 , 14 ].

The main limitation of this study was a challenge related to the classification of malnutrition. Weight for height criteria was used to make the results comparable to other studies. The WHO recommends the use of both MUAC and weight for height as independent criteria for classifying malnutrition whereas nutrition rehabilitation centres in Ghana including PML use only MUAC [ 20 ]. We found that about a third of patients who would have passed as being well-nourished using MUAC criteria could not be included in the control group because they were malnourished using weight-for-height criteria. This means that there may be several malnourished children who are missed each day. Missed opportunities for picking up malnourished children has been reported in several studies, including a study in a teaching hospital in Ghana [ 37 – 39 ]. Understandably, MUAC is an easier and more practical measurement in small peripheral health facilities. However, in larger health facilities like PML and teaching hospitals, it should be possible to do weight and height measurements routinely and hence record weight for height measurements. Further studies are needed to assess the effect of using either criteria on the prevalence and cost-benefit of management as it may well be that the burden of malnutrition in the hospital is much higher than we are treating.

Children with Kwashiorkor who could not stand to have their heights measured or were too ill were not included. There was a slight over representation of older children among the well nourished children. Also the patients were not matched so it is possible that this may have created a bias. We also recognise that children labelled as well-nourished are likely to contain some children with mild malnutrition; however, for the purposes of this study, we have classified them as controls in line with current classification of malnutrition.

Conclusions

Malnutrition was associated with a monthly family income of ≤200 GH Cedis (≤100 USD) but not with maternal educational status and employment status which highlights a need to address poverty. Malnutrition was also associated with lack or inadequate antenatal care, not de-worming children regularly, low birth weight, previous diarrhoea episodes, and developmental delay. Though the latter three conditions could be consequences of malnutrition they could aggravate malnutrition through lack of health services. Thus preventing these conditions and providing adequate follow up for diarrhoea patients will be important steps in preventing malnutrition in this population. Interventions to reduce malnutrition were generally better patronised by the mothers of well nourished children. Efforts must be made to reach mothers who default on antenatal visits and de-worming their children regularly. Furthermore, growth monitoring should be encouraged in this setting and further studies on the timing and use of information from the activity are needed.

Acknowledgments

Peter Nuro-Ameyaw, Samson Dziekpor, Priscilla Tete-Donkor and Hannah Ofori assisted in the data collection and entry. Professor Richard Biritwum assisted in editing and research advice. ORID of the University of Ghana funded the study.

Abbreviations

Competing interests

The authors declare that they have no competing interests.

Authors’ contribution

The authors EMAT, EKS and ETN worked in the conception, study design, and the final article composition. EMAT, ETN and EKS contributed to the methods. ETN and EMAT worked on the data analysis, results, discussion, conclusion and its continuous critical review. All the authors read and approved the final manuscript.

Contributor Information

Edem M. A. Tette, Phone: 233 030 2665101, Email: moc.liamelgoog@rotanemede .

Eric K. Sifah, Phone: 233 020 8172870, Email: moc.oohay@hafiscire .

Edmund T. Nartey, Phone: 233 024 4220 014, Email: hg.ude.shc@yetrante .

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Fergusson, Pamela Lynne. "Severe acute malnutrition and HIV in children in Malawi." Thesis, University of Chester, 2009. http://hdl.handle.net/10034/93477.

Kellerhals, Sarah. "Understanding Severe Acute Malnutrition in Children Globally: A Systematic Review." Thesis, The University of Arizona, 2017. http://hdl.handle.net/10150/624202.

Piniel, Abigail. "Factors contributing to severe acute malnutrition among the under five children in Francistown-Botswana." Thesis, University of the Western Cape, 2016. http://hdl.handle.net/11394/5253.

Sadler, K. "Community-based therapeutic care : treating severe acute malnutrition in sub-Saharan Africa." Thesis, University College London (University of London), 2009. http://discovery.ucl.ac.uk/16480/.

Tadesse, Elazar. "Integrated community-based management of severe acute child malnutrition : Studies from rural Southern Ethiopia." Doctoral thesis, Uppsala universitet, Internationell mödra- och barnhälsovård (IMCH), 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-292781.

Dailey-Chwalibóg, Trenton. "Biomedical Investigations for the Optimized Diagnosis and Monitoring of Severe Acute Malnutrition : The OptiDiag Study." Thesis, Paris, Institut agronomique, vétérinaire et forestier de France, 2020. http://www.theses.fr/2020IAVF0005.

Boltena, Sisay Sinamo. "Factors affecting the rehabilitation outcome (of outpatient therapeutic program) of children with severe acute malnutrition in Durame, Southern Ethiopia." Thesis, UWC, 2008. http://hdl.handle.net/11394/2868.

Mwanza, Mike. "Evaluation of the outpatient therapeutic programme for management of severe acute malnutrition in three districts of eastern province , Zambia." University of Western Cape, 2013. http://hdl.handle.net/11394/3919.

Akparibo, Robert. "A realist evaluation of community-based model used to treat children suffering from severe-acute malnutrition in non-emergency context in Ghana." Thesis, University of Sheffield, 2014. http://etheses.whiterose.ac.uk/6671/.

Tidjani, Alou Maryam. "Etude du microbiote digestif des enfants atteints de malnutrition sévère aiguë." Thesis, Aix-Marseille, 2016. http://www.theses.fr/2016AIXM5036/document.

Palmer, R. A. C. "Emotional stimulation as an addition to therapeutic food intervention for treatment of young children with severe acute malnutrition in a low-income country." Thesis, University College London (University of London), 2016. http://discovery.ucl.ac.uk/1532876/.

van, Aswegen Tanya. "Factors associated with morbidity and mortality in children under-five years admitted with severe acute malnutrition to a regional paediatric hospital in Kwazulu-Natal." University of the Western Cape, 2018. http://hdl.handle.net/11394/6741.

Pham, Thi Phuong Thao. "Caractérisation du microbiote intestinal des enfants atteints de la malnutrition aigüe sévère." Thesis, Aix-Marseille, 2019. http://www.theses.fr/2019AIXM0583.

Grellety, Bosviel Emmanuel. "Analysis of variation of mid-upper arm circumference and weight-for-height in children for the assessment of malnutrition in populations and individuals." Doctoral thesis, Universite Libre de Bruxelles, 2019. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/283364.

Salameh, Emmeline. "Développement d'un modèle murin de dénutrition avec entéropathie et évaluation de molécules d'intérêt permettant de contribuer au rétablissement de la fonction de barrière intestinale." Thesis, Normandie, 2019. http://www.theses.fr/2019NORMR064.

Kerac, M. "Improving the treatment of severe acute malnutrition in childhood : a randomized controlled trial of synbiotic-enhanced therapeutic food with long term follow-up of post-treatment mortality and morbidity." Thesis, University College London (University of London), 2011. http://discovery.ucl.ac.uk/1306755/.

Mclaren, Britta Jane. "Lactose malabsortion and diarrhoea in children with severe acute malnutrition." Thesis, 2015. http://hdl.handle.net/10539/19956.

Demisse, Bekele Negussie. "Performance of community-based management of children with severe acute malnutrition in a pastoral area of Ethiopia." Diss., 2013. http://hdl.handle.net/10500/13393.

Anthony, A. C. "Assessment of clinical practices in children admitted with severe acute malnutrition in three district hospitals, in the Western Cape, South Africa." 2013. http://hdl.handle.net/11394/3208.

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A Study To Assess The Knowledge Regarding Malnutrition
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(PDF) Determinants of Malnutrition among Children: A Systematic Review
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78 Malnutrition Essay Topic Ideas & Examples
Obesity is considered a malnutrition because the extended consumption of nutrients can still lead to the lack macro- and microelements. Overweight and obesity are serious disorders affecting a substantial part of the current population. We will write. a custom essay specifically for you by our professional experts.
(PDF) A descriptive study on Malnutrition
1) Malnutrition: In this study it refers to the lesser intake. of food for children in terms of quality and quantity to. maintain optimum health. 2) Mother of Under Five Children: In this study it ...
Malnutrition in all its forms and associated factors affecting the
Introduction. As studies show, malnutrition is one of the risk factors responsible for non-communicable diseases (NCDs) globally. 1 2 About one-third of people in any community have at least one form of malnutrition, which includes disorders caused by excessive and/or imbalanced intake, leading to obesity and overweight, and disorders caused by deficient intake of energy or nutrients, leading ...
Malnutrition in children under the age of 5 years in a primary health
Causes of malnutrition. Malnutrition amongst children under the age of 5 years is a result of a complex interaction of availability, accessibility, and utilisation of food and healthcare services. 16 Nutrition-specific factors include inadequate food intake, poor caregiving and parenting, improper food practices and infectious comorbidities. Nutrition-sensitive factors include food insecurity ...
PDF Understanding Severe Acute Malnutrition in Children Globally: A
Abstract. Severe acute malnutrition (SAM) affects 13 million children under the age of 5 worldwide, and contributes to 1‐2 million preventable deaths each year. Malnutrition is a significant factor in approximately one third of the nearly 8 million deaths in children who are under 5 years of age worldwide (1).
Global Prevalence of Malnutrition: Evidence from Literature
Malnutrition is an important global issue. 1. currently, as it affects all people despite the geography, socio-economic status, sex. and gender, overlapping households, communities and countries ...
Malnutrition and undernutrition: causes, consequences, assessment and
Malnutrition is also a major resource issue for public expenditure. BAPEN has calculated that the costs associated with disease-related malnutrition in 2011-2012 in the UK were £19.6 billion (far greater than those associated with obesity), or about 15% of the total expenditure on health and social care. These costs represent an increase of ...
Child Malnutrition in a Developing Country: A Persistent Challenge in Haiti
a persistent challenge among children under 5 years of age in developing countries, including Haiti, despite food aid provided. The purpose of this study was to determine the. association between dietary habits in children under 5 years of age in Haiti and their. malnutrition status.
Impact of malnutrition on the academic performance of school children
Introduction. Malnutrition refers to deficiency, excess, or an impaired utilization of one or more essential nutrients. 1 It consists of both under and over-nutrition. 2 Undernutrition includes wasting, stunting, underweight, and micronutrient deficiencies. 3 Malnutrition in any of its forms is a significant public health problem. 4 Globally, 29.8% of school-age children have insufficient ...
Tackling malnutrition: a systematic review of 15-year research evidence
Relevant publications titles (related to malnutrition studies) from the member research centres of INDEPTH were uploaded onto the Zotero research tool from different databases (60% from PubMed). Using the keywords 'nutrition, malnutrition, and over and under nutrition', publications were selected that were based only on data generated ...
(PDF) Determinants of Malnutrition in Children Under Five Years in
The rst screening was done through the titles and . abstracts. Then, the nal selection was done through . ... These malnutrition rates are lower than that of other developing countries [44,45] but ...
Empirical studies of factors associated with child malnutrition
Children who experience poor nutrition during the first 1000 days of life are more vulnerable to illness and death in the near term, as well as to lower work capacity and productivity as adults. These problems motivate research to identify basic and underlying factors that influence risks of child malnutrition. Based on a structured search of existing literature, we identified 90 studies that ...
(PDF) MALNUTRITION RESEARCH BY ORYEM JOSEPH
The World Health Organization (WHO) defines malnutrition as the cellular imbalance between the supply of nutrients and energy and the body's demand for them to ensure growth, maintenance, and specific functions. Brown (2013) defines malnutrition as the shortage of one or more nutritional elements needed for health and well-being.
PhD thesis- Nutrition Economics. Disease-related malnutrition and the
Malnutrition, meaning under‐nutrition (lack of nutrients) in health care also known as disease related malnutrition (DRM) in this thesis, is leading to health impairment associated with high health care costs. DRM is one of the most important indications for the use of medical nutrition, which is a special food indicated to be used in the ...
The Face of Child Malnutrition in the Philippines
Defines malnutrition and its related terms, analyzes the pattern of malnutrition in the Philippines, and explains the focus on stunting. In recent decades, rates of both stunting and wasting—the two principal markers of undernutrition—have fallen only slightly in the Philippines. With stunting at 30 percent nationally, the Philippines ranks fifth among countries with the highest prevalence ...
PDF Determinants Of Under-Five Malnutrition In Kenya
The study's overall objective was to determine the determinants of malnutrition among children between 0 and 59 months of age in Kenya. The specific objectives were: To determine the effect of socio-economic factors on under-five malnutrition in Kenya; To investigate the effect of bio-demographic factors on under-five malnutrition in.
(PDF) Malnutrition in children under the age of 5 years in a primary
Malnutrition is the most severe consequence of food insecurity amongst children under the age of. 5 years. Acute malnutrition can lead to morbidity, mortality and disability, as well as impaired ...
PDF Breaking the Curse: Addressing Chronic Malnutrition in the Philippines
Widespread chronic malnutrition in the Philippines is a human development disaster, which needs critical and urgent attention. Its consequences are multifaceted and extreme. Hence, it should be at the front and center of economic and health dialogue. This paper provides the current state of child stunting, a marker of chronic malnutrition.
Factors affecting malnutrition in children and the uptake of
Malnutrition often causes developmental delay however malnutrition can also be precipitated in feeding difficulties due to a chronic neurological problem . It appears this association was more of an effect rather than a cause of malnutrition in most of the children. However eight (8) out of the 29 malnourished children with developmental delay ...
Dissertations / Theses: 'Severe acute malnutrition'
A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. Severe acute malnutrition (SAM) affects 13 million children under the age of 5 worldwide, and contributes to 1‐2 million preventable deaths each year.
The Impact of Mothers' Knowledge and Attitudes on Malnutrition
Malnutrition is a global concern and it impacts negatively on mortality, morbidity, educability and productivity. Millions of children in South Africa are affected. This study examines the key ...
Thesis: Implications of Malnutrition in Underdeveloped Countries
The incidence of malnutrition as a result of the absence of adequate nutrition does not merely have implications on almost every organ of the human body but as a direct result, has implications on almost every segment of the society in which the absence of proper nutrition prevails. Please order custom thesis paper, dissertation, term paper ...
malnutrition thesis.
World Health Organization,, 1-25page. Request PDF | malnutrition thesis. | Causes for the prevalence of malnutrition among under five children in Ergavo district of Somaliland. | Find, read and ...