Anemia is a global public health problem but the burden of anemia is disproportionately borne among children in developing countries. Anemia in early stages of life has serious consequences on the growth and development of the children. We examine the prevalence of anemia, possible association between anemia and different socio-economic, demographic, health and other factors among children with ages from 6 to 59 months from the nationally representative 2011 Bangladesh Demographic and Health Survey (BDHS). Data on hemoglobin (Hb) concentration among the children aged 6–59 months from the most recent BDHS (2011) were used. This nationally representative survey allowed a multistage stratified cluster sampling design and provided data on a wide range of indicators such as fertility, mortality, women and child health, nutrition and other background characteristics. Anemia status was determined using hemoglobin level (<11.0 g/dl), and weighted prevalence of childhood anemia along with 95 % confidence intervals were provided. We also examined the distribution of weighted anemia prevalence across different groups and performed logistic regression to assess the association of anemia with different factors. A total of 2171 children aged 6–59 months were identified for this analysis, with weighted prevalence of anemia being 51.9 % overall- 47.4 % in urban and 53.1 % in rural regions. Results of a multivariable logistic regression analysis showed that, children below 24 months of age (odds ratio, [OR] 3.01; 95 % confidence interval [CI] 2.38-3.81), and those from an anemic mother (OR 1.80; 95 % CI 1.49-2.18) were at higher risk of anemia. Childhood anemia was significantly associated with chronic malnutrition of child, source of drinking water, household wealth and geographical location (defined by division). A high prevalence of anemia among 6–59 months aged children was observed in Bangladesh. Given the negative impact of anemia on the development of children in future, there is an urgent need for effective and efficient remedial public health interventions.

/pdf/determinants-of-anemia-among-6-59-months-aged-children-in-31801sb2eo.pdf

Determinants of anemia among 6–59 months aged children in Bangladesh: evidence from nationally representative data

Background Bangladesh is one of the most anemia prone countries in South Asia. Children of age under five years and women of reproductive age are particularly vulnerable in this region. Although several studies have investigated the risk factors of anemia, only few have explored its association with malnutrition, despite its high prevalence in the same group. The objective of this paper is to investigate the association of malnutrition with anemia by conducting separate analyses for under-five children and women of reproductive age using data from the nationally representative 2011 Bangladesh Demographic and Health Survey. Methods Two binary outcome variables are considered separately: presence of anemia in children under five years of age (Hb<11.0 g/dl) and presence of anemia in women of childbearing age (Hb<12.0 g/dl). The exposures of interest corresponding to these two outcomes are stunting (low height-for-age) and low BMI (<18.5 kg/m2), respectively. Preliminary analysis involves estimating the association between exposure and outcome while controlling for a single confounder by computing adjusted odds ratios (adjOR) using the Cochran-Mantel-Haenszel approach in stratified analysis. Later, associations between the exposures and outcomes are estimated separately for under-five children and women of reproductive age by fitting multivariable regression models that adjust simultaneously for several confounders. Results The prevalence of anemia is found to be higher among both the stunted children and women with low BMI compared to their healthy counterparts (Children: 56% vs 48%; women: 50% vs 43%). Furthermore, stunted children and women with low BMI have significantly increased odds of developing anemia, as reflected by the adjusted ORs of 1.76 (95% CI:1.10–2.83) and 1.81 (95% CI: 1.11–3.48), respectively. The association of stunting with anemia in children was modified by their age and socio-economic condition, where risk of being anemic decreases with increasing age but with a lower rate for stunted children from richest family. In addition, stunted children of anemic mothers are at greater risk of being anemic compared to non-stunted children of anemic or non-anemic mothers. Again the association between BMI and anemia in women is modified by the level of education, with risk of anemia being lowest among women with low BMI and higher education. Conclusion Evidence–based policies targeting the vulnerable groups are required to combat anemia and nutritional deficiencies simultaneously under the same program.

/pdf/association-between-malnutrition-and-anemia-in-under-five-4fkkhf0ews.pdf

Association between malnutrition and anemia in under-five children and women of reproductive age: Evidence from Bangladesh Demographic and Health Survey 2011.

Despite the importance of early initiation of and exclusive breastfeeding, prelacteal feeds continue to pose a barrier to optimal breastfeeding practices in several countries, including Vietnam. This study examined the factors associated with prelacteal feeding among Vietnamese mothers. Data from 6068 mother-child (<6 m) dyads were obtained from a cross-sectional survey conducted in 11 provinces in Vietnam in 2011. Multivariate logistic regression analyses were used to examine factors associated with prelacteal feeding. During the first three days after birth, 73.3% of the newborns were fed prelacteals, 53.5% were fed infants formula, and 44.1% were fed water. The odds of feeding prelacteals declined with increased breastfeeding knowledge, beliefs about social norms in favor of exclusive breastfeeding, and confidence in one’s own breastfeeding behaviors. Women who harbored misconceptions about breastfeeding had twice the odds of feeding any prelacteals (OR: 2.09, 95% CI: 1.74–2.50). Health care factors increasing the odds of prelacteal feeding included delivery by caesarean section (OR: 2.94, 95% CI: 2.39–3.61) or episiotomy (OR: 1.36, 95% CI: 1.17–1.58) and experiencing breastfeeding problems (OR: 1.31, 95% CI: 1.04–1.66). Health staff support during pregnancy and after birth reduced the odds of feeding formula. However, family support after delivery increased the odds of feeding water to newborns. The multiple factors contributing to the high prevalence of prelacteal feeding behaviors stress the need for early and appropriate breastfeeding interventions in Vietnam, particularly during routine healthcare contacts. Improving breastfeeding practices during the first days of an infant’s life could be achieved by improving knowledge and confidence of mothers through appropriate perinatal counseling and support. Ensuring that health facilities integrate these practices into routine ante-natal care and post-delivery management is critical.

/pdf/prelacteal-feeding-practices-in-vietnam-challenges-and-69ajne1a5r.pdf

Prelacteal feeding practices in Vietnam: challenges and associated factors.

In spite of the enormous economic progress and development witnessed in Indonesia in the last few decades, still more than 30% of Indonesian children under the age of five suffer from stunting, or low height for age. This concern is exacerbated by the fact that stunting remains more concentrated among the poorer households, leading to further intergenerational transmission of poverty and ill health. We examine recent trends in the evolution of the prevalence of childhood stunting and severe stunting, its socioeconomic inequality and the factors that appear to have contributed to these developments. Using the two most recent waves of the Indonesia Family Life Survey (IFLS), we study the changes in the prevalence of (severe) stunting between 2007 and 2014 for children aged 0-59 months and their socioeconomic-inequality using the Erreygers Concentration Index (EI) and its regression-based decomposition. We find a significant drop in the rate of severe stunting but not in stunting, as well as a significant reduction in the degree of absolute inequality of stunting. A decomposition analysis shows that household wealth, maternal education, institutional delivery, and availability of adequate sanitation contribute most to socioeconomic inequality in under-five stunting. Further analysis of the change in inequality over time indicates that the reduction in the association of wealth with stunting and a substantial improvement of health care access of the poor (as proxied by immunizations and institutional deliveries) play the most important role in narrowing the stunting gap between richer and poorer kids. General economic growth, poverty reduction, and implementation of pro-poor health and social programs during the studied period such as the expansion of health insurance coverage for the poor (Jamkesmas) and Conditional Cash Transfer program (Program Keluarga Harapan, PKH) are some plausible explanations of the observed result.

/pdf/explaining-the-fall-of-socioeconomic-inequality-in-childhood-2ba6pkd866.pdf

Explaining the fall of socioeconomic inequality in childhood stunting in Indonesia.

Background/objectives Fruits and vegetables are integral parts of a healthy diet. This study evaluated the quantity and diversity of the fruit and vegetable intake in India, with a focus on its distribution across sectors and wealth quintiles. Subjects/methods A secondary data analysis on the nation-wide NSSO Household Consumer Expenditure Survey 2011-2012 was performed to estimate the amount (g/capita/day) and diversity of household intake of fruits and vegetables in the rural and the urban sectors of India. Using the expenditure data, households in both the sectors were further divided into wealth quintiles and differences in the diversity of intake was evaluated across these quintiles separately for each sector. Results The per capita household vegetable and fruit intake was found to be 145 and 15 g, respectively, for rural India, and 155 and 29 g for urban India. A significant portion of this intake came from energy-dense food items; potatoes and bananas for vegetable and fruit intake respectively. Further, while wealth marginally improved the diversity in vegetable intake, no such trend was observed in fruit intake. Conclusions Given the high proportion of energy-dense fruits and vegetables in the Indian total intake, the focus should be on improving the diversity of vegetables, as well as on increasing the intake and diversity of fruits.

Are 'fruits and vegetables' intake really what they seem in India?

This report first presents causes of malnutrition of concern in Asia potential solutions and current global and USG efforts to reduce it (Section 2). Next regional analysis is provided in Section 3 that compares data on nutrition status and trends across and within Bangladesh India Nepal and Tajikistan. From this analysis potential causes of malnutrition are identified in Section 4 followed by priorities to address these causes (Sections 5 and 6) and recommendations for USAID (Section 7). This report also includes separate individual nutrition profiles for each country consisting of an overview of programs and policies that address nutrition for young children and women of reproductive age data on nutrition status and trends priority nutrition problems and their probable causes and recommendations for dealing with them effectively. (Excerpts)

Overview of the nutrition situation in four countries in South and Central Asia.

The intended purpose of this profile is to provide a broad overview of the status of nutrition in Vietnam in order to inform potential US-supported efforts. This profile examines why there should be investment in nutrition in Vietnam; summarizes nutritional status and priorities; lists the key drivers of maternal and child malnutrition in Vietnam; provides graphic summaries of key statistics in child and maternal health and nutrition; lists relevant indicators in food security diet diversity and water sanitation and hygiene; discusses the role of gender; describes the needs and challenges of the government policies and program environment; summarizes development partner support; and discusses recommended nutrition priorities and recommended indicators to monitor nutritional impact.

Vietnam nutrition profile.

Adequate nutrition is critical to a child’s optimal development particularly during the first 1000 days (pregnancy through the child’s second birthday) a period of rapid growth where nutrient deficiencies can have long-term consequences. Recent evidence suggests that integrated nutrition and early childhood development programs can help improve both child development and nutrition outcomes laying the best foundation for children to achieve their full potential as adults. However most programs do not yet effectively integrate early childhood development interventions within nutrition and health services targeting children under 2 resulting in a missed opportunity. This technical note explores the interaction between nutrition and early childhood development during the 1000 days examines how programs are integrating the two areas and outlines the potential impact that integrated programs can have on improving a child’s growth and development.

/pdf/giving-children-the-best-start-in-life-integrating-nutrition-3iz7mojmd7.pdf

Giving children the best start in life: Integrating nutrition and early childhood development programming within the first 1000 days.

The intended purpose of this profile is to provide a broad overview of the status of nutrition in Bangladesh in order to inform potential US-supported efforts.This profile examines why there should be investment in nutrition in Bangladesh; summarizes nutritional status and priorities; lists the key drivers of maternal and child malnutrition in Bangladesh; provides graphic summaries of key statistics in child and maternal nutrition; lists relevant indicators in food security diet diversity and water sanitation and hygiene; discusses the role of gender; describes the needs and challenges of the government policies and program environment; summarizes development partner support; and discusses recommended nutrition priorities and recommended indicators to monitor nutritional impact.

Bangladesh nutrition profile.

The intended purpose of this profile is to provide a broad overview of the status of nutrition in Nepal in order to inform potential US-supported efforts. This profile examines why there should be investment in nutrition in Nepal; summarizes nutritional status and priorities; lists the key drivers of maternal and child malnutrition in Nepal; provides graphic summaries of key statistics in child and maternal health and nutrition; lists relevant indicators in food security diet diversity and water sanitation and hygiene; discusses the role of gender; describes the needs and challenges of the government policies and program environment; summarizes development partner support; and discusses recommended nutrition priorities and recommended indicators to monitor nutritional impact.

Nepal nutrition profile.

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