Wasting

If you work in an office for a small or large organization, you will notice managers, supervisors, and even your co-workers engaging in time-wasting activities during the day. Typical examples of such activities are talking around the water cooler spreading office gossip or sitting in non-productive meetings. These non-productive, time-wasting activities are common in the workplace. The objective of this article is to help you to identify time-wasting behaviors and what to do about them based on information gathered through observations in the workplace and recent research articles on the topic. In particular, the article identifies three areas of non-productivity such as preoccupation, attending useless meetings, and time-consuming communication unrelated to office business. For both the manager, supervisor and individual worker identification and elimination of the time-wasting activity can foster an organization that promotes efficiency and increases productivity with increase profitability.

Physical growth and development studies were carried out among the populations of both tribal and non-tribal in eastern India by different scholars in different milieu and environmental factors from the eighties and onwards. Since then, the inhabitants of those areas have been doing agriculture, fishing, etc as prime occupation, but after a few decades in the same region, demographic and socio-economic changes took place under the influences of worldwide globalization of industrialization. These are evident in the increase of budget allocation of the respective governments. At the same time, people living in the regions who are under the influence of industrialization have received improved life style being marked with over nutrition; while people in the regions that do not have the impact of socioeconomic improvement still struggle with under-nutrition. This co-existing situation of under-and over nutrition among the populations of Indian subcontinent is aptly described as double burden of malnutrition by Shukla et al. In this paper, growth based on anthropometric measurements of height and weight statistically treated in terms of height-for-age-, weight-for-age and BMI-for-age-z score is analyzed by lms formula with reference to WHO. The nutritional status of 3 to 10 years plus children of Mishing (a scheduled tribe) and Kaibarta (a caste population of Assam, India) is studied. The children of 3-10 years plus of Mishing and Kaibarta populations were observed to be shorter than those of the children of CDC2000, Indian, and IndUp; but are taller than their ICMR counterpart. In the present study, the proportions of stunting, underweight, and thinness categories among the boys of both populations were observed to be higher than those of girls; this indicates suffering from chronic under-nutrition due to prolonged deprivation of required nutrients and illness.

AbstrAct: Being a developing nation, rural India is still facing a serious health problem in form of undernutrition particularly among young children. To optimize this problem, the Central Government has been operating a nationwide nutritional intervention programme in the form of Integrated Child Development Service (ICDS) scheme. Unfortunately, it has failed to achieve the desired goal during last four decades. Therefore the present study was designed to measure the seriousness and severity of overall undernutrition using Composite Index of Anthropometric Failure (CIAF) among the rural Bengalee preschool children of Sagar Block, South 24 Parganas, West Bengal, India. This cross-sectional study was conducted among 656 preschool children (326 boys and 330 girls) aged 3 to 5 years. Height (cm) and weight (kg) measurements were taken according to standard procedure, age and sex specific 2 z-scores values of height-forage , weight-for-height and weight-forage were used to assess stunting, wasting and underweight, respectively, as per the World Health Organization Guidelines. CIAF was also computed as per standard methodology to assess the degree of undernutrition among the studied children. The overall age and sex combined prevalence of stunting, wasting, underweight and CIAF was 26.2%, 35.4%, 51.1% and 61.3%, respectively. CIAF showed a higher prevalence of undernutrition (61.28%) in comparison to other three indicators i.e., stunting, wasting and underweight. We conclude that the nutritional status of the subjects was not satisfactory. It was also established that the CIAF is a better indicator of nutritional status than traditional measures of stunting, wasting and underweight, because it determines overall (total) anthropometric failure. Assessment of nutritional status by composite index of anthropometric failure (CIAF): a study among preschool children of Sagar Block, South 24 Parganas District, West Bengal, India

Malnutrition is the largest risk factor caused by inadequate nutrition that leads to childhood morbidity and mortality, as well as inadequate growth and development. Infants are at increased risk of malnutrition by six months, when breast milk alone is no longer suffi cient to meet their nutritional requirements. However the factors associated with nutritional status of infants after 6 months of age have received little attention in pastoralist communities of Ethiopia. The aim of this study was to assess the complementary foods of infants and young children (6-23 months) in Gode town of Kebele 01. The prevalences of wasting, stunting and underweight among infants and young children were 6.1%, 56.1%, 10.0% reespectively. Undernutrition is a public health problem among infants and young children in Gode town of Kebele 01. Breastfeeding was slightly positive associated with lower chances of wasting at r=0.61, p= 0.01 and underweight at r=0.331, p=0.01. While diarrheal disease was associated with higher chances of wasting and underweight. Initiation of complementary food was slightly positive association with wasting at r=0.179, p=0.05.

Aim: This study was carried out to determine the prevalence of undernutrition among Bengalee children of Purba Medinipur. Stunting, wasting and underweight were used to assess the prevalence of under-nutrition among children. However, these indices were not properly determined appropriate prevalence due to overlapping condition, but Composite Index of Anthropometric Failure (CIAF) is a single measure to assess the prevalence of under-nutrition which is better than other indices for the determination of undernutrition among children.
Methods: This cross-sectional study was conducted among school going Bengalee children of Desopran block and Haldia municipality of Purba Medinipur district, West Bengal, India. Total no. of participants were 622 aged 6 to 10 years. Among them 307 and 315 were boys and girls, respectively. Age and sex specific nutritional status of the subjects was assessed using height-for-age, weight-for-height, and weight-for-age as per NCHS guidelines and CIAF (Composite Index of Anthropometric Failure) was also computed as per standard methodology. Results: Boys were taller and heavier than girls. Significant age variations were noticed in anthropometric variables. Prevalence of wasting, stunting and underweight were 21.0%, 31.0%, and 41.9%, respectively. Moreover, prevalence of CIAF was 55.3% among the studied children. Result also revealed that rate of CIAF was much higher than the other three conventional indicators. Conclusion: It can be concluded that undernutrition among the school going children was very high and might be treated as a serious health problem. Appropriate authorities should take immediate remedial measures to reduce the rate of undernutrition. Similar studies should also be conducted from other regions of West Bengal.

Malnutrition across the world is a global issue but in the developing countries it is catastrophic. Poverty affects nutrition and nutrition affects poverty, while income poverty is important to nutrition it is not strongly correlated, it is here we begin this interdisciplinary dialogue on a growing phenomenon in Asia called stunting. Stunting or chronic under nutrition, resulting in growth retardation is indicated by height for-age. Nearly 40 percent of the children in SAARC countries are engulfed in poor conditions for growth and development. Clinical etiology suggests that lack of nutrition, presence of infection and lack of motherinfant interaction insufficient food supply both in quantity and quality and recurrence of infectious diseases results in stunting or chronic under nutrition. Stunting, as a manifestation of deprivation in early childhood, is a common problem among young children. We suggest that poverty and lack of resources may predispose a child to maladjustment in the grown-up society, lacking in resiliency. This paper examines the relationship between poverty, marginalization and health in the context of stunting, under weight and wasting among children and malnutrition among women and adolescent girls lacking in resilience.

Despite growing evidence in support of exclusive breastfeeding (EBF) among infants in the first 6 months of birth, the debate over the optimal duration of EBF continues. This study examines the effect of termination of EBF during the first 2, 4 and 6 months of birth on a set of adverse health and nutritional outcomes of infants.Three waves of Bangladesh Demographic and Health Survey data were analysed using multivariate regression. The adverse health outcomes were: an episode of diarrhea, fever or acute respiratory infection (ARI) during the 2 weeks prior to the survey. Nutritional outcomes were assessed by stunting (height-for-age), wasting (weight-for-height) and underweight (weight-for-age). Population attributable fraction was calculated to estimate percentages of these six outcomes that could have been prevented by supplying EBF.Fifty-six percent of infants were exclusively breastfed during the first 6 months. Lack of EBF increased the odds of diarrhea, fever and ARI. Among the babies aged 6 months or less 27.37% of diarrhea, 13.24% of fever and 8.94% of ARI could have been prevented if EBF was not discontinued. If EBF was terminated during 0-2 months, 2-4 months the odds of becoming underweight were 2.16 and 2.01 times higher, respectively, than babies for whom EBF was not terminated.Children who are not offered EBF up to 6 months of their birth may suffer from a range of infectious diseases and under-nutrition. Health promotion and other public health interventions should be enhanced to encourage EBF at least up to six-month of birth.

Wasting is an acute malnutrition which could indirectly increase infant mortality and morbidity. Currently, wasting was serious public health problem in Indonesia with 11,1% of prevalence. This study aimed to determine the incidence of wasting in childrens aged 6-59 months in the working area of Puskesmas Kelurahan Penjaringan I, North Jakarta from March to April, 2019. The researcher measured antropometry of children to see nutritional status based on indicator of BB/TB. A case control method, as well as purposive and accidental sampling technique, was carried out in this study. As many as 60 respondents were divided into 2 groups (30 cases group and 30 control group). The data were analyzed by using chi square test and multiple logistic regression. Infectious disease history (p=0.031) and protein intake (p=0.024) were associated with wasting incidence in children. Infectious diseases history was dominant factor determining of wasting in children aged 6-59 months in Puskesmas Kelur...

This study aims to assess the patterns of wasting and stunting and their concurrence among vulnerable Venezuelan children. We performed an analysis of 46,462 anthropometric records captured by Caritas Venezuela between 2017 and 2019 and relating to children under 5 years old in the poorest parishes. Based on the WHO 2006 child growth standards, we identify 31.7% and 11.5% of the records from 2019 as stunted and wasted, respectively. Our unconditional analysis shows that stunting was more frequent among boys and shows an inverted U-shape association with age. The prevalence of stunting increases from 0.28 in 2017 to 0.32 in 2019. By contrast, the wasting prevalence decreases from 0.15 in 2017 to 0.11 in 2019. The concurrence of stunting and wasting slightly decreases over the same period from 0.045 to 0.039, all three trends being statistically significant. Using multilevel regression models, our conditional analysis shows that the odds of wasted children being stunted are 1.079 times greater than for non-wasted children. Similarly, the odds of stunted children being wasted are 1.085 times greater than for non-stunted children. While age is not statistically associated with stunting, it reduces the likelihood of being wasted. Furthermore, each additional month of age reduces by 1.16% the odds of facing the simultaneous concurrence of stunting and wasting instead of not facing it. The children’s sex is also found to have a significant association with the probability of stunting and wasting. The odds of stunting and wasting amongst boys are found to be 1.19 and 1.084 times greater than for girls, respectively. We also found a significant and sizeable association between food insecurity and both stunting and wasting. Although lack of access to clean water is not associated with stunting, it is associated with higher levels of wasting. Protracted humanitarian crisis in Venezuela has brought considerable damage to child growth. Findings have policy and programming implications: stunting should be targeted as a humanitarian priority in protracted crisis, not only to mitigate the growth failure in children facing multiple nutritional deficiencies, but also as an approach for preventing persistent acute malnutrition.

Background
Malnutrition contributes to children’s morbidity and mortality, and the situation undermines the economic growth and development of Bangladesh. Malnutrition is associated with lower levels of education that decrease economic productivity and lead to poverty. The global burden of malnutrition continues to be unacceptably high amid social and economic growth, including in Bangladesh. Therefore, identifying the factors associated with childhood malnutrition and poverty is necessary to stop the vicious cycle of malnutrition leaded poverty.

Methods
The study utilized the 2017–18 Bangladesh Demographic and Health Survey (BDHS), accumulating 7,738 mother-child pairs. Associations between potential risk factors and nutritional status were determined using chi-square tests, and multivariate logistic regression models were utilized on significant risk factors to measure their odds ratio (OR) with their 95% confidence intervals (CI).

Results
The prevalence of moderate and severe wasting was 7.0% and 1.8%, respectively, whereas the prevalence of moderate and severe stunting was 19.2% and 8.0%, while 16.4% and 3.6% of children were moderately and severely underweight. Children from the poorest and poor households were suffering from at least one form of malnutrition. Adjusted ORs were estimated by controlling socio-economic and demographic risk factors, such as poor maternal body mass index, parents’ lower education level, use of unhygienic toilet, child age in months, and recent experience of diarrhea and fever. The pattern was almost similar for each malnutrition status (i.e., stunting, underweight, and wasting) in the poorest and poor households.

Conclusion
Bangladesh achieved the Millennium Development Goals, focusing primarily on health-related indicators and working to achieve the Sustainable Development Goals. Even considering this success, the prevalence of malnutrition and poverty in same household remains relatively high compared to other developing countries. Therefore, the study recommends the implementation of nationwide systematic measures to prevent poverty and malnutrition.

What we know: Both weight-for-height z-score (WHZ) and mid-upper arm circumference (MUAC) are recommended to identify severely malnourished children for treatment. MUAC has distinct advantages for community-level screening; however several countries have gone further to instigate MUAC-only admissions for treatment.

What this article adds: A recent review examined the consequences of excluding children with severe acute malnutrition (SAM) identified using WHZ from admission to treatment programmes. Analysis of individual data from 14,935 children admitted to a range of treatment programmes over 22 years and a literature review examined case fatality rates (CFR) with different indicators and caseload. Simpson’s paradox (mathematical coupling) results in reversal of significance that affects interpretation of the relative mortality rates of WHZ and MUAC. The analysis suggests that children with SAM identified by WHZ <-3Z and admitted for treatment have as high a risk of death as children in treatment with MUAC <115mm.  Review of 21 datasets that compared WHZ and MUAC mortality rates show problems with interpretation of the reported CFRs; inconsistencies greatly limit analysis, comparability and interpretation. Caseload is a more important determinant of the number of SAM-related child deaths than the relative CFR to give SAM-attributable deaths. Where most of the children are identified as SAM using WHZ rather than MUAC, it is estimated that fewer than half of all SAM-related deaths will be identified using a MUAC-only programme. Strong advocacy for the use of MUAC to maximise coverage of treatment programmes has developed into MUAC-only programmes that are inadequately evidenced on the consequences of excluding WHZ cases. Urgent research is needed to develop simple methods to identify children with low WHZ at community level.

Most of the Sustainable Development Goals are not likely to be achieved, partly because the goals were not tightly linked to strategies through which achievement of each goal could realistically be expected. The outcomes might have been much better if the goals were cast as rights. They would be treated as enforceable claims. Rights-based strategies would provide accountability, helping to ensure that duty bearers carried out their duties. This would establish the means for steady steering toward achievement of the goal. Wise use of computers and the Internet could facilitate the entire system.

Sustainable Development goal 2 focusses on preventing all forms of malnutrition by 2030. Therefore, it is important to understand the double burden of malnutrition (DBM) in mother-child pairs in India. This study attempted to explore the coexistence of DBM among mother-child pairs in India. Also, this study tries to explore various factors associated with DBM in India. The study utilized data from national representative cross-sectional fourth round of National Family Health Survey (NFHS-4) conducted in 2015-16. The study used anthropometric indices such as height-forage , weight-for-height, and weight-forage to examine the nutritional status of children aged 0-59 months. Further, the study used body mass index (BMI) of women and classified according to WHO cutoff values (normal BMI: 18.5 to < 24.99 kg/m 2 and overweight/obesity: ≥25.0 kg/m 2). The bivariate and multivariate logistic regression analysis were applied to assess the factors associated with DBM. It was found that 4.1 percent, 3.3 percent, and 2.1 percent of mother-child pairs in the same household were a combination of Overweight/Obese women with stunted children (OM/SC), Overweight/Obese women with underweight children (OM/UC), and Overweight/Obese women with wasted children respectively (OM/WC). Additionally, 6% of mother-child pairs in the same household were suffering from DBM. Mothers with secondary education were more likely to face risk of DBM as compared to uneducated mothers [OR: 1.17, p < 0.01]. DBM was higher among mother-child pairs, which belong to rich wealth quintile than mother-child pairs from poor wealth quintile [OR: 1.98, p < 0.01]. Interventions need to be scaled up to target undernutrition as well as obesity at the same time in a household. Isolated focus on undernourished children may not be sufficient, and it is recommended to address different nutritional problems simultaneously. Another important recommendation is to formulate nutrition interventions keeping in mind the inclusion of wealthier families, as DBM is higher among such families.

To determine the relationship between maternal nutritional status and infant growth pattern, a cross
sectional study was conducted in a postnatal clinic of government general hospital of south Kolkata,
West Bengal, India. A total of 97 mother and their children were measured following standard
techniques. Nutritional status of mothers and children’s were assessed based on WHO recommended
body mass index (BMI) guidelines, mid upper arm circumference (MUAC) and z-score methods,
respectively. The result shows that BMI is the most important predictive variable of WAZ, LAZ and
WLZ. Maternal BMI explained for 34.9%, 10.2% and 15.6% variation of WAZ, LAZ, and WLZ.
When maternal MUAC enter into the model, further MUAC explained by 4.5% and 5.3% of
variation for WAZ and WLZ score. In conclusion, interventions by improving maternal nutritional
status could have a significant role in the prevention of childhood malnutrition.

‘Growth-and-Obesity Profiles’ of a family gave percentiles of height, mass, optimal mass and status, indicating obesity or wasting as
percentage, for all family members. Additionally, for children, target height, current-age-mid-parental height and status, indicating
tallness or stunting as percentage, were calculated. To compute parents’ obesity profiles, gender-specific heights and masses were
used to interpolate respective percentiles using age-20 values. Either parent was suggested to gain mass, if optimal mass exceeded
actual mass. In case, value of optimal mass was lesser than actual mass, father was advised to reduce mass corresponding to that
difference, provided the value was less than 10 kilograms, otherwise he should shed off 10 kilograms within the next 6 months. For
mothers, currently married or recently divorced/widowed, the recommended suggestion to lose mass was computed by adding 5
kilograms to their mass, to account for possible pregnancy and the associated fetal mass. Up to the age of 30 years, optimal mass was
taken as the mass corresponding to height percentile. For individuals older than 30 years, body-mass index (BMI) was considered to
be the reference, computed by dividing mass in kilograms by square of height in meters. Optimal mass was determined by multiplying
square of height with the ideal BMI value (24 kilogram/meter2). Linear interpolation was employed to compute target-height
percentile. Box interpolation was used to determine child’s height/mass percentiles. A comparison of optimal mass with actual mass
determined whether the child was wasted or obese. A similar procedure was adopted to compute current-age-mid-parental height.
Comparison of child’s height with gender-specific-mid-parental height at current age, indicated whether the child was tall or stunted.
When more than one profile (each profile representing a checkup) was available, ‘Growth-and-Obesity Roadmap’ was generated. This
roadmap included month-wise recommendations to pick up height and put on or lose mass (weight). These recommendations were
generated from the most-recent profile, in such a way that a child was not required to lose more than 10 kilograms within the next 6
months, in order to avoid any adverse health effects from a rapid loss of mass.

Background: Research on trends in child undernutrition in Kenya has been hindered by the challenges of changing criteria for classifying undernutrition, and an emphasis in the literature on international comparisons of countries' situations. There has been little attention to within-country trend analyses. This paper presents child undernutrition trend analyses from 1993 to 2008-09, using the 2006 WHO criteria for undernutrition. The analyses are decomposed by child's sex and age, and by maternal education level, household Wealth Index, and province, to reveal any departures from the overall national trends. Methods: The study uses the Kenya Demographic and Health Survey data collected from women aged 15-49 years and children aged 0-35 months in 1993, 1998, 2003 and 2008-09. Logistic regression was used to test trends. Results: The prevalence of wasting for boys and girls combined remained stable at the national level but declined significantly among girls aged 0-35 months (p < 0.05). While stunting prevalence remained stagnant generally, the trend for boys aged 0-35 months significantly decreased and that for girls aged 12-23 months significantly increased (p < 0.05). The pattern for underweight in most socio-demographic groups showed a decline. Conclusion: The national trends in childhood undernutrition in Kenya showed significant declines in underweight while trends in wasting and stunting were stagnant. Analyses disaggregated by demographic and socioeconomic segments revealed some significant departures from these overall trends, some improving and some worsening. These findings support the importance of conducting trend analyses at detailed levels within countries, to inform the development of better-targeted childcare and feeding interventions.

This Topic Guide has been compiled to provide an overview of undernutrition in the context of development. It covers the nature, scale and complex range of causes of undernutrition and summarises the evidence for what works to address the problem. The Guide covers direct nutrition interventions (or nutrition specific development as it is often termed), indirect interventions (nutrition sensitive), and the global coordination structures, governance and funding which are essential for an enabling environment within which undernutrition can be successfully reduced. The focus of this Guide is on undernutrition, defined as the outcome of insufficient (quantity and quality) of food intake (hunger) and repeated infectious diseases. Undernutrition includes being underweight for one’s age, too short for one’s age (stunted), underweight for one’s height (wasted), and deficient in vitamins and minerals (micronutrient malnutrition). This review does not focus on the other component of malnutrition, which is overnutrition.

Hyponatremia is the most frequent electrolyte disorder in critically neurological patients. Cerebral salt wasting syndrome (CSW) is defined as a renal loss of sodium during intracranial disease leading to hyponatremia and a decrease in extracellular fluid volume. The pathogenesis of this disorder is still not completely understood. Sympathetic responses as well as some natriuretic factors play a role in this syndrome. Distinction between SIADH and CSW might be difficult. The essential point is the volemic state. It is necessary to rule out other intermediate causes. Treatment requires volume replacement and maintenance of a positive salt balance. Mineral corticoids may be useful in complicated cases.

Hyponatremia is the most frequent electrolyte disorder in critically neurological patients. Cerebral salt wasting syndrome (CSW) is defined as a renal loss of sodium during intracranial disease leading to hyponatremia and a decrease in extracellular fluid volume. The pathogenesis of this disorder is still not completely understood. Sympathetic responses as well as some natriuretic factors play a role in this syndrome. Distinction between SIADH and CSW might be difficult. The essential point is the volemic state. It is necessary to rule out other intermediate causes. Treatment requires volume replacement and maintenance of a positive salt balance. Mineral corticoids may be useful in complicated cases.

BACKGROUND/OBJECTIVES: Northeastern Indian region has a high density of marginalised populations with a concerning quality of health services. We observed the trends in prevalence of infectious diseases and nutritional disorders among children under-five years from 2006 to 2020 in the Northeastern states. We also assessed the distribution of their burden by place of residence. METHODS: A secondary data analysis of select indicators on infectious diseases and nutritional disorders in seven Northeastern states across three rounds of the National Family Health Survey (2005-06, 2015-16, 2019-20) was undertaken. We calculated outcome indicator mean prevalence, relative change and average annual rates of reduction of the indicators. RESULTS: A significant relative reduction between 2006-2020 in the prevalence of diarrhoea (0.4 [95CI:0.7,0.1]) at p < 0.05; acute respiratory illness (ARI) (0.7 [95CI:0.1,0.4]), stunting (0.3 [95CI: 0.3,0.12]) and underweight (0.3 [95CI:0.5,0.2]) at p < 0.001 were noted. However, overweight prevalence increased (10.1[95CI:4.3,16.0, p < 0.001]) due to a low annual reduction rate. The highest annual reduction rates were observed in Sikkim and Tripura for diarrhoea and ARI respectively (>10.0%), and in Meghalaya for wasting and severely wasting (6.3%). Rural areas had a higher burden of stunting, wasting (including severe), underweight, anaemia and diarrhoea; overweight was seen in both rural and urban settings. CONCLUSION: Significant reductions were observed in ARI, diarrhoea, stunting and underweight prevalence between 2006-2020, with sub-regional variations and a greater burden in rural areas. During this period, overweight prevalence worsened; and anaemia showed a large increase from 2016. To reduce the equity-gap, programmes should be adapted to meet the differential needs of the Northeastern states.

Food insecurity has always been and still continues to be one of the key global development issues. Close to one billion people around the world go to bed hungry every night, two billion people experience micronutrient malnutrition, and almost the same number are overweight or obese. Global food security is predicted to worsen further in the near future as climate change hinders agricultural production, by inducing higher temperatures, more frequent droughts and floods, and land degradation, and global population continues to rise, topping nine billion by mid-century. This course will enhance students' understanding of some of the complex issues and controversies that surround globalisation of agriculture and the global food chain, and review and discuss factors that influence food-and nutrition security at the global, national, community and household level.

Objectives: To examine maternal nutritional status and its relationship to infant weight and body proportions. Design: Retrospective study of births from January±December 1990. Setting: University Hospital of the West Indies, Jamaica. Subjects: Records for 2394 live, singleton births, between 200±305 d gestation. Main outcome measures: Birth weight, crown heel length, head circumference, ponderal index, head circumference:length ratio, placental weight, placental:birth weight ratio. Results: Mothers who were lighter had babies who had lower birth weight, were shorter, had smaller heads and had a higher HC:L ratio. Shorter and thinner women had babies who had lower birth weights, were shorter, had smaller heads and lighter placentas. Thinner women also had babies with a lower placental:birth weight ratio, and their BMI's were not linearly related to ponderal index and HC:L ratio. Women whose ®rst trimester Hb levels were`9.5 g/dl had babies with the lowest birth weight, crown heel length, placental weight and ponderal index. These measurements increased as the Hb levels rose to 12.5 g/dl but then fell at Hb levels b 12.5 g/dl. In the second and third trimester Hb levels were negatively associated with birth weight, crown heel length, head circumference, placenta weight and ponderal index. Conclusions: The data support the hypothesis that poor maternal nutrition is associated with foetal growth restraint. Poor maternal nutrition as indicated by low weight, height, and BMI are associated with smaller, shorter babies with smaller heads. Haemoglobin levels b 12.5 g/dl in pregnancy are associated with lighter, shorter, thinner babies, with smaller heads. Descriptors: foetal growth restraint; maternal nutrition; birth weight Correspondence: Dr T Forrester.

Objectives: To examine maternal nutritional status and its relationship to infant weight and body proportions. Design: Retrospective study of births from January±December 1990. Setting: University Hospital of the West Indies, Jamaica. Subjects: Records for 2394 live, singleton births, between 200±305 d gestation. Main outcome measures: Birth weight, crown heel length, head circumference, ponderal index, head circumference:length ratio, placental weight, placental:birth weight ratio. Results: Mothers who were lighter had babies who had lower birth weight, were shorter, had smaller heads and had a higher HC:L ratio. Shorter and thinner women had babies who had lower birth weights, were shorter, had smaller heads and lighter placentas. Thinner women also had babies with a lower placental:birth weight ratio, and their BMI's were not linearly related to ponderal index and HC:L ratio. Women whose ®rst trimester Hb levels were`9.5 g/dl had babies with the lowest birth weight, crown heel length, placental weight and ponderal index. These measurements increased as the Hb levels rose to 12.5 g/dl but then fell at Hb levels b 12.5 g/dl. In the second and third trimester Hb levels were negatively associated with birth weight, crown heel length, head circumference, placenta weight and ponderal index. Conclusions: The data support the hypothesis that poor maternal nutrition is associated with foetal growth restraint. Poor maternal nutrition as indicated by low weight, height, and BMI are associated with smaller, shorter babies with smaller heads. Haemoglobin levels b 12.5 g/dl in pregnancy are associated with lighter, shorter, thinner babies, with smaller heads. Descriptors: foetal growth restraint; maternal nutrition; birth weight Correspondence: Dr T Forrester.

Food insecurity has prejudicial impact in protecting child undernutrition. To explore this, using nationally representative two-stage stratified sample from Bangladesh demographic and health survey 2011 data collected from mothers about their household and child born during their last delivery, a total of 5904 children having valid information of all variables selected for this study were analyzed. Following the WHO guidelines and cut-off points, the prevalence of nutritional status- stunting (40.2%), underweight (35.7%) and wasting (16.3%) were accessed by the Z-scores approach of anthropometric criterion height-for-age, weight-for-age and weight-for-height respectively. The Household Food Insecurity Access Scale (HFIAS) measure was used to measure household food insecurity in this study. Food insecurity of household was discovered to have significant impact on child undernutrition in the form of stunting (OR = 1.62, 95% confidence interval: 1.42, 1.85, p< 0.01), underweight (OR = 1.80, 95% confidence interval: 1.58, 2.06, p < 0.01) and wasting (OR = 1. 28, 95% confidence interval: 1.09, 1.51, p < 0.01). These findings persisted even after adjusted for some significant socioeconomic characteristics. It indicates that a sufficient reduction of food insecurity is obvious for protecting child from undernutrition.

Background It is not known at which size a congenital Patent ductus arteriosus (PDA) in children becomes associated with a resultant severe malnutrition in children. Furthermore, the effect of ductal size on anthropometry of children with PDA is yet to be determined. Objectives This study was aimed to asses if the ductal size had any effect on anthropometry of children with PDA and at which size evidence of severe malnutrition ensues Methods This was a five-year observational cross-sectional study of children who presented at three tertiary institutions with PDA. Results There was a negative non-significant correlation between the size of PDA and the weight of patients, (Pearson correlation coefficient = -0.1, p = 0.7). There was also a negative non-significant correlation between the size of PDA and patient’s height/length, (correlation coefficient = -0.1, p = 0.5). The association between the  size of PDA and  the severity of malnutrition revealed greater proportion of 35.3% (6/17...

Background Malnutrition is a critical public health issue that has been related to a significant increase in mortality and morbidity rates. Despite the fact that children are expected to benefit from home gardening products, their nutritional condition in Ethiopia, particularly in the planned study region, is not thoroughly monitored. Therefore the purpose of this is to determine the nutritional status of 6–59 months of age children between households with and without home gardening practices at Zege. Methods A community based comparative cross-sectional study was conducted among paired mothers with 6–59 month children from February to March 2020. Data were collected using questionnaire and anthropometric measurement tools. Binary logistic regression models were used. A-p-value &lt; 0.05 was used as cutoff point to declare statistically significant variables with the outcome variable. Result Stunting and wasting among children aged 6–59 months was high and did not show significant v...

Malnutrition across the world is a global issue but in the developing countries it is catastrophic. Poverty affects nutrition and nutrition affects poverty, while income poverty is important to nutrition it is not strongly correlated, it is here we begin this interdisciplinary dialogue on a growing phenomenon in Asia called stunting. Stunting or chronic under nutrition, resulting in growth retardation is indicated by height forage. Nearly 40 percent of the children in SAARC countries are engulfed in poor conditions for growth and development. Clinical etiology suggests that lack of nutrition, presence of infection and lack of motherinfant interaction insufficient food supply both in quantity and quality and recurrence of infectious diseases results in stunting or chronic under nutrition. Stunting, as a manifestation of deprivation in early childhood, is a common problem among young children. We suggest that poverty and lack of resources may predispose a child to maladjustment in the grown-up society, lacking in resiliency. This paper examines the relationship between poverty, marginalization and health in the context of stunting, under weight and wasting among children and malnutrition among women and adolescent girls lacking in resilience.

Optimal mass (weight) was defined in 2011 as the mass (weight) corresponding to percentile of height. Status of obesity was
determined as percentage, by considering optimal mass as reference and could be used in conjunction with body-mass index (BMI) to
classify an individual as obese or wasted. This work puts forward a regression model (named as KJ-Regression Model) to evaluate
optimal masses of children and adults, whose heights and masses lie below third percentile or above ninety-seventh percentile. For
such cases, CDC growth charts, converted into tabular form, cannot be used to determine numerical values of percentiles. Sigmoid
function and linear interpolation were used to compute heights and masses corresponding to extreme percentiles (below 3rd or above
97th). In addition to growth curves (plots of height and mass versus age), which include plots corresponding to 0.01th, 0.1th, 1st, 99th,
99.9th and 99.99th percentiles, mathematical formulae are given to compute heights and masses corresponding to any value of
percentile (between zero and hundred). Height and mass tables for boys and girls with entries to 5 decimal places, including those
corresponding to extreme percentiles, are given in additional files.

The study was designed to investigate the quantity and reasons of wastage of blood products. This was an observational study conducted from February 2018 to February 2019 at the National Institute of Blood Disease and Bone Marrow Transplantation (NIBD and BMT), PECHS campus. The study was approved by the institutional review board. Wastage and reasons of wastage for all the blood products were evaluated. Frequencies were calculated by using SPSS version 23.0. A total of 2,880 bags of blood products were available, including 960 each of platelets, packed red cells and fresh frozen plasma. The overall wastage rate was 3.5%. Packed red cells and platelets were fully consumed, yet shortage of supply was observed. However, highest wastage was observed in fresh frozen plasma i.e. 102 bags. Expiry of unused products 60 (59%) followed by broken bags 30 (29%) were two common modes of wastage. Wastage of blood products is a genuine issue in a hospital setup, strategies and plan of action shou...

Background: Undernutrition among preschool children in Northern region is the highest in Ghana. However, there is scarcity of data on the factors that determine undernutrition in these children. This study investigated the effect of maternal and child factors on undernutrition among preschool children in Northern Ghana. Methods: This study was a community based analytical cross-sectional survey on a sample of 425 mother-child pairs drawn from 25 clusters. A semi-structured questionnaire was used to collect data on maternal and child socio-demographic characteristics, feeding practices and anthropometry. Anthropometric indices of Height-forage Z-scores (HAZ), Weight-for-height Z-scores (WHZ) and Weight-forage Z-scores (WAZ) were used to classify child stunting, wasting and underweight respectively. Bivariate and multivariate analyses were performed to determine associations between explanatory variables and undernutrition. Results: The prevalence of stunting, wasting and underweight were 28.2, 9.9 and 19.3% respectively. Multiple logistic regression analysis showed that, the odds of stunting was higher among male children [AOR = 1.99; 95% CI (1.26-3.13); p = 0.003], children of mothers less than 150 cm in height [AOR = 3.87; 95% CI (1.34-11.20); p = 0.01], mothers 155-159 cm tall [AOR = 2.21; 95% CI (1.34-3.66); p = 0.002], and older children aged 12-23 months [AOR 9.81; 95% CI (2.85-33.76); p < 0.001]. Wasting was significantly higher among male children [AOR = 2.40; 95% CI (1.189-4.844); p = 0.015], consumption of less than four food groups [AOR = 3.733; 95% CI (1.889-7.376); p < 0.001] and among children of underweight mothers [AOR = 3.897; 95% CI (1.404-10.820); p = 0.009]. Male children [AOR = 2.685; 95% CI (1.205-5.98); p = 0.016] and having low birth weight [AOR = 3.778; 95% CI (1.440-9.911); p < 0.001] were associated with higher odds of underweight in children. Conclusion: Maternal height associated negatively with stunting but not wasting. Factors that affect low height-forage z-score (HAZ) may not necessarily be the same as stunting. Infant and child feeding practices as measured by dietary diversity score associated positively with weight-for-height Z-scores than length-forage Z-scores of young children. Surprisingly, consumption of some specific food groups including, animal source foods, legumes, staples and eggs were associated with lower HAZ but with increased likelihood of higher WHZ among children 6-59 months.

Poor nutritional status of children is a major public health problem throughout the developing world and is the underlying cause for 35% of child deaths and 11% of the total global disease burden. The global burden of childhood mortality, morbidity, and under nutrition is now increasingly concentrated in the most deprived and underserved populations within countries. The aim of this study was to investigate the socioeconomic differences of malnutrition of the under-five children and women at reproductive age in Bangladesh. Bangladesh Demographic Health Survey data 2011 were used for this study. Three of the most commonly used anthropometric indicators (weight-for-height, height-forage , and weight-forage) have been constructed for under five children. Asset quintiles have been constructed using principal component analysis technique. The concentration index (CI) has been estimated to show the direction of nutritional status across asset quintiles. Using concentration index it is found that child and mother malnutrition were more common in poor quintiles compared to rich quintiles. Stunting (CI = −30.127) and underweight (CI = −0.163) among child and thin/malnutrition condition (CI = −0.241) among women were highly pro-poor. On the other hand overweight condition (CI = −0.376) among women was highly pro-rich. Beside this urban and rural differential showed that rural area was better-off than urban area in terms of inequity in nutritional indicators of children and women. Even stunting and wasting is more prevalent among poorest children in urban area than children of same economic group in rural area. The community level nutritional intervention strategies aiming at reducing socioeconomic inequality should be taken for addressing large inequity in nutritional status of children and women in Bangladesh.

T he profound impacts of childhood malnutrition, including both undernutrition and overweight, affect the economic, social and medical well-being of individuals, families, communities and nations 1,2. Undernutrition has been the most common form of malnutrition in LMICs 3 , but as populations experience economic growth, urbanization and demographic change, overweight is an emerging problem, leading to a double burden of malnutrition (DBM). DBM may be manifested at the individual level as stunting in childhood followed by overweight in adulthood 4. At the household level, research has focused on maternal and child indicators of malnutrition, whereas at the population level, prevalence of both undernutrition with overweight has been reported 5. In children, DBM can be defined using different combinations of the various indicators of undernutrition (wasting and/or stunting) and overweight, obesity and diet-related noncommunicable diseases (NCDs) 6. While the most studied type of double burden is that of stunting and obesity, it is mostly applicable at the individual level among overweight adults who were previously stunted from chronic undernutrition during childhood. Wasting is associated with high rate of child mortality, whereas stunting has significant negative impact across the life course and is highly predictive of economic outcomes 7. Public health nutrition programs designed to address undernutrition may exacerbate overweight 8 , thus a comprehensive understanding of DBM at the population level is crucial for the design of effective interventions. Our aim was to determine the prevalence of overweight among children under 5 years old in LMICs (N = 105) for policy-relevant administrative units (district, state, and national level) and determine DBM by combining these estimates with those of wasting prevalence. As there is no broad consensus on the preferred international child growth standards for assessing overweight and obesity among children under 5 (refs. 9,10), we used weight-for-height above established cutoff points defined by the World Health Organization (WHO). This was to analyze overweight estimates in relation to the Global Nutrition Targets (GNTs), which were developed based on WHO standards. Prevalence of early childhood overweight (including obesity) is defined as the proportion of children under 5 with a weight-for-height z score (WHZ) more than two standard deviations (s.d.) above the WHO sex-and age-specific median growth reference standards 10. This is different from the definition for children between the ages of 5-18 years, which is above one s.d. for overweight and above two s.d. for obese. We selected wasting as the comparative indicator against overweight, as both share recommended population prevalence ranges, which can be used to create bivariate categories for DBM. Child wasting prevalence is defined as the proportion of children under 5 with a WHZ more than two s.d. below the median WHO growth standards 10. Using WHZs allowed modeling of the three categories in the same distribution and thus enabled us to reliably determine the relative proportions for each category using an ordinal approach. Based on WHO and United Nations Children's Fund (UNICEF)-defined thresholds, a moderate level of separate or dual conditions is defined as >5-10%, a high level as >10-15% and a very high level as >15% estimated prevalence 11. Finally, we have defined DBM in this study as the simultaneous occurrence of >5% estimated prevalence for both wasting and overweight within the same locations in the same year. Reversing the rise in childhood overweight is indicated in the United Nations (UN) Sustainable Development Goal 2.2 (ref. 12) and WHO's GNTs to improve maternal, infant and young child nutrition 13. WHO has also set an international target to reduce wasting to <5% by 2025 (ref. 14). Quantifying changes in childhood overweight and wasting prevalence can be used to measure progress toward these targets, while identifying locales with simultaneous overweight and wasting will better inform intervention planning. In addition, mapping changes in DBM prevalence will provide a deeper understanding of the impact of past intervention strategies, including insight into overweight in children under 5. Global and local variation in malnutrition trends Globally in 2017, an estimated 38.3 million (5.6%) children under 5 were overweight and 50.5 million (7.5%) were wasted 15. The majority (91%) of children under 5 affected by wasting and nearly half A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low-and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1-70.8) million) to 6.4% (58.3 (47.6-70.7) million), but is predicted to remain above the World Health Organization's Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8-38.5) million) in 2000 to 6.0% (55.5 (44.8-67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic. Nature MeDiCiNe | www.nature.com/naturemedicine