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The nutritional status of children living within institutionalized care: a systematic review.

ABSTRACT: Background:There are an estimated 2.7 million children living within institutionalized care worldwide. This review aimed to evaluate currently available data on the nutrition status of children living within institutionalized care. Methods:We searched four databases (Pubmed/Medline, CINHAL Plus, Embase and Global Health Database) for relevant articles published from January 1990 to January 2019. Studies that included information on anthropometry or micronutrient status of children living within institutionalized care were eligible for inclusion. The review is registered on PROSPERO: CRD42019117103. Results:From 3,602 titles screened, we reviewed 98 full texts, of which 25 papers were eligible. Two (8%) studies reported data from multiple countries, nine (36%) were from Asia, four (16%) from Africa, three (12%) from Eastern Europe, four (16%) from the European Union and one (4%) from each of the remaining regions (Middle East, South America and the Caribbean). Twenty-two (88%) were cross sectional. Ten (40%) of the studies focused on children >5 years, seven (28%) on children <5 years, seven (28%) covered a wide age range and one did not include ages. Low birth weight prevalence ranged from 25-39%. Only five (20%) included information on children with disabilities and reported prevalence from 8-75%. Prevalence of undernutrition varied between ages, sites and countries: stunting ranged from 9-72%; wasting from 0-27%; underweight from 7-79%; low BMI from 5-27%. Overweight/obesity ranged from 10-32% and small head circumference from 17-41%. The prevalence of HIV was from 2-23% and anemia from 3-90%. Skin conditions or infections ranged from 10-31% and parasites from 6-76%. Half the studies with dietary information found inadequate intake or diet diversity. Younger children were typically more malnourished than older children, with a few exceptions. Children living within institutions were more malnourished than community peers, although children living in communities were also often below growth standards. High risk of bias was found. Conclusions:This study highlights the limited amount of evidence-based data available on the nutritional status of children in institutions. Of the studies reviewed, children living within institutionalized care were commonly malnourished, with undernutrition affecting young children particularly. Micronutrient deficiencies and obesity were also prevalent. Data quality was often poor: as well as suboptimal reporting of anthropometry, few looked for or described disabilities, despite disability being common in this population and having a large potential impact on nutrition status. Taken together, these findings suggest a need for greater focus on improving nutrition for younger children in institutions, especially those with disabilities. More information is needed about the nutritional status of the millions of children living within institutionalized care to fully address their right and need for healthy development.

SUBMITTER: DeLacey E

PROVIDER: S-EPMC7007983 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Background Growth references (growth charts) are used to assess the nutritional and growth status of children. In developed countries, there are growth charts based on the country’s national surveys. However, many developing countries do not have their own growth references, so they usually use WHO and US CDC references. In such cases, it is known that the growth statuses of the subject are underestimated or overestimated. This study sought to accurately assess the growth status of children by developing a local growth chart for children living in the Southern Province of Zambia. Methods Anthropometric measurements were conducted on 1135 children aged 2–19 years in the target area. The height and weight data for each sex and age were smoothed using the LMS method, and a percentile curve of height and weight was developed. Based on the US CDC reference, three indicators of undernutrition (stunting, underweight, and thinness) were calculated to determine the proportion of those who are undernourished (z-score < ??2). Results The 50th percentile curve of height and weight in the growth chart of the target population was equivalent to the 5–25th percentile curve of the US reference, and the children of Zambia were both small and of low weight. Conversely, although many subjects are small and of low weight, it was found that there were few poor nutritional statuses as judged by BMI. Through comparison with a previous study in the Southern Province of Zambia, a secular change in the growth of children over 20 years was found. Although there was no significant increase in height and weight in the older age group, there was a significant increase in height and weight at an earlier age. This is thought to be due to an increase in the growth rate of children due to improved socioeconomic conditions, women’s education level, and improvement in health care standards. Conclusions The subjects were small and of low weight compared to the US population, but the nutritional status was not poor by BMI. The height and weight at an earlier age increased compared to 20 years ago. Supplementary Information The online version contains supplementary material available at 10.1186/s40101-020-00244-8.

Project description:ObjectiveTo assess the effectiveness of agricultural interventions in improving the nutritional status of children in developing countries.DesignSystematic review.Data sourcesPublished and unpublished reports (after 1990) in English identified by searching 10 databases (Agris, Econlit, Eldis, IBSS, IDEAS, IFPRI, Jolis, PubMed, Web of Science, and World Bank), websites, previous systematic reviews, and reference lists and by contacting experts.Study selectionIncluded studies assessed effects of agricultural interventions aiming at improving the nutritional status of children (bio-fortification, home gardens, small scale fisheries and aquaculture, dairy development, and animal husbandry and poultry development). Only studies that used a valid counterfactual analysis were included. Before/after studies and participants/non-participants comparisons affected by selection bias were excluded. Data analysis Results were analysed for four intermediate outcomes (programme participation, income, dietary diversity, and micronutrient intake) and one final outcome (prevalence of under-nutrition). Analysis was by summary tables of mean effects and by meta-analysis (for vitamin A absorption).ResultsThe review included 23 studies, mostly evaluating home garden interventions. The studies reviewed did not report participation rates or the characteristics of participants in programmes. The interventions had a positive effect on the production of the agricultural goods promoted, but not on households' total income. The interventions were successful in promoting the consumption of food rich in protein and micronutrients, but the effect on the overall diet of poor people remains unclear. No evidence was found of an effect on the absorption of iron, but some evidence exists of a positive effect on absorption of vitamin A. Very little evidence was found of a positive effect on the prevalence of stunting, wasting, and underweight among children aged under 5.ConclusionsThe question posed by the review cannot be answered with any level of confidence. The data available show a poor effect of these interventions on nutritional status, but methodological weaknesses of the studies cast serious doubts on the validity of these results. More rigorous and better designed studies are needed, as well as the establishment of agreed quality standards to guide researchers in this important area.

Project description:BackgroundNutritional status is an important indicator for measuring quality of life in children. A region that is recovering from war will face many problems related to nutrition. Very few studies have addressed the nutritional problems in school children. This study was undertaken to identify the prevalence of wasting, stunting and obesity among school children from Northern Sri Lanka and associated socio-demographic factors.MethodsA community based cross-sectional study was carried out using multistage stratified proportionate cluster among healthy children attending schools in the Northern part of the country. Height and weight were measured, and Body Mass Index (BMI) calculated [weight (kg)/Height (m) 2]. BMI-for-age z-score (BAZ) and Height for age Z (HAZ) scores were determined and WHO growth references were used to categorise the nutritional status. Correlation between various nutritional problems with Maternal education, household income, number of family members and the residential area was assessed.ResultsA total of 1012 children were recruited, and the mean age and standard deviation were 11.12±1.77 yrs. Girls in the age ranges of 9-14 were heavier and taller when compared to the boys compatible with the pubertal growth spurt. Stunting based on the height for age was seen in 10.9% of boys and 11.8% of girls. Wasting based on BMI for age WHO standard (WHO 2007) was seen in 30.6% of boys and 29.1% of the girls. The prevalence of overweight was 11% and Obesity was 6.3% of the population. Obesity was predominantly seen in boys (4.2%) and it was significantly higher when compared to the girls (2.1%) (p < 0.001). Obesity in older boys (> 10 years) was significantly more than the younger ones (p < 0.01). Maternal education and family income had a significant impact on the prevalence of wasting, stunting and obesity whereas the family size contributed to the wasting and obesity (p< 0.001).ConclusionFindings suggest that stunting, wasting, overweight and obesity are prevalent among 6-16-year-old leading to concerns in public health. The nutritional status significantly varies according to the geographical location, maternal education and the household income.

Project description:OBJECTIVE:To examine associations between receipt of an electronic food voucher (e-voucher) compared to food rations on the nutritional status of Rohingya children living in refugee camps in Bangladesh. METHODS:This is an associational study using cross-sectional data. We measured heights and weights of 523 children aged between 6 and 23 months in households receiving either a food ration consisting of rice, pulses, vegetable oil (362 children) or an e-voucher (161 children) that could be used to purchase 19 different foods. Data were also collected on the characteristics of their mothers and the households in which they lived, including household demographics, consumption and expenditure, coping strategies, livelihoods and income profiles, and access to assistance. Associations between measures of anthropometric status (height-for-age z scores, stunting, weight-for-height z scores, wasting, weight-for-age z scores and mid-upper arm circumference) and household receipt of the e-voucher were estimated using ordinary least squares regressions. Control variables included child, maternal, household and locality characteristics. The study received ethical approval from the Institutional Review Board of the International Food Policy Research Institute, Washington DC. RESULTS:Household receipt of an e-voucher was associated with improved linear growth in children. This association is robust to the inclusion of maternal, household and location characteristics. The magnitude of the association is 0.38 SD (CI: 0.01, 0.74), and statistically significant at the five percent level. We cannot reject the null hypothesis that these associations differ by child sex. Receipt of an e-voucher is not associated with stunting when a full set of control variables are included. There is no association between receipt of e-vouchers and weight-for-length, weight-for-age or mid-upper arm circumference. We cannot reject the null hypothesis that these associations differ by child sex. CONCLUSIONS:In a humanitarian assistance setting, Rohingya refugee camps in Bangladesh, household receipt of an electronic food voucher instead of a food ration is associated with improvements in the linear growth of children between 6 and 23 months but not in measures of acute undernutrition or other anthropometric outcomes. Our associational evidence indicates that transitioning from food rations to electronic food vouchers does not adversely affect child nutritional status.

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The nutritional status of children living within institutionalized care: a systematic review.

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