Associations of single versus multiple anthropometric failure with mortality in children under 5 years: A prospective cohort study
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ABSTRACT: Background/objectives
Stunting, underweight, and wasting are used to monitor nutritional status in children, but they do not identify children with concurrent anthropometric failures (AF). Our study estimates the association between AF and mortality in children with single versus multiple failures, then calculates the percentage of child deaths attributable to AF. Subjects/methods
Using data from a prospective, longitudinal study of 3605 children from age 1 to age 5 years in Ethiopia and India, we estimate the association between AF and mortality using conventional definitions (stunting, underweight, and wasting) and the mutually exclusive categories of stunted only underweight only, wasted only, stunted and underweight (SU), underweight and wasted, and stunted, underweight, and wasted (SUW), adjusting for socioeconomic status and other demographic variables. Last, we calculate the population attributable fraction. Results
Children who were SU and SUW had 3.20 (95% CI: 1.69, 6.06; p < 0.001) and 5.52 (95% CI: 2.25, 13.56; p < 0.001) times the odds of death in fully adjusted models by Round 2 compared to children with no failure, while no increased mortality risk was found among children with other categories of failure. We estimate that 42.69% of child deaths can be attributed to children who are SUW (17.02%) or SU (25.67%), accounting for nearly 80% of child deaths from AF. Conclusions
This study provides new insight to programs and policy to better identify children most at risk of malnutrition-related mortality. Highlights • Children with multiple anthropometric failures have a greater risk of all-cause mortality.• Our study uses prospective, longitudinal data that adjusts for socioeconomic status.• Our results provide new insight to identify children most at risk of death due to growth faltering.
SUBMITTER: Gausman J
PROVIDER: S-EPMC8626676 | biostudies-literature |
REPOSITORIES: biostudies-literature
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| S-EPMC8467097 | biostudies-literature
Project description:Prior research on the determinants of child health has focused on contemporaneous risk factors such as maternal behaviors, dietary factors, and immediate environmental conditions. Research on intergenerational factors that might also predispose a child to increased health adversity remains limited.To examine the association between maternal height and child mortality, anthropometric failure, and anemia.We retrieved data from the 2005-2006 National Family Health Survey in India (released in 2008). The study population constitutes a nationally representative cross-sectional sample of singleton children aged 0 to 59 months and born after January 2000 or January 2001 (n = 50 750) to mothers aged 15 to 49 years from all 29 states of India. Information on children was obtained by a face-to-face interview with mothers, with a response rate of 94.5%. Height was measured with an adjustable measuring board calibrated in millimeters. Demographic and socioeconomic variables were considered as covariates. Modified Poisson regression models that account for multistage survey design and sampling weights were estimated.Mortality was the primary end point; underweight, stunting, wasting, and anemia were included as secondary outcomes.In adjusted models, a 1-cm increase in maternal height was associated with a decreased risk of child mortality (relative risk [RR], 0.978; 95% confidence interval [CI], 0.970-0.987; P < .001), underweight (RR, 0.971; 95% CI, 0.968-0.974; P < .001), stunting (RR, 0.971; 95% CI, 0.968-0.0973; P < .001), wasting (RR, 0.989; 95% CI, 0.984-0.994; P < .001), and anemia (RR, 0.998; 95% CI, 0.997-0.999; P = .02). Children born to mothers who were less than 145 cm in height were 1.71 times more likely to die (95% CI, 1.37-2.13) (absolute probability, 0.09; 95% CI, 0.07-0.12) compared with mothers who were at least 160 cm in height (absolute probability, 0.05; 95% CI, 0.04-0.07). Similar patterns were observed for anthropometric failure related to underweight and stunting. Paternal height was not associated with child mortality or anemia but was associated with child anthropometric failure.In a nationally representative sample of households in India, maternal height was inversely associated with child mortality and anthropometric failure.
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Project description:BACKGROUND:India introduced rotavirus vaccines (RVV, monovalent, Rotavac™ and pentavalent, Rotasiil™) in April 2016 with 6, 10 and 14?weeks schedule and expanded countrywide in phases. We describe the epidemiology of intussusception among children aged 2-23?months in India. METHODS:The prospective surveillance at 19 nationally representative sentinel hospitals from four regions recruited children with intussusception from April 2016 to September 2017. Data on sociodemography, immunization, clinical, treatment and outcome were collected. Along with descriptive analysis, key parameters between four regions were compared using Chi-Square/Fisher's exact/Mann-Whitney U/Kruskal-Wallis tests. The pre- and post-RVV periods were compared to estimate the risk ratios. RESULTS:Six hundred twenty-one children with intussusception from South (n?=?262), East (n?=?190), North (n?=?136) and West (n?=?33) regions were recruited. Majority (n?=?465, 74.8%) were infants (40.0% aged 4-7?months) with median age 8?months (IQR 5, 13?months), predominantly males (n?=?408, 65.7%) and half (n?=?311, 50.0%) occurred during March-June months. A shorter interval between weaning and intussusception was observed for ragi based food (median 1?month, IQR 0-4.2?months) compared to rice (median 4?months, IQR 1-9?months) and wheat (median 3?months, IQR 1-7?months) based food (p?<?0.01). Abdominal pain or excessive crying (82.8%), vomiting (72.6%), and bloody stool (58.1%) were the leading symptoms. Classical triad (abdominal pain, vomiting and bloody stool) was observed in 34.8% cases (24.4 to 45.8% across regions). 95.3% of the cases were diagnosed by ultrasound. 49.3% (10.5 to 82.4% across regions) cases were managed by reduction, 39.5% (11.5 to 71.1% across regions) cases underwent surgery and 11.1% spontaneously resolved. Eleven (1.8%) cases died. 89.1% cases met Brighton criteria level 1 and 7.6% met Level 2. RVV was received by 12 cases within 1-21?days prior to intussusception. No increase in case load (RR?=?0.44; 95% CI 0.22-1.18) or case ratio (RR?=?0.5; 95% CI 0.3-1.2) was observed after RVV introduction in select sites. CONCLUSIONS:Intussusception cases were observed across all sites, although there were variations in cases, presentation and mode of management. The high case load age coincided with age of the RVV third dose. The association with ragi based weaning food in intussusception needs further evaluation.
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