Improving Infant and Young Child Nutrition in a Highly Stunted Rural Community: A Practical Case Study from Guatemala

Martinez, Boris; Flood, David; Cnop, Katia; Guzmán, Alfredo Echegollen; Rohloff, Peter

doi:10.1007/978-3-319-40007-5_52-1

Cited by 8 publications

(9 citation statements)

References 21 publications

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“…Malnutrition reduction must include not just prevention of new cases but effective treatment of prevalent cases to assist in counteracting growth faltering. In other areas with high rates of stunting, robust malnutrition interventions targeted at smaller areas have been successful at reducing stunting at the population or community level [10,30]. However, other factors than malnutrition alone can contribute to stunting, and important hidden factors contributing to growth-faltering, such as gender roles, age at onset of stunting, breast feeding duration, maternal mental health, dietary diversity and micronutrient availability can vary from site to site; thus formative research in communities should be undertaken to understand how national programs can be adapted on bolstered to have greatest effects.…”

Section: Discussionmentioning

confidence: 99%

“…Some of these factors, if identified early enough, are potentially modifiable through intervention, such as caregiver interaction and stimulation [8,9], or treatment for or prevention of malnutrition [3,10]. System and policy changes can influence access to health care for prevention and treatment of illness, malnutrition, early marriage and first birth, and maternal education, all of which may influence children's development.…”

Section: (Continued From Previous Page)mentioning

confidence: 99%

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Factors associated with risk of developmental delay in preschool children in a setting with high rates of malnutrition: a cross-sectional analysis of data from the IHOPE study, Madagascar

et al. 2020

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Background: 50% of Malagasy children have moderate to severe stunting. In 2016, a new 10 year National Nutrition Action Plan (PNAN III) was initiated to help address stunting and developmental delay. We report factors associated with risk of developmental delay in 3 and 4 year olds in the rural district of Ifanadiana in southeastern Madagascar in 2016. Methods: The data are from a cross-sectional analysis of the 2016 wave of IHOPE panel data (a populationrepresentative cohort study begun in 2014). We interviewed women ages 15-49 using the MICS Early Child Development Indicator (ECDI) module, which includes questions for physical, socio-emotional, learning and literacy/ numeracy domains. We analyzed ECDI data using standardized z scores for relative relationships for 2 outcomes: atrisk-for-delay vs. an international standard, and lower-development-than-peers if ECDI z scores were > 1 standard deviation below study mean. Covariates included demographics, adult involvement, household environment, and selected child health factors. Variables significant at alpha of 0.1 were included a multivariable model; final models used backward stepwise regression, clustered at the sampling level. Results: Of 432 children ages 3 and 4 years, 173 (40%) were at risk for delay compared to international norms and 68 children (16.0%) had lower-development than peers. This was driven mostly by the literacy/numeracy domain, with only 7% of children considered developmentally on track in that domain. 50.5% of children had moderate to severe stunting. 76 (17.6%) had > = 4 stimulation activities in past 3 days. Greater paternal engagement (OR 1.5 (1.09, 2.07)) was associated with increased delay vs. international norms. Adolescent motherhood (OR. 4.09 (1.40, 11.87)) decreased children's development vs. peers. Engagement from a non-parental adult reduced odds of delay for both outcomes (OR (95%CI = 0.76 (0.63, 0.91) & 0.27 (0.15, 0 48) respectively). Stunting was not associated with delay risk (1.36 (0.85, 2.15) or low development (0.92 (0.48, 1.78)) when controlling for other factors.

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Section: Discussionmentioning

confidence: 99%

Section: (Continued From Previous Page)mentioning

confidence: 99%

Factors associated with risk of developmental delay in preschool children in a setting with high rates of malnutrition: a cross-sectional analysis of data from the IHOPE study, Madagascar

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Malnutrition reduction must include not just prevention of new cases but effective treatment of prevalent cases to assist in counteracting growth faltering. In other areas with high rates of stunting, robust malnutrition interventions targeted at smaller areas have been successful at reducing stunting at the population or community level (10,29). However, other factors than malnutrition alone can contribute to stunting, and important hidden factors contributing to growth-faltering, such as gender roles, age at onset of stunting, breast feeding duration, maternal mental health, dietary diversity and micronutrient availability can vary from site to site; thus formative research in communities should be undertaken to understand how national programs can be adapted on bolstered to have greatest effects.…”

Section: Resultsmentioning

confidence: 99%

Factors associated with risk of developmental delay in preschool children in a setting with high rates of malnutrition: a cross-sectional analysis of data from the IHOPE study, Madagascar

Miller

Garchitorena

Rabemananjara

et al. 2020

Preprint

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Background: 50% of Malagasy children have moderate to severe stunting. In 2016, a new 10-year National Nutrition Action Plan (PNAN III) was initiated to help address stunting and developmental delay. We report factors associated with risk of developmental delay in 3 and 4 year olds in the rural district of Ifanadiana in southeastern Madagascar in 2016. Methods: The data are from a cross-sectional analysis of the 2016 wave of IHOPE panel data (a population-representative cohort study begun in 2014). We interviewed women ages 15-49 using the MICS Early Child Development Indicator (ECDI) module, which includes questions for physical, socio-emotional, learning and literacy/numeracy domains. We analyzed ECDI data using standardized z scores for relative relationships for 2 outcomes: at-risk-for-delay vs. an international standard, and lower-development-than-peers if ECDI z scores were >1 standard deviation below study mean. Covariates included demographics, adult involvement, household environment, and selected child health factors. Variables significant at alpha of 0.1 were included a multivariable model; final models used backward stepwise regression, clustered at the sampling level. Results: Of 432 children ages 3 and 4 years, 173 (40%) were at risk for delay compared to international norms and 68 children (16.0%) had lower-development than peers. This was driven mostly by the literacy/numeracy domain, with only 7% of children considered developmentally on track in that domain. 50.5% of children had moderate to severe stunting. 76 (17.6%) had >=4 stimulation activities in past 3 days. Greater paternal engagement (OR 1.59(1.13, 2.21)) was associated with increased delay vs. international norms. Adolescent motherhood (OR3.89 (1.32, 11.48)) decreased children’s development vs. peers. Engagement from a non-parental adult reduced odds of delay for both outcomes (OR(95%CI =0.76 (0.61, 0.93) & 0.28(0.16, 0.50) respectively). Stunting was not associated with delay risk (1.33 (0.83, 2.14) or low development (0.91(0.47, 1.74)) when controlling for other factors. Conclusions: In this setting of high child malnutrition, stunting is not independently associated with developmental risk. A low proportion of children receive developmentally supportive stimulation from adults, but non-parent adults provide more stimulation in general than either mother or father. Stimulation from non-parent adults is associated with lower odds of delay

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“…Some of these factors, if identified early enough, are potentially modifiable through intervention, such as caregiver interaction and stimulation (8,9), or treatment for or prevention of malnutrition (3,10). System and policy changes can influence access to health care for prevention and treatment of illness, malnutrition, early marriage and first birth, and maternal education, all All rights reserved.…”

Section: Introductionmentioning

confidence: 99%

“…These results highlight the importance of the PNAN III strategy for reducing malnutrition in these areas, as many cognitive effects of chronic malnutrition may only become apparent as deficits in metacognitive skills (such as memorization, concentration and attention) at a later age when a child starts school and learning may be compromised.Malnutrition reduction must include not just prevention of new cases but effective treatment of prevalent cases to assist in counteracting growth faltering. In other areas with high rates of stunting, robust malnutrition interventions targeted at smaller areas have been successful at reducing stunting at the population or community level(10,26). However, important hidden factors contributing to growth-faltering, such as gender roles, age at onset of stunting, breast feeding duration, maternal mental health, dietary diversity and micronutrient availability can vary from site to site; thus formative research in communities should be undertaken to understand how national programs can be adapted on bolstered to have greatest effects.…”

mentioning

confidence: 99%

Factors associated with risk of developmental delay in preschool children in a setting with high rates of malnutrition: a cross-sectional analysis of data from the IHOPE study, Madagascar

Miller

Garchitorena

Rabemananjara

et al. 2019

Preprint

View full text Add to dashboard Cite

Background: Madagascar has one of the highest rates of stunting and at-risk child development in the world:50% of Malagasy children have moderate to severe stunting. In 2016, a new 10 year National Nutrition Action Plan (PNAN III), supported by the World Bank, was initiated to help address stunting and developmental delay. PIVOT, a health care NGO operating in collaboration with the MOH, conducts a longitudinal study, the IHOPE, to assess the population level impact of their collaborative health system strengthening activities on the rural district of Ifanadiana in southeastern Madagascar. We report factors associated with risk to developmental delay in children ages 3 and 4 years old in Ifanadiana district in 2016. Methods: The household survey data are from a cross-sectional analysis of a one wave of panel data in 2016, at the time of the initiation of PNAN III. Women ages 15 to 49 were interviewed, using the Multiple Indicator Cluster Survey (MICS) Early Child Development Indicator (ECDI) module, which includes questions for physical, socio-emotional, learning and literacy/numeracy domains. ECDI data were analyzed using standardized z scores for relative relationships. We assessed 2 outcomes: at risk for delayed development compared to an international standard, and lower development than peers if ECDI z scores were <1 standard deviation below the international normed population and study mean, respectively. Covariates included demographics (maternal age, education level, household wealth, number of other children under 5 in the house), adult involvement (reading, singing, playing with child), household environment (number and type of childrens books or toys, whether child was left alone or in the care of another child <10 years), and child health (wasting, stunting, underweight, ill in last 4 weeks, vaccination status). We included variables significant in univariable analysis at an alpha of <0.1 in a multivariable model. We constructed the final models using backward stepwise regression on generalized linear models, clustered at the sampling level. Results: Of 432 children ages 3 and 4 years, 173 were at risk for delay compared to international norms and 68 children (16.0%) were considered lower-development compared to their peers. 50.5% of the children had moderate to severe stunting and 19.0% had severe stunting. Greater paternal engagement (OR 1.59(1.13, 2.21)) was associated with being at risk for delay based on ECDI z scores <-1 compared to international norms Factors associated with lower risk for delay included having some adult play with the child and greater engagement from a non-parental adult. Factors associated with low development compared to peers included: under age 5 in the household, having a teenaged mother (age <20 years--OR3.89 (1.32, 11.48)), and having an adult who recently took the child outside. Factors associated with less developmental risk included increased number of developmentally stimulating activities by someone other than a parent(OR 0.28(0.16, 0.50)), and primary child toys are found objects rather than store bought or homemade(OR 0.33 (0.14, 0.73)). Discussion: In this setting of high malnutrition, stunting in children is not associated with lower-development compared to their peers, when adjusting for other factors. Families with teenaged mothers are more likely to have children with lower-development. Non-parent adult involvement seems very relevant to child development in this setting. Further research in the IHOPE longitudinal study may help to clarify direction of association. Interventions targeting adolescent girls before they become parents may be of particular utility in this setting.

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Improving Infant and Young Child Nutrition in a Highly Stunted Rural Community: A Practical Case Study from Guatemala

Cited by 8 publications

References 21 publications

Factors associated with risk of developmental delay in preschool children in a setting with high rates of malnutrition: a cross-sectional analysis of data from the IHOPE study, Madagascar

Factors associated with risk of developmental delay in preschool children in a setting with high rates of malnutrition: a cross-sectional analysis of data from the IHOPE study, Madagascar

Factors associated with risk of developmental delay in preschool children in a setting with high rates of malnutrition: a cross-sectional analysis of data from the IHOPE study, Madagascar

Factors associated with risk of developmental delay in preschool children in a setting with high rates of malnutrition: a cross-sectional analysis of data from the IHOPE study, Madagascar

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