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      Children concurrently wasted and stunted: A meta‐analysis of prevalence data of children 6–59 months from 84 countries

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          Abstract

          Children can be stunted and wasted at the same time. Having both deficits greatly elevates risk of mortality. The analysis aimed to estimate the prevalence and burden of children aged 6–59 months concurrently wasted and stunted. Data from demographic and health survey and Multi‐indicator Cluster Surveys datasets from 84 countries were analysed. Overall prevalence for being wasted, stunted, and concurrently wasted and stunted among children 6 to 59 months was calculated. A pooled prevalence of concurrence was estimated and reported by gender, age, United Nations regions, and contextual categories. Burden was calculated using population figures from the global joint estimates database. The pooled prevalence of concurrence in the 84 countries was 3.0%, 95% CI [2.97, 3.06], ranging from 0% to 8.0%. Nine countries reported a concurrence prevalence greater than 5%. The estimated burden was 5,963,940 children. Prevalence of concurrence was highest in the 12‐ to 24‐month age group 4.2%, 95% CI [4.1, 4.3], and was significantly higher among boys 3.54%, 95% CI [3.47, 3.61], compared to girls; 2.46%, 95% CI [2.41, 2.52]. Fragile and conflict‐affected states reported significantly higher concurrence 3.6%, 95% CI [3.5, 3.6], than those defined as stable 2.24%, 95% CI [2.18, 2.30]. This analysis represents the first multiple country estimation of the prevalence and burden of children concurrently wasted and stunted. Given the high risk of mortality associated with concurrence, the findings indicate a need to report on this condition as well as investigate whether these children are being reached through existing programmes.

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          Maternal and child undernutrition: global and regional exposures and health consequences.

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            Boys are more stunted than girls in Sub-Saharan Africa: a meta-analysis of 16 demographic and health surveys

            Background Many studies in sub-Saharan Africa have occasionally reported a higher prevalence of stunting in male children compared to female children. This study examined whether there are systematic sex differences in stunting rates in children under-five years of age, and how the sex differences in stunting rates vary with household socio-economic status. Methods Data from the most recent 16 demographic and health surveys (DHS) in 10 sub-Saharan countries were analysed. Two separate variables for household socio-economic status (SES) were created for each country based on asset ownership and mothers' education. Quintiles of SES were constructed using principal component analysis. Sex differentials with stunting were assessed using Student's t-test, chi square test and binary logistic regressions. Results The prevalence and the mean z-scores of stunting were consistently lower amongst females than amongst males in all studies, with differences statistically significant in 11 and 12, respectively, out of the 16 studies. The pooled estimates for mean z-scores were -1.59 for boys and -1.46 for girls with the difference statistically significant (p < 0.001). The stunting prevalence was also higher in boys (40%) than in girls (36%) in pooled data analysis; crude odds ratio 1.16 (95% CI 1.12–1.20); child age and individual survey adjusted odds ratio 1.18 (95% CI 1.14–1.22). Male children in households of the poorest 40% were more likely to be stunted compared to females in the same group, but the pattern was not consistent in all studies, and evaluation of the SES/sex interaction term in relation to stunting was not significant for the surveys. Conclusion In sub-Saharan Africa, male children under five years of age are more likely to become stunted than females, which might suggest that boys are more vulnerable to health inequalities than their female counterparts in the same age groups. In several of the surveys, sex differences in stunting were more pronounced in the lowest SES groups.
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              Child malnutrition in sub-Saharan Africa: A meta-analysis of demographic and health surveys (2006-2016)

              Background Sub-Saharan Africa has one of the highest levels of child malnutrition globally. Therefore, a critical look at the distribution of malnutrition within its sub-regions is required to identify the worst affected areas. This study provides a meta-analysis of the prevalence of malnutrition indicators (stunting, wasting and underweight) within four sub-regions of sub-Saharan Africa. Methods Cross-sectional data from the most recent Demographic and Health Surveys (2006–2016) of 32 countries in sub-Saharan Africa were used. The countries were grouped into four sub-regions (East Africa, West Africa, Southern Africa and Central Africa), and a meta-analysis was conducted to estimate the prevalence of each malnutrition indicator within each of the sub-regions. Significant heterogeneity was detected among the various surveys (I2 >50%), hence a random effect model was used, and sensitivity analysis was performed, to examine the effects of outliers. Stunting was defined as HAZ<-2; wasting as WHZ<-2 and underweight as WAZ<-2. Results Stunting was highest in Burundi (57.7%) and Malawi (47.1%) in East Africa; Niger (43.9%), Mali (38.3%), Sierra Leone (37.9%) and Nigeria (36.8%) in West Africa; Democratic Republic of Congo (42.7%) and Chad (39.9%) in Central Africa. Wasting was highest in Niger (18.0%), Burkina Faso (15.50%) and Mali (12.7%) in West Africa; Comoros (11.1%) and Ethiopia (8.70%) in East Africa; Namibia (6.2%) in Southern Africa; Chad (13.0%) and Sao Tome & Principle (10.5%) in Central Africa. Underweight was highest in Burundi (28.8%) and Ethiopia (25.2%) in East Africa; Niger (36.4%), Nigeria (28.7%), Burkina Faso (25.7%), Mali (25.0%) in West Africa; and Chad (28.8%) in Central Africa. Conclusion The prevalence of malnutrition was highest within countries in East Africa and West Africa compared to the WHO Millennium development goals target for 2015. Appropriate nutrition interventions need to be prioritised in East Africa and West Africa if sub-Saharan Africa is to meet the WHO global nutrition target of improving maternal, infant and young child nutrition by 2025.
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                Author and article information

                Contributors
                carmel@ennonline.net
                Journal
                Matern Child Nutr
                Matern Child Nutr
                10.1111/(ISSN)1740-8709
                MCN
                Maternal & Child Nutrition
                John Wiley and Sons Inc. (Hoboken )
                1740-8695
                1740-8709
                25 September 2017
                April 2018
                : 14
                : 2 ( doiID: 10.1111/mcn.2018.14.issue-2 )
                : e12516
                Affiliations
                [ 1 ] ENN Oxford UK
                [ 2 ] KEMRI‐Wellcome Trust Research Programme KEMRI Centre for Geographic Medicine Research‐Coast Kilifi Kenya
                Author notes
                [*] [* ] Correspondence

                Carmel Dolan, ENN, 32 Leopold Street, Oxford OX4 1TW, UK.

                Email: carmel@ 123456ennonline.net

                Author information
                http://orcid.org/0000-0002-6251-0052
                http://orcid.org/0000-0003-4806-1307
                http://orcid.org/0000-0001-7149-5491
                http://orcid.org/0000-0003-1130-6948
                Article
                MCN12516 MCN-03-17-OA-2548.R2
                10.1111/mcn.12516
                5901398
                28944990
                505c49b1-8ec6-4f08-9370-d800bb2deb48
                © 2017 The Authors. Maternal and Child Nutrition Published by John Wiley & Sons, Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 31 March 2017
                : 27 July 2017
                : 25 August 2017
                Page count
                Figures: 2, Tables: 3, Pages: 7, Words: 3662
                Funding
                Funded by: United States Agency for International Development (USAID)
                Award ID: ENN AID‐OFDA‐G‐15‐00190
                Funded by: Irish Aid
                Award ID: 2016/RESNUT/001/ENN
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                mcn12516
                April 2018
                Converter:WILEY_ML3GV2_TO_NLMPMC version:version=5.3.4 mode:remove_FC converted:16.04.2018

                burden,children,concurrent wasting and stunting,global,prevalence

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