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      Prevalence and associated factors influencing stunting in children aged 2–5 years in the Gaza Strip-Palestine: a cross-sectional study

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          Abstract

          Background

          Stunting continues to be a major public health problem in developing countries. It is one of the most important risk factors for morbidity and mortality during childhood. In Palestine, it is another health problem, which adds to the catastrophic issues in the region. This study aimed to determine the prevalence of stunting and its associated factors among preschool children in the Gaza Strip.

          Methods

          A cross-sectional study design was conducted in the Gaza Strip. A total of 357 children aged 2–5 years and their mothers aged 18–50 years were recruited. A multistage cluster sampling was used in the selection of the study participants from three geographical areas in the Gaza Strip: Jabalia refugee camp, El Remal urban area, and Al Qarara rural area. A structured questionnaire was used for face- to -face interviews with the respective child’s mother to collect sociodemographic information and feeding practice. Anthropometric measurements for children were taken to classify height-for-age (HAZ), while maternal height was measured as well. Descriptive and binary logistic regression analyses were applied to determine the prevalence and associated factors with stunting.

          Results

          The total prevalence of stunting in this study was 19.6%, with the highest prevalence being (22.6%) in Jabalia refugee camp. It turns out that shorter mothers had increased the odds of stunting in preschool children in the Gaza Strip. Children born to mothers whose height was 1.55–1.60 m or <1.55 m were more likely to be stunted ( p = 0. 008), or ( p < 0.001), respectively, than children born to mothers whose height was >1.60 m. Moreover, parental consanguinity increased the risk of stunted children ( p = 0. 015).

          Conclusions

          This study showed the prevalence of stunting was of alarming magnitude in the Gaza Strip. Our results also demonstrated that parental consanguinity and short maternal stature were associated with stunting. Culturally appropriate interventions and appropriate strategies should be implemented to discourage these types of marriages. Policy makers must also raise awareness of the importance of the prevention and control of nutritional problems to combat stunting among children in the Gaza Strip.

          Electronic supplementary material

          The online version of this article (10.1186/s12887-017-0957-y) contains supplementary material, which is available to authorized users.

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          Most cited references32

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          Association of maternal stature with offspring mortality, underweight, and stunting in low- to middle-income countries.

          Although maternal stature has been associated with offspring mortality and health, the extent to which this association is universal across developing countries is unclear. To examine the association between maternal stature and offspring mortality, underweight, stunting, and wasting in infancy and early childhood in 54 low- to middle-income countries. Analysis of 109 Demographic and Health Surveys in 54 countries conducted between 1991 and 2008. Study population consisted of a nationally representative cross-sectional sample of children aged 0 to 59 months born to mothers aged 15 to 49 years. Sample sizes were 2,661,519 (mortality), 587,096 (underweight), 558,347 (stunting), and 568,609 (wasting) children. Likelihood of mortality, underweight, stunting, or wasting in children younger than 5 years. The mean response rate across surveys in the mortality data set was 92.8%. In adjusted models, a 1-cm increase in maternal height was associated with a decreased risk of child mortality (absolute risk difference [ARD], 0.0014; relative risk [RR], 0.988; 95% confidence interval [CI], 0.987-0.988), underweight (ARD, 0.0068; RR, 0.968; 95% CI, 0.968-0.969), stunting (ARD, 0.0126; RR, 0.968; 95% CI, 0.967-0.968), and wasting (ARD, 0.0005; RR, 0.994; 95% CI, 0.993-0.995). Absolute risk of dying among children born to the tallest mothers (> or = 160 cm) was 0.073 (95% CI, 0.072-0.074) and to those born to the shortest mothers (< 145 cm) was 0.128 (95% CI, 0.126-0.130). Country-specific decrease in the risk for child mortality associated with a 1-cm increase in maternal height varied between 0.978 and 1.011, with the decreased risk being statistically significant in 46 of 54 countries (85%) (alpha = .05). Among 54 low- to middle-income countries, maternal stature was inversely associated with offspring mortality, underweight, and stunting in infancy and childhood.
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            Food security, poverty, and human development in the United States.

            Access to food is essential to optimal development and function in children and adults. Food security, food insecurity, and hunger have been defined and a U.S. Food Security Scale was developed and is administered annually by the Census Bureau in its Current Population Survey. The eight child-referenced items now make up a Children's Food Security Scale. This review summarizes the data on household and children's food insecurity and its relationship with children's health and development and with mothers' depressive symptoms. It is demonstrable that food insecurity is a prevalent risk to the growth, health, cognitive, and behavioral potential of America's poor and near-poor children. Infants and toddlers in particular are at risk from food insecurity even at the lowest levels of severity, and the data indicate an "invisible epidemic" of a serious condition. Food insecurity is readily measured and rapidly remediable through policy changes, which a country like the United States, unlike many others, is fully capable of implementing. The food and distribution resources exist; the only constraint is political will.
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              Consanguinity and its relevance to clinical genetics.

              AH Bittles (2001)
              Marriage between close biological relatives is generally regarded with suspicion and distaste within Western society, reflecting historical and religious prejudice. By comparison, in many other populations there is a strong preference for consanguineous unions, most frequently contracted between first cousins, and marriage outside the family is perceived as a risky and disruptive option. The increasing importance of the genetic contribution to the overall disease profile in both developed and developing countries has highlighted potential problems associated with detrimental recessive gene expression in consanguineous progeny. This review examines the outcomes of consanguineous unions, with proposals as to how the ongoing preference for consanguinity in many communities can best be accommodated from a clinical genetics perspective.
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                Author and article information

                Contributors
                +60192844132 , rimaa2_us@yahoo.com
                +60162639562 , sookl@usm.my
                +972599404344 , Yabed333@yahoo.com
                +60129543059 , wanmanan@usm.my
                Journal
                BMC Pediatr
                BMC Pediatr
                BMC Pediatrics
                BioMed Central (London )
                1471-2431
                21 December 2017
                21 December 2017
                2017
                : 17
                : 210
                Affiliations
                [1 ]ISNI 0000 0001 2298 706X, GRID grid.16662.35, School of Public Health, Al Quds University, ; Gaza City, Gaza Strip Palestine
                [2 ]ISNI 0000 0001 2294 3534, GRID grid.11875.3a, Program of Nutrition, School of Health Sciences, Health Campus, Universiti Sains Malaysia, ; 16150 Kubang Kerian, Kelantan Malaysia
                Article
                957
                10.1186/s12887-017-0957-y
                5740756
                29268788
                9c3828c9-6b66-426e-9e3d-b10bd57a104c
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 18 November 2015
                : 7 December 2017
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2017

                Pediatrics
                stunting,prevalence,associated factors,gaza strip
                Pediatrics
                stunting, prevalence, associated factors, gaza strip

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