Background In developing countries, malnutrition in children and developmental delays are two major challenges for public health. To achieve the vision of the Sustainable Development Goals from the broader perspective of child health, early identification of developmental delays and timely intervention are crucial. The aim of this study is to assess the prevalence of suspected developmental delay and their predictors in children under the age of 5 years with uncomplicated severe acute malnutrition in rural areas of Pakistan. Methods A multicentre cross-sectional study was conducted among 185 children with uncomplicated severe acute malnutrition. We screened children aged 6–59 months for their nutritional status and clinical complications. Children fulfilling the inclusion criteria underwent the Denver Development Screening Tool II (DDST-II). The children’s global developmental profile was calculated according to the established protocols of DDST-II, which are based on four important domains of development: personal and social behaviour, language, gross motor adaptive skills and fine motor adaptive skills. A pretested questionnaire was used to collect data on socio-demographic and nutritional factors for assessing predictors of developmental delay, which were analysed using a multivariate logistic regression model. Results Out of 177 children with severe acute malnutrition, 69 (38.9%) had normal global development and 108 (61.1%) had delayed global development. Significant associations were found between global developmental delay and younger children (6–24 months vs. 25–59 months; AOR = 4.53, 95% CI: 1.56–13.10, p < 0.01), children who were not exclusively breastfed (AOR = 3.07, 95% CI: 1.24–7.56, p = 0.01), and a history of contact with a tuberculosis smear-positive adult (AOR = 2.67, 95% CI: 1.30–5.49, p < 0.01). Conclusion About two thirds of the study participants showed delayed or unstable global development. Thus, according to DDST-II-established protocols, there is a high prevalence of suspected developmental delay among children under the age of five years with uncomplicated severe acute malnutrition in rural areas of Pakistan. Children in their first 2 years of life were at particularly high risk due to insufficient breastfeeding. This emphasizes the need to provide adequate infrastructure and information to parents for the prevention of developmental delay in remote areas.

Background: Climate change is evident around the globe causing heat stress as an emerging public health problem for people working in tropical and subtropical areas. Occupational heat stress can impact the health and productivity of small and mid-sized enterprise workers. Objective: This study aimed to profile the indoor thermal environmental conditions and modify the working practices by recommending the work/rest cycle according to the international organization for standardization 7243. Study Design: This cross-sectional study design included eight industrial (Iron spare parts manufacturing) small and mid-size enterprises in Lahore, Pakistan. The indoor thermal environment, including globe temperature, natural wet bulb temperature, ambient temperature, relative humidity, and air velocity, were recorded during summer to measure the wet bulb globe temperature (WBGT). Quest heat stress meter (model 2500), modified Testo loggers (177-T4), and EL-USB-2-LCD data loggers were placed at different working stations to measure these thermal environmental parameters. A self-administered questionnaire was used to measure the workers’ demographic characteristics and working practices. The International Organization for Standardization 7243 reference was used to estimate and recommend the work/rest cycle. Results: 138 workers aged 28.59 ± 10.46 years participated in this study. Continuous work of 8.8 ± 1.5 hours per day with a conventional resting period of 30-60 minutes was recorded on a typical working day. The indoor wet bulb globe temperature ranged from 26.8°C to 36.4°C. The workers were registered for low (72.5%), moderate (18.1%), and high (9.4%) metabolic rates according to the International Organization for Standardization 7243 reference values. Conclusion: A high wet bulb globe temperature was recorded in the selected small and mid-sized enterprises making these workers vulnerable to heat stress and related illnesses. Work/rest cycle evaluation suggested that the workers were required to improve their cool-down time by avoiding continuous exposure to high temperatures and reducing the metabolic rate.

The objective of this study was to assess whether the standard therapy of ready-to-use therapeutic food in the treatment of uncomplicated severe acute malnutrition (SAM) is effective in improving developmental potential and weight gain in children aged under five years. A multicenter pretest-posttest study was conducted among 91 children aged under five with uncomplicated SAM in Pakistan. Study participants completed their eight weeks’ therapy of ready-to-use therapeutic food according to the World Health Organization’s (WHO) standard guidelines. The study outcome was the proportion of children with improved developmental potential in all domains in comparison with the pretreatment status and children gaining >15% of their baseline weight; mean weight-for-height/length z-score after completing eight weeks’ therapy of ready-to-use therapeutic food. The Denver Development Screening Tool II was used for developmental screening. Significant changes (p < 0.05) were observed for developmental status milestones in terms of gross motor, fine motor, and personal/social milestones, as well as language and global development milestones. There was a strong positive correlation (r = 0.961) between initial weight and weight at the last visit (p < 0.001). Ready-to-use therapeutic food is effective in improving development potential as well as promoting weight gain in children aged under five with uncomplicated SAM if provided according to WHO guidelines.

ObjectivesThis study aims to compare the developmental profile of severe acute malnourished (SAM) and normal under-five children and to find sociodemographic determinants accountable for their developmental disabilities.SettingWe conducted a multi-centre cross-sectional study in three basic health units and one rural health centre in Pakistan.Participants200 children (SAM and healthy) aged 6–59 months.Primary and secondary measuresWe screened for nutritional status and clinical complications. Children underwent for developmental assessment by Denver Development Screening Tool II. A pretested structured questionnaire on sociodemographic characteristics and nutrition was used for collecting data about determinants of developmental delay.ResultsWe observed statistically significant differences in anthropometric measurements among SAM compared with normal nourished in weight, height, mid-upper arm circumference and weight-for-height z-scores. SAM serves as a significant risk factors (p<0.001) for delayed personal or social development (69% vs 11%; OR (95% CI)=18.01 (8.45 to 38.37)), delayed fine motor development (39% vs 8%; OR (95% CI)=7.35 (3.22 to 16.81)), delayed language development (32% vs 8%; OR (95% CI)=5.41 (2.35 to 12.48)), delayed gross motor development (34% vs 10%; OR (95% CI)=4.64 (2.14 to 10.05)) and delayed global development (66% vs 20%; OR (95% CI)=7.77 (4.09 to 14.74)). Applying logistic regression, personal or social development (p<0.001) and language development (p<0.05), under-five siblings was a risk factor, while among gross motor development, mother’s educational status (p<0.05) was a significant risk factor for developmental delay.ConclusionsOur analysis indicates that children with malnutrition have a high frequency of developmental delays. Missing maternal education and a higher number of under-five siblings are also potential risk factors for developmental delay.

Background Malnutrition is a serious concern globally and may lead to early death if it remains untreated. Prevalence of malnutrition is high in South Asian countries. Therefore, this study aims to evaluate the determinants of wasting, stunting, and undernutrition in under-five children of southern Punjab, Pakistan. Methods We conducted a cross-sectional study among 185 children. Anthropometric measures were done by nutritional experts and pediatricians. Data were analyzed with SPSS version 25.0. A p-value <0.05 was considered statistically significant. Results Significant determinants of wasting (weight-for-height) were family monthly earnings (β=-0.14; 95% CI: -0.89 to -0.04; p=0.03) and complementary feeding practices (β=-0.21; 95% CI: -1.14 to 0.19; p<0.001). For stunting (length/height-for-age), the significant determinants were tuberculosis (TB) contact history (β=-0.15; 95% CI: -0.97 to -0.03; p=0.03) and non-use of exclusive breastfeeding practices (β=-0.19; 95% CI: -1.40 to 0.16; p=0.01). For undernutrition, significant determinants were monthly income (β=0.28; 95% CI: 0.11 to 0.62; p=0.02) and exclusive breastfeeding practices (β=0.22; 95% CI: 0.17 to 0.39; p=0.02). Conclusion Social determinants such as family earnings, family food security, practices of exclusive breastfeeding and proper complementary feeding, number of under-five siblings, and history of TB contact have a strong association with malnutrition and undernutrition. Concerted and comprehensive strategies are needed for the improvement of associated factors to combat malnutrition as well as undernutrition among children.