Stunting risk of orphans by caregiver and living arrangement in low-income and middle-income countries

Finlay, Jocelyn E.; Fink, Günther; McCoy, Dana Charles; Tavárez, L Carolina; Chai, Jeanne; Danaei, Goodarz; Ezzati, Majid; Fawzi, Wafaie W.; Fawzi, Mary C. Smith

doi:10.1136/jech-2015-206346

Cited by 16 publications

(18 citation statements)

References 35 publications

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“…Thus, we are only able to speculate on the results. While orphans are vulnerable to malnutrition, studies have found mixed results on this topic, and it appears the adverse effects of a parental loss may be mitigated if the appropriate resources and support are provided for the child [23, 55]. Child outcomes may also depend on who is ultimately responsible for the orphan’s care [56].…”

Section: Discussionmentioning

confidence: 99%

Growth of young HIV-infected and HIV-exposed children in western Kenya: A retrospective chart review

et al. 2019

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IntroductionThe objective of this study was to determine the growth patterns, rates of malnutrition, and factors associated with malnutrition in children born to HIV-infected mothers in western Kenya using data from an electronic medical record system.MethodsThis study was a retrospective chart review of HIV-infected (HIV+) and–exposed (HEU) children (<5 years) using data collected prospectively in the course of routine clinical care and stored in the electronic medical record system in western Kenya between January 2011 and August 2016. Demographics and anthropometrics were described, with Chi-square testing to compare proportions. Multiple variable logistic regression analysis was used to identify correlates of children being stunted, underweight, and wasted. We also examined growth curves, using a resampling method to compare the areas under the fitted growth curves to compare males/females and HIV+/HEU.ResultsData from 15,428 children were analyzed. The children were 51.6% (n = 7,955) female, 5.2% (n = 809) orphans, 83.3% (n = 12,851) were HEU, and 16.7% (n = 2,577) were HIV+. For HIV+ children assessed at 24 months, 50.9% (n = 217) were stunted, 26.5% (n = 145) were underweight, and 13.6% (n = 58) were wasted, while 45.0% (n = 577) of HEU children were stunted, 14.8% (n = 255) were underweight, and 5.1% (n = 65) were wasted. When comparing mean z-scores, HIV+ children tended to have larger and earlier dips in z-scores compared to HIV-exposed children, with significant differences found between the two groups (p<0.001). Factors associated with an increased risk of malnutrition included being male, HIV+, and attending an urban clinic. Maternal antiretroviral treatment during pregnancy and mixed feeding at 3 months of age decreased the risk of malnutrition.ConclusionsHIV+ and HEU children differ in their anthropometrics, with HIV+ children having overall lower z-scores. Continued efforts to develop and implement sustainable and effective interventions for malnutrition are needed for children born to HIV+ mothers.

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Section: Discussionmentioning

confidence: 99%

Growth of young HIV-infected and HIV-exposed children in western Kenya: A retrospective chart review

et al. 2019

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“…Based on this literature search, only one study was identified that performed a formal meta-analysis on the association between maternal depression and childhood stunting 13. Since this was the only meta-analysis, studies that were based on analysis of Demographic and Health Survey (DHS) data across a broad range of low/middle-income countries were used for other psychosocial variables, including low maternal education,14 IPV15 and orphanhood 16. For other psychosocial risk factors that did not have a meta-analysis or DHS data across a number of low/middle-income countries, including child abuse, parental use of alcohol and parental substance abuse, insufficient information was available on exposure prevalence to include them in the study.…”

Section: Methodsmentioning

confidence: 99%

Lifetime economic impact of the burden of childhood stunting attributable to maternal psychosocial risk factors in 137 low/middle-income countries

et al. 2019

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IntroductionThe first 1000 days of life is a period of great potential and vulnerability. In particular, physical growth of children can be affected by the lack of access to basic needs as well as psychosocial factors, such as maternal depression. The objectives of the present study are to: (1) quantify the burden of childhood stunting in low/middle-income countries attributable to psychosocial risk factors; and (2) estimate the related lifetime economic costs.MethodsA comparative risk assessment analysis was performed with data from 137 low/middle-income countries throughout Asia, Latin America and the Caribbean, North Africa and the Middle East, and sub-Saharan Africa. The proportion of stunting prevalence, defined as <−2 SDs from the median height for age according to the WHO Child Growth Standards, and the number of cases attributable to low maternal education, intimate partner violence (IPV), maternal depression and orphanhood were calculated. The joint effect of psychosocial risk factors on stunting was estimated. The economic impact, as reflected in the total future income losses per birth cohort, was examined.ResultsApproximately 7.2 million cases of stunting in low/middle-income countries were attributable to psychosocial factors. The leading risk factor was maternal depression with 3.2 million cases attributable. Maternal depression also demonstrated the greatest economic cost at $14.5 billion, followed by low maternal education ($10.0 billion) and IPV ($8.5 billion). The joint cost of these risk factors was $29.3 billion per birth cohort.ConclusionThe cost of neglecting these psychosocial risk factors is significant. Improving access to formal secondary school education for girls may offset the risk of maternal depression, IPV and orphanhood. Focusing on maternal depression may play a key role in reducing the burden of stunting. Overall, addressing psychosocial factors among perinatal women can have a significant impact on child growth and well-being in the developing world.

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“…Living conditions in childhood have profound short- and long-term effects on mental and physical development, even on future marriage [ 9 ]. Current studies on the effects of living arrangements on health mainly focus on children with divorced parents, or who are orphaned, children of political refugees, disabled children, and children in boarding schools [ 10 , 11 , 12 , 13 , 14 , 15 ]. Studies on migrant students mainly focus on the children who are left behind and/or comparisons with local children [ 16 , 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

Living Arrangements and Health-Related Quality of Life in Chinese Adolescents Who Migrate from Rural to Urban Schools: Mediating Effect of Social Support

Wu³

et al. 2017

IJERPH

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Changes in living arrangements (from living with, or not living with family) may affect the health-related quality of life (HRQoL). This study aimed to investigate the impact of living arrangement on HRQoL among adolescents migrating from rural to urban schools, and whether social support, in addition to living with a family, had an impact. A cross-sectional survey of 459 school adolescents was carried out in two public schools in Guyuan County, Ningxia Hui Autonomous Region, China in 2015. The survey contained the following questionnaires: a self-designed questionnaire, the 12-item Short Form Health Survey (SF-12), and the Social Support Rating Scale (SSRS). Of the 459 adolescents sampled (aged 15.41 ± 1.07 years with range of 13 to 18), 61.7% were living with family, and 38.3% were not living with family. Those students not living with families had lower Mental Component Scale (MCS) scores as well as less social support overall. Those students, who were not living with families, also reported more chronic health problems and more alcohol consumption compared to those students living with families. Social support was a statistically significant mediating factor on the effect of living arrangements on MCS. Our findings demonstrated that those students, who were not living with families, tended to have more health-related quality of life issues, but social support partially mediated the relationship between living arrangements and health.

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Stunting risk of orphans by caregiver and living arrangement in low-income and middle-income countries

Cited by 16 publications

References 35 publications

Growth of young HIV-infected and HIV-exposed children in western Kenya: A retrospective chart review

Growth of young HIV-infected and HIV-exposed children in western Kenya: A retrospective chart review

Lifetime economic impact of the burden of childhood stunting attributable to maternal psychosocial risk factors in 137 low/middle-income countries

Living Arrangements and Health-Related Quality of Life in Chinese Adolescents Who Migrate from Rural to Urban Schools: Mediating Effect of Social Support

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