Browsing by Subject "Stunting"

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    Open Access
    Complex interactions between malaria and malnutrition: a systematic literature review
    (BioMed Central, 2018-10-29) Das, D; Grais, R F; Okiro, E A; Stepniewska, K; Mansoor, R; van der Kam, S; Terlouw, D J; Tarning, J; Barnes, K I; Guerin, P J
    Abstract Background Despite substantial improvement in the control of malaria and decreased prevalence of malnutrition over the past two decades, both conditions remain heavy burdens that cause hundreds of thousands of deaths in children in resource-poor countries every year. Better understanding of the complex interactions between malaria and malnutrition is crucial for optimally targeting interventions where both conditions co-exist. This systematic review aimed to assess the evidence of the interplay between malaria and malnutrition. Methods Database searches were conducted in PubMed, Global Health and Cochrane Libraries and articles published in English, French or Spanish between Jan 1980 and Feb 2018 were accessed and screened. The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale and the risk of bias across studies was assessed using the GRADE approach. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guideline were followed. Results Of 2945 articles screened from databases, a total of 33 articles were identified looking at the association between malnutrition and risk of malaria and/or the impact of malnutrition in antimalarial treatment efficacy. Large methodological heterogeneity of studies precluded conducting meaningful aggregated data meta-analysis. Divergent results were reported on the effect of malnutrition on malaria risk. While no consistent association between risk of malaria and acute malnutrition was found, chronic malnutrition was relatively consistently associated with severity of malaria such as high-density parasitemia and anaemia. Furthermore, there is little information on the effect of malnutrition on therapeutic responses to artemisinin combination therapies (ACTs) and their pharmacokinetic properties in malnourished children in published literature. Conclusions The evidence on the effect of malnutrition on malaria risk remains inconclusive. Further analyses using individual patient data could provide an important opportunity to better understand the variability observed in publications by standardising both malaria and nutritional metrics. Our findings highlight the need to improve our understanding of the pharmacodynamics and pharmacokinetics of ACTs in malnourished children. Further clarification on malaria-malnutrition interactions would also serve as a basis for designing future trials and provide an opportunity to optimise antimalarial treatment for this large, vulnerable and neglected population. Trial registration PROSPERO CRD42017056934 .
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    Open Access
    Has the prevalence of stunting in South African children changed in 40 years? A systematic review
    (BioMed Central, 2015-06-05) Said-Mohamed, Rihlat; Micklesfield, Lisa K; Pettifor, John M; Norris, Shane A
    Background: In the last 20 years, South Africa has experienced political, economic, and demographic transitions accompanied by an epidemiological transition. Like several sub-Saharan countries, the South African population is facing both under–and over–nutrition, and nutrition and lifestyle related chronic disease while the burden of infectious disease remains high. It is critical to understand these trends overtime in order to highlights the pitfalls and successful measures initiatives taken in the efforts to tackle malnutrition. The objective of this systematic review is to investigate the changes in the prevalence of stunting, a chronic form of undernutrition, in South Africa over 40 years, and to derive lessons from the South African experience, a country in an advanced process of transition in sub-Saharan Africa. Methods: We undertook a systematic review of publications selected from PubMed, Science Direct and Scopus. We included studies and surveys published between 1970 and 2013 if they reported the prevalence of stunting (low height-for-age) in children under-6 years of age living in South Africa. We excluded studies conducted in health facility outpatients or hospital wards, or children with known chronic and acute infectious diseases. We extracted Date of data collection, study setting, ethnicity, age, sex, sample size, growth references/standards, diagnostic criteria for stunting and prevalence of stunting from each study. Results: Over the last decade, the national prevalence of stunting has decreased. However, between and within provincial, age and ethnic group disparities remain. Unlike other countries in sub-Saharan Africa, no sex or rural/urban differences were found in preschool children. However, the analysis of long-term trends and identification of vulnerable groups is complicated by the use of different growth references/standards and sampling methods. Conclusion: Despite economic growth, political and social transitions, and national nutritional programs, stunting remains stubbornly persistent and prevalent in South Africa. A multi-sectoral and public health approach is needed to: (i) better monitor stunting over time, (ii) combat malnutrition during the first thousand days of life through continued efforts to improve maternal nutrition during pregnancy and infant feeding practices.
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    Open Access
    The association of early childhood nutrition and growth with the intestinal microbiome and pneumonia
    (2025) Budree, Shrish; Zar, Heather; Nicol, Mark
    Background Malnutrition and pneumonia contribute significantly to under-5 mortality. The gut microbiome is associated with development of malnutrition and pneumonia. However, data on longitudinal growth, infant feeding practices, and the microbiome in children with malnutrition and pneumonia in low and middle-income countries (LMIC) are scarce. This work aimed to investigate growth in early childhood, and associations of the microbiome with growth and pneumonia in an LMIC. Methods A prospective study of growth, pneumonia, and the microbiome was performed in the Drakenstein Child Health Study (DCHS), a birth cohort in a low-income setting in South Africa. Mothers enrolled antenatally, and mother-child pairs were followed through birth and early childhood. Comprehensive health, socio-demographic, nutritional, and psychosocial data were collected longitudinally from birth through 3 years. Anthropometry was measured by trained study staff. Dietary information was collected using food-frequency questionnaires. Active surveillance for World Health Organization (WHO)-defined pneumonia was undertaken. Longitudinal stool samples were collected at study visits and during pneumonia episodes. WHO z-scores were calculated, and malnutrition classified as stunted, wasted, or overweight/obese. Dietary data were analysed using WHO infant and young child feeding indicators. Microbiome 16S ribosomal RNA (rRNA) gene amplicon sequencing was performed and bioinformatic analysis conducted in QIIME2 and Phyloseq (R packages). Results Subsets of children in the DCHS were analysed. Growth analysis among 792 infants (50% female; 15% preterm) showed that birth weight was a significant determinant of growth (p<0.001). Stunting was highly prevalent (17% and 13% at 2 and 12 months, respectively). Feeding practices evaluated in 1076 infants (50% female, 17% preterm) showed low exclusive breastfeeding rates (13%), and high consumption of inappropriate foods (high sugar or high-fat food) at 1 year (91%). Microbiome analysis of 138 children aged 1–40 months (49% females) included 90 children with pneumonia (10% hospitalised) and 48 non-pneumonia controls. Stunted children had low diversity (p=0.009) and significant depletion in Ruminococcus (q=0.03). Compared with age-matched controls, dysbiosis was found during pneumonia episodes and before the onset of pneumonia, characterised by significant enrichment in (Escherichia coli) E. coli (q=0.04). 6 Conclusion Malnutrition and poor infant feeding practices were highly prevalent despite strong primary healthcare programs. Correction of microbiome disruption may improve outcomes in pneumonia and malnutrition.