Search Results (430)

This non-randomized, open-labelled, controlled pilot trial investigated the impact of stunting on oral health and the oral microbiome, and evaluated the effect of 14-day probiotic or essential oil mouthwash interventions in children aged 8–12 years. Thirty-six participants (18 stunted, 18 non-stunted) were randomized into three parallel arms: probiotic lozenges (Limosilactobacillus reuteri DSM 17938 + ATCC PTA 5289), essential oil mouthwash, or water control. D-25OH level was assessed with ELISA, OHI-S, and PBI were examined, and oral microbiome was analyzed using 16S metagenomic sequencing. Stunted children demonstrated significantly higher gingival inflammation (PBI, F = 10.57, p = 0.002), reduced microbial alpha diversity, reductions in commensal Streptococcus spp., and increases in pathobionts, including Parvimonas micra, Fusobacterium nucleatum, and Tannerella forsythia. Beta-diversity analysis revealed distinct microbial communities (p = 0.001), with network analysis identifying these anaerobes as keystone hubs in stunted individuals. Salivary vitamin D and oral hygiene indices (OHI-S) also differed by stunting status. Fourteen-day interventions produced only modest, non-significant improvements in clinical indices and failed to induce significant shifts in microbial diversity or composition. These findings indicate that nutritional stunting is independently associated with oral dysbiosis and gingival inflammation. Short-term antiseptic interventions appear insufficient to reverse established microbial shifts, highlighting the need for sustained, integrated nutritional—oral health strategies. Full article

Background/Objectives: Empowered mothers are more likely to adopt recommended childcare practices, thereby contributing to reduced childhood undernutrition. However, the magnitude of the association between maternal empowerment and childhood undernutrition in Bangladesh has not been comprehensively assessed. This study aims to address this research gap. Methods: The Bangladesh Demographic and Health Survey (BDHS) 2017-18 and BDHS 2022 served as data sources. Maternal empowerment was assessed across three domains, e.g., attitude to violence, social independence, and decision making, using the Survey-based Women’s Empowerment (SWPER) index. The undernutrition status of children was assessed through z-score based indicators, including stunting (height-for-age z-score < −2 SD), wasting (weight-for-height z-score < −2 SD), and underweight (weight-for-age < −2 SD). Children with at least two and any of these undernutrition conditions were categorized as multiple undernutrition and any undernutrition, respectively. Multivariable logistic regression models were utilized to observe the survey-specific and pooled association between maternal empowerment and childhood undernutrition. Results: The analysis includes 11,647 mother–child pairs. The association between maternal empowerment and childhood undernutrition was consistent across individual surveys and the pooled sample, although the significance level varied by empowerment domains and undernutrition categories. Maternal social independence was found to be a significant protective factor against both multiple and any childhood undernutrition status in individual surveys and the pooled sample. For example, in the pooled sample, high maternal empowerment in the social independence domain was significantly associated with 18% (AOR: 0.82; 95% CI: 0.69, 0.98; p = 0.026) lower odds of multiple undernutrition statuses and 18% (AOR: 0.82; 95% CI: 0.71, 0.95; p = 0.009) lower odds of any undernutrition statuses than those of low maternal empowerment. Conclusions: Improving the status of maternal social independence can potentially result in reduced childhood undernutrition. The scope remains to cascade the benefits of the other two maternal empowerment domains, e.g., attitude to violence and decision making, to child nutrition in Bangladesh. Full article

Background: Stunting remains a major public health problem among ethnic minority children in mountainous areas of Vietnam. Picky eating has been suggested as a potential behavioral risk factor for poor child growth, but evidence from vulnerable rural populations remains limited. This study examined the association between picky eating and stunting among ethnic minority children aged 12–35 months in Vietnam. Methods: This cross-sectional study was conducted from October to November 2025 in two communes of Phu Tho province, formerly part of Lac Son District, Hoa Binh Province, Vietnam. A total of 341 children aged 12–35 months and their caregivers were included. Data were collected using structured interviewer-administered questionnaires on feeding practices and child characteristics. Picky eating was assessed based on caregiver-reported behaviors. Anthropometric measurements were performed according to standard procedures, and height-for-age Z-scores were calculated using the WHO Child Growth Standards. Zinc status was assessed in a subsample of children. Bivariate and multivariable logistic regression analyses were conducted to identify factors associated with stunting. Adjusted odds ratios (AORs) with 95% confidence intervals (95% CIs) were reported. Results: The prevalence of picky eating was 39.6%, while 24.9% of children were stunted. Zinc deficiency was identified in 41.9% of children with available blood samples. In multivariable analysis, picky eating was significantly associated with increased odds of stunting (AOR = 3.63; 95% CI: 1.71–7.70). Snacking before main meals was also independently associated with stunting (AOR = 1.81; 95% CI: 1.01–3.24). In contrast, zinc deficiency was associated with stunting in crude analysis but was not statistically significant after adjustment. Other factors, including child age, sex, caregiver identity, and timing of complementary feeding, were not independently associated with stunting. Conclusions: Picky eating was common and was independently associated with stunting among ethnic minority children in this mountainous setting. These findings suggest that behavioral feeding practices, particularly picky eating and pre-meal snacking, warrant attention in nutritional programs targeting this population; however, longitudinal studies are needed to confirm the direction of this relationship. Full article

Background and aim: Celiac disease (CD) is a systemic autoimmune disorder triggered by gluten ingestion, and the only effective treatment is strict adherence to a gluten-free diet (GFD). Many factors, including limited dietary diversity and poor adherence, are associated with an increased risk of specific micronutrient deficiencies and malnutrition. This study aims to evaluate the relationship between adherence to GFD, celiac antibody levels, micronutrient levels, and nutritional status in children with CD. Methods: This retrospective study was conducted on 402 children aged 2–18 years with a diagnosis of CD confirmed positive by anti-tTG IgA and duodenal biopsy, all of whom had been on GFD for at least six months. Demographic, anthropometric, clinical, serological, and biochemical data (including hemogram, serum iron, ferritin, vitamin D, folate, and B12 levels), and GFD adherence were collected from medical records. Results: Most individuals are girls (64.9%), with a mean age of 10.6 ± 4.20 years. Chronic malnutrition was observed in 29.4% of patients. Acute malnutrition was identified in 27.8% of children, and wasting was observed in 6.7%. Iron deficiency anemia was the most frequently encountered micronutrient deficiency among the patients (23.9%). The prevalence of stunting was significantly higher among individuals with positive tTG-IgA levels and poor adherence to the GFD. Conclusions: Poor adherence to the GFD and positive tTG-IgA levels were associated with higher rates of stunting, underlining the need for individualized dietary follow-up and regular monitoring of both nutritional status and serological response in children with CD. Full article

Objective: This study aimed to estimate the trends, projections, and determinants of standalone and coexisting forms of malnutrition (CFM) at the global, regional, national, and individual level among children under five in low- and middle-income countries (LMICs). It also assessed the projection trajectory towards the 2030 global nutrition targets (GNTs) for child growth including stunting, wasting, obesity, and CFM. Methods: Data from 48 LMICs were analyzed using the Multiple Indicator Cluster Surveys (MICS) and Demographic and Health Surveys (DHS). Children with complete anthropometry were included for national- and individual-level descriptive analyses. Projected prevalence of each form of malnutrition, including CFM, was calculated using the Annual Rate of Change. Inferential analyses employed generalized linear regression models with two-way interaction terms to identify determinants of each malnutrition type. Findings: By 2030, 22 of 48 LMICs are projected to achieve the GNT of stunting, wasting, and obesity, that is up from 10 countries currently, while Yemen and Zimbabwe are expected to remain off-track. Stunting is the most prevalent form, affecting 42 countries, with nine nations projected to have over 50% of children affected by a form of malnutrition. Wasting, obesity, and CFM are rising in several countries. Maternal education and household wealth were the strongest determinants, with children of uneducated mothers and from poorest households at the highest risk. Inequalities are narrowing slowly by 1–2% per year, and marked regional disparities persist. Conclusions: Many LMICs are off-track to meet child-growth targets when CFM is considered alongside standalone indicators. The government and global health partners must strengthen nutrition surveillance systems and equity-focused policies and programs to routinely capture CFM and prevent as well as manage all forms of malnutrition at the national and individual levels. Full article

Background/Objective: Child health serves as a foundational part of human development. Inequities in access to key health services remain high in Sub-Saharan Africa (SSA), most notably among children from disadvantaged, racially, or ethnically marginalized groups. The objective of this structured narrative review is to evaluate and aggregate the available evidence on racial/ethnic disparities in childhood healthcare access in SSA. Methods: A comprehensive search on African Index Medicus (AIM), Web of Science and PubMed for studies published between 2010 and 2025 was executed using relevant MeSH terms and Boolean operators. Studies on healthcare access inequalities among racial or ethnic groups in SSA were included. This study was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Ten articles were included. Ethnicity was an independent contributor to inequities in childhood healthcare across four domains: vaccination coverage (lower for Hausa/Fulani in Nigeria and Somali/Luhya in Kenya compared to dominant groups), timeliness of vaccination, child mortality (higher in economically and ethnically marginalized groups), and nutritional status (elevated stunting and underweight odds in certain ethnic minorities). Conclusions: Racial and ethnic inequalities in child healthcare access across SSA are driven by multi-factor structural, geographical, and cultural barriers. Although socioeconomic improvement reduces some disparities, it does not eradicate them, highlighting that ethnic identity continues to shape health outcomes independently. Addressing these disparities requires strengthening culturally inclusive healthcare delivery, improving access in underserved regions, and integrating ethnicity-disaggregated monitoring into national health systems. Full article

Stunting remains a major public health challenge in Indonesia, with a national prevalence of 21.6% in 2022. Rural regions such as Madura face heightened vulnerability due to cultural dietary taboos, gendered caregiving structures, intergenerational authority, and digital disparities that shape household nutrition decision-making. This formative qualitative study explores stakeholders’ perceptions to inform the conceptual development of gender-sensitive serious games for nutrition communication in rural Indonesia. Using an exploratory design, 42 informants, including mothers of children under five, brides-to-be, health cadres, midwives, religious and community leaders, and local digital actors, were recruited across rural Madura. Thematic analysis examined trust-based communication patterns, gender dynamics, perceptions of artificial intelligence (AI), and contextual conditions influencing digital health acceptance. Findings indicate that acceptance of gender-sensitive serious games depends on cultural alignment, institutional endorsement, perceived credibility, and usability in low-resource settings. Participants consistently positioned serious games and AI-supported features as complementary communication layers rather than replacements for health workers. Game-based tools were considered potentially relevant when designed to support intergenerational co-play, integrate local narratives and religious values, and function in low-connectivity environments. Rather than evaluating an implemented intervention, this study proposes a conceptual design framework grounded in feminist communication perspectives, serious games scholarship, and technology acceptance theory. The findings provide context-sensitive insights to guide future prototype development and pilot testing within hybrid, community-based nutrition communication systems. Full article

Access to safe drinking water is critical for child growth and development. However, microbial contamination is a constant threat in many low- and middle-income countries. The current systematic review sets out to examine the evidence of drinking water quality and the physical and cognitive development of children aged 0 to 5 years. The review authors conducted a comprehensive search of SCOPUS, EBSCO, PubMed, the Cochrane Library, and Google Search for cohort studies and clinical trials conducted in English between the years 2010 and 2025. Of 222 studies, 15 were included in the review and the majority were conducted in low- and middle-income countries The findings consistently demonstrate that microbiological contamination, predominantly by Escherichia coli (the primary water quality indicator examined across studies), is associated with an increased risk of stunting (odds ratio up to 4.14) and reductions in height-for-age Z-scores (HAZ) (by 0.29–0.57). There is currently limited evidence in the studies reviewed that suggests a correlation between the presence of unsafe drinking water and a decrease in cognitive development; however, the evidence is insufficient and warrants further study. Integrated water, sanitation and hygiene (WASH) and nutrition programs had promising growth results, which varied depending on the initial sanitation coverage of the target population, adherence to the intervention, and the overall design of the program. To sum up, contaminated drinking water negatively affects physical and cognitive development during early childhood. Comprehensive WASH–nutrition strategies need to be implemented to reduce this impact and further progress towards Sustainable Development Goal (SDG) 6. Full article

Introduction: Stunting is associated with poor nutritional intake during early childhood. This study evaluated the effect of a daily intake of 510 mL of an oral nutritional supplement for 180 days on linear growth among children with stunting and at-risk of stunting aged 12–36 months. Methods: A community-based, single-arm intervention was conducted among 91 children in Kelantan, Malaysia. The children at enrolment had height-for-age Z-scores (HAZs) between <−1.0 SD and >−3 SD based on WHO Growth Standards. Anthropometric measurements were collected at baseline (T0), 90 days (T90; mid-intervention), and 180 days (T180; post-intervention). Nutrient intake was assessed using 24 h dietary recalls, and compliance was monitored via returned empty sachets. Results: The mean age of the children at baseline was 26.7 ± 6.6 months (range, 12.9–36.0 months), with 37 (41%) being stunted and 54 (59%) at risk of stunting. After intervention, the linear growth (height-for-age Z-score) was significantly improved over time (p < 0.001) in both stunted and at-risk children. A significant time-by-group interaction (p = 0.014) indicated differential effects between the stunted and at-risk groups. Post hoc analysis showed HAZ improvements from baseline (T₀) to 180 days in stunted and at-risk groups (p < 0.001), with the stunted group demonstrating a greater mean change in HAZ compared with the at-risk group. The number of stunted children declined by 37.8% (p = 0.003). Nutrient intakes of protein, vitamin D, vitamin C, vitamin B-complex, calcium, phosphorus, magnesium, and iron improved significantly. Conclusions: A daily intake of 510 mL of oral nutrition supplement improved linear growth and nutrient intake. These findings support the potential of targeted supplementation in addressing child growth faltering and micronutrient inadequacies. Full article

Children living in resource-limited regions with inadequate environmental sanitation, such as the Bolivian highlands, are affected by parasitic infections that may compromise nutritional status. Objective: This study aimed to assess the prevalence of intestinal parasitic infections and their associations with nutritional status, micronutrient deficiencies, and anemia in school-aged children from La Paz, Bolivia. Methods: A cross-sectional study was conducted among 212 schoolchildren aged 5–13 years in the municipality of La Paz, in highland areas characterized by high poverty levels. Parasitological examination, anthropometric measurements, and biochemical assessment of micronutrients (vitamins A and D, zinc, iron) were performed to evaluate children’s health status. Results: Mild malnutrition was more prevalent than moderate-to-severe forms. Micronutrient analysis revealed substantial deficiencies in vitamin A (39%), zinc (25%), and vitamin D (18%). Zinc deficiency was significantly more common in children aged 11–13 years compared to younger age groups (p = 0.034). Intestinal protozoan infections showed significant associations with micronutrient deficiencies. Giardia lamblia infection was associated with both vitamin A (30.9%, p = 0.042) and vitamin D (78.9%, p = 0.001) deficiencies. Blastocystis spp. infection was similarly linked to higher prevalence of vitamin A (35.8%, p = 0.025) and vitamin D (69.7%, p = 0.004) deficiencies. Entamoeba coli infection was significantly associated with vitamin D deficiency (p = 0.021), while Iodamoeba bütschlii infection showed a significant association with zinc status (p = 0.027), with notably lower zinc deficiency prevalence in infected children (7.7%) compared to non-infected children. Among helminth infections, Ascaris lumbricoides was significantly associated with vitamin D deficiency (37%, p = 0.018). Moderate-to-severe anemia was highly prevalent, affecting over half of the children regardless of sex. Wasting (BAZ) was significantly associated with age (p = 0.030), with moderate-to-severe cases most prevalent in children aged 5–7 years and absent in older groups, while mild wasting increased with age. In univariate logistic regression analysis, zinc deficiency emerged as a significant risk factor for anemia (OR = 2.51, 95% CI: 1.19–5.29, p = 0.016). No significant associations were observed between anemia and sex, age group, vitamin A or D status, or anthropometric indicators including underweight, stunting, or wasting. Conclusions: These findings highlight the substantial burden of micronutrient deficiencies, parasitic infections, and anemia among children in this impoverished region, underscoring the urgent need for targeted public health interventions addressing nutritional supplementation, parasite control, and improved sanitation. Full article

Childhood malnutrition remains a pressing public health challenge in Europe, where stunting, wasting, and underweight coexist with rising rates of childhood overweight and obesity. This policy review provides a strategic roadmap for promoting healthy nutrition in early childhood by synthesizing WHO and EU guidance and proposing coordinated action across three time horizons. Short-term goals (1–3 years) include harmonizing food-based dietary guidelines, implementing universal nutrition screening in pediatric care, and strengthening breastfeeding-supportive environments. Mid-term priorities (3–7 years) focus on fiscal levers, such as sugar taxes and healthy food subsidies; reformulating children’s products; and embedding nutrition education within school curricula. Long-term strategies (7+ years) emphasize harmonized EU-wide monitoring systems, alignment of early-life nutrition with social protection policies, and sustained investment in research on the DOHaD. Through a unified, multisectoral strategy emphasizing early-life nutrition, equitable access to healthy foods, education, and robust regulation, Europe can effectively address the double burden of malnutrition and sustainably reduce childhood obesity. Full article

Background/Objectives: Child undernutrition remains a major public health in Djibouti, yet conventional anthropometric indicators may underestimate its true burden by failing to capture overlapping forms of malnutrition. The Composite Index of Anthropometric Failure (CIAF) provides a more comprehensive assessment by identifying children experiencing one or multiple anthropometric deficits. This study aimed to estimate the prevalence and determinants of undernutrition among children under five years of age in Djibouti using the CIAF. Methods: This study is a secondary analysis of data from the nationally representative 2023 Multisectoral Survey conducted in Djibouti. A cross-sectional design with a two-stage stratified cluster sampling method was used to collect data on a national random sample (n = 2103) of children aged 6–59 months. Standardized anthropometric measurements were used to derive conventional indicators (stunting, wasting, and underweight) and the CIAF. Binary logistic regression analyses were performed to identify factors associated with anthropometric failures, adjusting for child, household, and contextual characteristics. Results: Based on conventional indicators, 23.4% of children were stunted, 20.0% were underweight, and 9.9% were wasted. Using the CIAF, 36.9% of children experienced at least one anthropometric failure, including 18.8% with multiple concurrent failures. Boys, children aged 6–47 months, those living in nomadic households, and those residing in specific regions had significantly higher risks of undernutrition. Socioeconomic indicators and household food security were not independently associated with undernutrition after adjustment. Conclusions: More than one-third of children under five in Djibouti experience undernutrition when assessed using the CIAF, revealing a substantial hidden burden not captured by conventional indicators alone. Incorporating the CIAF into routine nutrition surveillance could improve identification of vulnerable children and support more targeted, context-specific interventions. Full article

Background/Objectives: Inclusive nutrition services and data on children with disabilities living in low- and middle-income countries remain limited. We estimated the prevalence of undernutrition and described feeding practices and difficulties among children with disabilities ages birth to 10 years at a rehabilitation hospital in Uganda and identified barriers and opportunities for inclusive nutrition. Methods: This cross-sectional study enrolled 428 children. Data included demographics, weight, height, mid–upper arm circumference (MUAC), hemoglobin levels, risk for feeding difficulties, caregiver-reported feeding practices, and functional difficulties complemented by 32 caregiver and stakeholder interviews. Undernutrition was defined using WHO z-scores, MUAC, and anemia cutoffs. Associations were examined using Pearson’s chi-squared tests and adjusted odds ratios from logistic regression. Results: Over half of participants were boys (56.1%) and 65.9% were <24 months old. Common conditions included cleft lip/palate (55.4%) and cerebral palsy (38.6%). Undernutrition was prevalent: 45.2% were underweight, 38.3% stunted, 16.1% wasted (by MUAC), and 39.5% anemic. Being at risk for feeding difficulties (67.2% of children) increased the odds of underweight [AOR = 2.28 (1.23–4.24)], stunting [2.46 (1.26–4.79)], and wasting [2.43 (1.10–5.35)] after adjusting for covariates. Bottle-feeding increased the odds of stunting [3.09 (1.24–7.70)] in infants with cleft lip/palate < 12 months old. Poor access to services, food insecurity, and feeding challenges were key barriers to optimal nutrition. Most caregivers reported using practices that support responsive feeding. Conclusions: Reported barriers to services and high levels of undernutrition, strongly linked to feeding difficulties, underscore the need for targeted feeding interventions and better access to inclusive nutrition services in Uganda. Full article

Background/Objectives. Associations between stunting and dietary practices have been understudied among HIV-exposed and HIV-free children. We investigated associations between birthweight, socio-demographics, and dietary and feeding practices with stunting at 9 and 18 months among children in eSwatini. Methods. We used generalized linear mixed models (GLMs) with a logit link to characterize associations between stunting and birthweight quartiles, socio-demographics, maternal characteristics, and infant dietary diversity scores. We examined the moderating effects of dietary factors on relations between birthweight and stunting. Generalized structural equation models characterized direct and indirect associations between exposures and stunting at 18 months, mediated through stunting at 9 months. Results. We included 367 HIV-exposed and HIV-free children. Infants in the third and fourth birthweight quartiles had reduced odds of stunting at 9 months [adjusted odds ratio (adj OR) 0.24 (IQR 0.11, 0.55), p < 0.001; 0.10 (0.03, 0.33), p < 0.001, respectively]. Moderation by dietary diversity was limited to a relative decline in the second birthweight quartile. Stunting prevalence significantly increased from 9 months (21%) to 18 months (37%). Mediated by stunting at 9 months, there were significant direct and indirect effects of birthweight and dietary diversity on stunting at 18 months. Conclusions. Among HIV-exposed and HIV-free children, stunting prevalence increased with age and was associated with lower birthweight. Dietary diversity attenuated stunting risk among children in the second birthweight quartile. Prenatal strategies to reduce low birth weight (LBW) and additional attention to the social determinants of health, particularly dietary diversity, are warranted in programs and policies to reduce stunting. Full article

Background: Childhood undernutrition and overnutrition continue to be major public health challenges in South Africa. There is limited evidence on how socio-economic factors and dietary behaviors influence nutritional outcomes among school-aged children, particularly in rural areas such as Thulamela Municipality. Objective: This study aimed to examine the socio-demographic determinants, dietary patterns, and nutritional status among school-aged children in Thulamela Municipality, Limpopo Province, South Africa. Methods: A cross-sectional survey was conducted with 347 children aged 8–12 years. Simple random sampling was used to select eight villages from a total of 227 within the municipality. A snowball sampling method was used to recruit eligible children. Data on socio-demographic characteristics, including the child’s sex, parental education level, marital status, and employment status, were collected. Additionally, their dietary habits and meal frequency patterns were collected using structured questionnaires. Anthropometric measurements including height, weight, and BMI-for-age were obtained following WHO growth standards. Associations between variables were assessed using chi-square tests, with p-values < 0.05 considered statistically significant. Results: The prevalence of severe and moderate stunting was 20.5% and 21.0%, respectively. Overweight conditions and obesity affected 32.6% and 16.2% of participants, respectively. Parental education (p = 0.027), marital status (p = 0.001), and household income (p = 0.043) showed significant associations with height-for-age and BMI-for-age Z-scores. Additionally, regular breakfast consumption and the frequent intake of vegetables and dairy products were positively associated with improved nutritional outcomes (p < 0.05). Conclusions: The nutritional profile of school-aged children in Thulamela Municipality reflects a double burden of malnutrition, with concurrent high rates of stunting, overweight conditions, and obesity. Interventions that promote balanced diets and address socio-economic disparities are crucial for improving child growth and overall health. Socio-economic factors, including parental education, marital status, and household income, were significantly associated with children’s height-for-age and BMI-for-age. Furthermore, the regular consumption of breakfast, vegetables, and dairy products was associated with better nutritional outcomes, highlighting the influence of both dietary behaviors and socio-demographic determinants on child growth and health. Implementing nutrition education programs within schools that emphasize the value of balanced diets and highlighting the significance of eating breakfast regularly and incorporating vegetables and dairy products into daily meals is important. These programs should include both children and their caregivers to support regular healthy eating behaviors at home and in school. Additionally, schools should carry out regular growth monitoring and nutritional assessments to identify early indications of undernutrition or overnutrition, enabling prompt referrals and interventions for children who may be at risk. Full article