The Role of Food Insecurity and Dietary Diversity on Recovery from Wasting among Hospitalized Children Aged 6–23 Months in Sub-Saharan Africa and South Asia
Background: Current guidelines for the management of childhood wasting primarily focus on the provision of therapeutic foods and the treatment of medical complications. However, many children with wasting live in food-secure households, and multiple studies have demonstrated that the etiology of was...
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MDPI AG
2022-08-01
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| Series: | Nutrients |
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| Online Access: | https://www.mdpi.com/2072-6643/14/17/3481 |
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| author | Adino Tesfahun Tsegaye Patricia B. Pavlinac Lynnth Turyagyenda Abdoulaye H. Diallo Blaise S. Gnoumou Roseline M. Bamouni Wieger P. Voskuijl Meta van den Heuvel Emmie Mbale Christina L. Lancioni Ezekiel Mupere John Mukisa Christopher Lwanga Michael Atuhairwe Mohammod J. Chisti Tahmeed Ahmed Abu S.M.S.B. Shahid Ali F. Saleem Zaubina Kazi Benson O. Singa Pholona Amam Mary Masheti James A. Berkley Judd L. Walson Kirkby D. Tickell |
| author_facet | Adino Tesfahun Tsegaye Patricia B. Pavlinac Lynnth Turyagyenda Abdoulaye H. Diallo Blaise S. Gnoumou Roseline M. Bamouni Wieger P. Voskuijl Meta van den Heuvel Emmie Mbale Christina L. Lancioni Ezekiel Mupere John Mukisa Christopher Lwanga Michael Atuhairwe Mohammod J. Chisti Tahmeed Ahmed Abu S.M.S.B. Shahid Ali F. Saleem Zaubina Kazi Benson O. Singa Pholona Amam Mary Masheti James A. Berkley Judd L. Walson Kirkby D. Tickell |
| author_sort | Adino Tesfahun Tsegaye |
| collection | DOAJ |
| description | Background: Current guidelines for the management of childhood wasting primarily focus on the provision of therapeutic foods and the treatment of medical complications. However, many children with wasting live in food-secure households, and multiple studies have demonstrated that the etiology of wasting is complex, including social, nutritional, and biological causes. We evaluated the contribution of household food insecurity, dietary diversity, and the consumption of specific food groups to the time to recovery from wasting after hospital discharge. Methods: We conducted a secondary analysis of the Childhood Acute Illness Network (CHAIN) cohort, a multicenter prospective study conducted in six low- or lower-middle-income countries. We included children aged 6–23 months with wasting (mid-upper arm circumference [MUAC] ≤ 12.5 cm) or kwashiorkor (bipedal edema) at the time of hospital discharge. The primary outcome was time to nutritional recovery, defined as a MUAC > 12.5 cm without edema. Using Cox proportional hazards models adjusted for age, sex, study site, HIV status, duration of hospitalization, enrollment MUAC, referral to a nutritional program, caregiver education, caregiver depression, the season of enrollment, residence, and household wealth status, we evaluated the role of reported food insecurity, dietary diversity, and specific food groups prior to hospitalization on time to recovery from wasting during the 6 months of posthospital discharge. Findings: Of 1286 included children, most participants (806, 63%) came from food-insecure households, including 170 (13%) with severe food insecurity, and 664 (52%) participants had insufficient dietary diversity. The median time to recovery was 96 days (18/100 child-months (95% CI: 17.0, 19.0)). Moderate (aHR 1.17 [0.96, 1.43]) and severe food insecurity (aHR 1.14 [0.88, 1.48]), and insufficient dietary diversity (aHR 1.07 [0.91, 1.25]) were not significantly associated with time to recovery. Children who had consumed legumes and nuts prior to diagnosis had a quicker recovery than those who did not (adjusted hazard ratio (aHR): 1.21 [1.01,1.44]). Consumption of dairy products (aHR 1.13 [0.96, 1.34], <i>p</i> = 0.14) and meat (aHR 1.11 [0.93, 1.33]), <i>p</i> = 0.23) were not statistically significantly associated with time to recovery. Consumption of fruits and vegetables (aHR 0.78 [0.65,0.94]) and breastfeeding (aHR 0.84 [0.71, 0.99]) before diagnosis were associated with longer time to recovery. Conclusion: Among wasted children discharged from hospital and managed in compliance with wasting guidelines, food insecurity and dietary diversity were not major determinants of recovery. |
| first_indexed | 2024-03-10T01:26:19Z |
| format | Article |
| id | doaj.art-dcfaaf1fa07f4ddfa40df785e7337563 |
| institution | Directory Open Access Journal |
| issn | 2072-6643 |
| language | English |
| last_indexed | 2024-03-10T01:26:19Z |
| publishDate | 2022-08-01 |
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| series | Nutrients |
| spelling | doaj.art-dcfaaf1fa07f4ddfa40df785e73375632023-11-23T13:51:07ZengMDPI AGNutrients2072-66432022-08-011417348110.3390/nu14173481The Role of Food Insecurity and Dietary Diversity on Recovery from Wasting among Hospitalized Children Aged 6–23 Months in Sub-Saharan Africa and South AsiaAdino Tesfahun Tsegaye0Patricia B. Pavlinac1Lynnth Turyagyenda2Abdoulaye H. Diallo3Blaise S. Gnoumou4Roseline M. Bamouni5Wieger P. Voskuijl6Meta van den Heuvel7Emmie Mbale8Christina L. Lancioni9Ezekiel Mupere10John Mukisa11Christopher Lwanga12Michael Atuhairwe13Mohammod J. Chisti14Tahmeed Ahmed15Abu S.M.S.B. Shahid16Ali F. Saleem17Zaubina Kazi18Benson O. Singa19Pholona Amam20Mary Masheti21James A. Berkley22Judd L. Walson23Kirkby D. Tickell24Department of Epidemiology, University of Washington, Seattle, WA 98195, USADepartments of Global Health, University of Washington, Seattle, WA 98195, USAUganda-CWRU Research Collaboration, Kampala P.O. Box 663, UgandaDepartment of Public Health, University Joseph Ki-Zerbo, Ouagadougou 03BP7021, Burkina FasoDepartment of Public Health, University Joseph Ki-Zerbo, Ouagadougou 03BP7021, Burkina FasoDepartment of Public Health, University Joseph Ki-Zerbo, Ouagadougou 03BP7021, Burkina FasoAmsterdam UMC, University of Amsterdam, Amsterdam Centre for Global Child Health & Emma Children’s Hospital, Meibergdreef 9, 1105 AZ, Amsterdam, The NetherlandsDivision of Paediatric Medicine, Hospital for Sick Children, Toronto, ON M5G 1X8, CanadaDepartment of Paediatrics and Child Health, Kamuzu University of Health Sciences, Private Bag 360, Chichiri, Blantyre 265, MalawiDepartment of Pediatrics, Oregon Health and Science University, Portland, OR 97239, USAUganda-CWRU Research Collaboration, Kampala P.O. Box 663, UgandaUganda-CWRU Research Collaboration, Kampala P.O. Box 663, UgandaUganda-CWRU Research Collaboration, Kampala P.O. Box 663, UgandaUganda-CWRU Research Collaboration, Kampala P.O. Box 663, UgandaNutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka 1212, BangladeshNutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka 1212, BangladeshNutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka 1212, BangladeshDepartment of Pediatrics and Child Health, Aga Khan University, Karachi 74800, PakistanDepartment of Pediatrics and Child Health, Aga Khan University, Karachi 74800, PakistanKenya Medical Research Institute, Nairobi 54840, KenyaKenya Medical Research Institute, Nairobi 54840, KenyaKenya Medical Research Institute, Nairobi 54840, KenyaKEMRI/Wellcome Trust Research Programme, Kilifi 80108, KenyaDepartments of Global Health, University of Washington, Seattle, WA 98195, USADepartments of Global Health, University of Washington, Seattle, WA 98195, USABackground: Current guidelines for the management of childhood wasting primarily focus on the provision of therapeutic foods and the treatment of medical complications. However, many children with wasting live in food-secure households, and multiple studies have demonstrated that the etiology of wasting is complex, including social, nutritional, and biological causes. We evaluated the contribution of household food insecurity, dietary diversity, and the consumption of specific food groups to the time to recovery from wasting after hospital discharge. Methods: We conducted a secondary analysis of the Childhood Acute Illness Network (CHAIN) cohort, a multicenter prospective study conducted in six low- or lower-middle-income countries. We included children aged 6–23 months with wasting (mid-upper arm circumference [MUAC] ≤ 12.5 cm) or kwashiorkor (bipedal edema) at the time of hospital discharge. The primary outcome was time to nutritional recovery, defined as a MUAC > 12.5 cm without edema. Using Cox proportional hazards models adjusted for age, sex, study site, HIV status, duration of hospitalization, enrollment MUAC, referral to a nutritional program, caregiver education, caregiver depression, the season of enrollment, residence, and household wealth status, we evaluated the role of reported food insecurity, dietary diversity, and specific food groups prior to hospitalization on time to recovery from wasting during the 6 months of posthospital discharge. Findings: Of 1286 included children, most participants (806, 63%) came from food-insecure households, including 170 (13%) with severe food insecurity, and 664 (52%) participants had insufficient dietary diversity. The median time to recovery was 96 days (18/100 child-months (95% CI: 17.0, 19.0)). Moderate (aHR 1.17 [0.96, 1.43]) and severe food insecurity (aHR 1.14 [0.88, 1.48]), and insufficient dietary diversity (aHR 1.07 [0.91, 1.25]) were not significantly associated with time to recovery. Children who had consumed legumes and nuts prior to diagnosis had a quicker recovery than those who did not (adjusted hazard ratio (aHR): 1.21 [1.01,1.44]). Consumption of dairy products (aHR 1.13 [0.96, 1.34], <i>p</i> = 0.14) and meat (aHR 1.11 [0.93, 1.33]), <i>p</i> = 0.23) were not statistically significantly associated with time to recovery. Consumption of fruits and vegetables (aHR 0.78 [0.65,0.94]) and breastfeeding (aHR 0.84 [0.71, 0.99]) before diagnosis were associated with longer time to recovery. Conclusion: Among wasted children discharged from hospital and managed in compliance with wasting guidelines, food insecurity and dietary diversity were not major determinants of recovery.https://www.mdpi.com/2072-6643/14/17/3481wastinghospitalizationfood securitydietary diversity |
| spellingShingle | Adino Tesfahun Tsegaye Patricia B. Pavlinac Lynnth Turyagyenda Abdoulaye H. Diallo Blaise S. Gnoumou Roseline M. Bamouni Wieger P. Voskuijl Meta van den Heuvel Emmie Mbale Christina L. Lancioni Ezekiel Mupere John Mukisa Christopher Lwanga Michael Atuhairwe Mohammod J. Chisti Tahmeed Ahmed Abu S.M.S.B. Shahid Ali F. Saleem Zaubina Kazi Benson O. Singa Pholona Amam Mary Masheti James A. Berkley Judd L. Walson Kirkby D. Tickell The Role of Food Insecurity and Dietary Diversity on Recovery from Wasting among Hospitalized Children Aged 6–23 Months in Sub-Saharan Africa and South Asia Nutrients wasting hospitalization food security dietary diversity |
| title | The Role of Food Insecurity and Dietary Diversity on Recovery from Wasting among Hospitalized Children Aged 6–23 Months in Sub-Saharan Africa and South Asia |
| title_full | The Role of Food Insecurity and Dietary Diversity on Recovery from Wasting among Hospitalized Children Aged 6–23 Months in Sub-Saharan Africa and South Asia |
| title_fullStr | The Role of Food Insecurity and Dietary Diversity on Recovery from Wasting among Hospitalized Children Aged 6–23 Months in Sub-Saharan Africa and South Asia |
| title_full_unstemmed | The Role of Food Insecurity and Dietary Diversity on Recovery from Wasting among Hospitalized Children Aged 6–23 Months in Sub-Saharan Africa and South Asia |
| title_short | The Role of Food Insecurity and Dietary Diversity on Recovery from Wasting among Hospitalized Children Aged 6–23 Months in Sub-Saharan Africa and South Asia |
| title_sort | role of food insecurity and dietary diversity on recovery from wasting among hospitalized children aged 6 23 months in sub saharan africa and south asia |
| topic | wasting hospitalization food security dietary diversity |
| url | https://www.mdpi.com/2072-6643/14/17/3481 |
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