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      Prevalence and factors associated with underweight children: a population-based subnational analysis from Pakistan

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          Abstract

          Objectives

          This study aims to determine the prevalence of and factors associated with underweight children under the age of 5 in Punjab, Pakistan.

          Design

          We analysed cross-sectional household-level subnationally representative Multiple Indicator Cluster Survey.

          Settings

          Punjab province, Pakistan.

          Participants

          24 042 children under 5 years of age.

          Data analysis

          Multilevel multivariate logistic regression analysis.

          Results

          Prevalence of moderately and severely underweight children was found to be (33.3% and 11.3%, respectively). Multivariate multilevel logistic regression results show that as the child grows older the likelihood of the child being underweight increases significantly (eg, children between 12 and 23 months are one and half times more likely to be underweight, whereas children between the ages of 36 and 47 months are two and a half times more likely to be underweight). Gender was found to be another significant factor contributing to underweight prevalence among children under the age of 5. The likelihood of a girl child being underweight is more than that of a boy child being underweight (OR 0.92, 95% CI 0.8 to 1.0). Similarly, a child whose birth order is three or more is two times more likely to be underweight (OR 1.96, 95% CI 1.5 to 2.5) relative to a child of a lower birth order. Moreover, diarrhoea also significantly increases the likelihood of the child being underweight (OR 1.31, 95% CI 1.1 to 1.5). Child size is another determinant for underweight prevalence among children under 5, for example, a child with a size smaller than average at the time of birth is 2.7 times more likely to be moderately underweight than a child with an average or larger than average size at the time of birth.

          Conclusion

          Rigorous community-based interventions should be developed and executed throughout the province to improve this grave situation of underweight prevalence in Punjab. Mother’s education should be uplifted by providing them formal education and providing awareness about the importance of proper nutrition for children.

          Related collections

          Most cited references32

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          Maternal and child undernutrition and overweight in low-income and middle-income countries

          The Lancet, 382(9890), 427-451
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            Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost?

            The Lancet, 382(9890), 452-477
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              The impoverished gut--a triple burden of diarrhoea, stunting and chronic disease.

              More than one-fifth of the world's population live in extreme poverty, where a lack of safe water and adequate sanitation enables high rates of enteric infections and diarrhoea to continue unabated. Although oral rehydration therapy has greatly reduced diarrhoea-associated mortality, enteric infections still persist, disrupting intestinal absorptive and barrier functions and resulting in up to 43% of stunted growth, affecting one-fifth of children worldwide and one-third of children in developing countries. Diarrhoea in children from impoverished areas during their first 2 years might cause, on average, an 8 cm growth shortfall and 10 IQ point decrement by the time they are 7-9 years old. A child's height at their second birthday is therefore the best predictor of cognitive development or 'human capital'. To this 'double burden' of diarrhoea and malnutrition, data now suggest that children with stunted growth and repeated gut infections are also at increased risk of developing obesity and its associated comorbidities, resulting in a 'triple burden' of the impoverished gut. Here, we Review the growing evidence for this triple burden and potential mechanisms and interventions that must be understood and applied to prevent the loss of human potential and unaffordable societal costs caused by these vicious cycles of poverty.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2019
                30 July 2019
                : 9
                : 7
                : e028972
                Affiliations
                [1 ] departmentHealth Systems and Policy Department , Health Services Academy , Islamabad, Pakistan
                [2 ] departmentDepartment of Economics , George August University , Goettingen, Germany
                [3 ] departmentIndependant Researcher , and Development Consultant , Islamabad, Pakistan
                [4 ] departmentDepartment of Economics , Chitral University , Chitral, Pakistan
                [5 ] departmentCollege of Public Health Sciences , Chulalongkorn University , Bangkok, Thailand
                Author notes
                [Correspondence to ] Dr Ramesh Kumar; ramesh@ 123456hsa.edu.pk , drramesh1978@ 123456gmail.com
                Author information
                http://orcid.org/0000-0002-9701-3179
                Article
                bmjopen-2019-028972
                10.1136/bmjopen-2019-028972
                6678069
                31366654
                dbc702ea-7541-4108-b1d3-46c9c6482332
                © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 08 January 2019
                : 25 June 2019
                : 26 June 2019
                Categories
                Public Health
                Research
                1506
                1724
                Custom metadata
                unlocked

                Medicine
                community child health,nutrition,epidemiology,public health
                Medicine
                community child health, nutrition, epidemiology, public health

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