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Health of homeless children and housed, poor children.

Homeless children in families are increasing in numbers across the country and have been noted to have frequent health problems. The health status of homeless children was assessed on multiple dimensions through parental report in a survey conducted with 196 homeless families in 10 shelters in Los Angeles and 194 housed poor families after March 1987 through January 1988. During the month before the survey, the homeless and housed poor children experienced high rates of illness symptoms, disability, and bed days. Homeless and housed poor children were frequently rated by their parents to be in fair or poor health (17% vs 13%, P = .14). Homeless children, however, were reported to have more behavior problems and school failure [30% vs 18%, P = .06] than housed poor children. Homeless children also had high rates of other health problems such as developmental delay (9%) and overweight (13%). The diets of homeless children were frequently imbalanced, dependent on food from "fast-food" restaurants, and characterized by repeated periods of deprivation. Family problems were more common among homeless families, especially among single-parent homeless families compared with single-parent housed families (spousal abuse, 68% vs 41%, P less than .01; parental drug and alcohol abuse, 60% vs 39%, P less than .01). It is concluded that homeless children have significant child behavior and developmental problems and disorders of nutrition and growth, which are associated with multiple risk factors in their environment.

Child

[Nutritional status of 0-to-59-month-old children in urban and rural areas of Cameroon].

The nutritional status of preschool-age children (0-59 months) in the Littoral Province of Cameroon was studied in a representative sample of the population of this age group in rural and urban areas, with a total of 2011 children. The nutritional indicators weight-for-height, weight-for-age, and height-for-age were compared with reference data from the United States National Center for Health Statistics. A high prevalence of stunting (15.2% in urban and 21.8% in rural areas, P < 0.0008) was found among the children. The prevalence of wasting was 4.0% in urban and 6.5% in rural areas (P < 0.03). In all age groups, rural children were shorter than urban children with no significant difference between the sexes. The increase in the prevalence of acute malnutrition (8.4%) since the last nutritional survey in 1978 (0.7%), which is probably due to a deterioration in the economic situation in recent years, indicates that urgent measures should be taken to improve the nutritional situation of these children, especially in the villages. The findings of the study could serve as baseline data for the evaluation of the effectiveness of future nutrition programmes.

Anthropometry

Nutritional status as a predictor of child survival: summarizing the association and quantifying its global impact.

By pooling the results from five previously published prospective studies, we have obtained estimates of the relative risks of mortality among young children 6-24 months after they had been identified as having mild-to-moderate or severe malnutrition. These risk estimates, along with global malnutrition prevalence data, were then used to calculate the total number of young-childhood deaths "attributable" to malnutrition in developing countries. Young children (6-60 months of age) with mild-to-moderate malnutrition (60-80% of the median weight-for-age of the reference population) had 2.2 times the risk of dying during the follow-up period than their better nourished counterparts (> 80% of the median reference weight-for-age). Severely malnourished young children (< 60% of the reference median weight-for-age) had 6.8 times the risk of dying during the follow-up period than better nourished children. Each year approximately 2.3 million deaths of young children in developing countries (41% of the total for this age group) are associated with malnutrition. The comparability of studies, methods used to derive pooled values, potentially confounding factors that may influence risk estimates, and the validity of the results are discussed. Child survival programmes should assign greater priority to the control of childhood malnutrition.

Body Weight

Growth, behavior, development and intelligence in rural children between 1-3 years of life.

In a rural cohort of 625 children registered from 1981 to 1983 in 10 villages of K.V. Block, Varanasi, 196 children were assessed for physical growth, development, intelligence and concept development between 1 and 3 years of age. Home environment was also assessed using Caldwell Home inventory. These rural children remained below 3rd centile of NCHS standard for weight, height, skull and mid-arm circumferences throughout the study. Malnourished children scored poorly in all the areas of development, i.e., motor, adaptive, language and personal social, 9% in Grade I and 16.6% children in Grade II + III had IQ less than 79 (inferior). Concept for color shape and size was poorly developed in malnourished children. Maternal involvement and stimulation was strongly associated with better behavior development and intelligence. Multiple regression analysis showed that the effect of home environment on development and intelligence was of a higher magnitude as compared to status and family variables and nutritional status during 1-3 years of age.

Adult

[Evolution of child undernutrition in Chile and some of its conditioning factors: a time series analysis].

The objective of this study was to determine the evolution of the nutritional status of the population under five years of age during the period 1975-1990. Several conditioning factors were also assessed. The information was evaluated through time series analysis by using the AREG procedure. This procedure allows for the estimation of a regression model correcting by the autocorrelation of errors. Results indicates a significant trend to decreased undernutrition rates (p < 0.0001). A seasonal effect on undernutrition was observed, being higher the prevalences in summer. Analysis of selected conditioning factors, as well as the familiar buying capacity remained stable during the period. An exception to the lack of association among undernutrition and the conditioning factors evaluated, was seen during the period 1975-1982 when clear inverse relationship was evidenced. In conclusion, the decrease of infant undernutrition in Chile during the period 1975-1990 was not related to the changes observed in certain socioeconomic indices.

Child Nutrition Disorders

Dietary pattern and state of nutrition among children in drought-prone areas of southern Ethiopia.

To assess dietary habits and nutritional state in drought-prone areas of southern Ethiopia, we studied 334 households in a pastoral and 282 in an agricultural community. Milk and cereals were the main sources of food among children of the pastoral Boran in Dubluk, while cereals with limited supplements of animal products or legumes formed the main sources of food among children of the agricultural population of Elka in the Rift valley. Of the children in Elka, 54.9% were stunted, as compared with 19.5% among children in Dubluk. Also, stunting occurred at an earlier age among the Elka children. Prevalences of wasting were less than 5% in both communities. Improvement in the state of nutrition of the pastoral children followed soon after the main rains, but occurred later and after the main harvest among the agricultural children. In contrast to arm circumference, the weight-for-height measure showed marked seasonal variation. Socio-economic factors, such as family wealth and crowding, significantly influenced the state of nutrition among the children. Nutritional recovery following the prolonged drought among the agricultural children was slow and associated with families acquiring more wealth.

Anthropometry

Age-specific responsiveness of weight and length to nutritional supplementation.

Evaluation of the responsiveness of weight and length to supplementary feeding shows that the two periods of greatest response coincide with weaning (ages 3-6 mo) and peak incidence and duration of diarrheal disease (ages 9-12 mo). Analyses were done for seven consecutive nonoverlapping intervals comparing children randomly assigned to receive supplemental feeding from birth to age 36 mo or to serve as control subjects. Absolute responsiveness was greatest between ages 3-6 mo; supplemented infants grew 0.61 cm more and gained 162 g more than did unsupplemented infants (p less than 0.005). Relative to rates of growth, responsiveness was greatest between ages 9 and 12 mo (the period of peak diarrheal prevalence), followed by ages 3-6 mo (the period of weaning). Responsiveness to supplementation is thus directly related to age-dependent risk patterns for malnutrition. Targeting supplementation programs to coincide with periods of high nutritional risk should maximize their effectiveness in reducing malnutrition, though caution should be exercised to avoid disruption of breast-feeding.

Age Factors

Field validation of the Tallstick in marginal communities in Nicaragua.

The Tallstick is a new, simplified anthropometric field tool which allows immediate visual interpretation of height-for-age. This tool was field tested in community-based programmes in Managua, Nicaragua, and the rural community of Los Zarzales, screening 1004 children aged 0-60 months for nutritional stunting. Overall sensitivity and specificity analysis comparing HAZ scores and Tallstick results revealed that the Tallstick correctly identified 83-85 per cent of severely stunted children (HAZ < -2.5) and two-thirds of those with HAZ of -2 and below. It also had good positive predictive value for the mildly stunted. As a screening tool for low weight-for-age, the Tallstick performed better than arm circumference. The best of the community volunteers trained with the Tallstick could use it as well as their trainers. Progressive stunting was found in the 280 children in the sample who did not receive any form of milk. The advantages of the Tallstick for community-level screening and the importance of sustained linear growth are discussed.

Animals

Women's work in agriculture and child nutrition in Tanzania.

This paper examines the food related work that women are doing, and the possible effect on child feeding and nutritional status. Women's participation in food production may have positive as well as negative consequences for child nutrition. On the one hand, it may augment the total amount of food procured, while on the other, it may give women less time for child care and feeding. The data show that women are using less time in cooking and children are fed less often during the peak labour seasons. However, a profound and conclusive negative effect of mother's agricultural work on child nutritional status could not be shown. This finding is explained by various compensatory mechanisms employed by the mothers which may buffer the negative effect of the women's time constraints. The norm of feeding children at the maximum only three times a day was seen as the major contributing factor to child malnutrition. According to the women, this feeding frequency was seen as the maximum possible taking into account their heavy work in agricultural production.

Agriculture

Protein turnover in malnourished patients with cystic fibrosis: effects of elemental and nonelemental nutritional supplements.

To evaluate the relative efficacy of nonelemental versus semielemental enteral supplements for nutritional rehabilitation of cystic fibrosis (CF) patients, whole-body protein turnover using the [15N]glycine method was studied in nine malnourished CF patients during enteral feedings, in a block design study comparing a semielemental formula (Criticare), a higher protein density but nonelemental formula (Traumacal) (T), and a nonelemental formula that had been modified to become isocaloric and isonitrogenous to the semielemental formula (modified Traumacal, MT). No significant differences in rates of protein synthesis or catabolism were observed comparing the three formulas. However, the higher protein density nonelemental formula resulted in higher net protein deposition compared to the other two formulas (T + 0.42 g kg-1 10 h-1 versus 0.33 g kg-1 10 h-1 for Criticare and -0.59 g kg-1 10 h-1 for MT), although this was significant (p less than 0.05) for the MT versus T comparison only. This study lends support to the use of less expensive nonelemental formulas for the nutritional management of malnourished patients with CF.

Adolescent

Incorporating explanatory models in planning nutrition education programmes in Thailand.

An intersectoral child development services project is being undertaken in Thailand to develop a model process for providing age appropriate care and education to rural children through an integrated programme of nutrition, health and educational services designed to meet community needs and perceptions. Using behavioral analysis and explanatory models, project results show that the effectiveness of nutrition education can be facilitated by (1) recognizing the family as the unit of service, (2) focusing on solutions rather than problems, (3) using a two-stage promotional message strategy to encourage better child caretaking, and (4) viewing potential new practices as behavioral processes, rather than single entities aimed at a specific outcome. Program planning should also include the successive construction and analysis of community-based explanatory models which justify people's nutrition and health behaviors. The ultimate aim is to identify differences between explanatory models held by community members and health/nutrition educators, negotiate this conflict, and thereafter develop more practical and realistic methods for modifying behavior.

Child