Tackling malnutrition: a systematic review of 15-year research evidence from INDEPTH health and demographic surveillance systems

Figures & data

Fig. 1 Diagram showing how the papers were selected for the study.

Table 1 Prevalence of under-nutrition and obesity: findings from INDEPTH studies

HDSS site	Year	Authors	Main findings
Nouna HDSS, Burkina Faso	2000	Beiersmann et al.	Slight reduction in the underweight prevalence from 40% in June 1999 to 35% in June 2009 and from 43% in December 1999 to 34% in December 2009.
Agincourt HDSS, South Africa	2010	Kimani-Murage et al.	20% of children aged 1–4 years had stunted growth.
Agincourt HDSS, South Africa	2007	Saloojee et al.	45% of children below the age of 5 had stunted growth.
Purworejo HDSS, Indonesia	2000	Winkvist et al.	15% of adult women had chronic energy deficiency from insufficient food intake; 14% were obese.
Matlab HDSS, Bangladesh	2006	Kabir et al.	50% of adults over 60 years of age had chronic energy deficiency; 62% at risk of malnutrition.
Agincourt HDSS, South Africa	2013	Gomez-Olive et al.	Women aged 50 years or above were significantly more obese than males.
Dikgale HDSS, South Africa	2005	Mamabolo et al.	22% of 3-year-old children were overweight or obese; 19% had both stunted growth and obesity.
Agincourt HDSS, South Africa	2011	Kimani-Murage et al.	15% of adolescent girls were overweight or obese, and 4% of adolescent boys.

Table 2 Biological causes of malnutrition: findings from INDEPTH studies

HDSS site	Year	Authors	Main findings
Agincourt HDSS, South Africa	2011	Kimani-Murage et al.	Children infected with HIV had significantly worse nutritional outcomes than their uninfected peers.
West Kiang HDSS, Gambia	2008	Nweneka	HIV-positive children had significantly worse scores in terms of weight-for-age, height-for-age, and BMI than HIV-negative children.
Africa Centre, South Africa	2007	Papathakis et al.	Breastfeeding mothers in South Africa who were HIV-positive had poorer protein and micronutrient status than HIV-negative women.
Africa Centre, South Africa	2001	Filteau et al.	Providing pregnant women who are HIV-positive with vitamin A supplementation may improve gut function of their HIV-infected infants. Vitamin A supplementation for HIV-infected infants may decrease gastrointestinal morbidity.
Kilifi HDSS, Kenya	2004	Nyakeriga et al.	Significant relationship between malaria and subsequent underweight and stunting in children below the age of 2 years.
Kisumu DSS, Kenya	2005	Mamiro et al.	Infants who had had malaria were more likely to have stunting, anaemia, and iron deficiency.
Farafenni HDSS, Gambia	2002	Deen et al.	No association between malaria and subsequent malnutrition in children below the age of 5 years during the malaria season.
Nouna HDSS, Burkina Faso	2003	Muller et al.	Anaemia was significantly associated with malnutrition.
Kilifi HDSS, Kenya	2011	Aiken et al.	Hospital-acquired bacteraemia (nosocomial bacteraemia) a significant risk factor for severe malnutrition.

Table 3 Social causes of malnutrition: findings from INDEPTH studies

HDSS site	Year	Authors	Main findings
West Kiang HDSS, Gambia	2010	Mwangome et al.	Poverty a key constraint preventing mothers from putting into practise their knowledge of child health and nutrition.
Kilifi HDSS, Kenya	2011	Abubakar et al.	Mothers reported that ‘financial constraints’ were the main cause of severe malnutrition in children.
Nairobi HDSS, Kenya	2006	Fotso et al.	Household wealth and community socio-economic status significantly associated with childhood stunting.
Nairobi HDSS, Kenya	2005	Fotso et al.	Neighbourhood characteristics exert an influence on malnutrition independently of household wealth.
Agincourt HDSS, South Africa	2007	Saloojee et al.	Cases with severe malnutrition were from households with fewer assets and lower incomes that were less likely to receive a social support grant or to have anyone employed.
Agincourt HDSS, South Africa	2011	Kimani-Murage et al.	Four-fold higher odds of overweight for adolescent girls and two-fold higher odds for participants from households with the highest socio-economic status.
Matlab HDSS, Bangladesh	1998	Ahmed et al.	Women aged over 35 years from wealthier households were 0.77 times less likely to have chronic energy deficiency than poorer women.
Nairobi HDSS, Kenya	2011	Abuya et al.	Children born to mothers educated to primary level had a 94% lower chance of stunting than those born to mothers with no education.
Multiple sites in Ethiopia, India, Peru, Vietnam	2013	Barnett et al.	Mothers’ education level associated with stunting in early childhood of their children.
Matlab HDSS, Bangladesh	1998	Ahmed et al.	Women aged over 35 were half as likely to suffer chronic energy deficiency if they had had one or more years of education than if they had had no schooling.
Nairobi HDSS, Kenya	2006	Fotso et al.	Urban children significantly less likely to be malnourished than rural children.
Niakhar HDSS, Senegal	1999	Bénéfice et al.	Rural adolescent girls who migrated seasonally to urban areas for work had improved nutritional status compared with girls who remained in villages.
Niakhar HDSS, Senegal	2001	Garnier and Bénéfice	Rural adolescent girls who migrated seasonally to urban areas for work had improved nutritional status compared with girls who remained in villages.
Kanchanaburi HDSS, Thailand	2011	Firestone et al.	Urban residence associated with lower rates of under-nutrition in children, but also with higher rates of obesity.
Agincourt HDSS, South Africa	2007	Madhavan and Townsend	Children whose fathers did not provide financial support were at higher risk of malnutrition.
Chililab HDSS, Vietnam	2008	Tran et al.	Children whose fathers took them to a medical facility to be immunised against childhood diseases were 1.7 times less likely to be underweight and stunted than other children.

Table 4 Effects of malnutrition: findings from INDEPTH studies

HDSS site	Year	Authors	Main findings
Kilifi HDSS, Kenya	2008	Bejon et al.	Under-nutrition a factor in half of in-hospital deaths of children and half of morbidity from severe diseases.
West Kiang HDSS, Gambia	2011	Ngom et al.	Ten times higher mortality among young adults born in the hunger season than in harvest season.
Niakhar HDSS, Senegal	2006	Enel et al.	Decline in child mortality despite no improvement in nutritional status among children.
Niakhar HDSS, Senegal	2004	Pinchinat et al.	Decline in child mortality despite no improvement in nutritional status among children.
Matlab HDSS, Bangladesh	2008	Bosch et al.	Stunting in early childhood a significant predictor of stunting in adolescence.
Multiple sites in Ethiopia, India, Peru, Vietnam	2013	Barnett et al.	Stunting in early childhood associates with lower cognitive achievement among 5-year-olds.
Kilifi HDSS, Kenya	2008	Okiro et al.	Stunting in infants and children associated with developing severe respiratory syncytial virus-associated pneumonia, and with lower respiratory tract infections from all causes.
Kilifi HDSS, Kenya	2009	Berkley et al.	Malnutrition associated with severe falciparum malaria.
Farafenni HDSS, Gambia	2002	Deen et al.	51% of children with stunting subsequently experienced malaria during the malaria season, compared with 38% of children who were not stunted.
Nouna HDSS, Burkina Faso	2003	Muller et al.	No association between protein-energy malnutrition and malaria morbidity.
Kilifi HDSS, Kenya	2004	Nyakeriga et al.	Children with iron deficiency were less likely than other children to develop mild clinical malaria.

Table 5 Tackling malnutrition – prevention efforts: findings from INDEPTH studies

HDSS site	Year	Authors	Main findings
Bandim HDSS, Guinea-Bissau	2004	Nielsen et al.	During civil war, vitamin A supplementation for children helped reduce mortality.
Bandim HDSS, Guinea-Bissau	2005	Nielsen et al.	During civil war, supplementary feeding programme helped reduce mortality in children.
FilaBavi HDSS, Vietnam	2009	Nga et al.	Fortification with multiple micronutrients of biscuits provided in schools reduced risk of anaemia and of iron and zinc deficiencies by 40%.
Nouna HDSS, Burkina Faso	2003	Müller et al.	No significant impact of zinc supplementation for children on height-for-age, weight-for-age, and weight-for-height scores.
Kintampo HDSS, Ghana	2007	Newton et al.	No positive effect of vitamin A supplements in combination with vaccines during the first few months of life.
Farafenni HDSS, Gambia	2013	Van der Merwe et al.	Fish oil supplementation had no effect on growth, intestinal integrity, morbidity, or cognitive development.
Kilifi HDSS, Kenya	2010	Akech et al.	Use of low-dose hypotonic fluid resuscitation for children who develop shock as a result of severe malnutrition has poor outcomes in terms of persistent shock, oliguria, and high case fatality.
Agincourt HDSS, South Africa	2003	Deen et al.	Introduction of WHO guidelines in two hospitals strengthened the management of malnutrition.
Kintampo HDSS, Ghana	2006	Tchum et al.	Vitamin A supplementation increased liver reserves of mothers during the postpartum period, with effects persisting for at least five months.
Niakhar HDSS, Senegal	2006	Ly et al.	Provision of high energy, nutrient-dense food supplements to infants aged between four and seven months contributed to decreased postpartum weight loss in their mothers.
West Kiang HDSS, Gambia	2011	Hawkesworth et al.	Nutrient supplementation during pregnancy had little effect on infants’ risk of cardiovascular disease.
West Kiang HDSS, Gambia	2009	Hawkesworth et al.	Protein-energy supplementation of mothers during pregnancy had no effect on the blood pressure of their children in adolescence.
West Kiang HDSS, Gambia	2009	Prentice et al.	Calcium supplementation for pregnant mothers had no effect on foetal and infant growth.
West Kiang HDSS, Gambia	2010	Jarjou et al.	Women given calcium supplements while pregnant had lower bone mineral content, bone area and bone mineral density at the hip during the 12-month lactation period than other women.
Dikgale HDSS, South Africa	2002	Nthangeni et al.	The majority of people with type 2 diabetes had poor glycaemic control and were obese or had high blood pressure and were given poor advice by health educators.
Africa Centre HDSS, South Africa	2002	O'Donnell et al.	Agencies working to tackle a flood disaster in Bangladesh in 1998 achieved mixed results in terms of meeting international disaster response standards. Some agencies complied with most standards, some with few.