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Birth weight mediates the association of maternal undernutrition with child undernutrition prevalence in West Africa

Abstract

Background

Maternal nutritional status before and during pregnancy is an important determinant of foetal health. In West Africa, maternal and child undernutrition remains a major public health problem and it is important to establish the mechanistic pathway linking the two disorders to help address the problem. We therefore assessed the mediating role of low birth weight (LBW) in the relationship of maternal undernutrition with child undernutrition in West Africa.

Methods

We included recent (2010–2019) DHS data from thirteen West African countries. Poisson regression model with robust standard errors was used to assess the relationship between maternal undernutrition (body mass index and anaemia) and child undernutrition (stunting, wasting, underweight, and anaemia). Structural equation modelling was used to conduct the mediation analysis.

Results

Prevalence of stunting, wasting, underweight, and anaemia among under-five children in West Africa was found to be 32.4%, 8.1%, 20.1%, and 71.5%, respectively. We found children of underweight mothers to be more likely to be undernourished (stunted, wasted, and underweight) and anaemic compared to children of normal-weight mothers. Also, children of anaemic mothers were more likely to be stunted and anaemic but not wasted compared with children of non-anaemic mothers. LBW mediated the observed relationships between maternal BMI and childhood stunting (22.6%), and maternal anaemia and childhood stunting (24.9%), wasting (11.7), and anaemia (6.6%).

Conclusion

We found maternal undernutrition to be associated with child undernutrition in West Africa with LBW noted to be a mediator of the observed relationship. We recommend that, to address the child undernutrition problem in West Africa, governments and policymakers must integrate measures to address the burden of LBW.

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Data availability

The Demographic and Health Survey datasets were available in the public domain (https://dhsprogram.com/data/available-datasets.cfm). All Stata codes used in the analysis are available upon request.

Code availability

The Demographic and Health Survey datasets were available in the public domain (https://dhsprogram.com/data/available-datasets.cfm). All Stata codes used in the analysis are available upon request.

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Acknowledgements

The study was funded by Science for Africa Foundation under the Grand Challenges Africa Data Science Approaches to Improve Maternal, Neonatal, and Child Health in Africa Round 6 call (Grant Number: GCA/MNCH/round6/036). The funder was not involved in the study design, conduct of the study, analysis of the data, interpretation of findings, and preparation of the manuscript.

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Contributions

AKA conceived the idea and designed the study. DD accessed and merged all the dataset for the study. HMF conducted the data analysis. AKA wrote the manuscript together with RA, KY, CS and SAM. SKA, SS and NBK reviewed draft manuscripts for important intellectual content.

Corresponding author

Correspondence to A. Kofi Amegah.

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The authors declare no competing interest.

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As this study leverages secondary data from the Demographic and Health Surveys (DHS), no ethical approval and consent were required. Notwithstanding, DHS, the program directors ensured that IRB-approved procedures were used with all women interviewed giving verbal consent before data were collected. In this study, before the use of the dataset, the DHS Program gave the authors permission to use the dataset.

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Kofi Amegah, A., Ayinemi, R., Sewor, C. et al. Birth weight mediates the association of maternal undernutrition with child undernutrition prevalence in West Africa. Eur J Clin Nutr (2024). https://doi.org/10.1038/s41430-024-01453-5

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