International Journal of Child Health and Nutrition

Contextual Determinants of Stunting in Indonesia: A Systematic Review of Nutritional Interventions and Antenatal Care

2025-08-01T12:50:15+00:00

Background: Stunting is a significant global health issue, especially in Indonesia, where long-term malnutrition adversely affects children's growth and development, with prevalence rates still exceeding the WHO's recommended threshold. This study examines the contextual factors that influence the effectiveness of nutritional interventions and antenatal care (ANC) in combating stunting in Indonesia.

Methods: A systematic review was conducted by the PRISMA guidelines. A comprehensive search across five major academic databases (Google Scholar, PubMed, ScienceDirect, Embase, and ProQuest) identified 3,690 articles. After a rigorous screening process, 13 studies published between 2019 and 2023 were included in the analysis, focusing on key contextual factors that impact stunting interventions in Indonesia. The quality appraisal utilized Joanna Briggs Institute checklists for analytical cross-sectional studies, cohort studies, quasi-experimental studies, qualitative research, systematic reviews, case reports, and text and opinion papers, each matched to the respective study design.

Findings: The review identified four critical contextual factors shaping stunting interventions: (1) socioeconomic status, particularly household income and education, which significantly influence access to healthcare and nutrition; (2) cultural beliefs, including food taboos and misconceptions, which hinder optimal nutritional practices; (3) geographical disparities, with rural populations experiencing higher stunting rates due to limited access to healthcare and resources; and (4) government policies, highlighting the importance of strong political commitment, multisectoral collaboration, and localized programs.

Conclusion: Nutritional interventions and ANC are more effective in reducing stunting among Indonesian children when tailored to local socioeconomic, cultural, and geographical contexts. These findings highlight the need for targeted, context-specific strategies to improve child growth outcomes in vulnerable populations.

Mobile Health Solutions for Childhood Stunting: An Integrative Review of Prevention, Monitoring, and Reduction Applications – Review

2025-08-01T12:50:14+00:00

Background: This study seeks to provide a comprehensive review of existing literature on the application of mobile health (mHealth) technologies in efforts to prevent, monitor, and reduce the prevalence of childhood stunting. Additionally, it aims to explore the key challenges associated with implementing these digital health interventions.

Methods: The literature review was carried out by systematically searching six major databases—PubMed, ScienceDirect, Wiley, SAGE, ProQuest, and Google Scholar—for relevant articles published between February 2015 and February 2025. The inclusion criteria encompassed original, English-language studies that employed either quantitative or qualitative methodologies, focusing on digital applications for the prevention, monitoring, or management of childhood stunting. Only freely accessible full-text articles were considered. Studies that relied solely on traditional, non-digital approaches were excluded. The article selection process adhered to the PRISMA flow diagram, and the methodological quality of the included studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal tool. From an initial pool of 5,797 articles, a structured screening process was conducted using the Rayyan AI platform, culminating in the selection of seven studies for in-depth analysis.

Results: Thematic analysis identified five central themes: (1) improvements in knowledge, attitudes, and practices (KAP); (2) enhanced growth monitoring and early detection of stunting; (3) the vital role of community support and health cadres; (4) the overall effectiveness of mHealth interventions; and (5) implementation challenges within vulnerable populations. The findings highlight the substantial potential of mHealth applications in preventing childhood stunting, particularly in resource-constrained settings. Notably, applications such as SCATION and Nutritional Rangers have demonstrated effectiveness in enhancing KAP and improving children’s nutritional outcomes.

Conclusion: Integrating mHealth into maternal and child health programs at the community level is essential. Furthermore, supportive policy frameworks and additional research are necessary to overcome existing barriers to implementation.

Role of Recombinant Human Erythropoietin in Neonates with Moderate to Severe Hypoxic Ischemic Encephalopathy - A Prospective Cohort Study

2025-08-01T12:50:14+00:00

Background: Hypoxic-ischemic encephalopathy (HIE) is a significant brain injury that occurs when there is inadequate oxygen supply to the brain during the neonatal period. Newer researches have established that rhEPO, human recombinant erythropoietin possesses neurological, neuro-restorative, and anti-inflammatory properties in asphyxia newborns. These effects are invaluable in enhancing outcomes for neonates diagnosed with hypoxic-ischemic encephalopathy-HIE

Aims: To evaluate the role and effects of human recombinant erythropoietin in moderate to severe hypoxic-ischemic encephalopathy in neonates.

Objective: To assess the safety and feasibility of rhEPO in asphyxiated neonates with moderate to severe encephalopathy. To know and to correlate the effect of EPO on EEG, RI (resistive index) in Neurosonogram (NSG), MRI brain in asphyxiated neonates with moderate to severe encephalopathy.

Materials and methods: This is a Prospective Cohort Study conducted over 12-18 months with a sample size of 92, comprising 46 participants in each group. All neonates received intravenous recombinant human erythropoietin (rhEPO) after 6 hours of life. A total of 5 doses were administered.

Results: In the EPO group, 47.8% (n = 22) had moderate encephalopathy, while 52.2% (n = 24) had severe encephalopathy. In our study we found that Amplitude–integrated electroencephalogram [aEEG] showed burst suppression [21.7% vs. 6.5%], low voltage [10.9% vs. 4.3%], flat trace [13.0% vs. 8.7%], and status epilepticus [6.5% vs. 2.2%] in the control group in comparison with EPO Group. A neurosonogram [NSG] was done and showed Abnormal RI [56.5% vs. 15.2%] and Normal RI [43.5% vs. 84.8%] in the control group in comparison with the EPO Group. Brain magnetic-resonance imaging [MRI] done at discharge showed severe brain injury [32.6% vs. 8.6%] and regional-specific HIE [19.5% vs. 39.1%] in the control group in comparison with the EPO Group. Mortality outcome was 10.8% in control group in comparison with EPO Group(2.17%).

Conclusion: The study concludes that administering recombinant human erythropoietin (rhEPO) to newborns with moderate to severe hypoxic-ischemic encephalopathy (HIE) is safe and practical. In comparison to the control group, rhEPO treatment significantly reduces the occurrence of an abnormal resistive index (RI). Furthermore, EPO-treated neonates showed improvements in electroencephalographic (EEG) patterns, neurosonogram (NSG) resistive index, and MRI brain findings, suggesting possible neuroprotective advantages.

Endocrine Manifestations in Children and Adolescents with Thalassemia Major - A Prospective Cohort Study

2025-08-01T12:50:13+00:00

Background: Thalassemia major is a widely prevalent genetic hemoglobinopathy marked by inadequate erythropoiesis and persistent hemolytic anemia. Although frequent blood transfusions are life-saving, such therapy leads to accumulated iron excess, which impacts multiple organs, including the endocrine glands. Despite progress in iron chelation therapy, endocrinopathies continue to be a considerable source of morbidity in individuals with thalassemia major.

Objective: This article explores the endocrine manifestations in children and adolescents with thalassemia major and identifies associated risk factors.

Methods: This study included 51 children and adolescents with a thalassemia major attending the clinic. The researchers recorded a detailed history of each participant, made an anthropometric assessment, and conducted a clinical examination. Furthermore, laboratory investigations were performed to measure each participant's complete blood count, serum ferritin, glucose parameters (FBS, PPBS, HbA1c), thyroid function (T3, T4, TSH), serum calcium, and gonadotropin levels (LH, FSH) in children >13 years of age.

Results: Within the study population, 74.5% had initiated transfusions before one year of age, and 88.2% received monthly transfusions. Growth retardation was evident, with 23.5% and 29.4% having weight and height, respectively, below the third centile. Endocrine abnormalities included diabetes (25.5%), hypothyroidism (9.8%), hypogonadotropic hypogonadism (25% with low LH and 12.5% with low FSH) in children >13 years of age (n=8), and hypocalcemia (21.6%). Serum ferritin was elevated (> 1500 ng/mL) in 90.2% of patients. Significant associations were observed between HbA1c levels and chelation therapy (p < 0.001), as well as hypogonadism and chelation therapy (p = 0.005). Multiple endocrinopathies (> 2) were observed in 11.7% of patients.

Conclusion: Endocrine complications are common in pediatric thalassemia major patients, and glucose metabolism abnormalities are the most prevalent. Age, transfusion burden, and chelation therapy significantly influence the risk of endocrinopathies. Regular monitoring of endocrine function and appropriate interventions are essential for improving the quality of life and reducing morbidity in these patients.

Assessing the Impact of Nutritional Status on Psychomotor Development in Infants Aged 0-23 Months in the Gahombo Health District, Burundi

2025-08-01T12:50:12+00:00

This study aims to assess the influence of malnutrition on the psychomotor development of children aged 0–23 months in the Gahombo health district. The survey was conducted from 12 to 27 July 2024.

The results show disharmonious psychomotor development in children suffering from severe acute malnutrition (SAM) and moderate acute malnutrition (MAM) when compared to their adequately nourished peers. The ability to hold the head without support, sit, crawl, walk independently, pronounce simple words, babble, and track familiar faces is significantly affected in malnourished children.

Only 9.7% of MAM and 2.7% of SAM children walked independently at 12 months of age, in contrast to 39.2% of adequately nourished children. Furthermore, the ability to pronounce "papa" and "maman" or to babble and follow a familiar face was much lower in malnourished children (p < 0.05). These delays were more pronounced in cases of severe malnutrition. Therefore, malnutrition has a profound influence on psychomotor development in children under two years of age. The study highlights the importance of early intervention and appropriate nutritional care in mitigating the impact of these disorders.

Methods of Rehabilitation of Children through Eastern Martial Arts and their Impact on Health

2025-08-01T12:50:12+00:00

Purpose: This study aimed to evaluate the effectiveness of Eastern martial arts as a rehabilitation method for children and their impact on health outcomes.

Material and Methods: The research methodology involved a comprehensive three-month intervention program conducted at specialized rehabilitation centers in Bulgaria, including the National Sports Academy “Vassil Levski” Rehabilitation Center in Sofia and the Varna Martial Arts Therapy Center. The study included 128 children aged 5-17 years with various conditions who participated in twice-weekly, 60-minute adapted martial arts sessions. Physical parameters were evaluated using standardized tests, including the Bruininks-Oseretsky Test, astrometric platforms, and dynamometers, while psychological outcomes were assessed using validated scales.

Results: The analysis revealed significant physical improvements, with static balance enhancement of 54.9%, dynamic balance improvement of 18.2%, and overall motor proficiency increase of 26.3% across different martial arts disciplines. Psychological assessments demonstrated 50% improvement in emotional control, 50.8% enhancement in attention span, and also 46.2% reduction in anxiety levels. The implementation of martial arts-based rehabilitation programs achieved 82.6% adherence rates and 85.3% therapeutic goal achievement, with full integration models showing the highest success rates. Long-term monitoring revealed sustained improvements in cardiovascular fitness, with enhanced oxygen utilization and better recovery rates after physical exertion. Cross-environmental behavioral improvements showed 60.9% reduction in behavioral incidents at home and 56.4% in school settings.

Conclusion: These findings indicate that Eastern martial arts serve as effective complementary approaches in children’s rehabilitation programs in Bulgaria, offering comprehensive benefits for both physical and psychological development when properly implemented and adapted to specific therapeutic needs.

Gamification in Child and Adolescent Health: Trends, Applications, and Policy Relevance for Mental Well-Being, Physical Activity, and Nutrition

2025-08-01T12:50:11+00:00

Aim: This study presents a bibliometric analysis of the use of gamification in mental health research (GMHR), aiming to provide a comprehensive quantitative evaluation of publication trends, key contributors, collaboration networks, thematic development, and emerging research themes in this field.

Methods: Relevant literature was retrieved from the Scopus database and analyzed using bibliometric tools, including VOSviewer and RStudio. The analysis focused on identifying publication outputs, author collaborations, co-word networks, and thematic evolution from 2013 to 2024.

Results: A total of 276 documents were identified, with an annual growth rate of 32.98%. The average number of co-authors per document was 4.99, indicating robust collaborative activity, including international partnerships. Leading contributors included Cheng VWS, Hickie IB, and Fleisch E, who are affiliated with prominent research institutions. Key research themes included gamification, mHealth, anxiety, and ADHD. The findings revealed a dynamic and expanding field responding to contemporary societal mental health needs.

Conclusion: Gamification is increasingly being integrated into mental health interventions, showing promise in addressing psychological well-being, particularly among children, adolescents, and individuals with ADHD. Interventions utilizing serious games and mobile health apps have been shown to enhance user engagement, adherence, and cognitive outcomes, especially when targeting anxiety and attention disorders. Empirical studies within the most cited GMHR publications demonstrate effectiveness in areas such as cognitive-behavioral therapy (CBT) delivery, biofeedback-based regulation, and emotion recognition training through game mechanics.

Residual Infantile Feeding History and Speech Outcomes in Preschool-Age Children: A Balkan Cross-Sectional Study on Parent-Led Weaning Implications

2025-08-01T12:50:11+00:00

This study examines the relationship between residual infantile feeding history and subsequent speech sound disorders (SSD) in preschool-aged children within the Balkan region. It specifically investigates how traditional parent-led weaning practices influence the type and placement of SSD manifestations through their impact on early oromotor development. A cross-sectional analysis was conducted with 72 children, aged 3 to 6 years, diagnosed with moderate to severe SSD across two clinical centers in Kosovo and North Macedonia. Standardized articulation assessments and caregiver-completed developmental questionnaires were utilized to evaluate speech outcomes and feeding patterns. Key findings revealed significant associations: prolonged non-nutritive sucking (NNS) was strongly linked to anterior speech sound disorders and distortion errors; delayed progression to textured foods was correlated with middle/palatal SSD patterns; and oral sensory dysfunction was notably associated with substitution errors. The study underscores the clinical importance of early feeding interventions and individualized therapy approaches. Targeted strategies such as lingual strengthening for omissions and sensory-motor techniques for substitutions are recommended. These findings contribute to clinical practice and highlight the need for increased awareness and prevention of non-normative feeding patterns in the Balkan pediatric population.

Serum 25-Hydroxyvitamin D Concentration Status and Neonatal Immune Function: New Perspectives in Anticipating Late Onset Sepsis among Preterm Neonates at Tertiary Care Centres (A Prospective Study)

2025-08-01T12:50:10+00:00

Objective: This study aims to investigate the impact of low vitamin D levels in cord blood on the incidence of neonatal sepsis in preterm infants.

Patients and Methods: This prospective study was conducted at Al-Azhar and Helwan University Hospitals from September 2024 to January 2025. 150 neonate premature infants with a gestational age of <37 weeks were enrolled. In the present study, vitamin D deficiency (group 1, n=75) was defined as a 25-hydroxyvitamin D (25(OH)D) concentration <15 ng/mL; and vitamin D sufficiency (group 2, n =75), 25(OH)D concentration ≥15 ng/mL.

Results: All markers were higher in Group 1 compared to the other groups (P < 0.05). Interestingly, the mean Del PCT was lower in group 2 compared to different groups. The cut-off of the umbilical cord CRP was 10.5 mg/L, the sensitivity, specificity, PPV and NPV were 41, 88.0, 29 and 28%, respectively. At a PCT cut-off of 1.18 ng/mL, the sensitivity, specificity, PPV and NPV were 79, 91, 51 and 61%, respectively

Conclusion: Our study is one of the few that examines the relationship between neonatal sepsis in preterm newborns and the level of vitamin D in cord blood. Based on the findings of our investigation, we concluded that neonatal sepsis in preterm newborns is not related to vitamin D levels in the cord blood. To investigate these findings further, a larger patient sample or randomized controlled trials are required.

Effect of Nutrients on Cognitive Function during Childhood to Adolescence: A Review

2025-08-01T12:50:08+00:00

Background: Cognitive functioning and development include making decisions, processing information, and responding properly to the environment. People with healthy brains can identify their skills and modify their cognitive, mental, emotional, and behavioral functions to cope as best they can with various life situations.

Methods: Studies from the last 15 years included from various search engines like Google Scholar, Pubmed, Science Direct, Scopus

Result: The health of the brain is affected by many situations, including illnesses, injuries, mood disorders, substance addiction, and aging-related changes in the brain. There is evidence of numerous changeable lifestyle factors, even though some cannot be changed: Food and exercise, social interaction and mental activity, as well as alcohol and tobacco use, can all help stabilize or enhance deteriorating cognitive performance.

Conclusion: Each macronutrient and micronutrient plays a critical role in supporting cognitive function, and their combined effects may be synergistic due to the interrelated nature of their physiological and biochemical actions.

Feeding Practices and Nutritional Status of Infants and Young Children Aged 6-23 Months in the South Kivu Region: A Cross-Sectional Study

2025-08-01T12:50:08+00:00

Background: The increasing prevalence of stunting in the Democratic Republic of the Congo (DRC) represents a major public health concern. Adequate complementary feeding is crucial for preventing and reducing chronic malnutrition in early childhood in the long term.

Objective: This study aimed to assess the baseline complementary feeding practices and nutritional status of children aged 6–23 months in South Kivu Province, with a focus on commonly consumed complementary foods.

Methods: A cross-sectional analytical study was conducted among 515 children in the Kadutu and Miti-Murhesa health zones of South Kivu. Participants were selected through a systematic random sampling method. Dietary intakes and infant feeding practices were assessed using dietary recall questionnaires and a 7-day food frequency questionnaire. The nutritional status was measured by anthropometry.

Results: The mean age of children was 13.3 ± 5 months. Results showed that 59% of the children had a low dietary diversity score. Only 23% received an appropriate complementary feeding according to the minimum acceptable diet. Most of the children (88.5%) consumed porridge made exclusively of cereals, roots, or tubers and water. Animal-source foods, fruits, and vegetables were rarely consumed. Acute malnutrition and stunting affected 4.9% and 36.6% of children, respectively.

Conclusion: Stunting remains prevalent in both rural and urban areas of South Kivu. Furthermore, infant diets are nutritionally inadequate, as evidenced by their lack of diversity. Enriching widely consumed staple foods (maize, sorghum, and soy) with locally available animal-source products could improve micronutrient intake and constitute a promising strategy for preventing child malnutrition.

Assessment of Epicardial Fat Thickness in Infants of Diabetic Mothers and its Relation to Glycated Albumin Level

2025-08-01T12:50:07+00:00

Background: Infants of diabetic mothers (IDMs) are at increased risk for developing cardiometabolic disorders. Traditional markers like HbA1c have limitations in certain clinical scenarios, highlighting the need for alternative indicators. Epicardial fat thickness (EFT), due to its anatomical and functional proximity to the heart, and glycated albumin, a short-term glycemic marker, may provide early risk detection.

Objective: To assess epicardial fat thickness and umbilical cord glycated albumin levels in neonates of diabetic mothers and determine their association, exploring their potential as early predictors of short-term glycemic control and cardiometabolic risk.

Methods: This cross-sectional, case-control study involved 35 IDMs and 30 neonates born to non-diabetic mothers (NIDMs). Echocardiography measured EFT in the first week of life, while glycated albumin was measured via ELISA from umbilical cord blood. Statistical analysis included ROC curves and logistic regression to evaluate diagnostic performance.

Results: EFT and glycated albumin were significantly elevated in IDMs compared to NIDMs (p < 0.001). A cutoff value of EFT >16.3 mm had a specificity of 93.1% and a sensitivity of 54.29%. Glycated albumin>434 g/dl showed a sensitivity of 91.43% and specificity of 83.33%. Multivariate analysis identified glycated albumin as a strong independent predictor of pregestational diabetes mellitus, while both biomarkers were associated with gestational diabetes.

Conclusions: EFT and glycated albumin serve as effective, non-invasive markers for early detection of cardiometabolic risk in neonates born to diabetic mothers. Their incorporation into routine assessments may enhance early diagnosis and targeted intervention strategies.