Imteaz Mahmud

Malnutrition among infants aged under 6 months (u6m) is a global public health problem. As countries begin implementing 2023 WHO malnutrition guidelines, local prevalence and epidemiology must be well understood. We analysed Bangladesh Demographic Health Survey data (2011–2022), describing the prevalence and time trends of infant u6m wasting (weight‐for‐length z‐score [WLZ] < −2), stunting (length‐for‐age z‐score [LAZ] < −2), and underweight (weight‐for‐age z‐score [WAZ] < −2). In bivariate and multivariate analyses, we tested the association between wasting and underweight and established risk factors for malnutrition. Over the last 10 years, Bangladesh has seen some reduction in stunting and underweight, while wasting has remained relatively stable. In 2022, out of 440 infants u6m, 10.2% were wasted, 11.2% stunted, 11.3% underweight, 0.2% concurrently wasted/stunted. This translates to 178,394 infants u6m being wasted, 195,884 stunted, and 197,633 underweight, in 2022. Between the years 2011 and 2022, 30.3% of participants had at least one form of anthropometric deficit. Length (171) had more missing values than weight (79). WAZ had the lowest percentage of flagged data (0.5%) compared to WLZ (6.1%) and LAZ (2.5%). Underweight was associated with residence, wealth status, maternal age at delivery, maternal BMI, maternal height, maternal level of education, exclusive breastfeeding status and fever in the past 2 weeks. Factors associated with wasting were survey year, the sex of the household head, wealth status, maternal educational level, maternal age at delivery, infant age, and place of delivery. Our findings support the urgent need to roll out the 2023 WHO Guidelines in Bangladesh. They are also consistent with other recent literature highlighting potential advantages of weight‐for‐age (WAZ) as a measure of undernutrition. Given multiple associated factors, packages of care tackling a wide range of potential underlying causes are important for effective local interventions tailored to this age group.

Introduction: Minimum dietary diversity (MDD) is a key indicator of complementary feeding among children aged 6-23 months. This study examines the prevalence, trends, and determinants of MDD in Bangladesh over the period 2014 - 2022. Design: Secondary analysis of the Bangladesh Demographic and Health Survey (BDHS) data between 2014 and 2022. The primary outcome was MDD defined as consumption of at least 5 of 8 food groups (MDD-8). We included 6,080 children aged 6-23 months to assess trends over time. The pooled datasets were used to identify factors associated with MDD-8. Multiple logistic regression was performed to assess the association between different factors and MDD-8, accounting for the complex survey design. Setting: Bangladesh Results: The proportion of children achieving MDD-8 increased from 26.4% in 2014 to 38.7% in 2017, but plateaued at 37.1% in 2022, with an average annual increase of 4.3% between 2014 and 2022. MDD-8 improved with child age. Higher odds of achieving MDD-8 were observed among children surveyed in later years, from wealthier households, with mothers who had >=4 ANC visits, received PNC, had higher education, were employed, and had media exposure. Older age and higher birth order were also associated with achieving adequate MDD. Children in Chattogram and Sylhet were less likely to meet MDD-8 compared to Dhaka. Conclusions: While dietary diversity improved between 2014 and 2017, progress stalled thereafter. Targeted, multisectoral strategies focusing on womens empowerment, health service utilisation, media engagement, and disadvantaged regions are needed to improve child dietary diversity in Bangladesh.

Malnutrition among infants aged under six months (u6m) is a global public health problem. As countries begin implementing 2023 WHO malnutrition guidelines, local prevalence and epidemiology must be well understood. We analysed Bangladesh Demographic Health Survey data (2004 – 2022), describing the prevalence and time trends of infant u6m wasting (weight-for-length z-score [WLZ] <-2), stunting (length-for-age z-score [LAZ] <-2), and underweight (weight-for-age z-score [WAZ] <-2). In bivariate and multivariate analyses, we tested the association between wasting and underweight and established risk factors for malnutrition. Over the last 20 years, Bangladesh has seen a substantial reduction in stunting and underweight while wasting has remained relatively stable. In 2022, out of 476 infants u6m, 10.6% were wasted, 12.8% stunted, 13.7% underweight, 0.5% concurrently wasted/stunted, and 14.8% were reported small at birth. This translates to 185,390 infants u6m being wasted, 223,867 stunted, and 239,608 underweight, in 2022. WAZ had the lowest percentage of flagged data (0.8%) compared to WLZ (6.0%) and LAZ (6.4%). Underweight was associated with delivery place, small birth size, infant sex, post-natal check-ups, fever in the past 2 weeks, drinking water source, maternal BMI, and maternal height. Fewer factors were associated with being wasted, including the sex of the household head. Our findings support the urgent need to roll out 2023 WHO Guidelines in Bangladesh. They also support the superiority of underweight as a measure of undernutrition. Packages of care tackling a wide range of potential underlying causes are important for effective local interventions tailored to this age group.

Introduction: Despite WHO and UNICEF recommending the consumption of fruit and vegetables by children as one of their indicators for evaluating infant and young child feeding practices, there is a dearth of literature about the magnitude of fruit and vegetable consumption among 6– 23-month-old children in Eastern Africa. The current study adds to the scholarly discourse by providing insight into the magnitude of fruit and vegetable intake among 6– 23-months-old children in East Africa. Methods: The secondary source data analysis was conducted for 12 Eastern African countries. Twenty-three thousand seven hundred and fourteen children aged 6– 23 months were included in this analysis. A multilevel statistical model with an odds ratio of 95% was fitted to estimate the strength of the association between zero fruits and vegetables and explanatory variables. Results: Our study showed that 32.20%, with a 95% CI of 31.70– 32.81, of children aged 6– 23 months did not consume any fruit or vegetables. Mother’s educational status [AOR═ 0.77, CI: (0.69, 0.85)], [AOR ═ 0.75, CI: (0.68, 0.90)], [AOR ═ 0.49, CI: (0.37, 0.64)], husband’s educational status [AOR═ 0.75, CI: (0.62, 0.78)] and [AOR ═ 0.73, CI: (0.62, 0.82)], wealth index [AOR═0.82, CI: (0.73, 0.91), [AOR═0.78, CI: (0.69, 0.87)], [AOR═ 0.77, CI: (0.68, 0.89)], [AOR═ 0.67, CI: (0.56, 0.79)], Media exposure, [AOR═ 0.74, CI: (0.67, 0.81)], Place of delivery [AOR═0.88, CI: (0.80, 0.97)] and child’s postnatal checkup within the first 2 months [AOR═ 0.83, CI: (0.76, 0.91)] were significantly associated with zero fruit and vegetables. Conclusion: The magnitude of zero fruit and vegetables was found to be high. These findings are commendable, yet demand emphasis on interventions that target households with lower wealth indexes and integrating nutritional counseling into routine healthcare visits may help increase awareness and benefits of consuming fruits and vegetables.

Small and nutritionally at‐risk infants aged under 6 months (p = 0.009, and OR = 3.3, 95% CI: 0.8–13.6, p = 0.09, respectively). Boys had higher odds of inpatient mortality than girls (OR = 1.40, 95% CI: 1.02–1.92, p = 0.03). Mortality was only observed in infants p = 0.21 for stunted, wasted and underweight infants z‐score and weight‐for‐age z‐score were found to be useful indicators for programme admission and in‐programme prognosis. Future work needs to explore which better accounts for admission bias. Boys appear to be most at‐risk of dying while receiving malnutrition therapeutic care. Programmes should ensure that all infants receive timely, evidence‐based, effective care.

Glioblastoma is an aggressive primary brain tumor that poses many therapeutic difficulties because of the high rate of proliferation, genetic variability, and its immunosuppressive microenvironment. The theory of cancer immunoediting, which includes the phases of elimination, equilibrium, and escape, offers a paradigm for comprehending interactions between the immune system and glioblastoma. Immunoediting indicates the process by which immune cells initially suppress tumor development, but thereafter select for immune-resistant versions leading to tumor escape and progression. The tumor microenvironment (TME) in glioblastoma is particularly immunosuppressive, with regulatory T cells and myeloid-derived suppressor cells being involved in immune escape. To achieve an efficient immunotherapy for glioblastoma, it is crucial to understand these mechanisms within the TME. Existing immunotherapeutic modalities such as chimeric antigen receptor T cells and immune checkpoint inhibitors have been met with some level of resistance because of the heterogeneous nature of the immune response to glioblastoma. Solving these issues is critical to develop novel strategies capable of modulating the TME and re-establishing normal immune monitoring. Further studies should be conducted to identify the molecular and cellular events that underlie the immunosuppressive tumor microenvironment in glioblastoma. Comprehending and modifying the stages of immunoediting in glioblastoma could facilitate the development of more potent and long-lasting therapies.

Aim: We aimed to explore the predictors associated with obesity among adult ever-married Egyptian women aged 20–49 years based on the Egyptian Demographic and Health Survey (EDHS). Method: We included adult ever married women from the EDHS conducted in 2014 that initially recruited 21,903 women. Univariate and multivariable analysis was conducted to identify socio-demographic predictors of women’s obesity. Result: We included 12,975 Egyptian women. Among them, 76% of the total respondents were obese where as 24% were with normal body mass index (BMI). In multivariable analysis, the results revealed that increasing age, higher wealth index, listening to radio at least once a week and women with primary and secondary education were at significant odds of developing obesity (p < 0.05). However, we found no association between residence of participants and the frequency of watching television upon the development of obesity (p > 0.05). Conclusion: Appropriate and targeted interventions should be implemented among the Egyptian reproductive age women to reduce the obesity as well as non-communicable diseases load associated with obesity. National Health Service policy makers should take multilevel approach targeting high risk sub-groups to raise awareness and to provide prevention against obesity and the subsequent complications.

Background: Small and nutritionally at-risk infants aged <6 months are at high risk of death, but important evidence gaps exist on how to best identify them. We aimed to determine associations between anthropometric deficits and mortality among infants <6m admitted to inpatient therapeutic care. Methods: A secondary analysis of 2002-2008 data included 5,034 infants aged <6m from 12 countries. The prevalence, concurrence, and severity of wasted, stunted, underweight, and the Composite Index of Anthropometric Failure (CIAF) were analysed. We used logistic regression to examine the association of different anthropometric deficits with in-programme mortality. Results: Among 3,692 infants aged <6m with complete data, 3,539 (95.8%) were underweight, 3,058 (82.8%) were wasted, 2,875 (77.8%) were stunted, and 3,575 (96.8%) had CIAF. Infants with multiple anthropometric deficits were more severely wasted, stunted, and underweight. A total of 141 infants died during inpatient therapeutic care. Among these, severely wasted (116) and severely underweight (138) infants had higher odds of mortality than normal infants (OR=2.1, 95% CI: 1.2-2.7, p=0.009, and OR=3.3, 95% CI: 0.8-13.6, p=0.09, respectively). Boys had higher odds of inpatient mortality than girls (OR=1.40, 95% CI: 1.02-1.92, p=0.03). Conclusion: Multiple anthropometric deficits (CIAF) is common among infants <6m. Future work needs to explore which are the most useful indicator for programme admission and in-programme prognosis: our data supports both WLZ and WAZ, but future work which better accounts for admission bias is urgently needed. Boys appear to be most at-risk. Programmes should ensure that all infants receive timely, evidence-based, effective care.