Study warns of double burden of malnutrition in children from the Amazon

A study coordinated by Fiocruz Amazônia on the problem of double burden of malnutrition among children in rural and urban areas of hard-to-reach municipalities in the state of Amazonas raises an alarm for the situation of children under 5, especially the most vulnerable in the context of climate crisis, as direct impacts on their growth and development are expected, as well as later negative effects in adulthood. The study, recently published in the scientific journal Frontiers Public Health, was carried out by researchers from various institutions, such as the Lancaster University (UK), the King Abdullah University of Science and Technology (Saudi Arabia), the Federal University of Health Sciences of Porto Alegre (UFCSPA) ,and the University of São Paulo (USP).

Four river-dependent municipalities were assessed, with a total of 60 riverside communities (Photo: Jessem Orellana)

According to Fiocruz Amazônia epidemiologist and researcher Jesem Orellana, the work focused on assessing the double burden of malnutrition in children under 5 in remote areas of the Brazilian Amazon, further applying a method for estimating health problems of low occurrence (prevalence) and in relatively small populations, as repeatedly observed in the reality of municipalities in the countryside of the state of Amazonas - Jutaí, Ipixuna, Maués and Caapiranga - and in dozens of rural communities.

"The focus of the article was on the concept of double burden of malnutrition, i.e. when a child is both overweight and short for their age. In other words, fat and short at the same time. In addition to the unprecedented nutritional diagnosis of the problem, we innovated in data analysis, as we used models that helped overcome a well-known problem in smaller populations, that of estimating events whose population occurrence is low in proportional terms”, explains Orellana, head of the Laboratory of Modeling in Statistics, Geoprocessing and Epidemiology (LEGEPI) at Fiocruz Amazônia, based in Manaus.

According to the scientific article, the latent double burden of malnutrition (LDBM) in the same individual is a neglected public health concern, especially in low- and middle-income countries (LMICs) and one that tends to worsen as the climate crisis deepens and children's lifestyles change, especially among the most vulnerable. "The LDBM is associated with increased risks of non-communicable diseases, birth complications, and health costs related to obesity in adulthood. However, assessing low-prevalence outcomes (health problems/conditions) in relatively small populations remains a difficult challenge to overcome using conventional frequency statistics. For this reason, our study used latent Bayesian models to estimate the prevalence of LDBM in small populations of remote towns and rural communities in the Brazilian Amazon", the study highlights.

Children aged 6 to 59 months

The research was a comprehensive cross-sectional study carried out with urban and rural children aged 6 to 59 months in remote and geographically distant municipalities, “an initiative that is not so common in the Brazilian Amazon, due above all to its high operating costs, funding

and, more recently, the security of the research teams, due to the increasingly strong presence of criminals, such as river pirates, land grabbers, and illegal miners, for example”, the researcher emphasizes. Four river-dependent municipalities were assessed, recruiting children from randomly selected households in each city and a total of 60 riverside communities in the selected municipalities. "Through Bayesian modeling, we estimated the prevalence of latent double burden of malnutrition (LDBM) and its credibility intervals (CI), as well as surplus probabilities for certain values of LDBM", the publication points out.

As a result, the research showed that the rural prevalence of LDBM was significantly higher in Jutaí (3.3%; CI: 1.5% to 6.7%), compared to Maués and Caapiranga. The likelihood of the rural prevalence of LDBM exceeding 1% was very high in Jutaí (99.7%) and high in Ipixuna (63.2%). The likelihood of the LDBM exceeding 1% varied widely between the urban subpopulations, with values ranging from 6.7% in Maués to 41.2% in Caapiranga. On the other hand, the likelihood of the LDBM exceeding 3.0% was high in the rural area of Jutaí (59.7%).

According to Orellana, the innovative approach used in the article has important implications, including the possibility of allowing more accurate estimates of various health problems with low prevalence and in relatively small populations, as well as strengthening the monitoring of the LDBM, especially where health and nutritional status are often more precarious, and public health efforts often focus on malnutrition.