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Association between carriage of oral yeasts and malnutrition among Tanzanian infants aged 6-24 months.

OBJECTIVE: To determine if there is an association between carriage of oral yeasts and malnutrition in infants. DESIGN: A case-control study within a cross-sectional study. The dependent variable was carriage of oral yeasts. The exposure variable was malnutrition and confounders to be adjusted for were age, sex, and breast-feeding. SETTING: A maternal and child health clinic in Dar-es-Salaam, Tanzania that offers routine medical check-ups to all expectant mothers and children aged between 0 and 5 years in its catchment areas. SUBJECTS AND METHODS: 972 infants aged 6-24 months participated. Smears from the tongue and cheek mucosa were examined for candidal hyphae and blastospores. Malnutrition was categorized according to Tanzanian standards (weight-for-age) and World Health Organization (WHO) standards (weight-for-height and height-for-age). MAIN OUTCOME MEASURE: Carriage of oral yeasts (hyphae and blastospores). RESULTS: Carriage of oral yeasts was significantly higher in the 227 malnourished compared with the 745 well nourished adjusted for confounders. Odds ratio for presence of hyphae in smears from the severely malnourished (weight-for-age) was 4.5 (90% CI: 2.0-10.0). Odds ratio for presence of hyphae was 2.3 (90% CI: 1.1-4.8) when weight-for-height were used to categorize for malnutrition. CONCLUSION: The study tends to confirm the generally held view that malnutrition may predispose to carriage of oral yeasts and subsequent oral candidiasis.

Candida↗

The potentiating effects of malnutrition on child mortality: epidemiologic evidence and policy implications.

The physiologic synergism between malnutrition and infection has been recognized for some time, but its implications have not been addressed in current child survival policies and programs. This paper summarizes the conclusions from a recent analysis of 28 epidemiologic studies of the malnutrition-mortality relationship. It concludes that the relationship is consistent across diverse world populations, that there is a significant effect of both mild-to-moderate malnutrition and severe malnutrition, and that the effect is not simply due to confounding by socioeconomic factors or intercurrent illness. In addition, evidence is provided supporting the hypothesis that malnutrition and infection have multiplicative effects on child mortality, rather than the additive effects implicitly assumed, and the policy implications of these findings are described.

Cause of Death↗

Early malnutrition and metabolic abnormalities later in life.

Early malnutrition has been significantly associated with chronic diseases later in life. The finding of metabolic abnormalities in individuals with malnutrition in fetal life and early in postnatal life may have important public health implications in developing countries, although only a few studies have examined the relationship between body weight at the first year of life and later metabolic abnormalities. We assessed the effects of malnutrition during the first year of life (independent of birth weight) on several metabolic parameters in young men. The areas under the curves of glucose and insulin were significantly higher in 52 individuals with a history of malnutrition during the first year of life (cases) than in controls. An insulin sensitivity index was derived and was lower in cases than in controls. In cases, the insulin sensitivity index worsened as body mass index (BMI) increased within the normal range of BMI. A euglycemic insulin clamp as well as an abdominal CT scan were performed in 26 cases and 27 controls. Higher levels of abdominal adipose tissue were more detrimental to insulin sensitivity in previously malnourished individuals. This study suggests that metabolic programming early in life is not restricted to intrauterine growth. We conclude that early malnutrition in extrauterine life independent of birth weight has an adverse effect on insulin sensitivity, glucose tolerance, and lipid profile in young men. This appears to worsen as body mass index increases, even within "normal" limits.

Adult↗

Sequential disaccharidase loss in rat intestinal blind loops: impact of malnutrition.

We studied lactase, maltase, and sucrase activities in the mucosa of self-filling blind loops (SFBL) in adult rats at weekly intervals after SFBL formation in order to determine the sequence in which disaccharidase activities fall. The studies were carried out on nourished and malnourished rats and extended to a recovery period induced by antibiotics to determine the effects of malnutrition on the establishment and repair of disaccharidase deficiencies caused by bacterial overgrowth. Malnutrition was produced by feeding 50% of the intake of paired rats fed ad libitum. Disaccharidase activities were determined in SFBL from nourished and malnourished rats at 7-day intervals until pandisaccharidase deficiency was established and during a 2-wk recovery period induced by antibiotics. Maximal SFBL bacterial counts in both nourished and malnourished groups of rats and brush-border glycoprotein degradation ratios were established at 7 days. In nourished rats only lactase was deficient at 7 days; maltase and sucrase fell later and sequentially. In malnourished rats all three disaccharidases were reduced at 7 days. Disaccharidase activities in self-emptying blind loops (SEBL), used as operated controls, were not decreased 28 days after surgery. Malnutrition had no effect on disaccharidase activities in the SEBL, and malnutrition did not affect recovery rates with antibiotic therapy. We conclude that small intestinal bacterial overgrowth causes a staggered loss of disaccharidase activities beginning with the loss of lactase activity. In the presence of bacterial overgrowth, malnutrition accelerates the conversion of a mono- to a pan-disaccharidase deficiency.

Animals↗

Inflammation, malnutrition and atherosclerosis in end-stage renal disease: a global perspective.

End-stage renal disease (ESRD) is characterized by an exceptional cardiovascular mortality rate. Although traditional risk factors are common in ESRD patients, they alone may not be sufficient to account for the high prevalence of cardiovascular disease (CVD). Recent evidence demonstrated that chronic inflammation, a non-traditional risk factor which is commonly observed in ESRD patients, may cause malnutrition and progressive atherosclerotic CVD by several pathogenetic mechanisms. Although both malnutrition and inflammation have been shown to be strong predictors of cardiovascular mortality in ESRD patients, it must be remembered that the majority of studies describing the presence of inflammation and malnutrition have been performed in Western and Asian industrialized countries. As it is evident that the prevalence of malnutrition and inflammation may differ markedly between different regions of the world and developing countries face a much higher prevalence of chronic infectious diseases, comparative inter-regional studies focusing on the etiology and prevalence of the malnutrition, inflammation and atherosclerosis syndrome are warranted.

Arteriosclerosis↗

Triad of malnutrition, inflammation, and atherosclerosis in hemodialysis patients.

BACKGROUND/AIM: As chronic inflammation underlies both atherosclerosis and malnutrition, a possible link between these factors has been suggested in hemodialysis (HD) patients. We designed this study to compare nutritional indices and inflammatory parameters of HD patients with demonstrated atherosclerosis (group I) and HD patients without (group II). METHODS: We included 59 and 57 patients in groups I and II, respectively. The patient groups were matched for the risk factors for atherosclerosis such as age, gender, smoking habits, hypertension, and HD duration. The nutritional status of the patients was evaluated according to laboratory parameters, normalized protein catabolic rate, anthropometric measurements, and subjective global assessment. RESULTS: Laboratory parameters (albumin, prealbumin, total cholesterol, phosphorus, creatinine), normalized protein catabolic rate, and triceps skinfold thickness revealed a significant decline in the nutritional status of the patients with atherosclerosis. We found that the patients with atherosclerosis had significantly higher C-reactive protein, ferritin, and fibrinogen levels when we compared the patient groups for acute-phase reactants. When we assessed malnutrition as being in category B/C (B = mild to moderately malnourished, C = severely malnourished) according to subjective global assessment and inflammation on the basis of a C-reactive protein level > or =10 mg/l, among patients with atherosclerosis, there was a significantly higher proportion of them having malnutrition and inflammation. Additionally, the proportion of patients without any evidence of malnutrition and inflammation was significantly lower in group I than in group II. CONCLUSION: Our study gives evidence for the possible triad of malnutrition, inflammation, and atherosclerosis in HD patients.

Adult↗

Malnutrition is associated with increased blood pressure in childhood.

BACKGROUND/AIMS: Protein-energy malnutrition remains a major public health problem in many countries. Scanty information is available about the effects of malnutrition during childhood on blood pressure (BP). METHODS: In a cross-sectional study we assessed the BP of 172 children older than 2 years living in shantytowns in São Paulo city. Ninety-one children were malnourished (height-for-age or weight-for-age Z-score below -1 of the NCHS references); 20 had recovered from malnutrition after an average time of 6.4 years, and 61 were non-malnourished controls. RESULTS: A greater percentage of children in the malnourished and recovered groups had increased systolic or diastolic BP (>95th percentile of the Update of the 2nd Task Force references) after adjusting for age, sex and height, compared to the controls (29, 20 and 2%, respectively, p < 0.001). Mean diastolic BP, adjusted for age, sex, race, weight, height and birth weight, was significantly increased in malnourished and recovered children compared to controls (65.2 +/- 0.6, 66.5 +/- 1.5, and 61.8 +/- 0.8 mm Hg, respectively, p < 0.01). CONCLUSIONS: BP is increased in malnourished children and in those who recovered from malnutrition after an average period of 6 years. Malnutrition occurring during childhood may represent a risk factor for increased BP later in life.

Analysis of Variance↗

Key issues in the success of community-based management of severe malnutrition.

BACKGROUND: Acute malnutrition is an underlying factor in almost 50% of the 10 to 11 million children under 5 years of age who die each year of preventable causes. Inpatient treatment for severe acute malnutrition is associated with high opportunity and economic costs for affected families and health service providers. Community-based therapeutic care attempts to address these problems and to maximize population-level impact through improving coverage, access, and cost-effectiveness of treatment. THE COMMUNITY-BASED THERAPEUTIC CARE MODEL: Community-based therapeutic care programs provide effective care to the majority of acutely malnourished people as outpatients, using techniques of community mobilization to engage the affected population and maximize coverage and compliance. People with severe acute malnutrition without medical complications are treated in an outpatient therapeutic program with ready-to-use therapeutic food and routine medication. Those suffering from severe acute malnutrition with medical complications are treated in an inpatient stabilization center according to standard World Health Organization protocols until they are well enough to be transferred to the outpatient therapeutic program. IMPACT OF COMMUNITY-BASED THERAPEUTIC CARE PROGRAMS: Twenty-one (21) community-based therapeutic care programs were implemented in Malawi, Ethiopia, and North and South Sudan between 2000 and 2005. These programs, which treated 23,511 cases of severe acute malnutrition, achieved recovery rates of 79.4% and mortality rates of 4.1%. Coverage rates were approximately 73%. Of the severely malnourished children who presented, 76% were treated solely as outpatients. Initial data indicate that these programs are affordable, with the cost-effectiveness of emergency community-based therapeutic programs varying from US$12 to US$132 per year of life gained.

Child Health Services↗

Inequities in under-five child malnutrition in South Africa.

OBJECTIVES: To assess and quantify the magnitude of inequalities in under-five child malnutrition, particularly those ascribable to socio-economic status and to consider the policy implications of these findings. METHODS: Data on 3765 under-five children were derived from the Living Standards and Development Survey. Household income, proxied by per capita household expenditure, was used as the main indicator of socio-economic status. Socio-economic inequality in malnutrition (stunting, underweight and wasting) was measured using the illness concentration index. The concentration index was calculated for the whole sample, as well as for different population groups, areas of residence (rural, urban and metropolitan) and for each province. RESULTS: Stunting was found to be the most prevalent form of malnutrition in South Africa. Consistent with expectation, the rate of stunting is observed to be the highest in the Eastern Cape and the Northern Province - provinces with the highest concentration of poverty. There are considerable pro-rich inequalities in the distribution of stunting and underweight. However, wasting does not manifest gradients related to socio-economic position. Among White children, no inequities are observed in all three forms of malnutrition. The highest pro-rich inequalities in stunting and underweight are found among Coloured children and metropolitan areas. There is a tendency for high pro-rich concentration indices in those provinces with relatively lower rates of stunting and underweight (Gauteng and the Western Cape). CONCLUSION: There are significant differences in under-five child malnutrition (stunting and underweight) that favour the richest of society. These are unnecessary, avoidable and unjust. It is demonstrated that addressing such socio-economic gradients in ill-health, which perpetuate inequalities in the future adult population requires a sound evidence base. Reliance on global averages alone can be misleading. Thus there is a need for evaluating policies not only in terms of improvements in averages, but also improvements in distribution. Furthermore, addressing problems of stunting and underweight, which are found to be responsive to improvements in household income status, requires initiatives that transcend the medical arena.

Journal Article↗

The relation of severe malnutrition in infancy to the intelligence of school children with differing life histories.

The IQ's of Jamaican boys aged 6-10 were associated significantly with the presence or absence of severe malnutrition in infancy, with height at time of IQ testing, and with a measure of the boys' social background. A multiple correlation coefficient of 0.674 was obtained between IQ and the three factors. Social background contributed 0.294 of the variance, height 0.112, and severe malnutrition 0.049. The two extreme groups of boys, i.e., those malnourished, small at follow-up, and with unfavorable social backgrounds and those not malnourished, tall at follow-up, and with favorable social backgrounds had average IQ's of 49.4 and 74.9, respectively (from Table 5). Only two of the boys in the most advantaged group had IQ scores that overlapped with the most disadvantaged group. Boys with severe malnutrition in infancy, but who are tall at follow-up and have a favorable social background have an average IQ 11 points higher than boys who did not experience severe malnutrition, but who are short at follow-up and have a unfavorable social background. The difference in IQ between boys who did and did not experience severe malnutrition in infancy varies under different conditions of height and social background when those are held constant for both groups. Under the most favorable conditions of being tall and having an advantageous social history the average IQ of the malnourtished boys in only 2 points lower than those not malnourished. Unde the most unfavorable conditions of short stature and a disadvantageous social background the IQ of the malnourished boys is 9 points lower than those not malnourished (Table 6 and Fig. 1).

Body Height↗

Effects of malnutrition and chronic reserpine treatment on pancreatic exocrine function.

The chronically reserpine-treated rat, an experimental model for cystic fibrosis, exhibits generalized exocrinopathy, impaired pancreatic secretion, and decreased pancreatic amylase. Although chronic reserpine treatment induces malnutrition by decreasing food consumption and growth, the effects of this malnutrition per se on the exocrine pancreas have not been considered. In this study, the effects of chronic reserpine treatment and malnutrition on the exocrine pancreas were determined using pair-fed controls. Male, Sprague-Dawley rats were treated daily subcutaneously for 5 to 7 days with: no injection (control), 1.0 ml/kg vehicle or sham (control-sham, pair fed-sham), or 0.5 mg/kg reserpine (chronically reserpine-treated). Both chronic reserpine-treatment and pair-feeding significantly decreased food consumption (40%), body weight (51 and 59%), total pancreatic amylase (49 and 56%) and specific amylase activity (62 and 61%), pancreatic protein (65 and 75%), and pancreatic weights (62 and 65%) compared to controls. These decreases, however, were comparable between the chronically reserpine-treated and pair fed-sham rats. In contrast, the secretory response to the biologically active cholecystokinin analog cholecystokinin octapeptide was significantly attenuated in isolated pancreatic acini prepared from reserpine-treated rats compared to that from either control or pair-fed sham rats. Malnutrition decreased pancreatic amylase activity and protein comparably to reserpine treatment, but only partially attenuated the secretory response to cholecystokinin octapeptide. Based on the results of this study, pair-fed controls should be used to distinguish between the effects of reserpine alone and the induced malnutrition on pancreatic exocrine function in studies of this experimental model of cystic fibrosis.

Amylases↗

Malnutrition in hospital patients: where does it come from?

This article provides a comprehensive overview of malnutrition in hospital patients. It explores the issues surrounding nutrition and investigates factors that contribute to the malnutrition seen in patients within the community and to the malnutrition that develops while patients are in hospital. It proposes that although patients are at risk of malnutrition in the community, malnutrition can develop while the patient is in hospital, as the result of changes in diet, nutrition not being seen as a high priority, common hospital practices, and lack of knowledge of patients' previous nutritional state.

Diet↗

The global problems of child malnutrition and mortality in different world regions.

The study of child mortality occupies a special place in the field of demographic research, since it represents the negative component of population growth. Also, the world food problem has become a familiar topic since the end of the World War II. The idea that population growth will sometime in the future outrun food supplies and universal starvation occurs. This study deals with what happened in global and regional variations regarding the child malnutrition and mortality rates. The main objective of the study is to explain and to explore the effect of the social, demographic, economic and health factors on child malnutrition and mortality rates among different regions in the globe. The study includes ten regions of the whole world compared to other studies that covered only one or two regions. Data were collected from various sources. The sample involved 191 countries. These countries divided by regions of world as following. East Southern Africa, West Africa, East Asia and Pacific, South Asia, Eastern Europe and Central Asia, Europe, Middle East, North Africa, North America, and South America. The results of descriptive analysis show that the highest mean rate of child malnutrition was found in South Asia region (57 children per 100), while the smallest mean rate was found in Europe region (just 1 child per 100). In West Africa region, the average of child mortality rate per 1000, 172 children, was the highest among all regions in the world, while in Europe was found to be 14 children per 1000. The results of correlation coefficients reveal that there were positive associations between illiteracy rate, unemployment, poverty, fertility rate, family size, food consumption, maternal mortality rate, population per physician, and child malnutrition and mortality in the whole world regions. Some regions have strong significant associations, such as Sub-Saharan Africa, Asia, and Americas, and other were non-significant association, such as Europe, Middle East, and North Africa. The results suggest that there were negative associations between GNP, household income, protein consumption, and child malnutrition and mortality in all world regions except Europe and Central Asia regions.

Child↗

[Malnutrition mortality in the elderly, southeast Brazil, 1980-1997].

OBJECTIVE: To assess the frequency of nutritional disturbances as cause of death in elderly. METHODS: Female and male subjects aged 60 years and more were selected from municipalities of the southeastern region between 1980 and 1997. Data was collected from death certificates provided by the Death Data System (1980-1998) and the population size was estimated using data provided by the Center for Regional Development and Planning (Cedeplar). Death categorization was performed using the ICD-9 (260 to 263.9) for the period 1980 to 1995 and ICD-10 (E40 to E46) for recent years. RESULTS: In Brazil, between 1980 and 1997, there were 36,955 deaths associated to malnutrition among elderly. The southeast region concentrates the largest number of deaths, 23,968 (64.9%). In the state of São Paulo, there were 11,067 deaths caused by malnutrition in elderly and in the state of Rio de Janeiro, 7,763. These two regions are responsible for the highest values observed for the region. There are higher death proportions and mortality rates among subjects aged 70 years and more than in subjects of any sex of the age group 60 to 69 years. CONCLUSION: The preliminary results of the study raise some issues as follows: the role of malnutrition as an associated cause of death; the trend of increased number of deaths for malnutrition among elderly people; distinctive death characteristics among states in the same geographic region. Statistical analysis such as time series analysis might explain better these issues. There is a need to further study the role of malnutrition among elderly aged 60 years and more to establish adequate intervention programs.

Age Distribution↗

[Mother's ability of childcare and children malnutrition].

OBJECTIVES: To identify and measure the risk of malnutrition associated to determining indicators of mother's ability of childcare: familial structure, education level, work, maternal physical and mental health. METHODS: A case-control study was performed. Cases (101 children whose weight/age was below 5th percentile) and controls (200 children whose weight/age was above 25th percentile) were selected using anthropometric surveys during three vaccination campaigns in 1996 and 1997. Data was collected by interviewing the children's mothers at home. To detect the net effect of each factor studied, multivariate hierarchical analyses were carried out. The factors investigated and possible control variables were grouped in blocks, arranged according to order they affected the child's nutritional status. In order to identify the control variables a p<0.20 (univariate analyses) was assumed and to identify associations between a given factor and malnutrition a p<0.05 was assumed. RESULTS: Malnutrition risk factors identified are: (a) adverse familial structure, indicated by single parenting (OR=2.2; 95%CI, 1.1-4.5); (b) hospitalization of the mother during pregnancy (OR=3.5; 95%CI, 1.6-7.7); (c) mother's poor mental health, determined by the presence of 3 to 4 symptoms of depression included in the SRQ-20 (OR=3.1; 95%CI, 0.9-10.3); and (d) family stress factors, suggestive signs of alcoholism in at least one family member (OR=2.1; 95%CI, 1.2-3.9). In addition to these factors, child's age at the time the mother resumed/started working was also independently associated to malnutrition. However, it produced mixed effects: for children aged 4 to 12 months, the mothers' resuming work resulted in a protection factor whereas their resuming later tended to increase the risk of malnutrition. CONCLUSIONS: It was evidenced that the factors that define the mother's ability of child care affect the child's nutritional status.

Child Care↗

Clonidine treatment during gestation prevents functional deficits induced by prenatal malnutrition in the rat visual cortex.

It has been shown that prenatal malnutrition results at birth in increased concentration of noradrenaline (NA) in the brain. Besides, it is known that NA is an important regulator of normal regressive processes occurring during synaptogenesis such as cell death, axonal pruning and synaptic elimination. The present study was designed to investigate (i) whether prenatal malnutrition enhances the NA release in the visual cortex and (ii) whether or not chronic administration of clonidine during gestation may prevent long-term deleterious effects of fetal malnutrition on functional properties of interhemispheric connections of the visual cortex and on the interhemispheric asymmetry of visual evoked responses. Prenatal malnutrition was induced by restricting food consumption to pregnant rats from Day 8 postconception to parturition. Results show that at birth, prenatally malnourished rats had higher NA release than normals. At 45-50 days of age, the malnourished group exhibited (a) reduced peak-to-peak amplitude and diminished extent of the projecting field of transcallosal evoked responses, and (b) abolished interhemispheric asymmetry of visual evoked responses. Clonidine administration to malnourished mothers from Day 14 postconception to parturition (10 g/kg/day s.c.), prevented in the offspring disorders induced by prenatal malnutrition on cortical NA release, on interhemispheric connectivity of visual areas and on interhemispheric bioelectrical asymmetry, probably by restoring the normal trophic role of NA during synaptogenesis. Results are discussed in relationship to normal regressive events occurring during early brain development.

Animals↗

HIV infection and malnutrition change the clinical and radiological features of pulmonary tuberculosis.

Patients with HIV infection have atypical clinical features of pulmonary tuberculosis; however, our knowledge on how malnutrition affects the clinical presentation is limited. We studied the influence of malnutrition and HIV infection on the clinical and radiological features of pulmonary tuberculosis (TB). We studied 239 consecutive acid fast bacillus-positive adult patients. Patients were investigated by clinical, radiological, anthropometric and laboratory methods. 78% of the patients were malnourished (BMI < 18.5) and 43% were severely malnourished (BMI < 16). 20% were HIV-positive. HIV-positive TB had significantly more oral candidiasis (OR = 3.72), diarrhoea (OR = 2.71), generalized lymphadenopathy (OR = 2.63), skin disorders (OR = 2.27), neuropsychiatric illness (OR = 2.44), hilar lymphadenopathy (OR = 2.07), but less cavitation (OR = 0.64) and upper lung lobe involvement (OR = 0.70). HIV-negative and severe malnourished patients presented more often with dyspnoea (OR = 1.44), diarrhoea (OR = 1.64), night sweat (OR = 1.83), and less with haemoptysis (OR = 0.58) and cavitation (OR = 0.64). The size of Mantoux was associated with HIV infection and malnutrition. In a logistic regression analysis both HIV status and malnutrition were associated with atypical presentation of pulmonary tuberculosis. Malnutrition and HIV infection both contribute for atypical presentation of pulmonary tuberculosis. The risk of such atypical presentation is particularly high among the severely malnourished HIV-infected patients.

AIDS-Related Opportunistic Infections↗

Risk factors for the prevalence of malnutrition among urban children in Ghana.

A case-control study was completed at the Princess Marie Louise Hospital in Accra, Ghana, to identify risk factors for the prevalence of underweight and severe malnutrition in urban African children. A total of 170 children, aged 8 to 36 mo, with normally nutritional status (> or = 80% W/A of NCHS reference), underweight (moderate malnutrition) (60-80% W/A), or severe malnutrition (< 80% W/A and presence of edema, or < 60% of W/A) were recruited at the clinical ward and at the public health service section of the hospital. Anthropometric measurements and physical examinations were completed, and the guardians were interviewed about their children's health status, birth weight, child care, and household conditions. The severely malnourished children were more likely to have young mothers (p < 0.05) and low weight at birth (p < 0.05). The underweight children were also observed to have low birth weight (p < 0.05). The severely malnourished group showed the tendencies of less feeding frequency (p < 0.01), less access to breast-feeding (p < 0.01), and less support by both parents (p < 0.05). Moreover, the parents of the severely malnourished children had lower educational levels and lower income jobs, compared with those of the normal children (mother's education, p < 0.001; father's education, p < 0.001; mother's occupation, p < 0.05; father's occupation, p < 0.001). No significant differences in most variables existed between the normal and underweight groups. Multivariable analysis resulted in the conclusion that the Z-score of weight-for-age, birth weight, and mother's educational level were highly associated with one another. We conclude that low birth weight is one of the important risk factors for the prevalence of underweight and severe malnutrition and that the lack of a mother's education is also a risk factor for the prevalence of severe malnutrition in the urban children in Ghana.

Adolescent↗