Seasonality of underweight among infants 1–11 months old in Niger: an exploratory analysis of data from a cluster-randomised trial

Introduction Malnutrition is a risk factor for child mortality, with around 45% of deaths in children under 5 globally linked to malnutrition. Seasonality of malnutrition has important implications for the timing of child health programme activities, but evidence is mixed on the nature of such patte...

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Main Authors: Catherine E Oldenburg, Thomas M Lietman, Jeremy David Keenan, Elodie Lebas, Amza Abdou, Travis C Porco, Kieran S O’Brien, Ahmed Mamane Arzika, Ramatou Maliki, Alio Karamba Mankara, Benjamin Arnold, Brittany Peterson, Bawa Aichatou, Diallo Beidi, Nasser Galo, Nasser Harouna, Sani Mahamadou, Moustapha Abarchi, Almou Ibrahim, Ismael Sara
Format: Article
Language:English
Published: BMJ Publishing Group 2025-03-01
Series:BMJ Global Health
Online Access:https://gh.bmj.com/content/10/3/e017643.full
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author Catherine E Oldenburg
Thomas M Lietman
Jeremy David Keenan
Elodie Lebas
Amza Abdou
Travis C Porco
Kieran S O’Brien
Ahmed Mamane Arzika
Ramatou Maliki
Alio Karamba Mankara
Benjamin Arnold
Brittany Peterson
Bawa Aichatou
Diallo Beidi
Nasser Galo
Nasser Harouna
Sani Mahamadou
Moustapha Abarchi
Almou Ibrahim
Ismael Sara
author_facet Catherine E Oldenburg
Thomas M Lietman
Jeremy David Keenan
Elodie Lebas
Amza Abdou
Travis C Porco
Kieran S O’Brien
Ahmed Mamane Arzika
Ramatou Maliki
Alio Karamba Mankara
Benjamin Arnold
Brittany Peterson
Bawa Aichatou
Diallo Beidi
Nasser Galo
Nasser Harouna
Sani Mahamadou
Moustapha Abarchi
Almou Ibrahim
Ismael Sara
author_sort Catherine E Oldenburg
collection DOAJ
description Introduction Malnutrition is a risk factor for child mortality, with around 45% of deaths in children under 5 globally linked to malnutrition. Seasonality of malnutrition has important implications for the timing of child health programme activities, but evidence is mixed on the nature of such patterns. Moreover, the bulk of the existing evidence is focused on wasting and stunting in children 6–59 months, despite increasing evidence that younger children also face a high risk, and that underweight alone is an important predictor of mortality.Methods This study used data from the cluster-randomised AVENIR trial which compared the effect of biannual distribution of azithromycin vs placebo on mortality in children 1–59 months old in Niger. AVENIR included a biannual census conducted on a rolling basis over 2 years. A subset of 133 781 infants aged 1–11 months from 2904 communities were included in this study, and weight-for-age z-score (WAZ) was calculated at each census. The exposure for this analysis is the day of the year weight was captured. Harmonic regression was used to determine primary and secondary peaks and nadirs of WAZ over time.Results Overall, the primary peak of WAZ occurred in late February and the primary nadir occurred in mid-May, aligning with a seasonal temperature increase before the rainy season. A secondary peak in August and a secondary nadir in November were also seen, aligning with the postrainy season.Conclusion The seasonality of WAZ of infants 1–11 months in Niger may have implications for the timing of programmes aiming to decrease malnutrition.
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spelling doaj-art-03e34c57a4b94c04afd904079875d60a2025-08-20T02:10:50ZengBMJ Publishing GroupBMJ Global Health2059-79082025-03-0110310.1136/bmjgh-2024-017643Seasonality of underweight among infants 1–11 months old in Niger: an exploratory analysis of data from a cluster-randomised trialCatherine E Oldenburg0Thomas M Lietman1Jeremy David Keenan2Elodie Lebas3Amza Abdou4Travis C Porco5Kieran S O’Brien6Ahmed Mamane Arzika7Ramatou Maliki8Alio Karamba Mankara9Benjamin Arnold10Brittany Peterson11Bawa Aichatou12Diallo Beidi13Nasser Galo14Nasser Harouna15Sani Mahamadou16Moustapha Abarchi17Almou Ibrahim18Ismael Sara19Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California, USAFrancis I. Proctor Foundation, University of California San Francisco, San Francisco, California, USAFrancis I. Proctor Foundation, University of California San Francisco, San Francisco, California, USAFrancis I. Proctor Foundation, University of California San Francisco, San Francisco, California, USAProgramme Nationale de Santé Oculaire, Niamey, NigerFrancis I. Proctor Foundation, University of California San Francisco, San Francisco, California, USAFrancis I. Proctor Foundation, University of California San Francisco, San Francisco, California, USACentre de Recherche et Interventions en Sante Publique, Niamey, NigerCarter Center, Niamey, NigerCentre de Recherche et Interventions en Sante Publique, Niamey, NigerFrancis I. Proctor Foundation, University of California San Francisco, San Francisco, California, USAFrancis I. Proctor Foundation, University of California San Francisco, San Francisco, California, USACentre de Recherche et Interventions en Sante Publique, Niamey, NigerCentre de Recherche et Interventions en Sante Publique, Niamey, NigerCentre de Recherche et Interventions en Santé Publique, Birni N’Gaoure, NigerCentre de Recherche et Interventions en Sante Publique, Niamey, NigerCentre de Recherche et Interventions en Sante Publique, Niamey, NigerCentre de Recherche et Interventions en Sante Publique, Niamey, NigerProgramme Nationale de Santé Oculaire, Niamey, NigerCentre de Recherche et Interventions en Sante Publique, Niamey, NigerIntroduction Malnutrition is a risk factor for child mortality, with around 45% of deaths in children under 5 globally linked to malnutrition. Seasonality of malnutrition has important implications for the timing of child health programme activities, but evidence is mixed on the nature of such patterns. Moreover, the bulk of the existing evidence is focused on wasting and stunting in children 6–59 months, despite increasing evidence that younger children also face a high risk, and that underweight alone is an important predictor of mortality.Methods This study used data from the cluster-randomised AVENIR trial which compared the effect of biannual distribution of azithromycin vs placebo on mortality in children 1–59 months old in Niger. AVENIR included a biannual census conducted on a rolling basis over 2 years. A subset of 133 781 infants aged 1–11 months from 2904 communities were included in this study, and weight-for-age z-score (WAZ) was calculated at each census. The exposure for this analysis is the day of the year weight was captured. Harmonic regression was used to determine primary and secondary peaks and nadirs of WAZ over time.Results Overall, the primary peak of WAZ occurred in late February and the primary nadir occurred in mid-May, aligning with a seasonal temperature increase before the rainy season. A secondary peak in August and a secondary nadir in November were also seen, aligning with the postrainy season.Conclusion The seasonality of WAZ of infants 1–11 months in Niger may have implications for the timing of programmes aiming to decrease malnutrition.https://gh.bmj.com/content/10/3/e017643.full
spellingShingle Catherine E Oldenburg
Thomas M Lietman
Jeremy David Keenan
Elodie Lebas
Amza Abdou
Travis C Porco
Kieran S O’Brien
Ahmed Mamane Arzika
Ramatou Maliki
Alio Karamba Mankara
Benjamin Arnold
Brittany Peterson
Bawa Aichatou
Diallo Beidi
Nasser Galo
Nasser Harouna
Sani Mahamadou
Moustapha Abarchi
Almou Ibrahim
Ismael Sara
Seasonality of underweight among infants 1–11 months old in Niger: an exploratory analysis of data from a cluster-randomised trial
BMJ Global Health
title Seasonality of underweight among infants 1–11 months old in Niger: an exploratory analysis of data from a cluster-randomised trial
title_full Seasonality of underweight among infants 1–11 months old in Niger: an exploratory analysis of data from a cluster-randomised trial
title_fullStr Seasonality of underweight among infants 1–11 months old in Niger: an exploratory analysis of data from a cluster-randomised trial
title_full_unstemmed Seasonality of underweight among infants 1–11 months old in Niger: an exploratory analysis of data from a cluster-randomised trial
title_short Seasonality of underweight among infants 1–11 months old in Niger: an exploratory analysis of data from a cluster-randomised trial
title_sort seasonality of underweight among infants 1 11 months old in niger an exploratory analysis of data from a cluster randomised trial
url https://gh.bmj.com/content/10/3/e017643.full
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