# Childhood malnutrition, rickets, and anemia: a systematic review and meta-analysis on global prevalence, determinants, and public health implications

## TL;DR

This study reviews global childhood malnutrition, rickets, and anemia, finding that calcium, vitamin D, and targeted programs can reduce these issues.

## Contribution

The study provides a comprehensive meta-analysis of interventions for childhood malnutrition and rickets across multiple regions.

## Key findings

- Low calcium and vitamin D intake strongly associate with rickets (HR 1.51).
- Nutrition programs show protective effects against malnutrition (HR 0.80–0.85).
- Publication bias was detected in most study groups.

## Abstract

The world continues to face major health risks through childhood malnutrition and rickets and anemia which hinder the development of physical and mental and immune system functions. The public health system needs to study determinants of health problems and their effective solutions.

Our research team evaluated 96 studies, which include 153,694 participants from the Middle East and Africa and South and Southeast Asia and high-latitude regions through systematic review. The research team searched for studies in PubMed, Web of Science, Embase, Cochrane Library, and Google Scholar. The research team included observational studies and RCTs and cohort studies and individual participant data meta-analyses in their investigation. The study team evaluated research quality and bias risk through the use of Jadad scale and GRADE system and standard evaluation tools. The research team conducted random-effects meta-analyses to combine hazard ratio data while they used funnel plots and Egger’s test to check for publication bias.

The study found that Childhood Nutritional Rickets and Vitamin D/Calcium Status showed strong associations with low calcium and vitamin D intake (HR 1.51, 95% CI 1.26–1.82; I2 = 88%). The research team found that three programs which included Childhood Malnutrition Prevention and Micronutrient Supplementation and Maternal/Early Childhood Nutrition Programs showed protective effects (HR 0.80, 95% CI 0.77–0.84; I2 = 0%; HR 0.91, 95% CI 0.86–0.96; I2 = 22%; HR 0.85, 95% CI 0.78–0.93; I2 = 53%). The research team used long-term observational studies to demonstrate persistent malnutrition without significant pooled effects (HR 0.96, 95% CI 0.90–1.01; I2 = 10%). Publication bias was found in Groups 1–4 (Egger’s p < 0.001–0.001), publication bias was not found in Group 5 (p = 0.054).

The combination of calcium and vitamin D supplements with targeted micronutrients and integrated maternal-child programs effectively decreases rickets and malnutrition while it enhances global growth rate. The implementation of programs requires specific contextual understanding for achieving the best health results in children.