Stunting is a significant public health problem in low- and middle-income countries. This study assessed the prevalence of stunting and associated risk factors of stunting among preschool and school-going children in flood-affected areas of Pakistan. A cross-sectional study was conducted by visiting 656 households through multi-stage sampling. Respondent’s anthropometric measurements, socio-demographic information and sanitation facilities were explored. A logistic regression model was used to determine determinants of stunting, controlling for all possible confounders. The overall prevalence of stunting in children was 40.5%, among children 36.1% boys and 46.3% of girls were stunted. The prevalence of stunting in under-five children was 50.7%. Female children (OR=1.35, 95% CI:0.94-2.0), children aged 13-24 months (OR=6.5, 95% CI: 3.0-13.9), mothers aged 15-24 years (OR=4.4, 95% CI: 2.6-7.2), joint family (OR=2.1, 95% CI: 1.4-3.0) did not have access to improved drinking water (OR=3.3, 95% CI: 1.9-5.9), and the toilet facility (OR=2.8, 95% CI, 1.9-4.3), while the children from district Nowshera (OR=1.7, 95% CI: 0.9-3.2) were significantly (P<0.05) associated in univariate analysis. The regression model revealed that child age, maternal age, family type, quality of water, and toilet facility, were the significant (P<0.05) factors contributing to child stunting in the flood-hit areas. Identification of key factors might be helpful for policymakers in designing comprehensive community-based programs for the reduction of stunting in flood-affected areas. In disasters such as flood, the detrimental consequences of the stunting problem could be even more on children. Evidence-based education and care must be provided to the families in the flood-affected regions to reduce the stunting problem. The determinants of stunting should be targeted by making comprehensive policies regarding proper nutrition, livelihood, clean water, and sanitation facilities in flood-hit regions.

: There is minimal literature regarding micronutrient deficiencies in flood-affected regions. In our study, we aimed to find the prevalence of micronutrient deficiencies (vitamin A, calcium, zinc, iron, and iodine) among preschool and school-age children in flood-hit areas of Khyber Pakhtunkhwa, Pakistan. In this cross-sectional study, a multi-stage sampling technique was used for the selection of 656 households. Serum micronutrient status was detected in the targeted population in the affected districts. The least significant difference test was used with analysis of variance to determine significant differences in nutrient contents in different areas. Of the total respondents, 90.8% of the children were calcium deficient, 88.3% were zinc deficient, 26.7% were iron deficient, 53.5% were vitamin A deficient, and 39.5% were had an iodine deficiency in flood-affected areas. A significant difference (P < 0.05) was found in different age groups of children for zinc (5.7–42.63 μg/dL) and urinary iodine (69.6–85.4 μg/L). The 10- to 12-year-old age group had a lower serum zinc concentration (5.7 μg/dL), whereas the 1- to 3-year-old age group had a lower urinary iodine concentration (69.6 μg/L) than other groups. There was no significant difference (P > 0.05) between male and female children and various age groups for calcium and iron status. Vitamin A levels were significantly (P < 0.05) different among different age groups (high in age group 4–6 years) and districts. Vitamin A concentration was lower in the Nowshera District, whereas serum iron and zinc were lower in the Dera Ismail Khan District. All the important micronutrients in the population of children were deficient in the flood-affected areas of Pakistan. Therefore, policymakers should implement potential prevention strategies, such as food security, school health nutrition, food fortification, nutrition in the first 1,000 golden days, nutrition knowledge, and awareness of the local population, to reduce the burden of micronutrients deficiencies in flood-affected areas.

Aims. Floods badly impact the food and nutrition security in developing countries. The role of the government and the impact of floods on the underweight status of children in the affected areas is not clear. We aimed to find the determinants of underweight in flood‐affected areas of Khyber Pakhtunkhwa, Pakistan. Methods. We used a multistage sampling technique and selected 656 households during in the flood‐affected areas of Pakistan. Data were collected in the three most affected districts. A validated questionnaire was used to find socioeconomic and demographic information, hygiene, and sanitation information. We used logistic regression to find the determinants of underweight, controlling for confounders. Results. The prevalence of global malnutrition based on underweight was 25.2%. The prevalence of underweight was higher in young age mothers (40.6%), younger age children (71.4%), large family size (28.4%), joint family (27%), and no toilet facility (28.9%). District Nowshera was at high risk of underweight based undernutrition, followed by district Charsadda compared to children belonging to Dera Ismail Khan. The significant risk factor that causes underweight was child lower age (p < 0.01), young age of mothers (p < 0.01), children access to unimproved water sources (p < 0.01), and location (districts) due to environmental and constant flood consequences (p < 0.01). Conclusion. In conclusion, risk factors of underweight should be appropriately targeted in the flood‐hit areas of Pakistan. Governments should preallocate budgetary resources and enhance the emergency preparedness levels to facilitate the communities with flooding incidents and their aftermath in the shape of child underweight‐based malnutrition.

: Frequent floods can contribute to the spread of various diseases and complications, some of which may result in diarrhea, especially among children. The current study aimed to find the determinants of diarrhea among children aged 1–6 years in flood-affected areas in Khyber Pakhtunkhwa, Pakistan. A cross-sectional study was conducted in flood-affected districts. Data regarding sociodemographic information related to diarrhea and anthropometric data were collected through a validated questionnaire. Logistic regression was used to find the determinants of diarrhea. In the presence of diarrhea, the prevalences found of stunting, wasting, and being underweight were 75.2%, 76.5%, and 74.1%, respectively, which is higher than those in children without diarrhea (stunting, 24.8%; wasting, 23.5%; and being underweight, 25.9%). In bivariate regression, children aged 2–4 years (odds ratio [OR] = 1.65, P < 0.05), large family size (OR = 7.46, P < 0.01), low income (OR = 2.55, < 0.001), bathing in ponds (OR = 3.05, P < 0.05), drinking of untreated water (OR = 3, P < 0.05), flooding (OR = 1.8, P < 0.05), children living in mud houses (OR = 1.5, P < 0.05), and usage of utensils without lids (OR = 1.96, P < 0.001) were significantly associated with occurrence of diarrhea. In multivariate regression, the identified risk factors (P < 0.05) for diarrhea in flood-affected areas included illiterate mothers, flooding, large family size, households without livestock, poor water quality, untreated water, and lack of toilet facilities. In conclusion, addressing the determinants of diarrhea identified in this study is crucial for mitigating the impact of frequent floods on children in flood-affected areas. Moreover, the higher prevalence of malnutrition underscores the urgent need for comprehensive strategies and proper water, sanitation, and hygiene programs to reduce the occurrence and determinants of diarrhea.

Infections with soil-transmitted helminths (STHs) are one of the most common neglected tropical diseases globally and drive poor childhood development, which is a cycle within low and middle-income countries (LMICs). The infection is caused by Ascaris lumbricoides , Trichuris trichiura , and the hookworms ( Necator americanus, Ancylostoma duodenale ) and disproportionately affects school-age children and adolescents in the impoverished areas where water, sanitation, and hygiene are inadequate. This review is an integration to understand the association between STH infection and 4 key domains of childhood development: nutrition status, anemia, cognitive function and effect of school-based deworming, a public health intervention. At the global level, 37.16% of school-age children in LMICs are infected with STH, and the highest prevalence can be found in the Western Pacific (50.41%) and in Africa (37.10%). Chronic STH infection causes damage to nutritional status by inducing intestinal blood loss, malabsorption of nutrients and anorexia, directly contributing to stunting and underweight. In addition, hookworm infection worsens iron deficiency anemia, which is closely associated with cognitive development problems and lower academic attainment. Preventive chemotherapy, which is deworming for STH at school, is the main method for controlling STH at the global level and the World Health Organization recommends that children be dewormed annually or biannually depending on endemicity. Recent programmatic evaluations indicate that school-based deworming can decrease STH prevalence, improve nutritional markers, and can have long-term cognitive and economic impacts. Despite this, there are still barriers to be addressed: suboptimal deworming coverage in many areas, high risk of reinfection following deworming, low efficacy against Trichuris and Strongyloides , and a limited number of large-scale RCTs that provide evidence of benefit with regards to hemoglobin concentrations and cognitive function. The current review summarizes epidemiological data from the different regions, explains how STH is related to poor developmental outcomes, and summarizes the effectiveness of school-based deworming. It also identifies key areas of uncertainty that require research such as long-term cohort studies, identifiable and standardized integrated deworming protocols, and scalable protocols to help ensure the sustainability of deworming benefits.

Dengue fever is a significant mosquito-borne viral disease in tropical and subtropical areas that causes a significant burden to public health systems and the affected communities. There is no definite antiviral treatment that can be used routinely in clinical practice, though there is growing interest in natural management, especially in endemic countries where home-based care, traditional medicine, and plant-derived adjuncts are widely used. The objective of this review is to critically evaluate evidence for natural and supportive management strategies in dengue fever, including oral hydration, nutritional support, rest, non-pharmacological symptom relief, and selected herbal interventions. A focused narrative review of clinical, preclinical, systematic-review, and guideline-based literature was conducted. Evidence supports oral hydration as the most established supportive measure in uncomplicated dengue, while nutritional support and rest may aid recovery. Carica papaya leaf extract may improve platelet counts, but this has not consistently translated into better clinical outcomes such as reduced bleeding, shock, hospitalization, or mortality. Evidence for other ethnomedicinal plants remains limited and largely preclinical. Overall, natural approaches may be useful only as adjuncts to standard supportive care and should not replace clinical monitoring or timely referral. Further well-designed trials are needed to clarify efficacy, safety, dosing, and standardization.