Modeling the effects of maternal nutritional status and socioeconomic variables on the anthropometric and psychological indicators of Kenyan infants from age 0-6 months

Breast Milk Micronutrients and Infant Neurodevelopmental Outcomes: A Systematic Review

Micronutrients are fundamental for healthy brain development and deficiencies during early development can have a severe and lasting impact on cognitive outcomes. Evidence indicates that undernourished lactating individuals may produce breast milk containing lower concentrations of certain vitamins and minerals. Exclusively breastfed infants born to mothers deficient in micronutrients may therefore be at risk of micronutrient deficiencies, with potential implications for neurodevelopment. This systematic review aims to consider current knowledge on the effects of breast milk micronutrients on the developmental outcomes of infants. The databases Medline, Global Health, PsychInfo, Open Grey, and the Web of Science were searched for papers published before February 2021. Studies were included if they measured micronutrients in breast milk and their association with the neurodevelopmental outcomes of exclusively breastfed infants. Also, randomised control trials investigating neurocognitive outcomes following maternal supplementation during lactation were sought. From 5477 initial results, three observational studies were eligible for inclusion. These investigated associations between breast milk levels of vitamin B6, carotenoids, or selenium and infant development. Results presented suggest that pyroxidal, β-carotene, and lycopene are associated with infant neurodevelopmental outcomes. Limited eligible literature and heterogeneity between included papers prevented quantitative synthesis. Insufficient evidence was identified, precluding any conclusions on the relationship between breast milk micronutrients and infant developmental outcomes. Further, the evidence available was limited by a high risk of bias. This highlights the need for further research in this area to understand the long-term influence of micronutrients in breast milk, the role of other breast milk micronutrients in infant neurodevelopmental outcomes, and the impact of possible lactational interventions.

Associations between maternal BMI, breastfeeding practices and infant anthropometric status in Colombia; secondary analysis of ENSIN 2010

BACKGROUND

Maternal malnutrition and infant feeding mode impact short and long term infant and child morbidity and mortality. The period of lactation may provide an opportunity to modulate the risk of disease later in life. Our aim was to estimate the effect of maternal body mass index (BMI) and infant feeding mode, particularly breastfeeding practices, on the anthropometric status of children under 2 years in Colombia.

METHODS

A secondary analysis was performed using the data from ENSIN 2010. Term infants under 2y, singleton, with a mother older than 18y, were included in the analysis. Outcomes were wasting (WLZ < -2SD), overweight (WLZ > +2SD) and stunting (LAZ < -2SD). Predictors were infant feeding (exclusive and predominant BF constructed from 24-h recall, age at introduction of liquids, semisolids and solids) and maternal BMI. Socioeconomic variables, maternal education and age, conditions during pregnancy and birth weight were analyzed as covariates.

RESULTS

Mothers of overweight infants had higher BMI (Mean dif = 1.47 kg/m²; 95% CI = 2.1, 0.8) than those with normal weight infants. Stunting and wasting were not predicted by maternal anthropometry or infant feeding mode. Fewer maternal years of education were associated with wasting (OR = 0.90; 95% CI = 0.86, 0.97; p = 0.003) and stunting (OR = 0.92; 95% CI = 0.89, 0.94; p < 0.0001), while more maternal years of education were associated with overweight (OR = 1.06; 95% CI = 1.02, 1.01; p = 0.001); higher birth weight was associated with overweight (OR = 1.001; 95% CI = 1.00, 1.001; p < 0.0001) and lower birth was associated with stunting (OR = 0.99; 95% CI = 0.89; p < 0.0001) in the final regression model.

CONCLUSIONS

Maternal BMI is a modifiable target for public health policy to promote healthy infant growth. Infant nutritional status is affected by direct and indirect factors that need to be addressed in further studies.

Climate change, demographic pressures and global sustainability

This article emphasizes the need for broader approaches for formulating policies for mitigating the effects of climate change especially in the contexts of agricultural decisions, and population health and migration. Constraints imposed by rapid population growth in developing countries for achievement of Sustainable Development Goals are discussed and evidence is presented on "unwanted" fertility from India. Second, comparisons are made for India during 2002-2016 for average well depths in 495 districts and terrestrial water storage anomalies assessed via GRACE satellites for 274 1° × 1° grids using estimated parameters from dynamic random effects models. Lastly, migration patterns especially of the highly educated from 39 sending countries to OECD countries during 2000-2010 are analyzed using dynamic random effects models and total fertility rates were significantly associated with higher migration rates for the highly educated. Implications of the empirical evidence for enhancing global sustainability are discussed.

Analyses of Essential Elements and Heavy Metals by Using ICP-MS in Maternal Breast Milk from Şanlıurfa, Turkey

Maternal breast milk is a unique biological matrix that contains essential micronutrients. Potentially heavy metals may also affect infants' health and growth through maternal breast milk. The purpose of this study was to determine and compare the essential elements and heavy metals of maternal breast milk of nursery mothers residing in Şanlıurfa province, Turkey. Maternal breast milk concentrations of sodium, magnesium, phosphorus, potassium, calcium, iron, copper, zinc, arsenic, and lead were analyzed in a random sample of the first time in urban and suburban nursery Turkish mothers (n: 42). Eight essential elements and two heavy metals were analyzed using ICP-MS after microwave digestion. For bivariate analyses of variables, we use nonparametric Spearman's correlation coefficient test. The mean concentrations of essential elements and heavy metals were as follows: sodium 330 ± 417 mg/L, magnesium 32.6 ± 15.5 mg/L, phosphorus 156 ± 46.2 mg/L, potassium 488 ± 146 mg/L, calcium 193 ± 53.2 mg/L, iron 1.65 ± 1.43 mg/L, copper 0.54 ± 0.46 mg/L, zinc 2.89 ± 3.23 mg/L, arsenic < 1 μg/L, and lead < 1 μg/L. Concentrations of heavy metals in maternal breast milk may have the important implication that it is not affected by environmental pollution in this province. This study provides reliable information about maternal breast milk concentrations of nursery mothers residing in Şanlıurfa, Turkey, and also compares the relations between essential elements and socioeconomic conditions, residing areas, and using copper equipment for food preparation of which some have not previously been reported.

Identifying maternal and infant factors associated with newborn size in rural Bangladesh by partial least squares (PLS) regression analysis

Birth weight, length and circumferences of the head, chest and arm are key measures of newborn size and health in developing countries. We assessed maternal socio-demographic factors associated with multiple measures of newborn size in a large rural population in Bangladesh using partial least squares (PLS) regression method. PLS regression, combining features from principal component analysis and multiple linear regression, is a multivariate technique with an ability to handle multicollinearity while simultaneously handling multiple dependent variables. We analyzed maternal and infant data from singletons (n = 14,506) born during a double-masked, cluster-randomized, placebo-controlled maternal vitamin A or β-carotene supplementation trial in rural northwest Bangladesh. PLS regression results identified numerous maternal factors (parity, age, early pregnancy MUAC, living standard index, years of education, number of antenatal care visits, preterm delivery and infant sex) significantly (p<0.001) associated with newborn size. Among them, preterm delivery had the largest negative influence on newborn size (Standardized β = -0.29 − -0.19; p<0.001). Scatter plots of the scores of first two PLS components also revealed an interaction between newborn sex and preterm delivery on birth size. PLS regression was found to be more parsimonious than both ordinary least squares regression and principal component regression. It also provided more stable estimates than the ordinary least squares regression and provided the effect measure of the covariates with greater accuracy as it accounts for the correlation among the covariates and outcomes. Therefore, PLS regression is recommended when either there are multiple outcome measurements in the same study, or the covariates are correlated, or both situations exist in a dataset.

Developmental performance of hospitalized severely acutely malnourished under-six children in low- income setting

Background

Retrospective studies show that severe acute malnutrition (SAM) affects child development. However, to what extent SAM affects children of different ages at its acute stage is not well documented. This study was aimed at comparing the developmental performance of severely acutely malnourished children under six with that of age and gender-matched non-malnourished healthy children.

Methods

The developmental performances of 310 children with SAM (male = 155, female = 155); mean age = 30.7 mo; SD = 15.2 mo) admitted to the nutritional rehabilitation unit (NRU) at Jimma University’s Hospital was compared with that of 310 age and gender-matched, non-malnourished healthy children (male = 155, female = 155; mean age = 29.6 mo; SD = 15.4 mo) living in Jimma Town in Ethiopia. Two culturally adapted tools were used: (1) the Denver II-Jimma, to assess the children’s performance on personal social (PS), fine motor (FM) language (LA), gross motor (GM) skills, and (2) the Ages and Stages Questionnaires: Social-Emotional (ASQ:SE), to assess social-emotional (SE) skills. Multivariable Poisson regression analysis was conducted to compare the developmental performance scores of SAM and non-malnourished children.

Results

For one-year-old children, SAM delays their developmental performance on GM, FM, PS and LA by 300%, 200%, 140% and 71.4% respectively. For three-years-old children, SAM delays their developmental performance on GM by 80%, on FM and LA by 50% each, and on PS by 28.6%. Of the skills assessed on Denver II-Jimma, GM is the most, and PS is the least affected. Younger SAM children are more affected than older ones on all the domains of development. The delay in FM, GM, LA and PS generally decreases with an increase in age. Social-emotional behavior problems seem to be most pronounced in the very young and older age ranges.

Conclusions

SAM has a differential age effect on the different dimensions of development in children under 6 years of age.

Electronic supplementary material

The online version of this article (10.1186/s12887-017-0950-5) contains supplementary material, which is available to authorized users.

Nutrition, Health, and Economic Development: Some Policy Priorities

Most developing countries face different resource and infrastructural constraints that limit their economic growth. Nutritional deficiencies, poor environmental conditions, and inadequate educational infrastructure hamper children's learning, which is critical for the future supply of skilled labor and hence for economic development. There is a need to assign priorities for resource allocation among nutritional, health-care, and educational policies. This paper draws implications from several studies using data from less developed countries within a multidisciplinary framework. It concludes that iron supplementation of pregnant women and access to family-planning services are likely to enhance maternal and infant health. Where iodine deficiency is endemic, iodized salt is important for preventing cognitive damage to the fetus. Higher intakes of protein and micronutrients such as iron are important for children's physical growth, morbidity, and learning. Improved sanitation and vaccines against infections will prevent loss of vital nutrients. Investments in educational infrastructure, including adult literacy programs, are beneficial for children's cognitive development. Nutrition and health policies based on long-term considerations will lead to a well-trained labor force enabling non-resource-rich developing countries to escape from poverty traps.

Adaptation and standardization of a Western tool for assessing child development in non-Western low-income context

Background

Due to lack of culturally relevant assessment tools, little is known about children’s developmental profiles in low income settings such as Ethiopia. The objective of this study was to adapt and standardize the Denver II for assessing child development in Jimma Zone, South West Ethiopia.

Methods

Culture-specific test items in Denver II were modified. After translation into two local languages, all test items were piloted and fine-tuned. Using 1597 healthy children 4 days to 70.6 months of age, the 25, 50, 75 and 90 % passing ages were determined for each test item as milestones. Milestones attainment on the adapted version and the Denver II were compared on the 90 % passing age. Reliability of the adapted tool was examined.

Results

A total of 36 (28.8 %) test items, mostly from personal social domain, were adapted. Milestones attainment ages on the two versions differed significantly on 42 (34 %) test items. The adapted tool has an excellent inter-rater on 123 (98 %) items and substantial to excellent test-retest reliability on 119 (91 %) items.

Conclusions

A Western developmental assessment tool can be adapted reliably for use in low-income settings. Age differences in attaining milestones indicate a correct estimation of child development requires a population-specific standard.

An epidemiological study of urban and rural children in Pakistan: examining the relationship between delayed psychomotor development, low birth weight and postnatal growth failure

BACKGROUND

Low birth weight is known to be associated with postnatal growth failure. It is not yet established that both conditions are determinants of psychomotor development. The study investigated whether or not low birth weight leads to delayed psychomotor development of a child, and whether it can be mitigated by adequate postnatal growth.

METHODS

A cross-sectional study was conducted in 2002 in 15 rural and 11 urban communities of Sindh province, Pakistan. Assessment of 1234 children less than 3 years of age included Bayley's Scale of Infant Development II, socioeconomic questionnaire and anthropometry; WHO standards were used to calculate z-scores of height-for-age, weight-for-height and weight-for-age. The underlying study hypotheses were tested through multiple regression modelling.

RESULTS

Out of 1219 children, 283 (23.2%) had delayed psychomotor development and 639 (52.4%) were undernourished according to the composite index of anthropometric failure. Strong negative associations with the psychomotor development index were detected between stunting and being underweight, with a larger magnitude of effect for stunting (p<0.001). The strong relationship persisted even when the analysis was restricted to non-malnourished children. The psychomotor index increased by 2.07 points with every unit increase in height-for-age z-score.

CONCLUSIONS

The relationship between low birth weight and psychomotor development appears to be mediated largely by postnatal growth and nutritional status. This association suggests that among undernourished children there is significant likelihood of a group that is developmentally delayed. It is important to emphasize developmental needs in programmes that target underprivileged children.

Canonical correlation analysis of infant's size at birth and maternal factors: a study in rural northwest Bangladesh

This analysis was conducted to explore the association between 5 birth size measurements (weight, length and head, chest and mid-upper arm [MUAC] circumferences) as dependent variables and 10 maternal factors as independent variables using canonical correlation analysis (CCA). CCA considers simultaneously sets of dependent and independent variables and, thus, generates a substantially reduced type 1 error. Data were from women delivering a singleton live birth (n = 14506) while participating in a double-masked, cluster-randomized, placebo-controlled maternal vitamin A or β-carotene supplementation trial in rural Bangladesh. The first canonical correlation was 0.42 (P<0.001), demonstrating a moderate positive correlation mainly between the 5 birth size measurements and 5 maternal factors (preterm delivery, early pregnancy MUAC, infant sex, age and parity). A significant interaction between infant sex and preterm delivery on birth size was also revealed from the score plot. Thirteen percent of birth size variability was explained by the composite score of the maternal factors (Redundancy, R_Y/X = 0.131). Given an ability to accommodate numerous relationships and reduce complexities of multiple comparisons, CCA identified the 5 maternal variables able to predict birth size in this rural Bangladesh setting. CCA may offer an efficient, practical and inclusive approach to assessing the association between two sets of variables, addressing the innate complexity of interactions.

Modeling physical growth using mixed effects models

This article demonstrates the use of mixed effects models for characterizing individual and sample average growth curves based on serial anthropometric data. These models are advancement over conventional general linear regression because they effectively handle the hierarchical nature of serial growth data. Using body weight data on 70 infants in the Born in Bradford study, we demonstrate how a mixed effects model provides a better fit than a conventional regression model. Further, we demonstrate how mixed effects models can be used to explore the influence of environmental factors on the sample average growth curve. Analyzing data from 183 infant boys (aged 3-15 months) from rural South India, we show how maternal education shapes infant growth patterns as early as within the first 6 months of life. The presented analyses highlight the utility of mixed effects models for analyzing serial growth data because they allow researchers to simultaneously predict individual curves, estimate sample average curves, and investigate the effects of environmental exposure variables.

Association of cord blood levels of lead, arsenic, and zinc with neurodevelopmental indicators in newborns: a birth cohort study in Chitwan Valley, Nepal

In this study, we aimed to investigate the association between in utero toxic (lead [Pb] and arsenic [As]) and essential element (zinc [Zn]) levels and neurodevelopmental indicators after birth in Chitwan Valley, Nepal. We conducted a hospital-based birth cohort study with 100 pregnant women in Chitwan, Nepal. We measured Pb, As, and Zn concentrations in cord blood. We assessed 100 infants at 1 day after birth, using the Brazelton neonatal behavioral assessment scale, third edition (NBAS III). Multivariate regression was performed to adjust for mother's age, parity, educational level, and body mass index (BMI); family income; and newborn's birth weight, gestational age, and age in hours at the time of NBAS III assessment. Among the 7 clusters of NBAS III, the motor cluster score was inversely associated with the cord blood levels of Pb (coefficient=-2.15, at 95% confidence interval [CI]=-4.27 to -0.03). The cord blood levels of As were inversely associated with the state regulation cluster score (coefficient=-6.71, at 95% CI=-12.17 to -1.24). The cord blood levels of Zn were not associated with NBAS III scores. The cord blood levels of Pb and As, but not Zn, showed significant inverse association with the neurodevelopment of newborns. These results suggest that high levels of Pb or As exposure during the prenatal period may induce retardation during in utero neurodevelopment.

Motor development of Japanese twins in childhood as reported by mothers

OBJECTIVE

Twins tend to lag behind singletons in their motor development, though the causes of this appear to be complicated and are not yet fully understood. The present study was performed to clarify the factors associated with the motor development of twins.

METHODS

The twins in the first group consisted of school applicants, including 1131 twin pairs, and the second group consisted of children of members of several maternal associations, and included 951 pairs. All data were gathered by questionnaire survey, and six gross-motor development milestones were analyzed in individuals or pairs.

RESULTS

Relative to general population norms in Japan, twins tended to be delayed in reaching several motor development milestones. Stepwise regression analysis showed that of all the variables measured, gestational age was the most influential on all six milestones. Birthweight was also influential on most milestones. Other factors affecting motor development milestones were parity for 'sitting without support,' 'pulling up to a standing position,' and 'walking without support,' and zygosity for 'walking without support.' In these cases, longer gestational age, heavier birthweighf, primiparity, and dizygosity showed a tendency toward earlier attainment of development. Motor development within pairs was more similar in monozygotic pairs compared with dizygotic pairs regarding each item, suggesting genetic contributions.

CONCLUSION

The results of the present study showed specific and nonspecific factors that affect motor development of twins. These findings should prove useful in understanding the motor development of twin children and help clinicians to refine maternal and child health care for multiple-birth children.

Motor development of triplets: a Japanese prospective cohort study

We analyzed whether motor development in early life is different between singletons and triplets in Japan. The motor development was reported by mothers by postal questionnaire for 1,121 triplet children and in regular health check-ups for 13,906 singleton children. Children who were suspected of having neurological abnormality or disability were excluded from the analysis. The ages of milestone achievements were significantly higher in triplets for each outcome compared to singletons. Further, after adjustment for gestational age, birthweight, and birth length, the differences were significant for maintaining head, sitting alone and standing holding on. In children with birthweight of 2 kg or more, the ages of milestone achievements were significantly higher in triplets for each outcome compared to singletons, except walking holding on. Moreover, after adjustment for the confounding factors, the differences were significant for sitting alone and walking independently. On the contrary, singletons attained motor development facilitating crawling, walking holding on, and walking independently slower than triplets among those children with birthweight of 2 kg or less after adjustment for gestational age. In conclusion, triplets are overall at higher risk for the delay of gross motor milestones as compared to singletons independently of birth-related factors. In contrast, among children with a birthweight of less than 2 kg, singletons showed slower motor development than triplets after adjusting for gestational age. There is an obvious need to apply developmental standards that consider at least both multiple birth status (singleton, twin or triplet) and birthweight.

Breast milk macro- and micronutrient composition in lactating mothers from suburban and urban Shanghai

AIM

The objective of this study was to measure and compare the macro- and micronutrient composition of breast milk in urban and suburban lactating mothers living in Shanghai, China.

METHODS

Primiparous women residing in three urban regions (n= 30/region) and a suburban area of Shanghai (n= 30) were recruited. Breast milk samples were collected 8-10 days postpartum and dietary intake was determined.

RESULTS

Women from the suburban area were of lower socio-economic status as indicated by levels of education, occupation and income. With the exception of carbohydrates, mothers in all urban areas had significantly higher macronutrient intake levels than suburban area mothers. Sodium, potassium, phosphorus and calcium intake levels were significantly lower in suburban compared to all urban women. Concentrations of protein, lipids, copper, sodium, potassium, chlorine, zinc, manganese, phosphorus and iron were all significantly lower in milk obtained from suburban compared to urban women. Concentrations of carbohydrates in milk from suburban women were significantly higher than concentrations in than two of the three urban groups. Offspring from women in Chongming county gained significantly less weight between birth and 6 months than did offspring born to women from the three other counties.

CONCLUSIONS

In summary, there were significant differences in macro- and micronutrient intake levels and breast milk concentrations between women from urban and suburban Shanghai. These differences may have important implications for the growth and development of breastfed infants.

Changing trends in mastitis

The global dairy industry, the predominant pathogens causing mastitis, our understanding of mastitis pathogens and the host response to intramammary infection are changing rapidly. This paper aims to discuss changes in each of these aspects. Globalisation, energy demands, human population growth and climate change all affect the dairy industry. In many western countries, control programs for contagious mastitis have been in place for decades, resulting in a decrease in occurrence of Streptococcus agalactiae and Staphylococcus aureus mastitis and an increase in the relative impact of Streptococcus uberis and Escherichia coli mastitis. In some countries, Klebsiella spp. or Streptococcus dysgalactiae are appearing as important causes of mastitis. Differences between countries in legislation, veterinary and laboratory services and farmers' management practices affect the distribution and impact of mastitis pathogens. For pathogens that have traditionally been categorised as contagious, strain adaptation to human and bovine hosts has been recognised. For pathogens that are often categorised as environmental, strains causing transient and chronic infections are distinguished. The genetic basis underlying host adaptation and mechanisms of infection is being unravelled. Genomic information on pathogens and their hosts and improved knowledge of the host's innate and acquired immune responses to intramammary infections provide opportunities to expand our understanding of bovine mastitis. These developments will undoubtedly contribute to novel approaches to mastitis diagnostics and control.

Comparison of motor development between twins and singletons in Japan: a population-based study

This study was performed using population-based data to analyze whether motor development in early life is different between singletons and twins in Japan. For better comparison and investigation, we divided the 2 groups into a group with a birthweight of 2.5 kg or greater (subgroup A) and a group with a birthweight of less than 2.5 kg (subgroup B), respectively. We analyzed the database of medical check-ups for children aged 3 years between April 2001 and July 2004. They received medical checkups at 4 months, 1.5, and 3 years of age. Children who were suspected of having neurological abnormality or disability were referred to specialists and excluded from the database. The data of 14,132 children were analyzed. Among these, 13,040 (92.3%) children were singletons in subgroup A, 75 (0.5%) were twins in subgroup A, 866 (6.1%) were singletons in subgroup B and 151 (1.1%) were twins in subgroup B. The mean age at achieving milestones was slower in twins of subgroup A for each developmental outcome than singletons of subgroup A, and the difference between twins and singletons was significant after adjustment for rolling over. On the contrary, after adjusting for a confounding factor (gestational age), singletons of subgroup B attained motor development facilitating walking independently slower than twins of subgroup B. There were different tendencies in the results regarding the motor development of subjects of subgroup A and that of subjects of subgroup B.

Developmental potential in the first 5 years for children in developing countries

Many children younger than 5 years in developing countries are exposed to multiple risks, including poverty, malnutrition, poor health, and unstimulating home environments, which detrimentally affect their cognitive, motor, and social-emotional development. There are few national statistics on the development of young children in developing countries. We therefore identified two factors with available worldwide data--the prevalence of early childhood stunting and the number of people living in absolute poverty--to use as indicators of poor development. We show that both indicators are closely associated with poor cognitive and educational performance in children and use them to estimate that over 200 million children under 5 years are not fulfilling their developmental potential. Most of these children live in south Asia and sub-Saharan Africa. These disadvantaged children are likely to do poorly in school and subsequently have low incomes, high fertility, and provide poor care for their children, thus contributing to the intergenerational transmission of poverty.

Neonatal behaviour characteristics and psychological problems at 6 years

AIM

To examine the predictive capacity of the Neonatal Behavioral Assessment Scale (NBAS) on psychological problems at the age of 6 y.

METHODS

Eighty full-term infants of optimal health were evaluated at 3 d and 4 wk of age with the NBAS and at 6 y with the Child Behavior Checklist (CBCL) and the Inattention-Overactivity with Aggression Conners Teacher's Rating Scale (IOWA).

RESULTS

The NBAS clusters' predictive value was different at 3 d and at 4 wk. Orientation at 3 d and habituation at 4 wk were the best predictors of psychological problems. At 3 d, lower orientation scores and higher motor and habituation scores predicted higher scores in externalizing problems. Externalizing problems were least influenced by background variables. Only in girls were internalizing problems associated with lower orientation scores. At 4 wk, lower habituation cluster scores predicted higher scores in internalizing problems.

CONCLUSION

These findings suggest that the NBAS could be useful for identifying neonates at risk of later psychological problems.

Do the Effects of Early Severe Deprivation on Cognition Persist Into Early Adolescence? Findings From the English and Romanian Adoptees Study

Cognitive outcomes at age 11 of 131 Romanian adoptees from institutions were compared with 50 U.K. adopted children. Key findings were of both continuity and change: (1) marked adverse effects persisted at age 11 for many of the children who were over 6 months on arrival; (2) there was some catch-up between ages 6 and 11 for the bottom 15%; (3) there was a decrease of 15 points for those over 6 months on arrival, but no differentiation within the 6-42-month range; (4) there was marked heterogeneity of outcome but this was not associated with the educational background of the adoptive families. The findings draw attention to the psychological as well as physical risks of institutional deprivation.

Non-adult dental age assessment: correspondence analysis and linear regression versus Bayesian predictions

This study focuses on the evaluation of factors influencing the quality (accuracy and reliability) of non-adult dental age assessment from radiographic stages of permanent teeth (excluding the third molar). We used four distinct cross-sectional samples of 1,528 healthy children: 3 of known geographic origin (Ivory Coast, Iran and France) and 1 additional sample of children whose grandparents originated from a different continent. Two different methods of calculations are compared: the correspondence analysis combined with linear regression (CAR) and Bayesian predictions (with no independence assumption). Our results indicate that the quality of age assessment does not seem to depend predominantly on the use of geographic-specific standards. In the case of Bayesian predictions, we observed a clear trend in favour of significantly higher accuracy and reliability levels when using non-geographic-specific standards. One of the main advantage of Bayesian predictions over maximum likelihood methods of estimation is an overall increase in accuracy with high levels of reliability on a fraction of the test sample and, importantly, across all age categories (contrary to methods based on regression analysis). Importantly, in the case of Bayesian non-adult predictions, and contrary to age estimation techniques based on regression, a better quality does not depend on age.

Public policies and the orphans of AIDS in Africa

International help to care for Africa's orphans is essential not only for their immediate welfare but also to protect the long term prosperity of these countries. A researcher in child health and former Ugandan government peace minister assess how to make the best use of resources

Dietary intakes and socioeconomic factors are associated with the hemoglobin concentration of Bangladeshi women

Iron deficiency anemia affects a large number of women in developing countries, especially during child-bearing years. The hemoglobin concentration is useful for identifying iron deficiency anemia. The main objectives of this study were, first, to extend algorithms for calculating bioavailable iron from mixed diets, taking into account the enhancers and inhibitors of iron absorption under alternative assumptions on body iron stores. Second, a comprehensive longitudinal model was developed for the proximate determinants of hemoglobin concentration that included the subjects' dietary intakes, nutritional status, morbidity and socioeconomic factors and the unobserved between-subject differences. The model for hemoglobin concentration was estimated using three repeated observations on 514 free living women in Bangladesh. Socioeconomic factors affecting the iron intake from meat, fish and poultry and from all animal sources were also modeled. The main results were that bioavailable iron, women's height and mid upper arm circumference and intake of iron tablets were significant predictors of hemoglobin concentration. Increases in household incomes were associated with higher intake of iron from meat, fish and poultry and from all animal sources. The algorithms for estimating bioavailable iron showed the importance of assumptions regarding body iron stores and underscored the need to develop suitable algorithms for subjects in developing countries.