Planning of births and maternal, child health, and nutritional outcomes: recent evidence from India

A case-control study of the risk factors for fistula-in-ano in infants and toddlers

BACKGROUND

Limited data are available regarding the risk factors for fistula-in-ano (FIA) in infants and toddlers, potentially affecting their daily lives.

OBJECTIVES

The purpose of this study was to identify potential risk factors for FIA in infants and toddlers, in order to implement early preventive interventions, avoid disease progression, and develop therapeutic strategies.

DESIGN AND SETTINGS

A retrospective case-control study was conducted, comparing 41 infants and toddlers diagnosed with FIA with 41 healthy controls, between August 2020 and December 2021.

INDEPENDENT VARIABLES

(a) maternal characteristics during pregnancy and delivery, (b) perinatal characteristics, dietary behaviors, and defecation-related behaviors in infants and toddlers, (c) family dietary behaviors.

RESULTS

Mothers of infants and toddlers with FIA had given birth more times in the past, while the infants and toddlers themselves had less mealtime, a higher rate of exclusive breastfeeding, frequent loose stools, and a larger proportion of used wipes, experiencing perianal skin anomalies. The logistic regression analysis revealed that there are four significant risk factors associated with the development of FIA in infants and toddlers, including the number of previous deliveries by the mother (OR 6.327), defecation frequency score (OR 5.351), stool consistency score (OR 5.017), and cleaning with wipes after defecation (OR 8.089).

CONCLUSION

Based on our data, it appeared that FIA in infants and toddlers could be attributed to several factors. These included an increased number of previous deliveries by mothers, frequent loose stools, and repeated wipe use. To prevent the occurrence and worsening of the disease, it is important to improve the frequency and consistency of stooling and provide proper care. Further research is required to verify these findings in other clinical settings.

Undernutrition and associated factors among internally displaced lactating mothers in Sekota camps, northern Ethiopia: A cross-sectional study

Background

Undernutrition is the term used to describe when a person consumes insufficient amounts of nutrients and energy to meet their needs for maintaining health. Despite substantial progress, undernutrition remains a serious public health concern in many low and middle-income nations, including Ethiopia. Women and children are, in reality, the most nutritionally vulnerable individuals, particularly in times of crisis. In Ethiopia, 27 percent of lactating women are thin or malnourished, and 38% of children are stunted. Although the issue of undernutrition may worsen in times of emergency, like war, there are limited studies available in Ethiopia that show the nutritional status of lactating mothers in humanitarian settings.

Objectives

The main aim of this study was to determine the prevalence and investigate the factors associated with undernutrition among internally displaced lactating mothers in Sekota camps, in northern Ethiopia.

Methods

A cross-sectional study through a simple random sampling technique was conducted among 420 randomly selected lactating mothers in Sekota Internally Displaced Persons (IDP) camps. Data were collected using a structured questionnaire and anthropometric measurements. Logistic regression analysis was employed to identify independent factors associated with maternal undernutrition.

Results

Using a cut-off mid-upper arm circumference <23 cm, the prevalence of undernutrition among internally displaced lactating mothers was 54.8%. Large family size [adjusted odds ratio (AOR) = 4.35; 95% CI: 1.32, 10.22], short birth interval (AOR = 4.85; 95% CI: 1.24, 10.00), low maternal daily meal frequency (AOR = 2.54; 95% CI: 1.12, 5.75), and low dietary diversity score (AOR = 1.79; 95% CI: 1.03, 3.10) were all significantly associated with undernutrition.

Conclusion

The prevalence of undernutrition among internally displaced lactating mothers is relatively high. Governments and other concerned organizations involved in providing care and support to Sekota IDP camps should increase their efforts to improve the nutritional status of lactating mothers.

Interpregnancy Interval and Child Health Outcomes in India: Evidence from Three Recent Rounds of National Family Health Survey

INTRODUCTION

Short interpregnancy interval (IPI) is a well-known risk factor for preterm births and low birth weights. However, research on the association between interpregnancy interval (IPI) and health outcomes in children under age 5 is limited in India. We examined the associations between IPI and five child health outcomes in India.

METHODS

We used nationally representative cross-sectional data from three rounds of National Family Health Survey (NFHS) conducted in India during 2005-06, 2015-16 and 2019-21 to examine the associations between IPI [categorized as < 12 months, 12-17 months, 18-23 months (ref), 24-35 months, and 36-59 months] and five child health outcomes - neonatal mortality, postneonatal mortality, diarrhea and/or acute respiratory infections (ARI), stunting, and underweight, for the total sample and, secondarily, using sex-stratified analyses. We used multivariable and mother fixed-effects binary logistic regressions to examine the associations.

RESULTS

3% and 2% of infants died during the neonatal and postneonatal period, respectively. Thirteen, 40, and 37% of children had diarrhea and/or ARI, were stunted, and were underweight, respectively. IPI < 12 months was associated with higher odds of diarrhea and/or ARI (OR: 1.11; 95% CI: 1.05-1.18), stunting (OR: 1.13; 95% CI: 1.08-1.18) and underweight (OR: 1.06; 95% CI: 1.01-1.11). Mother fixed-effects adjustments confirmed these associations and also found that births with IPI of 12-17 months and 36-59 months had higher odds of stunting, and IPI of 12-17 months was also associated with higher odds of underweight.

DISCUSSION

Our findings indicate that IPIs shorter than 12 months are a risk factor for diarrhea and/or ARI, and IPIs shorter than 12 months and 12-17 months are risk factors for stunting and underweight among children under 5 in India. Mother fixed-effects models allowed us to adjust our estimates for unobserved heterogeneity; this has rarely been done before. Increases in birth spacing may improve child health outcomes in India.

Interbirth interval and maternal anaemia in 21 sub-Saharan African countries: A fractional-polynomial analysis

Background

Maternal anaemia is a global public health problem contributing to adverse maternal and perinatal outcomes. In addition to other risk factors, interbirth interval has been identified as a potentially modifiable risk factor of maternal anaemia. However, the current evidence for the association between interbirth interval and maternal anaemia remains inconclusive. Hence, this study examined the association between the interbirth interval and maternal anaemia in sub-Saharan Africa.

Methods

We conducted a multinational cross-sectional study of interbirth interval (time between two singleton live births) and maternal anaemia (haemoglobin levels < 12 g/dl for non-pregnant women, < 11 g/dl for pregnant women) for 21 sub-Saharan African countries using the most recent nationally representative Demographic and Health Surveys, 2010–2017. A weighted multivariable fractional polynomial function was used to estimate the non-linear relationship between interbirth interval and maternal anaemia, considering interbirth interval as a continuous variable and adjusting for potential confounders. Analyses were stratified by reproductive classification (non-pregnant and pregnant women).

Results

There were 81,693 women included in the study (89.2% non-pregnant, 10.8% pregnant). Of all women, 32.2% were in their postpartum period. Overall, 36.9% of women had anaemia (36.0% of non-pregnant and 44.3% of pregnant women). Of the participants, 15% had a short interbirth interval (<24 months), and 16% had a long interbirth interval (≥ 60 months). We found that both short and longer interbirth intervals were associated with an increased risk of maternal anaemia in a dose-response fashion. Relatively a lower risk of maternal anaemia was observed between 24 and 40 months of interbirth intervals.

Conclusions

Our findings suggest that both short and longer interbirth intervals were associated with an increased risk of maternal anaemia in sub-Saharan Africa.

Effect of maternal and child factors on stunting: partial least squares structural equation modeling

BACKGROUND

Stunting is affected by various factors from mother and child. Previous studies assessed only one or more influencing variables. Unfortunately, nor the significant influence of maternal and child factors nor the indicators contributing to maternal and child factors that affect the stunting incidence have ever been analyzed.

PURPOSE

This study analyzed the effect of maternal and child factors on stunting and the significant indicators that shape the maternal and child factors that impact stunting.

METHODS

This was a case-control study. Overall, 132 stunted children and 132 nonstunted children in Purbalingga Regency, Central Java Province, participated in the research. Direct interviews and medical record reviews were conducted to assess the studied variables. The research data were tested using the partial least squares structural equation with a formative model.

RESULTS

Maternal factors directly affected the occurrence of stunting (t=3.527, P<0.001) with an effect of 30.3%. Maternal factors also contributed a significant indirect effect on stunting through child factors (t=4.762, P<0.001) with an effect of 28.2%. Child factors affected the occurrence of stunting (t= 5.749, P<0.001) with an effect of 49.8%. The child factor was influenced by maternal factor with an effect of 56.7% (t=10.014, P<0.001). The moderation analysis results demonstrated that maternal and child factors were moderate predictive variables of stunting occurrence.

CONCLUSION

Child factors have more significant and direct effects on stunting than maternal factors but are greatly affected by them.

Anemia Among Children Under 5 Years in India: A District-Level Spatial Analysis Using NFHS-5 Data

The 2015/2016 National Family Health Survey (NFHS-4) revealed that the prevalence of anemia among children under 5 years is 58% in India. Lack of nutritional supplementation and lack of health care facilities are found to be important influential factors of anemia among children. We aimed to examine district-level spatial heterogeneity and clustering of associated factors with childhood anemia in India. Geographically weighted regression was applied on the NFHS-5 data for 335 districts. Factors such as prevalence of nutritional supplementation in children and mothers, birth order, antenatal care, diarrhea in children, and stunting were found to be significantly associated. Spatial scan statistics technique identified 3 significant local spatial clusters of anemia. This study provides findings based on the latest available data which can further assist in the design and execution of tailor-made policies.

Nutritional status and concomitant factors of stunting among pre-school children in Malda, India: A micro-level study using a multilevel approach

Background

Malnutrition was the main cause of death among children below 5 years in every state of India in 2017. Despite several flagship programmes and schemes implemented by the Government of India, the latest edition of the Global Nutrition Report 2018 addressed that India tops in the number of stunted children, which is a matter of concern. Thus, a micro-level study was designed to know the level of nutritional status and to study this by various disaggregate levels, as well as to examine the risk factors of stunting among pre-school children aged 36–59 months in Malda.

Method

A primary cross-sectional quantitative survey was conducted using structured questionnaires following a multi-stage, stratified simple random sampling procedure in 2018. A sum of 731 mothers with at least one eligible child aged 36–59 months were the study participants. Anthropometric measures of children were collected following the WHO child growth standard. Children were classified as stunted, wasted, and underweight if their HAZ, WHZ, and WAZ scores, respectively, were less than −2SD. The random intercept multilevel logistic regression model has been employed to estimate the effects of possible risk factors on childhood stunting.

Results

The prevalence of stunting in the study area is 40% among children aged 36–59 months, which is a very high prevalence as per the WHO’s cut-off values (≥40%) for public health significance. Results of the multilevel analysis revealed that preceding birth interval, low birth weight, duration of breastfeeding, mother’s age at birth, mother’s education, and occupation are the associated risk factors of stunting. Among them, low birth weight (OR 2.22, 95% CI: 1.44–3.41) and bidi worker as mothers’ occupation (OR 1.92, 95% CI: 1.18–3.12) are the most influencing factors of stunting. Further, about 14 and 86% variation in stunting lie at community and child/household level, respectively.

Conclusion

Special attention needs to be placed on the modifiable risk factors of childhood stunting. Policy interventions should direct community health workers to encourage women as well as their male partners to increase birth interval using various family planning practices, provide extra care for low birth weight baby, that can help to reduce childhood stunting.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11704-w.

The road from ICPD to SDGs: Health returns of reducing the unmet need for family planning in India

OBJECTIVE

This study attempts to estimate the impact of reducing the unmet need for family planning on the key maternal and child health indicators in India from 1993 to 2016, and projecting this for the period from 2016 to 2030.

DATA AND METHODS

The data have been compiled from various sources such as the United Nations' World Population prospects, national family health surveys and the sample registration system. The family planning and demographic projection modules of 'Spectrum', a modular computer simulation program, were used to estimate the impact of family planning programmes on reproductive, maternal and child health outcomes in India from 1993 to 2030.

RESULTS

Reduction of the unmet need for family planning averted approximately 56 million unintended pregnancies, 7 million unsafe abortions and 167,000 maternal deaths between 1993 and 2016. It is expected that an additional 41 million unintended pregnancies, 5 million unsafe abortions and 124,000 maternal deaths can be avoided by reducing the unmet need for family planning to 5% by 2030. Similarly, the declining unmet need for family planning between 1993 and 2016 led to a reduction in the pregnancy rate, abortion rate, and risk-adjusted infant and under-five mortality rates by 27 per 1000 married women, 1.8 per million married women, 10 per 1000 live births and 15 per 1000 live births, respectively. It is expected that approximately 24 pregnancies per 1000 married women, 1.6 abortions per million married women, 10 risk adjusted infant deaths per 1000 live births, and 14 under-five deaths per 1000 live births can be avoided by reducing the unmet need for family planning to 5% by 2030.

CONCLUSIONS

The findings of this study advocate that family planning is one of the best return on-investment strategies for India to achieve several targets under the reproductive, maternal and child health-related sustainable development goals.

Effects of short birth spacing on birth-order differences in child stunting: Evidence from India

Do firstborn children have a height advantage? Empirical findings have found mostly that, yes, second or higher-order children often lag behind firstborns in height outcomes, especially in developing countries. However, empirical investigations of birth-order effects on child height overlook the potential impact that birth spacing can have. We provide an explanation for the negative birth-order effect on stunting outcomes for young Indian children and show it is driven by short preceding-birth spacing. We find that firstborn children are taller than children of higher birth order: The height-for-age gap for third (or higher)-order children is twice the gap for children second in birth order. However, this pattern is observed when spacing between later-born children and their immediate elder siblings is fewer than 3 y. Interestingly, the firstborn height advantage disappears when later-born children are born at least 3 y after their elder siblings. Thus, our findings indicate that spacing length between children explains differences in height, over birth order. Although India's family planning policy has resulted in a substantial reduction in total fertility, its achievement in spacing subsequent births has been less impressive. In showing that spacing can alleviate or aggravate birth-order effects on attained height, our study fills an evidence gap: Reducing fertility alone may not be sufficient in overcoming negative birth-order effects. To reduce the detrimental effects of birth order on child stunting, policy responses-and therefore research priorities-require a stronger focus on increasing the time period between births.

Are myths surrounding long-acting reversible contraception the reason for a huge unmet need for spacing pregnancies?

Background:

Long-acting reversible contraceptives (LARC), a highly effective class of contraceptives, has a limited uptake by few couples due to lack of awareness, unavailability, and myths surrounding their application and side effects.

Aims:

This study was undertaken to understand and to clear myths of LARC among patients as well as to assess the knowledge, attitudes, practices, and preference.

Materials and Methods:

A hospital-based cross-sectional study using a semistructured questionnaire was conducted in the out-patient Department of Obstetrics and Gynecology, in a tertiary level hospital in Eastern India. A total of 600 women responded to the structured validated questionnaire.

Results:

High prevalence of teenage marriages (64%), teenage pregnancies (44%), and unwanted pregnancy (41%) was noted among responders. The knowledge scores were low in 66.7%, moderate in 26.66%, and only 6.66% had high level >80% scores in the 15 questions about LARC methods. While 41% had a positive attitude to future use of LARC, a majority (59%) had a strong negative attitude due to many myths of genital tract infections, discharges, and cancer, changed menstrual bleeding patterns, delayed conception after discontinuation, and altered sexual functions. Out of those with a positive attitude, 21% of women had a preference for intrauterine devices, 19.5% of women for injectables, and only 0.5% of women preferred contraceptive implants. 24.5% of women had used LARC in their lifetime but a meager 5% were currently using them.

Conclusions:

The study shows that there is a huge unmet need for spacing contraceptive methods as childbearing spacing is not maintained. There were lack of correct knowledge and awareness, and numerous myths surrounding LARC methods.

Planning of births and childhood undernutrition in Nepal: evidence from a 2016 national survey

BACKGROUND

Childhood undernutrition is a significant public health issue in low-and middle-income countries, including Nepal. However, there is limited evidence showing the association between the planning of birth (PoB) and childhood undernutrition (stunting and underweight). We aimed to investigate the relationship between PoB and childhood undernutrition in the current study.

METHODS

We used the Nepal Demographic and Health Survey (NDHS) 2016 data, a nationally representative cross-sectional household survey. We used two anthropometric indicators of childhood undernutrition as the outcome of this study. PoB is the main predictor. We used binary logistic regression with sampling weights to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) to examine the association between the PoB and childhood undernutrition. Unless stated, the significant association between the variables is calculated with p < 0.001.

RESULTS

The overall prevalence of stunting was 35.8%, and underweight was 27.1% in children under 5 years of age in Nepal. We found a higher rate of stunting (52.7%) and underweight (41.1%) in children with birth order > 3 and < 2 years of the interval between birth and subsequent birth (IBBSB). The association between the children's birth order and the prevalence of undernutrition had strong statistical significance. Mother's age at marriage (p = 0.001), underweight mother, mother's education, father's education, wealth quintile, no exposure to mass media, children's age, and place of residence(p = 0.001) were significantly associated with childhood undernutrition. The result of the multiple logistic regression showed that children with birth order one and 12-24 months of the interval between marriage and first birth (IBMFB) had significantly decreased odds of stunting than those children with birth order one and < 12 months of IBMFB (OR 0.6, 95% CI 0.4-0.9).

CONCLUSION

The findings of the study demonstrate that PoB has a protective effect on childhood undernutrition. Delaying of childbirth until 12-24 months after marriage was found to be associated with reduced childhood stunting odds. To mitigate childhood undernutrition, Nepal's government needs to promote delayed childbearing after marriage while focusing on uplifting the household economics status and wide coverage of and utilization of mass media.

Indirect health sector actions and supportive strategies to prevent malnutrition

PURPOSE OF REVIEW

Malnutrition is a pervasive problem that causes negative acute, long-term, and intergenerational consequences. As we have begun to move from efficacy to effectiveness trials of nutrition interventions, and further still to more holistic case study approaches to understanding how and why nutrition outcomes change over time, it has become clear that more emphasis on the 'nutrition-sensitive' interventions is required.

RECENT FINDINGS

In this article, we propose recategorizing the nutrition-specific and sensitive terminology into a new framework that includes direct and indirect health sector actions and supportive strategies that exist outside the health sector; an adjustment that will improve sector-specific planning and accountability. We outline indirect health sector nutrition interventions, with a focus on family planning and the evidence to support its positive link with nutrition outcomes. In addition, we discuss supportive strategies for nutrition, with emphasis on agriculture and food security, water, sanitation, and hygiene, and poverty alleviation and highlight some of the recent evidence that has contributed to these fields.

SUMMARY

Indirect health sector nutrition interventions and supportive strategies for nutrition will be critical, alongside direct health sector nutrition interventions, to reach global targets. Investments should be made both inside and outside the health sector.