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Milosavljevic B, Cook CJ, Fadera T, Ghillia G, Howard SJ, Makaula H, Mbye E, McCann S, Merkley R, Mshudulu M, Saidykhan M, Touray E, Tshetu N, Elwell C, Moore SE, Scerif G, Draper CE, Lloyd-Fox S. Executive functioning skills and their environmental predictors among pre-school aged children in South Africa and The Gambia. Dev Sci 2024; 27:e13407. [PMID: 37128134 DOI: 10.1111/desc.13407] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 04/11/2023] [Accepted: 04/18/2023] [Indexed: 05/03/2023]
Abstract
Executive functions (EFs) in early childhood are predictors of later developmental outcomes and school readiness. Much of the research on EFs and their psychosocial correlates has been conducted in high-income, minority world countries, which represent a small and biased portion of children globally. The aim of this study is to examine EFs among children aged 3-5 years in two African countries, South Africa (SA) and The Gambia (GM), and to explore shared and distinct predictors of EFs in these settings. The SA sample (N = 243, 51.9% female) was recruited from low-income communities within the Cape Town Metropolitan area. In GM, participants (N = 171, 49.7% female) were recruited from the rural West Kiang region. EFs, working memory (WM), inhibitory control (IC) and cognitive flexibility (CF), were measured using tablet-based tasks. Associations between EF task performance and indicators of socioeconomic status (household assets, caregiver education) and family enrichment factors (enrichment activities, diversity of caregivers) were assessed. Participants in SA scored higher on all EF tasks, but children in both sites predominantly scored within the expected range for their age. There were no associations between EFs and household or familial variables in SA, except for a trend-level association between caregiver education and CF. Patterns were similar in GM, where there was a trend-level association between WM and enrichment activities but no other relationships. We challenge the postulation that children in low-income settings have poorer EFs, simply due to lower socioeconomic status, but highlight the need to identify predictors of EFs in diverse, global settings. RESEARCH HIGHLIGHTS: Assessed Executive Functioning (EF) skills and their psychosocial predictors among pre-school aged children (aged 3-5 years) in two African settings (The Gambia and South Africa). On average, children within each setting performed within the expected range for their age, although children in South Africa had higher scores across tasks. There was little evidence of any association between socioeconomic variables and EFs in either site. Enrichment activities were marginally associated with better working memory in The Gambia, and caregiver education with cognitive flexibility in South Africa, both associations were trend-level significance.
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Affiliation(s)
- Bosiljka Milosavljevic
- Department of Psychology, University of Cambridge, Cambridge, UK
- Centre for Brain and Cognitive Development, Birkbeck, University of London, London, UK
| | - Caylee J Cook
- SAMRC/Wits Developmental Pathways for Health Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tijan Fadera
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Keneba, The Gambia
| | - Giulia Ghillia
- Centre for Brain and Cognitive Development, Birkbeck, University of London, London, UK
- Department of Women and Children's Health, King's College London, London, UK
| | - Steven J Howard
- Early Start and School of Education, University of Wollongong, Wollongong, New South Wales, Australia
| | - Hleliwe Makaula
- SAMRC/Wits Developmental Pathways for Health Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ebrima Mbye
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Keneba, The Gambia
| | - Samantha McCann
- Department of Women and Children's Health, King's College London, London, UK
| | - Rebecca Merkley
- Department of Cognitive Science, Carleton University, Ottawa, Canada
| | - Mbulelo Mshudulu
- SAMRC/Wits Developmental Pathways for Health Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mariama Saidykhan
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Keneba, The Gambia
| | - Ebou Touray
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Keneba, The Gambia
| | - Nosibusiso Tshetu
- SAMRC/Wits Developmental Pathways for Health Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Clare Elwell
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Sophie E Moore
- Department of Women and Children's Health, King's College London, London, UK
| | - Gaia Scerif
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Catherine E Draper
- SAMRC/Wits Developmental Pathways for Health Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sarah Lloyd-Fox
- Department of Psychology, University of Cambridge, Cambridge, UK
- Centre for Brain and Cognitive Development, Birkbeck, University of London, London, UK
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Rojas CFN, Pio DAM, Nonato AC. Understanding child development and care integrality: Primary Health Care doctors and nurses' view. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2024; 42:e2023127. [PMID: 38695417 PMCID: PMC11059932 DOI: 10.1590/1984-0462/2024/42/2023127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/25/2023] [Indexed: 05/05/2024]
Abstract
OBJECTIVE To identify perceptions of primary care health professionals regarding the conceptual aspects of child development and propose strategies to address difficulties. METHODS This descriptive-analytical study was conducted in a small municipality in the countryside of the State of São Paulo, Brazil. The primary health care in this region is comprised of Family Health Units and Basic Health Units. The sample included 52 participants, consisting of doctors and primary care nurses. A questionnaire with open and closed questions was utilized, covering knowledge and practices related to child development. For this study, the first question of the questionnaire, which asked for a descriptive response about participants' understanding of child development, was employed. The responses were transcribed, and content analysis using the thematic approach was conducted. RESULTS Among the participants, 54% were nurses, and the average duration of working with the pediatric population was ten years. 80% reported never having undergone training in child development. The analysis of the responses revealed heterogeneity in the professionals' understanding of the conceptual dimension of child development. Additionally, there was an insufficient grasp of the theoretical and practical aspects and a scarcity of resources to support comprehensive care for children. A predominant biomedical model focusing on disease and biological aspects of child health was evident in defining the understanding of the subject. CONCLUSIONS The findings underscore the necessity of implementing health education initiatives and service projects in primary care settings. It is crucial to strengthen a comprehensive perspective of child health within the biopsychosocial model of the health-disease process.
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Mbabazi J, Pesu H, Mutumba R, Bromley K, Ritz C, Filteau S, Briend A, Mupere E, Grenov B, Friis H, Olsen MF. Correlates of early child development among children with stunting: A cross-sectional study in Uganda. MATERNAL & CHILD NUTRITION 2024; 20:e13619. [PMID: 38291803 PMCID: PMC10981482 DOI: 10.1111/mcn.13619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 12/06/2023] [Accepted: 12/09/2023] [Indexed: 02/01/2024]
Abstract
Many children in low- and middle-income countries are not attaining their developmental potential. Stunting is associated with poor child development, but it is not known which correlates of stunting are impairing child development. We explored potential socioeconomic, nutritional, clinical, and household correlates of early child development among 12-59-month-old children with stunting in a cross-sectional study in Uganda. Development was assessed using the Malawi Development Assessment Tool (MDAT) across four domains of gross and fine motor, language, and social skills. Linear regression analysis was used to assess correlates of development in the four domains and total MDAT score. Of 750 children included, the median [interquartile range] age was 30 [23-41] months, 55% of the children resided in rural settings with 21% from female-headed households and 47% of mothers had no schooling. The mean ± standard deviation height-for-age z-score (HAZ) was -3.02 ± 0.74, 40% of the children had a positive malaria test and 65% were anaemic (haemoglobin < 110 g/L). One-third had children's books at home, majority (96%) used household objects to play with and most of them (70%) used toys as pretence items like those to mimic cooking. After age, sex, and site adjustments, HAZ (0.24, 95% confidence interval [CI]: 0.14-0.33) and head circumference (0.07, 95% CI: 0.02-0.12) were positive correlates of total MDAT score, whereas weight-for-height z-score (WHZ) was not. Current breastfeeding was associated with 0.41 (95% CI: 0.17-0.65) lower total MDAT score. Children from households with a single income earner had 0.22 (95% CI: 0.06-0.37) lower total MDAT score. Furthermore, severe food insecurity, inflammation and positive malaria test were associated with lower scores for motor development. All family care indicator subscales (FCIs) positively correlated with the total MDAT score and this association was independent of household's socioeconomic status. In conclusion, stunting degree, head circumference, number of household income earners and stimulation by improved FCIs correlate with early child development among stunted children. The negative association with prolonged breastfeeding is likely due to reverse causality. Identified correlates may inform initiatives to support children with stunting attain their development potential.
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Affiliation(s)
- Joseph Mbabazi
- Department of Nutrition, Exercise & SportsUniversity of CopenhagenCopenhagenDenmark
- Department of Paediatrics and Child HealthMakerere UniversityKampalaUganda
| | - Hannah Pesu
- Department of Nutrition, Exercise & SportsUniversity of CopenhagenCopenhagenDenmark
| | - Rolland Mutumba
- Department of Nutrition, Exercise & SportsUniversity of CopenhagenCopenhagenDenmark
- Department of Paediatrics and Child HealthMakerere UniversityKampalaUganda
| | | | - Christian Ritz
- The National Institute of Public HealthSouthern University of DenmarkCopenhagenDenmark
| | - Suzanne Filteau
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonUK
| | - André Briend
- Department of Nutrition, Exercise & SportsUniversity of CopenhagenCopenhagenDenmark
- Tampere Center for Child Health ResearchUniversity of TampereTampereFinland
| | - Ezekiel Mupere
- Department of Paediatrics and Child HealthMakerere UniversityKampalaUganda
| | - Benedikte Grenov
- Department of Nutrition, Exercise & SportsUniversity of CopenhagenCopenhagenDenmark
| | - Henrik Friis
- Department of Nutrition, Exercise & SportsUniversity of CopenhagenCopenhagenDenmark
| | - Mette F. Olsen
- Department of Nutrition, Exercise & SportsUniversity of CopenhagenCopenhagenDenmark
- Department of Infectious DiseasesRigshospitaletCopenhagenDenmark
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Mezmur H, Tefera M, Roba AA, Başdaş Ö. Multi-Level Mixed-Effects Analysis of Stunting Among 6 to 59 Months Children in Ethiopia: Evidenced from Analysis of Health and Demographic Survey, 2000 to 2019. Glob Pediatr Health 2024; 11:2333794X241239226. [PMID: 38525434 PMCID: PMC10958808 DOI: 10.1177/2333794x241239226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/06/2023] [Accepted: 02/27/2024] [Indexed: 03/26/2024] Open
Abstract
Background. Stunting remains a major public health issue in developing countries like Ethiopia. It is termed as a chronic malnutrition which leads to morbidity and mortality among children. This study aimed to assess the prevalence and factors associated with stunting among 6 to 59 months children in Ethiopia. Methods. A total weighted sample of 34 930 children aged 6 to 59 months was included in this study. A Multilevel Mixed-Effect logistic regression was carried out. The Median Odds Ratio (MOR) and the Intra class Correlation Coefficient (ICC) were calculated. An adjusted odds ratio along with a 95% confidence interval was reported and statistical significance was declared at a P-value ≤ .05. Results. The weighted prevalence of stunting in Ethiopia was 48.3% (95% CI: 47.8%, 48.8%). Being male, increased in age, having multiple births (twin), having less than 2 years birth interval, history of diarrhea, anemia, lack of maternal and paternal formal education, having poor and middle-wealth status, and living in rural areas were significantly associated with stunting. Conclusions. The prevalence of stunting is high in Ethiopia. The risk factors mentioned above increase the likely hood of stunting among children. Therefore, we recommend that responsible bodies place a greater emphasis and priority on promoting parental education, awareness on the impact of the birth interval on child nutrition, the prevention of childhood diarrhea and anemia, improving household economic status, and reducing rural-urban disparities.
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Affiliation(s)
| | | | - Aklilu Abrham Roba
- Haramaya University, Haramaya, Ethiopia
- Erciyes University, Kayseri, Turkey
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Dockrell J, Massonnié J, Ang L, Munoz-Chereau B, Fernandez Rao S, Kolopaking R, Ndiaye M, Heffernan C. Measurement of cognition and profiling early learning environments in India, Indonesia and Senegal: a UKRI GCRF Action Against Stunting Hub protocol paper. BMJ Paediatr Open 2024; 8:e001685. [PMID: 38417926 PMCID: PMC10900338 DOI: 10.1136/bmjpo-2022-001685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/13/2022] [Indexed: 03/01/2024] Open
Abstract
INTRODUCTION Childhood stunting is associated with poorer child health, growth and development including diminished cognitive abilities. Mapping out the links between child stunting and Early Childhood Education and Development is critical to increasing understanding of the causes and effects of childhood stunting, and for programme and policy development. The aim of this study is to investigate and compare the development and educational environments across India, Indonesia and Senegal, and to identify the multifactorial drivers and impacts of childhood stunting to inform a new typology. METHODS AND ANALYSIS This current study is part of an interdisciplinary observational research study, where women are recruited during pregnancy and mother-infant pairs followed prospectively, up to 24 months after birth. Eight measures will be used to profile children's early development and learning environments in two sample cohorts: (A) children aged 12 and 24 months born to the women recruited during pregnancy (ie, 500 pregnant mothers per country) and (B) a preschool case-control cohort of siblings from the main cohort aged between 3:6 and 5:6 years of age where anthropomorphic measures will be collected to assess degrees of stunting. Profiling of the development and learning environments in the countries will include both parent/caregiver self-reported and local staff (enumerators) direct assessments of children and settings. ETHICS AND DISSEMINATION This study was approved by the institutional ethics committees of all partner institutions. In India, Indian Council of Medical Research-National Institute of Nutrition, Hyderabad; In Indonesia, Ethics Committee of the Faculty of Medicine, University of Indonesia; and in Senegal, National Ethics Committee for Scientific Research in Senegal.The findings of the study will be disseminated in national and international meetings, seminars, conferences and peer-reviewed journals.
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Affiliation(s)
- Julie Dockrell
- Psychology and Human Development, UCL Institute of Education, London, UK
| | - Jessica Massonnié
- School of Education and Sociology (EDSOC), University of Portsmouth, Portsmouth, UK
| | | | | | - Sylvia Fernandez Rao
- Behavioural Science Unit, Extension and Training Division, National Institute of Nutrition, Hyderabad, Telangana, India
| | - Risatianti Kolopaking
- Southeast Asian Ministers of Education Organization Regional Center for Food and Nutrition (SEAMEO RECFON)-Pusat Kajian Gizi Regional, Universitas Indonesia, Jakarta, Indonesia
- Faculty of Psychology, UIN Syarif Hidayatullah, Jakarta, Indonesia
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Li S, Mohamed Nor N, Kaliappan SR. Social determinants of child malnutrition outcomes: Evidence from CHNS in China. Heliyon 2024; 10:e23887. [PMID: 38187311 PMCID: PMC10767191 DOI: 10.1016/j.heliyon.2023.e23887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 01/09/2024] Open
Abstract
China is committed to reduce child malnutrition outcomes (CMO) rates to less than 5 % by 2030 in order to meet the Sustainable Development Goal (SDG). Yet, this is still an enormous challenge for China, particularly in disadvantaged areas, due to regional and urban-rural disparities. Using China Health and Nutrition Survey (CHNS) data from 1991 to 2015 and fixed-effect models, this study investigates the social determinants of stunting (n = 4012) measured by height-for-age z score (HAZ) and wasting (n = 4229) measured by weight-for-height z score (WHZ) in children under the age of five. According to the empirical findings, the significant social determinants of child stunting encompassed whether the child is insured (p < 0.01), maternal education level (primary school (p < 0.01) low middle school (p < 0.01); vocational school (p < 0.01)), maternal employment status (p < 0.05), mother's average working days (p < 0.05), average household per capita income (p < 0.01), household asset index (p < 0.01), urbanization index living in a community (medium (p < 0.05); higher (p < 0.01); highest (p < 0.01)) and living regions (west (p < 0.01); northeast (p < 0.05)). Children's maternal employment status (p < 0.05), mother's average working days (p < 0.05), living areas (p < 0.05) and living regions (central (p < 0.01); west (p < 0.01); north-east (p < 0.05)) are the significant factors impacting child wasting. Furthermore, the interaction impact between maternal employment and have one additional working day per week is positive. To attain SDGs, the Chinese government should priorities lowering stunting and wasting among 5-year-olds in the western region, particularly in impoverished regions. Also, it is possible to develop tailored policies for the growth and development of children under the age of five by addressing pertinent socio-economic factors.
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Affiliation(s)
- Sa Li
- School of Business and Economics, Universiti Putra Malaysia, 43400, UPM, Serdang, Selangor, Malaysia
- School of Business, Zhengzhou College of Finance and Economics, Zhengzhou, 450000, China
| | - Norashidah Mohamed Nor
- School of Business and Economics, Universiti Putra Malaysia, 43400, UPM, Serdang, Selangor, Malaysia
| | - Shivee Ranjanee Kaliappan
- School of Business and Economics, Universiti Putra Malaysia, 43400, UPM, Serdang, Selangor, Malaysia
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Feng J, Wang Y, Liu T, Huo J, Zhuo Q, Gong Z. The Effects of Ying Yang Bao on Nutritional Status of Children Aged 6-60 Months in Underdeveloped Rural Areas of China. Nutrients 2024; 16:202. [PMID: 38257096 PMCID: PMC10820366 DOI: 10.3390/nu16020202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
The Ying Yang Bao (YYB) intervention, a national policy in China, has been implemented for over two decades. Most previous studies have focused only on the short-term effects of YYB, while the long-term effects remain unexplored. This study was designed to evaluate the long-term effects of YYB in children aged 6-60 months. A sample of 4666 children was divided into intervention and control groups. Information on basic characteristics, physical examination, YYB consumption, etc., was obtained annually from 2018 to 2021. T-tests or chi-square tests were used to compare differences between the groups for continuous or categorical variables. Children in the intervention group showed greater incremental improvements in hemoglobin levels and physical development (p < 0.05). Prevalence of anemia, underweight, and stunting were lower in the intervention group than in the control group (all p < 0.05). Two-level regression models were constructed to assess the long-term effects of YYB. YYB reduced the risk of anemia and wasting by 37% (OR: 0.63, 95% CI: 0.52-0.75) and 49% (OR: 0.51, 95% CI: 0.39-0.67), respectively. This study indicates that YYB could significantly improve the nutritional status of children aged 6-60 months in underdeveloped rural areas of China.
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Affiliation(s)
- Jing Feng
- Key Laboratory of Trace Element Nutrition of National Health Commission, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (J.F.); (Y.W.); (T.L.); (J.H.)
| | - Yongjun Wang
- Key Laboratory of Trace Element Nutrition of National Health Commission, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (J.F.); (Y.W.); (T.L.); (J.H.)
- Department of Clinical Nutrition, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan 250014, China
| | - Tingting Liu
- Key Laboratory of Trace Element Nutrition of National Health Commission, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (J.F.); (Y.W.); (T.L.); (J.H.)
| | - Junsheng Huo
- Key Laboratory of Trace Element Nutrition of National Health Commission, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (J.F.); (Y.W.); (T.L.); (J.H.)
| | - Qin Zhuo
- Key Laboratory of Trace Element Nutrition of National Health Commission, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (J.F.); (Y.W.); (T.L.); (J.H.)
| | - Zhaolong Gong
- Key Laboratory of Trace Element Nutrition of National Health Commission, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (J.F.); (Y.W.); (T.L.); (J.H.)
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Marinho I, Silva MRG, Paiva T, Santos-Rocha R, Silva HH. Nutritional Knowledge about Maternal and Newborn Health among Physiotherapists during the COVID-19 Pandemic in Minas Gerais, Brazil. Nutrients 2024; 16:180. [PMID: 38257072 PMCID: PMC10820058 DOI: 10.3390/nu16020180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024] Open
Abstract
Adequate nutrition before and during pregnancy, as well as postpartum, is among the major contributors to maternal and newborn health. Physiotherapists' knowledge of this area is still scarce, although their clinical practice has been linked to newborns' neuropsychomotor development, which, in turn, is influenced by maternal health and nutritional status. Therefore, this study aimed to evaluate the nutritional knowledge of physiotherapists regarding maternal and newborn health. A total of 70 Brazilian physiotherapists (32.2 ± 6.0 years; 72.9% females) were evaluated between November 2019 and February 2020 for their sociodemographic characteristics, professional experience, and nutritional knowledge about maternal and newborn health through a validated questionnaire personally administered by the same trained researcher. Most of the physiotherapists had graduated but had no specialization in maternal and child physiotherapy (96.1% of the females and all the males). The nutritional knowledge about maternal and newborn health was significantly different between the female and male health professionals, as well as between the less and more experienced participants, i.e., female physiotherapists and the more experienced ones had more correct answers on the nutritional questionnaire than the male and less experienced physiotherapists, respectively (p < 0.05). Our results open an interesting window for the future education and training of Brazilian physiotherapists in nutrition.
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Affiliation(s)
- Isabelle Marinho
- School of Health Sciences, University Fernando Pessoa, 4249-004 Porto, Portugal
| | - Maria-Raquel G. Silva
- FP-I3ID, FP-BHS, CEBIMED and Faculty of Health Sciences, University Fernando Pessoa, 4200-150 Porto, Portugal
- CIAS—Research Centre for Anthropology and Health—Human Biology, Health and Society, University of Coimbra, 3000-456 Coimbra, Portugal
- CHRC—Comprehensive Health Research Centre, Nova Medical School, Nova University of Lisbon, 1150-090 Lisbon, Portugal;
- Gymnastics Federation of Portugal—Scientific Committee, 1600-159 Lisbon, Portugal
- CENC—Sleep Medicine Centre, 1649-035 Lisbon, Portugal
| | - Teresa Paiva
- CHRC—Comprehensive Health Research Centre, Nova Medical School, Nova University of Lisbon, 1150-090 Lisbon, Portugal;
- CENC—Sleep Medicine Centre, 1649-035 Lisbon, Portugal
| | - Rita Santos-Rocha
- ESDRM-IPSANTARÉM Sport Sciences School of Rio Maior, Polytechnic Institute of Santarém, 2001-904 Rio Maior, Portugal;
- CIPER—Laboratory of Biomechanics and Functional Morphology, Interdisciplinary Centre for the Study of Human Performance, Faculty of Human Kinetics, University of Lisbon, 1499-002 Lisbon, Portugal
| | - Hugo-Henrique Silva
- ICBAS—School of Medicine and Biomedical Sciences, University of Porto, 4050-313 Porto, Portugal;
- Portuguese Ministry of Education, 1399-025 Lisbon, Portugal
- Leixões Sport Clube, Senior Female Volleyball Team, 4450-277 Matosinhos, Portugal
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Karlsson O, Kim R, Moloney GM, Hasman A, Subramanian SV. Patterns in child stunting by age: A cross-sectional study of 94 low- and middle-income countries. MATERNAL & CHILD NUTRITION 2023; 19:e13537. [PMID: 37276243 PMCID: PMC10483943 DOI: 10.1111/mcn.13537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 04/26/2023] [Accepted: 05/06/2023] [Indexed: 06/07/2023]
Abstract
Child stunting prevalence is primarily used as an indicator of impeded physical growth due to undernutrition and infections, which also increases the risk of mortality, morbidity and cognitive problems, particularly when occurring during the 1000 days from conception to age 2 years. This paper estimated the relationship between stunting prevalence and age for children 0-59 months old in 94 low- and middle-income countries. The overall stunting prevalence was 32%. We found higher stunting prevalence among older children until around 28 months of age-presumably from longer exposure times and accumulation of adverse exposures to undernutrition and infections. In most countries, the stunting prevalence was lower for older children after around 28 months-presumably mostly due to further adverse exposures being less detrimental for older children, and catch-up growth. The age for which stunting prevalence was the highest was fairly consistent across countries. Stunting prevalence and gradient of the rise in stunting prevalence by age varied across world regions, countries, living standards and sex. Poorer countries and households had a higher prevalence at all ages and a sharper positive age gradient before age 2. Boys had higher stunting prevalence but had peak stunting prevalence at lower ages than girls. Stunting prevalence was similar for boys and girls after around age 45 months. These results suggest that programmes to prevent undernutrition and infections should focus on younger children to optimise impact in reducing stunting prevalence. Importantly, however, since some catch-up growth may be achieved after age 2, screening around this time can be beneficial.
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Affiliation(s)
- Omar Karlsson
- Takemi Program in International Health, Harvard T.H. Chan School of Public HealthHarvard UniversityBostonMassachusettsUSA
- Department of Economic History, School of Economics and ManagementLund UniversityLundSweden
| | - Rockli Kim
- Division of Health Policy & Management, College of Health ScienceKorea UniversitySeoulKorea
- Harvard Center for Population and Development StudiesCambridgeMassachusettsUSA
| | - Grainne M. Moloney
- Nutrition Section, United Nations Children's Fund (UNICEF), Kenya Country OfficeUN Complex GigiriNairobiKenya
| | | | - S. V. Subramanian
- Harvard Center for Population and Development StudiesCambridgeMassachusettsUSA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public HealthHarvard UniversityBostonMassachusettsUSA
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Li X, Li Y, Yu B, Nima Q, Meng H, Shen M, Zhou Z, Liu S, Tian Y, Xing X, Yin L. Urban-rural differences in the association between long-term exposure to ambient particulate matter (PM) and malnutrition status among children under five years old: A cross-sectional study in China. J Glob Health 2023; 13:04112. [PMID: 37736866 PMCID: PMC10515095 DOI: 10.7189/jogh.13.04112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023] Open
Abstract
Background The evidence regarding the relationship between postnatal exposure of air pollution and child malnutrition indicators, as well as the corresponding urban-rural disparities, is limited, especially in low-pollution area of low- and middle-income countries (LMICs). Therefore, our aim was to contrast the effect estimates of varying ambient particulate matter (PM) on malnutrition indicators between urban and rural areas in Tibet, China. Methods Six malnutrition indicators were evaluated in this study, namely, Z-scores of height for age (HFA), Z-scores of weight for age (WFA), Z-scores of weight for height (WFH), stunting, underweight, and wasting. Exposure to particles with an aerodynamic diameter ≤2.5 micron (μm) (PM2.5), particles with an aerodynamic diameter ≤10 μm (PM10) and particles with an aerodynamic diameter between 2.5 and 10 μm (PMc) was estimated using satellite-based random forest models. Linear regression and logistic regression models were used to assess the associations between PM and the above malnutrition indicators. Furthermore, the effect estimates of different PM were contrasted between urban and rural areas. Results A total of 2511 children under five years old were included in this study. We found long-term exposure to PM2.5, PMc, and PM10 was associated with an increased risk of stunting and a decreased risk of underweight. Of these air pollutants, PMc had the strongest association for Z-scores of HFA and stunting, while PM2.5 had the strongest association for underweight. The results showed that the odds ratio (OR) for stunting were 1.36 (95% confidence interval (CI) = 1.06 to 1.75) per interquartile range (IQR) microgrammes per cubic metre (μg/m3) increase in PM2.5, 1.80 (95% CI = 1.30 to 2.50) per IQR μg/m3 increase in PMc and 1.55 (95% CI = 1.17 to 2.05) per IQR μg/m3 increase in PM10. The concentrations of PM were higher in urban areas, and the effects of PM on malnutrition indicators among urban children were higher than those of rural children. Conclusions Our results suggested that PM exposure might be an important trigger of child malnutrition. Further prospective researches are needed to provide important scientific literature for understanding child malnutrition risk concerning postnatal exposure of air pollutants and formulating synthetically social and environmental policies for malnutrition prevention.
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Affiliation(s)
- Xianzhi Li
- Meteorological Medical Research Center, Panzhihua Central Hospital, Panzhihua, Sichuan Province, China
- Clinical Medical Research Center, Panzhihua Central Hospital, Panzhihua, Sichuan Province, China
- Dali University, Dali, Yunnan Province, China
| | - Yajie Li
- Tibet Center for Disease Control and Prevention, Lhasa, Tibet Autonomous Region, China
| | - Bin Yu
- Institute for Disaster Management and Reconstruction, Sichuan University - Hong Kong Polytechnic University, Chengdu, Sichuan Province, China
| | - Qucuo Nima
- Tibet Center for Disease Control and Prevention, Lhasa, Tibet Autonomous Region, China
| | - Haorong Meng
- Yunnan Center for Disease Control and Prevention, Kunming, Yunnan Province, China
| | - Meiying Shen
- Nursing department, Panzhihua Central Hospital, Panzhihua, Sichuan Province, China
| | - Zonglei Zhou
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
| | - Shunjin Liu
- Meteorological Medical Research Center, Panzhihua Central Hospital, Panzhihua, Sichuan Province, China
- Clinical Medical Research Center, Panzhihua Central Hospital, Panzhihua, Sichuan Province, China
- Dali University, Dali, Yunnan Province, China
| | - Yunyun Tian
- Clinical Medical Research Center, Panzhihua Central Hospital, Panzhihua, Sichuan Province, China
- Dali University, Dali, Yunnan Province, China
| | - Xiangyi Xing
- Meteorological Medical Research Center, Panzhihua Central Hospital, Panzhihua, Sichuan Province, China
- Dali University, Dali, Yunnan Province, China
- Department of Pharmacy, Panzhihua Central Hospital, Panzhihua, Sichuan Province, China
| | - Li Yin
- Meteorological Medical Research Center, Panzhihua Central Hospital, Panzhihua, Sichuan Province, China
- Clinical Medical Research Center, Panzhihua Central Hospital, Panzhihua, Sichuan Province, China
- Dali University, Dali, Yunnan Province, China
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11
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Chongwo EJ, Wedderburn CJ, Nyongesa MK, Sigilai A, Mwangi P, Thoya J, Odhiambo R, Ngombo K, Kabunda B, Newton CR, Abubakar A. Neurocognitive outcomes of children exposed to and living with HIV aged 3-5 years in Kilifi, Kenya. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1193183. [PMID: 37732169 PMCID: PMC10508958 DOI: 10.3389/frph.2023.1193183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 08/14/2023] [Indexed: 09/22/2023] Open
Abstract
Introduction Globally, 1.7 million children are living with HIV, with the majority of them residing in sub-Saharan Africa. Due to reduced rates of vertical transmission of HIV, there is an increasing population of children born to HIV-infected mothers who remain uninfected. There is a growing concern around the development of these children in the antiretroviral therapy era. This study examined the neurocognitive outcomes of children who are HIV-exposed infected (CHEI), HIV-exposed uninfected (CHEU) and HIV-unexposed uninfected (CHUU) and explored the relationship between child neurocognitive outcomes and child's biomedical and caregivers' psychosocial factors. Methods CHEI, CHUU and CHEU aged 3-5 years and their caregivers were recruited into the study. Neurocognitive outcomes were assessed using a validated battery of assessments. One-way analysis of variance and covariance (ANOVA and ANCOVA) were used to evaluate differences among the three groups by neurocognitive outcomes. Linear regression models were used to investigate the association between child neurocognitive outcomes and biomedical factors (nutritional status, HIV disease staging) and caregivers' psychosocial factors [symptoms of common mental disorders (CMDs) and parenting behaviour]. Results The study included 153 children and their caregivers: 43 (28.1%) CHEI, 52 (34.0%) CHEU and 58 (39.9%) CHUU. ANOVA and ANCOVA revealed a significant difference in cognitive ability mean scores across the child groups. Post hoc analysis indicated that CHEU children had higher cognitive ability mean scores than the CHUU group. Better nutritional status was significantly associated with higher cognitive ability scores (β = 0.68, 95% CI [0.18-1.18], p = 0.008). Higher scores of CMDs were negatively associated with inhibitory control (β = -0.28, 95% CI [-0.53 to 0.02], p = 0.036). While comparing HIV stages 2 and 3, large effect sizes were seen in working memory (0.96, CI [0.08-1.80]) and cognitive ability scores (0.83 CI [0.01-1.63]), indicating those in stage 3 had poor performance. Conclusions Neurocognitive outcomes were similar across CHEI, CHEU and CHUU, although subtle differences were seen in cognitive ability scores where CHEU had significantly higher cognitive mean scores than the CHUU. Well-designed longitudinal studies are needed to ascertain these findings. Nonetheless, study findings underscore the need for strategies to promote better child nutrition, mental health, and early antiretroviral therapy initiation.
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Affiliation(s)
| | - Catherine J. Wedderburn
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Paediatrics and Child Health and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | | | - Antipa Sigilai
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
| | - Paul Mwangi
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Janet Thoya
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
| | - Rachel Odhiambo
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Katana Ngombo
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
| | - Beatrice Kabunda
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
| | - Charles R. Newton
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Amina Abubakar
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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12
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Masilela LN, Modjadji P. Child Nutrition Outcomes and Maternal Nutrition-Related Knowledge in Rural Localities of Mbombela, South Africa. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1294. [PMID: 37628293 PMCID: PMC10453191 DOI: 10.3390/children10081294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/20/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023]
Abstract
Poor nutrition outcomes among children have become one of the major public health concerns in South Africa, attributed to poor feeding practices and maternal nutrition-related knowledge with conflicting data. In view of this, a cross-sectional study was conducted to determine the association of nutrition outcomes of children aged under two years with feeding practices and maternal nutrition-related knowledge in Mbombela, South Africa. Mothers' nutrition-related knowledge was estimated using an adapted structured questionnaire on colostrum, continued breastfeeding, diarrhea prevention and treatment using oral rehydration solution, immunization, and family planning, and scored as excellent (80-100), good (60-79), average (40-59), and fair (0-39). This was along with questions on socio-demographic factors and obstetric history, as well as anthropometric measurements. Child nutrition outcomes were estimated by WHO classification using z-scores for stunting (length-for-age (LAZ)), underweight (weight-for-age (WAZ)), and thinness (body mass index-for-age (BAZ)). Using STATA 17, 400 pairs of children (8 ± 6 months) and their mothers (29 ± 6 years) participated in the study and were living in a poor socio-economic status environment. Half of children were stunted (50%) and over half (54%) were obese, while mothers were underweight (39%) and overweight (34%). In addition to one third of mothers reporting obstetric complications, two thirds, initiated breastfeeding within one hour of delivery, 30% exclusively breastfed, 48% introduced early complementary feeding, and 70% practiced mixed feeding. Twenty-eight percent (28%) of mothers had fair nutrition-related knowledge, while 66% had average knowledge, 6% good knowledge, and none of the mothers had excellent knowledge. A chi-square test showed that mothers' nutrition-related knowledge was significantly associated with child stunting. The final hierarchical logistic regression showed significant associations of stunting with mothers' nutrition-related knowledge (average: AOR = 1.92, 95%CI: 1.12-3.29), child's age (6-11 months: AOR = 2.63, 95%CI: 1.53-4.53 and 12-23 months: AOR = 3.19, 95%CI: 1.41-7.25), and education (completing Grade 12: AOR = 0.36, 95%CI: 0.15-0.86). Contextual and intensified interventions on continued education for mothers to gain accurate information on nutrition-related knowledge and feeding practices could ultimately enhance child nutrition outcomes in poorer settings. Efforts should therefore be made to ensure that nutrition knowledge is appropriately provided based on the phases of child growth from 0 to 2 years, even beyond infancy into school age.
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Affiliation(s)
- Lucy Nomsa Masilela
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, 1 Molotlegi Street, Ga-Rankuwa, Pretoria 0208, South Africa
| | - Perpetua Modjadji
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, 1 Molotlegi Street, Ga-Rankuwa, Pretoria 0208, South Africa
- Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town 7505, South Africa
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Floridia M, Galluzzo CM, Orlando S, Luhanga R, Mphwere R, Kavalo T, Andreotti M, Amici R, Ciccacci F, Marazzi MC, Giuliano M. Micronutrient and Nutritional Status of HIV-Exposed and HIV-Unexposed Malawian Infants in the First Year of Life: Assessment of Ferritin, Vitamin A, and D Status and Its Association with Growth. Nutrients 2023; 15:3282. [PMID: 37513701 PMCID: PMC10386663 DOI: 10.3390/nu15143282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023] Open
Abstract
Breastfed Malawian infants from Human Immunodeficiency Virus (HIV)-uninfected and HIV-infected women who received antiretroviral therapy were followed until 12 months of age, allowing us to evaluate plasma levels of ferritin, vitamin A (as retinol-binding protein, RBP), and vitamin D (25(OH)D) at six months, as well as nutritional status and growth between six and 12 months. Ferritin and RBP levels were adjusted for inflammation. The study included 88 infants, 63 of whom were part of a recent cohort (2019-2021) that included 49 HIV-exposed but uninfected (HEU) and 14 HIV-unexposed and uninfected (HUU) infants, as well as 25 infants (all HEU) from an earlier cohort (2008-2011). No differences were observed between HEU and HUU infants regarding micronutrient levels, anthropometric indexes, growth, and rates of stunting, being underweight, or wasting. HEU infants from the earlier cohort, when compared to more recent HEU infants, had significantly worse anthropometric measures at six months and inferior growth between six and twelve months. Overall, ferritin deficiency involved 68.6% of infants, while vitamin A and vitamin D deficiency involved 8% and 1.2% of infants, respectively. Micronutrient deficiencies were not associated with HIV exposure, cohort, stunting, being underweight, or wasting. At six months, stunting, being underweight, and wasting involved 25.0%, 2.7% and 2.8% of infants, respectively, with no differences related to HIV exposure. Ferritin deficiency at six months was associated with inferior subsequent growth. In this small observational study conducted in Malawian infants, no major nutritional gap was observed between HIV-exposed and HIV-unexposed infants, though the study highlighted specific nutritional deficiencies that deserve attention. High rates of stunting and ferritin deficiency were observed in the first year of life in Malawian infants, irrespective of maternal HIV status; a significant association between ferritin deficiency and worse subsequent growth was found. Vitamin A and vitamin D deficiencies were much less frequent. Based on the data observed, nutritional interventions should give priority to the correction of ferritin deficiency and chronic undernutrition.
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Affiliation(s)
- Marco Floridia
- National Center for Global Health, Istituto Superiore di Sanità, 00161 Rome, Italy
| | | | - Stefano Orlando
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Richard Luhanga
- DREAM Program, Community of S. Egidio, Blantyre P.O. Box 30355, Malawi
| | - Robert Mphwere
- DREAM Program, Community of S. Egidio, Blantyre P.O. Box 30355, Malawi
| | - Thom Kavalo
- DREAM Program, Community of S. Egidio, Blantyre P.O. Box 30355, Malawi
| | - Mauro Andreotti
- National Center for Global Health, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Roberta Amici
- National Center for Global Health, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Fausto Ciccacci
- UniCamillus, Department of Medicine, Saint Camillus International University of Health Sciences, 00131 Rome, Italy
| | | | - Marina Giuliano
- National Center for Global Health, Istituto Superiore di Sanità, 00161 Rome, Italy
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Delgado-Ron JA, Andrade-Rivas F. Unwanted or Mistimed Pregnancy and Developmental Issues in Ecuadorian Children Aged 3 to 5: A Doubly Robust Estimate Using Data from the National Health and Nutrition Survey 2018. Matern Child Health J 2023:10.1007/s10995-023-03713-5. [PMID: 37261593 DOI: 10.1007/s10995-023-03713-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Past studies in high-income countries have shown an association between unintended (unwanted or mistimed) pregnancy and child development; no national-level studies in low-and-middle-income countries have been conducted. Moreover, extant studies often adjust for potential mediators, underestimating the average population effect. METHODS We aimed to estimate the effect of unintended pregnancy on early childhood development in Ecuadorian children aged 3 to 5, participating in the National Health and Nutrition Survey 2018. We used a design-based doubly robust estimate. First, we used propensity score matching (1:1) to identify a subsample equally likely to come from a desired vs. unintended pregnancy based on geographic area, household income, paternal intendedness, the mother's current marital status, age, ethnicity, and educational level, depressive symptoms, and the child's gender and age. Then, we used a logistic regression model to explore the relation of maternal pregnancy intentions with adequate development, as defined by the Early Childhood Development Index (ECDI). While exempt from review by an Institutional Review Board, this secondary research was conducted in accord with prevailing ethical principles. RESULTS Among 1694 observations representing 162,285 Ecuadorian children, unintended pregnancy associated with inadequate development (odds ratio: 1.56; 95% confidence interval: 1.06; 2.29), after adjusting for all relevant confounders. Unintended pregnancy was also negatively associated with all four ECDI domains, socio-emotional development being the most affected. DISCUSSION Our doubly robust design found evidence of the relation between the maternal perception of pregnancy and early child development. Addressing this relation to achieve reproductive justice entails considering a wide spectrum of population health and legal interventions to allow adequate access to education, contraception, and safe abortion. Moreover, pre- and post-natal check-ups could screen for unintended pregnancy and provide support accordingly.
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Affiliation(s)
- Jorge Andrés Delgado-Ron
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - Federico Andrade-Rivas
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
- Instituto de Salud y Ambiente, Universidad el Bosque, Bogotá, Colombia
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15
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van Buuren S, Eekhout I. Child development with the D-score: turning milestones into measurement. Gates Open Res 2022. [DOI: 10.12688/gatesopenres.13222.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The chapter equips the reader with a basic understanding of robust psychometric methods that are needed to turn developmental milestones into measurements, introducing the fundamental issues in defining a unit for child development and demonstrates the relevant quantitative methodology. It reviews quantitative approaches to measuring child development;introduces the Rasch model in a non-technical way;shows how to estimate model parameters from real data;puts forth a set of principles for model evaluation and assessment of scale quality;analyses the relation between early D-scores and later intelligence;and compares the D-scores from three studies that all use the same instrument.
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16
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de Melo NP, de Souza JM, Cordeiro SM, Veríssimo MDLÓR. Clinical validation of the nursing diagnosis "Risk for delayed child development". Rev Esc Enferm USP 2022; 56:e20220229. [PMID: 36541418 PMCID: PMC10081643 DOI: 10.1590/1980-220x-reeusp-2022-0229en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/15/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To validate clinically the risk factors of the nursing diagnosis "Risk for delayed child development". METHOD Cross-sectional quantitative study carried out in a specialty outpatient clinic and in family health units with 124 children. The data was collected through interviews with the children's guardians to investigate the risk factors for delay in child development. RESULTS The tested risk factors affected 108 of the evaluated children (87.1%). In the accuracy tests, most specificity values were above 80% and sensitivity values were lower than 30%. Most risk factors had odds ratio >1, three of which were noteworthy: genetic disorder (OR = 38, p < 0.05) and congenital disorder (OR = 4.4, p < 0.05), among child-related aspects, and impaired cognitive development in parents (OR = 27, p < 0.05), among caregiver-related aspects. CONCLUSION The study contributed to a refined diagnostic accuracy, identifying potential associated factors of the evaluated diagnosis.
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17
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Obradović J, Finch JE, Connolly C, Siyal S, Yousafzai AK. The unique relevance of executive functions and self-regulation behaviors for understanding early childhood experiences and preschoolers' outcomes in rural Pakistan. Dev Sci 2022; 25:e13271. [PMID: 35561073 DOI: 10.1111/desc.13271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 04/13/2022] [Accepted: 04/07/2022] [Indexed: 01/13/2023]
Abstract
Performance-based measures of children's executive functions (EFs) do not capture children's application of these skills during everyday emotionally-laden and socially-mediated interactions. The current study demonstrates the value of using assessor report of self-regulation behaviors (inhibitory control and positive affect/engagement) in addition to EF tasks when studying early childhood experiences and development in a rural lower-middle-income country setting. In a sample of 1302 disadvantaged 4-year-olds living in rural Pakistan, we found that directly assessed EFs were significantly related to assessor observations of children's inhibitory control and positive affect/engagement during a structured assessment protocol. However, EFs and two types of self-regulation behaviors demonstrated unique associations with children's (1) contextual experiences, as indexed by family socio-economic resources, participation in parenting interventions, and children's physical growth; and (2) age-salient developmental outcomes, as indexed by direct assessment of pre-academic skills and maternal report of prosocial behaviors and behavior problems. First, family wealth uniquely predicted only observed positive affect/engagement, whereas maternal education uniquely predicted only EFs. Second, children's antecedent linear growth was a significant predictor of both EFs and positive affect/engagement, but exposure to an enhanced nutrition intervention during the first 2 years of life and preschoolers' hair cortisol concentration were associated only with observed self-regulation behaviors. Finally, both EFs and observed positive affect/engagement uniquely predicted children's pre-academic skills. In contrast, only assessors' ratings of positive affect/engagement uniquely predicted maternal report of prosocial behaviors and only assessors' ratings of inhibitory control uniquely predicted maternal report of behavioral problems.
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Affiliation(s)
- Jelena Obradović
- Graduate School of Education, Stanford University, Stanford, California, USA
| | - Jenna E Finch
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Catie Connolly
- Graduate School of Education, Stanford University, Stanford, California, USA
| | - Saima Siyal
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.,DREAM Community Development and Research Organization, Naushahero Feroze, Pakistan
| | - Aisha K Yousafzai
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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18
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Li X, Li Y, Xing X, Liu Y, Zhou Z, Liu S, Tian Y, Nima Q, Yin L, Yu B. Urban-rural disparities in the association between long-term exposure to high altitude and malnutrition among children under 5 years old: evidence from a cross-sectional study in Tibet. Public Health Nutr 2022; 26:1-10. [PMID: 36098091 PMCID: PMC10131156 DOI: 10.1017/s1368980022001999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 08/05/2022] [Accepted: 08/18/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess urban-rural disparities in the association between long-term exposure to high altitude and malnutrition among children under 5 years old. DESIGN A three-stage, stratified, cluster sampling was used to randomly select eligible individuals from July to October 2020. The data of participants, including demographic characteristics, altitude of residence, and nutritional status, were collected via questionnaire and physical examination. SETTING Tibet, China. PARTICIPANTS Children under 5 years old in Tibet. RESULTS Totally, 1975 children under 5 years old were included in this study. We found that an additional 1000 m increase in altitude was associated with decreased Z-scores of height-for-age (β = -0·23, 95 % CI: -0·38, -0·08), Z-scores of weight-for-age (β = -0·24, 95 % CI: -0·39, -0·10). The OR for stunting and underweight were 2·03 (95 % CI: 1·51 to 2·73) and 2·04 (95 % CI: 1·38 to 3·02) per 1000 m increase in altitude, respectively; and OR increased rapidly at an altitude above 3500 m. The effects of long-term exposure to high altitudes on the prevalence of underweight in rural children were higher than that in urban children (P < 0·05). CONCLUSIONS High-altitude exposure is tightly associated with malnutrition among children under 5 years old. Improving children's nutrition is urgently needed in areas above 3500 m, especially in rural ones.
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Affiliation(s)
- Xianzhi Li
- Meteorological Medical Research Center, Panzhihua Central Hospital, Panzhihua, People’s Republic of China
- Clinical Research Center, Panzhihua Central Hospital, Panzhihua, People’s Republic of China
| | - Yajie Li
- Tibet Center for Disease Control and Prevention, Lhasa, People’s Republic of China
| | - Xiangyi Xing
- Meteorological Medical Research Center, Panzhihua Central Hospital, Panzhihua, People’s Republic of China
- Department of Pharmacy, Panzhihua Central Hospital, Panzhihua, People’s Republic of China
| | - Yu Liu
- Chongqing Center for Disease Control and Prevention, Chongqing, People’s Republic of China
| | - Zonglei Zhou
- Department of Epidemiology, School of Public Health, Fudan University, People’s Republic of China
| | - Shunjin Liu
- Meteorological Medical Research Center, Panzhihua Central Hospital, Panzhihua, People’s Republic of China
- Clinical Research Center, Panzhihua Central Hospital, Panzhihua, People’s Republic of China
| | - Yunyun Tian
- Clinical Research Center, Panzhihua Central Hospital, Panzhihua, People’s Republic of China
| | - Qucuo Nima
- Tibet Center for Disease Control and Prevention, Lhasa, People’s Republic of China
| | - Li Yin
- Meteorological Medical Research Center, Panzhihua Central Hospital, Panzhihua, People’s Republic of China
- Clinical Research Center, Panzhihua Central Hospital, Panzhihua, People’s Republic of China
| | - Bin Yu
- Institute for Disaster Management and Reconstruction, Sichuan University – Hong Kong Polytechnic University, Chengdu, People’s Republic of China
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, People’s Republic of China
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Topothai T, Suphanchaimat R, Topothai C, Tangcharoensathien V, Cetthakrikul N, Waleewong O. Thailand Achievement of SDG Indicator 4.2.1 on Early Child Development: An Analysis of the 2019 Multiple Indicator Cluster Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137599. [PMID: 35805256 PMCID: PMC9265658 DOI: 10.3390/ijerph19137599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/15/2022] [Accepted: 06/20/2022] [Indexed: 02/06/2023]
Abstract
The early years of a child’s life are the foundation for their future capability development. Poor health, hunger, poverty, low parental education, lack of parental interaction, high screen time, and poor housing environment hamper their development. There is little evidence of a link between early child development (ECD) and sociodemographic factors in Thailand. In response to monitoring the achievement of SDG target 4.2.1 (the proportion of young children who are developmentally on track in health, learning and psychosocial well-being) as required by all UN Member States, this study analyses the prevalence of appropriate levels of ECD and its correlates of Thai children aged 3 to 4 years. A cross-sectional study of the 6th Multiple Indicator Cluster Survey (MICS) data in 2019 conducted by the National Statistical Office was employed. Face-to-face interviews with mothers and/or legal guardians were conducted. A total of 5787 children aged 3 to 4 were enrolled in this study. The majority of participants, approximately 92.3%, had achieved an appropriate level of ECD index, defined as children who were developmentally on track in at least three out of these four domains: cognitive, physical, social, and learning. Multivariate logistic regression showed that girls had a higher appropriate development index than boys (Adjusted Odds Ratio [AOR] = 1.56, 95% Confidence Interval [95% CI] 1.28–1.90; children living in the 5th wealth quintile had a higher appropriate index than those in a less well-off family the first wealth quintile (AOR = 2.92, 95% CI: 1.86–4.58. Univariate logistic regression showed children living with parents achieving post-secondary education had a significantly greater appropriate index than children living with parents completing secondary education or below (Crude OR = 1.95, 95% CI 1.47–2.58); children who had appropriate parental interactions of more than four out of six interactions, had a significantly higher chance of having an appropriate index than less than four interactions (Crude OR = 1.52, 95% CI 1.14–2.04). Multi-sectoral policies to support child development in low socio-economic households should be strengthened. In addition, family and community should promote parental interactions through reading and playing with young children. Future studies which directly measure ECD in conjunction with regular monitoring through MICS are recommended.
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Affiliation(s)
- Thitikorn Topothai
- International Health Policy Program, Ministry of Public Health, Nonthaburi 11000, Thailand; (R.S.); (C.T.); (V.T.); (N.C.); (O.W.)
- Division of Physical Activity and Health, Department of Health, Ministry of Public Health, Nonthaburi 11000, Thailand
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore
- Correspondence: ; Tel.: +66-2590-2366
| | - Rapeepong Suphanchaimat
- International Health Policy Program, Ministry of Public Health, Nonthaburi 11000, Thailand; (R.S.); (C.T.); (V.T.); (N.C.); (O.W.)
- Division of Epidemiology, Department of Disease Control, Ministry of Public Health, Nonthaburi 11000, Thailand
| | - Chompoonut Topothai
- International Health Policy Program, Ministry of Public Health, Nonthaburi 11000, Thailand; (R.S.); (C.T.); (V.T.); (N.C.); (O.W.)
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore
- Bureau of Health Promotion, Department of Health, Ministry of Public Health, Nonthaburi 11000, Thailand
| | - Viroj Tangcharoensathien
- International Health Policy Program, Ministry of Public Health, Nonthaburi 11000, Thailand; (R.S.); (C.T.); (V.T.); (N.C.); (O.W.)
| | - Nisachol Cetthakrikul
- International Health Policy Program, Ministry of Public Health, Nonthaburi 11000, Thailand; (R.S.); (C.T.); (V.T.); (N.C.); (O.W.)
| | - Orratai Waleewong
- International Health Policy Program, Ministry of Public Health, Nonthaburi 11000, Thailand; (R.S.); (C.T.); (V.T.); (N.C.); (O.W.)
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Gansaonré RJ, Moore L, Bleau LP, Kobiané JF, Haddad S. Stunting, age at school entry and academic performance in developing countries: A systematic review and meta-analysis. Acta Paediatr 2022; 111:1853-1861. [PMID: 35691004 DOI: 10.1111/apa.16449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 05/12/2022] [Accepted: 06/09/2022] [Indexed: 11/30/2022]
Abstract
AIM To review evidence of the effects of stunting, or height-for-age, on schooling level and schooling trajectories, defined as the combination of school entry age, grade repetition, and dropouts. METHODS We conducted a systematic review of studies (last update March 20, 2021) that assessed the association between stunting, or height-for-age, and at least one component of school trajectory using five databases (PubMed, Embase, Education Resources Information Center (ERIC), Web of Science and PsycINFO). Two independent reviewers performed study selection and data extraction. Pooled effects were calculated using the generic inverse variance weighting random effect model. The risk of bias was assessed using the ROBINS-I tool. PROSPERO ID CRD42020198346. RESULTS We screened 3944 articles and 16 were eligible for the qualitative and quantitative synthesis. Meta-analysis showed that an increase in height-for-age leads to an increase in early enrollment [OR=1.34 (95% CI, 1.07-1.67)], a reduction in late enrollment [OR=0.63 (95% CI, 0.51-0.78)], an increase in schooling level [MD=0.24 (95% CI, 0.14-0.34)], and a reduction of school overage [OR=0.79 (95% CI, 0.70-0.90)]. Stunted children were more likely to repeat a grade than non-stunted [OR=1.59 (95% CI, 1.18-2.14). CONCLUSION This review suggests that stunting in childhood might negatively affect school trajectories. Future research should evaluate the effect of stunting on school trajectories and the modification effect of socioeconomic status.
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Affiliation(s)
- Rabi Joël Gansaonré
- Département de Médecine Sociale et Préventive, Faculté de Médecine, Université Laval, Québec, QC, Canada
| | - Lynne Moore
- Département de Médecine Sociale et Préventive, Faculté de Médecine, Université Laval, Québec, QC, Canada.,Axe Santé des Populations et Pratiques Optimales en Santé, Traumatologie-Urgence-Soins intensifs, Centre de Recherche du CHU de Québec - Université Laval (Hôpital de l'Enfant-Jésus), Université Laval, Québec, QC, Canada
| | - Louis-Philippe Bleau
- VITAM - Centre de recherche en santé durable de l'Université Laval, Québec, QC, Canada
| | - Jean-François Kobiané
- Institut Supérieur des Sciences de la Population, Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Slim Haddad
- Département de Médecine Sociale et Préventive, Faculté de Médecine, Université Laval, Québec, QC, Canada
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21
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Broadbent E, McConkie M, Aleson E, Kim L, Stewart R, Mulokozi G, Dearden KA, Linehan M, Cherian D, Torres S, Crookston BT, Hall PC, West JH. Promoting Caregiver Early Childhood Development Behaviors through Social and Behavioral Change Communication Program in Tanzania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095149. [PMID: 35564545 PMCID: PMC9103222 DOI: 10.3390/ijerph19095149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/15/2022] [Accepted: 04/20/2022] [Indexed: 12/04/2022]
Abstract
Objectives: Stunting remains a prevalent issue in Tanzania. The consequences of stunting include reduced height, greater susceptibility to disease, and diminished cognitive ability throughout the lifespan. Lack of psychosocial stimulation is associated with increased stunting, particularly in terms of its cognitive impact. The Addressing Stunting in Tanzania Early (ASTUTE) program was a large social and behavior change communication (SBCC) intervention that aimed to reduce childhood stunting in the region by targeting early childhood development (ECD) behaviors. The purpose of this study is to report on the extent to which exposure to ASTUTE might be related to ECD behaviors. Methods: ASTUTE disseminated program messages via a mass media campaign and interpersonal communication (IPC). Logistic regression models were used to explore the relationship between exposure to TV, radio, IPC messages, and key ECD behaviors of female primary caregivers and male heads of household. Results: Among primary caregivers, IPC was positively associated with all ECD behaviors measured. Radio was associated with all behaviors except drawing with their child. TV was associated with all behaviors except playing with their child. Among heads of household, only the radio was positively associated with the ECD behaviors measured. Conclusions for practice: Findings indicate that SBCC interventions that include mass media and IPC components may be effective at promoting parental engagement in ECD behaviors. Significance: We know that ECD is important for a child’s development. We know that parents play a critical role in promoting ECD behaviors. We are still exploring ways to influence parents so that they are more involved in ECD behaviors. The results presented here provide evidence for successful mass media and IPC efforts to improve parents’ ECD behaviors. We hope this study will add more evidence for large interventions such as these to the literature, and we are very hopeful that governments and large international NGOs will prioritize SBCC approaches in the future, especially in locations where face-to-face interventions may be challenging.
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Affiliation(s)
- Eliza Broadbent
- Department of Public Health, Brigham Young University, Provo, UT 84602, USA; (E.B.); (M.M.); (E.A.); (L.K.); (R.S.); (B.T.C.); (P.C.H.)
| | - McKayla McConkie
- Department of Public Health, Brigham Young University, Provo, UT 84602, USA; (E.B.); (M.M.); (E.A.); (L.K.); (R.S.); (B.T.C.); (P.C.H.)
| | - Emily Aleson
- Department of Public Health, Brigham Young University, Provo, UT 84602, USA; (E.B.); (M.M.); (E.A.); (L.K.); (R.S.); (B.T.C.); (P.C.H.)
| | - Lily Kim
- Department of Public Health, Brigham Young University, Provo, UT 84602, USA; (E.B.); (M.M.); (E.A.); (L.K.); (R.S.); (B.T.C.); (P.C.H.)
| | - Rebekah Stewart
- Department of Public Health, Brigham Young University, Provo, UT 84602, USA; (E.B.); (M.M.); (E.A.); (L.K.); (R.S.); (B.T.C.); (P.C.H.)
| | | | - Kirk A. Dearden
- Corus International, Washington, DC 20036, USA; (K.A.D.); (M.L.); (D.C.)
| | - Mary Linehan
- Corus International, Washington, DC 20036, USA; (K.A.D.); (M.L.); (D.C.)
| | - Dennis Cherian
- Corus International, Washington, DC 20036, USA; (K.A.D.); (M.L.); (D.C.)
| | | | - Ben T. Crookston
- Department of Public Health, Brigham Young University, Provo, UT 84602, USA; (E.B.); (M.M.); (E.A.); (L.K.); (R.S.); (B.T.C.); (P.C.H.)
| | - Parley C. Hall
- Department of Public Health, Brigham Young University, Provo, UT 84602, USA; (E.B.); (M.M.); (E.A.); (L.K.); (R.S.); (B.T.C.); (P.C.H.)
| | - Joshua H. West
- Department of Public Health, Brigham Young University, Provo, UT 84602, USA; (E.B.); (M.M.); (E.A.); (L.K.); (R.S.); (B.T.C.); (P.C.H.)
- Correspondence: ; Tel.: +1-801-422-3444
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Klemm GC, Kayanda R, Kazoba A, McCann J, Nnally LP, Dickin KL. Translating Multisectoral Nutrition Policy into Community Practice: Participation of Nutrition Officers in Tanzania Fosters Effective Collaborative Strategies to Improve Child Nutrition. Curr Dev Nutr 2022; 6:nzac030. [PMID: 35415387 PMCID: PMC8992576 DOI: 10.1093/cdn/nzac030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/28/2022] [Accepted: 02/23/2022] [Indexed: 11/24/2022] Open
Abstract
Background Globally, multisectoral coordination for nutrition is needed to tackle multiple determinants of undernutrition and address unacceptably high rates of stunting in young children. Tanzania has strong national policies and implementation plans to strengthen multisectoral nutrition (MSN) governance, yet local actors must transcend sector silos to fully implement MSN actions in communities. Objectives We engaged with Nutrition Officers in Regional Secretariats and District Councils to explore strategies, barriers, and facilitators for creating novel "MSN action teams." Methods An initial "Learning Exchange" workshop gathered input from nutrition staff in 5 regions and invited their participation in mentoring and supporting MSN collaboration. Regional Nutrition Officers piloted action teams in their districts, supporting District Nutrition Officers to create teams of 3-4 officers from relevant sectors (agriculture, community development, health, education) to plan and implement community-based activities consistent with sector priorities and national policy. To learn from stakeholder experiences, longitudinal data were collected through individual semistructured interviews and documentation of activities; 27 officers were interviewed 1-4 times over 14 mo. Results Four districts successfully created action teams that bridged communication gaps between administrators and implementors; made progress on advocacy, collaboration, and budgeting for nutrition; and initiated MSN implementation in communities. Participants identified strategies to overcome challenges to cross-sector collaboration including heavy workloads and limited resources and supervisor buy-in. Based on their experiences and innovations in creating MSN action teams, stakeholders shared valuable recommendations for peer learning across sectors to scale up MSN collaboration. Officers' presentation of insights to regional and district leaders buoyed interest in MSN action teams as a feasible and acceptable approach to strengthen local governance and implementation to improve child nutrition. Conclusions Experience-based input from government officers engaged in novel community and intersectoral collaborations provided actionable guidance for putting national MSN policy into practice and leveraging the capacity of implementation staff.
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Affiliation(s)
- Gina C Klemm
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | | | | | - Juliet McCann
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Luitfrid P Nnally
- Tanzania Food and Nutrition Centre, Ministry of Health, Community Development, Gender, Elderly, and Children, Dar es Salaam, Tanzania
| | - Katherine L Dickin
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
- Department of Public and Ecosystem Health, Cornell University, Ithaca, NY, USA
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Chandwe K, Zyambo K, Mulenga C, Haritunians T, Amadi B, Kosek M, Heimburger DC, McGovern D, Kelly P. Histo-Blood Group Antigens, Enteropathogen Carriage and Environmental Enteropathy in Stunted Zambian Children. J Pediatr Gastroenterol Nutr 2022; 74:529-534. [PMID: 34724448 PMCID: PMC9046470 DOI: 10.1097/mpg.0000000000003343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Stunting, the most common form of childhood undernutrition, is associated with environmental enteropathy (EE). Enteric infections are believed to play a role in the pathophysiology of EE and stunting though the exact mechanism remains undetermined. The FUT2 (secretor) and FUT3 (Lewis) genes have been shown to be associated with some symptomatic enteric infections in both children and adults. These genes are responsible for the presence of histo-blood group antigens (HBGAs) in various secretions and epithelial surfaces.We evaluated whether the secretor and Lewis status influences asymptomatic enteric infections and thus EE severity on duodenal biopsies of stunted children. METHODS In this case-control study, we used saliva samples to determine the secretor and Lewis status of stunted children (cases, n = 113) enrolled in a nutritional rehabilitation program and from their well-nourished counterparts (controls, n = 42). Where available, saliva was also collected from the mothers. Baseline stool samples were used to detect asymptomatic enteropathogen carriage. Duodenal biopsies were collected from a subgroup of stunted children (n = 77) who had an upper gastrointestinal endoscopy done as part of the evaluation process for their non-response to nutritional therapy. RESULTS The proportion of secretors was similar between the cases and the controls (82% vs 81%, P = 0.81). The stunted children had significantly higher rates of carrying multiple enteropathogens, but this was not associated with their secretor status nor that of their mothers. The secretor status was also not associated with mucosal morphometry of duodenal biopsies. CONCLUSION This case-control analysis in Zambian children does not support the hypothesis that fucosylation status determines asymptomatic enteropathogen carriage in stunting.
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Affiliation(s)
- Kanta Chandwe
- University of Zambia School of Medicine, Lusaka, Zambia
- Tropical Gastroenterology & Nutrition group, Lusaka, Zambia
| | - Kanekwa Zyambo
- Tropical Gastroenterology & Nutrition group, Lusaka, Zambia
| | - Chola Mulenga
- Tropical Gastroenterology & Nutrition group, Lusaka, Zambia
| | - Talin Haritunians
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Beatrice Amadi
- University of Zambia School of Medicine, Lusaka, Zambia
- Tropical Gastroenterology & Nutrition group, Lusaka, Zambia
| | | | - Douglas C. Heimburger
- University of Zambia School of Medicine, Lusaka, Zambia
- Vanderbilt University Medical Center
| | - Dermot McGovern
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Paul Kelly
- Tropical Gastroenterology & Nutrition group, Lusaka, Zambia
- Queen Mary University of London, London, UK
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Shrestha ML, Perry KE, Thapa B, Adhikari RP, Weissman A. Malnutrition matters: Association of stunting and underweight with early childhood development indicators in Nepal. MATERNAL & CHILD NUTRITION 2022; 18:e13321. [PMID: 35050554 PMCID: PMC8932687 DOI: 10.1111/mcn.13321] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 12/19/2021] [Accepted: 01/04/2022] [Indexed: 11/28/2022]
Abstract
Malnutrition is a threat to optimal child development, with its occurrence during foetal and infancy stages associated with poor cognitive, motor and socio‐emotional skills. However, information on the effects of various types of malnutrition on early childhood development (ECD) is limited in Nepal. To assess the association of stunting, wasting and underweight (three prominent forms of malnutrition) with the four domains of the ECD index (literacy‐numeracy, physical, social‐emotional and learning development) among children 36–59 months of age, we conducted an adjusted logistic regression using Nepal's national household Multiple Indicator Cluster Survey (MICS) 2019 data set. The study sample consisted of children aged 36–59 months (n = 2871). Children were considered developmentally on track if they met criteria in each of the four ECD domains. Regarding ECD status of children 36–59 months old, 35% of children were not developmentally on track for the ECD index. The adjusted odds ratio indicated that stunting was associated with lower odds of not being developmentally on track according to the ECD index as well as the literacy‐numeracy, physical and learning domains of the ECD index. Likewise, underweight was associated with lower odds of not being developmentally on track according to the ECD index, primarily for ECD domains of literacy‐numeracy, physical and learning. Notably, no association between wasting and ECD indicators was observed. Children's nutrition status impacts child development outcomes. Adding ECD interventions, such as responsive and stimulating caregiving, within nutrition programmes among children who are stunted and underweight could improve child development outcomes. In Nepal, 35% of children in our data set did not display optimal early childhood development (ECD). Children who are malnourished, especially indicating signs of stunting and underweight, are likely to exhibit poor ECD indicators and may have limited cognitive capabilities in adulthood. Wasting demonstrated no notable association with ECD indicators. Study findings suggest that ECD interventions among children who are stunted and underweight could support optimal childhood development globally. Establishing partnerships between nutrition and ECD sectors to adopt the Nurturing Care Framework, especially targeting the first 5 years of life, would contribute to childhood development efforts.
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Affiliation(s)
| | | | | | | | - Amy Weissman
- FHI 360 Asia Pacific Regional Office Bangkok Thailand
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25
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Donkor WES, Mbai J, Sesay F, Ali SI, Woodruff BA, Hussein SM, Mohamud KM, Muse A, Mohamed WS, Mohamoud AM, Mohamud FM, Petry N, Galvin M, Wegmüller R, Rohner F, Katambo Y, Wirth JP. Risk factors of stunting and wasting in Somali pre-school age children: results from the 2019 Somalia micronutrient survey. BMC Public Health 2022; 22:264. [PMID: 35139826 PMCID: PMC8827289 DOI: 10.1186/s12889-021-12439-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 12/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stunting and wasting in children less than 5 years of age are two key indicators of child malnutrition. Reducing their prevalence is a priority of the global public health community and for Somalia, a country suffering complex humanitarian emergencies such as drought, flooding, conflict and large-scale displacements. METHODS Data from the nationally representative cross-sectional Somalia Micronutrient Survey (SMS 2019) on 1947 children were analyzed to assess the prevalence and potential risk factors of stunting and wasting. Bivariate and multivariable analyses were conducted separately for children 0-5 months and 6-59 months, and population attributable fractions were calculated using adjusted risk ratios produced by Poisson regression models. RESULTS Among the 1947 children, the prevalence of stunting and wasting were 17.2% (95% CI: 15.0, 19.6) and 11.0% (95% CI: 9.3, 12.9), respectively. Among children 6-59 months of age, those residing in severely food insecure households had a higher risk of stunting (adjusted risk ratio [aRR] 1.47; CI: 1.12, 1.93) compared to those in food secure households. This risk of stunting was also higher in children with inflammation (aRR 1.75; CI: 1.35, 2.25) and iron deficiency (ID) (aRR 2.09; CI: 1.58, 2.80). For wasting, a dose-response relationship was found with household wealth, with the risk of wasting increasing significantly as the household wealth quintile decreased. On the other hand, the risk of wasting was lower in iron-deficient children (aRR 0.69; CI: 0.49, 0.98) than in iron-replete children. Among children 0-5 months of age no variables remained statistically significantly associated with stunting in the multivariable analysis. Wasting, however, was more common in children with recent diarrhea (aRR 3.51; CI: 1.68, 7.36). CONCLUSIONS Nutritional status of children in Somalia may be improved by prevention of diarrhea and other infections and improvements in household food security.
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Affiliation(s)
| | | | | | | | | | | | | | - Ahmed Muse
- Department of Nutrition, Ministry of Health, Hargeisa, Somaliland
| | | | | | | | - Nicolai Petry
- GroundWork, Hintergasse 1, 7306, Fläsch, Switzerland
| | | | | | - Fabian Rohner
- GroundWork, Hintergasse 1, 7306, Fläsch, Switzerland
| | | | - James P Wirth
- GroundWork, Hintergasse 1, 7306, Fläsch, Switzerland.
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Stop Not Till The Goal Is Reached. Indian Pediatr 2022. [DOI: 10.1007/s13312-022-2411-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Bach AM, Xie W, Piazzoli L, Jensen SKG, Afreen S, Haque R, Petri WA, Nelson CA. Systemic inflammation during the first year of life is associated with brain functional connectivity and future cognitive outcomes. Dev Cogn Neurosci 2022; 53:101041. [PMID: 34973509 PMCID: PMC8728426 DOI: 10.1016/j.dcn.2021.101041] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 10/09/2021] [Accepted: 11/27/2021] [Indexed: 01/01/2023] Open
Abstract
The first years of life are a sensitive period of rapid neural and immune system development vulnerable to the impact of adverse experiences. Several studies support inflammation as a consequence of various adversities and an exposure negatively associated with developmental outcomes. The mechanism by which systemic inflammation may affect brain development and later cognitive outcomes remains unclear. In this longitudinal cohort study, we examine the associations between recurrent systemic inflammation, defined as C-reactive protein elevation on ≥ 2 of 4 measurements across the first year of life, electroencephalography (EEG) functional connectivity (FC) at 36 months, and composite cognitive outcomes at 3, 4, and 5 years among 122 children living in a limited-resource setting in Dhaka, Bangladesh. Recurrent systemic inflammation during the first year of life is significantly negatively associated with cognitive outcomes at 3, 4, and 5 years, after accounting for stunting and family care indicators (a measure of stimulation in the home environment). Recurrent systemic inflammation is significantly positively associated with parietal-occipital FC in the Beta band at 36 months, which in turn is significantly negatively associated with composite cognitive scores at 3 and 4 years. However, FC does not mediate the relationship between recurrent systemic inflammation and cognitive outcomes.
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Affiliation(s)
- Ashley M Bach
- Labs of Cognitive Neuroscience, Division of Developmental Medicine, Boston Children's Hospital, USA; Harvard T.H. Chan School of Public Health, USA
| | - Wanze Xie
- School of Psychological and Cognitive Sciences, Peking University, China; PKU-IDG/McGovern Institute for Brain Research, Peking University, China; Beijing Key Laboratory of Behavior and Mental Health, Peking University, China
| | - Laura Piazzoli
- Labs of Cognitive Neuroscience, Division of Developmental Medicine, Boston Children's Hospital, USA; Harvard Medical School, USA
| | | | - Sajia Afreen
- International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Rashidul Haque
- International Centre for Diarrhoeal Disease Research, Bangladesh
| | - William A Petri
- Division of Infectious Diseases, University of Virginia School of Medicine, USA
| | - Charles A Nelson
- Labs of Cognitive Neuroscience, Division of Developmental Medicine, Boston Children's Hospital, USA; Harvard Medical School, USA; Harvard Graduate School of Education, USA.
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Comley-White N, Potterton J, Ntsiea V. The physical sequelae of growing into adolescence with perinatally acquired HIV: a scoping review. PHYSICAL THERAPY REVIEWS 2022. [DOI: 10.1080/10833196.2022.2026009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Nicolette Comley-White
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Joanne Potterton
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Veronica Ntsiea
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Melo NPD, Souza JMD, Cordeiro SM, Veríssimo MDLÓR. Validação clínica do diagnóstico de enfermagem “Risco de atraso no desenvolvimento infantil”. Rev Esc Enferm USP 2022. [DOI: 10.1590/1980-220x-reeusp-2022-0229pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
RESUMO Objetivo: Realizar a validação clínica dos fatores de risco do diagnóstico de Enfermagem “Risco de atraso no desenvolvimento infantil”. Método: Estudo transversal, de abordagem quantitativa, realizado em um ambulatório de especialidades e em unidades de saúde da família, com 124 crianças. A coleta de dados ocorreu por meio de entrevistas com os responsáveis pelas crianças e investigou os fatores de risco para atraso no desenvolvimento infantil. Resultados: Os fatores de risco sob teste estiveram presentes em 108 crianças avaliadas (87,1%). Nos testes de acurácia, a maioria dos valores de especificidade foi acima de 80%, e os de sensibilidade, inferiores a 30%. A maioria dos fatores de risco teve odds ratio >1, com destaque para três: distúrbio genético (OR = 38, p < 0,05) e distúrbio congênito (OR = 4,4, p < 0,05), entre os aspectos relativos à criança, e o desenvolvimento cognitivo dos pais prejudicado (OR = 27, p < 0,05), entre os aspectos dos cuidadores. Conclusão O estudo contribuiu para o refinamento da acurácia diagnóstica, identificando fatores potencialmente associados ao diagnóstico avaliado.
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Segoviano-Lorenzo MDC, Trigo-Esteban E, Gyorkos TW, St-Denis K, Guzmán FMD, Casapía-Morales M. Prevalence of malnutrition, anemia, and soil-transmitted helminthiasis in preschool-age children living in peri-urban populations in the Peruvian Amazon. CAD SAUDE PUBLICA 2022; 38:e00248221. [DOI: 10.1590/0102-311xen248221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 10/06/2022] [Indexed: 12/23/2022] Open
Abstract
Stunting, anemia, and soil-transmitted helminth (STH) infections are major health concerns for children in extremely poor regions of the world, especially rural and periurban ones. This study aimed to determine the prevalence of these three cooccurring conditions in preschool-age children in an extremely poor district on the outskirts of Iquitos, in the Peruvian Amazon, to inform public health actions. Malnutrition was assessed by standard World Health Organization-recommended metrics; anemia, by hemoglobin levels; and STH, by the Kato-Katz technique. Logistic regression analyses were performed to identify the risk factors for our three outcomes of interest. A total of 572 children aged 6-59 months were recruited in March 2019. We found a 31.3% stunting, 47.2% anemia, and 34.1% STH prevalence. Stunting and anemia figures exceeded both regional and national estimates for 2019. Having more children was a risk factor for stunting, whereas married mothers were associated with a lower risk. Risk factors for anemia included younger age and the male sex, whereas those for STH, older age, incomplete vaccination, and a lower socioeconomic status. Mothers’ employment outside the home was also associated with a lower STH risk. This recent evidence highlights the need for prompt and integrated clinical attention and public health actions to address both short- and long-term health consequences in this vulnerable child age group. The integration of a monitoring and evaluation framework is important to effectively manage these conditions, optimize resources and accountability, and show their impact.
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Affiliation(s)
| | | | | | - Kariane St-Denis
- Research Institute of the McGill University Health Centre, Canada
| | | | - Martín Casapía-Morales
- Asociación Civil Selva Amazónica, Perú; Universidad Nacional de la Amazonia Peruana, Peru
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Sanchez-Alonso S, Aslin RN. Towards a model of language neurobiology in early development. BRAIN AND LANGUAGE 2022; 224:105047. [PMID: 34894429 DOI: 10.1016/j.bandl.2021.105047] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 10/24/2021] [Accepted: 10/27/2021] [Indexed: 06/14/2023]
Abstract
Understanding language neurobiology in early childhood is essential for characterizing the developmental structural and functional changes that lead to the mature adult language network. In the last two decades, the field of language neurodevelopment has received increasing attention, particularly given the rapid advances in the implementation of neuroimaging techniques and analytic approaches that allow detailed investigations into the developing brain across a variety of cognitive domains. These methodological and analytical advances hold the promise of developing early markers of language outcomes that allow diagnosis and clinical interventions at the earliest stages of development. Here, we argue that findings in language neurobiology need to be integrated within an approach that captures the dynamic nature and inherent variability that characterizes the developing brain and the interplay between behavior and (structural and functional) neural patterns. Accordingly, we describe a framework for understanding language neurobiology in early development, which minimally requires an explicit characterization of the following core domains: i) computations underlying language learning mechanisms, ii) developmental patterns of change across neural and behavioral measures, iii) environmental variables that reinforce language learning (e.g., the social context), and iv) brain maturational constraints for optimal neural plasticity, which determine the infant's sensitivity to learning from the environment. We discuss each of these domains in the context of recent behavioral and neuroimaging findings and consider the need for quantitatively modeling two main sources of variation: individual differences or trait-like patterns of variation and within-subject differences or state-like patterns of variation. The goal is to enable models that allow prediction of language outcomes from neural measures that take into account these two types of variation. Finally, we examine how future methodological approaches would benefit from the inclusion of more ecologically valid paradigms that complement and allow generalization of traditional controlled laboratory methods.
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Affiliation(s)
| | - Richard N Aslin
- Haskins Laboratories, New Haven, CT, USA; Department of Psychology, Yale University, New Haven, CT, USA; Child Study Center, Yale University, New Haven, CT, USA.
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Cusick SE, Barks A, Georgieff MK. Nutrition and Brain Development. Curr Top Behav Neurosci 2022; 53:131-165. [PMID: 34622395 DOI: 10.1007/7854_2021_244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
All nutrients are essential for brain development, but pre-clinical and clinical studies have revealed sensitive periods of brain development during which key nutrients are critical. An understanding of these nutrient-specific sensitive periods and the accompanying brain regions or processes that are developing can guide effective nutrition interventions as well as the choice of meaningful circuit-specific neurobehavioral tests to best determine outcome. For several nutrients including protein, iron, iodine, and choline, pre-clinical and clinical studies align to identify the same sensitive periods, while for other nutrients, such as long-chain polyunsaturated fatty acids, zinc, and vitamin D, pre-clinical models demonstrate benefit which is not consistently shown in clinical studies. This discordance of pre-clinical and clinical results is potentially due to key differences in the timing, dose, and/or duration of the nutritional intervention as well as the pre-existing nutritional status of the target population. In general, however, the optimal window of success for nutritional intervention to best support brain development is in late fetal and early postnatal life. Lack of essential nutrients during these times can lead to long-lasting dysfunction and significant loss of developmental potential.
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Affiliation(s)
- Sarah E Cusick
- Department of Pediatrics, University of Minnesota School of Medicine, Minneapolis, MN, USA.
| | - Amanda Barks
- University of Minnesota Medical School, Minneapolis, MN, USA
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Oumer A, Fikre Z, Girum T, Bedewi J, Nuriye K, Assefa K. Stunting and Underweight, but not Wasting are Associated with Delay in Child Development in Southwest Ethiopia. Pediatric Health Med Ther 2022; 13:1-12. [PMID: 35046749 PMCID: PMC8761030 DOI: 10.2147/phmt.s344715] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 12/16/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Abdu Oumer
- Department of Public Health, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
- Correspondence: Abdu Oumer Department of Public Health, College of Medicine and Health Sciences, Wolkite University, Wolkite, EthiopiaTel +251 966365785 Email
| | - Zinash Fikre
- Department of Public Health, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Tadele Girum
- Department of Public Health, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Jemal Bedewi
- Department of Public Health, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Keyredin Nuriye
- Department of Midwifery, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Kenzudin Assefa
- Department of Public Health, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
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Pizzol D, Tudor F, Racalbuto V, Bertoldo A, Veronese N, Smith L. Systematic review and meta-analysis found that malnutrition was associated with poor cognitive development. Acta Paediatr 2021; 110:2704-2710. [PMID: 34077582 DOI: 10.1111/apa.15964] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/25/2021] [Accepted: 05/31/2021] [Indexed: 12/23/2022]
Abstract
AIM Malnutrition is a major public health issue that has been associated with high susceptibility for impaired brain development and mental functioning. However, to date studies on this topic have not been collated and appraised. This systematic review and meta-analysis investigated the association between malnutrition and cognitive development. METHODS We searched the MEDLINE, Scopus, CINAHL, Embase PsycINFO and Cochrane Library databases in English up to 8 December 2020. All studies reporting an association between nutritional status and cognitive development were included. p values of less than 0.05 were considered statistically significant and the results are reported as standardised mean differences (SMD), 95% confidence intervals (95%) and I2 statistics. RESULTS We included 12 studies comprising 7,607 participants aged 1 to 12 years. Children with malnutrition had worse scores than controls for the Wechsler Intelligence Scale (SMD -0.40; 95% CI -0.60 to -0.20; p < 0.0001; I2 77.1%), the Raven's Coloured Progressive Matrices (SMD -3.75; 95% CI -5.68 to -1.83; p < 0.0001; I2 99.2%), visual processing (SMD -0.85; 95% CI -1.23 to -0.46; p 0.009; I2 11.0%) and short memory (SMD 0.85; 95% CI -1.21 to -0.49; p < 0.0001; I2 0%) tests. CONCLUSION Normal cognitive development requires access to good and safe nutrition.
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Affiliation(s)
- Damiano Pizzol
- Italian Agency for Development Cooperation ‐ Khartoum Khartoum Sudan
| | - Florina Tudor
- Primary Care Department Azienda ULSS 3 Serenissima, Dolo‐Mirano District Dolo‐Mirano Italy
| | | | | | - Nicola Veronese
- Geriatric Unit Department of Internal Medicine and Geriatrics University of Palermo Palermo Italy
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences Anglia Ruskin University Cambridge UK
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Sandler A. The legacy of a standard of normality in child nutrition research. SSM Popul Health 2021; 15:100865. [PMID: 34345645 PMCID: PMC8319510 DOI: 10.1016/j.ssmph.2021.100865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 06/05/2021] [Accepted: 07/03/2021] [Indexed: 12/03/2022] Open
Abstract
Anthropometric evaluation of children is among the most vital and widely used instruments of public health and clinical medicine. Anthropometry is used for establishing norms, identifying variations, and monitoring development. Yet the accurate assessment of physical growth and development of children remains a perpetually beleaguering subject. This paper focuses on the evolution of anthropometry as a science and its associated measurements, indices, indicators, standards, references, and best practices. This paper seeks to clarify aspects of the assessment of child growth, explores the historical trajectory of the study of anthropometry and its contemporary limitations, and contributes to the debate surrounding references and standards, and the applicability of international anthropometric standards to an individual's health. Among its findings is a surprisingly nonlinear and contested record of events, up to and including leading contemporary practices and datasets. It contextualizes the legacy of child malnutrition studies in a broad framework, including the linkage between the early eugenics movement and contemporary notions of a "normal" child, the interpersonal and intuitional competition to become the preeminent child growth authority, the obfuscated distinction between reference growth charts and standards of growth, and the hidden consequences of universal growth standards that no longer reflect any observable populations.
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Affiliation(s)
- Austin Sandler
- Department of Geographical Sciences, University of Maryland, 2181 LeFrak Hall, 7251 Preinkert Dr, College Park, MD, 20740, USA
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Heemann M, Kim R, Vollmer S, Subramanian SV. Assessment of Undernutrition Among Children in 55 Low- and Middle-Income Countries Using Dietary and Anthropometric Measures. JAMA Netw Open 2021; 4:e2120627. [PMID: 34383059 DOI: 10.1001/jamanetworkopen.2021.20627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Evidence on the suitability of anthropometric failure (ie, stunting, underweight, and wasting) as a stand-alone measure of child undernutrition can inform global and national nutrition and health agendas. OBJECTIVE To provide a comprehensive estimate of the prevalence of child undernutrition by evaluating both dietary and anthropometric measures simultaneously across 55 low- and middle-income countries. DESIGN, SETTING, AND PARTICIPANTS This was a cross-sectional study that used Demographic and Health Surveys program data from July 2009 to January 2019, to allocate children into dietary and anthropometric failure categories. Nationally representative household surveys were conducted in 55 low- and middle-income countries. Participants included children aged 6 to 23 months who were born singleton and had valid anthropometric measures as well as available 24-hour food intake recollection. Data analysis was conducted from August 23 to October 22, 2020. EXPOSURES Two factors were considered to allocate children into the respective categories. Dietary failure was based on the World Health Organization standards for minimum dietary diversity. Anthropometric failure was constructed using the World Health Organization child growth reference standard z score for stunted growth, muscle wasting, and less than average weight for age. MAIN OUTCOMES AND MEASURES Dietary and anthropometric failures were cross-tabulated, which yielded 4 potential outcomes: dietary failure only, anthropometric failure only, both failures, and neither failure. Total child populations for each category were extrapolated from United Nations population estimates. RESULTS Of the 162 589 children (median age [range], 14 months [6-23 months]; 83 467 boys [51.3%]; 78 894 Asian children [48.5%]) in our sample, 42.9% of children had dietary failure according to the standard World Health Organization definition without being identified as having anthropometric failures. In all, 34.7% had both failures, 42.9% had dietary failure only, 8.3% had anthropometric failure only, and 14.1% had neither failure. Dietary and anthropometric measures were discordant for 51.2% of children; these children had nutritional needs identified by only 1 of the 2 measures. Dietary failure doubled the proportion of children in need of dietary interventions compared with anthropometry alone (43%). A total of 45.3 million additional children who experienced undernutrition in these 55 countries were not captured through the evaluation of anthropometric failures only. These results were consistent across geographic regions. CONCLUSIONS AND RELEVANCE The results of this cross-sectional study suggest that the current standard of measuring child undernutrition by estimating the prevalence of anthropometric failure should be complemented with dietary and food-based measures. Anthropometry alone may fail to identify many children who have insufficient dietary intake.
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Affiliation(s)
- Markus Heemann
- Department of Development Economics, Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany
| | - Rockli Kim
- Division of Health Policy and Management, Korea University College of Health Science, Seoul, South Korea
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea
- Harvard Center for Population and Development Studies, Cambridge, Massachusetts
| | - Sebastian Vollmer
- Department of Development Economics, Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany
| | - S V Subramanian
- Harvard Center for Population and Development Studies, Cambridge, Massachusetts
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Adair LS, Carba DB, Lee NR, Borja JB. Stunting, IQ, and final school attainment in the Cebu Longitudinal Health and Nutrition Survey birth cohort. ECONOMICS AND HUMAN BIOLOGY 2021; 42:100999. [PMID: 33865193 PMCID: PMC8222184 DOI: 10.1016/j.ehb.2021.100999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 02/27/2021] [Accepted: 03/31/2021] [Indexed: 06/12/2023]
Abstract
School attainment is an important aspect of human capital, and a key determinant of long-term health and well-being. Early life deprivation and poor nutritional status are well known predictors of school entry and progression. We examine the persistence of early life influences and subsequent socioeconomic disadvantage (SED) across the multiple school continuation decisions that lead to final school attainment. Using data from a Philippine birth cohort followed for 35 years, we model 6 continuation decisions: Did not complete elementary school, elementary graduate only (completed grade 6), some secondary schooling, high school graduate, some postsecondary schooling, and college graduate, as well as total years of schooling. We estimate the association of school attainment with early life length for age Z-score (LAZ at 2 years of age) and cognitive development (IQ) as well as underlying indicators of SED and other family influences through early adulthood. The analysis sample includes >1900 participants in the Cebu Longitudinal Health and Nutrition Survey. Females completed, on average, one year more schooling than males, and twice as many females as males were college graduates (29.1 vs 15.0 %). LAZ and one standard deviation of IQ were each independently associated with 0.4 more years of attained schooling. A path model demonstrated strong direct associations of SED with years of schooling as well as indirect associations through LAZ and IQ. Sequential logits used to estimate continuing education decisions show persistent associations of early life LAZ and IQ and schooling even after accounting for changing SED of households over the schooling life course. Filipino parents had high but often unmet educational aspirations for their children because of the child's loss of interest in school and perceived financial barriers. Results further emphasize the importance of early life SED as a key risk factor for suboptimal school attainment.
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Affiliation(s)
- Linda S Adair
- Department of Nutrition, Gillings School of Global Public Health, Carolina Population Center, CB #8120, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, United States.
| | - Delia B Carba
- USC-Office of Population Studies Foundation, Inc., University of San Carlos, Cebu City, Philippines
| | - Nanette R Lee
- USC-Office of Population Studies Foundation, Inc., University of San Carlos, Cebu City, Philippines
| | - Judith B Borja
- USC-Office of Population Studies Foundation, Inc., University of San Carlos, Cebu City, Philippines
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Trends in underweight, stunting, and wasting prevalence and inequality among children under three in Indian states, 1993-2016. Sci Rep 2021; 11:14137. [PMID: 34238988 PMCID: PMC8266817 DOI: 10.1038/s41598-021-93493-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 06/16/2021] [Indexed: 11/09/2022] Open
Abstract
Child undernutrition remains high in India with far-reaching consequences for child health and development. Anthropometry reflects undernutrition. We examined the state-level trends in underweight, stunting, and wasting prevalence and inequality by living standards using four rounds of the National Family Health Surveys in 26 states in India, conducted in 1992–1993, 1998–1999, 2005–2006, and 2015–2016. The average annual reduction (AAR) for underweight ranged from 0.04 percentage points (pp) (95% CI − 0.12, 0.20) in Haryana to 1.05 pp (95% CI 0.88, 1.22) in West Bengal for underweight; 0.35 pp (95% CI 0.11, 0.59) in Manipur to 1.47 (95% CI 1.19, 1.75) in Himachal Pradesh for stunting; and − 0.65 pp (95% CI − 0.77, − 0.52) in Haryana to 0.36 pp (95% CI 0.22, 0.51) in Bihar & Jharkhand for wasting. We find that change in the pp difference between children with the poorest and richest household living standards varied by states: statistically significant decline (increase) was observed in 5 (3) states for underweight, 5 (4) states for stunting, and 2 (1) states for wasting. Prevalence of poor anthropometric outcomes as well as disparities by states and living standards remain a problem in India.
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Webb CM, Morales ML, Lopez M, Baca-Turpo B, Arque E, White AC, Cabada MM. Stunting in pre-school and school-age children in the Peruvian highlands and its association with Fasciola infection and demographic factors. PLoS Negl Trop Dis 2021; 15:e0009519. [PMID: 34153050 PMCID: PMC8248620 DOI: 10.1371/journal.pntd.0009519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 07/01/2021] [Accepted: 05/30/2021] [Indexed: 11/18/2022] Open
Abstract
Fascioliasis is a zoonotic trematode infection that is endemic in the highlands of Peru. Chronic fascioliasis can be asymptomatic and remain undiagnosed for years. Chronic malnutrition in children, as manifested by stunting, leads to delayed cognitive development and lost productivity. We hypothesized that fascioliasis is among the factors associated with stunting in children from endemic areas. We conducted a cross-sectional study among children attending pre-school and school in 26 communities in the Anta province in the Cusco region of Peru. We conducted interviews to collect information on demographic, socioeconomic, and medical history. Blood was collected and tested for complete cell count and FAS2 ELISA for Fasciola antibodies. Three stool samples per participant were tested for parasites by Kato-Katz and Lumbreras rapid sedimentation methods. Chronic fascioliasis was determined by the presence of ova in stool. Children's height, weight, and age were recorded and used to calculate height for age Z scores (HAZ). Three thousand children participated in the study. Nine percent (264) of children had at least one positive test for Fasciola infection, 6% (164) had chronic fascioliasis, and 3% (102) had only positive antibody tests. The median HAZ was -1.41 (IQR: -2.03 to -0.81) and was similar in males and females. Twenty six percent (776) of children had stunting with HAZ < -2. Children with chronic fascioliasis had a lower median HAZ than children without Fasciola (-1.54 vs. -1.4, p = 0.014). History of treatment for malnutrition, history of treatment for anemia, having other helminths in stool, lower socioeconomic score, living at a higher elevation, and fewer years of schooling of both parents were associated with a lower HAZ score. In a multiple regression analysis, older age and a lower socioeconomic score were associated with a lower HAZ score. While fascioliasis and other helminths were associated with lower HAZ, they were not independent of the socioeconomic score.
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Affiliation(s)
- Camille M. Webb
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
- Alexander von Humboldt Tropical Medicine Institute, Department of Medicine, Universidad Peruana Cayetano Heredia, Cusco, Peru
| | - Maria Luisa Morales
- Alexander von Humboldt Tropical Medicine Institute, Department of Medicine, Universidad Peruana Cayetano Heredia, Cusco, Peru
- UPCH–UTMB Collaborative Research Center—Cusco, Universidad Peruana Cayetano Heredia, Cusco, Peru
| | - Martha Lopez
- Alexander von Humboldt Tropical Medicine Institute, Department of Medicine, Universidad Peruana Cayetano Heredia, Cusco, Peru
- UPCH–UTMB Collaborative Research Center—Cusco, Universidad Peruana Cayetano Heredia, Cusco, Peru
| | - Benicia Baca-Turpo
- Alexander von Humboldt Tropical Medicine Institute, Department of Medicine, Universidad Peruana Cayetano Heredia, Cusco, Peru
- UPCH–UTMB Collaborative Research Center—Cusco, Universidad Peruana Cayetano Heredia, Cusco, Peru
| | - Eulogia Arque
- Alexander von Humboldt Tropical Medicine Institute, Department of Medicine, Universidad Peruana Cayetano Heredia, Cusco, Peru
- UPCH–UTMB Collaborative Research Center—Cusco, Universidad Peruana Cayetano Heredia, Cusco, Peru
| | - A. Clinton White
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
- Alexander von Humboldt Tropical Medicine Institute, Department of Medicine, Universidad Peruana Cayetano Heredia, Cusco, Peru
- UPCH–UTMB Collaborative Research Center—Cusco, Universidad Peruana Cayetano Heredia, Cusco, Peru
| | - Miguel M. Cabada
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
- Alexander von Humboldt Tropical Medicine Institute, Department of Medicine, Universidad Peruana Cayetano Heredia, Cusco, Peru
- UPCH–UTMB Collaborative Research Center—Cusco, Universidad Peruana Cayetano Heredia, Cusco, Peru
- * E-mail:
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Dekker Nitert M. Increasing pregnancy duration, fetal and early postnatal growth in LMIC: The importance of a gut microbiome that exploits dietary staples. EBioMedicine 2021; 69:103449. [PMID: 34157483 PMCID: PMC8220586 DOI: 10.1016/j.ebiom.2021.103449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/02/2021] [Indexed: 12/01/2022] Open
Affiliation(s)
- Marloes Dekker Nitert
- School of Chemistry and Molecular Biosciences, The University of Queensland, St Lucia, QLD 4072, Australia.
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Ghosh PK, Das P, Goswam DR, Islam A, Chowdhury S, Mollah MM, Harun GD, Akhtar Z, Chowdhury F. Maternal Characteristics Mediating the Impact of Household Poverty on the Nutritional Status of Children Under 5 Years of Age in Bangladesh. Food Nutr Bull 2021; 42:389-398. [PMID: 34058896 DOI: 10.1177/0379572121999016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We explored the maternal characteristics that mediate the effect of household poverty on childhood undernutrition. METHODS We used the population-based Bangladesh Demographic Health Survey data from 2014 for demographic characteristics, child and maternal factors. RESULTS Of the 7173 under-5 children, 3456 (48.2%) had undernutrition. The prevalence of undernutrition was less common in wealthy households (poorest vs richest: adjusted prevalence ratio [aPR] = 1.37), mothers having history of antenatal care (ANC) visits (no visit vs ≥ 4 visits: aPR = 1.22), maternal higher education (no education vs higher education: aPR = 1.54), and mothers with good nutritional status (underweight vs healthy: aPR = 1.13). The risk of undernutrition (37.1%) was attributed to household wealth, mediated 55% by maternal factors; of which 20% by maternal education, 21% by ANC visits, and 14% by maternal nutritional status. CONCLUSIONS Our study findings outlined higher maternal education, ≥ 4 ANC visits and good maternal nutritional status in mediating the impact of household wealth on childhood nutrition.
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Affiliation(s)
- Probir Kumar Ghosh
- 56291International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Pritimoy Das
- 56291International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Doli Rani Goswam
- 56291International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Ausraful Islam
- 56291International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Sukanta Chowdhury
- 56291International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | | | - Zubair Akhtar
- 56291International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Fahmida Chowdhury
- 56291International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
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van Buuren S, Eekhout I. Child development with the D-score: turning milestones into measurement. Gates Open Res 2021. [DOI: 10.12688/gatesopenres.13222.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The chapter equips the reader with a basic understanding of robust psychometric methods that are needed to turn developmental milestones into measurements, introducing the fundamental issues in defining a unit for child development and demonstrates the relevant quantitative methodology. It reviews quantitative approaches to measuring child development;introduces the Rasch model in a non-technical way;shows how to estimate model parameters from real data;puts forth a set of principles for model evaluation and assessment of scale quality;analyses the relation between early D-scores and later intelligence;and compares the D-scores from three studies that all use the same instrument.
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Successes and Challenges in Sustainable Development Goals Localisation for Host Communities around Kruger National Park. SUSTAINABILITY 2021. [DOI: 10.3390/su13105341] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Tourism has often been blamed for its unsustainable ways for a number of years now. Consequently, there have been efforts to ensure that tourism contributes to the host communities to address some of the sustainability challenges through responsible and sustainable tourism initiatives in the recent past. With less than nine years to go before the lapse of the Sustainable Development Goals (SDGs), there is a need to take stock of how tourism enterprises such as national parks are contributing to the SDGs. This study examines how Kruger National Parks (KNP) is assisting the host communities in meeting the SDG goals and targets. The study made use of 30 in-depth key informant interviews, field observations and critical document analysis. The study found that regardless of the challenges it faces as an organization in partnering with host communities for developmental purposes, Kruger National Park has assisted communities to meet at least 15 out of the 17 SDGs. These span from social to economic, environmental and cultural SDGs. Since KNP’s projects address host community needs, several challenges need to be dealt with to ensure the sustainability of these projects post COVID-19 pandemic, which has undermined many nature tourism establishments worldwide. Besides the pandemic, there is a need to manage community expectations with regard to how far it can address some of the challenges faced by communities.
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Atef H, Abdel-Raouf R, Zeid AS, Elsebaie EH, Abdalaleem S, Amin AA, Aboulghar H. Development of a simple and valid nutrition screening tool for pediatric hospitalized patients with acute illness. F1000Res 2021; 10:173. [PMID: 33968365 PMCID: PMC8080976 DOI: 10.12688/f1000research.51186.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/18/2021] [Indexed: 12/17/2022] Open
Abstract
Background: Nutritional screening, intervention and assessment in patients with undernutrition are key components of any nutritional care. The goal of any nutritional assessment is to determine the specific nutritional risk(s). Presently, there are no guidelines on any ideal screening tool to be used on admission for identification of children that are at risk of developing malnutrition during their hospital stay. The objective of the study was to develop a valid and simple nutritional screening tool which can be used on hospital admission to identify pediatric patients at risk of malnutrition . Methods: This study was cross sectional analytical that enrolled children (n:161) admitted with acute illness to the general wards at Cairo University Children Hospitals (CUCH). The answers to the developed questionnaire were compared to the Subjective Global Assessment (SGA), those with high accuracy (≥80%) were used for validity with anthropometric measures. Results: In the 'less than two years of age' group, the simple and valid nutritional screening tools were the following questions: (Is there a problem during breast-feeding?), (Is there scanty breast milk?), (Is there appetite loss?). The simple and valid nutritional screening tools during the 'early childhood' group were the following questions: (Is there appetite loss?), (Is there any skipping of meals?), (Are they watching TV, videotapes and/or playing computer games for more than two hours/day?). The simple and valid nutritional screening tools during the 'late childhood' group were the following questions: (Is there appetite loss?), (Are they watching TV, videotapes and/or playing computer games for more than two hours/day?). Conclusion: The simple and valid nutritional screening tools differ according to age groups. The one which is valid in all ages is the question about the appetite loss.
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Affiliation(s)
- Hoda Atef
- Pediatrics Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rasha Abdel-Raouf
- Pediatrics Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed S Zeid
- Pediatrics Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Eman H Elsebaie
- Public Health and Community Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Shaimaa Abdalaleem
- Cancer Epidemiology and Biostatistics, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Aya A Amin
- Cancer Epidemiology and Biostatistics, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Hanna Aboulghar
- Pediatrics Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Aiga H, Abe K, Randriamampionona E, Razafinombana AR. Possible causalities between malnutrition and academic performances among primary schoolchildren: a cross-sectional study in rural Madagascar. BMJ Nutr Prev Health 2021; 4:18-29. [PMID: 34308108 PMCID: PMC8258079 DOI: 10.1136/bmjnph-2020-000192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/03/2020] [Accepted: 12/12/2020] [Indexed: 11/04/2022] Open
Abstract
Background The importance of addressing malnutrition is increasing in the context of children’s health and their academic performances. Childhood malnutrition further could reduce a country’s economic productivity. No earlier study adequately estimated the causalities between schoolchildren’s malnutrition and their academic performances. How nutritional status contributes to children’s academic performances has never been reported from Madagascar. This study aims to estimate the possible causalities between their nutritional status and academic performances in rural Madagascar. Methods A cross-sectional household survey was conducted in Antananarivo-Avaradrano district, Madagascar, from November to December 2017, by targeting 404 first and second graders 5–14 years of age enrolled in 10 public primary schools. Children’s anthropometric measurements and structured interviews with their mothers/caregivers were conducted. Children’s academic performances data (mathematical and national language proficiencies) were collected at each school. To estimate associations between their malnutrition and academic performances, bivariate and multivariate analyses were conducted. To estimate their possible causalities between them, three conditions were examined (crude covariational relationship, covariational relationship through controlling for a third variable and temporal precedence). Results Four independent variables produced significantly positive coefficients with mathematical proficiency in multivariate analysis. Of the four, ‘not being stunted’ and ‘attendance rate’ were estimated to be possible causes of higher mathematical proficiency because they satisfied all the three conditions for a causality. On the other hand, three independent variables produced significantly positive coefficients with national language proficiency in multivariate analysis. Yet, none of them were estimated to be possible causes of higher national language proficiency. Conclusions A hypothetical causal path indicates that ‘not being stunted’ is likely to have caused higher ‘attendance rate’ and thereby higher ‘mathematical proficiency’ in a two-step manner. This study is the first attempt to estimate the possible causalities between schoolchildren’s nutritional status and their academic performances in Madagascar.
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Affiliation(s)
- Hirotsugu Aiga
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | | | - Emmanuel Randriamampionona
- Association des consultants a la recherche au devellopement economique et social (ACREDES), Ministry of National Education, Antananarivo, Madagascar
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Abu-Fatima O, Abbas AAG, Racalbuto V, Smith L, Pizzol D. Child Undernutrition in Sudan: The Social and Economic Impact and Future Perspectives. Am J Trop Med Hyg 2020; 104:1149-1152. [PMID: 33350372 DOI: 10.4269/ajtmh.20-1251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 10/26/2020] [Indexed: 11/07/2022] Open
Abstract
The nutrition situation in Sudan is one of the worst in northeast Africa and it is characterized by persistently high levels of acute and chronic malnutrition that have increased over the last two decades. The underlying causes of malnutrition are multi-sectoral and are mainly due to inequalities, inadequate food practices, and limited access to healthcare services. Based on the report The Economic and Social Impacts of Child Undernutrition in Sudan, this study assesses the impact that malnutrition has on health, education, and productivity in Sudan. The country is estimated to have lost an equivalent of about 11.6 billion Sudanese pound in 2014, which represented 2.6% of the gross domestic product (GDP). Productivity-related losses contributed the largest costs at 1.5% of GDP followed by health and education sectors at 1.1% and 0.1%, respectively. In 2020, the outbreak of the COVID-19 pandemic further exposed the fragility of Sudan's health, social, and economic system. It is mandatory that all stakeholders address child nutrition as a main concern and stunting is incorporated in the center of the development agenda. In particular, the national development frameworks should be updated to ensure the reduction of the stunting prevalence and to put in place a comprehensive multi-sectoral nutrition policy, strategy, and plan of action.
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Affiliation(s)
| | | | | | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, United Kingdom
| | - Damiano Pizzol
- Italian Agency for Development Cooperation, Khartoum, Sudan
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Panda BK, Mohanty SK, Nayak I, Shastri VD, Subramanian SV. Malnutrition and poverty in India: does the use of public distribution system matter? BMC Nutr 2020; 6:41. [PMID: 33014406 PMCID: PMC7528460 DOI: 10.1186/s40795-020-00369-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 08/03/2020] [Indexed: 11/17/2022] Open
Abstract
Background Large scale public investment in Public Distribution System (PDS) have aimed to reduce poverty and malnutrition in India. The PDS is the largest ever welfare programme which provides subsidised food grain to the poor households. This study attempt to examine the extent of stunting and underweight among the children from poor and non-poor households by use of public distribution system (PDS) in India. Methods Data from the National Family and Health Survey-4 (NFHS-4), was used for the analysis. A composite variable based on asset deprivation and possession of welfare card provided under PDS (BPL card), was computed for all households and categorised into four mutually exclusive groups, namely real poor, excluded poor, privileged non-poor and non-poor. Real poor are those economically poor and have a welfare card, excluded poor are those economically poor and do not have welfare card, privileged poor are those economically non-poor but have welfare card, and non-poor are those who are not economically poor and do not have welfare card. Estimates of stunting and underweight were provided by these four categories. Descriptive statistics and logistic regression were used for the analysis. Results About half of the children from each real poor and excluded poor, two-fifths among privileged non-poor and less than one-third among non-poor households were stunted in India. Controlling for socio-economic and demographic covariates, the adjusted odds ratio of being stunted among real poor was 1.42 [95% CI: 1.38, 1.46], 1.43 [95% CI: 1.39, 1.47], among excluded poor and 1.15 [95% CI: 1.12, 1.18], among privileged non-poor. The pattern was similar for underweight and held true in most of the states of India. Conclusions Undernutrition among children from poor households those excluded from PDS is highest, and it warrants inclusion in PDS. Improving the quality of food grains and widening food basket in PDS is recommended for reduction in level of malnutrition in India.
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Affiliation(s)
| | - Sanjay K Mohanty
- Department of fertility studies, International Institute for Population Sciences, Mumbai, India
| | - Itishree Nayak
- International Institute for Population Sciences, Mumbai, India
| | - Vishal Dev Shastri
- Senior Advisor, FHI Solutions LLC, Alive & Thrive, # 503-506, 5th Floor, Mohan Dev Building, 13 Tolstoy Marg, New Delhi, 110001 India
| | - S V Subramanian
- Harvard Centre for Population and Development Studies, Harvard T.H. Chan School of Public Health, 9 Bow Street, Cambridge, MA 02138 USA.,Department of Social and Behavioural Science, Harvard T.H. Chan School of Public Health, Boston, MA USA
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Pyykkö J, Ashorn U, Chilora E, Maleta K, Ashorn P, Leppänen JM. Associations between individual variations in visual attention at 9 months and behavioral competencies at 18 months in rural Malawi. PLoS One 2020; 15:e0239613. [PMID: 33002053 PMCID: PMC7529224 DOI: 10.1371/journal.pone.0239613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 09/10/2020] [Indexed: 11/18/2022] Open
Abstract
Theoretical and empirical considerations suggest that individual differences in infant visual attention correlate with variations in cognitive skills later in childhood. Here we tested this hypothesis in infants from rural Malawi (n = 198-377, depending on analysis), who were assessed with eye tracking tests of visual orienting, anticipatory looks, and attention to faces at 9 months, and more conventional tests of cognitive control (A-not-B), motor, language, and socioemotional development at 18 months. The results showed no associations between measures of infant attention at 9 months and cognitive skills at 18 months, either in analyses linking infant visual orienting with broad cognitive outcomes or analyses linking specific constructs between the two time points (i.e., switching of anticipatory looks and manual reaching responses), as correlations varied between -0.08 and 0.14. Measures of physical growth, and family socioeconomic characteristics were also not correlated with cognitive outcomes at 18 months in the current sample (correlations between -0.10 and 0.19). The results do not support the use of the current tests of infant visual attention as a predictive tool for 18-month-old infants' cognitive skills in the Malawian setting. The results are discussed in light of the potential limitations of the employed infant tests as well as potentially unique characteristics of early cognitive development in low-resource settings.
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Affiliation(s)
- Juha Pyykkö
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Ulla Ashorn
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Eletina Chilora
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Kenneth Maleta
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Per Ashorn
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Paediatrics, Tampere University Hospital, Tampere, Finland
| | - Jukka M. Leppänen
- Infant Cognition Laboratory, Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Randell H, Gray C, Grace K. Stunted from the start: Early life weather conditions and child undernutrition in Ethiopia. Soc Sci Med 2020; 261:113234. [PMID: 32823214 PMCID: PMC7716344 DOI: 10.1016/j.socscimed.2020.113234] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/26/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
Abstract
This paper examines the relationship between weather conditions and child nutrition in Ethiopia. We link data from four rounds of the Ethiopia Demographic and Health Survey to high-resolution climate data to measure exposure to rainfall and temperature in utero and during early life. We then estimate a set of multivariate regression models to understand how weather conditions impact child stunting, an indicator of sustained early life undernutrition. We find that greater rainfall during the rainy seasons in early life is associated with greater height for age. In addition, higher temperatures in utero, particularly during the first and third trimesters, and more rainfall during the third trimester, are positively associated with severe stunting, though stunting decreases with temperature in early life. We find potential evidence for a number of pathways underlying the weather-child nutrition relationship including agricultural livelihoods, heat stress, infectious disease transmission, and women's time use during pregnancy. These findings illuminate the complex pathways through which climate change may influence child health and should motivate additional research focused on identifying the causal mechanisms underlying these links.
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Affiliation(s)
- Heather Randell
- Department of Agricultural Economics, Sociology, and Education, Penn State University, 110-A Armsby Building, University Park, PA, 16802, USA.
| | - Clark Gray
- Department of Geography, University of North Carolina at Chapel Hill, USA
| | - Kathryn Grace
- Department of Geography, Environment, and Society, University of Minnesota, Twin Cities, USA
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Richter LM, Orkin FM, Adair LS, Kroker-Lobos MF, Mayol NL, Menezes AMB, Martorell R, Murray J, Stein AD, Victora C. Differential influences of early growth and social factors on young children's cognitive performance in four low-and-middle-income birth cohorts (Brazil, Guatemala, Philippines, and South Africa). SSM Popul Health 2020; 12:100648. [PMID: 32953965 PMCID: PMC7486449 DOI: 10.1016/j.ssmph.2020.100648] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/07/2020] [Accepted: 08/11/2020] [Indexed: 11/28/2022] Open
Abstract
Background Studies relating childhood cognitive development to poor linear growth seldom take adequate account of social conditions related to both, leading to a focus on nutrition interventions. We aimed to assess the roles of both biological and social conditions in determining early childhood cognition, mediated by birthweight and early linear growth. Methods After exploratory structural equation modelling to identify determining factors, we tested direct and indirect paths to cognitive performance through birthweight and child height-for-age at 2 years, assessed between 4 and 8.5 years of age among 2448 children in four birth cohort studies in low-and-middle-income countries (Brazil, Guatemala, Philippines and South Africa). Determinants were compared across the cohorts. Findings Three factors yielded excellent fit, comprising birth endowment (primarily maternal age and birth order), household resources (crowding, dependency) and parental capacity (parental education). We estimated their strength together with maternal height in determining cognitive performance. Percentage shares of total effects of the four determinants show a marked transition from mainly biological determinants of birth weight (birth endowment 34%) and maternal height (30%) compared to household resources (25%) and parental capacity (11%), through largely economic determinants of height at 2 years (household resources (60%) to cognitive performance being predominantly determined by parental capacity (64%) followed by household resources (29%). The largely biological factor, birth endowment (maternal age and birth order) contributed only 7% to childhood cognitive performance and maternal height was insignificant. In summary, the combined share of social total effects (household resources and parental capacity) rises from 36∙2% on birth weight, to 78∙2% on height for age at 24 m, and 93∙4% on cognitive functioning. Interpretation Across four low- and middle-income contexts, cognition in childhood is influenced more by the parental capacity of families and their economic resources than by birth weight and early linear growth. Improving children's cognitive functioning requires multi-sectoral interventions to improve parental education and enhance their economic wellbeing, interventions that are known to improve also early childhood growth. We aimed to investigate separate and combined biological and social determination of young children’s cognitive performance. We used path analysis of longitudinal data from birth cohort studies in four differing low-and-middle countries. We distinguished biological and social factors, as well as household resources from parental capacity. Biological factors determine birthweight, 2-year height depends on social factors, and the latter drive child cognitive performance. No single domain intervention provides both necessary and sufficient support for young children’s unfolding development.
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Affiliation(s)
- L M Richter
- DSI-NRF Centre of Excellence in Human Development, School of Public Health, University of the Witwatersrand, York Road, 2193, Johannesburg, South Africa
| | - F M Orkin
- Developmental Pathways to Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, York Road, 2193, Johannesburg, South Africa
| | - L S Adair
- Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, Chapel Hill, NC, 27599-7400, USA
| | - M F Kroker-Lobos
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - N Lee Mayol
- USC-Office of Population Studies Foundation, Inc., University of San Carlos, Talamban, Cebu City, Cebu, Philippines
| | - A M B Menezes
- Postgraduate Program in Epidemiology and Human Development, Federal University of Pelotas, Rua Mal. Deodoro, 1160, 3 Andar Zip Code: 96020-220, Pelotas, RS, Brazil
| | - R Martorell
- Rollins School of Public Health, Emory University, 1518 Clifton Rd NE #5001, Atlanta GA, 30322, USA
| | - J Murray
- Postgraduate Program in Epidemiology and Human Development and Violence Research Centre (DOVE), Federal University of Pelotas, Rua Mal. Deodoro, 1160, 3 Andar Zip Code: 96020-220, Pelotas, RS, Brazil
| | - A D Stein
- Hubert Department of Global Health, Emory University, 1518 Clifton Rd NE #5001, Atlanta, GA, 30322, USA
| | - C Victora
- Federal University of Pelotas, Rua Mal. Deodoro, 1160, 3 Andar Zip Code: 96020-220, Pelotas, RS, Brazil
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