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Maru Y, Tamiru D, Baye K, Chitekwe S, Lailou A, Darsene H, Abdulai R, Worku M, Belachew T. Effect of a simplified approach on recovery of children 6-59 months with wasting in Ethiopia: A noninferiority, cluster randomized controlled trial. MATERNAL & CHILD NUTRITION 2024:e13670. [PMID: 38800892 DOI: 10.1111/mcn.13670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 05/06/2024] [Accepted: 05/07/2024] [Indexed: 05/29/2024]
Abstract
Worldwide, nearly 45 million children under the age of 5 years were affected by wasting in 2022. Ethiopia has been challenged by disasters increasing the caseload of children with wasting. This study aimed to determine the effect of a simplified approach on recovery of children with acute malnutrition as compared with the standard protocol. A cluster randomized, controlled, noninferiority trial was carried out in three regions of Ethiopia from December 4, 2021, to July 30, 2022. A total of 58 clusters (health posts) were randomized into intervention and control groups. Children with SAM in the intervention groups received two sachets of Ready-to-Use Therapeutic Food (RUTF), whereas children in the control groups received RUTF based on their body weight. Children with moderate acute malnutrition (MAM) received one sachet of RUTF and one sachet of Ready-to-Use Supplementary Food (RUSF) daily in the intervention and control groups, respectively. Per protocol (PP) and intention-to-treat analysis were used to compare recovery at a noninferiority margin of 15%. Data were collected from 55 health posts and 1032 children. In the PP analysis, the recovery rate of children with wasting among the simplified group (97.8%) was noninferior to the standard protocol group (97.7%), p = 0.399. The RUTF cost per treatment of child with SAM was 56.55 USD for the standard versus 42.78 USD for the simplified approach. The simplified approach is noninferior to the standard protocol in terms of recovery and has a lower cost of RUTF. Further study is recommended to assess the effectiveness of the simplified approach in emergency contexts.
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Affiliation(s)
- Yetayesh Maru
- Nutrition and Dietetics Department, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Dessalegn Tamiru
- Nutrition and Dietetics Department, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Kaleab Baye
- Center for Food Science and Nutrition, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Arnaud Lailou
- UNICEF West and Central Africa Regional Office, Nutrition Section, Dakar, Senegal
| | - Hiwot Darsene
- Nutrition Coordination Office, Ethiopian Ministry of Health, Addis Ababa, Ethiopia
| | - Rashid Abdulai
- Nutrition Section, UNICEF Ethiopia, Addis Ababa, Ethiopia
| | - Mesfin Worku
- Nutrition Section, UNICEF Ethiopia, Addis Ababa, Ethiopia
| | - Tefera Belachew
- Nutrition and Dietetics Department, Faculty of Public Health, Jimma University, Jimma, Ethiopia
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Li X, Li Z, Lin Y, Tan H, Chen C, Shen J. Growing-rod implantation improves nutrition status of early-onset scoliosis patients: a case series study of minimum 3-year follow-up. BMC Surg 2021; 21:106. [PMID: 33648467 PMCID: PMC7923317 DOI: 10.1186/s12893-021-01120-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early onset scoliosis (EOS) may cause malnutrition in affected patients. Growing-rod treatment has been an effective protocol for treating EOS. The objective of this study is to demonstrate whether growing-rod treatment improves nutritional status of EOS patients. METHODS Fifty-two EOS patients who had dual growing-rod surgery was enrolled. The minimum follow-up was 3-years. Their body weights were normalized based on the data of two National Population Census of China. Z-scores were used to indicate the standard deviation from the median body weight-for-age. RESULTS The median follow-up time was 6 years. Preoperatively, the prevalence of malnutrition (Z < - 2) was 21.2%, and reduced to 9.6% at the end of the follow-up. Preoperatively, the average Z-score was - 0.94, and it increased to - 0.65 at the latest follow-up (p < 0.05). Patients with preoperative Z-score below - 1 had more significant increase of Z-scores (- 2.15 vs - 1.26, p < 0.001). A significant negative correlation between the change of Z-score and the preoperative Z-score (correlation coefficient - 0.65, p < 0.001). CONCLUSIONS The growing rod surgery and lengthening procedures significantly improves the nutrition status of EOS patients. The body weight gains are more significant in patients with lower body weights.
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Affiliation(s)
- Xingye Li
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Shuaifuyuan #1, Dongcheng District, Beijing, 100730, China
- Department of Orthopaedics, Peking University Fourth Clinical Medical College, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Zheng Li
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Shuaifuyuan #1, Dongcheng District, Beijing, 100730, China
| | - Youxi Lin
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Shuaifuyuan #1, Dongcheng District, Beijing, 100730, China
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangzhou, 510080, China
| | - Haining Tan
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Shuaifuyuan #1, Dongcheng District, Beijing, 100730, China
| | - Chong Chen
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Shuaifuyuan #1, Dongcheng District, Beijing, 100730, China
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangzhou, 510080, China
| | - Jianxiong Shen
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Shuaifuyuan #1, Dongcheng District, Beijing, 100730, China.
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Machine Learning to Evaluate Impacts of Flood Protection in Bangladesh, 1983–2014. WATER 2020. [DOI: 10.3390/w12020483] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Impacts of climate change adaptation strategies need to be evaluated using principled methods spanning sectors and longer time frames. We propose machine-learning approaches to study the long-term impacts of flood protection in Bangladesh. Available data include socio-economic survey and events data (death, migration, etc.) from 1983–2014. These multidecadal data, rare in their extent and quality, provide a basis for using machine-learning approaches even though the data were not collected or designed to assess the impact of the flood control investments. We test whether the embankment has affected the welfare of people over time, benefiting those living inside more than those living outside. Machine-learning approaches enable learning patterns in data to help discriminate between two groups: here households living inside vs. outside. They also help identify the most informative indicators of discrimination and provide robust metrics to evaluate the quality of the model. Overall, we find no significant difference between inside/outside populations based on welfare, migration, or mortality indicators. However, we note a significant difference in inward/outward movement with respect to the embankment. While certain data gaps and spatial heterogeneity in sampled populations suggest caution in any conclusive interpretation of the flood protection infrastructure, we do not see higher benefits accruing to those living with higher levels of protection. This has implications for Bangladesh’s planning for future and more extreme climate futures, including the national Delta Plan, and global investments in climate resilient infrastructure to create positive social impacts.
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Frost MB, Forste R, Haas DW. Maternal education and child nutritional status in Bolivia: finding the links. Soc Sci Med 2005; 60:395-407. [PMID: 15522494 DOI: 10.1016/j.socscimed.2004.05.010] [Citation(s) in RCA: 154] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study models various pathways linking maternal education and child nutritional status in Bolivia, using a national sample of children. Pathways examined include socioeconomic status, health knowledge, modern attitudes towards health care, female autonomy, and reproductive behavior. The data come from the 1998 Bolivia Demographic and Health Survey. Logistic regression results suggest that socioeconomic factors are the most important pathways linking maternal education and child nutritional status, and that modern attitudes about health care also explain the impact of education. Health care knowledge accounts for less of the effect of maternal education on child nutritional status, with autonomy being the weakest pathway. Other pathways, such as reproductive behaviors, appear to influence nutritional status independent of maternal education. Overall, the pathways examined accounted for 60 percent of the effect of maternal education on child nutritional status.
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Affiliation(s)
- Michelle Bellessa Frost
- Office of Population Research, Wallace Hall, Princeton University, Princeton, NJ 08540, USA.
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Pande RP. Selective gender differences in childhood nutrition and immunization in rural India: the role of siblings. Demography 2003; 40:395-418. [PMID: 12962055 DOI: 10.1353/dem.2003.0029] [Citation(s) in RCA: 164] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article examines the role of the sex composition of surviving older siblings on gender differences in childhood nutrition and immunization, using data from the National Family Health Survey, India (1992-1993). Logit and ordered logit models were used for severe stunting and immunization, respectively. The results show selective neglect of children with certain sex and birth-order combinations that operate differentially for girls and boys. Both girls and boys who were born after multiple same-sex siblings experience poor outcomes, suggesting that parents want some balance in sex composition. However, the preference for sons persists, and boys who were born after multiple daughters have the best possible outcomes.
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Affiliation(s)
- Rohini P Pande
- International Center for Research on Women, 1717 Massachusetts Avenue, NW, Suite 302, Washington, DC 20036, USA.
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Abstract
There is a general agreement that childhood mortality in Egypt has substantially declined during the last two decades. The decline has been traditionally attributed to the impact of the National Control of Diarrhoeal Diseases Program (NCDDP). However, a controversy still exists over the magnitude of that decline and the claimed impact of the NCDDP on diarrhoea related mortality. This study was carried out in six sites in rural Upper Egypt to determine indices, leading causes, and sociodemographic determinants of childhood mortality. Verbal autopsy was conducted with mothers or caretakers who had reported the death of a child under the age of five (U5) before the study to determine the leading cause of death. Then, the association between childhood mortality and a wide set of sociodemographic risk factors was examined by comparing these children with 1025 living U5 children using a multivariate logistic regression analysis. Results showed that the average infant and U5 mortality rates are 97.2 and 130.8 per 1000 live births respectively. Verbal autopsy revealed that the leading causes of U5 mortality are: diarrhoeal diseases (39.4%), acute respiratory infection (26.8%), combined episode of both (5.1%), febrile illnesses including meningitis (10.6%), neonatal causes (12.6%), and accidents (2.5%). Diagnosis was not determined in 3.0% of the cases. Child age (< 12 month) and mother age at childbirth are the strongest determinants of childhood mortality. Other determinants include parental illiteracy, parental age difference, house ownership, child order and average household meat consumption.
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Affiliation(s)
- K M Yassin
- Department 2: Public Health Medicine, School of Public Health, University of Bielefeld, Germany.
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Chacon-Puignau GC, Jaffe K. Sex ratio at birth deviations in modern Venezuela: the Trivers-Willard effect. SOCIAL BIOLOGY 1996; 43:257-270. [PMID: 9204700 DOI: 10.1080/19485565.1996.9988927] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
This study evaluates the impact of the Trivers-Willard (T-W) effect on human populations, using demographic data collected from vital registration data in Venezuela. The evaluation of the sex ratio at birth (SRB) and of fetal and infant deaths supports the existence of T-W effect in the Venezuelan population in extreme conditions. This T-W effect was observable in the SRB but not at later ages and is related to the marital status of the mother. The results indicate that the investment in females associated with environmental adversity is greater than the investment in males associated with good environmental conditions.
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Affiliation(s)
- G C Chacon-Puignau
- Department de Ciencia y Technologia del Comportamiento, Universidad Simon Bolivar, Miranda, Venezuela
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Choudhury AY, Bhuiya A. Effects of biosocial variables on changes in nutritional status of rural Bangladeshi children, pre- and post-monsoon flooding. J Biosoc Sci 1993; 25:351-7. [PMID: 8360229 DOI: 10.1017/s002193200002068x] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
This study examined the effects of biosocial variables on changes in nutritional status of rural Bangladeshi children, aged less than 2 years, pre- and post-1987 monsoon flooding. Nutritional status was measured by weight for age: variables included were age, sex, sickness during 2 weeks preceding the survey, intake of vitamin A capsules, socioeconomic status of household, and mother's education. A multivariate logistic regression analysis revealed an adverse effect of flood on nutrition and the effect was dependent on sex of child and intake of vitamin A. After the flood the proportion of severely malnourished children was significantly greater among those who had not taken vitamin A. For boys the proportion with severe malnutrition increased after the flood and the increase was greater than for girls; however, boys always had a lower risk of severe malnutrition than girls.
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Affiliation(s)
- A Y Choudhury
- Programme for the Introduction and Adaptation of Contraceptive Technology, Bangladesh
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Shoff S, Csete J, Ladinsky J, Nguyen HT. Nutritional status of preschool children in Northern Vietnam. Ecol Food Nutr 1993. [DOI: 10.1080/03670244.1993.9991308] [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]
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Abstract
This paper represents a speculative approach to the question of changing mortality levels in human populations. The surprising resilience and reluctance of mortality declines to respond to powerful countervailing is considered. A more integrated approach is proposed to examine the interactive roles of income, technology and behavior in relation to life expectancy. The paper concludes by a discussion of the relevance of the accumulation of health assets to national mortality levels.
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Affiliation(s)
- C J Murray
- Havard Center for Population and Development Studies, Cambridge, MA 02138
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