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Belay JK, Abebe SM, Baffa LD, Mengistu B. Food consumption score and predictors among pregnant women attending antenatal care services in health centers of Addis Ababa, Ethiopia: Using ordinal logistic regression model. PLoS One 2024; 19:e0306169. [PMID: 38924049 PMCID: PMC11207176 DOI: 10.1371/journal.pone.0306169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Poor maternal nutrition during pregnancy creates a stressful environment that can lead to long-term effects on tissue development. Understanding the food consumption score can be used to prevent problems associated with poor dietary intake of pregnant mothers. In Ethiopia, the food consumption score ranges from 54% to 81.5%, which is far below the World Food Program (WFP) recommendation. Thus, this study aimed to assess food consumption score and associated factors among pregnant women attending antenatal care services in health centers of Addis Ababa, Ethiopia. METHODS This study has used institution based cross sectional study. Overall, 999 pregnant women were selected for this study. A multistage sampling technique followed by systematic random sampling was used to include pregnant women coming for antenatal care services in the selected health centers of Addis Ababa from June 07 to July 08, 2022. We used interviewer administered questionnaire using the Kobo toolbox. Food consumption score (FCS) was assessed after collecting data on frequency of eight food groups consumed over the previous seven days, which were weighted according to their relative nutritional value. STATA 14 was used to analyse the data. Ordinal logistic regression was used to identify independent predictors of food consumption score. Those variables having p value < 0.25 in the bivariable ordinal logistic regression were considered for the final model. Crude and Adjusted Odds Ratio were used to assess the strength of the association. In the final model, p value < 0.05 at 95% confidence interval was used to declare statistical significance. RESULT From the total of 949 pregnant women a little over half (51.20% (95%CI: 48.00%-54.40%) had acceptable food consumption score, while just over two fifth (42.60% (95% CI: 39.40%-45.70%)) and a small proportion (6.2% (95%CI: 4.84%-7.94%)) of the study participants had borderline and poor food consumption score, respectively. No meal skip (AOR = 1.37, 95% CI:1.03-1.81), able to read and write (AOR = 3.99, 95% CI: 1.33-11.96), poorest wealth status (AOR = 0.52, 95% CI: 0.34-0.78), positive attitude towards consumption of a diversified diet (AOR = 1.52,95% CI: 1.17-1.98) were independent predictors of acceptable food consumption score. CONCLUSION In this study, considerably low level of acceptable food consumption score among the study participants was observed. Besides, not skipping meal, having better educational status, wealth status and attitude towards consumption of a diversified diet were associated with acceptable food consumption score. Therefore, nutritional education considering important dietary modifications should be intensified targeting vulnerable groups.
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Affiliation(s)
- Jerusalem Ketema Belay
- Department of Human Nutrition, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Solomon Mekonnen Abebe
- Department of Human Nutrition, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Lemlem Daniel Baffa
- Department of Human Nutrition, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Berhanu Mengistu
- Department of Human Nutrition, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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Sultana T, Ruiz-Casares M, Iwo R, Janus M, Nazif-Muñoz JI. Maternal Education and Children Home Alone in 63 Low- and Middle-Income Countries. Glob Pediatr Health 2024; 11:2333794X241258179. [PMID: 38854820 PMCID: PMC11159552 DOI: 10.1177/2333794x241258179] [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: 08/29/2023] [Revised: 05/09/2024] [Accepted: 05/13/2024] [Indexed: 06/11/2024] Open
Abstract
Background. Maternal education may influence child supervision practices in low-and middle-income countries (LMIC). However, little is known about the maternal factors that can improve child supervision in LMIC with scarce childcare facilities. Objective. To investigate the prevalence of children under 5 years home alone and examine the association between mother's formal education and children home alone across 63 LMIC. Methods. The study used data from 50 Multiple Indicator Cluster Surveys and 13 Demographic and Health Surveys with a sample of 501 769 children. We estimated Prevalence Ratios (PRs) for the association between maternal education and children home alone using multivariable Poisson regression, adjusting for covariates such as child's age and sex, mother's age and marital status, number of adults inhabiting the households, and urbanicity. Results. Prevalence of children home alone across 63 LMIC ranged from 1.1% to 50.1%. A significant negative association between mothers with more years of formal education and children home alone was found across 16 LMIC. However, the opposite trend was observed in Nigeria, Senegal, and Côte d'Ivoire. Null association was found across 44 LMIC. Conclusions. The varied pattern of the associations observed across LMIC underscores the importance of regional and local factors when developing policies and interventions to ensure safety and adequate care for children aged under 5 years in LMIC.
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Affiliation(s)
- Toufica Sultana
- Toronto Metropolitan University, Toronto, Ontario, Canada
- South Asian Institute of Social Transformation, Dhaka, Bangladesh
| | - Mónica Ruiz-Casares
- Toronto Metropolitan University, Toronto, Ontario, Canada
- McGill University, Montreal, Quebec, Canada
| | - René Iwo
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Yismaw GA, Abuhay HW, Alemayehu MA, Derseh NM, Agimas MC, Tesfie TK. Geospatial variation of exclusive breastfeeding and its determinants among mothers of infants under 6 months in Ethiopia: spatial and geographical weighted regression analysis. BMJ Paediatr Open 2024; 8:e002573. [PMID: 38684333 PMCID: PMC11086437 DOI: 10.1136/bmjpo-2024-002573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 03/26/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Exclusive breastfeeding (EBF) is a major public health problem in Ethiopia. However, the spatial variation of EBF and the associated factors have not been studied as much as we have searched. This study aimed at assessing geospatial variation and the predictors of EBF using geographically weighted regression. METHODS A cross-sectional study was conducted using the 2019 Mini-Ethiopian Demographic and Health Survey data set. The study used a total weighted sample of 548 infants. Hotspot spatial analysis showed the hotspot and cold spot areas of EBF. The spatial distribution of EBF was interpolated for the target population using spatial interpolation analysis. SaTScan V.9.6 software was used to detect significant clusters. Ordinary least squares regression analysis identified significant spatial predictors. In geographically weighted regression analysis, the effect of predictor variables on the spatial variation of EBF was detected using local coefficients. RESULTS The weighted prevalence of EBF in Ethiopia was 58.97% (95% CI 52.67% to 64.99%), and its spatial distribution was found to be clustered (global Moran's I=0.56, p<0.001). Significant hotspot areas were located in Amhara, Tigray, Southern Nations, Nationalities, and Peoples' Region, and Somali regions, while significant cold spots were located in Dire Dawa, Addis Ababa and Oromia regions. Kulldorff's SaTScan V.9.6 was used to detect significant clusters of EBF using a 50% maximum cluster size per population. The geographically weighted regression model explained 35.75% of the spatial variation in EBF. The proportions of households with middle wealth index and married women were significant spatial predictors of EBF. CONCLUSION Middle wealth index and married women were significant spatial predictors of EBF. Our detailed map of EBF hotspot areas will help policymakers and health programmers encourage the practice of EBF in hotspot areas and set national and regional programmes focused on improving EBF in cold spots by considering significant predictor variables.
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Affiliation(s)
- Getaneh Awoke Yismaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Habtamu Wagnew Abuhay
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Meron Asmamaw Alemayehu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Nebiyu Mekonnen Derseh
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Muluken Chanie Agimas
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tigabu Kidie Tesfie
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Sukwa N, Bosomprah S, Somwe P, Muyoyeta M, Mwape K, Chibesa K, Luchen CC, Silwamba S, Mulenga B, Munyinda M, Muzazu S, Chirwa M, Chibuye M, Simuyandi M, Chilengi R, Svennerholm AM. The Incidence and Risk Factors for Enterotoxigenic E. coli Diarrheal Disease in Children under Three Years Old in Lusaka, Zambia. Microorganisms 2024; 12:698. [PMID: 38674642 PMCID: PMC11051722 DOI: 10.3390/microorganisms12040698] [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: 01/19/2024] [Revised: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 04/28/2024] Open
Abstract
This study aimed to estimate the incidence and risk factors for Enterotoxigenic Escherichia coli (ETEC) diarrhea. This was a prospective cohort study of children recruited in a household census. Children were enrolled if they were 36 months or below. A total of 6828 children were followed up passively for 12 months to detect episodes of ETEC diarrhea. Diarrheal stool samples were tested for ETEC using colony polymerase chain reaction (cPCR). Among the 6828 eligible children enrolled, a total of 1110 presented with at least one episode of diarrhea. The overall incidence of ETEC diarrhea was estimated as 2.47 (95% confidence interval (CI): 2.10-2.92) episodes per 100 child years. Children who were HIV-positive (adjusted Hazard ratio (aHR) = 2.14, 95% CI: 1.14 to 3.99; p = 0.017) and those whose source of drinking water was public tap/borehole/well (aHR = 2.45, 95% CI: 1.48 to 4.06; p < 0.002) were at increased risk of ETEC diarrhea. This study found that children whose mothers have at least senior secondary school education (aHR = 0.49, 95% CI: 0.29 to 0.83; p = 0.008) were at decreased risk of ETEC diarrhea. Our study emphasizes the need for integrated public health strategies focusing on water supply improvement, healthcare for persons living with HIV, and maternal education.
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Affiliation(s)
- Nsofwa Sukwa
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka P.O. Box 34681, Zambia; (N.S.); (P.S.); (M.M.); (K.M.); (K.C.); (C.C.L.); (S.S.); (B.M.); (M.M.); (S.M.); (M.C.); (M.C.); (M.S.); (R.C.)
| | - Samuel Bosomprah
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka P.O. Box 34681, Zambia; (N.S.); (P.S.); (M.M.); (K.M.); (K.C.); (C.C.L.); (S.S.); (B.M.); (M.M.); (S.M.); (M.C.); (M.C.); (M.S.); (R.C.)
- Department of Biostatistics, School of Public Health, University of Ghana, Accra P.O. Box LG13, Ghana
| | - Paul Somwe
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka P.O. Box 34681, Zambia; (N.S.); (P.S.); (M.M.); (K.M.); (K.C.); (C.C.L.); (S.S.); (B.M.); (M.M.); (S.M.); (M.C.); (M.C.); (M.S.); (R.C.)
| | - Monde Muyoyeta
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka P.O. Box 34681, Zambia; (N.S.); (P.S.); (M.M.); (K.M.); (K.C.); (C.C.L.); (S.S.); (B.M.); (M.M.); (S.M.); (M.C.); (M.C.); (M.S.); (R.C.)
| | - Kapambwe Mwape
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka P.O. Box 34681, Zambia; (N.S.); (P.S.); (M.M.); (K.M.); (K.C.); (C.C.L.); (S.S.); (B.M.); (M.M.); (S.M.); (M.C.); (M.C.); (M.S.); (R.C.)
| | - Kennedy Chibesa
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka P.O. Box 34681, Zambia; (N.S.); (P.S.); (M.M.); (K.M.); (K.C.); (C.C.L.); (S.S.); (B.M.); (M.M.); (S.M.); (M.C.); (M.C.); (M.S.); (R.C.)
| | - Charlie Chaluma Luchen
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka P.O. Box 34681, Zambia; (N.S.); (P.S.); (M.M.); (K.M.); (K.C.); (C.C.L.); (S.S.); (B.M.); (M.M.); (S.M.); (M.C.); (M.C.); (M.S.); (R.C.)
| | - Suwilanji Silwamba
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka P.O. Box 34681, Zambia; (N.S.); (P.S.); (M.M.); (K.M.); (K.C.); (C.C.L.); (S.S.); (B.M.); (M.M.); (S.M.); (M.C.); (M.C.); (M.S.); (R.C.)
| | - Bavin Mulenga
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka P.O. Box 34681, Zambia; (N.S.); (P.S.); (M.M.); (K.M.); (K.C.); (C.C.L.); (S.S.); (B.M.); (M.M.); (S.M.); (M.C.); (M.C.); (M.S.); (R.C.)
| | - Masiliso Munyinda
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka P.O. Box 34681, Zambia; (N.S.); (P.S.); (M.M.); (K.M.); (K.C.); (C.C.L.); (S.S.); (B.M.); (M.M.); (S.M.); (M.C.); (M.C.); (M.S.); (R.C.)
| | - Seke Muzazu
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka P.O. Box 34681, Zambia; (N.S.); (P.S.); (M.M.); (K.M.); (K.C.); (C.C.L.); (S.S.); (B.M.); (M.M.); (S.M.); (M.C.); (M.C.); (M.S.); (R.C.)
| | - Masuzyo Chirwa
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka P.O. Box 34681, Zambia; (N.S.); (P.S.); (M.M.); (K.M.); (K.C.); (C.C.L.); (S.S.); (B.M.); (M.M.); (S.M.); (M.C.); (M.C.); (M.S.); (R.C.)
| | - Mwelwa Chibuye
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka P.O. Box 34681, Zambia; (N.S.); (P.S.); (M.M.); (K.M.); (K.C.); (C.C.L.); (S.S.); (B.M.); (M.M.); (S.M.); (M.C.); (M.C.); (M.S.); (R.C.)
| | - Michelo Simuyandi
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka P.O. Box 34681, Zambia; (N.S.); (P.S.); (M.M.); (K.M.); (K.C.); (C.C.L.); (S.S.); (B.M.); (M.M.); (S.M.); (M.C.); (M.C.); (M.S.); (R.C.)
| | - Roma Chilengi
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka P.O. Box 34681, Zambia; (N.S.); (P.S.); (M.M.); (K.M.); (K.C.); (C.C.L.); (S.S.); (B.M.); (M.M.); (S.M.); (M.C.); (M.C.); (M.S.); (R.C.)
| | - Ann-Mari Svennerholm
- Department of Microbiology and Immunology, University of Gothenburg, 40530 Gothenburg, Sweden;
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Roy A, Rahaman M, Chouhan P. Decomposing rural-urban gap in unsafe disposal practice of child stool in India using nationwide sample survey data. Sci Rep 2024; 14:6632. [PMID: 38503836 PMCID: PMC10950857 DOI: 10.1038/s41598-024-56715-w] [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: 08/21/2023] [Accepted: 03/09/2024] [Indexed: 03/21/2024] Open
Abstract
A significant rural-urban disparity in unsafe child stool disposal practices exists in India, yet existing research falls short in identifying the contributing factors to this gap. This study addresses the research gap by contextualizing the rural-urban divide in unsafe child stool disposal using data from the fifth round of the National Family Health Survey (NFHS-5, 2019-21). In particular, the study examines the prevalence and predictors of unsafe disposal practices, exploring associated contributing factors to this gap. The study involves a sample of 78,074 women aged 15-49 with a living child under 2 years, without any missing data related to the study interest. Employing descriptive statistics, the Pearson chi-square test, multilevel logistic regression, and the Fairlie decomposition model, the research aims to fulfill its objectives. The rural-urban gap in unsafe child stool disposal practices among the study participants was 22.3 percentage points (pp), with a more pronounced gap among the Scheduled Tribes (ST). Notably, the gap was particularly wide in Madhya Pradesh (33.9 pp), Telangana (27.5 pp), Gujarat (26.1 pp), and Rajasthan (25.8 pp). Predictors such as mother's education, mass media exposure, household wealth quintile, and sanitation facilities proved significant irrespective of residence. However, religion, social group, and water facility on household premises emerged as significant factors in rural areas only. The study identified that 67% of the explained gap in unsafe child stool disposal practices was attributed to the rural-urban difference in household wealth. Other noteworthy contributors were 'household sanitation facility' (21.3%), 'mother's education level' (3.9%), and 'water facility on household premises' (3.9%). These findings underscore the need for population and area-specific policy interventions, especially for individuals from socio-economically disadvantaged backgrounds, those with lower education levels, and limited exposure to mass media, particularly in states with a high prevalence of unsafe disposal practices. Such interventions are crucial to mitigating the existing rural-urban gap in unsafe child stool disposal practices.
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Affiliation(s)
- Avijit Roy
- Department of Geography, State Aided College Teacher, Malda College, Malda, West Bengal, 732101, India
| | - Margubur Rahaman
- Doctoral Fellow, International Institute for Population Sciences (IIPS), Govandi Station Road, Deonar, Mumbai, 400088, India.
| | - Pradip Chouhan
- Department of Geography, University of Gour Banga, Malda, West Bengal, 732103, India
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Duarte A, Martins S, Augusto C, Silva MJ, Lopes L, Santos R, Rosário R. The impact of a health promotion program on toddlers' socio-emotional development: a cluster randomized study. BMC Public Health 2024; 24:415. [PMID: 38331822 PMCID: PMC10854086 DOI: 10.1186/s12889-024-17953-9] [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: 05/02/2023] [Accepted: 02/01/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND The first 3 years of life are a critical period for the development of socio-emotional skills, highlighting the importance of socio-emotional development in early childhood. This study aimed to evaluate the effectiveness of a health promotion intervention program on the socio-emotional development of children aged 12 to 42 months during the COVID-19 pandemic. METHODS A total of 344 children from 15 childcare centers participated in this study, with six centers in the intervention group and nine in the control group. Childcare teachers in the intervention group received a 6-month training program aimed at promoting healthy lifestyles, including topics such as diet, sleep, physical activity, and sedentary behavior. Sociodemographic and anthropometric measures were assessed at baseline, and socio-emotional development was assessed using the Bayley Scales of Infant and Toddler Development - Third Edition (Bayley-III) at baseline and post-intervention. RESULTS After the intervention, a significant difference in socio-emotional development was observed between children with mothers of varying education levels. Specifically, children whose mothers had lower education levels demonstrated significantly greater socio-emotional development (B = 19.000, p = 0.028) compared to the control group. In contrast, there was no significant difference in socio-emotional development among children with mothers from higher education levels. CONCLUSION These findings suggest that intervention programs for childcare teachers can effectively promote healthy socio-emotional development in children from socioeconomically disadvantaged backgrounds. Future intervention programs should consider tailoring their approaches to target disadvantaged populations. TRIAL REGISTRATION This cluster randomized controlled trial was registered in the Clinical Trials database/platform on 09/09/2019 (number NCT04082247).
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Affiliation(s)
- Ana Duarte
- School of Nursing, University of Minho, Campus de Gualtar, Braga, 4710-057, Portugal
- UICISA:E, The Health Sciences Research Unit: Nursing, School of Nursing of Coimbra, Coimbra, Portugal
- CIEnf, Research Centre in Nursing, School of Nursing, University of Minho, Braga, Portugal
- CIEC, Research Centre on Child Studies, Institute of Education, University of Minho, Braga, Portugal
| | - Silvana Martins
- ProChild CoLAB Against Poverty and Social Exclusion - Association, Campus de Couros, Rua de Vila Flor, Guimarães, 4810-225, Portugal
| | - Cláudia Augusto
- School of Nursing, University of Minho, Campus de Gualtar, Braga, 4710-057, Portugal
- UICISA:E, The Health Sciences Research Unit: Nursing, School of Nursing of Coimbra, Coimbra, Portugal
- CIEnf, Research Centre in Nursing, School of Nursing, University of Minho, Braga, Portugal
| | - Maria José Silva
- School of Nursing, University of Minho, Campus de Gualtar, Braga, 4710-057, Portugal
- UICISA:E, The Health Sciences Research Unit: Nursing, School of Nursing of Coimbra, Coimbra, Portugal
- CIEnf, Research Centre in Nursing, School of Nursing, University of Minho, Braga, Portugal
| | - Luís Lopes
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sports, University of Porto, Porto, Portugal
| | - Rute Santos
- Institute of Education, University of Minho, Braga, Portugal
| | - Rafaela Rosário
- School of Nursing, University of Minho, Campus de Gualtar, Braga, 4710-057, Portugal.
- UICISA:E, The Health Sciences Research Unit: Nursing, School of Nursing of Coimbra, Coimbra, Portugal.
- CIEnf, Research Centre in Nursing, School of Nursing, University of Minho, Braga, Portugal.
- CIEC, Research Centre on Child Studies, Institute of Education, University of Minho, Braga, Portugal.
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Elmighrabi NF, Fleming CAK, Agho KE. Factors Associated with Childhood Stunting in Four North African Countries: Evidence from Multiple Indicator Cluster Surveys, 2014-2019. Nutrients 2024; 16:473. [PMID: 38398798 PMCID: PMC10892369 DOI: 10.3390/nu16040473] [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: 12/15/2023] [Revised: 01/30/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024] Open
Abstract
Stunting remains a significant public health issue among North African children, even though significant progress has been made in reducing hunger and poverty. This study aimed to identify factors associated with stunting among children in four North African countries (Algeria, Egypt, Sudan, and Tunisia). A logistic regression model adjusted for clustering and sampling weights was used to identify factors associated with childhood stunting. It was found that the prevalence of stunting in Algeria, Egypt, Sudan, and Tunisia was 9.7%(95% CI: 9.1, 10.3), 21.1% (95% CI: 19.8, 22.5), 33.8% (95% CI: 32.7, 34.9), and 8.2% (95% CI: 7.3, 9.2), respectively. Stunting was more common among children from Sudan and Egypt. Our analysis showed that a low wealth index, being a boy, low BMI, dietary diversity <5 foods, and low birth weight were associated with stunting from 0 to 23 months; however, rural residency, a low-educated mother, low BMI, family size, and diarrhea were associated with stunting from 24 to 59 months. A collaborative approach that prioritizes maternal health and nutrition, invests in struggling families, and customizes interventions to meet the specific needs of each North African country is essential for eradicating undernutrition by 2030.
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Affiliation(s)
- Nagwa Farag Elmighrabi
- School of Health Science, Western Sydney University, Campbelltown, NSW 2560, Australia (K.E.A.)
- Department of People Determination and Sustainable Development, Benghazi 18251, Libya
- Department of Nutrition, Faculty of Public Health, University of Benghazi, Benghazi 18251, Libya
| | - Catharine A. K. Fleming
- School of Health Science, Western Sydney University, Campbelltown, NSW 2560, Australia (K.E.A.)
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Penrith, NSW 2750, Australia
| | - Kingsley E. Agho
- School of Health Science, Western Sydney University, Campbelltown, NSW 2560, Australia (K.E.A.)
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Penrith, NSW 2750, Australia
- Faculty of Health Sciences, University of Johannesburg, Johannesburg 2094, South Africa
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Bhatia KP, Ganguly S, Sasi A, Kumar V, Agarwala S, Meel R, Khan SA, Pushpam D, Bagai P, Sharma S, Ahamad N, Kumari M, Bakhshi S. Sex Bias in Treatment Abandonment of Childhood Cancer in India. Indian J Pediatr 2024:10.1007/s12098-023-05010-z. [PMID: 38270753 DOI: 10.1007/s12098-023-05010-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/21/2023] [Indexed: 01/26/2024]
Abstract
OBJECTIVES To explore the magnitude of sex bias and determinants of treatment abandonment (TA) in childhood cancer in India. METHODS Individual data of children (0-19 y) registered between January 1, 2017 and July 31, 2022, was compiled. TA was defined as defaulting curative intent treatment ≥4 wk. Defaulting treatment irrespective of intent ≥4 wk was defined as Treatment Default (TD). The primary outcome was the proportion of male-to-female children with TA. Secondary outcomes included the proportion of male-to-female children with upfront TA, TA at relapse, TD, TD-p (TD only in the palliative setting). The impact of clinico-demographic factors on TA was analysed using multivariable regression and propensity score matching (PSM). RESULTS Three thousand two hundred eighty four patients were analysed. The overall male-to-female ratio (MFR) was 2.08 (95% CI 1.94-2.24). Of 2906 patients treated with curative intent, 415 (14·3%) abandoned treatment. TA was higher in females than males (16·4% vs. 13·3%; p = 0·022) with adjusted MFR of 0·81 (0·66-0·98). The adjusted MFR of TA for treatment-naïve and relapsed patients and TD were 0·73 (0·59-0·91), 1·13 (0·65-1·96) and 0·84 (0·71-1·00) respectively. Sex independently predicted TA on multivariable analysis. However, on PSM analysis including socio-economic variables, lower maternal education predicted higher TA in children with cancer (10·1% vs. 6%, p = 0·015). CONCLUSIONS Child sex predicted TA in childhood cancer in India with more females abandoning treatment. Maternal education is a more crucial factor predicting TA over child sex, when socio-economic factors were considered. Hence, policies promoting female education and gender equality may mitigate sex-based gaps in childhood cancer care.
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Affiliation(s)
- Kanu Priya Bhatia
- Department of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Shuvadeep Ganguly
- Department of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Archana Sasi
- Department of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Vivek Kumar
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sandeep Agarwala
- Department of Pediatric Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Rachna Meel
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Shah Alam Khan
- Department of Orthopedics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Deepam Pushpam
- Department of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Poonam Bagai
- CanKids KidsCan, National Society for Change for Childhood Cancer in India, New Delhi, India
| | - Sonal Sharma
- CanKids KidsCan, National Society for Change for Childhood Cancer in India, New Delhi, India
| | - Nasim Ahamad
- CanKids KidsCan, National Society for Change for Childhood Cancer in India, New Delhi, India
| | - Mamta Kumari
- Department of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
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Jordaan EM, Joubert G, Robb L, Ngounda J, Walsh CM. Associations between socio-demographic characteristics of pregnant women and birth outcome: The Nutritional status of Expectant Mothers and their newborn Infants study. Child Care Health Dev 2024; 50:e13181. [PMID: 37737654 DOI: 10.1111/cch.13181] [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: 03/23/2023] [Revised: 08/30/2023] [Accepted: 09/10/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Low socio-economic status is associated with poor birth outcomes, however, few studies on this topic have been conducted in South Africa. We determined associations between socio-demographic variables of pregnant women and birth outcome in their offspring. METHODS This study was nested in a prospective cohort study conducted at an antenatal clinic at a regional hospital in Bloemfontein, South Africa. Questionnaires on socio-demographic information were completed on 682 pregnant women in a structured interview. Post-delivery, 331 participants provided the Road to Health Booklets for 347 infants, in which birth data were recorded. Associations between socio-demographic variables and birth outcome (defined as premature delivery or low length-for-age or low weight-for-length at birth) were investigated. Logistic regression with backward selection (p < 0.05) was used to select independent factors that were significantly associated with birth outcome. Variables with a p-value of <0.15 on bivariate analysis were considered for inclusion in the model. RESULTS Poor birth outcome was observed in 36.3% (116/320) of women. The odds of experiencing poor birth outcome were lower for women who owned a stove versus those who did not (OR 0.11, 95% CI: 0.02-0.67), and higher for women with grade 8-10 (OR 5.84, 95% CI: 1.90-17.91) or grade 10-12 (OR 4.33, 95% CI: 1.50-12.49) as their highest level of education versus tertiary education. The odds of experiencing poor birth outcomes were also higher for those employed part-time (OR 2.55, 95% CI: 1.10-5.93) versus full-time and/or self-employed. CONCLUSION Our findings confirm that the presence of basic amenities such as a stove, better education and employment improve the chances of better birth outcomes. Early screening of pregnant women for the identification of socio-demographic risk factors that may impact on birth outcome is recommended.
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Affiliation(s)
- Elizabeth Margaretha Jordaan
- Department of Nutrition and Dietetics, School of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of the Free State, Bloemfontein, Republic of South Africa
| | - Gina Joubert
- Department of Biostatistics, School of Biomedical Sciences, Faculty of Health Sciences, University of the Free State, Bloemfontein, Republic of South Africa
| | - Liska Robb
- Department of Nutrition and Dietetics, School of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of the Free State, Bloemfontein, Republic of South Africa
| | - Jennifer Ngounda
- Department of Nutrition and Dietetics, School of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of the Free State, Bloemfontein, Republic of South Africa
| | - Corinna May Walsh
- Department of Nutrition and Dietetics, School of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of the Free State, Bloemfontein, Republic of South Africa
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10
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Nyongesa P, Ekhaguere OA, Marete I, Tenge C, Kemoi M, Bann CM, Bucher SL, Patel AB, Hibberd PL, Naqvi F, Saleem S, Goldenberg RL, Goudar SS, Derman RJ, Krebs NF, Garces A, Chomba E, Carlo WA, Mwenechanya M, Lokangaka A, Tshefu AK, Bauserman M, Koso-Thomas M, Moore JL, McClure EM, Liechty EA, Esamai F. Maternal age extremes and adverse pregnancy outcomes in low-resourced settings. Front Glob Womens Health 2023; 4:1201037. [PMID: 38090046 PMCID: PMC10715413 DOI: 10.3389/fgwh.2023.1201037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 11/14/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction Adolescent (<20 years) and advanced maternal age (>35 years) pregnancies carry adverse risks and warrant a critical review in low- and middle-income countries where the burden of adverse pregnancy outcomes is highest. Objective To describe the prevalence and adverse pregnancy (maternal, perinatal, and neonatal) outcomes associated with extremes of maternal age across six countries. Patients and methods We performed a historical cohort analysis on prospectively collected data from a population-based cohort study conducted in the Democratic Republic of Congo, Guatemala, India, Kenya, Pakistan, and Zambia between 2010 and 2020. We included pregnant women and their neonates. We describe the prevalence and adverse pregnancy outcomes associated with pregnancies in these maternal age groups (<20, 20-24, 25-29, 30-35, and >35 years). Relative risks and 95% confidence intervals of each adverse pregnancy outcome comparing each maternal age group to the reference group of 20-24 years were obtained by fitting a Poisson model adjusting for site, maternal age, parity, multiple gestations, maternal education, antenatal care, and delivery location. Analysis by region was also performed. Results We analyzed 602,884 deliveries; 13% (78,584) were adolescents, and 5% (28,677) were advanced maternal age (AMA). The overall maternal mortality ratio (MMR) was 147 deaths per 100,000 live births and increased with advancing maternal age: 83 in the adolescent and 298 in the AMA group. The AMA groups had the highest MMR in all regions. Adolescent pregnancy was associated with an adjusted relative risk (aRR) of 1.07 (1.02-1.11) for perinatal mortality and 1.13 (1.06-1.19) for neonatal mortality. In contrast, AMA was associated with an aRR of 2.55 (1.81 to 3.59) for maternal mortality, 1.58 (1.49-1.67) for perinatal mortality, and 1.30 (1.20-1.41) for neonatal mortality, compared to pregnancy in women 20-24 years. This pattern was overall similar in all regions, even in the <18 and 18-19 age groups. Conclusion The maternal mortality ratio in the LMICs assessed is high and increased with advancing maternal age groups. While less prevalent, AMA was associated with a higher risk of adverse maternal mortality and, like adolescence, was associated with adverse perinatal mortality with little regional variation.
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Affiliation(s)
- Paul Nyongesa
- Department of Obstetrics and Gynecology, Moi University School of Medicine, Eldoret, Kenya
| | - Osayame A. Ekhaguere
- Division of Neonatal-Perinatal Medicine, Indiana University School of Medicine, Indiana University, Indianapolis, IN, United States
| | - Irene Marete
- Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, Kenya
| | - Constance Tenge
- Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, Kenya
| | - Milsort Kemoi
- Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, Kenya
| | - Carla M. Bann
- Social Statistical, and Environmental Sciences Unit, RTI International, Durham, NC, United States
| | - Sherri L. Bucher
- Division of Neonatal-Perinatal Medicine, Indiana University School of Medicine, Indiana University, Indianapolis, IN, United States
- Department of Community and Global Health, Richard M. Fairbanks School of Public Health, IU-Indianapolis, Indianapolis, IN, United States
| | - Archana B. Patel
- Department of Pediatrics, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
| | - Patricia L. Hibberd
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States
| | - Farnaz Naqvi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Robert L. Goldenberg
- Department of Obstetrics and Gynecology, Columbia University School of Medicine, New York, NY, United States
| | - Shivaprasad S. Goudar
- Women's and Children's Health Research Unit, J N Medical College Belagavi, KLE Academy Higher Education and Research, Karnataka, India
| | - Richard J. Derman
- Global Affairs, Thomas Jefferson University, Philadelphia, PA, United States
| | - Nancy F. Krebs
- Department of Pediatrics, University of Colorado School of Medicine, Denver, CO, United States
| | - Ana Garces
- Department of Pediatrics, Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | - Elwyn Chomba
- Department of Pediatrics, University Teaching Hospital, Lusaka, Zambia
| | - Waldemar A. Carlo
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | | | - Adrien Lokangaka
- Department of Pediatrics, Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Antoinette K. Tshefu
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Melissa Bauserman
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MA, United States
| | - Janet L. Moore
- Social Statistical, and Environmental Sciences Unit, RTI International, Durham, NC, United States
| | - Elizabeth M. McClure
- Social Statistical, and Environmental Sciences Unit, RTI International, Durham, NC, United States
| | - Edward A. Liechty
- Division of Neonatal-Perinatal Medicine, Indiana University School of Medicine, Indiana University, Indianapolis, IN, United States
| | - Fabian Esamai
- Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, Kenya
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Hossain MI, Kabir S, Zinia FA. Gender disparity in minimum dietary diversity failure among currently breastfed children aged 6-23 months in Bangladesh: evidence from Bangladesh Multiple Indicator Cluster Survey, 2019. J Nutr Sci 2023; 12:e107. [PMID: 37964976 PMCID: PMC10641693 DOI: 10.1017/jns.2023.89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 09/03/2023] [Accepted: 10/06/2023] [Indexed: 11/16/2023] Open
Abstract
Research on children's dietary diversity plays a crucial role in designing effective health interventions. Thus, this study aimed to identify the factors contributing to minimum dietary diversity failure (MDDF) among male and female children aged 6-23 months in Bangladesh. The data for this study was obtained from the Bangladesh Multiple Indicator Cluster Survey, 2019, which included children currently breastfed within a specific age range. Multivariable binary logistic regression was employed to assess the strength and significance of the association. The findings revealed that approximately 59⋅4 % of children in Bangladesh experienced MDDF, with 57⋅8 % of male children and 61 % of female children affected. Proportion test uncovered a significant gender disparity (χ2=6⋅58, P-value = 0⋅01) among children aged 6-23 months. However, the multivariable binary logistic regression analysis revealed that both male and female children shared common risk factors for MDDF, which included child age, maternal educational status, wealth status, number of antenatal care visits, and division. In our study, we observed varied spatial patterns in minimal dietary diversity. Sherpur, Netrokona, Sunamganj, and Sylhet districts showed the highest failure rates. Notably, all are flood-affected areas, impacting food availability and diversity. For targeted regional development programmes, district mapping results may offer valuable insights to policymakers, especially in areas with a high prevalence of dietary diversity failure. By understanding these risk factors, policymakers and stakeholders can implement targeted strategies to improve dietary diversity among children, promoting better health and well-being for the young population in Bangladesh.
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Affiliation(s)
- Md. Ismail Hossain
- Department of Statistics, Jagannath University, Dhaka 1100, Bangladesh
- Department of Mathematics and Natural Sciences, BRAC University, Dhaka 1212, Bangladesh
| | - Samia Kabir
- Department of Statistics, Jagannath University, Dhaka 1100, Bangladesh
| | - Faozia Afia Zinia
- Department of Statistics, Jagannath University, Dhaka 1100, Bangladesh
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12
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Ghosh P. Undernutrition Among the Children from Different Social Groups in India: Prevalence, Determinants, and Transition Over Time (2005-2006 to 2019-2021). J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01796-y. [PMID: 37775680 DOI: 10.1007/s40615-023-01796-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/03/2023] [Accepted: 09/07/2023] [Indexed: 10/01/2023]
Abstract
Combating undernutrition among children under 5 years is presently an enormous challenge for India. The study aims to determine the prevalence of undernutrition by the Composite Index of Anthropometric Failure (CIAF) and the time-dependent significant determinants of undernutrition among children under 5 years from four recognized social groups, i.e., Scheduled Tribe (ST), Scheduled Caste (SC), Other Backward Class (OBC), and Others, or General group, between 2005-2006 and 2019-2021 in India. It also explains the transition in the probability of CIAF among ST, SC, OBC, and General children belonging to different socio-demographic, economic backgrounds, and geographic regions from 2005-2006 to 2015-2016, 2015-2016 to 2019-2021, and 2005-2006 to 2019-2021 in India. Time-dependent and time-independent logistic regression models are employed to identify the major determinants and predicted probabilities of CIAF, respectively, among four social groups. The predicted probabilities of CIAF among ST, SC, OBC, and General children belonging to various socio-demographic, economic backgrounds, and geographic regions are extracted from logistic regression models and represented graphically. The study outlines a higher prevalence of CIAF among ST children, followed by SC, OBC, and General children throughout the last 15 years. Since 2005-2006, the magnitude of CIAF risk elimination has been comparatively higher among socially marginalized children (ST, SC, OBC) than in General. The investigation also outlines a significant (p < 0.001), and consistent effect of child age, maternal nutritional level, education status, household economic status, and geographic regions on the prevalence of undernutrition among all four social groups in India from 2005-2006 to 2019-2021. The policymakers must focus much on the ST, SC, and OBC sections for eliminating childhood undernutrition. Specifically, more attention is needed for the ST, SC, and OBC children living with non- or less-educated mothers, belonging to poor families, living in central, western, and eastern Indian states for eliminating the childhood CIAF. This might contribute to lowering intergroup inequality (SDG 10.2) in India in terms of the incidence of hunger (SDG 2.2), undernutrition, and child mortality (SDG 3.2).
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Affiliation(s)
- Pritam Ghosh
- Department of Geography, Ramsaday College, Amta, Howrah, West Bengal, 711401, India.
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13
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Okobi OE, Ibanga IU, Egbujo UC, Egbuchua TO, Oranu KP, Oranika US. Trends and Factors Associated With Mortality Rates of Leading Causes of Infant Death: A CDC Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) Database Analysis. Cureus 2023; 15:e45652. [PMID: 37868558 PMCID: PMC10589454 DOI: 10.7759/cureus.45652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND Infant mortality is a critical indicator of a nation's healthcare system and social well-being. This study explores trends and factors associated with mortality rates for three leading causes of infant death: congenital malformations, deformations, and chromosomal abnormalities; disorders related to short gestation and low birth weight, not elsewhere classified; and sudden infant death syndrome (SIDS). METHODS Utilizing the CDC WONDER (CDC Wide-Ranging Online Data for Epidemiologic Research) database, we conducted a retrospective observational analysis of infant mortality rates and associated factors. Data encompassed multiple years, allowing for trend analysis and exploration of influencing variables. Study variables included demographic, maternal, prenatal, and leading cause as factors. RESULT Trends in infant mortality rates varied across causes. The overall mortality rate was 2.69 per 1,000 (p=0.000) people during 2007-2020. The highest rates were observed in 2007 (3.05), 2008 (3.01), and 2009 (2.93) per 1,000 infants. For congenital malformations, deformations, and chromosomal abnormalities, the rate ranged from 1.35 to 1.12 (2007-2020). Gender-based mortality differences were subtle (male rate 2.88 per 1,000 infants, p=0.000; female infants 2.50 per 1,000 infants, p=0.000). The examination of infant mortality trends also explored maternal variables, including maternal age, education, and delivery method. The analysis revealed disparities across variables. Teenage maternal age correlated with higher mortality rates, while maternal education was associated with lower rates. Vaginal delivery (2.61 per 1,000 infants, p=0.199) showed slightly lower rates compared to cesarean section (2.86 per 1,000 infants, p=0.076). CONCLUSION This study utilizes the CDC WONDER database and offers evidence of changing trends in infant mortality rates for the selected causes. Factors such as maternal age (30-34 years and 35-39 years), race/ethnicity (Black or African-American and White), birthplace (in hospital), and mother's education (master's degree) were identified as influencing mortality rates. These findings contribute to informed policymaking and interventions aimed at mitigating infant mortality and improving the well-being of infants and their families. Further research is needed to fully understand the underlying dynamics of these trends and factors.
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Affiliation(s)
- Okelue E Okobi
- Family Medicine, Larkin Community Hospital Palm Springs Campus, Miami, USA
- Family Medicine, Medficient Health Systems, Laurel, USA
- Family Medicine, Lakeside Medical Center, Belle Glade, USA
| | | | | | - Thelma O Egbuchua
- Pediatrics and Neonatology, Delta State University Teaching Hospital, Oghara, NGA
| | - Kelechukwu P Oranu
- Obstetrics and Gynaecology, Kenechukwu Specialist Hospital and Maternity, Enugu, NGA
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14
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Chatterjee P, Chen J, Yousafzai A, Kawachi I, Subramanian SV. When social identities intersect: understanding inequities in growth outcomes by religion- caste and religion-tribe as intersecting strata of social hierarchy for Muslim and Hindu children in India. Int J Equity Health 2023; 22:115. [PMID: 37316862 DOI: 10.1186/s12939-023-01917-3] [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: 12/27/2022] [Accepted: 05/12/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Minority social status determined by religion, caste and tribal group affiliations, are usually treated as independent dimensions of inequities in India. This masks relative privileges and disadvantages at the intersections of religion-caste and religion-tribal group affiliations, and their associations with population health disparities. METHODS Our analysis was motivated by applications of the intersectionality framework in public health, which underlines how different systems of social stratification mutually inform relative access to material resources and social privilege, that are associated with distributions of population health. Based on this framework and using nationally representative National Family Health Surveys of 1992-93, 1998-99, 2005-06, 2015-16 and 2019-21, we estimated joint disparities by religion-caste and religion-tribe, for prevalence of stunting, underweight and wasting in children between 0-5 years of age. As indicators of long- and short-term growth interruptions, these are key population health indicators capturing developmental potential of children. Our sample included Hindu and Muslim children of < = 5 years, who belonged to Other (forward) castes (the most privileged social group), Other Backward Classes (OBCs), Schedule Castes (SCs) and Schedule Tribe (STs). Hindu-Other (forward) caste, as the strata with the dual advantages of religion and social group was specified as the reference category. We specified Log Poisson models to estimate multiplicative interactions of religion- caste and religion-tribe identities on risk ratio scales. We specified variables that may be associated with caste, tribe, or religion, as dimensions of social hierarchy, and/or with child growth as covariates, including fixed effects for states, survey years, child's age, sex, household urbanicity, wealth, maternal education, mother's height, and weight. We assessed patterns in growth outcomes by intersectional religion-caste and religion-tribe subgroups nationally, assessed their trends over the last 30 years, and across states. FINDINGS The sample comprised 6,594, 4,824, 8,595, 40,950 and 3,352 Muslim children, and 37,231, 24,551, 35,499, 1,87,573 and 171,055 Hindu children over NFHS 1, 2, 3, 4, and 5, respectively. As one example anthropometric outcome, predicted prevalence of stunting among different subgroups were as follows- Hindu Other: 34.7% (95%CI: 33.8, 35.7), Muslim Other: 39.2% (95% CI: 38, 40.5), Hindu OBC: 38.2 (95%CI: 37.1, 39.3), Muslim OBC: 39.6% (95%CI: 38.3, 41), Hindu SCs: 39.5% (95%CI: 38.2, 40.8), Muslims identifying as SCs: 38.5% (95%CI: 35.1, 42.3), Hindu STs: 40.6% (95% CI: 39.4, 41.9), Muslim STs: 39.7% (95%CI: 37.2, 42.4). Over the last three decades, Muslims always had higher prevalence of stunting than Hindus across caste groups. But this difference doubled for the most advantaged castes (Others) and reduced for OBCs (less privileged caste group). For SCs, who are the most disadvantaged caste group, the Muslim disadvantage reversed to an advantage. Among tribes (STs), Muslims always had an advantage, which reduced over time. Similar directions and effect sizes were estimated for prevalence of underweight. For prevalence of wasting, effect sizes were in the same range, but not statistically significant for two minority castes-OBCs and SCs. INTERPRETATION Hindu children had the highest advantages over Muslim children when they belonged to the most privileged castes. Muslim forward caste children were also disadvantaged compared to Hindu children from deprived castes (Hindu OBCs and Hindu SCs), in the case of stunting. Thus, disadvantages from a socially underprivileged religious identity, seemed to override relative social advantages of forward caste identity for Muslim children. Disadvantages born of caste identity seemed to take precedence over the social advantages of Hindu religious identity, for Hindu children of deprived castes and tribes. The doubly marginalized Muslim children from deprived castes were always behind their Hindu counter parts, although their differentials were less than that of Muslim-Hindu children of forward castes. For tribal children, Muslim identity seemed to play a protective role. Our findings indicate monitoring child development outcomes by subgroups capturing intersectional social experiences of relative privilege and access from intersecting religion and social group identities, could inform policies to target health disparities.
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Affiliation(s)
- Pritha Chatterjee
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Jarvis Chen
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Aisha Yousafzai
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
- Harvard Center for Population and Development Studies, Cambridge, MA 02138; and, Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, MA 02115, Boston, USA
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15
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Ghosh P. Determinants and transition of anaemia among under-five children from different social groups in India from 2005-06 to 2015-16. Soc Sci Med 2023; 320:115702. [PMID: 36702030 DOI: 10.1016/j.socscimed.2023.115702] [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: 06/11/2022] [Revised: 10/28/2022] [Accepted: 01/17/2023] [Indexed: 01/20/2023]
Abstract
Anaemia among under-five children is a global health problem and a major cause of child morbidity and mortality, especially in Lower-Middle-Income countries including India. Despite a significant decrease over the last decade, nearly 58% of children in India suffered from anaemia in 2015-16. This national average hides the inequality in the prevalence of anaemia among indigenous people and other social groups. Therefore, the study focuses on identifying time-dependent significant determinants of the prevalence of anaemia from 2005-06 to 2015-16 among children belonging to Scheduled Tribe (ST), Scheduled Caste (SC), Other Backward Class (OBC) and Other or General social groups. Besides, it also identified social group-wise transition of anaemia among under-five children belonging to different socio-demographic, economic, residential and regional backgrounds in India. Time-dependent and independent logistic regression models were used to identify significant determinants of child anaemia and the mean probability of anaemia across different categories of explanatory backgrounds. Though the probability of anaemia has decreased more among marginalized children during the last decade, it remains relatively higher among them. The study has outlined the significant effects of child age, birth order, maternal anaemia, education level and geographic regions on the prevalence of anaemia among ST, SC, OBC and General social groups in India over the past decade. The effect of economic status on the prevalence of anaemia among ST and SC children was insignificant. Four subpopulations demonstrated a relatively greater magnitude of decadal anaemia risk reduction among children of early age groups, living with teenage, non-anaemic, less educated mothers and living in northeast India. The study suggests the arrangement of region-specific, social-group based strategies for reducing the prevalence of anaemia among under-five children in India. In this way, the nation can achieve "health and well-being for all" (SDG 03) by eliminating the geographical, and social inequality in the prevalence of child anaemia within the country (SDG 10).
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Affiliation(s)
- Pritam Ghosh
- Department of Geography, University of Calcutta, 35, Ballygunge Circular Road, Kolkata, 700019, West Bengal, India; Department of Geography, Ramsaday College, Amta, Haora, 711401, West Bengal, India.
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16
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Moradhvaj, Samir KC. Differential impact of maternal education on under-five mortality in rural and urban India. Health Place 2023; 80:102987. [PMID: 36801652 DOI: 10.1016/j.healthplace.2023.102987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 01/15/2023] [Accepted: 02/02/2023] [Indexed: 02/20/2023]
Abstract
Under-five mortality rate (U5MR) differs by rural-urban place of residence and mother's education; however, the rural-urban gap in U5MR by mother's educational attainment is unclear in the existing literature. Using five rounds of the national family health surveys (NFHS I-V) conducted between 1992-93 and 2019-21 in India, this study estimated the main and interaction effects of rural-urban and maternal education on U5MR. The mixed effect Cox proportional hazard (MECPH) model was used to predict the risk of under-five mortality (U5M). The finding shows that unadjusted U5MR remained 50 per cent higher in rural areas than in urban areas across the surveys. Whereas, after controlling for demographic, socioeconomic, and maternal health care predictors of U5M, the MECPH regression results indicated that urban children had a higher risk of death than their rural counterparts in NFHS I-III. However, there are no significant rural-urban differences in the last two surveys (NFHS IV -V). In addition, increasing maternal education levels were associated with lower U5M in all surveys. Though, in recent years, primary education has had no significant effect. The U5M risk was additionally lower for urban children than rural children whose mothers had secondary and higher education by NFHS-III; however, this additional urban advantage was no longer significant in recent surveys. The higher impact of secondary education on U5MR in urban areas in the past may be attributed to poor socio-economic, healthcare conditions in rural areas. Overall, maternal education, particularly secondary education, remained a protective factor for U5M in both rural and urban areas, even after controlling for predictors. Therefore, there is a need to increase the focus on secondary education for girls for a further decline in U5M.
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Affiliation(s)
- Moradhvaj
- International Institute for Applied Systems Analysis (IIASA), Laxenburg, Austria; Vienna Institute of Demography of the Austrian Academy of Sciences, Vienna, Austria; Wittgenstein Centre for Demography and Global Human Capital (IIASA, VID/OAW, WU), Vienna, Austria.
| | - K C Samir
- International Institute for Applied Systems Analysis (IIASA), Laxenburg, Austria; Wittgenstein Centre for Demography and Global Human Capital (IIASA, VID/OAW, WU), Vienna, Austria; Asian Demographic Research Institute (ADRI) at Shanghai University, Shanghai, China.
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Timing and Frequency of Fathers’ Migration and Nutritional Status of Left-Behind Children in India: A Life Course Approach. POPULATION RESEARCH AND POLICY REVIEW 2023. [DOI: 10.1007/s11113-023-09746-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Marume A, Archary M, Mahomed S. Predictors of stunting among children aged 6-59 months, Zimbabwe. Public Health Nutr 2023; 26:1-14. [PMID: 36621006 PMCID: PMC10131138 DOI: 10.1017/s1368980023000046] [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: 04/02/2021] [Revised: 09/15/2022] [Accepted: 12/05/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Stunted children have an increased risk of diminished cognitive development, diabetes, degenerative and CVD later in life. Numerous modifiable factors decrease the risk of stunting in children. This study aimed to assess the role of the individual, household and social factors on stunting in Zimbabwean children. DESIGN A 1:2 unmatched case-control study. SETTING This study was conducted in two predominantly rural provinces (one with the highest national prevalence of stunting and one with the lowest prevalence) in Zimbabwe. PARTICIPANTS Data were obtained from the caregivers of 150 children aged between 6 and 59 months with stunting and from the caregivers of 300 children without stunting. RESULTS Multiple (39) correlates of stunting were identified. Child's age, birth length, birth weight, and weight-for-age outcome (child-related factors), caregiver's age, maternal HIV status, occupation, and education (parental factors), breast-feeding status, number of meals, and dietary quality (dietary factors), child's appetite, diarrhoeal and worm infection (childhood illnesses), income status, access to safe water, access to a toilet, health clubs and maternal support in infant feeding (household, socio-cultural factors) were all found to be significant predictors of childhood stunting. CONCLUSION Nearly all aspects under review from the individual-, household- to social-level factors were significantly associated with childhood stunting. These findings add to the growing body of evidence supporting the WHO stunting framework and strengthen the need to focus interventions on a multi-sectoral approach to effectively address stunting in high prevalence countries.
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Affiliation(s)
- Anesu Marume
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Ministry of Health and Child Care, Parirenyatwa Hospital, A178 Avondale, Harare, Zimbabwe
| | - Moherndran Archary
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- King Edward VIII Hospital, Durban, South Africa
| | - Saajida Mahomed
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Kamal S, Kamaralzaman S, Sharma S, Jaafar NH, Chern PM, Hassan NI, Toran H, Ismail NAS, Yusri G, Hamzaid NH. A Review of Food Texture Modification among Individuals with Cerebral Palsy: The Challenges among Cerebral Palsy Families. Nutrients 2022; 14:nu14245241. [PMID: 36558401 PMCID: PMC9782059 DOI: 10.3390/nu14245241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/03/2022] [Accepted: 12/04/2022] [Indexed: 12/13/2022] Open
Abstract
Individuals with cerebral palsy (CP) frequently present with multiple feeding problems, which may require food texture modification to ensure safe feeding. This review aims to explore the challenges individuals with CP and their caregiver's face and recommend modified food textures to ensure safety and improve the quality of life and nutritional status. A systematic search was carried out through four databases (i.e., EBSCO (Medline), PubMed, Science Direct, and Web of Science) between January 2011 and May 2022. Out of 86 articles retrieved, seven were selected based on keywords and seven other studies through manual search-five cross-sectional studies, two qualitative studies, one correlational study, one mixed method study, one case-control study, two sections of books, and two educational materials. The findings suggest that preparation and intake of food with modified texture play a necessary role in the safety of swallowing in addition to physical, social, and environmental aspects. Safety was found to be the crucial part of the food texture modification provision besides considering the stress of the caregivers and the nutritional status of individuals with CP. Currently, there are no standard guidelines available pertaining to food texture modification. This led to uncertainties in the dietary provision among caregivers, which may lead to undernourishment. Hence, standard guidelines relating to food texture modification that focuses on food preparation and menus with calorie and nutrient information are timely to be developed.
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Affiliation(s)
- Sakinah Kamal
- Center for Rehabilitation and Special Needs Studies (iCaRehab), Faculty of Health Sciences, Universiti Kebangsaan Malaysia (UKM), Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia
- Dietetics Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia (UKM), Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia
| | - Sazlina Kamaralzaman
- Center for Rehabilitation and Special Needs Studies (iCaRehab), Faculty of Health Sciences, Universiti Kebangsaan Malaysia (UKM), Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia
| | - Shobha Sharma
- Center for Healthy Aging and Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia (UKM), Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia
| | - Nurul Hazirah Jaafar
- Department of Nutrition Sciences, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia (IIUM), Jalan Sultan Ahmad Shah, Bandar Indera Mahkota, Kuantan 25200, Malaysia
| | - Phei Ming Chern
- Department of Rehabilitation Medicine (Paediatric Rehabilitation), Hospital Rehabilitasi Cheras, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia
| | - Nurul Izzaty Hassan
- Department of Chemical Sciences, Faculty of Science & Technology, Universiti Kebangsaan Malaysia (UKM), Bandar Baru Bangi 43600, Malaysia
| | - Hasnah Toran
- Faculty of Education, Universiti Kebangsaan Malaysia (UKM), Bandar Baru Bangi 43600, Malaysia
| | - Noor Akmal Shareela Ismail
- Department of Biochemistry, Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM), Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia
| | - Ghazali Yusri
- Akademi Pengajian Bahasa, Universiti Teknologi Mara (UiTM), Shah Alam 40450, Malaysia
- Malaysian Advocates for Cerebral Palsy (MyCP), No 4., USJ3/4X, USJ3, Subang Jaya 47600, Malaysia
| | - Nur Hana Hamzaid
- Center for Rehabilitation and Special Needs Studies (iCaRehab), Faculty of Health Sciences, Universiti Kebangsaan Malaysia (UKM), Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia
- Dietetics Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia (UKM), Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia
- Correspondence:
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20
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Mohammed M, Akuoko M. Subnational variations in electricity access and infant mortality: Evidence from Ghana. HEALTH POLICY OPEN 2022. [DOI: 10.1016/j.hpopen.2021.100057] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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21
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Nsiah-Asamoah C, Adjei G, Agblorti S, Doku DT. Association of maternal characteristics with child feeding indicators and nutritional status of children under-two years in Rural Ghana. BMC Pediatr 2022; 22:581. [PMID: 36207712 PMCID: PMC9540729 DOI: 10.1186/s12887-022-03651-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 09/30/2022] [Indexed: 11/10/2022] Open
Abstract
Background Optimal nutrition during the first two years of a child’s life is critical for the reduction of morbidity and mortality. In Ghana, majority of children miss out on optimal nutrition and only few (13%) of children receive a Minimum Acceptable Diet (MAD). Several studies have investigated the influence of community-level factors on infants and young children feeding (IYCF) practices. However, little is known about the influence of maternal factors on IYCF practices in rural settings. Therefore, this study assessed the influence of maternal factors on the feeding indicators and nutritional status of children aged 6–23 months in two administrative districts in Ghana. Methods Data were collected among 935 mothers who had children aged 6–23 months and accessed 21 Child Welfare Clinics within the study area. The study involved a face- to-face interview using structured questionnaires to capture maternal characteristics, dietary intake and anthropometric measurements of children. Multivariate logistic regression was used to study the association between maternal factors and child nutrition outcomes (MAD, dietary diversity score (DDS) and anthropometric indicators) using Stata 16.0 software. Results Being employed (AOR = 3.07, 95% CI: 1.71—5.49, p < 0.001) and attaining secondary or higher education (AOR = 2.86, 95% CI: 1.42—5.78, p = 0.003) were significant predictors of children receiving MAD. Similarly, having an average decision-making autonomy increased the child’s odds of receiving MAD (AOR = 1.68, 95% CI: 1.02—2.76, p = 0.040). Children of mothers who attained secondary or a higher level of education (AOR = 0.59, 95% CI: 0.36 -0.97, p = 0.040) and those whose mothers were employed (AOR = 0.71, 95% CI: 0.47—1.07, p = 0.043) were associated with a reduced risk of underweight and stunting respectively. Children of mothers with average financial independence status were more likely to receive diversified meals (AOR = 1.55, 95% CI: 1.01–2.38, p = 0.045). Conclusions High educational level and being employed have positive influence on MAD, stunting and underweight of children. High decision-making power and average financial independence of mothers are good predictors of children receiving MAD. Family planning, women empowerment in decision-making, providing employment opportunities for mothers and promoting girl-child education are recommended.
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Affiliation(s)
| | - George Adjei
- Department of Community Medicine, University of Cape Coast, Cape Coast, Ghana
| | - Samuel Agblorti
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - David Teye Doku
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
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22
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Loleka BY, Ogawa K. Influence of the level of education on women's knowledge, attitude, and practices to control the transmission of COVID-19 in the Democratic Republic of the Congo. SCIENTIFIC AFRICAN 2022; 17:e01299. [PMID: 35912070 PMCID: PMC9308146 DOI: 10.1016/j.sciaf.2022.e01299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 05/24/2022] [Accepted: 07/20/2022] [Indexed: 11/19/2022] Open
Abstract
Adequate knowledge, attitude, and practices (KAP) towards the novel coronavirus (COVID-19) can reduce its spread and may also be useful in preventing and controlling the transmission of severe acute respiratory syndrome coronavirus 2 (ARS-CoV-2) in the community. This study examines the influence of women's education level on COVID-19 KAP behaviour in the Democratic Republic of the Congo (DRC). This study uses COVID-19 data obtained from the Performance Monitoring for Action (PMA) in Kinshasa, the DRC's capital city. Data were collected through telephone interviews held in June 2020 with a representative sample of 1773 women aged 15–49 years. Data were then analysed using multiple probit regression and marginal effects techniques. To address possible sample selection bias due to the use of a telephone to recruit participants, the data were adjusted to account for the selectivity due to telephone number ownership through inverse probability weighting. In general, the results of this study indicate no statistically significant difference in the influence of the level of education on women's KAP to control the transmission of COVID-19 in the DRC, women with higher levels of education are not found to always exhibit improved knowledge, attitude, or practices of appropriate strategies for the prevention and control of COVID-19 in the DRC. The results also indicate that education can have both positive and negative influences in alleviating the burden of COVID-19.
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Neonatal Mortality and Education Related Inequality in Cesarean Births in Sub-Saharan Africa: Multi-Country Propensity Score Matching and Meta-Analysis. CHILDREN 2022; 9:children9081260. [PMID: 36010150 PMCID: PMC9406966 DOI: 10.3390/children9081260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022]
Abstract
Background: Sub-Saharan African (SSA) newborns are ten times more likely to die in the first month than a neonate born in a high-income country. The objective of this study was to examine the relationship between educational attainment and neonatal mortality (NM) among women with cesarean section (CS) deliveries in SSA countries. Methods: Using data from recent demographic and health surveys from 33 countries in SSA, we applied propensity score matching to estimate the effect of education attainment on post-CS neonatal mortality using a propensity-matched cohort where being educated was defined as completing at least primary school education Results: The number of reported CS births ranged from 186 in Niger to 1695 in Kenya. The odds of neonatal mortality between uneducated and educated women ranged from as low as 2.31 in Senegal to 35.5 in Zimbabwe, with a pooled overall risk for NM from all of the countries of OR 2.54 (95% CI: 1.72–3.74) and aOR 1.7 (95% CI: 1.12–2.57). From the 17,220 respondents, we successfully matched 11,162 educated respondents with 2146 uneducated respondents. Uneducated women had a 6% risk compared to a 2.9% risk among educated women for neonatal mortality, with an overall risk of 3.4%; babies from uneducated women were twice as likely to die compared to babies from educated women, RR 2.1 (95% CI, 1.69–2.52). Conclusion: Neonates from uneducated women were twice as likely to die following CS delivery than neonates from educated women. This evidence suggests that a means of achieving Sustainable Development Goal target 3.2 to lower newborn and child mortality is ensuring that everyone has access to high-quality care with efforts made at ensuring education for all and improving socio-economic conditions.
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Nutritional Status of Saudi Children with Celiac Disease Following the Ministry of Health’s Gluten-Free Diet Program. Nutrients 2022; 14:nu14142792. [PMID: 35889749 PMCID: PMC9315680 DOI: 10.3390/nu14142792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/01/2022] [Accepted: 07/06/2022] [Indexed: 02/04/2023] Open
Abstract
This study aimed to evaluate the nutritional status of Saudi children with celiac disease (CD) who followed the Ministry of Health’s gluten-free diet (GFD) program. This study involved 66 children with CD (29 boys and 37 girls) from 5 hospitals belonging to the Ministry of Health. Socioeconomic characteristics were obtained using a structured questionnaire. Anthropometric indices were measured using a body composition analyzer. Dietary intake was assessed using three 24 h dietary records. The biochemical parameters were determined in the hospitals’ laboratories. According to the findings, the majority of respondents had ages ranging from 10 to 13 years, a father and mother with a university education, a high family income, and 5 to 7 family members. Carbohydrates and protein intake for both genders were significantly higher than the DRI’s recommended dietary intake. However, the majority of nutrients consumed were at levels significantly lower than the DRI. Both genders had normal anthropometric indices, with girls having at significantly higher indices than boys. The biochemical parameters of both genders were comparable and within the normal range, except for vitamin D, which was below the normal range. The most important factors influencing nutritional status were age for both genders, and family income and number of family members for boys. In conclusion, data obtained for nutrient intake, anthropometric indicators, body composition, and biochemical analysis indicated that CD children following the Ministry of Health GFD program have a generally good nutritional status.
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The Influence of Intensive Nutritional Education on the Iron Status in Infants. Nutrients 2022; 14:nu14122453. [PMID: 35745183 PMCID: PMC9229227 DOI: 10.3390/nu14122453] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/09/2022] [Accepted: 06/12/2022] [Indexed: 02/06/2023] Open
Abstract
Iron is an essential nutrient for a child’s proper development at every growth stage. It is crucial for the production of red blood and muscle cells, DNA replication, and the development of the brain, nervous and immune systems. Iron deficiency is the most common micronutrient deficiency in children worldwide. Despite widespread access to nutritional information for children, parents continue to make many feeding mistakes. This study aimed to assess whether any nutritional intervention would affect the iron status in children. The parents of 203 children were randomly assigned to one of two groups: the study group received intensive mobile nutritional education for a year, while the control group received no intervention. Blood tests were performed on both groups at the beginning of the study and one year later. The educational intervention resulted in statistically significantly higher levels of RBC (red blood cells; p = 0.020), HGB (haemoglobin; p = 0.039), HCT (haematocrit; p = 0.036), MCV (mean cell volume; p = 0.018) parameters and iron dietary intake (p ≤ 0.001). Even a non-targeted dietary intervention improves the iron status in children. As iron management is insufficient in most children, an iron-targeted nutritional intervention appears necessary.
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Meitei WB, Singh A, Ladusingh L. The effects of community clustering on under-five mortality in India: a parametric shared frailty modelling approach. GENUS 2022. [DOI: 10.1186/s41118-022-00165-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractThe study of the effect of community clustering of under-five mortality has its implications in both research and policy. Studies have shown the contribution of community factors on under-five mortality. However, these studies did not account for censoring. We examine the presence of community dependencies and determine the risk factors of under-five mortality in India and its six state-regions by employing a Weibull hazard model with gamma shared frailty. We considered every possible way to ensure that the frailty models used in the study are not merely a consequence of how the data are organized rather than representing a substantive assumption about the source of the frailty. Data from the fourth round of the National Family Health Survey has been used. The study found that except for south India, children born in the same community in India and the other five state-regions shared similar characteristics of under-five mortality. The risk of under-five mortality decreased with an increase in mother’s schooling. Except for northern region, female births were less likely to die within first five years of life. We found a U-shaped relationship between preceding birth interval and under-five mortality. History of sibling’s death, multiple births and low-birthweight significantly increases the risk of under-five mortality in all the six state-regions. The Hindu–Muslim mortality gaps and Scheduled Caste or Tribe’s mortality disadvantage is diminishing. Since the factors associated with under-five mortality were not necessarily the same across the six state-regions of India, adopting a uniform approach in dealing with under-five mortality in India may not benefit all the regions equally.
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27
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Kumar G, R.S. R. Availability of public health facilities and utilization of maternal and child health services in districts of India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2022.101070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Maternal education, health care system and child health: Evidence from India. Soc Sci Med 2022; 296:114740. [DOI: 10.1016/j.socscimed.2022.114740] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 12/09/2021] [Accepted: 01/19/2022] [Indexed: 11/24/2022]
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Das S, Loba F, Mozumder K, Roy P, Das J, Das SK. Trend of maternal education in Bangladesh from 2004–2018: Analysis of demographic surveillance data. PLoS One 2022; 17:e0255845. [PMID: 35100288 PMCID: PMC8803158 DOI: 10.1371/journal.pone.0255845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 10/20/2021] [Indexed: 11/19/2022] Open
Abstract
Background
Maternal education is universally recognised as a major factor in positive societal indicators (health, wellbeing, overall education, etc.) and a country’s growth and economic sustainability, yet the underlying factors contributing to maternal education have not been widely investigated, especially in developing countries.
Objective
This study investigated the 15-year trend of maternal education in Bangladesh (2004–2018) to identify the factors contributing to maternal education.
Method
This study used publicly available cross-data from five consecutive Bangladesh Demographic and Health Surveys (2004, 2007, 2011, 2014 and 2018). Level of maternal education was grouped as ‘no education’, ‘incomplete primary’, ‘complete primary’, ‘incomplete secondary’, ‘complete secondary’ and ‘higher education’ (reference group). The differences in factors/exposure variables suspected to contribute to maternal education were measured for these groups for 2004–2018, and a survey multinomial logistic regression was performed to estimate the explanatory value of these factors.
Results
From 2004–2018, there was a 62% gross reduction of the no education group and a 61% gross increase in the higher education group. A gross increase was also observed for complete secondary (49%), incomplete secondary (39%) and complete primary education (14%). In multivariate analysis, in rural areas, in 2018, the probability of a woman being in the complete primary, incomplete primary or no education groups was increased (adjusted relative risk ratio: 1.21, 1.40 and 1.59), compared to 2004 (0.73, 1.09, 1.12), respectively. From 2004–2018, the factor of no television watching reduced the probability of maternal education levels. Having a husband/partner who had no education increased the probability of a woman’s education level. The probability of all maternal education levels decreased across all wealth index groups.
Conclusion
The data suggest that average maternal education level in Bangladesh increased from 2004–2018. However, an integrated effort is required to improve factors associated with maternal education to both increase maternal education and Bangladesh’s long-term sustainability.
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Affiliation(s)
- Shathi Das
- St. Gregory’s High School & College, Dhaka, Bangladesh
- * E-mail: (SD); , (SKD)
| | - Fharia Loba
- College of Education, Charles Darwin University, Darwin, Australia
| | | | - Palash Roy
- Kumudini Pharmaceutical Limited, Dhaka, Bangladesh
| | - Jui Das
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia
| | - Sumon Kumar Das
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- * E-mail: (SD); , (SKD)
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Epidemiology of Malnutrition among Children with Cerebral Palsy in Low- and Middle-Income Countries: Findings from the Global LMIC CP Register. Nutrients 2021; 13:nu13113676. [PMID: 34835932 PMCID: PMC8619063 DOI: 10.3390/nu13113676] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/11/2021] [Accepted: 10/15/2021] [Indexed: 01/25/2023] Open
Abstract
Background: This study aimed to describe the epidemiology of malnutrition among children with cerebral palsy (CP) in low- and middle-income countries (LMICs). Methods: Data from children with confirmed CP aged <18 years registered into the Global LMIC CP Register (GLM CPR) from Bangladesh, Indonesia, Nepal, and Ghana were included. Anthropometric measurements were collected, and nutritional status was determined following the WHO guidelines. Descriptive statistics and adjusted logistic regression were used to describe the nutritional status and identify predictors of malnutrition. Results: Between January 2015 and December 2020, 3619 children with CP were registered into the GLM CPR (median age at assessment: 7.0 years, 39% female). Overall, 72–98% of children from Bangladesh, Indonesia, Nepal, and Ghana had at least one form of undernutrition. The adjusted analysis showed, older age, low maternal education, spastic tri/quadriplegia, and Gross Motor Functional Classification System (GMFCS) levels III–V were significant predictors of underweight and stunting among children with CP in Bangladesh. In Nepal, female children, GMFCS III–V had higher odds of underweight and stunting. In Ghana, low maternal education was significantly associated with underweight, whereas older age and the presence of associated impairments were the significant predictors of stunting among children with CP. Having a GMFCS of III–V increased the odds of being underweight among children in Indonesia; however, no predictors were identified for stunting, as nearly all children with CP registered from Indonesia were stunted. Conclusion: Most children with CP in GLM CPR had undernutrition. Maternal education and moderate-to-severe motor impairment (GMFCS III–V) were significant predictors. Practical nutrition education to mothers/caregivers and management guidelines according to the motor severity using local resources could improve the nutritional outcome of children with CP in LMICs.
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Selvamani Y, Arokiasamy P. Association of life course socioeconomic status and adult height with cognitive functioning of older adults in India and China. BMC Geriatr 2021; 21:354. [PMID: 34107877 PMCID: PMC8191062 DOI: 10.1186/s12877-021-02303-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 05/26/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Cognitive functioning is an important measure of intrinsic capacity. In this study, we examine the association of life course socioeconomic status (SES) and height with cognitive functioning among older adults (50+) in India and China. The age pattern of cognitive functioning with measures of life course socioeconomic status has also been examined. METHODS Cross-sectional comparative analysis was conducted using the WHO's Study on global AGEing and adult health (SAGE) data for India and China. Multilevel mixed-effect linear regression analysis was used to examine the association of life course socioeconomic status and adult height with cognitive functioning. RESULTS In both India and China, parental education as a measure of childhood socioeconomic status was positively associated with cognitive functioning. The association between adult socioeconomic status and cognitive functioning was positive and significant. Height was significantly and positively associated with improved cognitive functioning of older adults in India and China. Furthermore, the age-related decline in cognitive functioning score was higher among older adults whose parents had no schooling, particularly in China. The cognitive functioning score with age was much lower among less-educated older adults than those with higher levels of education in China. Wealthier older adults in India had higher cognitive functioning in middle ages, however, wealth differences narrowed with age. CONCLUSIONS The results of this study suggest a significant association of lifetime socioeconomic status and cumulative net nutrition on later-life cognitive functioning in middle-income settings.
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Affiliation(s)
- Y Selvamani
- International Institute for Population Sciences (IIPS), Govandi Station Road, Mumbai, 400088, India.
| | - P Arokiasamy
- Department of Development Studies, International Institute for Population Sciences (IIPS), Govandi Station Road, Mumbai, 400088, India
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Mostafavi F, Zamani-Alavijeh F, Mansourian M, Bastami F. The promotion of healthy breakfast and snacks based on the social marketing model: a mixed-methods study. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2021; 40:22. [PMID: 33962686 PMCID: PMC8106147 DOI: 10.1186/s41043-021-00245-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 04/22/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Skipping breakfast and replacing it with non-nutritious snacks are progressively increasing among adolescents. This study aimed to develop an educational intervention based on the Social Marketing Model and evaluate its effects on healthy breakfast and snack consumption among female adolescent students. METHODS This mixed-methods study was conducted in 2016-2019 in two phases. In the first phase, a qualitative study was conducted through directed content analysis in guidance schools in Khorramabad, Isfahan, and Tehran, Iran, to explore factors affecting breakfast consumption. The results of this phase were set in the benchmarks of the Social Marketing Model. In the second phase, a randomized controlled trial was conducted based on the benchmarks of the Social Marketing Model on 94 students randomly recruited from guidance schools in Khorramabad, Iran. RESULTS The findings of the qualitative phase were categorized into the benchmarks of the Social Marketing Model, namely the social marketing mix, the intended behavior, internal and external competing factors for behavior modification, theoretical concepts related to the behavior, and the role of supporters. In the quantitative phase, the univariate analysis showed significant between-group differences concerning the product, price, promotion, and behavior (p < 0.05). CONCLUSION Healthy breakfast and snack consumption can be promoted through making acceptable the tastes, costs, preparations, and consumption places of breakfast and snack. TRIAL REGISTRATION The trial was registered in the Iranian Registry of Clinical Trials (code: IRCT20170201032347N1 ). The trial was registered in 11/07/2018 and is accessible on the Iranian Clinical Trial Registration website.
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Affiliation(s)
- Firoozeh Mostafavi
- Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fereshteh Zamani-Alavijeh
- Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marjan Mansourian
- Department of Epidemiology and Biostatistic, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Bastami
- Department of Public Health, School of Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
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Abolurin OO, Olaleye AO, Adekoya AO. Addressing the Sub-Optimal Use of Oral Rehydration Solution for Childhood Diarrhoea in the Tropics: Findings From a Rural Setting in Nigeria. J Trop Pediatr 2021; 67:5948851. [PMID: 33130901 DOI: 10.1093/tropej/fmaa071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Oral rehydration solution (ORS) is an evidence-based intervention to reduce diarrhoea-related morbidity and mortality, but consistently low rates of ORS use have been documented in Nigeria. AIM To identify barriers to the optimal use of ORS for childhood diarrhoea in Nigeria and recommend appropriate interventions to improve uptake of ORS at community and facility levels. METHODS A quantitative cross-sectional survey of 400 mothers with children under 5 years of age was conducted in Nigeria to explore reasons for suboptimal utilization of ORS for childhood diarrhoea. An interviewer-administered questionnaire was used for data collection. Data were analysed using the statistical software SPSS version 21.0®. RESULTS Sixty-one (15.3%) of the respondents were unaware of ORS. Of the 339 that were aware, their source of information was mainly hospital/health workers (81.1%). Among mothers that affirmed they could prepare ORS, only 64 (22.1%) prepared it correctly. Level of education significantly influenced awareness of ORS as well as its correct preparation. Nineteen mothers (5.6%) had difficulty getting ORS when needed, whereas 13 (3.8%) reported that it was difficult for them to remember how to prepare ORS. Four in ten children took ORS reluctantly or refused it outrightly. No cultural taboo concerning the use of ORS was reported. CONCLUSION There is still a wide gap in the awareness of ORS and many caregivers prepared the solution incorrectly. We recommend that the method of preparation of ORS be clearly indicated on the sachets, and production of commercial 1-L water packages for ORS preparation be encouraged. Lay summaryOral rehydration solution (ORS) is an evidence-based intervention to reduce diarrhoea-related morbidity and mortality, but consistently low rates of ORS use have been documented in Nigeria. A quantitative cross-sectional study was carried out among 400 mothers to identify barriers to the optimal use of ORS for childhood diarrhoea and recommend appropriate interventions. Sixty-one (15.3%) of the respondents were unaware of ORS. Among mothers that affirmed they could prepare ORS, only 64 (22.1%) prepared it correctly. Level of education significantly influenced awareness of ORS as well as its correct preparation. Some mothers had difficulty getting ORS when needed, while some found it difficult to remember how to prepare it. Four in ten children took ORS reluctantly or refused it outrightly. No cultural taboo concerning the use of ORS was reported. The study showed that there is still a wide gap in the awareness of ORS and many caregivers prepared the solution incorrectly. Hence, we recommend that the method of preparation of ORS be clearly indicated on the sachets, and production of commercial 1-L water packages for ORS preparation be encouraged.
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Affiliation(s)
- Olufunmilola O Abolurin
- Department of Paediatrics, Babcock University Teaching Hospital, Ilishan-Remo, Ogun State, Nigeria
| | - Atinuke O Olaleye
- Department of Obstetrics and Gynaecology, Babcock University Teaching Hospital, Ilishan-Remo, Ogun State, Nigeria
| | - Adesola O Adekoya
- Department of Paediatrics, Babcock University Teaching Hospital, Ilishan-Remo, Ogun State, Nigeria
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Do tribal children experience elevated risk of poor nutritional status in India? A multilevel analysis. J Biosoc Sci 2020; 53:683-708. [PMID: 32873356 DOI: 10.1017/s0021932020000474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Economic progress in India over the past three decades has not been accompanied by a commensurate improvement in the nutritional status of children, and a disproportionate burden of undernutrition is still focused on socioeconomically disadvantaged populations in the poorest regions. This study examined the nutritional status of children under 3 years of age using data from the fourth round of Indian National Family Health Survey conducted in 2015-2016. Child undernutrition was assessed in a sample of 126,431 under-3 children using the anthropometric indices of stunting, underweight and wasting ('anthropometric failure') across 640 districts, 5489 primary sampling units and 35 states/UTs of India. Descriptive statistics were used to examine the regional pattern of childhood undernutrition. Multilevel logistic regression models were fitted to examine the adjusted effect of social group (tribal vs non-tribal) and economic, demographic and contextual factors on the risks of stunting, underweight and wasting accounting for the hierarchical nature of the data. Interaction effects were estimated to model the joint effects of socioeconomic position (household wealth, maternal education, urban/rural residence and geographical region) and social group (tribal vs non-tribal) with the likelihood of anthropometric failure among children. The burden of childhood undernutrition was found to vary starkly across social, economic, demographic and contextual factors. Interaction effects demonstrated that tribal children from economically poorer households, with less-educated mothers, residing in rural areas and living in the Central region of India had elevated odds of anthropometric deprivation than other tribal children. The one-size-fits-all approach to tackling undernutrition in tribal children may not be efficient and could be counterproductive.
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Maghfiroh MS, Laksono AD. “Diberi air gula… awalnya nangis menjadi diam, karena kenyang, gak lemas, daya tahan tubuhnya meningkat”; Studi Pola Asupan pada Bayi. AMERTA NUTRITION 2020. [DOI: 10.20473/amnt.v4i2.2020.116-122] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Babies were vulnerable to health and nutrition problems. WHO states that 60% of deaths of children under five were caused by malnutrition. Of these, two-thirds of them were caused by improper feeding of babies. Objective: to describe patterns of food intake in infants in Kepung Village, Kediri District.Methods: The study was designed qualitatively with an ethnographic approach. Data collection was performed using in-depth interviews and participatory observation. The study was conducted in Kepung Village, Kediri, East Java. The process of collecting data was done by researchers by staying with the target for 6 months. Results: The pattern of intake in infants aged 0-6 months in Kepung Village was not only given breast milk but was given food in the form of formula milk, sugar water and ‘kepok’ banana. When the mother or caregiver feels that the baby was still hungry, it will be given food intake other than the milk. The practice of feeding was inseparable from the influence of hereditary belief, where sugar water was believed to make the baby not fussy because the baby becomes full and healthy. Conclusion: The pattern of intake in infants in Kepung Village was very varied. Not only breast milk, babies have also been given mashed up adult food. People in Kepung Village also have a habit of giving their babies sugar water. ABSTRAKLatar Belakang: Bayi adalah masa yang rentan terhadap masalah kesehatan dan gizi. WHO menyatakan bahwa 60% kematian anak balita disebabkan oleh keadaan kurang gizi. Dari jumlah tersebut, dua per tiga diantaranya disebabkan oleh pemberian makan yang kurang tepat.Tujuan: Penelitian ditujukan untuk menggambarkan pola asupan pada bayi di Desa Kepung, Kabupaten Kediri.Metode: Studi didesain secara kualitatif dengan pendekatan etnografi. Pengumpulan data dilakukan dengan menggunakan metode wawancara mendalam dan observasi partisipatif. Studi dilakukan di Desa Kepung, Kecamatan Kepung, Kabupaten Kediri, Jawa Timur. Proses pengumpulan data dilakukan oleh peneliti dengan tinggal bersama target. Peneliti lived in di lokasi penelitian selama 6 bulan.Hasil: Pola asupan pada bayi usia 0-6 bulan di Desa Kepung tidak hanya diberikan ASI saja, tapi diberikan makanan berupa susu formula, air gula dan pisang kepok. Praktik pemberian makanan tersebut tidak terlepas dari pengaruh kepercayaan yang turun-temurun, yang mana air gula diyakini dapat membuat bayi tidak rewel karena bayi menjadi kenyang dan menyehatkan.Kesimpulan: Pola asupan pada bayi di Desa Kepung sangat bervariasi. Tidak hanya ASI, bayi juga sudah diberi makanan orang dewasa yang dilembutkan. Masyarakat di Desa Kepung juga memiliki kebiasaan memberikan bayinya air gula.
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