1
|
Wand H, Naidoo S, Govender V, Reddy T, Moodley J. Preventing Stunting in South African Children Under 5: Evaluating the Combined Impacts of Maternal Characteristics and Low Socioeconomic Conditions. JOURNAL OF PREVENTION (2022) 2024; 45:339-355. [PMID: 38416314 PMCID: PMC11033229 DOI: 10.1007/s10935-024-00766-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/05/2024] [Indexed: 02/29/2024]
Abstract
More than 140 million children under five suffered from stunting in 2020. This highlights the ongoing challenge of addressing childhood malnutrition globally. We utilized data from a nationally representative sample of children under five years of age (n = 14,151) who participated in five cycles of the South African National Income Dynamics Study (SA-NIDS) (2008-2017). We estimated the proportion of stunted children attributed to the mothers' anthropometric characteristics and socioeconomic conditions. We also quantified the population-level burden of low-socioeconomic conditions on hunger/food insecurity among pregnant women (n = 22,814) who participated in the nine rounds of the South African General Household Surveys (GHS) (2008-2021). Results from weighted-multivariate logistic regression were incorporated into the population-level impacts of correlates of stunting and low-socioeconomic conditions. The prevalence of stunting declined from 25% in 2008 to 23% in 2017. Mothers' anthropometric measures (underweight/height < 160 cm), marital status, low education, absence of medical insurance and low-socioeconomic conditions were all identified as the most influential risk factors for stunting. Their population-level impacts on stunting increased substantially from 34% (in 2008) to 65% (in 2017). Comprehensive strategies emphasizing enhanced food security, extended breastfeeding, appropriate nutrition, and access to adequate healthcare and education are urgently needed to reduce the burden of food insecurity low-socioeconomic, malnutrition, and its long-term consequences.
Collapse
Affiliation(s)
- Handan Wand
- Biostatistics and Databases Program, Kirby Institute, University of New South Wales (UNSW Sydney), Kirby Institute Level 6, Wallace Wurth Building, Kensington, NSW, 2052, Australia.
| | | | | | - Tarylee Reddy
- Biostatistics Unit, South African Medical Research Council, Durban, Kwazulu-Natal, South Africa
| | | |
Collapse
|
2
|
Lestari E, Siregar A, Hidayat AK, Yusuf AA. Stunting and its association with education and cognitive outcomes in adulthood: A longitudinal study in Indonesia. PLoS One 2024; 19:e0295380. [PMID: 38709786 PMCID: PMC11073707 DOI: 10.1371/journal.pone.0295380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/21/2023] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Stunting is associated with adverse outcomes in adulthood. This article specifically aims to analyse the relationship between childhood stunting and education as well as cognitive outcomes for adults in Indonesia. METHODS Pooled data from wave one (1) and two (2) of the Indonesia Family Life Survey (IFLS) in 1993 and 1997 identified a sub-sample of 4,379 children aged 0-5 by their height-for-age (HAZ) to be compared for their differences in educational outcomes and cognitive abilities in 2014. HAZ was used to proxy relative height to determine stunting status based on 2006 WHO child's growth standards. Education and cognitive abilities outcomes include years of schooling, age of school entry, grade repetition, and scores for cognitive and math tests. The study employs estimation models of pooled regressions and instrumental variable (IV) to address problems of endogeneity and bias from omitted variables. RESULTS Stunting and relatively small stature had significant associations with cognitive development, and they worked as intermediaries to cognitive developmental barriers as manifested in reduced educational outcomes. A lack of one SD in HAZ was associated with 0.6 years shortened length of the school, 3% higher chances of dropouts from secondary school, and 0.10-0.23 SD lowered cognitive and numerical scores. Similarly, stunting is associated with decrease cognitive test scores by 0.56-0.8 SD compared to non-stunting, two years less schooling, and 0.4 years of delayed entry to school. As for cognitive abilities, stunting is associated with lower cognitive and numerical abilities by 0.38-0.82 z-scores. CONCLUSION Growth retardation during childhood in Indonesia was associated with lower cognitive abilities, particularly during school age, and this correlation faded as individuals grew up. Subsequently, growth retardation is significantly linked to lower educational outcomes. Impaired growth has implications for reduced lifetime earnings potential mediated by diminished cognitive capacity and lower educational attainment. The finding suggests that development in Indonesia during recent decades has not provided an adequate environment to enable children to achieve their potential educational outcomes.
Collapse
Affiliation(s)
- Esta Lestari
- Doctorate in Economics Program, Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Bandung, West Java, Indonesia
- Research Center for Behavioral and Circular Economics, National Research and Innovation Agency (BRIN), Jakarta, Indonesia
| | - Adiatma Siregar
- Doctorate in Economics Program, Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Bandung, West Java, Indonesia
- Center for Economics and Development Studies, Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Achmad K. Hidayat
- Doctorate in Economics Program, Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Bandung, West Java, Indonesia
- Center for Economics and Development Studies, Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Arief A. Yusuf
- Doctorate in Economics Program, Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Bandung, West Java, Indonesia
- SDGs Center, Universitas Padjajaran, Bandung, West Java, Indonesia
| |
Collapse
|
3
|
Van der Spek L, Sonneveld BGJS. Analyzing the impact of an MDG-Fund program on childhood malnutrition in Timor-Leste. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:46. [PMID: 38576057 PMCID: PMC10993443 DOI: 10.1186/s41043-024-00539-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 03/19/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Timor-Leste's food insecurity, propelled by political conflicts, a fragile economy and biophysical limitations that characterize mountainous Small Island Developing States (SIDS), is expressed in a high incidence (50%) of stunted children. Hence, the Millennium Development Goals Achievement Fund's Joint Program's (MDG-F JP) in 2009 was a timely intervention to reduce prevalence of underweight among under-fives. Since the impact of the program remains largely unclear, the current study investigates the contributions of the MDG-F JP on improving children's nutritional status in Timor-Leste, in order to inform policymakers on how to make future programs more effective. METHODS Using bivariate analyses and multiple linear regression models we analyzed Demographic and Health Survey (DHS) data from under-fives in 2009-2010 and 2016, combined with spatially explicit data from geographic information systems (GIS). The analyses generated trends and factors associated with undernutrition, which were used in a quasi-experimental setting to compare districts that received the MDG-F JP with similar districts that did not receive MDG-F JP interventions. RESULTS A comprehensive set of factors dependent on seasons, locations, and individuals determine undernutrition in Timor-Leste. A positive impact of the MDG-F JP was found for the average severity of wasting, but not for stunting and underweight. CONCLUSIONS The findings reinforce the pressing need for integrated and cross-sectoral programs, aimed especially at agricultural workers, mothers, and children. The agricultural challenge is to sustainably select, produce and conserve higher-yield and nutrient-rich crops, and educational enhancement should be aligned with local practices and research.
Collapse
Affiliation(s)
- L Van der Spek
- Athena Institute, VU University Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands.
| | - B G J S Sonneveld
- Amsterdam Centre for World Food Studies, Athena Institute, VU University Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands
| |
Collapse
|
4
|
Frongillo EA, Suresh S, Thapa DK, Cunningham K, Pandey Rana P, Adhikari RP, Kole S, Pun B, Kshetri I, Adhikari DP, Klemm R. Impact of Suaahara, an integrated nutrition programme, on maternal and child nutrition at scale in Nepal. MATERNAL & CHILD NUTRITION 2024:e13630. [PMID: 38342986 DOI: 10.1111/mcn.13630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 02/13/2024]
Abstract
Suaahara was an innovative, complex, multi-sectoral, large-scale, nutrition programme in Nepal to increase exposure to nutrition-related information and services, improve nutrition-related knowledge and practices among pregnant women and mothers of infants and young children, and improve their nutrition. This study evaluated the effectiveness of Suaahara to improve nutrition and nutrition-related practices by comparing changes over 10 years between intervention and comparison districts. The samples of households at baseline in 2012 and endline in 2022 were 2040 and 2480, respectively, from 120 old wards. The impact was estimated using intent-to-treat regression models in which survey year, arm and their interaction were fixed effects, accounting for district clustering, with the interaction estimating differences between arms in changes over time. The intervention, relative to comparison, reduced maternal underweight by 8.43 percentage points (p < 0.001), consistent with improved maternal and fetal condition that was manifested as the greater length of 0.761 z-scores (p = 0.004) of infants 0-5.9 months. Complementary feeding practices with children between 6 and 23.9 months of age improved more in the intervention than comparison districts: child dietary diversity by 0.294 food groups (p = 0.072) and minimum dietary diversity by 9.51 percentage points (p = 0.028), feeding sick child more (p = 0.002) and administering oral rehydration solution and zinc for diarrhoea (p = 0.057) by about 17 percentage points each, and minimum meal frequency (p = 0.004) and minimum acceptable diet (p = 0.022) by about 15 percentage points each. Substantial impacts were demonstrated despite political restructuring, earthquakes, and other major challenges that Nepal and Suaahara faced and limitations in statistical power because of the reduced number of districts that then could be included in the study. Registered at clinicaltrials.gov with identifier NCT05448287.
Collapse
Affiliation(s)
- Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | | | - Deependra K Thapa
- Nepal Public Health Research and Development Center, Kathmandu, Nepal
| | | | | | | | - Subir Kole
- Helen Keller International, New York City, New York, USA
| | - Bhim Pun
- Helen Keller International, New York City, New York, USA
| | - Indra Kshetri
- Helen Keller International, New York City, New York, USA
| | | | - Rolf Klemm
- Helen Keller International, New York City, New York, USA
| |
Collapse
|
5
|
Kalinda C, Qambayot MA, Ishimwe SMC, Regnier D, Bazimya D, Uwizeyimana T, Desie S, Rudert C, Gebremariam A, Brennan E, Karumba S, Wong R, Bekele A. Leveraging multisectoral approach to understand the determinants of childhood stunting in Rwanda: a systematic review and meta-analysis. Syst Rev 2024; 13:16. [PMID: 38183064 PMCID: PMC10768136 DOI: 10.1186/s13643-023-02438-4] [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: 06/27/2023] [Accepted: 12/14/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Addressing childhood stunting is a priority and an important step in the attainment of Global Nutrition Targets for 2025 and Sustainable Development Goals (SDGs). In Rwanda, the prevalence of child stunting remains high despite concerted efforts to reduce it. METHODS Utilizing the United Nations International Children's Emergency Fund (UNICEF) framework on maternal and child nutrition, this study systematically evaluated the determinants of child stunting in Rwanda and identified available gaps. Twenty-five peer-reviewed papers and five Demographic and Health Surveys (DHS) reports were included in the final selection of our review, which allowed us to identify determinants such as governance and norms including wealth index, marital status, and maternal education, while underlying determinants were maternal health and nutrition factors, early initiation of breastfeeding, water treatment and sanitation, and immediate factors included infections. RESULTS A total of 75% of the overall inequality in stunting was due to the difference in the social determinants of stunting between poor and nonpoor households. Maternal education (17%) and intergenerational transfer (31%) accounted for most of the inequalities in stunting, and an increase in gross domestic product per capita contributed to a reduction in its prevalence. There is a paucity of information on the impact of sociocultural norms, early life exposures, maternal health and nutrition, and Rwandan topography. CONCLUSION The findings of this study suggest that improving women's status, particularly maternal education and health; access to improved water, sanitation, and hygiene-related factors; and the socioeconomic status of communities, especially those in rural areas, will lay a sound foundation for reducing stunting among under-5 children.
Collapse
Affiliation(s)
- Chester Kalinda
- Bill and Joyce Cummings Institute of Global Health, University of Global Health Equity, Kigali Heights, Plot 772 KG 7 Ave, PO Box 6955, Kigali, Rwanda.
| | - Maria Albin Qambayot
- Centre for One Health, University of Global Health Equity, Kigali Heights, Plot 772 KG 7 Ave, PO Box 6955, Kigali, Rwanda
| | - Sage Marie C Ishimwe
- Institute of Global Health Equity Research (IGHER), University of Global Health Equity, Kigali Heights, Plot 772 KG 7 Ave, PO Box 6955, Kigali, Rwanda
| | - Denis Regnier
- School of Medicine, University of Global Health Equity, Kigali Heights, Plot 772 KG 7 Ave, PO Box 6955, Kigali, Rwanda
| | - Darius Bazimya
- Bill and Joyce Cummings Institute of Global Health, University of Global Health Equity, Kigali Heights, Plot 772 KG 7 Ave, PO Box 6955, Kigali, Rwanda
| | - Theogene Uwizeyimana
- Bill and Joyce Cummings Institute of Global Health, University of Global Health Equity, Kigali Heights, Plot 772 KG 7 Ave, PO Box 6955, Kigali, Rwanda
| | - Samson Desie
- UNICEF Kigali Office, P.O. Box 381, Kigali, Rwanda
| | | | - Alemayehu Gebremariam
- Health Office, US Agency For International Development (USAID), Rwanda Office, KG 7 Avenue, Kigali, Rwanda
| | - Elizabeth Brennan
- Catholic Relief Services, Rwanda Country Program, Chadel Building, P.O. Box 65, Kigali, Rwanda
| | - Silver Karumba
- Catholic Relief Services, Rwanda Country Program, Chadel Building, P.O. Box 65, Kigali, Rwanda
| | - Rex Wong
- Bill and Joyce Cummings Institute of Global Health, University of Global Health Equity, Kigali Heights, Plot 772 KG 7 Ave, PO Box 6955, Kigali, Rwanda
| | - Abebe Bekele
- School of Medicine, University of Global Health Equity, Kigali Heights, Plot 772 KG 7 Ave, PO Box 6955, Kigali, Rwanda
| |
Collapse
|
6
|
Poix S, Elmusharaf K. The cost of inaction on preconception health in Nigeria: An economic impact analysis. Glob Public Health 2024; 19:2361782. [PMID: 38837785 DOI: 10.1080/17441692.2024.2361782] [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: 08/29/2023] [Accepted: 05/25/2024] [Indexed: 06/07/2024]
Abstract
A growing body of evidence has shown the effects of poor preconception health on adverse pregnancy outcomes and, subsequently, maternal and child morbidity and mortality. However, the cost of poor preconception health remains relatively unexplored. Using the case of Nigeria, this study provides the first estimate of the disease and economic burden of poor preconception health at a country level. Using data from international databases and the scientific literature, the study used a cost-of-illness approach to quantify the foregone productivity and direct healthcare costs resulting from six preconception risk factors (adolescent pregnancy, short birth interval, overweight and obesity, intimate partner violence, female genital mutilation, folate deficiency). The results indicate that 6.7% of maternal deaths, 10.9% of perinatal deaths, and 10.5% of late neonatal deaths were attributable to the selected preconception risk factors in 2020. The economic burden of poor preconception health in Nigeria was estimated at US$ 3.3 billion in 2020, of which over 90% was generated by premature mortality. If prevalence rates remain constant, total economic losses could amount to US$ 46.2 billion by 2035. This analysis paves the way for further studies investigating the economic costs and benefits of preconception interventions and policies in low and middle-income countries.
Collapse
Affiliation(s)
- Sébastien Poix
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Khalifa Elmusharaf
- Public Health, Applied Health Research, University of Birmingham Dubai, Dubai, United Arab Emirates
| |
Collapse
|
7
|
Siegal K, Wekesa B, Custer E, Gatwaza TH, Uweh J, Niyonshuti M. A good egg: An evaluation of a social and behavior change communication campaign to increase egg consumption among children in Rwanda. MATERNAL & CHILD NUTRITION 2024; 20:e13573. [PMID: 37830401 PMCID: PMC10750004 DOI: 10.1111/mcn.13573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 09/11/2023] [Accepted: 09/19/2023] [Indexed: 10/14/2023]
Abstract
Childhood malnutrition, which is endemic in rural areas of low-income countries, leads to a host of deleterious outcomes such as poor cognitive development, low educational attainment and lower lifetime wages. Promoting the consumption of eggs among young children has emerged as a promising strategy to combat childhood malnutrition, though pathways to scale remain unclear. In this paper, we evaluate the impact of a social and behaviour change communication (SBCC) campaign combined with a program in which rural families purchased chickens on credit (poultry + SBCC; n = 769) relative to an arm in which families only received the poultry intervention (poultry only; n = 750), using a difference-in-difference estimation strategy with propensity score matching. The SBCC consisted of radio messages, in-person training, text message reminders and posters. We found a relatively modest but statistically significant increase in the number of times per week respondents in the poultry + SBCC arm reported feeding eggs to children of 0.28 (p = 0.02) compared to the poultry-only arm. The increase in egg feeding, however, was more pronounced for boys (0.42, p < 0.01) than for girls (0.14, p = 0.26). In addition, the campaign increased egg feeding more for those who were already feeding eggs to children (0.63, p < 0.01) than those who were not engaging in those practices at baseline (0.26, p < 0.01). However, the difference in these differences was not statistically significant. Future campaigns should ensure higher saturation of messaging and include specific messaging around the importance of feeding girls as well as boys. Campaigns seeking to scale up egg feeding quickly could potentially target the easier-to-reach segment of caregivers who already occasionally feed eggs to children though these might not be the neediest group.
Collapse
Affiliation(s)
- Kim Siegal
- One Acre FundKigaliRwanda
- George Washington UniversityWashingtonDCUSA
- Present address:
Mathematica Policy ResearchWashingtonDCUSA
| | | | - Emily Custer
- One Acre FundKakamegaKenya
- Stronger Foundations for NutritionWashingtonDCUSA
| | | | | | | |
Collapse
|
8
|
Gallagher L, Brady V, Kuliukas L, Dykes C, Rubertsson C, Hauck YL. Australian, Irish, and Swedish women's comfort levels when breastfeeding in public. BMC Public Health 2023; 23:2535. [PMID: 38110935 PMCID: PMC10729571 DOI: 10.1186/s12889-023-17472-z] [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: 04/14/2023] [Accepted: 12/13/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Despite a flux of global initiatives to increase and sustain breastfeeding rates, challenges persist. The decision to commence and sustain breastfeeding is influenced by multiple, complex factors. Feelings of social embarrassment, shame, fear of judgement, and lack of confidence when breastfeeding in public, compound women's decisions to breastfeed and may result in formula feeding or early cessation of breastfeeding. A greater understanding of where and how women feel most comfortable when breastfeeding in public can assist in designing interventions to support the initiation and continuation of breastfeeding. METHODS A cross-sectional survey was conducted with women living in Australia (n = 10,910), Sweden (n = 1,520), and Ireland (n = 1,835), who were currently breastfeeding or who had breastfed within the previous two years. Our aim was to explore where, and how often women breastfeed in public and to compare their levels of comfort when breastfeeding in public. Data were collected in 2018 using an anonymous online survey over a four-week period in Ireland, Australia, and Sweden, and were analyzed using SPSS Version 25. RESULTS Most respondents were highly educated, with over 70% in each country reporting having a university or college degree. Observing women breastfeeding in public was more commonly reported to be a weekly or daily occurrence in Sweden (24.5%) and Australia (28%), than in Ireland (13.3%). Women in the participating countries reported breastfeeding in public most commonly whenever their babies needed feeding. Very few women never or rarely breastfed publicly. Coffee shops/cafes, restaurants, and parks were the most popular locations. In all three countries, partners were reported to be very supportive of breastfeeding in public, which enhanced breastfeeding women's comfort levels. When asked to score out of a maximum comfort level of 10, women reported higher mean levels of comfort when breastfeeding in front of strangers (Ireland M = 7.33, Australia M = 6.58, Sweden M = 6.75) than with those known to them, particularly in front of their father-in-law (Ireland M = 5.44, Australia M = 5.76, Sweden M = 6.66 out of 10), who scored lowest in terms of women's comfort levels. CONCLUSION This study offers important insights into the experiences and comfort levels of women breastfeeding in public. Limitations include the anonymous nature of the surveys, thus preventing follow-up, and variances in terminology used to describe locations across the three settings. Recommendations are made for research to determine the relationships between the frequency of breastfeeding in public and breastfeeding women's perceived comfort levels, the influence of family members' perceptions of breastfeeding in public and women's experiences, and the experience of women who feel uncomfortable while breastfeeding in public, with a view to developing support measures.
Collapse
Affiliation(s)
- Louise Gallagher
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, D02 T283, Ireland.
| | - Vivienne Brady
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, D02 T283, Ireland
| | - Lesley Kuliukas
- School of Nursing, Curtin University Perth, Perth, WA, Australia
| | | | - Christine Rubertsson
- Perinatal and Sexual Health, Department of Health Sciences, Medical Faculty, Lund University, Lund, Sweden
| | - Yvonne L Hauck
- School of Nursing, Curtin University Perth, Perth, WA, Australia
| |
Collapse
|
9
|
Hartinger Pena SM, Mäusezahl D, Jäggi L, Aguilar L, Alvarado Llatance M, Castellanos A, Huaylinos Bustamante ML, Hinckley K, Charles McCoy D, Zhang C, Fink G. Digital Support Systems to Improve Child Health and Development in Peru: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e50371. [PMID: 38096020 PMCID: PMC10755649 DOI: 10.2196/50371] [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: 06/29/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 12/31/2023] Open
Abstract
BACKGROUND Children living in low and middle-income countries (LMICs) are at greater risk for experiencing adversities that can undermine their health and early development. Recently launched digital early childhood development (ECD) programs attempt to support families with young children in their home environments using digital technologies. However, relatively little is known regarding the effectiveness of these new technologies. OBJECTIVE The goal of this study is to rigorously assess the reach, effectiveness, and cost-effectiveness of a newly developed digital ECD platform called Afini. The Afini platform was designed to support parents of young children in low-resource settings to improve ECD and interact with caregivers through messenger services and a chatbot. METHODS This is a 3-arm cluster randomized controlled trial. In total, 2471 caregivers and their 3- to 9-month-old children were enrolled in the study across 164 study clusters in the San Marcos, Cajabamba, and Cajamarca provinces of Peru. Clusters of participants were randomly assigned to 1 of 3 groups: a control group (72 community clusters and 980 caregiver-child dyads), a home visit intervention group (20 community clusters and 316 caregiver-child dyads), and an Afini intervention group (72 community clusters and 1175 caregiver-child dyads). Families in the control group receive no focused ECD intervention. The home visit group is receiving biweekly home visits by a trained field staff following the national ECD program (Programa Nacional Cuna Más) curriculum and training guidelines. Caregivers in the Afini group are receiving ECD activities and advice through the digital platform. The primary study outcome is children's overall development at the age of 2.5 years, using the internationally validated long form of the Global Scales for Early Development. Secondary outcomes include caregiver engagement; caregiver mental health; screen time; as well as caregiver reports of children's motor, cognitive, language, and socioemotional development measured through locally piloted and validated tools. RESULTS Enrollment started in September 2021 and ended in March 2023. Endline assessments will take place between August 2023 and September 2024. CONCLUSIONS This study is, to our knowledge, the first to rigorously assess the effectiveness and cost-effectiveness of digital ECD technologies in LMICs. Given the large number of children in LMICs currently receiving only limited external support, the evaluated platform has the potential to improve the short- and long-term well-being of millions of children and their parents globally. TRIAL REGISTRATION ClinicalTrials.gov NCT05202106; https://clinicaltrials.gov/ct2/show/NCT05202106. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/50371.
Collapse
Affiliation(s)
- Stella Maria Hartinger Pena
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Daniel Mäusezahl
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Lena Jäggi
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Leonel Aguilar
- Institute for Computing Platforms, Federal Institute of Technology Zurich, Zürich, Switzerland
| | | | | | | | - Kristen Hinckley
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Ce Zhang
- Institute for Computing Platforms, Federal Institute of Technology Zurich, Zürich, Switzerland
| | - Günther Fink
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| |
Collapse
|
10
|
O'Hara C. Editorial. Food Nutr Bull 2023; 44:223-225. [PMID: 38095291 DOI: 10.1177/03795721231220185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
|
11
|
Hongoli JJ, Hahn Y. Early life exposure to cold weather shocks and growth stunting: Evidence from Tanzania. HEALTH ECONOMICS 2023; 32:2855-2879. [PMID: 37715298 DOI: 10.1002/hec.4758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 08/11/2023] [Accepted: 09/02/2023] [Indexed: 09/17/2023]
Abstract
This study examines the effects of early life and in utero exposure to cold weather shocks on the incidence of growth stunting for children under age five in Tanzania. We find that an increase of 10 percentage points in the proportion of days with temperatures below 15 degrees Celsius (one standard deviation below the long-term average) is associated with an increase in the probability of stunting and severe stunting by 2.0 and 1.4 percentage points (equivalent to 5.5 and 9.7 percent of the mean stunting and severe stunting), respectively. The results also show strong effects of in utero exposure during the second trimester of pregnancy on child stunting and wasting. In terms of the mechanisms, we find that the effects on disease environment, food insecurity, and reduced agricultural productivity are the possible channels driving the results.
Collapse
Affiliation(s)
| | - Youjin Hahn
- Yonsei University, School of Economics, Seodaemun-gu, Korea
| |
Collapse
|
12
|
Musheiguza E, Mbegalo T, Mbukwa JN. Bayesian multilevel modelling of the association between socio-economic status and stunting among under-five-year children in Tanzania. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:135. [PMID: 38031170 PMCID: PMC10685585 DOI: 10.1186/s41043-023-00474-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/14/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Stunting is associated with socioeconomic status (SES) which is multidimensional. This study aimed to compare different SES indices in predicting stunting. METHODS This was the secondary data analysis using Tanzania Demographics and Health Surveys (TDHS). The study used 7492, 6668, and 8790 under-five-year children from TDHS 2004/5, 2010, and 2015/16, respectively. The Household Wealth Index (HWI); Water and Sanitation, Assets, Maternal education and Income (WAMI); Wealth Assets, Education, and Occupation (WEO); and the Multidimensional Poverty Index (MPI) indices were compared. The summated scores, principal component analysis (PCA), and random forest (RF) approaches were used to construct indices. The Bayesian and maximum likelihood multilevel generalized linear mixed models (MGLMM) were constructed to determine the association between each SES index and stunting. RESULTS The study revealed that 42.3%, 38.4%, and 32.4% of the studied under-five-year children were stunted in 2004/5, 2010, and 2015/16, respectively. Compared to other indicators of SES, the MPI had a better prediction of stunting for the TDHS 2004/5 and 2015/16, while the WAMI had a better prediction in 2010. For each score increase in WAMI, the odds of stunting were 64% [BPOR = 0.36; 95% CCI 0.3, 0.4] lower in 2010, while for each score increase in MPI there was 1 [BPOR = 1.1; 95% CCI 1.1, 1.2] times higher odds of stunting in 2015/16. CONCLUSION The MPI and WAMI under PCA were the best measures of SES that predict stunting. Because MPI was the best predictor of stunting for two surveys (TDHS 2004/5 and 2015/16), studies dealing with stunting should use MPI as a proxy measure of SES. Use of BE-MGLMM in modelling stunting is encouraged. Strengthened availability of items forming MPI is inevitable for child growth potentials. Further studies should investigate the determinants of stunting using Bayesian spatial models to take into account spatial heterogeneity.
Collapse
Affiliation(s)
- Edwin Musheiguza
- Department of Mathematics and Information Communication Technology, College of Business Education, P.O. Box 1968, Dar es Salaam, Tanzania.
- Department of Mathematics and Statistics Studies, Mzumbe University, P.O Box 87, Mzumbe, Tanzania.
| | - Tukae Mbegalo
- Department of Mathematics and Statistics Studies, Mzumbe University, P.O Box 87, Mzumbe, Tanzania
| | - Justine N Mbukwa
- Department of Mathematics and Statistics Studies, Mzumbe University, P.O Box 87, Mzumbe, Tanzania
| |
Collapse
|
13
|
Kemajou Njatang D, Bouba Djourdebbé F, Adda Wadou ND. Climate variability, armed conflicts and child malnutrition in sub-saharan Africa: A spatial analysis in Ethiopia, Kenya and Nigeria. Heliyon 2023; 9:e21672. [PMID: 38027550 PMCID: PMC10656247 DOI: 10.1016/j.heliyon.2023.e21672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Background Sub-Saharan Africa (SSA) has one of the highest prevalence of malnutrition among children under 5 in the world. It is also the region most vulnerable to the adverse effect of climate change, and the one that records the most armed conflicts. The chains of causality suggested in the literature on the relationship between climate change, armed conflict, and malnutrition have rarely been supported by empirical evidence for SSA countries. Methods This study proposes to highlight, under the hypothesis of spatial non-stationarity, the influence of climatic variations and armed conflicts on malnutrition in children under 5 in Ethiopia, Kenya, and Nigeria. To do this, we use spatial analysis on data from Demographic and Health Surveys (DHS), Uppsala Conflict Data Program Georeferenced Event Dataset (UCDP GED), Climate Hazards center InfraRed Precipitation with Station data (CHIRPS) and Moderate Resolution Imaging Spectroradiometer (MODIS). Results The results show that there is a spatial autocorrelation of malnutrition measured by the prevalence of underweight children in the three countries. Also, local geographically weighted analysis shows that armed conflict, temperature and rainfall are positively associated with the prevalence of underweight children in localities of Somali in Ethiopia, Mandera and Turkana of Wajir in Kenya, Borno and Yobe in Nigeria. Conclusion In conclusion, the results of our spatial analysis support the implementation of conflict-sensitive climate change adaptation strategies.
Collapse
|
14
|
Kamiya Y, Kishida T. Effect of Drinking Water and Sanitation on Child Undernutrition and Diarrhea in Lao PDR. Asia Pac J Public Health 2023; 35:494-501. [PMID: 37837291 DOI: 10.1177/10105395231204797] [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] [Indexed: 10/15/2023]
Abstract
Childhood undernutrition and diarrhea remain a global health burden in the 21st century. We assessed the effect of access to basic drinking water and sanitation at home on reducing children's likelihood of being undernourished and experiencing diarrhea in Laos. We pooled two rounds of nationally representative cross-sectional household surveys: the Lao Social Indicator Surveys 2011/2012 and 2017, encompassing 23 070 children aged <5 years. We employed multivariate multilevel logistic regression for the analysis. The results showed that access to basic drinking water was associated with a reduced likelihood of undernutrition and was effective in improving child undernutrition. Moreover, access to basic sanitation reduced diarrhea in addition to undernutrition. Notably, sanitation facilities only mitigated childhood stunting and diarrhea when basic drinking water facilities were present in the household. We also confirmed that socio-economic disparities existed among children accessing basic drinking water and sanitation. Consequently, further efforts are needed toward equitable access to these facilities in Laos.
Collapse
Affiliation(s)
- Yusuke Kamiya
- Faculty of Economics, Ryukoku University, Kyoto, Japan
| | - Takaaki Kishida
- Department of Economics, University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
15
|
Adeyemi O, Adesiyun Y, Omenka S, Ezekannagha O, Adanlawo A, Oyeleke R, Umunna L, Aminu F, Onabolu A, Ajieroh V. Government Budget for Nutrition-Sensitive Agriculture in Nigeria Increased Following Development of Related Strategy. Food Nutr Bull 2023; 44:S103-S114. [PMID: 37317553 DOI: 10.1177/03795721231179783] [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] [Indexed: 06/16/2023]
Abstract
BACKGROUND Financial resources that are commensurate with the magnitude of malnutrition problem are requisite for effective interventions to reduce malnutrition. Understanding the amount and nature of sectoral investments in nutrition is important for advocating and mobilizing increased government budgetary allocations and release. OBJECTIVE This study assessed trends in Nigeria's agriculture sector nutrition allocations and whether launch of nutrition-sensitive agriculture strategy and/or the COVID-19 pandemic may have affected these nutrition allocations. METHODS Agricultural budgets from 2009 to 2022 of Nigeria's federal government were analyzed. Nutrition-related budget lines were identified using a keyword search and were then classified as nutrition-specific, nutrition-sensitive, or potentially nutrition-sensitive, based on defined criteria. Potentially nutrition-sensitive items were further screened. Budget lines finally included as nutrition allocations directly targeted improvements in nutrition or intermediate outcomes in pathways between agriculture and nutrition. Budget lines were summed, and these nominal values were adjusted for inflation (using the consumer price index for each year) to obtain real values. RESULTS Nutrition allocations in the agriculture budget increased considerably even after adjusting for inflation and went from 0.13% of agriculture capital budget in 2009 to 2.97% in 2022; while the real value of total government agricultural budget declined. Large budgetary increases coincided with the development/launch of costed strategies with nutrition-sensitive agriculture components. Still, there were some missed opportunities to increase nutrition allocations. CONCLUSIONS Existence of nutrition-sensitive agriculture strategies has facilitated increased nutrition funding and improved the enabling environment. There is need to optimize existing nutrition allocations while advocating for additional funds.
Collapse
Affiliation(s)
- Olutayo Adeyemi
- Department of Human Nutrition and Dietetics, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| | - Yeside Adesiyun
- Department of Human Nutrition and Dietetics, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
- Federal Institute of Industrial Research, Oshodi, Lagos, Nigeria
| | - Samuel Omenka
- Budget Office of the Federation, Federal Ministry of Finance, Budget and National Planning, Abuja, Nigeria
| | | | - Adekunle Adanlawo
- Federal Ministry of Agriculture and Rural Development, Abuja, Nigeria
| | - Rasaq Oyeleke
- Federal Ministry of Agriculture and Rural Development, Abuja, Nigeria
| | | | | | - Adeyinka Onabolu
- Federal Ministry of Agriculture and Rural Development, Abuja, Nigeria
- Global Alliance for Improved Nutrition, Abuja, Nigeria
| | | |
Collapse
|
16
|
Sahoo J, Mohanty S, Gupta S, Panigrahi SK, Mohanty S, Prasad D, Epari V. Prevalence and Risk Factors of Iron Deficiency Anemia among the Tribal Residential Adolescent School Students of Odisha: A Cross-Sectional Study. Indian J Community Med 2023; 48:562-566. [PMID: 37662116 PMCID: PMC10470574 DOI: 10.4103/ijcm.ijcm_453_22] [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: 05/27/2022] [Accepted: 04/26/2023] [Indexed: 09/05/2023] Open
Abstract
Background Globally, anemia is one of the biggest public health challenges. The highest prevalence of anemia is seen among adolescents. Tribal communities are especially at a disadvantage, with several studies documenting a high prevalence of anemia among tribal adolescents. We investigated the prevalence of anemia and its associated risk factors among the tribal residential adolescent school students in Odisha. Material and Methods In a cross-sectional survey, the prevalence of anemia was estimated by spectrophotometry among adolescents of residential schools in three predominantly tribal districts of Odisha. The severity of anemia was defined as per the World Health Organization classification for adolescents. Results The mean age of 953 subjects was 13.07 ± 1.48 years. The prevalence of anemia was found to be 37.3%. As per the World Health Organization classification, 19.9% had mild anemia, 16.3% had moderate, and 1% had severe anemia. Consumption of Iron Folic Acid (IFA) was associated with the level of hemoglobin at a statistically significant level. Conclusion We found that the prevalence of anemia was lower than in similar studies conducted in other parts of the country. Despite poor coverage of beneficiaries with iron and folic acid at the national level, our study showed better compliance and was associated with a significantly higher level of hemoglobin among those who consumed IFA.
Collapse
Affiliation(s)
- Jyotiranjan Sahoo
- Department of Community Medicine, Institute of Medical Sciences and SUM Hospital, Siksha ‘O’ Anusandhan Deemed to be University, Bhubaneswar, Odisha, India
| | - Smaraki Mohanty
- Department of Community Medicine, Institute of Medical Sciences and SUM Hospital, Siksha ‘O’ Anusandhan Deemed to be University, Bhubaneswar, Odisha, India
| | - Sandhya Gupta
- Department of Physiology, Institute of Medical Sciences and SUM Hospital, Siksha ‘O’ Anusandhan Deemed to be University, Bhubaneswar, Odisha, India
| | - Sandeep K. Panigrahi
- Department of Community Medicine, Institute of Medical Sciences and SUM Hospital, Siksha ‘O’ Anusandhan Deemed to be University, Bhubaneswar, Odisha, India
| | - Sambedana Mohanty
- Department of Community Medicine, Institute of Medical Sciences and SUM Hospital, Siksha ‘O’ Anusandhan Deemed to be University, Bhubaneswar, Odisha, India
| | | | - Venkatarao Epari
- Department of Community Medicine, Institute of Medical Sciences and SUM Hospital, Siksha ‘O’ Anusandhan Deemed to be University, Bhubaneswar, Odisha, India
| |
Collapse
|
17
|
Amegbor PM, Sabel CE, Mortensen LH, Mehta AJ, Rosenberg MW. Early-life air pollution and green space exposures as determinants of stunting among children under age five in Sub-Saharan Africa. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2023:10.1038/s41370-023-00572-8. [PMID: 37386059 DOI: 10.1038/s41370-023-00572-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Childhood malnutrition is a major public health issue in Sub-Saharan Africa (SSA) and 61.4 million children under the age of five years in the region are stunted. Although insight from existing studies suggests plausible pathways between ambient air pollution exposure and stunting, there are limited studies on the effect of different ambient air pollutants on stunting among children. OBJECTIVE Explore the effect of early-life environmental exposures on stunting among children under the age of five years. METHODS In this study, we used pooled health and population data from 33 countries in SSA between 2006 and 2019 and environmental data from the Atmospheric Composition Analysis Group and NASA's GIOVANNI platform. We estimated the association between early-life environmental exposures and stunting in three exposure periods - in-utero (during pregnancy), post-utero (after pregnancy to current age) and cumulative (from pregnancy to current age), using Bayesian hierarchical modelling. We also visualise the likelihood of stunting among children based on their region of residence using Bayesian hierarchical modelling. RESULTS The findings show that 33.6% of sampled children were stunted. In-utero PM2.5 was associated with a higher likelihood of stunting (OR = 1.038, CrI = 1.002-1.075). Early-life exposures to nitrogen dioxide and sulphate were robustly associated with stunting among children. The findings also show spatial variation in a high and low likelihood of stunting based on a region of residence. IMPACT STATEMENT This study explores the effect of early-life environmental exposures on child growth or stunting among sub-Saharan African children. The study focuses on three exposure windows - pregnancy, after birth and cumulative exposure during pregnancy and after birth. The study also employs spatial analysis to assess the spatial burden of stunted growth in relation to environmental exposures and socioeconomic factors. The findings suggest major air pollutants are associated with stunted growth among children in sub-Saharan Africa.
Collapse
Affiliation(s)
- Prince M Amegbor
- School of Gobal Public Health, New York University, 708 Broadway, New York, NY, 10003, USA.
- Denmark Statistics, Sejrøgade 11, DK-2100, Copenhagen, Denmark.
| | - Clive E Sabel
- Department of Public Health, Bartholins Allé 2, 8000, Aarhus C, Denmark
- The Big Data Centre for Environment and Health (BERTHA), Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark
| | - Laust H Mortensen
- Denmark Statistics, Sejrøgade 11, DK-2100, Copenhagen, Denmark
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Amar J Mehta
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Lundbeck A/S, Ottiliavej 9, 2500, Valby, Denmark
| | - Mark W Rosenberg
- Department of Geography & Planning, Queen's University, Kingston, ON, Canada
| |
Collapse
|
18
|
Barati Jozan MM, Ghorbani BD, Khalid MS, Lotfata A, Tabesh H. Impact assessment of e-trainings in occupational safety and health: a literature review. BMC Public Health 2023; 23:1187. [PMID: 37340453 DOI: 10.1186/s12889-023-16114-8] [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: 01/25/2023] [Accepted: 06/13/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Implementing workplace preventive interventions reduces occupational accidents and injuries, as well as the negative consequences of those accidents and injuries. Online occupational safety and health training is one of the most effective preventive interventions. This study aims to present current knowledge on e-training interventions, make recommendations on the flexibility, accessibility, and cost-effectiveness of online training, and identify research gaps and obstacles. METHOD All studies that addressed occupational safety and health e-training interventions designed to address worker injuries, accidents, and diseases were chosen from PubMed and Scopus until 2021. Two independent reviewers conducted the screening process for titles, abstracts, and full texts, and disagreements on the inclusion or exclusion of an article were resolved by consensus and, if necessary, by a third reviewer. The included articles were analyzed and synthesized using the constant comparative analysis method. RESULT The search identified 7,497 articles and 7,325 unique records. Following the title, abstract, and full-text screening, 25 studies met the review criteria. Of the 25 studies, 23 were conducted in developed and two in developing countries. The interventions were carried out on either the mobile platform, the website platform, or both. The study designs and the number of outcomes of the interventions varied significantly (multi-outcomes vs. single-outcome). Obesity, hypertension, neck/shoulder pain, office ergonomics issues, sedentary behaviors, heart disease, physical inactivity, dairy farm injuries, nutrition, respiratory problems, and diabetes were all addressed in the articles. CONCLUSION According to the findings of this literature study, e-trainings can significantly improve occupational safety and health. E-training is adaptable, affordable, and can increase workers' knowledge and abilities, resulting in fewer workplace injuries and accidents. Furthermore, e-training platforms can assist businesses in tracking employee development and ensuring that training needs are completed. Overall, this analysis reveals that e-training has enormous promise in the field of occupational safety and health for both businesses and employees.
Collapse
Affiliation(s)
- Mohammad Mahdi Barati Jozan
- Department of Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Md Saifuddin Khalid
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Aynaz Lotfata
- School Of Veterinary Medicine, Department Of Veterinary Pathology, University of California, Davis, USA
| | - Hamed Tabesh
- Department of Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| |
Collapse
|
19
|
Puett C, Anderson JD, Bagamian KH, Muhib F, Scheele S, Hausdorff WP, Pecenka C. Projecting the long-term economic benefits of reducing Shigella-attributable linear growth faltering with a potential vaccine: a modelling study. Lancet Glob Health 2023; 11:e892-e902. [PMID: 37202024 PMCID: PMC10205973 DOI: 10.1016/s2214-109x(23)00050-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 12/25/2022] [Accepted: 01/17/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Linear growth is an important outcome of child development with implications for economic productivity. Enteric infections, particularly Shigella, have been linked to linear growth faltering (LGF). However, benefits from potential reductions in LGF are rarely included in economic analyses of enteric infections. We aimed to quantify the economic benefits of vaccination related to reduced Shigella-attributable disease and associated LGF compared with the net costs of a vaccine programme. METHODS In this benefit-cost analysis, we modelled productivity benefits in 102 low-income and middle-income countries that had recent stunting estimates available, at least one Shigella-attributable death annually, and available economic data, particularly on gross national income and growth rate projections. We modelled benefits strictly related to linear growth improvements and no other benefits associated with reducing diarrhoeal burden. The effect size in each country was calculated as shifts in height-for-age Z score (HAZ), representing population average changes for preventing Shigella-attributable less-severe diarrhoea and moderate-to-severe diarrhoea separately for children younger than 5 years. Benefits data were calculated per country and combined with estimated net costs of the vaccine programme in the form of benefit-cost ratios (BCRs); BCRs above parity, or $1 in benefits per $1 in costs (with a 10% margin representing borderline results: 1·10:1), were considered cost-beneficial. Countries were aggregated for analysis by WHO region, World Bank income category, and eligibility for support from Gavi, the Vaccine Alliance. FINDINGS In the base-case scenario, all regions exhibited cost-beneficial results, with the South-East Asia region and Gavi-eligible countries exhibiting the highest BCRs (21·67 for the South-East Asia region and 14·45 for Gavi-eligible countries), and the Eastern Mediterranean region yielding the lowest BCRs (2·90). All regions exhibited cost-beneficial results from vaccination, except in more conservative scenarios (eg, those assuming early retirement ages and higher discount rates). Our findings were sensitive to assumed returns for increased height, assumptions about vaccine efficacy against linear growth detriments, the anticipated shift in HAZ, and discount rate. Incorporating the productivity benefits of LGF reduction into existing cost-effectiveness estimates resulted in longer-term cost-savings in nearly all regions. INTERPRETATION LGF is a secondary outcome of Shigella infection and reduction in LGF is not often quantified as a health or economic benefit of vaccination. However, even under conservative assumptions, a Shigella vaccine only moderately effective against LGF could pay for itself from productivity gains alone in some regions. We recommend that LGF be considered in future models assessing the economic and health impacts of interventions preventing enteric infections. Further research is needed on vaccine efficacy against LGF to inform such models. FUNDING Bill & Melinda Gates Foundation, Wellcome Trust.
Collapse
Affiliation(s)
- Chloe Puett
- Department of Family, Population & Preventive Medicine, Program in Public Health, Health Sciences Center, Stony Brook University, Stony Brook, NY, USA.
| | | | - Karoun H Bagamian
- Bagamian Scientific Consulting, Gainesville, FL, USA; Department of Environmental and Global Health, University of Florida, Gainesville, FL, USA
| | | | | | - William P Hausdorff
- PATH, Washington, DC, USA; Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | | |
Collapse
|
20
|
Self-Brown S, Perry EW, Recinos M, Cotner MA, Guastaferro K, Owolabi S, Spears CA, Whitaker DJ, Huang J, Kegler MC. Systematic braiding of Smoke-Free Home SafeCare to address child maltreatment risk and secondhand smoke exposure: findings from a pilot study. Pilot Feasibility Stud 2023; 9:81. [PMID: 37173799 PMCID: PMC10175921 DOI: 10.1186/s40814-023-01303-4] [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: 11/09/2022] [Accepted: 04/21/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Exposure to secondhand tobacco smoke (SHS) and child maltreatment are preventable threats to child health. Few evidence-based interventions target both SHS and child maltreatment risk. The purpose of this paper is to describe the systematic braiding process of two evidence-based programs to address child SHS in the home and maltreatment perpetration risk, and present results from the formative work and pilot study. METHODS The first 4 steps of the systematic braiding process were completed, including the following: (1) the identification of core elements of both programs, (2) the development of an initial draft of the braided curriculum (Smoke-Free Home SafeCare - SFH-SC), (3) an acceptability and feasibility pilot of SFH-SC with caregivers of young children who reported a smoker living in the home (N = 8), and (4) feedback collection on the braided curriculum from SafeCare Providers (N = 9). RESULTS Experts identified common pedagogical and theoretical underpinnings for the two programs and braided Smoke-Free Homes: Some Things Are Better Outside into two SafeCare modules. Caregiver feedback from the pilot demonstrated that participants were engaged with SFH-SC and felt supported and comfortable discussing SHS intervention content with the SFH-SC Provider. Caregiver self-reports indicated a slight increase in smoke-free home rules from baseline to follow-up and a notable reduction in parent stress on the Parent Stress Index of 5.9 points (SD = 10.2). SafeCare Provider feedback following intensive review of the curriculum indicated high feasibility for SFH-SC delivery. CONCLUSIONS Parent and Provider findings suggest SFH-SC is a viable intervention that has potential to reduce the public health impact of SHS and child maltreatment for at-risk families. PROTOCOL The protocol for the pilot is not published elsewhere; however, the full protocol for the hybrid trial can be found here: https://clinicaltrials.gov/ct2/show/NCT05000632 . TRIAL REGISTRATION NCT, NCT05000632. Registered 14 July 2021, there is not a separate registration number for the pilot.
Collapse
Affiliation(s)
- Shannon Self-Brown
- Georgia State University - School of Public Health, 140 Decatur St. SE, Atlanta, GA, 30303, USA.
| | - Elizabeth W Perry
- Georgia State University - School of Public Health, 140 Decatur St. SE, Atlanta, GA, 30303, USA
| | - Manderley Recinos
- Georgia State University - School of Public Health, 140 Decatur St. SE, Atlanta, GA, 30303, USA
| | - Michaela A Cotner
- Georgia State University - School of Public Health, 140 Decatur St. SE, Atlanta, GA, 30303, USA
| | - Kate Guastaferro
- New York University - School of Global Public Health, 708 Broadway, New York, NY, 10003, USA
| | - Shadé Owolabi
- Emory University - Rollins School of Public Health, 1518 Clifton Rd., Atlanta, GA, 30322, USA
| | - Claire A Spears
- Georgia State University - School of Public Health, 140 Decatur St. SE, Atlanta, GA, 30303, USA
| | - Daniel J Whitaker
- Georgia State University - School of Public Health, 140 Decatur St. SE, Atlanta, GA, 30303, USA
| | - Jidong Huang
- Georgia State University - School of Public Health, 140 Decatur St. SE, Atlanta, GA, 30303, USA
| | - Michelle C Kegler
- Emory University - Rollins School of Public Health, 1518 Clifton Rd., Atlanta, GA, 30322, USA
| |
Collapse
|
21
|
Ikoona EN, Toure MA, Njenga A, Namulemo L, Kaluya R, Kamara K, Oyat FWD, Aloyo J, Kitara DL. Prevalence and factors associated with underweight among 15-49-year-old women in Sierra Leone: a secondary data analysis of Sierra Leone demographic health survey of 2019. BMC Womens Health 2023; 23:192. [PMID: 37085835 PMCID: PMC10122406 DOI: 10.1186/s12905-023-02358-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 04/14/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND Women are at higher risks of being underweight than men due to biological, socio-economic, and cultural factors. Underweight women have high risks of poor obstetric outcomes. We aimed to determine the prevalence and factors associated with being underweight among women of reproductive age (15-49 years) in Sierra Leone. METHODS We used Sierra Leone Demographic and Health Survey (2019-SLDHS) data of 7,514 women aged 15 to 49 years, excluding pregnant, post-natal, lactating, and post-menopausal women. A multistage stratified sampling approach was used to select study participants, and data was collected using validated questionnaires. A multivariable logistic regression analysis was used to determine factors associated with underweight among 15-49-year-old women in Sierra Leone. Ethical approval for the study was obtained. RESULTS The prevalence of underweight was 6.7% (502/7,514). Underweight was likely among age-group of 15-24 years, AOR = 2.50,95%CI:2.39-2.60;p < 0.001 compared to 25-34 year age-group and likely among women with parity of one to four, AOR = 1.48,95%CI:1.08-2.03;p = 0.015 compared to women who never gave birth. Underweight was unlikely among women who did not listen to radios AOR = 0.67,95%CI:0.55-0.83;p < 0.001 compared to those who did; women from the north AOR = 0.73,95%CI:0.56-0.96;p = 0.026 compared to the east, and not married women AOR = 0.59,95%CI:0.47-0.76;p < 0.001 compared to married. All household wealth indices were not significantly associated with underweight. CONCLUSION The prevalence of underweight among women in the reproductive age (15-49 years) in Sierra Leone was 6.7% and it is lower compared to global and most sub-Saharan African data. Factors associated with underweight were 15-24-year age-group, and parity of one to four. Being underweight was unlikely among women who did not listen to radios, women from the north and not married. All household wealth indices were not significantly associated with underweight. Even though household wealth indices were not significantly associated with being underweight, most underweight women 68.7% (345/502) were in the poorest, poorer, and middle household wealth indices. The need to address socio-economic determinants of underweight among women (aged 15-49 years) due to household poverty is a priority in Sierra Leone.
Collapse
Affiliation(s)
| | | | - Amon Njenga
- ICAP at Columbia University, Freetown, Sierra Leone
| | - Lucy Namulemo
- Foothills Community Based Interventions, Monticello, KY, USA
- Lindsey Wilson College, School of Professional Counseling, Kentucky, USA
- Uganda Counseling and Support Services, Kampala, Uganda
| | - Ronald Kaluya
- Uganda Counseling and Support Services, Kampala, Uganda
| | - Kassim Kamara
- Directorate of Health Security and Emergencies, Ministry of Health and Sanitation, Free Town, Sierra Leone
| | | | - Judith Aloyo
- Uganda Medical Association (UMA), UMA-Acholi Branch, Gulu City, Uganda
- Rhites-N, Acholi, Gulu City, Uganda
| | - David Lagoro Kitara
- Uganda Medical Association (UMA), UMA-Acholi Branch, Gulu City, Uganda.
- Department of Surgery, Harvard University and Faculty at Gulu University, Faculty of Medicine, P.0. Box 166, Gulu City, Uganda.
| |
Collapse
|
22
|
Wake SK, Zewotir T, Lulu K, Fissuh YH. Longitudinal trends and determinants of stunting among children aged 1-15 years. Arch Public Health 2023; 81:60. [PMID: 37081559 PMCID: PMC10116743 DOI: 10.1186/s13690-023-01090-7] [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: 02/03/2023] [Accepted: 04/15/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Stunting increases morbidity and mortality, hindering mental development and influencing cognitive capacity of children. This study aimed to examine the trends and determinants of stunting from infancy to middle adolescence in four countries: Ethiopia, India, Peru, and Vietnam. METHODS A 15-year longitudinal data on the trends of stunting were obtained from the Young Lives cohort study. The study includes 38,361 observations from 4 countries. A generalized mixed-effects model was adopted to estimate the determinant of stunting. RESULTS The patterns of stunting in children from aged 1 to 15 years have declined from an estimated 30% in 2002 to 20% in 2016. Stunting prevalence varied among four low- and middle-income countries with children in Ethiopia, India, and Peru being more stunted compared to children in Vietnam. The highest stunted was recorded in India and the lowest was recorded in Vietnam. In all four countries, the highest prevalence of severe stunting was observed in 2002 and moderate stunting was observed in 2006. Parents' education level played a significance role in determining a child stunting. Children of uneducated parents were shown to be at a higher risk of stunting. CONCLUSION Disparities of stunting were observed between- and within-country of four low- and middle-income with the highest prevalence recorded in low-income country. Child stunting is caused by factors related to child's age, household wealth, household size, the mother's and father's education level, residence area and access to save drinking water.
Collapse
Affiliation(s)
- Senahara Korsa Wake
- Department of Statistics, College of Natural and Computational Sciences, Ambo University, Ambo, Ethiopia.
| | - Temesgen Zewotir
- School of Mathematics, Statistics and Computer Science, College of Agriculture Engineering and Science, University of KwaZulu-Natal, Durban, South Africa
| | - Kebede Lulu
- Department of Statistics, College of Natural and Computational Sciences, Ambo University, Ambo, Ethiopia
| | - Yemane Hailu Fissuh
- Department of Statistics, College of Natural and Computational Sciences, Aksum University, Axum, Ethiopia
| |
Collapse
|
23
|
Bragg MG, Prado EL, Caswell BL, Arnold CD, George M, Oakes LM, Beckner AG, DeBolt MC, Bennett BJ, Maleta KM, Stewart CP. The association between plasma choline, growth and neurodevelopment among Malawian children aged 6-15 months enroled in an egg intervention trial. MATERNAL & CHILD NUTRITION 2023; 19:e13471. [PMID: 36567549 PMCID: PMC10019050 DOI: 10.1111/mcn.13471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 11/23/2022] [Accepted: 12/01/2022] [Indexed: 12/27/2022]
Abstract
Choline is an essential micronutrient that may influence growth and development; however, few studies have examined postnatal choline status and children's growth and development in low- and middle-income countries. The aim of this observational analysis was to examine associations of plasma choline with growth and development among Malawian children aged 6-15 months enrolled in an egg intervention trial. Plasma choline and related metabolites (betaine, dimethylglycine and trimethylamine N-oxide) were measured at baseline and 6-month follow-up, along with anthropometric (length, weight, head circumference) and developmental assessments (the Malawi Developmental Assessment Tool [MDAT], the Infant Orienting with Attention task [IOWA], a visual paired comparison [VPC] task and an elicited imitation [EI] task). In cross-sectional covariate-adjusted models, each 1 SD higher plasma choline was associated with lower length-for-age z-score (-0.09 SD [95% confidence interval, CI -0.17 to -0.01]), slower IOWA response time (8.84 ms [1.66-16.03]) and faster processing speed on the VPC task (-203.5 ms [-366.2 to -40.7]). In predictive models, baseline plasma choline was negatively associated with MDAT fine motor z-score at 6-month follow-up (-0.13 SD [-0.22 to -0.04]). There were no other significant associations of plasma choline with child measures. Similarly, associations of choline metabolites with growth and development were null except higher trimethylamine N-oxide was associated with slower information processing on the VPC task and higher memory scores on the EI task. In this cohort of children with low dietary choline intake, we conclude that there were no strong or consistent associations between plasma choline and growth and development.
Collapse
Affiliation(s)
- Megan G. Bragg
- Department of NutritionUniversity of California DavisDavisCaliforniaUSA
- AJ Drexel Autism InstituteDrexel UniversityPhiladelphiaPennsylvaniaUSA
| | | | - Bess L. Caswell
- USDA Western Human Nutrition Research CenterDavisCaliforniaUSA
| | - Charles D. Arnold
- Department of NutritionUniversity of California DavisDavisCaliforniaUSA
| | - Matthews George
- School of Public Health and Family MedicineKamuzu University of Health SciencesBlantyreMalawi
| | - Lisa M. Oakes
- Center for Mind and BrainUniversity of California DavisDavisCaliforniaUSA
| | - Aaron G. Beckner
- Center for Mind and BrainUniversity of California DavisDavisCaliforniaUSA
| | - Michaela C. DeBolt
- Center for Mind and BrainUniversity of California DavisDavisCaliforniaUSA
| | | | - Kenneth M. Maleta
- School of Public Health and Family MedicineKamuzu University of Health SciencesBlantyreMalawi
| | | |
Collapse
|
24
|
Makinde OA, Olamijuwon E, Mgbachi I, Sato R. Childhood exposure to armed conflict and nutritional health outcomes in Nigeria. Confl Health 2023; 17:15. [PMID: 36978100 PMCID: PMC10053485 DOI: 10.1186/s13031-023-00513-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 03/19/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Armed conflicts are associated with an increased risk of food insecurity, the leading cause of malnutrition in low-and-middle-income countries. Multiple studies have uncovered significant influences of childhood malnutrition on children's overall health and development. As a result, it is increasingly important to understand how childhood experience of armed conflict intersects with childhood malnutrition in conflict-prone countries like Nigeria. This study examined the association between different measures of childhood experiences of armed conflicts and the nutritional health outcomes of children aged 36-59 months. METHODS We used data from the Nigeria Demographic and Health Survey linked with Uppsala Conflict Data Program Geo-Referenced Events Dataset using geographic identifiers. Multilevel regression models were fitted on a sample of 4226 children aged 36-59 months. RESULTS The prevalence of stunting, underweight and wasting was 35%, 20% and 3%, respectively. Armed conflicts were mostly recorded in the North-eastern states of Borno (222 episodes) and Adamawa (24 episodes). Exposure to armed conflicts ranged from 0 (no experience of armed conflict) to 3.75 conflicts per month since the child's birth. An increase in the frequency of armed conflicts is associated with increased odds of childhood stunting [AOR = 2.52, 95%CI: 1.96-3.25] and underweight [AOR = 2.33, 95%CI: 1.19-4.59] but not wasting. The intensity of armed conflict was only marginally associated with stunting and underweight but not wasting. Longer conflicts that occurred in the last year were also associated with the odds of stunting [AOR = 1.25, 95%CI: 1.17-1.33] and underweight [AOR = 1.19, 95%CI: 1.11-1.26] but not wasting. CONCLUSION Childhood exposure to armed conflict is associated with long-term malnutrition in children aged 36-59 months in Nigeria. Strategies that aim to end childhood malnutrition could target children exposed to armed conflicts.
Collapse
Affiliation(s)
- Olusesan Ayodeji Makinde
- Viable Knowledge Masters, Plot C114, First Avenue, Gwarimpa, Abuja, Federal Capital Territory, Nigeria
- Viable Helpers Development Organization, Abuja, Federal Capital Territory, Nigeria
| | - Emmanuel Olamijuwon
- School of Geography and Sustainable Development, University of St Andrews, St Andrews, KY16 9AL, UK.
| | - Ifeanyi Mgbachi
- Viable Helpers Development Organization, Abuja, Federal Capital Territory, Nigeria
| | - Ryoko Sato
- Harvard University, 677 Huntington Ave, Boston, MA, 02115, USA
| |
Collapse
|
25
|
Syuhada G, Akbar A, Hardiawan D, Pun V, Darmawan A, Heryati SHA, Siregar AYM, Kusuma RR, Driejana R, Ingole V, Kass D, Mehta S. Impacts of Air Pollution on Health and Cost of Illness in Jakarta, Indonesia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2916. [PMID: 36833612 PMCID: PMC9963985 DOI: 10.3390/ijerph20042916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 01/30/2023] [Accepted: 02/04/2023] [Indexed: 06/18/2023]
Abstract
(1) Background: This study aimed to quantify the health and economic impacts of air pollution in Jakarta Province, the capital of Indonesia. (2) Methods: We quantified the health and economic burden of fine particulate matter (PM2.5) and ground-level Ozone (O3), which exceeds the local and global ambient air quality standards. We selected health outcomes which include adverse health outcomes in children, all-cause mortality, and daily hospitalizations. We used comparative risk assessment methods to estimate health burdens attributable to PM2.5 and O3, linking the local population and selected health outcomes data with relative risks from the literature. The economic burdens were calculated using cost-of-illness and the value of the statistical life-year approach. (3) Results: Our results suggest over 7000 adverse health outcomes in children, over 10,000 deaths, and over 5000 hospitalizations that can be attributed to air pollution each year in Jakarta. The annual total cost of the health impact of air pollution reached approximately USD 2943.42 million. (4) Conclusions: By using local data to quantify and assess the health and economic impacts of air pollution in Jakarta, our study provides timely evidence needed to prioritize clean air actions to be taken to promote the public's health.
Collapse
Affiliation(s)
- Ginanjar Syuhada
- Environmental, Climate, and Urban Health Division, Vital Strategies, Singapore 068807, Singapore
| | - Adhadian Akbar
- Center for Economics and Development Studies, Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Bandung 40115, Indonesia
| | - Donny Hardiawan
- Center for Economics and Development Studies, Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Bandung 40115, Indonesia
| | - Vivian Pun
- Environmental, Climate, and Urban Health Division, Vital Strategies, Singapore 068807, Singapore
| | - Adi Darmawan
- Environment Agency of DKI Jakarta Province, Jakarta 13640, Indonesia
| | | | - Adiatma Yudistira Manogar Siregar
- Center for Economics and Development Studies, Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Bandung 40115, Indonesia
| | - Ririn Radiawati Kusuma
- Environmental, Climate, and Urban Health Division, Vital Strategies, Singapore 068807, Singapore
| | - Raden Driejana
- Faculty of Civil and Environment Engineering, Institut Teknologi Bandung, Bandung 40132, Indonesia
| | - Vijendra Ingole
- Environmental, Climate, and Urban Health Division, Vital Strategies, New York, NY 10005, USA
| | - Daniel Kass
- Environmental, Climate, and Urban Health Division, Vital Strategies, New York, NY 10005, USA
| | - Sumi Mehta
- Environmental, Climate, and Urban Health Division, Vital Strategies, New York, NY 10005, USA
| |
Collapse
|
26
|
Brou AM, Djalega FA, Tokpa V, Seri ECG, Anoua ALF, Robinson JA. Urban-rural differences in the relationship between stunting, preschool attendance, home learning support, and school readiness: A study in Côte d'Ivoire. Front Public Health 2023; 10:1035488. [PMID: 36699902 PMCID: PMC9868242 DOI: 10.3389/fpubh.2022.1035488] [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] [Received: 09/02/2022] [Accepted: 12/12/2022] [Indexed: 01/10/2023] Open
Abstract
Background Stunted physical growth during early childhood is a marker of chronic undernutrition, and the adverse life circumstances that underlie it. These have the potential to disrupt normal brain development and the acquisition of foundational cognitive, language, social and motor skills. Stunting is prevalent in most low-and middle-income countries. Because the prevention of stunting requires large-scale structural and attitudinal changes, several psycho-educational interventions have been developed to mitigate the adverse association between early stunting and skill development. However, the resource-intensive nature of custom-designed interventions limit their sustainability and scalability in resource-limited settings. This study explored the possibility that available resources that promote positive development (existing preschool education programs, and no- or low-cost home-based learning activities and resources) may protect against any negative association between stunting and the acquisition of foundational skills required for academic learning and adaptation at school. Method Data for 36-to 59-month-old children (n = 3,522; M = 46.7 months; 51.2% male; 74.1% rural) were drawn from the most recent Multiple Indicator Cluster Survey conducted in Côte d'Ivoire (MICS5, 2016). Stunting was assessed using the WHO Child Growth Standards. Preschool attendance and home learning activities and resources were assessed by maternal report. School readiness was assessed using the 8-item form of the Early Child Development Index (ECDI). Results A high percentage of children met the criteria for stunting (28.5%; 19.7% moderate; 8.8% severe). There were marked urban-rural differences in the prevalence of stunting, rates of preschool attendance, home learning activities and resources, children's school readiness scores, and the relationships between stunting, the protective factors and school readiness scores. These urban-rural differences in ECDI scores could be fully explained by differences between these settings in stunting and the protective factors. However, only two protective factors (access to books and home-based activities that promote learning) made independent contributions to variance in ECDI scores. There was tentative evidence that stunted children whose homes provided highly diverse learning activities and multiple types of learning resources were more likely than those who did not to have a high level of school readiness. Conclusion Capitalizing on the existing practices of families that show positive deviance in caregiving may provide a basis for culturally appropriate, low-cost interventions to improve school readiness among children in low- and middle-income countries, including children with stunted growth.
Collapse
Affiliation(s)
- Abenin Mathieu Brou
- Institute of Anthropological Development Sciences (ISAD), University of Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire,*Correspondence: Abenin Mathieu Brou ✉
| | - Franck Adjé Djalega
- Laboratory of Nutrition and Food Security of the Department of Food Science and Technology, University of Nangui Abrogoua, Abidjan, Côte d'Ivoire
| | - Venance Tokpa
- Department of Language Sciences, University of Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire
| | - Edy Constant Gbala Seri
- Ivorian Center for Studies and Research in Applied Psychology, University of Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire
| | - Apie Léa Fabienne Anoua
- Institute of Anthropological Development Sciences (ISAD), University of Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire
| | - Julie Ann Robinson
- College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia
| |
Collapse
|
27
|
Desmond C, Watt K, Boua PR, Moore C, Erzse A, Sorgho H, Hofman K, Roumba T, Tinto H, Ward KA. Investing in human development and building state resilience in fragile contexts: A case study of early nutrition investments in Burkina Faso. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001737. [PMID: 36989221 DOI: 10.1371/journal.pgph.0001737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 02/27/2023] [Indexed: 03/30/2023]
Abstract
Maternal and early malnutrition have negative health and developmental impacts over the life-course. Consequently, early nutrition support can provide significant benefits into later life, provided the later life contexts allow. This study examines the limits of siloed investments in nutrition and illustrates how ignoring life-course contextual constraints limits human development benefits and exacerbates inequality, particularly in fragile contexts. This case study focuses on Burkina Faso, a country with high rates of early malnutrition and a fragile state. We modelled the impact of scaling up 10 nutrition interventions to 80% coverage for a single year cohort on stunting, nationally and sub-nationally, using the Lives Saved Tool (LiST), and the consequent impact on earnings, without and with a complementary cash-transfer in later life. The impact on earnings was modelled utilising the well-established pathway between early nutrition, years of completed schooling and, consequent adult earnings. Productivity returns were estimated as the present value of increased income over individuals' working lives, then compared to estimates of the present value of providing the cost of nutrition interventions and cash-transfers. The cost benefit ratio at the national level for scaled nutrition alone is 1:1. Sub-nationally the worst-off region yields the lowest ratio < 0.2 for every dollar spent. The combination of nutrition and cash-transfers national cost benefit is 1:12, still with regional variation but with great improvement in the poorest region. This study shows that early nutrition support alone may not be enough to address inequality and may add to state fragility. Taking a life-course perspective when priority-setting in contexts with multiple constraints on development can help to identify interventions that maximizing returns, without worsening inequality.
Collapse
Affiliation(s)
- Chris Desmond
- SAMRC/ Wits Centre for Health Economics and Decision Science, PRICELESS SA, Faculty of Health Sciences, University of Witwatersrand School of Public Health, Johannesburg, South Africa
| | - Kathryn Watt
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Palwendé R Boua
- Clinical Research Unit of Nanoro (CRUN), Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
- Sydney Brenner Institute for Molecular Biosciences (SBIMB), University of Witwatersrand, Johannesburg, South Africa
| | - Candice Moore
- Department of International Relations, School of Social Sciences, Faculty of Humanities, University of the Witwatersrand, Johannesburg, South Africa
| | - Agnes Erzse
- SAMRC/ Wits Centre for Health Economics and Decision Science, PRICELESS SA, Faculty of Health Sciences, University of Witwatersrand School of Public Health, Johannesburg, South Africa
| | - Hermann Sorgho
- Clinical Research Unit of Nanoro (CRUN), Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Karen Hofman
- SAMRC/ Wits Centre for Health Economics and Decision Science, PRICELESS SA, Faculty of Health Sciences, University of Witwatersrand School of Public Health, Johannesburg, South Africa
| | - Toussaint Roumba
- Clinical Research Unit of Nanoro (CRUN), Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Halidou Tinto
- Clinical Research Unit of Nanoro (CRUN), Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Kate A Ward
- SAMRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
- Global Health Research Institute, School of Human Development and Health, Faculty of Medicine, University of Southampton, United Kingdom
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
| |
Collapse
|
28
|
Association of BCC Module Roll-Out in SHG meetings with changes in complementary feeding and dietary diversity among children (6-23 months)? Evidence from JEEViKA in Rural Bihar, India. PLoS One 2023; 18:e0279724. [PMID: 36602987 DOI: 10.1371/journal.pone.0279724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 12/13/2022] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES Child dietary diversity is very low across rural communities in Bihar. Based on the experience of behavior change communication (BCC) module roll out in self-help group (SHG) sessions in rural Bihar, this study aims to assess the impact of the intervention on child dietary diversity levels in the beneficiary groups. METHODS The study is based on a pre-post study design whereby child dietary diversity is examined for a sample of 300 children (6-23 months old from 60 village organizations) during both pre-intervention as well as post-intervention phase. The latter consists of two types of group viz. a) children whose mothers were directly exposed to BCC module in SHGs sessions and b) those who were non-participants but may have indirect exposure through spillovers of BCC activities. Econometric analysis including logistic regression as well as propensity score matching techniques are applied for estimating the changes in dietary diversity in the post-intervention phase. RESULTS During the pre-intervention phase, 19% of the children (6-23 months) had adequate dietary diversity (eating from at least 4 out of 7 different food groups) and this increased to 49% among the exposed group and to 28% among the non-exposed group in the post-intervention phase. The exposed group have an odds ratio of 3.81 (95% CI: 2.03, 7.15) for consuming diverse diet when compared to the pre-intervention group. The propensity score matching analysis finds a 33% average treatment effect on the treated (ATT) for the group participating in BCC sessions at SHG events. CONCLUSION BCC roll out among SHG members is an effective mode to increase dietary diversity among infants and young children. The impact on child dietary diversity was significantly higher among mothers directly exposed to BCC modules. The BCC module also improved knowledge and awareness levels on complementary feeding and child dietary diversity.
Collapse
|
29
|
Saha UR, van Wesenbeeck CFA. Changes in the determinants and spatial distribution of under-five stunting in Bangladesh: Evidence from Bangladesh Demographic Health Surveys (BDHS) 1996-97, 2014 and 2017/18. PLoS One 2022; 17:e0278094. [PMID: 36454888 PMCID: PMC9714885 DOI: 10.1371/journal.pone.0278094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/09/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Bangladesh has experienced tremendous change in child nutrition over the past few decades, but there are large differences between different regions in progress made. The question is whether continuation of current policies will bring the progress needed to reach national and international targets on child nutrition security. DATA AND METHODS Using national data BDHS 1996/97, 2014, and 2017, this study attempts to map such reductions across Bangladesh and to explore the distribution of covariate effects (joint effects) that are associated with childhood stunting over these two periods, overall and by region. The main contribution of this paper is to link observed stunting scores to a household profile. This implies that different variables are evaluated jointly with stunting to assess the likelihood of being associated with stunting. RESULTS Overall, the covariates: 'Parental levels of education', 'children older than one year old', 'children live in rural area', 'children born at home' formed the country winning profile in 1996/97, whereas parental levels of education disappear in the winning profile for children stunted in 2014. This implies that over the years, Bangladesh has been successful in addressing parental education for long-term reductions in child undernutrition. In addition, the diversity of profiles of households with stunted children increases over time, pointing at successful targeting of policies to increase food security among children over the period. However, in areas where improvements have been insignificant, also the profiles remain stable, indicating a failure of policies to reach the target populations. The analysis for 2017 confirms this picture: the diversity of profiles remains high, with little change in the dominant profiles. CONCLUSION Further decline in stunting is possible through region specific multipronged interventions, targeting children older than one year among vulnerable groups, in addition with strengthening family planning programs as larger families also have a higher risk to have stunted children. In general, the profiles in 2014 and 2017/18 are much more diverse than in 1996, which can be explained by the relative success of specific targeted policies in some divisions, while being much less successful in other regions. In sum, our results suggest that the challenge lies in the implementation of policies, rather than in the generic approach and assumed theory of change.
Collapse
Affiliation(s)
- U. R. Saha
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - C. F. A. van Wesenbeeck
- Amsterdam Centre for World Food Studies, VU University Amsterdam, Amsterdam, The Netherlands
- * E-mail:
| |
Collapse
|
30
|
Ngan OM, Ang CE, Balmores MDC, Nagtalon SP, Calderon PE. Reproductive Health Deemed "Non-Essential" During COVID-19: A Neglected Health Vulnerability. Asia Pac J Public Health 2022; 34:868-869. [PMID: 35919940 PMCID: PMC9679205 DOI: 10.1177/10105395221116496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Olivia M.Y. Ngan
- Medical Ethics and Humanities Unit,
School of Clinical Medicine, University of Hong Kong, Hong Kong SAR, China,Olivia M.Y. Ngan, CUHK Centre for
Bioethics, Faculty of Medicine, The Chinese University of Hong Kong, Room 602
Wong Foo Yuan Building, Hong Kong SAR, China.
| | | | - Marina Dolores C. Balmores
- Department of Professionalism, Medical
Ethics and Humanities, St. Luke’s Medical Center College of Medicine-William H.
Quasha Memorial, Quezon, Philippines,Department of Obstetrics and
Gynecology, St. Luke’s Medical Center, Quezon, Philippines
| | - Susan Pelea Nagtalon
- Department of Professionalism, Medical
Ethics and Humanities, St. Luke’s Medical Center College of Medicine-William H.
Quasha Memorial, Quezon, Philippines,Department of Obstetrics and
Gynecology, St. Luke’s Medical Center, Quezon, Philippines
| | - Pacifico Eric Calderon
- Department of Professionalism, Medical
Ethics and Humanities, St. Luke’s Medical Center College of Medicine-William H.
Quasha Memorial, Quezon, Philippines,Faculty of Education, Monash
University, Melbourne, VIC, Australia
| |
Collapse
|
31
|
Yao M, Li L, Yang M, Wu Y, Cheng F. Household air pollution and childhood stunting in China: A prospective cohort study. Front Public Health 2022; 10:985786. [PMID: 36388319 PMCID: PMC9650942 DOI: 10.3389/fpubh.2022.985786] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/27/2022] [Indexed: 01/25/2023] Open
Abstract
Background Exposure to air pollution, especially indoor air pollution, was associated with an increased risk of childhood stunting. However, few longitudinal studies have explored the long-term impacts of indoor air pollution from household solid fuel use on child growth. We aimed to investigate the association between household air pollution (HAP) from solid fuel use and childhood stunting in Chinese children. Method The longitudinal data from the Chinese Family Panel Study over 2010-2018 were included in this study with a total of 6,013 children aged 0-15 years enrolled at baseline. Exposure to HAP was measured as solid fuel use for cooking, while solid fuel was defined as coal and firewood/straw according to the questionnaire survey. Stunting was defined as-2SD below the height-for-age z-score (HAZ) of the reference children. Logistic regression and Cox proportional hazards models with time-varying exposures were employed to estimate the association between childhood stunting and HAP exposure. Results At baseline, children with exposure to HAP from combusting solid fuels had a relatively higher risk of stunting [OR (95%CI): 1.42 (1.24-1.63)]. Among children without stunning at baseline, those living in households with solid fuel use had a higher stunting risk over an 8-year follow-up [HR (95%CI): 2.05 (1.64-2.57)]. The risk of childhood stunting was increased for those with HAP exposure from firewood/straw combustion or with longer exposure duration [HR (95%CI): 2.21 (1.74-2.79) and 3.01 (2.23-4.08), respectively]. Meanwhile, this risk was significantly decreased among children from households switching from solid fuels to clean fuels [HR (95%CI): 0.53 (0.39-0.70)]. Solid fuel use was suggested to be a mediator of the relationship between poor socioeconomic factors (i.e., household income and parental education level) and childhood stunning, with a mediation effect ranging from 11.25 to 14.26%. Conclusions HAP exposure from solid fuel use was associated with childhood stunting. Poor parental education and low household income might be socioeconomic factors contributing to solid fuel use. Therefore, household energy policies to facilitate access to clean fuels are urgently needed, especially for low-income and low-educated households.
Collapse
Affiliation(s)
- Min Yao
- Research Center for Economy of Upper Reaches of the Yangtze River, Chongqing Technology and Business University, Chongqing, China
| | - Lingou Li
- Department of Endocrinology, The First People's Hospital of Chong Qing Liang Jiang New Area, Chongqing, China
| | - Mei Yang
- Department of Endocrinology, The First People's Hospital of Chong Qing Liang Jiang New Area, Chongqing, China
| | - Yuanyuan Wu
- Health Management Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China,*Correspondence: Yuanyuan Wu
| | - Feifei Cheng
- Health Management Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China,Feifei Cheng
| |
Collapse
|
32
|
Andersen CT, Cain JS, Chaudhery DN, Ghimire M, Higashi H, Tandon A. Assessing public financing for nutrition in Bhutan, Nepal and Sri Lanka. MATERNAL & CHILD NUTRITION 2022; 18:e13320. [PMID: 35307937 DOI: 10.1111/mcn.13320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 12/20/2021] [Accepted: 01/04/2022] [Indexed: 11/30/2022]
Abstract
The objective of this study was to assess public financing for nutrition in Bhutan, Nepal and Sri Lanka to identify limitations of available data and to discuss policy implications. A variant of the Scaling Up Nutrition Movement methodology was used. Budget allocations and expenditures for relevant government ministries during 2012-2018 were identified. Nutrition-related line items were tagged using definitions of nutrition-specific and nutrition-sensitive interventions. Data were aggregated by year and calculated in constant United States dollars (USD). Expenditures by year were presented as a proportion of gross domestic product and general government expenditures. The percent utilization of budget allocations and proportion of funding from central government sources were determined. Per capita expenditures on nutrition-specific interventions varied from USD 1.08-8.76 and for nutrition-sensitive interventions varied from USD 20.22-51.20. Nutrition-specific expenditures as a percent of gross domestic product ranged from 0.08% in Sri Lanka in 2017% to 0.34% in Nepal in 2016. The median utilization rate was 64% for nutrition-specific and 84% for nutrition-sensitive interventions. Nutrition-specific funding financed by the central government was 90.7% in Bhutan and 99.4% in Sri Lanka. This study revealed the need to prioritize and invest in evidence-based interventions, including balancing investments in nutrition-specific versus -sensitive interventions. Challenges in estimation of nutrition expenditures and cross-country comparison were also observed, highlighting the need for appropriate nutrition line item tagging and standardized systems for data collection.
Collapse
Affiliation(s)
- Christopher T Andersen
- The World Bank, Health, Nutrition, and Population Global Practice, Washington, District of Columbia, USA
| | - Jewelwayne S Cain
- The World Bank, Health, Nutrition, and Population Global Practice, Washington, District of Columbia, USA
| | - Deepika N Chaudhery
- The World Bank, Health, Nutrition, and Population Global Practice, New Delhi, India
| | - Mamata Ghimire
- The World Bank, Health, Nutrition, and Population Global Practice, Kathmandu, Nepal
| | - Hideki Higashi
- The World Bank, Health, Nutrition, and Population Global Practice, Colombo, Sri Lanka
| | - Ajay Tandon
- The World Bank, Health, Nutrition, and Population Global Practice, Washington, District of Columbia, USA
| |
Collapse
|
33
|
Montenegro CR, Gomez G, Hincapie O, Dvoretskiy S, DeWitt T, Gracia D, Misas JD. The pediatric global burden of stunting: Focus on Latin America. LIFESTYLE MEDICINE 2022. [DOI: 10.1002/lim2.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
|
34
|
McCoy DC, Seiden J, Cuartas J, Pisani L, Waldman M. Estimates of a multidimensional index of nurturing care in the next 1000 days of life for children in low-income and middle-income countries: a modelling study. THE LANCET CHILD & ADOLESCENT HEALTH 2022; 6:324-334. [DOI: 10.1016/s2352-4642(22)00076-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 12/16/2022]
|
35
|
Nurbaiti L, Taslim NA, Bukhari A, Hatta M. Serum Concentration and mRNA Expression of Transforming Growth Factor-Beta 1 (TGF-β1) in Stunted Stunting and Non- Stunted Toddlers. Clin Nutr ESPEN 2022; 49:208-216. [PMID: 35623815 DOI: 10.1016/j.clnesp.2022.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/17/2022] [Accepted: 04/20/2022] [Indexed: 10/18/2022]
|
36
|
Understanding drivers of stunting reduction in Nigeria from 2003 to 2018: a regression analysis. Food Secur 2022; 14:995-1011. [PMID: 35911867 PMCID: PMC9325817 DOI: 10.1007/s12571-022-01279-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 02/17/2022] [Indexed: 11/05/2022]
Abstract
Nigeria is a high burden country for stunting. Stunting reduction has been slow and characterized by unequal progress across the 36 states and federal capital territory of the country. This study aimed to assess the changes in prevalence of stunting and growth determinants from 2003 to 2018, identify factors that predicted the change in stunting, and project future stunting prevalence if these predicted determinants improve. Trend and linear decomposition analyses of growth outcomes and determinants were conducted using 2003, 2008, 2013, and 2018 Nigeria Demographic and Health Survey data. Pooled data included 57,507 children 0 to 59 months old. Findings show that stunting and severe stunting significantly reduced from 43 to 37% and 23% to 17%, respectively (p < 0.001), between 2003 and 2018. Disturbingly, height-for-age z-scores at birth significantly decreased, indicating risks of potential future stunting increase. Improvements in nine stunting determinants (maternal body mass index, maternal height, ≥ 4 antenatal care visits, health facility delivery, reduced child illnesses, asset index, maternal education, paternal education, and preceding birth interval) predicted stunting reductions in children 0–59 months. Few of these nine determinants improved in subpopulations with limited stunting progress. Intra-sectoral and multisectoral coordination were potentially inadequate; 12% of children had received all of three selected health sector interventions along a continuum of care and 6% had received all of six selected multisector interventions. Forward looking projections suggest that increased efforts to improve the nine predictors of stunting change can reduce under-five stunting in Nigeria to ≤ 27% in the short term.
Collapse
|
37
|
Shahid M, Cao Y, Shahzad M, Saheed R, Rauf U, Qureshi MG, Hasnat A, Bibi A, Ahmed F. Socio-Economic and Environmental Determinants of Malnutrition in under Three Children: Evidence from PDHS-2018. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9030361. [PMID: 35327732 PMCID: PMC8947569 DOI: 10.3390/children9030361] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/20/2022] [Accepted: 02/23/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This research investigates the association of malnutrition with social and economic factors in general and environmental factors in specific such as sanitation facilities and drinking water sources for Pakistan. METHODS Authors used the latest data of 1010 Under-Three children from Pakistan Demographic and Health Survey (PDHS) 2017-2018. Cumulative Index of Anthropometric Failure (CIAF) was developed to measure the malnutrition status among children based on z-scores of WHZ, WAZ, and HAZ, respectively. The study has applied the discrete-choice logistic methodology to find the relationship of malnutrition with socio-economic characteristics. The interaction terms of drinking water source and sanitation facility have been measured to see the impact of environmental factors on child malnutrition. RESULTS The study results depict that the likelihood of malnutrition increases when the child had diarrhea recently and the child belongs to the deprived region such as KPK, Sind, and Baluchistan. However, the chances of child malnutrition drop with (1) an escalation of mothers' education, (2) a rise in wealth status of the household, and (3) the improved water source and sanitation facility in the household. The only water-improved sanitation category of the interaction term is significant in the model which depicts that households having both improved water and improved sanitation facilities had very fewer chances of malnutrition among their children. CONCLUSION Authors conclude that malnutrition in younger children is associated with improved water as well as sanitation facilities, maternal education, and household wealth in Pakistan.
Collapse
Affiliation(s)
- Muhammad Shahid
- School of Insurance and Economics, University of International Business and Economics (UIBE), Beijing 100029, China;
| | - Yang Cao
- School of Insurance and Economics, University of International Business and Economics (UIBE), Beijing 100029, China;
- Correspondence: ; Tel.: +86-173-1948-0430
| | - Muhammad Shahzad
- Department of Anthropology, Bahauddin Zakariya University, Multan 60800, Pakistan;
| | - Rafit Saheed
- School of Public Policy, Pakistan Institute of Development Economics, Islamabad 44000, Pakistan;
| | - Umara Rauf
- Department of Psychology, GC Women University, Sialkot 2021, Pakistan;
| | - Madeeha Gohar Qureshi
- Department of Economics, Pakistan Institute of Development Economics, Islamabad 44000, Pakistan;
| | - Abdullah Hasnat
- Medical and Dental College, Bahria University, Karachi 74400, Pakistan;
| | - Asma Bibi
- Independent Researcher in Applied Psychology, Lahore 54000, Pakistan;
| | - Farooq Ahmed
- Department of Anthropology, Quaid-i-Azam University, Islamabad 44000, Pakistan;
- Department of Anthropology, University of Washington, Seattle, WA 98195, USA
| |
Collapse
|
38
|
Mekonnen TC, Tadesse SE, Dawed YA, Cherie N, Abebe H, Shumye G, Mohammed F, Hussien A. The role of nutrition‐sensitive agriculture combined with behavioral interventions in childhood growth in Ethiopia: An adequacy evaluation study. Health Sci Rep 2022; 5:e524. [PMID: 35284644 PMCID: PMC8893299 DOI: 10.1002/hsr2.524] [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: 12/15/2020] [Revised: 01/20/2022] [Accepted: 01/26/2022] [Indexed: 11/25/2022] Open
Abstract
Objective The study aimed to investigate the role of nutrition‐sensitive and specific interventions along with nutrition education on child stunting during the first 1000 days in Ethiopia. Methods An adequacy evaluation study was used to see changes between the baseline and end‐line data after following for 1 year. A sample of 170 mother‐child pairs who had a 1‐year followed up was used to detect differences. We performed structural equation modeling to elucidate changes in feeding behaviors, socioeconomic status, water, sanitation and hygiene on child linear growth. Furthermore, the independent effect of covariates on child linear growth was handled using a general linear model. Results A total of 170 and 270 mother‐child dyads were interviewed at baseline and end‐line surveys, respectively. After about 1 year of intervention, the annual rate of stunting prevalence declined from 29.3% (95% confidence interval [CI] = 18.6, 42.7) to 16.4% (95% CI = 10.7, 24.2). There was a significant change in the mean of length‐for‐age Z‐score which changed from −1.18 to −0.45 (P < .034). Adjusting for the different constructs of the health belief model, child sex, age, feeding behaviors, and dietary diversity, one egg consumption per day was responsible for the most significant variability explained (36%) for stunting reduction. Conclusions Sustainable access to egg consumption for children below 2 years experienced a substantial reduction in childhood stunting. A combination of nutrition‐sensitive agricultural and direct nutrition interventions along with behavioral‐based education is a sustainable strategy in reducing and preventing child growth from faltering in the early life stages.
Collapse
Affiliation(s)
- Tefera Chane Mekonnen
- Nutrition and Dietetics Department School of Public Health, College of Medicine and Health Sciences, Wollo University Dessie Ethiopia
| | - Sisay Eshete Tadesse
- Nutrition and Dietetics Department School of Public Health, College of Medicine and Health Sciences, Wollo University Dessie Ethiopia
| | - Yeshimebet Ali Dawed
- Nutrition and Dietetics Department School of Public Health, College of Medicine and Health Sciences, Wollo University Dessie Ethiopia
| | - Nigus Cherie
- Reproductive and Family Health Department School of Public Health, College of Medicine and Health Sciences, Wollo University Dessie Ethiopia
| | - Hunegnaw Abebe
- Departments of Animal Science College of Agriculture, Wollo University Dessie Ethiopia
| | - Getachew Shumye
- Department of Plant Science College of Agriculture, Wollo University Dessie Ethiopia
| | - Foziya Mohammed
- Nutrition and Dietetics Department School of Public Health, College of Medicine and Health Sciences, Wollo University Dessie Ethiopia
| | - Ahmed Hussien
- Nutrition and Dietetics Department School of Public Health, College of Medicine and Health Sciences, Wollo University Dessie Ethiopia
| |
Collapse
|
39
|
Akseer N, Tasic H, Nnachebe Onah M, Wigle J, Rajakumar R, Sanchez-Hernandez D, Akuoku J, Black RE, Horta BL, Nwuneli N, Shine R, Wazny K, Japra N, Shekar M, Hoddinott J. Economic costs of childhood stunting to the private sector in low- and middle-income countries. EClinicalMedicine 2022; 45:101320. [PMID: 35308896 PMCID: PMC8927824 DOI: 10.1016/j.eclinm.2022.101320] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/01/2022] [Accepted: 02/09/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Stunting during childhood has long-term consequences on human capital, including decreased physical growth, and lower educational attainment, cognition, workforce productivity and wages. Previous research has quantified the costs of stunting to national economies however beyond a few single-country datasets there has been a limited number of which have used diverse datasets and have had a dedicated focus on the private sector, which employs nearly 90% of the workforce in many low- and middle-income countries (LMICs). We aimed to examine (i) the impact of childhood stunting on income loss of private sector workforce in LMICs; (ii) to quantify losses in sales to private firms in LMICs due to childhood stunting; and (iii) to estimate potential gains (benefit-cost ratios) if stunting levels are reduced in select high prevalence countries. METHODS This multiple-methods study engaged multi-disciplinary technical advisers, executed several literature reviews, used innovative statistical methods, and implemented health and labor economic models. We analyzed data from seven longitudinal datasets (up to 30+ years of follow-up; 1982-2016; Peru, Ethiopia, India, Vietnam, Philippines, Tanzania, Brazil), 108 private firm datasets (spanning 2008-2020), and many global datasets including Joint Malnutrition Estimates, and World Development Indicators to produce estimates for 120+ LMICs (with estimates up to 2021). We studied the impact of childhood stunting on adult cognition, education, and height as pathways to wages/productivity in adulthood. We employed cloud-based artificial intelligence (AI) platforms, and conducted comparative analyses using three analytic approaches: traditional frequentist statistics, Bayesian inferential statistics and machine learning. We employed labour and health economic models to estimate wage losses to the private sector worker and firm revenue losses due to stunting. We also estimated benefit-cost ratios for countries investing in nutrition-specific interventions to prevent stunting. FINDINGS Across 95 LMICs, childhood stunting costs the private sector at least US$135.4 billion in sales annually. Firms from countries in Latin America and the Caribbean and East Asia and Pacific regions had the greatest losses. Totals sales losses to the private sector accumulated to 0.01% to 1.2% of national GDP across countries. Sectors most affected by childhood stunting were manufacturing (non-metallic mineral, fabricated metal, other), garments and food sectors. Sale losses were highest for larger sized private firms. Across regions (representing 123 LMICs), US$700 million (Middle East and North Africa) to US$16.5 billion (East Asia and Pacific) monthly income was lost among private sector workers. Investing in stunting reduction interventions yields gains from US$2 to US$81 per $1 invested annually (or 100% to 8000% across countries). Across sectors, the highest returns were in elementary occupations (US$46) and the lowest were among agricultural workers (US$8). By gender, women incurred a higher income penalty from childhood stunting and earned less than men; due to their relatively higher earnings, the returns for investing in stunting reduction were consistently higher for men across most countries studied. INTERPRETATION Childhood stunting costs the private sector in LMICs billions of dollars in sales and earnings for the workforce annually. Returns to nutrition interventions show that there is an economic case to be made for investing in childhood nutrition, alongside a moral one for both the public and private sector. This research could be used to motivate strong public-private sector partnerships to invest in childhood undernutrition for benefits in the short and long-term.
Collapse
Affiliation(s)
- Nadia Akseer
- Johns Hopkins Bloomberg School of Public Health, USA
- Modern Scientist Global, Canada
- Corresponding author at: Johns Hopkins Bloomberg School of Public Health, USA.
| | | | | | | | | | | | | | | | | | - Ndidi Nwuneli
- Sahel Consulting Agriculture and Nutrition Ltd., Nigeria
| | - Ritta Shine
- Global Alliance for Improved Nutrition, Switzerland
| | - Kerri Wazny
- Johns Hopkins Bloomberg School of Public Health, USA
- The Power of Nutrition, UK
| | | | | | | |
Collapse
|
40
|
Putri DSK, Achadi EL, Gunardi H, Widodo Y. The Consecutive 3-month Length Increment to Predict Early Linear Growth Failure. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM: This study aimed to assess the consecutive 3-month length increment thresholds, by the first 6 months, to predict stunted at the age of 6 months.
METHODS: We analyzed data from the Bogor Longitudinal Study on Child Growth and Development in West Java, Indonesia. A total of 635 free of stunting at birth children were analyzed in this study. Early linear growth faltering, as the dependent variable, was the stunted at 6 months of age. The four thresholds of the consecutive 3-month length increment were considered in predicting stunted at the age of 6 months. The thresholds were a consecutive 3-month length increment below 25th percentile, 15th percentile, and 5th percentile of the WHO Child Growth Velocity Standard. The 4th threshold was generated from the Bogor Longitudinal Study sample and determined using receiver operating characteristic analysis. The sensitivity, specificity, PPV, and NPV of the thresholds were calculated.
RESULTS: Among the thresholds, the 25th percentile of the WHO Child Growth Velocity Standard generates the highest sensitivity. The ability of the 25th percentile threshold to correctly identify children who had stunting at 6 months of age is 56.7%. However, the children whose experience a consecutive 3-month length increment below 15th percentile had highest risk to become stunted at the age of 6 months, adjusted by sex, birthweight, and birth length.
CONCLUSION: A consecutive 3-month length increment could be beneficial as a tool in identifying infants at high risk of early linear growth failure in stunted prevalent population.
Collapse
|
41
|
Tang X, Zhao Y, Liu Q, Hu D, Li G, Sun J, Song G. The Effect of Risk Accumulation on Childhood Stunting: A Matched Case-Control Study in China. Front Pediatr 2022; 10:816870. [PMID: 35712625 PMCID: PMC9194815 DOI: 10.3389/fped.2022.816870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Childhood stunting is still a public health issue in developing countries. However, the traditional risk factors in underdeveloped areas are not suitable for developed areas. Moreover, childhood stunting is influenced by several aspects, including genetic factors, perinatal conditions, maternal conditions, and feeding practices, but researchers have not yet clearly determined which aspect of risk accumulation exerts the strongest effect on stunting. A matched case-control study was performed to assess the effect of different aspects of risk accumulation on childhood stunting. METHODS In total, 173 non-stunted children aged under 7 years were matched in our study from June 2015 to August 2015. The children's heights and weights were measured, and a self-administered questionnaire was used to collect information from the children and their parents. The risk factors were assigned to the following five aspects: genetic factors, family socioeconomic status, perinatal conditions, maternal conditions, and feeding practices. The risk accumulation (cumulative risk score) in each aspect was defined as the total number of risk factors that occurred in a certain aspect. A conditional logistic regression model was used to assess the effect of risk accumulation in different aspects on stunting, and a decision-tree model was used to predict the children's stunting based on the cumulative risk scores. RESULTS Risk accumulation in perinatal conditions, genetic factors, maternal conditions, and feeding practices was significant in the conditional logistic regression model (P < 0.05). Perinatal conditions showed the strongest association with stunting in both the regression analysis and the decision-tree model. The risk of stunting increased by 1.199 times if the cumulative risk score for perinatal conditions increased by one, and the probability of stunting was 75.8% if the cumulative risk score for perinatal conditions was ≥1. CONCLUSION Risk accumulation in perinatal conditions, genetic factors, maternal conditions, and feeding practices substantially increased the probability of stunting in childhood. Perinatal conditions were the main aspect associated with stunting. Prevention and intervention measures should be adopted to avoid risk accumulation in stunting.
Collapse
Affiliation(s)
- Xiao Tang
- Department of Health Statistics, School of Public Health, Dalian Medical University, Dalian, China
| | - Yanxiang Zhao
- Department of Mathematics, George Washington University, Washington, DC, United States
| | - Qigui Liu
- Department of Health Statistics, School of Public Health, Dalian Medical University, Dalian, China
| | - Dongmei Hu
- Department of Health Statistics, School of Public Health, Dalian Medical University, Dalian, China
| | - Guorong Li
- Department of Health Statistics, School of Public Health, Dalian Medical University, Dalian, China
| | - Jin Sun
- Child Health Care Clinic, Dalian Women and Children's Medical Group, Dalian, China
| | - Guirong Song
- Department of Health Statistics, School of Public Health, Dalian Medical University, Dalian, China
| |
Collapse
|
42
|
Zhang M, Denison RN, Pelli DG, Le TTC, Ihlefeld A. An auditory-visual tradeoff in susceptibility to clutter. Sci Rep 2021; 11:23540. [PMID: 34876580 PMCID: PMC8651672 DOI: 10.1038/s41598-021-00328-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/12/2021] [Indexed: 01/13/2023] Open
Abstract
Sensory cortical mechanisms combine auditory or visual features into perceived objects. This is difficult in noisy or cluttered environments. Knowing that individuals vary greatly in their susceptibility to clutter, we wondered whether there might be a relation between an individual's auditory and visual susceptibilities to clutter. In auditory masking, background sound makes spoken words unrecognizable. When masking arises due to interference at central auditory processing stages, beyond the cochlea, it is called informational masking. A strikingly similar phenomenon in vision, called visual crowding, occurs when nearby clutter makes a target object unrecognizable, despite being resolved at the retina. We here compare susceptibilities to auditory informational masking and visual crowding in the same participants. Surprisingly, across participants, we find a negative correlation (R = -0.7) between susceptibility to informational masking and crowding: Participants who have low susceptibility to auditory clutter tend to have high susceptibility to visual clutter, and vice versa. This reveals a tradeoff in the brain between auditory and visual processing.
Collapse
Affiliation(s)
- Min Zhang
- grid.260896.30000 0001 2166 4955Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ USA ,grid.430387.b0000 0004 1936 8796Department of Biomedical Engineering, Rutgers New Jersey Medical School, Newark, NJ USA
| | - Rachel N Denison
- grid.189504.10000 0004 1936 7558Department of Psychology, Boston University, Boston, MA USA
| | - Denis G Pelli
- grid.137628.90000 0004 1936 8753Department of Psychology, New York University, New York, NY USA
| | - Thuy Tien C Le
- grid.260896.30000 0001 2166 4955Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ USA ,grid.430387.b0000 0004 1936 8796Department of Biomedical Engineering, Rutgers New Jersey Medical School, Newark, NJ USA
| | - Antje Ihlefeld
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, USA.
| |
Collapse
|
43
|
Ringoringo HP, Sholihah Q, Maharany D, Kuncoro W, Luthfansa I, Lenggono KA. Analysis of Baby Stunting Prevalence Causing Factors in the Pandemy Era COVID-19. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM: The research objectives are to analyze prevalence factors stunting of a baby during the COVID-19 pandemic. The prevalence rate of stunting under five in Indonesia is high due to the lack of awareness and knowledge of the community. This could prevent the government from fulfilling the need for quality human resources in the future.
METHODS: This study is an analytical descriptive study that aims to explain the factors that cause the prevalence of stunting under five in the era of the COVID-19 pandemic. Data analysis using fishbone diagrams, hazard identification, and risk assessment of the six factors.
RESULTS: Furthermore, the analysis was carried out using hazard identification and risk assessment and obtained several risk categories, namely low risk of 13.3%, moderate 40%, high by 20%, and extreme by 26.7%.
CONCLUSION: The recommendations for improvement given refer to the extreme category because it is felt that this category has the highest urgency. The recommendations given are expected to assist the government in achieving the target of reducing the prevalence rate of stunting under five in Indonesia.
Collapse
|
44
|
Prado EL, Sebayang SK, Adawiyah SR, Alcock KJ, Ullman MT, Muadz H, Shankar AH. Maternal depression is the predominant persistent risk for child cognitive and social-emotional problems from early childhood to pre-adolescence: A longitudinal cohort study. Soc Sci Med 2021; 289:114396. [PMID: 34600358 DOI: 10.1016/j.socscimed.2021.114396] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 08/18/2021] [Accepted: 09/10/2021] [Indexed: 11/24/2022]
Abstract
RATIONALE Brain development occurs rapidly during early childhood and continues throughout middle childhood. Early and later windows of opportunity exist to alter developmental trajectories. Few studies in low- and middle-income countries have examined the importance of the timing of exposure to risks for poor pre-adolescent cognitive and social-emotional outcomes. METHODS We assessed 359 children who participated in two follow-up studies of the Supplementation with Multiple Micronutrients Intervention Trial conducted in Indonesia in 2001-2004: at 3.5 years in 2006 and 9-12 years in 2012-2014. Using structural equation models, we examined indicators of early childhood (3.5 y) and pre-adolescent (9-12 y) exposure to risks (child height-for-age z-score [HAZ], hemoglobin [Hb], maternal depressive symptoms [MDS], home environment [HOME]), with two developmental outcomes: cognitive ability and social-emotional problems. We characterized patterns of change by calculating residuals of indicators measured earlier (3.5 y) predicting the same indicators measured later (9-12 y), for example, the residual of 3.5 y MDS predicting 9-12 y MDS (rMDS). RESULTS Three early risk indicators (HOME, Hb, and MDS) were indirectly associated with pre-adolescent cognitive scores through early cognitive scores (HOME: 0.15, [95% CI 0.09, 0.21]; Hb: 0.08 [0.04, 0.12], MDS: -0.07 [-0.12, -0.02]). Pre-adolescent cognitive scores were also associated with change in MDS (rMDS: -0.13 [-0.23, -0.02]) and Hb (rHb: 0.10 [0.00, 0.20]) during middle childhood. For pre-adolescent social-emotional problems, both early childhood MDS (0.31 [0.19, 0.44]) and change in MDS during middle childhood (rMDS: 0.48 [0.37, 0.60]) showed strong direct associations with this outcome. CONCLUSIONS Our findings confirm those of previous studies that prevention of risk exposures during early childhood is likely to support long-term child development. It also adds evidence to a previously scarce literature for the middle childhood period. Prevention of maternal depressive symptoms and child anemia during middle childhood should be assessed for effectiveness to support child development.
Collapse
Affiliation(s)
- Elizabeth L Prado
- Summit Institute of Development, Jl Bung Hatta No 28, Mataram, NTB, Indonesia; Institute for Global Nutrition & Department of Nutrition, University of California Davis, One Shields Ave, Davis, CA, 95616, USA.
| | - Susy K Sebayang
- Summit Institute of Development, Jl Bung Hatta No 28, Mataram, NTB, Indonesia; Department of Biostatistics and Population Studies, University of Airlangga, Banyuwangi Campus, Jalan Wijaya Kusuma No 113, Banyuwangi, 68414, Indonesia
| | - Siti R Adawiyah
- Summit Institute of Development, Jl Bung Hatta No 28, Mataram, NTB, Indonesia
| | - Katherine J Alcock
- Psychology Department, Lancaster University, Bailrigg, Lancaster, LA1 4YF, UK
| | - Michael T Ullman
- Department of Neuroscience, Georgetown University, Box 571464, Washington, DC, 20057, USA
| | - Husni Muadz
- Summit Institute of Development, Jl Bung Hatta No 28, Mataram, NTB, Indonesia; Center for Research on Language and Culture, University of Mataram, Jalan Pendidikan No 37, Mataram, NTB, Indonesia
| | - Anuraj H Shankar
- Summit Institute of Development, Jl Bung Hatta No 28, Mataram, NTB, Indonesia; Eijkman-Oxford Clinical Research Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia and the Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| |
Collapse
|
45
|
|
46
|
Choudhary KK, Das S, Ghodajkar P. Trends of adult height in India from 1998 to 2015: Evidence from the National Family and Health Survey. PLoS One 2021; 16:e0255676. [PMID: 34534216 PMCID: PMC8448320 DOI: 10.1371/journal.pone.0255676] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 07/21/2021] [Indexed: 11/18/2022] Open
Abstract
AIM The aim of the study is to investigate the trends in adult height between two consecutive surveys of NHFS and explore differences across variables such as gender, wealth, social groups etc. METHODS We used the NFHS-II (1998-99), NFHS-III (2005-2006) and NFHS-IV (2015-16) (all three for women and last two for men) data to examine the trends in average height. Comparison was done between the two age strata of 15-25 and 26-50 years, across both male and female, to assess the trends. RESULTS Between NFHS-III and NFHS-IV, the average height of women in the age group of 15-25 showed a decline by 0.12 cm [95% CI, -0.24 to 0.00, p-0.051] while in the 26-50 years age strata it demonstrated significant improvement in the mean height by 0.13 cm [95% CI, 0.02 to 0.023, p-0.015]. However, Between NFHS III and IV, the average height of women in the poorest wealth index category registered a significant decline [-0.57cm, 95% CI, -076 to -0.37, p-0.000]. Between NFHS III and IV, the average height of Scheduled Tribe (ST) women in the age group of 15-25 years also exhibited a significant decline by 0.42 cm, [95% CI, -0.73 to -0.12, p-0.007]. Among men, between the two surveys, both the age groups of 15-25 years and 26-50 years showed significant decline in average height: 1.10 cm [95% CI, -1.31 to -.099 cm, p-0.00] and 0.86 cm [95% CI, -1.03 to -0.69, p-0.000], respectively. CONCLUSION In the context of an overall increase in average heights worldwide the decline in average height of adults in India is alarming and demands an urgent enquiry. The argument for different standards of height for Indian population as different genetic group needs further scrutiny. However, the trends from India clearly underline the need to examine the non-genetic factors also to understand the interplay of genetic, nutritional and other social and environmental determinants on height.
Collapse
Affiliation(s)
| | - Sayan Das
- Centre of Social Medicine and Community Health, JNU, New Delhi, India
| | | |
Collapse
|
47
|
Nosratabadi M, Heidari Z, Moeeni M, Ponnet K. Construction and Examination of an Early Childhood Development Composite Index: Evidence from Iran's Multiple Indicator Demographic and Health Survey. Int J Prev Med 2021; 12:51. [PMID: 34447493 PMCID: PMC8356951 DOI: 10.4103/ijpvm.ijpvm_357_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 04/16/2020] [Indexed: 11/04/2022] Open
Abstract
Background Assessing children's early development can help health and social policymakers to improve children's well-being. This study aims to develop an early childhood composite index for measuring early childhood care and education among Iranian children considering each child's geographical area, socioeconomic status and gender. Methods In this cross-sectional secondary study, the data come from Iran's Multiple Indicator Demographic and Health Survey 2010. Of the 9,345 eligible children whose information had been collected, 3,532 fulfilled the inclusion criterion of being 3 or 4 years old at the time of the interview. We examined a composite index and three subscales of early childhood development including "Quality of Care", "Early Childhood Care and Education", and "Overall Developmental Status". Factor analysis and latent class analysis were used for analyzing the data. Results The results indicate that of the children in the sample, 47.3% were in the "low early child development" class, 6% were in the "middle early child development" class, and 46.7% were in the "high early child development" class. The means of the three subscales and the composite index were significantly different across geographical areas (P < 0.01) and between the socioeconomic classes (P < 0.0001), with children from poorer families having lower scores. The composite index was significantly higher for girls (M = 11.28, SD = 3.96) than boys (M = 10.99, SD = 3.87, P = 0.029). Conclusions The study presents significant differences in childhood development based on geographical divisions, quartile classes and gender. We suggest that future research is needed to explore the robustness of findings in this study over time and diversity between and within various Iranian populations.
Collapse
Affiliation(s)
- Mehdi Nosratabadi
- Social Determinants of Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Heidari
- Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Moeeni
- Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Koen Ponnet
- Department of Communication Sciences, Imec-mict-Ghent University, Ghent, Belgium
| |
Collapse
|
48
|
Economic evaluation of an early childhood development center–based agriculture and nutrition intervention in Malawi. Food Secur 2021; 14:67-80. [PMID: 35222745 PMCID: PMC8858302 DOI: 10.1007/s12571-021-01203-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 07/16/2021] [Indexed: 11/21/2022]
Abstract
Malnutrition is a leading cause of death and disability among children in low-income countries. Nutrition-sensitive interventions show promise in increasing food access and improving diets. There are possible synergies of integrating these programs with other sectors, improving effectiveness by leveraging resources. However, economic evaluations of these multi-sectoral programs are limited. We aimed to estimate the cost efficiency, cost-effectiveness, benefit-cost ratio, and net benefit of using community-based early childhood development (ECD) centers as platforms for an intervention promoting agricultural production and nutrition among households with young children in Malawi. The intervention was costed using bottom-up micro-costing and top-down expenditure analysis with a societal perspective and a 12-month horizon. Effectiveness estimates were derived from a cluster-randomized control trial. Premature deaths and stunting cases averted were estimated using the Lived Saved Tool. We calculated DALYs averted, and the value of three benefits streams resulting from reductions in premature mortality, increases in lifetime productivity and household agricultural productivity. We transferred the US value of a statistical life (VSL) to Malawi using an income elasticity of 1.5, and a 10% discount rate. Probabilistic sensitivity analysis was conducted using a Monte Carlo model. The intervention cost $197,377, reaching 4,806 beneficiaries at $41 per beneficiary, $595 per case of stunting, $18,310 per death, and $516 per DALY averted. Net benefit estimates ranged from $507,589 to $4,678,258, and benefit-cost ratios from 3.57 to 24.70. Sensitivity analyses confirmed a positive return on investment. Implementing agriculture-nutrition interventions through ECD platforms may be an efficient use of resources in Malawi and similar contexts.
Collapse
|
49
|
Chakrabarti S, Pan A, Singh P. Maternal and Child Health Benefits of the Mamata Conditional Cash Transfer Program in Odisha, India. J Nutr 2021; 151:2271-2281. [PMID: 34087932 DOI: 10.1093/jn/nxab129] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/10/2021] [Accepted: 04/14/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Conditional cash transfers (CCTs) are demand-side interventions that link cash receipt to fulfilment of health-promoting conditions such as regular health check-ups and investment in human capital. In 2011, the Indian state of Odisha, implemented a statewide CCT program-the Mamata Scheme-towards improving maternal/child health outcomes and promoting health-seeking behavior. Mamata targets pregnant and lactating women aged ≥19 y, and provides a sizable financial incentive relative to household income levels. OBJECTIVES We aimed to longitudinally examine whether, and to what extent, initiation of the Mamata scheme corresponded with changes in health and nutrition outcomes in Odisha, relative to comparison states in India. METHODS Outcomes included maternal health service utilization [antenatal care (ANC), iron-folic acid supplementation, breastfeeding counseling, full child immunization, tetanus vaccination, vitamin A supplementation] and nutrition [anemia during pregnancy and stunting, anemia in children <5 y old (U5)]. Data on outcomes and covariates were obtained from 3 waves of India's National Family Health Surveys corresponding to the years 1999, 2006, and 2016. We used difference-in-differences (DID) estimation strategy to estimate the impact of the program. RESULTS The pooled sampled size comprised >200,000 mother-child dyads. Tests of parallel trends indicated that preintervention trends were similar across all outcomes in Odisha with the exception of anemia. When comparing Odisha with other states for health services, DID models indicated that exposure to Mamata corresponded with increased odds of counseling for breastfeeding (OR: 2.74; 95% CI: 1.97, 3.80), ANC receipt (OR: 1.51; 95% CI: 1.15, 1.99), and full immunization (OR: 1.69; 95% CI: 1.37, 2.08). DID models also indicated decline in stunting (OR: 0.92; 95% CI: 0.84, 1.02) and anemia (OR: 0.62; 95% CI: 0.54, 0.71) among U5 children in Odisha following Mamata, relative to comparison states. Models comparing poor with nonpoor groups indicated the presence of heterogeneous effects. CONCLUSIONS This study provides proof-of-concept for potential improvements in maternal and child nutrition outcomes following CCTs that incentivize health care utilization in India.
Collapse
Affiliation(s)
- Suman Chakrabarti
- Department of Health Metrics Sciences, Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Anwesha Pan
- Department of Anthropology, University of Washington, Seattle, WA, USA
| | - Parvati Singh
- UC Institute for Prediction Technology, University of California, Irvine, CA, USA
| |
Collapse
|
50
|
Eozenou PHV, Neelsen S, Lindelow M. Child Health Outcome Inequalities in Low and Middle Income Countries. Health Syst Reform 2021; 7:e1934955. [PMID: 34402412 DOI: 10.1080/23288604.2021.1934955] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Prior to the Sustainable Development Goals (SDG) era, considerable progress was made toward the Millennium Development Goals (MDGs) health indicators. Despite these achievements, many countries failed to meet the MDG target levels, between-country inequalities in health outcomes did not improve, and many countries making progress in average indicator levels did so while at the same time seeing increasing within-country inequalities. We build on the existing literature documenting levels and trends in health inequalities by expanding the number of data-points under focus, and we contribute to this literature by analyzing the extent to which inequalities in child health outcomes are related to socioeconomic inequalities, and to aggregate income growth. The objective of this paper is to examine long-run trends in average population levels and within-country inequalities for two child health outcomes-the under-five mortality rate (U5MR) and stunting-in 102 countries across 6 regions. We find that only about a third of countries in our sample managed to both reduce U5MR levels and inequalities, and only a quarter did so for stunting. The fact that inequality in service coverage seems to follow a more favorable trend than inequality in health outcomes suggests that policies aiming to reduce health inequities should not only foster more equitable service coverage but also focus on the social determinants of health. Moreover, there is no strong correlation between changes in health inequalities and income growth, suggesting that income generating development policies alone will typically not suffice to improve health outcomes and reduce health inequalities.
Collapse
Affiliation(s)
| | - Sven Neelsen
- Health, Nutrition, and Population Unit, The World Bank, Washington, DC, USA
| | - Magnus Lindelow
- Health, Nutrition, and Population Unit, The World Bank, Washington, DC, USA
| |
Collapse
|