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MacLeod C, Ngabirano L, N'Diaye DS, Braun L, Cumming O. Household-level water, sanitation and hygiene factors and interventions and the prevention of relapse after severe acute malnutrition recovery: A systematic review. MATERNAL & CHILD NUTRITION 2024; 20:e13634. [PMID: 38372439 PMCID: PMC11168358 DOI: 10.1111/mcn.13634] [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: 05/09/2023] [Revised: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 02/20/2024]
Abstract
Severe acute malnutrition (SAM) is the most serious form of acute malnutrition and is associated with high mortality risk among children under 5. While the Community-based Management of Acute Malnutrition (CMAM) approach, recommended for treating cases of uncomplicated SAM, has increased treatment coverage and recovery outcomes, high relapse rates have been reported. Several risk factors for SAM relapse, such as insufficient food intake and high infectious disease burden in the community, have been identified. However, the role of household water, sanitation and hygiene (WASH) conditions remains unclear. This systematic review: (1) assesses the effectiveness of WASH interventions on preventing SAM relapse and (2) identifies WASH-related conditions associated with relapse to SAM among children aged 6-59 months discharged as recovered following SAM CMAM treatment. We performed electronic searches of six databases to identify relevant studies published between 1 January 2000 and 6 November 2023 and assessed their quality. After deduplication, 10,294 documents were screened by title and abstract, with 13 retrieved for full-text screening. We included three studies ranging from low- to medium-quality. One intervention study found that providing a WASH kit during SAM outpatient treatment did not reduce the risk of relapse to SAM. Two observational studies found inconsistent associations between household WASH conditions-unimproved sanitation and unsafe drinking water-and SAM relapse. Despite the paucity of evidence, the hypothesised causal pathways between WASH conditions and the risk of relapse remain plausible. Further evidence is needed to identify interventions for an integrated postdischarge approach to prevent relapse.
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Affiliation(s)
- Clara MacLeod
- Department of Disease ControlLondon School of Hygiene and Tropical MedicineLondonUnited Kingdom
| | | | | | - Laura Braun
- Department of Disease ControlLondon School of Hygiene and Tropical MedicineLondonUnited Kingdom
| | - Oliver Cumming
- Department of Disease ControlLondon School of Hygiene and Tropical MedicineLondonUnited Kingdom
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Nadeem M, Anwar M, Adil S, Syed W, Al-Rawi MBA, Iqbal A. The Association between Water, Sanitation, Hygiene, and Child Underweight in Punjab, Pakistan: An Application of Population Attributable Fraction. J Multidiscip Healthc 2024; 17:2475-2487. [PMID: 38799016 PMCID: PMC11128241 DOI: 10.2147/jmdh.s461986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 05/16/2024] [Indexed: 05/29/2024] Open
Abstract
Background Access to safe drinking water, sanitation, and hygiene (WASH) facilities is crucial for health and human rights, impacting nutrition and weight. Methods Multiple Indicators Cluster Survey (MICS) 2017-18 has been used in this study to examine the association between WASH and underweight, alongside other factors. Analysis included descriptive statistics, association tests, logistic regression, and population-attributable fractions (PAF). Results According to results child were 1.8, 1.1 and 1.04 times less likely to be underweight if they had access to improved source of drinking water, improved sanitation and hygiene facilities respectively. The likelihood of child being underweight reduces by 1.4, 1.89, 2.01 and 2.55 times if the household wealth status increases from poorest to second, middle, fourth and richest wealth quintiles, respectively. As the mothers' education level increases from no schooling to primary, middle, secondary, and higher level, the possibility of child being underweight reduces by 1.22, 1.24, 1.60 and 2.01 times, respectively. Moreover, the likelihood of a child being underweight decreases as the education level of the household head improves. If maternal age is less than 20 or more than 35 years the likelihood of the child being underweight is increased by 1.074 and 1.121 times, respectively. A child is 1.1 times more likely to be underweight if birth spacing is less than 2 years. A child's risk of being underweight decreases by 1.1 times if they have not experienced diarrhea. A child who has never been breastfed has 1.3 times higher risk of being underweight. The results of Population Attributable Fraction (PAF) indicate that holding the other factors constant, approximately 36.46% burden of underweight was preventable by access to improved drinking water, sanitation, and hygiene practices. Conclusion Comprehensive strategy is needed that focuses on improving access to safe drinking water, sanitation infrastructure, and hygiene behaviors.
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Affiliation(s)
- Muhammad Nadeem
- Department of Economics, University of Education, Lahore, Vehari Campus, Pakistan
| | - Mumtaz Anwar
- School of Economics, University of the Punjab, Lahore, Pakistan
| | - Shahid Adil
- Punjab Resource Improvement and Digital Effectiveness (PRIDE) Project, Planning and Development Board, Government of the Punjab, Punjab, Pakistan
| | - Wajid Syed
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Mahmood Basil A Al-Rawi
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Ayesha Iqbal
- Division of Pharmacy Practice and Policy, School of Pharmacy, University of Nottingham, NottinghamUK
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
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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.
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Affiliation(s)
- Yusuke Kamiya
- Faculty of Economics, Ryukoku University, Kyoto, Japan
| | - Takaaki Kishida
- Department of Economics, University of Lausanne, Lausanne, Switzerland
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Som SV, Wieringa FT, Campos Ponce M, Polman K, Dakurah P, Duncan D, Blomberg J, Rasphone S, Hoeven MVD. Association of both Water, Sanitation and Hygiene (WASH) and Infant and Young Child Feeding (IYCF) practices with childhood malnutrition in Lao PDR: a cross-sectional study of the 2017 Lao Social Indicator Survey II. BMJ Open 2023; 13:e073974. [PMID: 37832981 PMCID: PMC10582958 DOI: 10.1136/bmjopen-2023-073974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 09/11/2023] [Indexed: 10/15/2023] Open
Abstract
OBJECTIVE We assessed whether Water, Sanitation and Hygiene (WASH) and Infant and Young Child Feeding (IYCF), either alone or combined, were associated with malnutrition among Lao People's Democratic Republic (Lao PDR) children aged 6 to <24 months. DESIGN This is a secondary analysis of the 2017 Lao Social Indicator Survey II (LSIS II), which used multistage probability proportional to size sampling. Logistic regression analyses were conducted with OR and its corresponding 95% CI. SETTING The LSIS II was conducted a nationwide household-based survey covering all 18 provinces in Lao PDR. PARTICIPANTS We had a total of 3375 children (weighted sample 3345) and 357 households with data on drinking water. OUTCOME MEASURES The outcomes of this study were stunting and wasting. RESULTS The prevalence of stunting and wasting was 28.9% and 10.1%, respectively. Even though households with access to a basic or improved water source were high (82.5%), over 83% of drinking water was contaminated with Escherichia coli. Access to improved sanitation, basic hygiene and adequate IYCF gave a significant lower risk of becoming stunted. The combined effect of these practices on stunting was (adjusted OR (AOR)=0.54; 95% CI=0.41 to 0.73) greater than each practice alone (improved sanitation: AOR=0.75; 95% CI=0.61 to 0.93; basic hygiene: AOR=0.69; 95% CI=0.57 to 0.83; adequate IYCF: AOR=0.79; 95% CI=0.64 to 0.98). Access to improved sanitation and adequate IYCF was associated with a significant lower risk for being wasted, and again the combined effect of these practices was (AOR=0.64; 95% CI=0.44 to 0.92) greater than each practice alone (improved sanitation: AOR=0.68; 95% CI=0.49 to 0.93 and adequate IYCF: AOR=0.66; 95% CI=0.47 to 0.92). CONCLUSION Given the strong associations with both stunting and wasting, and the added benefits when combining WASH and IYCF, there is a need of multisectoral interventions to reduce early childhood malnutrition in Lao PDR.
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Affiliation(s)
- Somphos Vicheth Som
- Section of Infectious Diseases, Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Frank T Wieringa
- UMR QualiSud, French National Research Institute for Sustainable Development, Montpellier, France
| | - Maiza Campos Ponce
- Section of Infectious Diseases, Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Katja Polman
- Section of Infectious Diseases, Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Prosper Dakurah
- United Nations Children's Emergency Fund Lao PDR, Vientiane, Lao People's Democratic Republic
| | - David Duncan
- United Nations Children's Emergency Fund Lao PDR, Vientiane, Lao People's Democratic Republic
| | - Janneke Blomberg
- United Nations Children's Emergency Fund Lao PDR, Vientiane, Lao People's Democratic Republic
| | - Sitthorot Rasphone
- The Ministry of Planning and Investment's National Economic Research Institute, Vientiane, Lao People's Democratic Republic
| | - Marinka van der Hoeven
- Section of Infectious Diseases, Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Negussie A, Lejore E, Hailemariam A, Tefera B, Mazengia EM, Dejene T, Tadesse Y, Adane Y, Gugsa K, Banda K, Sharma R, Girma E. BabyWASH and diarrhea prevention practices following multimedia educational intervention in hard-to-reach areas of the Afar and Somali regions of Ethiopia: a mixed-method endline evaluation. BMC Public Health 2023; 23:1998. [PMID: 37833668 PMCID: PMC10576324 DOI: 10.1186/s12889-023-16887-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Water, sanitation, and hygiene (WASH) interventions, which are specifically targeted towards young children-known as "BabyWASH"-reduce exposure to environmental contamination and prevent microbial burden in their play and feeding environments. The purpose of this endline study was to evaluate the effectiveness and potential sustainability of a multimedia educational intervention in influencing key BabyWASH and diarrhea prevention practices in four hard-to-reach woredas (i.e. administrative districts) of the Afar and Somali regions of Ethiopia. METHODS A mixed-method, comparative cross-sectional study was conducted, which included 457 household surveys, 16 key informant interviews, and 8 focus group discussions. The multimedia educational intervention comprised: broadcasting radio talk shows and radio spot messages, capacity-building training for community health workers and community leaders, community mobilization campaigns, and the distribution of promotional print media materials. Propensity score matching analysis was used to estimate the effect of the multimedia educational intervention on key BabyWASH and diarrhea prevention attitudes and practices, which was then triangulated with qualitative findings. RESULTS The multimedia intervention had a significant positive impact on good BabyWASH and diarrhea prevention practices, including appropriate practices of child feces disposal (t-test = 5.17; p < 0.001), handwashing with soap or ash (t-test = 8.85; p < 0.001), maintaining separate playgrounds for young children (t-test = 2.83; p < 0.001), washing of child's body, hands, and faces (t-test = 15.78; p < 0.001), and food hygiene practices (t-test = 2.74; p < 0.05). The findings of the qualitative assessment also revealed that the multimedia intervention packages and the approaches used were successful in influencing key BabyWASH and diarrhea prevention behaviors in the intervention implementation woredas. In addition, providing capacity building training to local actors and community leaders and recording radio talk shows and sharing them with community members were recognized as effective intervention implementation strategies. CONCLUSION The endline evaluation found that the multimedia educational intervention improved awareness, perception, and practice of BabyWASH and diarrhea prevention behaviors in intervention woredas compared to control woredas. Sanitation and hygiene promotion interventions in pastoralist settings can be effective when using locally and contextually appropriate intervention strategies. However, considerations for integrating both behavioral and structural components in WASH interventions is essential.
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Affiliation(s)
- Abel Negussie
- Department of Social and Population Health, Yirgalem Hospital Medical College, Yirgalem, Ethiopia.
- Ethiopian Health Education and Promotion Professionals Association (EHEPA), Addis Ababa, Ethiopia.
| | - Ephrem Lejore
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- Ethiopian Health Education and Promotion Professionals Association (EHEPA), Addis Ababa, Ethiopia
| | - Ariam Hailemariam
- School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Ethiopian Health Education and Promotion Professionals Association (EHEPA), Addis Ababa, Ethiopia
| | - Bereket Tefera
- Department of Public Health, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
- Ethiopian Health Education and Promotion Professionals Association (EHEPA), Addis Ababa, Ethiopia
| | - Elyas Melaku Mazengia
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
- Ethiopian Health Education and Promotion Professionals Association (EHEPA), Addis Ababa, Ethiopia
| | - Tariku Dejene
- Center for Population Studies, College of Development Studies, Addis Ababa University, Addis Ababa, Ethiopia
- Ethiopian Health Education and Promotion Professionals Association (EHEPA), Addis Ababa, Ethiopia
| | | | | | - Kalkidan Gugsa
- Social and Behavior Change (SBC) Section, United Nations Children's Fund, Addis Ababa, Ethiopia
| | - Kabuka Banda
- Water, Sanitation and Hygiene (WASH) Section, United Nations Children's Fund, Addis Ababa, Ethiopia
| | - Rachana Sharma
- Social and Behavior Change (SBC) Section, United Nations Children's Fund, Addis Ababa, Ethiopia
| | - Eshetu Girma
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Ethiopian Health Education and Promotion Professionals Association (EHEPA), Addis Ababa, Ethiopia
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Karlsson O, Kim R, Moloney GM, Hasman A, Subramanian SV. Patterns in child stunting by age: A cross-sectional study of 94 low- and middle-income countries. MATERNAL & CHILD NUTRITION 2023; 19:e13537. [PMID: 37276243 PMCID: PMC10483943 DOI: 10.1111/mcn.13537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 04/26/2023] [Accepted: 05/06/2023] [Indexed: 06/07/2023]
Abstract
Child stunting prevalence is primarily used as an indicator of impeded physical growth due to undernutrition and infections, which also increases the risk of mortality, morbidity and cognitive problems, particularly when occurring during the 1000 days from conception to age 2 years. This paper estimated the relationship between stunting prevalence and age for children 0-59 months old in 94 low- and middle-income countries. The overall stunting prevalence was 32%. We found higher stunting prevalence among older children until around 28 months of age-presumably from longer exposure times and accumulation of adverse exposures to undernutrition and infections. In most countries, the stunting prevalence was lower for older children after around 28 months-presumably mostly due to further adverse exposures being less detrimental for older children, and catch-up growth. The age for which stunting prevalence was the highest was fairly consistent across countries. Stunting prevalence and gradient of the rise in stunting prevalence by age varied across world regions, countries, living standards and sex. Poorer countries and households had a higher prevalence at all ages and a sharper positive age gradient before age 2. Boys had higher stunting prevalence but had peak stunting prevalence at lower ages than girls. Stunting prevalence was similar for boys and girls after around age 45 months. These results suggest that programmes to prevent undernutrition and infections should focus on younger children to optimise impact in reducing stunting prevalence. Importantly, however, since some catch-up growth may be achieved after age 2, screening around this time can be beneficial.
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Affiliation(s)
- Omar Karlsson
- Takemi Program in International Health, Harvard T.H. Chan School of Public HealthHarvard UniversityBostonMassachusettsUSA
- Department of Economic History, School of Economics and ManagementLund UniversityLundSweden
| | - Rockli Kim
- Division of Health Policy & Management, College of Health ScienceKorea UniversitySeoulKorea
- Harvard Center for Population and Development StudiesCambridgeMassachusettsUSA
| | - Grainne M. Moloney
- Nutrition Section, United Nations Children's Fund (UNICEF), Kenya Country OfficeUN Complex GigiriNairobiKenya
| | | | - S. V. Subramanian
- Harvard Center for Population and Development StudiesCambridgeMassachusettsUSA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public HealthHarvard UniversityBostonMassachusettsUSA
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Wolf J, Johnston RB, Ambelu A, Arnold BF, Bain R, Brauer M, Brown J, Caruso BA, Clasen T, Colford JM, Mills JE, Evans B, Freeman MC, Gordon B, Kang G, Lanata CF, Medlicott KO, Prüss-Ustün A, Troeger C, Boisson S, Cumming O. Burden of disease attributable to unsafe drinking water, sanitation, and hygiene in domestic settings: a global analysis for selected adverse health outcomes. Lancet 2023; 401:2060-2071. [PMID: 37290458 PMCID: PMC10290941 DOI: 10.1016/s0140-6736(23)00458-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/25/2023] [Accepted: 02/28/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Assessments of disease burden are important to inform national, regional, and global strategies and to guide investment. We aimed to estimate the drinking water, sanitation, and hygiene (WASH)-attributable burden of disease for diarrhoea, acute respiratory infections, undernutrition, and soil-transmitted helminthiasis, using the WASH service levels used to monitor the UN Sustainable Development Goals (SDGs) as counterfactual minimum risk-exposure levels. METHODS We assessed the WASH-attributable disease burden of the four health outcomes overall and disaggregated by region, age, and sex for the year 2019. We calculated WASH-attributable fractions of diarrhoea and acute respiratory infections by country using modelled WASH exposures and exposure-response relationships from two updated meta-analyses. We used the WHO and UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene public database to estimate population exposure to different WASH service levels. WASH-attributable undernutrition was estimated by combining the population attributable fractions (PAF) of diarrhoea caused by unsafe WASH and the PAF of undernutrition caused by diarrhoea. Soil-transmitted helminthiasis was fully attributed to unsafe WASH. FINDINGS We estimate that 1·4 (95% CI 1·3-1·5) million deaths and 74 (68-80) million disability-adjusted life-years (DALYs) could have been prevented by safe WASH in 2019 across the four designated outcomes, representing 2·5% of global deaths and 2·9% of global DALYs from all causes. The proportion of diarrhoea that is attributable to unsafe WASH is 0·69 (0·65-0·72), 0·14 (0·13-0·17) for acute respiratory infections, and 0·10 (0·09-0·10) for undernutrition, and we assume that the entire disease burden from soil-transmitted helminthiasis was attributable to unsafe WASH. INTERPRETATION WASH-attributable burden of disease estimates based on the levels of service established under the SDG framework show that progress towards the internationally agreed goal of safely managed WASH services for all would yield major public-health returns. FUNDING WHO and Foreign, Commonwealth & Development Office.
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Affiliation(s)
- Jennyfer Wolf
- Department of Environment, Climate Change and Health, World Health Organization, Geneva, Switzerland.
| | - Richard B Johnston
- Department of Environment, Climate Change and Health, World Health Organization, Geneva, Switzerland
| | - Argaw Ambelu
- Division of Water and Health, Ethiopian Institution of Water Resources, Addis Ababa University, Addis Ababa, Ethiopia
| | - Benjamin F Arnold
- FI Proctor Foundation, University of California, San Francisco, CA, USA
| | - Robert Bain
- UNICEF Middle East and North Africa, Amman, Jordan
| | - Michael Brauer
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Joe Brown
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Bethany A Caruso
- The Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Thomas Clasen
- Gangarose Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - John M Colford
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, CA, USA
| | - Joanna Esteves Mills
- Department of Environment, Climate Change and Health, World Health Organization, Geneva, Switzerland
| | - Barbara Evans
- School of Civil Engineering, University of Leeds, Leeds, UK
| | - Matthew C Freeman
- Gangarose Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Bruce Gordon
- Department of Environment, Climate Change and Health, World Health Organization, Geneva, Switzerland
| | - Gagandeep Kang
- Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tami Nadu, India
| | - Claudio F Lanata
- Instituto de Investigación Nutricional, Lima, Peru; School of Medicine, Vanderbilt University, Nashville, TN, USA; Department of Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Kate O Medlicott
- Department of Environment, Climate Change and Health, World Health Organization, Geneva, Switzerland
| | - Annette Prüss-Ustün
- Department of Environment, Climate Change and Health, World Health Organization, Geneva, Switzerland
| | - Christopher Troeger
- Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - Sophie Boisson
- Department of Environment, Climate Change and Health, World Health Organization, Geneva, Switzerland
| | - Oliver Cumming
- Department of Disease Control, Faculty of Infectious Tropical Disease, London School of Hygiene & Tropical Medicine, London, UK
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Kamau-Mbuthia E, Lesorogol C, Wamukota A, Humphries A, Sarange C, Mbeyu R, Cheupe C, Cheupe J, Nunez-Garcia A, Blackmore I, Iannotti L. Sustainable aquatic food systems: Multisectoral analysis of determinants of child nutrition in coastal Kenya. FRONTIERS IN SUSTAINABLE FOOD SYSTEMS 2023. [DOI: 10.3389/fsufs.2023.1091339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Marine foods produced by small-scale fishers can make vital contributions to sustainable, healthy food systems with multisectoral considerations of public health nutrition, gender equity, economics, and marine ecology. This pilot study aimed to map the multidimensional determinants of fish food security and young child nutrition in four coastal communities of Kenya with a view toward designing a large intervention trial. We compared anthropometric and dietary diversity indicators of children under 5 years in fishing vs. non-fishing households. Mixed methods included household surveys, 24-h recalls for dietary intake, and anthropometric measures of children. Child dietary diversity score (CDDS) and height-for-age Z (HAZ) were primary outcomes tested in ordinary least square regression modeling. Stunting was widely prevalent (20.2%), as were morbidities for acute diarrhea (29.0%) and fever (46.5%), with no statistically significant differences in fishing compared to non-fishing households. High proportions of children showed nutrient intake inadequacies for vitamins A, C, and E, iron and zinc; <50% met requirements for all nutrients except protein, which was derived primarily from plant-based foods. Regression modeling showed children living in fishing households were associated with lower CDDS. Maternal education, maternal body mass index (BMI), and household livelihood diversity were positively associated with both CDDS and HAZ, while child morbidities and north coast (of Mombasa) residence showed negative associations. Our findings highlight nutritional vulnerabilities within a coastal food system of Kenya and the need to involve multiple sectors—education, environment, health, finance, communications, and governance and policy—in deriving solutions.
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Sangalang SO, Lemence ALG, Ottong ZJ, Valencia JC, Olaguera M, Canja RJF, Mariano SMF, Prado NO, Ocaña RMZ, Singson PAA, Cumagun ML, Liao J, Anglo MVJC, Borgemeister C, Kistemann T. School water, sanitation, and hygiene (WaSH) intervention to improve malnutrition, dehydration, health literacy, and handwashing: a cluster-randomised controlled trial in Metro Manila, Philippines. BMC Public Health 2022; 22:2034. [PMID: 36344973 PMCID: PMC9641834 DOI: 10.1186/s12889-022-14398-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 07/15/2022] [Accepted: 10/19/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The impacts of multicomponent school water, sanitation, and hygiene (WaSH) interventions on children's health are unclear. We conducted a cluster-randomized controlled trial to test the effects of a school WaSH intervention on children's malnutrition, dehydration, health literacy (HL), and handwashing (HW) in Metro Manila, Philippines. METHODS The trial lasted from June 2017 to March 2018 and included children, in grades 5, 6, 7, and 10, from 15 schools. At baseline 756 children were enrolled. Seventy-eight children in two clusters were purposively assigned to the control group (CG); 13 clusters were randomly assigned to one of three intervention groups: low-intensity health education (LIHE; two schools, n = 116 children), medium-intensity health education (MIHE; seven schools, n = 356 children), and high-intensity health education (HIHE; four schools, n = 206 children). The intervention consisted of health education (HE), WaSH policy workshops, provision of hygiene supplies, and WaSH facilities repairs. Outcomes were: height-for-age and body mass index-for-age Z scores (HAZ, BAZ); stunting, undernutrition, overnutrition, dehydration prevalence; HL and HW scores. We used anthropometry to measure children's physical growth, urine test strips to measure dehydration, questionnaires to measure HL, and observation to measure HW practice. The same measurements were used during baseline and endline. We used multilevel mixed-effects logistic and linear regression models to assess intervention effects. RESULTS None of the interventions reduced undernutrition prevalence or improved HAZ, BAZ, or overall HL scores. Low-intensity HE reduced stunting (adjusted odds ratio [aOR] 0.95; 95% CI 0.93 to 0.96), while low- (aOR 0.57; 95% CI 0.34 to 0.96) and high-intensity HE (aOR 0.63; 95% CI 0.42 to 0.93) reduced overnutrition. Medium- (adjusted incidence rate ratio [aIRR] 0.02; 95% CI 0.01 to 0.04) and high-intensity HE (aIRR 0.01; 95% CI 0.00 to 0.16) reduced severe dehydration. Medium- (aOR 3.18; 95% CI 1.34 to 7.55) and high-intensity HE (aOR 3.89; 95% CI 3.74 to 4.05) increased observed HW after using the toilet/urinal. CONCLUSION Increasing the intensity of HE reduced prevalence of stunting, overnutrition, and severe dehydration and increased prevalence of observed HW. Data may be relevant for school WaSH interventions in the Global South. Interventions may have been more effective if adherence was higher, exposure to interventions longer, parents/caregivers were more involved, or household WaSH was addressed. TRIAL REGISTRATION NUMBER DRKS00021623.
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Affiliation(s)
- Stephanie O Sangalang
- Center for Development Research, University of Bonn, Genscherallee 3, 53113, Bonn, Germany.
| | - Allen Lemuel G Lemence
- Department of Industrial Engineering, University of the Philippines Los Baños, Los Baños, Philippines
| | - Zheina J Ottong
- School of Earth Sciences and Environmental Engineering, Gwangju Institute of Science and Technology, Gwangju, South Korea
- National Institute of Physics, College of Science, University of the Philippines Diliman, Quezon City, Philippines
| | | | - Mikaela Olaguera
- College of Mass Communication, University of the Philippines Diliman, Quezon City, Philippines
| | - Rovin James F Canja
- Philippines Department of Education, Meralco Avenue, Pasig City, Philippines
| | - Shyrill Mae F Mariano
- Marine Science Institute, University of the Philippines Diliman, Quezon City, Philippines
| | - Nelissa O Prado
- Department of Environment Systems, University of Tokyo, Kashiwa, Chiba, Japan
- National Institute of Geological Sciences, University of the Philippines Diliman, Quezon City, Philippines
| | - Roezel Mari Z Ocaña
- School of Medicine, Far Eastern University - Nicanor Reyes Medical Foundation, Quezon City, Philippines
| | | | - Ma Lourdes Cumagun
- Department of Science and Technology, Food and Nutrition Research Institute, Taguig, Philippines
| | - Janine Liao
- School of Diplomacy and Governance, De La Salle - College of Saint Benilde, Manila, Philippines
| | | | - Christian Borgemeister
- Center for Development Research, University of Bonn, Genscherallee 3, 53113, Bonn, Germany
| | - Thomas Kistemann
- Center for Development Research, University of Bonn, Genscherallee 3, 53113, Bonn, Germany
- Institute of Hygiene and Public Health, University of Bonn, Bonn, Germany
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10
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Sahiledengle B, Petrucka P, Kumie A, Mwanri L, Beressa G, Atlaw D, Tekalegn Y, Zenbaba D, Desta F, Agho KE. Association between water, sanitation and hygiene (WASH) and child undernutrition in Ethiopia: a hierarchical approach. BMC Public Health 2022; 22:1943. [PMID: 36261797 PMCID: PMC9583486 DOI: 10.1186/s12889-022-14309-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 09/20/2022] [Accepted: 10/04/2022] [Indexed: 11/23/2022] Open
Abstract
Background Undernutrition is a significant public health challenge and one of the leading causes of child mortality in a wide range of developing countries, including Ethiopia. Poor access to water, sanitation, and hygiene (WASH) facilities commonly contributes to child growth failure. There is a paucity of information on the interrelationship between WASH and child undernutrition (stunting and wasting). This study aimed to assess the association between WASH and undernutrition among under-five-year-old children in Ethiopia. Methods A secondary data analysis was undertaken based on the Ethiopian Demographic and Health Surveys (EDHS) conducted from 2000 to 2016. A total of 33,763 recent live births extracted from the EDHS reports were included in the current analysis. Multilevel logistic regression models were used to investigate the association between WASH and child undernutrition. Relevant factors from EDHS data were identified after extensive literature review. Results The overall prevalences of stunting and wasting were 47.29% [95% CI: (46.75, 47.82%)] and 10.98% [95% CI: (10.65, 11.32%)], respectively. Children from households having unimproved toilet facilities [AOR: 1.20, 95% CI: (1.05,1.39)], practicing open defecation [AOR: 1.29, 95% CI: (1.11,1.51)], and living in households with dirt floors [AOR: 1.32, 95% CI: (1.12,1.57)] were associated with higher odds of being stunted. Children from households having unimproved drinking water sources were significantly less likely to be wasted [AOR: 0.85, 95% CI: (0.76,0.95)] and stunted [AOR: 0.91, 95% CI: (0.83, 0.99)]. We found no statistical differences between improved sanitation, safe disposal of a child’s stool, or improved household flooring and child wasting. Conclusion The present study confirms that the quality of access to sanitation and housing conditions affects child linear growth indicators. Besides, household sources of drinking water did not predict the occurrence of either wasting or stunting. Further longitudinal and interventional studies are needed to determine whether individual and joint access to WASH facilities was strongly associated with child stunting and wasting. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14309-z.
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Affiliation(s)
- Biniyam Sahiledengle
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia.
| | - Pammla Petrucka
- College of Nursing, University of Saskatchewan, Saskatoon, Canada
| | - Abera Kumie
- School of Public Health, College of Health Science, Addis Ababa University, Ababa, Ethiopia
| | - Lillian Mwanri
- Torrens University Australia, Adelaide Campus, 5000, Adelaide, SA, Australia
| | - Girma Beressa
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Daniel Atlaw
- Department of Human Anatomy, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Yohannes Tekalegn
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Demisu Zenbaba
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Fikreab Desta
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Kingsley Emwinyore Agho
- School of Health Sciences, Western Sydney University, Locked Bag 1797, 2751, Penrith, NSW, Australia
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11
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Asif AM, Akbar M. A non-linear decomposition analysis of children's dietary diversity scores: explaining rural-urban inequality. QUALITY & QUANTITY 2022; 57:1-12. [PMID: 36060546 PMCID: PMC9418646 DOI: 10.1007/s11135-022-01501-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 07/15/2022] [Indexed: 11/22/2022]
Abstract
Sufficient and nourishing foods during the early years of a child's life are essential for optimal growth and healthy life. The existing disparities among rural-urban populations also affect the dietary pattern as well. Therefore, this study aims to identify the factors that contribute towards the rural-urban disparity in children's dietary diversity (CDD) and quantify their importance for the reduction of rural-urban disparities in achieving a minimum dietary diversity level. Using Pakistan Demographic and Health Survey (PDHS) data, version 2017-18, a non-linear decomposition analysis was performed. Eighty-one (81%) of the gap in CDD between rural-urban areas is attributed to the differences in the observed factors (endowments) and of these most of the difference is explained by three factors i.e. number of antenatal care visits (45%), maternal education (18%) and type of toilet facility (15%). There is a need to explore maternal education-related interventions to decrease the rural-urban gap regarding CDD as maternal education may affect CDD through different dimensions. Moreover, such programs should be initiated that may be helpful to enhance women's role in society, such as skilled education, well-paid job opportunities and better health facilities.
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Affiliation(s)
- Atta Muhammad Asif
- Department of Mathematics and Statistics, Faculty of Basic and Applied Science, International Islamic University, Islamabad, Pakistan
| | - Muhammad Akbar
- Department of Mathematics and Statistics, Faculty of Basic and Applied Science, International Islamic University, Islamabad, Pakistan
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12
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Das M, Verma M, Sahoo SS, Gupta M. Regional Water Availability and WASH Indicators as Predictors of Malnutrition in Under-5 Children: Analysis of the National Family Health Survey, India (2015-16). J Trop Pediatr 2022; 68:6567632. [PMID: 35415753 DOI: 10.1093/tropej/fmac030] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Water, sanitation and hygiene (WASH) practices determine child nutrition in resource-constrained countries and are influenced by regional water availability. We assessed any relationship between malnutrition and WASH practices among under-5 children in India's areas as per water availability. METHODS We did a secondary data analysis of the National Family Health Survey-IV. Stunting, wasting and being underweight were the significant outcomes. Regional water availability, households' source of water, sanitation and disposal of the child stool were the major independent variables. We report the prevalence estimates, bivariate associations and adjusted odds ratio to predict the child's malnutrition per regional water availability after using appropriate sampling weight. RESULTS Of the 186 875 children, 41%, 20% and 36% were stunted, wasted and underweight. Only 26% of children had access to improved drinking water sources, whereas 50.0% were defecating in open. Around 65% of children's stools were disposed of in unhygienic ways. Undernutrition depicted a significant association with independent variables. There were higher chances of stunting with a decrease in regional water availability, unimproved sanitation and unhygienic ways of stool disposal. Wasting was intensified by all these factors, except the safe disposal of stools. CONCLUSIONS WASH indicators exert a protective effect on undernutrition.
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Affiliation(s)
- Milan Das
- Department of Development Studies, International Institute for Population Sciences (IIPS), Mumbai 400088, Maharashtra, India
| | - Madhur Verma
- Department of Community & Family Medicine, All India Institute of Medical Sciences, Bathinda 151001, Punjab, India
| | - Soumya Swaroop Sahoo
- Department of Community & Family Medicine, All India Institute of Medical Sciences, Bathinda 151001, Punjab, India
| | - Madhu Gupta
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
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13
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Associations of Nutritional Status with Full Immunization Coverage and Safe Hygiene Practices among Thai Children Aged 12–59 Months. Nutrients 2021; 14:nu14010034. [PMID: 35010909 PMCID: PMC8746758 DOI: 10.3390/nu14010034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 11/17/2022] Open
Abstract
Prevailing prevention measures against morbidity, such as vaccination and safe hygiene practices, vary among local cultural contexts, and little is known about the extent to which these behaviors mitigate poor nutritional status in young children in Southeast Asia. We examined the associations between nutrition status with full immunization coverage, and water, sanitation and hygiene status among children aged 12–59 months in the 2015–2016 Thailand Multiple Indicator Cluster Survey (n = 9060). When adjusted for confounding factors, children with incomplete immunization status were more likely to be stunted (adjusted odds ratio (aOR) 1.47; 95% confidence interval (CI): 1.24–1.75, p < 0.001), wasted (aOR 1.67, 95% CI: 1.31–2.12, p < 0.001), and overweight (aOR 1.24, 95% CI: 1.01–1.51, p < 0.05), whereas children who used unimproved water sources were more likely to be overweight (aOR 2.43, 95% CI: 1.27–4.64, p < 0.01). The further implementation of simple and cost-effective health promotion activities and practices at the household level may be important interventions for healthy child growth and development, particularly under restricted living conditions due to COVID-19.
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14
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Saaka M, Saapiire FN, Dogoli RN. Independent and joint contribution of inappropriate complementary feeding and poor water, sanitation and hygiene (WASH) practices to stunted child growth. J Nutr Sci 2021; 10:e109. [PMID: 35059190 PMCID: PMC8727702 DOI: 10.1017/jns.2021.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 11/14/2021] [Accepted: 11/28/2021] [Indexed: 11/07/2022] Open
Abstract
The causes of undernutrition are often linked to inappropriate complementary feeding practices and poor households' access to water, sanitation and hygiene (WASH), but limited evidence exists on the combined effect of poor WASH and inappropriate complementary feeding practices on stunted child growth. We assessed the independent and joint contribution of inappropriate complementary feeding and poor WASH practices to stunted growth among children aged 6-23 months in the Jirapa Municipality of Ghana. A community-based cross-sectional analytical study design was used with a sample of 301 mothers/caregivers having children aged 6-23 months. The results indicate that in a multivariable logistic regression model that adjusted for confounders, children receiving both unimproved water and inappropriate complementary feeding had a higher and significant odd of becoming stunted (adjusted odds ratio = 33. 92; 95 % confidence interval 3⋅04, 37⋅17; P = 0⋅004) compared to households having both improved water sources and appropriate complementary feeding practices. Except for unimproved drinking water sources, poor sanitation and hygiene, which comprised the use of unimproved household toilet facilities, washing hands without soap and improper disposal of child faeces were not associated with the risks of stunting among children aged 6-23 months. The combined effect of unimproved water and inappropriate complementary feeding on stunting was greater than either unimproved water only or inappropriate complementary feeding only.
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Affiliation(s)
- Mahama Saaka
- Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, P. O. Box 1883, Tamale, Ghana
| | - Ferguson N Saapiire
- St. Joseph Nursing Training College, Ministry of Health, P. O. BOX 24, Jirapa, Wa, Ghana
| | - Richard N Dogoli
- Jhpiego Ghana, 14 Ollenu Street, East Legon, PMB 18, Legon Accra, Ghana
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15
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Dharod JM, Nounkeu CD, Paynter L, Labban JD, Sastre LR. Examination of the Cameroon DHS data to investigate how water access and sanitation services are related to diarrhea and nutrition among infants and toddlers in rural households. JOURNAL OF WATER AND HEALTH 2021; 19:1030-1038. [PMID: 34874909 DOI: 10.2166/wh.2021.123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Undernutrition among children is a significant issue in rural areas in Cameroon, with diarrhea being one of the major contributing risk factors. To gain a better understanding of the risk factors of diarrhea, the main objective of this epidemiological study was to examine associations between water access and sanitation service with diarrhea, diet diversity, and anemia among infants and toddlers in rural households in Cameroon. The study involved household- and individual-level data of 2,129 rural-dwelling infants and toddlers from the Demographic and Health Survey database. About one-third of infants and toddlers were experiencing diarrhea, with higher odds among those who lived in households with limited water service (p = 0.028). The odds of having diarrhea were 50% higher among infants and toddlers when households did not have sanitation facilities (p = 0.007). The lack of improved water and sanitation was also associated with a low intake of various food groups among older infants and toddlers. The prevalence of anemia was high, but no significant differences were seen by water and sanitation services. The achievement of SDG #6 will help address undernutrition and achieve other SDGs, including improving health and wellbeing.
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Affiliation(s)
- Jigna M Dharod
- Department of Nutrition, University of North Carolina, Greensboro, NC, USA E-mail:
| | | | - Lauren Paynter
- Department of Nutrition, University of North Carolina, Greensboro, NC, USA E-mail:
| | - Jeffrey D Labban
- Office of Research, School of Health and Human Sciences, University of North Carolina, Greensboro, NC, USA
| | - Lauren R Sastre
- Department of Nutrition Science, College of Allied Health Sciences, East Carolina University, Greenville, NC 27834, USA
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16
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Rogawski McQuade ET, Benjamin-Chung J, Westreich D, Arnold BF. Population intervention effects in observational studies to emulate target trial results: reconciling the effects of improved sanitation on child growth. Int J Epidemiol 2021; 51:279-290. [PMID: 34151953 DOI: 10.1093/ije/dyab070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 03/17/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Improved sanitation has been associated with improved child growth in observational studies, but multiple randomized trials that delivered improved sanitation found no effect on child growth. We assessed to what extent differences in the effect estimated in the two study designs (the effect of treatment in observational studies and the effect of treatment assignment in trials) could explain the contradictory results. METHODS We used parametric g-computation in five prospective studies (n = 21 524) and 59 cross-sectional Demographic and Health Surveys (DHS; n = 158 439). We compared the average treatment effect (ATE) for improved sanitation on mean length-for-age z-score (LAZ) among children aged <2 years to population intervention effects (PIEs), which are the observational analogue of the effect estimated in trials in which some participants are already exposed. RESULTS The ATE was >0.15 z-scores, a clinically meaningful difference, in most prospective studies but in <20% of DHS surveys. The PIE was always smaller than the ATE, and the magnitude of difference depended on the baseline prevalence of the improved sanitation. Interventions with suboptimal coverage and interventions delivered in populations with higher mean LAZ had a smaller effect on population-level LAZ. CONCLUSIONS Estimates of PIEs corresponding to anticipated trial results were often smaller than clinically meaningful effects. Incongruence between observational associations and null trial results may in part be explained by expected differences between the effects estimated. Using observational ATEs to set expectations for trials may overestimate the impact that sanitation interventions can achieve. PIEs predict realistic effects and should be more routinely estimated.
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Affiliation(s)
- Elizabeth T Rogawski McQuade
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA.,Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | - Jade Benjamin-Chung
- Department of Epidemiology & Biostatistics, University of California, Berkeley, CA, USA
| | - Daniel Westreich
- Division of Epidemiology, University of North Carolina-Chapel Hill, NC, USA
| | - Benjamin F Arnold
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA.,Department of Ophthalmology, University of California, San Francisco, CA, USA
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17
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Scherer N, Mactaggart I, Huggett C, Pheng P, Rahman MU, Biran A, Wilbur J. The Inclusion of Rights of People with Disabilities and Women and Girls in Water, Sanitation, and Hygiene Policy Documents and Programs of Bangladesh and Cambodia: Content Analysis Using EquiFrame. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105087. [PMID: 34064939 PMCID: PMC8151976 DOI: 10.3390/ijerph18105087] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/30/2021] [Accepted: 05/06/2021] [Indexed: 01/09/2023]
Abstract
People with disabilities and as women and girls face barriers to accessing water, sanitation, and hygiene (WASH) services and facilities that fully meet their needs, especially in low- and middle-income countries. Women and girls with disabilities experience double discrimination. WASH policies should support and uphold the concepts of disability and gender inclusion, and they should also act as a guide to inform WASH programs and service delivery. Using a modified version of the EquiFrame content analysis tool, this study investigated the inclusion of 21 core concepts of human rights of people with disabilities and women and girls in 16 WASH policy documents and seven end-line program reports from Bangladesh and Cambodia. Included documents typically focused on issues of accessibility and neglected wider issues, including empowerment and support for caregivers. The rights of children and women with disabilities were scarcely focused on specifically, despite their individual needs, and there was a disconnect in the translation of certain rights from policy to practice. Qualitative research is needed with stakeholders in Bangladesh and Cambodia to investigate the inclusion and omission of core rights of people with disabilities, and women and girls, as well as the factors contributing to the translation of rights from policy to practice.
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Affiliation(s)
- Nathaniel Scherer
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (I.M.); (J.W.)
- Correspondence:
| | - Islay Mactaggart
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (I.M.); (J.W.)
| | | | | | | | - Adam Biran
- Environmental Health Group, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK;
| | - Jane Wilbur
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (I.M.); (J.W.)
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18
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Sema B, Azage M, Tirfie M. Childhood stunting and associated factors among irrigation and non-irrigation user northwest, Ethiopia: a comparative cross-sectional study. Ital J Pediatr 2021; 47:102. [PMID: 33902661 PMCID: PMC8074471 DOI: 10.1186/s13052-021-01048-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 04/09/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Stunting is a critical public health problem of developing countries like Ethiopia. Different interventions like irrigation activity have been carried out by the government of Ethiopia to improve the nutritional status of the community. However, there is scanty of data on childhood stunting and its associated factors between irrigation user and non-irrigation user. OBJECTIVE To assess the magnitude of childhood stunting and its associated factors between irrigation and non-irrigation user in North Mecha District, Northwest Ethiopia. METHODS A community-based comparative cross-sectional study design was employed from October to November 2019. A systematic sampling was used to draw mothers with children age 6-59 months (582 irrigated and 582 non- irrigated household users). Data were collected using questionnaire and anthropometric measurement tools. Multivariable logistic regression was used to identify the predictors of stunting. Adjusted odds ratios with 95% CI were used to determine the degree of association between independent and outcome variable. A-p-value < 0.05 was used as cutoff point to declare statistically significant variables with the outcome variable. RESULTS The prevalence of childhood stunting (6-59 months) among irrigation users [32.8% at 95%CI [29.1%-36.7%]] was slightly lower than non-users [40.2% at 95%CI [[36.3%-44.2%]]]. However, the difference did not show significant variation. The odds of childhood stunting were higher among a child from a mother had no antenatal visit, a child whose age was between 12 and 47 months, a child from a mother who did not use water and soap always for washing hands, and a child who had fever. CONCLUSION The prevalence of childhood stunting was high and did not show significant variation between irrigation and non-irrigation users. A child from mother had no antenatal visit, whose age was between 12 and 47 months, a mother who did not use water and soap always for washing hands, and who had fever were factors associated with higher child stunting. Thus, the identified modifiable factors should be strengthened to reduce stunting.
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Affiliation(s)
- Balew Sema
- Bahir Dar University Student Clinic, Bahir Dar University, P.O.Box 79, Bahir Dar, Ethiopia
| | - Muluken Azage
- Department of Environmental Health, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, P.O.Box 79, Bahir Dar, Ethiopia.
| | - Mulat Tirfie
- Department of Nutrition and Dietetics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, P.O.Box 79, Bahir Dar, Ethiopia
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Caffarelli C, Santamaria F, Santoro A, Procaccianti M, Castellano F, Nastro FF, Villani A, Bernasconi S, Corsello G. Best practices, challenges and innovations in pediatrics in 2019. Ital J Pediatr 2020; 46:176. [PMID: 33256810 PMCID: PMC7703504 DOI: 10.1186/s13052-020-00941-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 11/21/2020] [Indexed: 12/22/2022] Open
Abstract
This paper runs through key progresses in epidemiology, pathomechanisms and therapy of various diseases in children that were issued in the Italian Journal of Pediatrics at the end of last year. Novel research and documents that explore areas such as allergy, critical care, endocrinology, gastroenterology, infectious diseases, neonatology, neurology, nutrition, and respiratory tract illnesses in children have been reported. These observations will help to control childhood illnesses.
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Affiliation(s)
- Carlo Caffarelli
- Clinica Pediatrica, Department of Medicine and Surgery, Azienda Ospedaliera-Universitaria, University of Parma, Via Gramsci 14, Parma, Italy.
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Angelica Santoro
- Clinica Pediatrica, Department of Medicine and Surgery, Azienda Ospedaliera-Universitaria, University of Parma, Via Gramsci 14, Parma, Italy
| | - Michela Procaccianti
- Clinica Pediatrica, Department of Medicine and Surgery, Azienda Ospedaliera-Universitaria, University of Parma, Via Gramsci 14, Parma, Italy
| | - Fabio Castellano
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | | | - Alberto Villani
- UOC di Pediatria Generale e Malattie Infettive, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | | | - Giovanni Corsello
- Department of Sciences for Health Promotion and Mother and Child Care "G. D'Alessandro", University of Palermo, Palermo, Italy
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