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Takele BA, Gezie LD, Alamneh TS. Pooled prevalence of stunting and associated factors among children aged 6-59 months in Sub-Saharan Africa countries: A Bayesian multilevel approach. PLoS One 2022; 17:e0275889. [PMID: 36228030 PMCID: PMC9560624 DOI: 10.1371/journal.pone.0275889] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 09/26/2022] [Indexed: 11/06/2022] Open
Abstract
Background Over 155 million children under five suffer from stunting, and it is responsible for over one million deaths and 54.9 million Disability Adjusted Life Years (DALYS) of under-five children worldwide. These predominantly occurred in low-and middle-income countries like sub-Saharan Africa. Stunted children begin their lives at a marked disadvantage. Some of these are; poor cognition and educational performance, low adult wages, lost productivity and, when accompanied by excessive weight gain later in childhood, an increased risk of nutrition-related chronic diseases in adult life and the devastating effects of stunting can last a lifetime and even affect the next generation. Despite this, its magnitude rises in the past 25 years in sub-Saharan Africa. Studies that capture the pooled prevalence and associated factors of stunting among children aged 6–59 months in sub-Saharan Africa are limited. Therefore, this study was carried out on the basis of the Bayesian approach to determine the pooled prevalence and predictors of stunting among children aged 6–59 months in Sub-Saharan Africa. Objective To assess the pooled prevalence of stunting and associated factors among children aged 6–59 months in Sub-Saharan Africa Methods For this study a total of 173,483 weighted samples from the demography and health survey data set of 35 sub-Saharan African countries from 2008 to 2020 were used. After checking Variation between cluster by computing Intraclass Correlation Coefficient, binary logistic regression model was conducted based on hierarchical Bayesian statistical approach to account the hierarchical nature of demography and health survey data and to get reliable estimates by using additional information from the prior distribution. Adjusted odds ratio with 95% credible interval of the best fitted model was used to ascertain the predictors. Results The pooled prevalence of stunting in Sub-Saharan Africa was about 35% (95%CI: 34.87, 35.31). Of the sub-regions, the highest prevalence of stunting was in East Africa, 37% (95%, CI: 36.96, 37.63) followed by Central Africa, 35% (95%CI: (34.93, 35.94). Being male (AOR = 1.27, 95% CrI 1.25, 1.30), small birth size (AOR = 1.29, CrI 1.25, 1.32), home delivery (AOR = 1.17, CrI 1.14, 1.20), and no education of mothers (AOR = 3.07, CrI 2.79, 3.39) were some of the significant predictors of stunting of children. Conclusion and recommendation The prevalence of stunting of children in sub-Saharan Africa is among the highest in the world. Predictors such as being male, being small at birth, a child delivered at home, and, low level of maternal education were some of the predictors of childhood stunting. Stakeholders and non-governmental organizations should consider those contributing factors of stunting when they plan and design nutritional improvement programs.
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Affiliation(s)
- Bayley Adane Takele
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Lemma Derseh Gezie
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tesfa Sewunet Alamneh
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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When Local Trade-Offs between SDGs Turn Out to Be Wealth-Dependent: Interaction between Expanding Rice Cultivation and Eradicating Malaria in Rwanda. SUSTAINABILITY 2022. [DOI: 10.3390/su14042100] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Interactions between SDGs are increasingly mapped and mediating factors that determine whether existing synergies or trade-offs can be identified. However, if and how the wealth status of the concerned population shapes whether SDG interaction constitutes a vicious or virtuous circle is largely overlooked. This article focuses on interaction between SDG2 (nutrition) and SDG3 (health), in particular, the relationship between rice production intensification and the fight against malaria, and thus the role of wealth in explaining the trade-off. This study employed a large-scale survey of rural households (n = 3968) in eastern Rwanda, conducted at a time when a rapid expansion of rice fields co-existed with a strong resurgence of malaria. Logistic regression shows that rice-cultivating households faced significant higher malaria risk, as proxied by fever incidence, confirming the negative externality of agricultural intensification on public health through offering a habitat for vector-borne diseases. Even though rice-cultivating households tend to be higher up the local wealth distribution than those outside the rice sector, its distributional effects are generally biased against the poor. Poorer households outside the rice sector hardly share in the benefits from increased rice production but suffer the consequences in terms of increased malaria risk. The case thus draws attention to the importance of using a distributional lens when analyzing interaction between SDGs locally.
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Krezanoski PJ, Roh ME, Rek J, Nankabirwa JI, Arinaitwe E, Staedke SG, Nayiga S, Hsiang MS, Smith D, Kamya M, Dorsey G. Marked reduction in antibiotic usage following intensive malaria control in a cohort of Ugandan children. BMC Med 2021; 19:294. [PMID: 34844601 PMCID: PMC8630830 DOI: 10.1186/s12916-021-02167-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/21/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Intensive malaria control may have additional benefits beyond reducing the incidence of symptomatic malaria. We compared antibiotic treatment of children before and after the implementation of highly effective malaria control interventions in Tororo, a historically high transmission area of Uganda. METHODS Two successive cohorts of children, aged 0.5 to 10 years, were followed from September 2011 to October 2019 in a dedicated study clinic. Universal distribution of long-lasting insecticidal nets was conducted in 2013 and 2017. Sustained indoor residual spraying of insecticide (IRS) was initiated in December 2014. Generalized linear mixed-effects models were used to compare the incidence of antimalarial and antibiotic treatments before and after vector control measures were implemented. RESULTS Comparing the period prior to the implementation of IRS to the period after IRS had been sustained for 4-5 years, the adjusted incidence of malaria treatments decreased from 2.68 to 0.05 per person-year (incidence rate ratio [IRR] = 0.02, 95% CI 0.01-0.03, p < 0.001), and the adjusted incidence of antibiotic treatments decreased from 4.14 to 1.26 per person-year (IRR = 0.30, 95% CI 0.27-0.34, p < 0.001). The reduction in antibiotic usage was primarily associated with fewer episodes of symptomatic malaria and fewer episodes of fever with sub-microscopic parasitemia, both of which were frequently treated with antibiotics. CONCLUSIONS In a historically high transmission setting, the implementation of highly effective vector control interventions was followed by a marked reduction in antibiotic treatment of children. This added benefit of malaria control could have important implications for antibiotic prescribing practices, efforts to curtail antimicrobial resistance, and health system costs.
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Affiliation(s)
- Paul J Krezanoski
- University of California, 1001 Potrero Avenue, San Francisco, CA, 94118, USA.
| | - Michelle E Roh
- University of California, 1001 Potrero Avenue, San Francisco, CA, 94118, USA
| | - John Rek
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Joaniter I Nankabirwa
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | - Susan Nayiga
- Infectious Diseases Research Collaboration, Kampala, Uganda
- London School of Hygiene and Tropical Medicine, London, UK
| | - Michelle S Hsiang
- University of California, 1001 Potrero Avenue, San Francisco, CA, 94118, USA
| | | | - Moses Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Grant Dorsey
- University of California, 1001 Potrero Avenue, San Francisco, CA, 94118, USA
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Costello LH, Suh C, Burnett B, Kelsay K, Bunik M, Talmi A. Addressing Adolescent Depression in Primary Care: Building Capacity Through Psychologist and Pediatrician Partnership. J Clin Psychol Med Settings 2021; 28:53-66. [PMID: 31749100 DOI: 10.1007/s10880-019-09680-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Early identification and treatment of depression during adolescence can contribute to healthier outcomes across the lifespan, yet adolescent depression has been underidentified and undertreated. The American Academy of Pediatrics' (AAP) Guidelines for Adolescent Depression in Primary Care (GLAD-PC) were created to enhance the identification and treatment of adolescent depression. Integrated psychologists in a pediatric primary care setting partnered with providers and clinic staff to implement an adolescent depression screening initiative and transform primary care practice around identification and management. From January 2017 through August 2018, 2107 adolescents between the ages of 11 and 18 were screened using the PHQ-9A. Eleven percent (n = 226) of adolescents had an elevated screen with a score of ≥ 10 and 7% (n = 151) screened positive for suicidal ideation. Identification of depressive symptoms led to increased integrated behavioral health services delivered by psychologists, psychiatrists, and psychology trainees. Psychologists integrated in primary care can support primary care practices to develop service delivery systems aligned with AAP's GLAD-PC and address the diverse implementation barriers associated with incorporating clinical practice guidelines in real-world settings. Universal screening for adolescent depression and response protocols were successfully implemented in a pediatric primary care clinic under the leadership of psychologists and pediatrician partners.
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Affiliation(s)
- Lisa H Costello
- Department of Psychiatry, University of Colorado School of Medicine, and Pediatric Mental Health Institute, Children's Hospital Colorado, 13123 East 16th Avenue, B130, Aurora, CO, 80045, USA.
| | - Christina Suh
- Department of Pediatrics, University of Colorado School of Medicine, General Pediatrics, Children's Hospital Colorado, Aurora, USA
| | - Bridget Burnett
- Department of Psychiatry, University of Colorado School of Medicine, and Pediatric Mental Health Institute, Children's Hospital Colorado, 13123 East 16th Avenue, B130, Aurora, CO, 80045, USA.,Department of Pediatrics, University of Colorado School of Medicine, General Pediatrics, Children's Hospital Colorado, Aurora, USA
| | - Kimberly Kelsay
- Department of Psychiatry, University of Colorado School of Medicine, and Pediatric Mental Health Institute, Children's Hospital Colorado, 13123 East 16th Avenue, B130, Aurora, CO, 80045, USA
| | - Maya Bunik
- Department of Pediatrics, University of Colorado School of Medicine, General Pediatrics, Children's Hospital Colorado, Aurora, USA
| | - Ayelet Talmi
- Department of Psychiatry, University of Colorado School of Medicine, and Pediatric Mental Health Institute, Children's Hospital Colorado, 13123 East 16th Avenue, B130, Aurora, CO, 80045, USA.,Department of Pediatrics, University of Colorado School of Medicine, General Pediatrics, Children's Hospital Colorado, Aurora, USA
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Feleke BE, Feleke TE. Micronutrient levels and their effects on the prognosis of visceral leishmaniasis treatment, a prospective cohort study. BMC Infect Dis 2020; 20:867. [PMID: 33213392 PMCID: PMC7678206 DOI: 10.1186/s12879-020-05615-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 11/11/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Micronutrients are minerals and vitamins and they are essential for normal physiological activities. The objectives of the study were to describe the progress and determinants of micronutrient levels and to assess the effects of micronutrients in the treatment outcome of kalazar. METHODS A prospective cohort study design was used. The data were collected using patient interviews, measuring anthropometric indicators, and collecting laboratory samples. The blood samples were collected at five different periods during the leishmaniasis treatments: before starting anti-leishmaniasis treatments, in the first week, in the second week, in the third week, and in the 4th week of anti-leishmaniasis treatments. Descriptive statistics were used to describe the profile of patients and to compare the treatment success rate. The generalized estimating equation was used to identify the determinants of serum micronutrients. RESULTS The mean age of the patients were 32.88 years [SD (standard deviation) ±15.95]. Male constitute 62.3% of the patients and problematic alcohol use was present in 11.5% of the patients. The serum zinc level of visceral leishmaniasis patients was affected by alcohol (B - 2.7 [95% CI: - 4.01 - -1.5]), DDS (B 9.75 [95% CI: 7.71-11.79]), family size (B -1.63 [95% CI: - 2.68 - -0.58]), HIV (B -2.95 [95% CI: - 4.97 - -0.92]), and sex (B - 1.28 [95% CI: - 2.5 - -0.07]). The serum iron level of visceral leishmaniasis patients was affected by alcohol (B 7.6 [95% CI: 5.86-9.35]), family size (B -5.14 [95% CI: - 7.01 - -3.28]), malaria (B -12.69 [95% CI: - 14.53 - -10.87]), Hookworm (- 4.48 [- 6.82 - -2.14]), chronic diseases (B -7.44 [95% CI: - 9.75 - -5.13]), and HIV (B -5.51 [95% CI: - 8.23 - -2.78]). The serum selenium level of visceral leishmaniasis patient was affected by HIV (B -18.1 [95% CI: - 20.63 - -15.58]) and family size (B -11.36 [95% CI: - 13.02 - -9.7]). The iodine level of visceral leishmaniasis patient was affected by HIV (B -38.02 [95% CI: - 41.98 - -34.06]), DDS (B 25 .84 [95% CI: 22.57-29.1]), smoking (B -12.34 [95% CI: - 15.98 - -8.7]), chronic illness (B -5.14 [95% CI: - 7.82 - -2.46]), and regular physical exercise (B 5.82 [95% CI: 0.39-11.26]). The serum vitamin D level of visceral leishmaniasis patient was affected by HIV (B -9.43 [95% CI: - 10.92 - -7.94]), DDS (B 16.24 [95% CI: 14.89-17.58]), malaria (B -0.61 [95% CI: - 3.37 - -3.37]), and family size (B -1.15 [95% CI: - 2.03 - -0.28]). The serum vitamin A level of visceral leishmaniasis patient was affected by residence (B 0.81 [95% CI: 0.08-1.54]), BMI (B 1.52 [95% CI: 0.42-2.6]), DDS (B 1.62 [95% CI: 0.36-2.88]), family size (B -5.03 [95% CI: - 5.83 - -4.22]), HIV (B -2.89 [95% CI: - 4.44 - -1.34]),MUAC (B 0.86 [95% CI: 0.52-1.21]), and age (B 0.09 [95% CI: 0.07-0.12]). CONCLUSION The micronutrient levels of visceral leishmaniasis patients were significantly lower. The anti-leishmaniasis treatment did not increase the serum micronutrient level of the patients.
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Affiliation(s)
- Berhanu Elfu Feleke
- Department of Epidemiology and Biostatistics, University of Bahir Dar, Bahir Dar, Ethiopia.
| | - Teferi Elfu Feleke
- Department of pediatrics and child health, Wolkite University, Butajira, Ethiopia
- General hospital, Wolkite, Ethiopia
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Gonzales GF, Tapia V, Vásquez-Velásquez C. Changes in hemoglobin levels with age and altitude in preschool-aged children in Peru: the assessment of two individual-based national databases. Ann N Y Acad Sci 2020; 1488:67-82. [PMID: 33147649 DOI: 10.1111/nyas.14520] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 10/01/2020] [Accepted: 10/08/2020] [Indexed: 12/30/2022]
Abstract
According to the World Health Organization, the cutoff hemoglobin (Hb) value for defining anemia is 11 g/dL in preschool-aged children, and Hb measurements should be corrected above an altitude of 1000 meters. This study sought to determine the altitude at which the Hb value increases compared with that at sea level, Hb changes with age and region in Peru, the prevalence of anemia according to three different models used to correct Hb for altitude, and the association of the Hb value with stunting. Two individual-based Peruvian national databases were analyzed. Hb increased from an altitude of 375 meters. Hb concentration was lower at younger ages and higher at older ages. The increase in Hb with increasing altitude was lower in southern Peru. Implementing the different models for Hb measurement correction resulted in a higher and lower prevalence of anemia at altitudes >2500 and <2500 m, respectively, using the CDC adjustment. In children aged 6-23 months, the rate of stunting was lower in those with an Hb level of 10-12 g/dL (including mild anemia). In conclusion, the adjustment of Hb values for altitude should be considered before 1000 m and reference ranges should be adjusted to smaller groups of children instead of the same reference range for children aged 6-59 months.
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Affiliation(s)
- Gustavo F Gonzales
- Laboratories of Investigation and Development and Department of Biological and Physiological Sciences, Faculty of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Peru.,High Altitude Research Institute, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Vilma Tapia
- Laboratories of Investigation and Development and Department of Biological and Physiological Sciences, Faculty of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Peru.,High Altitude Research Institute, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Cinthya Vásquez-Velásquez
- Laboratories of Investigation and Development and Department of Biological and Physiological Sciences, Faculty of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Peru.,High Altitude Research Institute, Universidad Peruana Cayetano Heredia, Lima, Peru
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Bendabenda J, Patson N, Hallamaa L, Ashorn U, Dewey KG, Ashorn P, Maleta K. Does anthropometric status at 6 months predict the over-dispersion of malaria infections in children aged 6-18 months? A prospective cohort study. Malar J 2019; 18:143. [PMID: 31010435 PMCID: PMC6477714 DOI: 10.1186/s12936-019-2778-y] [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: 02/28/2019] [Accepted: 04/13/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND In malaria-endemic settings, a small proportion of children suffer repeated malaria infections, contributing to most of the malaria cases, yet underlying factors are not fully understood. This study was aimed to determine whether undernutrition predicts this over-dispersion of malaria infections in children aged 6-18 months in settings of high malaria and undernutrition prevalence. METHODS Prospective cohort study, conducted in Mangochi, Malawi. Six-months-old infants were enrolled and had length-for-age z-scores (LAZ), weight-for-age z-scores (WAZ), and weight-for-length z-scores (WLZ) assessed. Data were collected for 'presumed', clinical, and rapid diagnostic test (RDT)-confirmed malaria until 18 months. Malaria microscopy was done at 6 and 18 months. Negative binomial regression was used for malaria incidence and modified Poisson regression for malaria prevalence. RESULTS Of the 2723 children enrolled, 2561 (94%) had anthropometry and malaria data. The mean (standard deviation [SD]) of LAZ, WAZ, and WLZ at 6 months were - 1.4 (1.1), - 0.7 (1.2), and 0.3 (1.1), respectively. The mean (SD) incidences of 'presumed', clinical, and RDT-confirmed malaria from 6 to 18 months were: 1.1 (1.6), 0.4 (0.8), and 1.3 (2.0) episodes/year, respectively. Prevalence of malaria parasitaemia was 4.8% at 6 months and 9.6% at 18 months. Higher WLZ at 6 months was associated with lower prevalence of malaria parasitaemia at 18 months (prevalence ratio [PR] = 0.80, 95% confidence interval [CI] 0.67 to 0.94, p = 0.007), but not with incidences of 'presumed' malaria (incidence rate ratio [IRR] = 0.97, 95% CI 0.92 to 1.02, p = 0.190), clinical malaria (IRR = 1.03, 95% CI 0.94 to 1.12, p = 0.571), RDT-confirmed malaria (IRR = 1.00, 95% CI 0.94 to 1.06, p = 0.950). LAZ and WAZ at 6 months were not associated with malaria outcomes. Household assets, maternal education, and food insecurity were significantly associated with malaria. There were significant variations in hospital-diagnosed malaria by study site. CONCLUSION In children aged 6-18 months living in malaria-endemic settings, LAZ, WAZ, and WLZ do not predict malaria incidence. However, WLZ may be associated with prevalence of malaria. Socio-economic and micro-geographic factors may explain the variations in malaria, but these require further study. Trial registration NCT00945698. Registered July 24, 2009, https://clinicaltrials.gov/ct2/show/NCT00945698 , NCT01239693. Registered Nov 11, 2010, https://clinicaltrials.gov/ct2/show/NCT01239693.
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Affiliation(s)
- Jaden Bendabenda
- Department of Public Health, School of Public Health, University of Malawi College of Medicine, Mahatma Gandhi Road, Private Bag 360, Blantyre 3, Malawi
- Faculty of Medicine and Life Sciences, Center for Child Health Research, University of Tampere, Tampere, Finland
| | - Noel Patson
- Department of Public Health, School of Public Health, University of Malawi College of Medicine, Mahatma Gandhi Road, Private Bag 360, Blantyre 3, Malawi
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Lotta Hallamaa
- Faculty of Medicine and Life Sciences, Center for Child Health Research, University of Tampere, Tampere, Finland
| | - Ulla Ashorn
- Faculty of Medicine and Life Sciences, Center for Child Health Research, University of Tampere, Tampere, Finland
| | - Kathryn G Dewey
- Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Per Ashorn
- Faculty of Medicine and Life Sciences, Center for Child Health Research, University of Tampere, Tampere, Finland
| | - Kenneth Maleta
- Department of Public Health, School of Public Health, University of Malawi College of Medicine, Mahatma Gandhi Road, Private Bag 360, Blantyre 3, Malawi.
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