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彭 银, 赵 莉, 李 祥, 龙 宇, 徐 新, 张 换, 蒋 莉. [Effect of Family Functioning on Adolescents' Internalizing and Externalizing Problem Behaviors: The Multiple Mediating Roles of Empathy and Emotional Competence]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2024; 55:146-152. [PMID: 38322518 PMCID: PMC10839476 DOI: 10.12182/20240160507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Indexed: 02/08/2024]
Abstract
Objective To examine the mediating role of empathy and emotional competence in the association between family functioning and internalizing and externalizing problem behaviors among adolescents in China. Methods In this study, we used the data from the June-July 2022 survey of Chengdu Positive Child Development (CPCD) cohort. All respondents were 5th-9th graders from six primary or secondary schools in Chengdu. The Achenbach Child Behavior Checklist (CBCL), the Chinese Family Assessment Instrument (C-FAI), the empathy subscale of the Chinese version of the Interpersonal Reactivity Index (C-IRI), and the emotional competence (EC) subscale of the Chinese Positive Youth Development Scale (CPYD) were used to evaluate the respondents' internalizing and externalizing problem behaviors, family functioning, empathy, and emotional competence, respectively. The average score derived from the total score of a scale divided by the number of entries in each dimension was used as the final score of the scale. Independent samples t-tests or one-way analysis of variance (ANOVA) were performed to examine the differences in family functioning, empathy, emotional competence, and internalizing and externalizing problem behaviors across student groups with different demographic characteristics (sex, grade, and region). Pearson correlation analysis was conducted to examine the relationship between family functioning, empathy, emotional competence, and internalizing and externalizing problem behaviors. AMOS 24.0 was used to validate the hypothesized model and structural equation modeling was used to analyze the mediating effects of empathy and emotional competence between family functioning and internalizing and externalizing problem behaviors among adolescents. Results A total of 3026 eligible participants were included, including 1548 (51.16%) male students and 1478 (48.84%) female students. Among the respondents, 798 (26.37%) were 5th graders, 738 (24.39%) were 6th graders, 567 (18.74%) were 7th graders, 614 (20.29%) were 8th graders, and 309 (10.21%) were 9th graders. In addition, 2064 (68.21%) of all respondents were from urban areas and 962 (31.79%) were from rural areas. The results of the difference analysis showed that the differences in adolescents' internalizing and externalizing problem behaviors were statistically significant between students of different grades (P=0.004), and that the differences in family functioning and empathy scores were also statistically significant between students of different grades (all P<0.001), whereas the differences in adolescents' internalizing and externalizing problem behaviors were not statistically significant between sexes and regions (P=0.919, 0.959). The results of correlation analysis showed that family functioning scores (the higher the score, the worse the family functioning) were significantly negatively correlated with empathy and emotional competence (r=-0.482, -0.432, P<0.01), and significantly positively correlated with internalizing and externalizing problem behaviors (r=0.220, P<0.01). Empathy was significantly positively correlated with emotional competence (r=0.402, P<0.01). Empathy and emotional competence were significantly negatively correlated with all the dimensions of internalizing and externalizing problem behaviors (r=-0.115, -0.305, P<0.01). Emotional competence partially mediated the relationship between family functioning and adolescents' internalizing and externalizing problem behaviors, with a mediation effect value being 0.042 (95% [confidence interval] CI: 0.031-0.057). Empathy and emotional competence had chain mediation effect between family functioning and adolescents' internalizing and externalizing problem behaviors, with the value of the mediation effect being 0.010 (95% CI: 0.007-0.014). Conclusion Family functioning influences adolescents' internalizing and externalizing problem behaviors in a direct way and through the chain-mediating roles of empathy and emotional competence.
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Affiliation(s)
- 银辉 彭
- 四川大学华西公共卫生学院/四川大学华西第四医院 卫生政策与管理学系 (成都 610041)Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 莉 赵
- 四川大学华西公共卫生学院/四川大学华西第四医院 卫生政策与管理学系 (成都 610041)Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 祥 李
- 四川大学华西公共卫生学院/四川大学华西第四医院 卫生政策与管理学系 (成都 610041)Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 宇 龙
- 四川大学华西公共卫生学院/四川大学华西第四医院 卫生政策与管理学系 (成都 610041)Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 新茂 徐
- 四川大学华西公共卫生学院/四川大学华西第四医院 卫生政策与管理学系 (成都 610041)Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 换芳 张
- 四川大学华西公共卫生学院/四川大学华西第四医院 卫生政策与管理学系 (成都 610041)Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 莉华 蒋
- 四川大学华西公共卫生学院/四川大学华西第四医院 卫生政策与管理学系 (成都 610041)Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
- 四川大学华西临床医学院/四川大学华西医院 全科医学中心/全科医学教研室 (成都 610041)Center for Family Medicine/Faculty of Family Medicine, West China Hospital and West China School of Medicine, Sichuan University, Chengdu 610041, China
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Alidou S, Dahourou LD, Dah TTE, Sogo A, Kenao TS, Yehadji D, Meda N, Ekouevi DK. Unmet needs for modern contraceptive methods among sexually active adolescents and young women in Togo: a nationwide cross-sectional study. Front Public Health 2023; 11:1169180. [PMID: 37575119 PMCID: PMC10412928 DOI: 10.3389/fpubh.2023.1169180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 04/05/2023] [Indexed: 08/15/2023] Open
Abstract
Background The unmet need for modern contraceptives among sexually active adolescent and young women (AYW) in Africa contributes to high morbidity and mortality. To investigate the prevalence of unmet need for modern contraceptives and its associated factors among AYW in Togo, we performed a secondary analysis of data from the MICS-62017 survey. Method We extracted data from sexually active AYW aged 15-24 years for the analysis and used multi-level logistic regression models to identify factors associated with unmet need for modern contraceptives. Results Among the AYW, the median age was 20 years. The prevalence of unmet need for modern contraceptives was 27.02%. Factors that increased the likelihood of having unmet need for contraceptives included being in the "Poor" or "Middle" quintile of household wealth, aged 20-24 years, and completing primary or secondary education. Living in a household headed by a woman and having a household head aged 19-38, 39-58, or greater than 78 years decreased the likelihood of unmet need for modern contraceptives. Conclusion The study highlights the high-unmet need for modern contraceptives among sexually active AYW in Togo and emphasizes the importance of addressing individual and household/community factors to improve their sexual and reproductive health. Interventions such as increasing AYW awareness, providing social marketing campaigns in schools, and targeting men-headed households could help promote modern contraceptive use and improve the sexual and reproductive health of AYW in Togo.
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Affiliation(s)
- Smaila Alidou
- Département de Santé Publique, Unité de Formation et de Recherche en Sciences de la Santé, Université Joseph KI-ZERBO, Ouagadougou, Burkina Faso
- Ministère de la Santé, Hygiène Publique et de l’Accès Universel aux Soins, Lomé, Togo
| | - Lucien Désiré Dahourou
- Institut de Recherche en Sciences de la Santé (IRSS/CNRST), Ouagadougou, Burkina Faso
- Institut National de la Santé et de la Recherche Médicale (INSERM, UMR1295), Centre d’épidémiologie et de Recherche en Santé des Populations (CERPOP), Université de Toulouse, Toulouse, France
| | - Ter Tiero Elias Dah
- Unité de Formation et de Recherche en Sciences de la Santé, Université de Ouahigouya, Ouahigouya, Burkina Faso
| | - Armel Sogo
- Institut de Recherche en Sciences de la Santé (IRSS/CNRST), Ouagadougou, Burkina Faso
| | - Tchasso Serge Kenao
- Département de Promotion de la Santé, Institut Régionale de Santé Publique, Université d’Abomey-Calavi, Cotonou, Benin
| | - Dègninou Yehadji
- Ministère de la Santé, Hygiène Publique et de l’Accès Universel aux Soins, Lomé, Togo
| | - Nicolas Meda
- Département de Santé Publique, Unité de Formation et de Recherche en Sciences de la Santé, Université Joseph KI-ZERBO, Ouagadougou, Burkina Faso
| | - Didier Koumavi Ekouevi
- Département de Santé Publique, Faculté des Sciences de la Santé (FSS), Université de Lomé, Lomé, Togo
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Anaduaka US. Multilevel analysis of individual- and community-level determinants of birth certification of children under-5 years in Nigeria: evidence from a household survey. BMC Public Health 2022; 22:2340. [DOI: 10.1186/s12889-022-14786-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 11/30/2022] [Indexed: 12/15/2022] Open
Abstract
AbstractPromoting birth certification is central to achieving legal identity for all - target 16.9 of the 2030 Sustainable Development Goals. Nigeria is not on track to achieve this goal with its low coverage of birth certification (BC). This study is aimed at identifying patterns of BC and its associated individual- and community-level factors, using pooled cross-sectional data from three rounds (2008, 2013, and 2018) of the nationally representative Nigerian Demographic and Health Survey. A weighted sample of 66,630 children aged 0–4 years was included, and a two-level multilevel logistic model which accommodates the hierarchical nature of the data was employed. Of the total sample, 17.1% [95% CI: 16.3–17.9] were reported to be certified. Zamfara state (2.3, 95% CI: 0.93–3.73) and the Federal Capital Territory (36.24, 95% CI: 31.16–41.31) reported the lowest and the highest BC rates. Children with an SBA [AOR = 1.283, 95% CI: 1.164–1.413] and with at least one vaccination [AOR = 1.494, 95% CI: 1.328–1.681] had higher odds of BC. The AOR for mothers with at least one prenatal visit was 1.468 [95% CI: 1.271–1.695], and those aged 30–34 years at the time of birth [AOR = 1.479, 95% CI: 1.236–1.772] had the highest odds. Further, the odds of BC increased the most for mothers [AOR = 1.559, 95% CI: 1.329–1.829] and fathers [AOR = 1.394, 95% CI: 1.211–1.605] who were tertiary-educated. In addition, children in middle-income [AOR = 1.430, 95% CI: 1.197–1.707] or rich wealth HHs [AOR = 1.776, 95% CI: 1.455–2.169] or those whose families had bank accounts [AOR = 1.315, 95% CI: 1.187–1.456] had higher odds. Living in non-poor and within close proximity to a registration center (RC) act as protective factors for BC, while living in poor communities [AOR = 0.613, 95% CI: 0.486–0.774] and more than 10kms from an RC reduce the odds of BC [AOR = 0.466, 95% CI: 0.377–0.576]. The study identified several protective and risk factors which policymakers can adopt as strategic areas for universal birth certification. National and sub-national programs should integrate non-formal institutions as well as target child and maternal utilization of healthcare services to promote BC in Nigeria.
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Dwivedi LK, Banerjee K, Sharma R, Mishra R, Ramesh S, Sahu D, Mohanty SK, James K. Quality of anthropometric data in India's National Family Health Survey: Disentangling interviewer and area effect using a cross-classified multilevel model. SSM Popul Health 2022; 19:101253. [PMID: 36268139 PMCID: PMC9576578 DOI: 10.1016/j.ssmph.2022.101253] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 09/01/2022] [Accepted: 10/02/2022] [Indexed: 11/06/2022] Open
Abstract
India has adopted a target-based approach to reduce the scourge of child malnourishment. Because the monitoring and evaluation required by this approach relies primarily on large-scale data, a data quality assessment is essential. As field teams are the primary mode of data collection in large-scale surveys, this study attempts to understand their contribution to variations in child anthropometric measures. This research can help disentangle the confounding effects of regions/districts and field teams on the quality of child anthropometric data. The anthropometric z-scores of 2,25,002 children below five years were obtained from the fourth round of India's National Family and Health Survey (NFHS-4), 2015–16. Unadjusted and adjusted standard deviations (SD) of the anthropometric measures were estimated to assess the variations in measurements. In addition, a cross-classified multilevel model (CCMM) approach was adopted to estimate the contribution of geographical regions/districts and teams to variations in anthropometric measures. The unadjusted SDs of the measures of stunting, wasting, and underweight were 1.7, 1.4, and 1.2, respectively. The SD of stunting was above the World Health Organisation threshold (0.8–1.2), as well as the Demographic and Health Survey mark. After adjusting for team-level characteristics, the SDs of all three measures reduced marginally, indicating that team-level workload had a marginal but significant role in explaining the variations in anthropometric z-scores. The CCMM showed that the maximum contribution to variations in anthropometric z-scores came from community-level (Primary Sampling Unit (PSU)) characteristics. Team-level characteristics had a higher contribution to variations in anthropometric z-scores than district-level attributes. Variations in measurement were higher for child height than weight. The present study decomposes the effects of district- and team-level factors and highlights the nuances of introducing teams as a level of analysis in multilevel modelling. Population size, density, and terrain variations between PSUs should be considered when allocating field teams in large-scale surveys. Unadjusted standard deviation for child malnourishment indicators are above the recommended level of DHS data quality standards. Variation in stunting is directly proportional to workload measured by number of eligible children in the PSUs. Cross-classified multilevel models show significant team-level contribution in explaining variations in anthropometric scores. Team-level contribution to explaining variations in child anthropometric measures is larger than district-level factors. The number of days assigned to gather anthropometric measurements should be dependent on the number of eligible respondents in a PSU, which may be identified at the time of mapping & listing, rather than being a fixed number of days across all the states of India.
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Key Words
- Anthropometric measures
- CCMM, cross-classified multilevel model
- Children
- Cross-classified multilevel model
- Data quality
- HAZ, height-for-age z-score
- NFHS, National Family Health Survey
- NFHS-4
- POSHAN, Prime Minister's Overarching Scheme for Holistic Nutrition
- PSU, Primary Sampling Unit
- SD, standard deviation
- SDGs, Sustainable Development Goals
- Standard deviation
- Team-level variation
- WAZ, weight-for-age z-score
- WHO, World Health Organisation
- WHZ, weight-for-height z-score
- Workload of health investigators
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Affiliation(s)
- Laxmi Kant Dwivedi
- Department of Survey Research & Data Analytics, International Institute for Population Sciences, Mumbai, India,Corresponding author.
| | - Kajori Banerjee
- SVKM's Narsee Monjee Institute of Management Studies (NMIMS), Mumbai, India
| | - Radhika Sharma
- International Institute for Population Sciences, Mumbai, India
| | | | | | - Damodar Sahu
- National Institute of Medical Statistics, Indian Council of Medical Research, New Delhi, India
| | - Sanjay K. Mohanty
- Department of Population & Development, International Institute for Population Sciences, Mumbai, India
| | - K.S. James
- International Institute for Population Sciences, Mumbai, India
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Ahmed SA, Hegazy NN, Kumar AP, Abouzeid E, Wasfy NF, Atta K, Wael D, Hamdy H. A guide to best practice in faculty development for health professions schools: a qualitative analysis. BMC MEDICAL EDUCATION 2022; 22:150. [PMID: 35248032 PMCID: PMC8898439 DOI: 10.1186/s12909-022-03208-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 02/24/2022] [Indexed: 05/16/2023]
Abstract
BACKGROUND This is a practice guide for the evaluation tool specifically created to objectively evaluate longitudinal faculty development programs (FDP) using the "5×2 -D backward planning faculty development model". It was necessary to create this tool as existing evaluation methods are designed to evaluate linear faculty development models with a specific endpoint. This backward planning approach is a cyclical model without an endpoint, consisting of 5 dynamic steps that are flexible and interchangeable, therefore can be a base for an evaluation tool that is objective and takes into account all the domains of the FDP in contrast to the existing, traditional, linear evaluation tools which focus on individual aspects of the program. The developed tool will target evaluation of longitudinal faculty development programs regardless of how they were planned. METHODOLOGY Deductive qualitative grounded theory approach was used. Evaluation questions were generated and tailored based on the 5 × 2-D model followed by 2 Delphi rounds to finalize them. Based on the finalized evaluation questions from the results of the Delphi rounds, two online focus group discussions (FGDs) were conducted to deduce the indicators, data sources and data collection method. RESULTS Based on the suggested additions, the authors added 1 new question to domains B, with a total of 42 modifications, such as wording changes or discarding or merging questions. Some domains received no comments, therefore, were not included in round 2. For each evaluation question, authors generated indicators, data sources and data collection methods during the FGD. CONCLUSION The methodology used to develop this tool takes into account expert opinions. Comprehensiveness of this tool makes it an ideal evaluation tool during self-evaluation or external quality assurance for longitudinal FDP. After its validation and testing, this practice guide can be used worldwide, along with the provided indicators which can be quantified and used to suit the local context.
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Affiliation(s)
| | - Nagwa N. Hegazy
- Faculty of Medicine, Menoufia University (MU), Menoufia, Egypt
| | - Archana Prabu Kumar
- Medical Education Unit, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
- Department of Physiology, Sri Ramachandra Medical College and Research Institute, SRIHER, Chennai, Tamil Nadu India
| | - Enjy Abouzeid
- Medical Education Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Nourhan F. Wasfy
- Medical Education Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Komal Atta
- The University of Faisalabad Pakistan, Faisalabad, Pakistan
| | - Doaa Wael
- Forensic Medicine Ain Shams University, Cairo, Egypt
| | - Hossam Hamdy
- Pediatric Surgery & Medical Education and Chancellor, Gulf Medical University, Ajman, United Arab Emirates
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Boo YY, Rai K, Cupp MA, Lakhanpaul M, Factor-Litvak P, Parikh P, Panda R, Manikam L. What are the determinants of childhood infections in India's peri-urban slums? A case study of eight cities. PLoS One 2021; 16:e0257797. [PMID: 34653203 PMCID: PMC8519422 DOI: 10.1371/journal.pone.0257797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/11/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Respiratory Tract Infections (RTIs) and Gastro-Intestinal (GI) infections are the leading causes of child mortality and morbidity. This study investigates the associations between the individual, household and slum-level determinants of children's health and vulnerability to RTIs and GI infections in peri-urban slums in India; an area of research interest at the Childhood Infections and Pollution Consortium. METHODS The 2015-16 Indian National Family Health Survey was used for data analysis on children aged 0-5 years. NFHS-4 includes data on slums in eight Indian cities, including Delhi, Meerut, Kolkata, Indore, Mumbai, Nagpur, Hyderabad, Chennai. The outcome variables, having fever and cough (FeCo) and diarrhoea in the last two weeks, were used to define the phenotype of infections; for this analysis fever and cough were measures of RTIs and diarrhoea was used to measure GI infections. Exposures considered in this study include variables at the individual, household and slum level and were all informed by existing literature. Multilevel models were used to estimate the association between exposures and outcomes variables; a prior of Cauchy distribution with a scale of 2.5 was selected when building the multilevel logistic models. RESULTS The total sample size of the number of children included in the analysis was n = 1,424. Data was imputed to account for missingness, and the original and imputed sample showing similar distributions. Results showed that diarrhoea and FeCo were both found to be more present in younger children than older children by a few months. In fixed effects, the odds of developing FeCo were higher if the mother perceives the child was born smaller than average (AOR 4.41, 1.13-17.17, P<0.05) at individual level. On the other hand, the odds of the diarrhoea outcome were lower if the child was older (AOR 0.97, 0.96-0.98, P<0.05) at individual level, and household's water source was public tap or standpipe (AOR 0.54, 0.31-0.96, P<0.05) at household level. CONCLUSION The determinants of health, both social and related to health care, at all levels demonstrated linkages to child morbidity in RTIs and GI infections. The empirical evidence highlights the need for contextualised ideas at each level, including one health approach when designing interventions to improve child health.
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Affiliation(s)
- Yebeen Ysabelle Boo
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Aceso Global Health Consultants PTE Ltd., Singapore, Singapore
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Kritika Rai
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Aceso Global Health Consultants PTE Ltd., Singapore, Singapore
| | - Meghan A. Cupp
- Aceso Global Health Consultants PTE Ltd., Singapore, Singapore
- Brown University School of Public Health, Providence, Rhode Island, United States of America
| | - Monica Lakhanpaul
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Whittington Health NHS Trust, London, United Kingdom
| | - Pam Factor-Litvak
- Columbia University Mailman School of Public Health, New York, New York, United States of America
| | - Priti Parikh
- Engineering for International Development Centre, Bartlett School of Construction and Project Management, Faculty of Built Environment, University College London, London, United Kingdom
| | | | - Logan Manikam
- Aceso Global Health Consultants PTE Ltd., Singapore, Singapore
- Department of Epidemiology and Public Health, University College London Institute of Epidemiology and Health Care, London, United Kingdom
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Namirembe G, Shrestha R, Mezzano J, Ausman LM, Davis D, Baral K, Ghosh S, Shively G, Webb P. Effective nutrition governance is correlated with better nutrition outcomes in Nepal. BMC Pediatr 2021; 21:434. [PMID: 34615509 PMCID: PMC8493744 DOI: 10.1186/s12887-021-02898-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 08/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The public health burden of undernutrition remains heavy and widespread, especially in low-income countries like Nepal. While predictors of undernutrition are well documented, few studies have examined the effects of political will and quality of policy or program implementation on child growth. METHODS Data were collected from two nationwide studies in Nepal to determine the relationship between a metric of nutrition 'governance' (the Nutrition Governance Index), derived from interviews with 520 government and non-government officials responsible for policy implementation and anthropometry measured for 6815 children in 5556 households. We employed Generalized Estimating Equation (GEE) and multilevel regression models. RESULTS A higher NGI (more effective nutrition governance) is positively associated with height-for-age as well as weight-for-height in children over 2 years of age compared to younger children (HAZ; β = 0.02, p < 0.004, WHZ; β = 0.01, p < 0.37). Results from the hierarchical model show that a one-point increase in the NGI is significantly associated with a 12% increase in HAZ and a 4% increase in WHZ in older children (> 24 months old). Mothers' education, child's age, BMI and no fever in the past 30 days were also protective of stunting and wasting. Seven percent and 17% of the overall variance in HAZ and WHZ, respectively, are accounted for by variations across the 21 district locations in which sampled households were located. Mean HAZ differs considerably across districts (intercept = 0.116, p < 0.001). CONCLUSIONS These results highlight the importance of effective management of policy-based programming and resource use to bring about nutrition gains on the ground. The NGI explained a non-negligible amount of variation in HAZ and WHZ, which underscores the fundamental role that good governance plays in promoting child nutrition and growth, and the value of seeking to measure it to assist governments in moving policies from paper to practice.
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Affiliation(s)
- Grace Namirembe
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA, 02111, USA.
| | - Robin Shrestha
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA, 02111, USA
| | - Julieta Mezzano
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA, 02111, USA
| | - Lynne M Ausman
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA, 02111, USA
| | - Dale Davis
- Helen Keller International, Patan, Nepal
| | - Kedar Baral
- Department of Community Health Sciences, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Shibani Ghosh
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA, 02111, USA
| | - Gerald Shively
- Department of Agricultural Economics, Purdue University, West Lafayette, IN, USA
| | - Patrick Webb
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA, 02111, USA
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Chehab RF, Nasreddine L, Forman MR. Determinants of nutritional status during the first 1000 days of life in Lebanon: Sex of the child matters. Paediatr Perinat Epidemiol 2021; 35:501-510. [PMID: 33428236 DOI: 10.1111/ppe.12747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/16/2020] [Accepted: 11/29/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The first 1000 days of life support child growth and long-term health, but few studies address this period in Lebanon and the Eastern Mediterranean Region. OBJECTIVE To examine the determinants of nutritional status among Lebanese children ≤2 years old by child's sex. METHODS We analysed data from a nationally representative cross-sectional survey of 466 mother-child dyads. We classified socio-economic, maternal, and child characteristics using a hierarchical conceptual framework into distal, intermediate, and proximal levels, respectively. Sex-stratified weighted multiple linear regression was computed to identify the determinants of length-for-age z-scores (LAZ) and weight-for-length z-scores (WLZ). RESULTS The mean (standard deviation) of LAZ and WLZ was -0.3 (1.6) and 0.5 (1.5) among boys and -0.1 (1.4) and 0.5 (1.0) among girls, respectively. At the distal level, maternal intermediate or high school education was associated with higher boys' LAZ (β 1.0, 95% confidence interval (CI) 0.2, 1.8), and less crowded households were associated with higher girls' LAZ (β 0.8, 95% CI 0.3, 1.4). At the intermediate level, maternal obesity was associated with lower girls' LAZ (β -0.9, 95% CI -1.4, -0.4). At the proximal level, birth length directly (β 0.1, 95% CI 0.0, 0.2) and breast-feeding duration inversely (β -0.1, 95% CI -0.1, -0.0) associated with girls' LAZ. For WLZ, paternal attainment of university degree or technical diploma was associated with lower boys' WLZ (β -0.9, 95% CI -1.8, -0.1). Among the proximal determinants, birthweight was directly associated with boys' WLZ (β 1.2, 95% CI 0.6, 1.8), while being a third or later child was associated with lower girls' WLZ (β -0.5, 95% CI -0.8, -0.2). Child age was directly associated with WLZ among boys and girls (β 0.1, 95% CI 0.0, 0.1). CONCLUSIONS Nutritional status determinants differed by child's sex in Lebanon. These findings may help inform interventions to improve child growth.
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Affiliation(s)
- Rana F Chehab
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
| | - Lara Nasreddine
- Department of Nutrition and Food Science, American University of Beirut, Beirut, Lebanon
| | - Michele R Forman
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
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Wasfy NF, Abouzeid E, Nasser AA, Ahmed SA, Youssry I, Hegazy NN, Shehata MHK, Kamal D, Atwa H. A guide for evaluation of online learning in medical education: a qualitative reflective analysis. BMC MEDICAL EDUCATION 2021; 21:339. [PMID: 34112155 PMCID: PMC8190722 DOI: 10.1186/s12909-021-02752-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/20/2021] [Indexed: 05/12/2023]
Abstract
BACKGROUND With the strike of Covid-19, an unprecedented rapid shift to remote learning happened worldwide with a paradigm shift to online learning from an institutional adjuvant luxury package and learner choice into a forced solo choice. This raises the question of quality assurance. While some groups have already established standards for online courses, teaching and programs yet very little information is included on methodology of their development and very little emphasis is placed on the online learning experience. Nevertheless, no work has been done specifically for medical education institutions. AIM To develop a set of descriptors for best practice in online learning in medical education utilizing existing expertise and needs. METHODS This work utilizes a qualitative multistage approach to identify the descriptors of best practice in online learning starting with a question guided focus group, thematic analysis, Delphi technique and an expert consensus session done simultaneously for triangulation. This was done involving 32 institution in 19 countries. RESULTS This materialized into the development of a set of standards, indicators, and development of a checklist for each standard area. The standard areas identified were organizational capacity, educational effectiveness, and human resources each of which listed a number of standards. Expert consensus sessions identified the need for qualification of data and thus the development of indicators for best practice. CONCLUSION Standards are needed for online learning experience and their development and redesign is situational and needs to be enhanced methodologically in axes that are pertaining to the needs of the education community. Taking such axes into consideration by educators and institutions will lead to planning and implementing successful online learning activities, while taking them into consideration by the evaluators will help them conduct comprehensive audits and provide stakeholders with highly informative evaluation reports.
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Affiliation(s)
- Nourhan F. Wasfy
- Medical Education Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Enjy Abouzeid
- Medical Education Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Asmaa Abdel Nasser
- Medical Education Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
- Ibn Sina National College, Jeddah, Kingdom of Saudi Arabia
| | - Samar A. Ahmed
- Ain shams University Middle East North Africa FAIMER Regional Institute, Ain shams University, Cairo, Egypt
| | - Ilham Youssry
- Pediatrics & Head of the Pediatric Hematology Unit, Cairo University, Cairo, Egypt
| | - Nagwa N. Hegazy
- Family Medicine Department, Faculty of Medicine, Medical Education and human resources development Center, Menoufia University, Shebin Elkom, Egypt
| | - Mohamed Hany K. Shehata
- Faculty of Medicine, Helwan University, Helwan, Egypt
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain
| | - Doaa Kamal
- Medical Education Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Hani Atwa
- Medical Education Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain
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The burden of anthropometric failure and child mortality in India. Sci Rep 2020; 10:20991. [PMID: 33268799 PMCID: PMC7710716 DOI: 10.1038/s41598-020-76884-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 11/04/2020] [Indexed: 12/12/2022] Open
Abstract
The public health burden of nutritional deficiency and child mortality is the major challenge India is facing upfront. In this context, using National Family Health Survey, 2015–16 data, this study estimated rate of composite index of anthropometric failure (CIAF) among Indian children by their population characteristics, across states and examined the multilevel contextual determinants. We further investigated district level burden of infant and child mortality in terms of multiple anthropometric failure prevalence across India. The multilevel analysis confirms a significant state, district and PSU level variation in the prevalence of anthropometric failures. Factors like- place of residence, household’s economic wellbeing, mother’s educational attainment, age, immunization status and drinking water significantly determine the different forms of multiple anthropometric failures. Wealth status of the household and mother’s educational status show a clear gradient in terms of the estimated odds ratios. The district level estimation of infant and child mortality demonstrates that districts with higher burden of multiple anthropometric failures show elevated risk of infant and child mortality. Unlike previous studies, this study does not use the conventional indices, instead considered the CIAF to identify the exact and severe form of undernutrition among Indian children and the associated nexus with infant and child mortality at the district level.
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Ahinkorah BO. Individual and contextual factors associated with mistimed and unwanted pregnancies among adolescent girls and young women in selected high fertility countries in sub-Saharan Africa: A multilevel mixed effects analysis. PLoS One 2020; 15:e0241050. [PMID: 33091050 PMCID: PMC7580885 DOI: 10.1371/journal.pone.0241050] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 10/07/2020] [Indexed: 12/21/2022] Open
Abstract
Introduction Unintended pregnancies are associated with a number of risk factors such as malnutrition, mental illness, unsafe abortion, maternal mortality and horizontal transmission of HIV to children. These risks are predominant among adolescent girls and young women compared to older women. This study examined the individual and contextual factors associated with unintended pregnancy among adolescent girls and young women in selected high fertility countries in sub-Saharan Africa. Materials and methods Data for this study was obtained from recent Demographic and Health Surveys carried out between 2010 and 2018 in 10 countries in sub-Sahara Africa. The sample size for this study was made up of 6,791 adolescent girls and young women (aged 15–24), who were pregnant during the surveys and had complete responses on all the variables considered in the study. Unintended pregnancy was the outcome variable in this study. Descriptive and multilevel logistic regression analyses were performed and the fixed effect results of the multilevel logistic regression analysis were reported as adjusted odds ratios at 95% confidence interval. Results Unintended pregnancy in the selected countries was 22.4%, with Angola, recording the highest prevalence of 46.6% while Gambia had the lowest prevalence of 10.2%. The likelihood of unintended pregnancy was high among adolescent girls and young women aged 15–19 [aOR = 1.48; 95% CI = 1.26–1.73], those with primary [aOR = 1.99; 95% CI = 1.69–2.33] and secondary/higher [aOR = 2.30; 95% CI = 1.90–2.78] levels of education, single (never married/separated/divorced/widowed) adolescent girls and young women [aOR = 9.23; 95% CI = 7.55–11.28] and those who were cohabiting [aOR = 2.53; 95% CI = 2.16–2.96]. The odds of unintended pregnancy also increased with increasing birth order, with adolescent girls and young women having three or more births more likely to have unintended pregnancies compared to those with one birth [aOR = 1.99; 95% CI = 1.59–2.48]. Adolescent girls and young women who had ever used contraceptives (modern or traditional), had higher odds of unintended pregnancies compared to those who had never used contraceptives [aOR = 1.32; 95% CI = 1.12–1.54]. Finally, adolescent girls and young women who belonged to the rich wealth quintile were more likely to have unintended pregnancy compared to those in the poor wealth quintile [1.28; 95% CI = 1.08–1.51]. Conclusion The study found that age, marital status, level of education, parity, use of contraceptives and wealth quintile are associated with unintended pregnancy among adolescent girls and young women in high fertility sub-Saharan African countries. These findings call for the need for government and non-governmental organisations in high fertility sub-Saharan African countries to restructure sexual and reproductive health services, taking into consideration these individual and contextual level characteristics of adolescent girls and young women.
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Affiliation(s)
- Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Liverpool, Australia
- * E-mail:
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Vaivada T, Akseer N, Akseer S, Somaskandan A, Stefopulos M, Bhutta ZA. Stunting in childhood: an overview of global burden, trends, determinants, and drivers of decline. Am J Clin Nutr 2020; 112:777S-791S. [PMID: 32860401 PMCID: PMC7487433 DOI: 10.1093/ajcn/nqaa159] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/29/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Progress has been made worldwide in reducing chronic undernutrition and rates of linear growth stunting in children under 5 y of age, although rates still remain high in many regions. Policies, programs, and interventions supporting maternal and child health and nutrition have the potential to improve child growth and development. OBJECTIVE This article synthesizes the available global evidence on the drivers of national declines in stunting prevalence and compares the relative effect of major drivers of stunting decline between countries. METHODS We conducted a systematic review of published peer-reviewed and gray literature analyzing the relation between changes in key determinants of child linear growth and contemporaneous changes in linear growth outcomes over time. RESULTS Among the basic determinants of stunting assessed within regression-decomposition analyses, improvement in asset index score was a consistent and strong driver of improved linear growth outcomes. Increased parental education was also a strong predictor of improved child growth. Of the underlying determinants of stunting, reduced rates of open defecation, improved sanitation infrastructure, and improved access to key maternal health services, including optimal antenatal care and delivery in a health facility or with a skilled birth attendant, all accounted for substantially improved child growth, although the magnitude of variation explained by each differed substantially between countries. At the immediate level, changes in several maternal characteristics predicted modest stunting reductions, including parity, interpregnancy interval, and maternal height. CONCLUSIONS Unique sets of stunting determinants predicted stunting reduction within countries that have reduced stunting. Several common drivers emerge at the basic, underlying, and immediate levels, including improvements in maternal and paternal education, household socioeconomic status, sanitation conditions, maternal health services access, and family planning. Further data collection and in-depth mixed-methods research are required to strengthen recommendations for those countries where the stunting burden remains unacceptably high.
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Affiliation(s)
- Tyler Vaivada
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Nadia Akseer
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Selai Akseer
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Ahalya Somaskandan
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | | | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan
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Ahinkorah BO. Predictors of unmet need for contraception among adolescent girls and young women in selected high fertility countries in sub-Saharan Africa: A multilevel mixed effects analysis. PLoS One 2020; 15:e0236352. [PMID: 32760153 PMCID: PMC7410238 DOI: 10.1371/journal.pone.0236352] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/03/2020] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Despite the desire of adolescent girls and young women (AGYW) in sub-Saharan Africa (SSA) to use contraceptives, the majority of them have challenges with access to contraceptive services. This is more evident in high fertility countries in SSA. The purpose of this study was to examine the predictors of unmet need for contraception among AGYW in selected high fertility countries in SSA. MATERIALS AND METHODS Data from current Demographic and Health Surveys (DHS) carried out between 2010 and 2018 in 10 countries in SSA were analysed. A sample size of 24,898 AGYW who were either married or cohabiting was used. Unmet need for contraception was the outcome variable in this study. The explanatory variables were age, marital status, occupation, educational level, frequency of reading newspaper/magazine, frequency of listening to radio, frequency of watching television and parity (individual level variables) and wealth quintile, sex of household head, place of residence and decision-maker in healthcare (household/community level variables). Descriptive and multilevel logistic regression analyses were carried out. The results of the multilevel logistic regression analyses were reported using adjusted odds ratios at 95% confidence interval. RESULTS The prevalence of unmet need for contraception in all the countries considered in this study was 24.9%, with Angola, recording the highest prevalence of 42.6% while Niger had the lowest prevalence of 17.8%. In terms of the individual level predictors, the likelihood of unmet need for contraception was low among AGYW aged 20-24 [aOR = 0.82; 95% CI = 0.76-0.88], those with primary [aOR = 1.22; 95% CI = 1.13-1.31] and secondary/higher levels of formal education [aOR = 1.18; 95% CI = 1.08-1.28, p < 0.001], cohabiting AGYW [aOR = 1.52; 95% CI = 1.42-1.63] and AGYW with three or more births [aOR = 3.41; 95% CI = 3.02-3.85]. At the household/community level, the odds of unmet need for contraception was highest among poorer AGYW [aOR = 1.36; 95% CI = 1.21-1.53], AGYW in female-headed households [aOR = 1.22; 95% CI = 1.13-1.33], urban AGYW [aOR = 1.21; 95% CI = 1.11-1.32] and AGYW who took healthcare decisions alone [aOR = 1.10; 95% CI = 1.01-1.21]. CONCLUSION This study has identified disparities in unmet need for contraception among AGYW in high fertility countries in SSA, with AGYW in Angola having the highest prevalence. Both individual and household/community level factors predicted unmet need for contraception among AGYW in this study. However, based on the ICC values, household/community level factors prevailed the individual level factors. Enhancing access to contraception among poorer AGYW, those in female-headed households, those in urban areas and those who take healthcare decisions alone by both governmental and non-governmental organisations in high fertility countries is recommended.
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Affiliation(s)
- Bright Opoku Ahinkorah
- The Australian Centre for Population and Public Health Research [ACPPHR], Faculty of Health, University of Technology Sydney, Liverpool, Australia
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Asif AM, Akbar M, Tahir MR, Arshad IA. Role of Maternal Education and Vaccination Coverage: Evidence From Pakistan Demographic and Health Survey. Asia Pac J Public Health 2020; 31:679-688. [PMID: 31852229 DOI: 10.1177/1010539519889765] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this study was to examine the impact of maternal education on child immunization uptake in Pakistan, both at individual and community levels. Pakistan Demographic and Health Survey data were used for analysis. Multilevel logistic regression was used to access the individual- and community-level factors associated with childhood immunization coverage. Out of 6765 children 2659 (39.3%) were fully immunized. Parents education, access to media, and wealth status have positive while ethnicity and working status of mother have a negative impact on the immunization uptake. In the community with a high percentage of educated mothers, the odds of immunized children were high (odds ratio = 1.43, 95% confidence interval = 1.14-1.80) as compared with communities with lower percentage of educated mothers. Moreover, significant variation was found in the likelihood of full immunization across communities. Both community- and individual-level factors have substantial impact on children immunization status. There is a need of improvement in maternal education, poverty alleviation, and removal of rural-urban disparities.
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Kumar A, Thapa G, Mishra AK, Joshi PK. Assessing food and nutrition security in Nepal: evidence from diet diversity and food expenditure patterns. Food Secur 2020. [DOI: 10.1007/s12571-019-01004-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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