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Siddiqui M, Bajwa N, Junaid K, Awais M, Amin A, Haleem I, Rasool SH, Afzal S. The Impact of Vaccination Status on Anthropometric Indices of Growth Among Children: A Cross-Sectional Study. Cureus 2024; 16:e64123. [PMID: 39119393 PMCID: PMC11306984 DOI: 10.7759/cureus.64123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2024] [Indexed: 08/10/2024] Open
Abstract
Background Childhood immunization programs in underdeveloped nations can improve children's growth and nutritional status and prevent growth delays while protecting against infectious diseases and meeting growth norms. This study aimed to assess the impact of vaccination status on the anthropometric indices of children aged 12-18 months at an Expanded Programme on Immunization vaccination center and compare the anthropometric indices of growth in children with complete and incomplete vaccination statuses. Methodology This study was conducted at the rural health center in Kala Shah Kaku, Pakistan, from November 2023 to December 2023. Children aged 12-18 months were enrolled and their vaccination status was recorded. Height and weight were measured using World Health Organization growth charts. The data were analyzed using descriptive statistics and chi-square and Fisher's exact tests. A p-value <0.05 was considered statistically significant. Results The mean age of the 110 children who visited the vaccination site for this study was 16.36 months ± 2.415. There were 28 (25.5%) stunted children. In the study, 17.6 (16%) participants were underweight, and 15.95 (14.5%) were wasted. Of the children, 79% had received all recommended vaccinations. A statistically significant (p < 0.05) association was found between vaccination and nutritional status. Conclusions This study emphasizes the significance of vaccination in promoting child health and nutrition, reducing stunting risk, and ensuring equitable access to vaccination services and comprehensive healthcare interventions. This can help mitigate the malnutrition burden and promote optimal growth, contributing to global health and development goals.
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Affiliation(s)
- Meha Siddiqui
- Community Medicine, King Edward Medical University, Lahore, PAK
| | - Naila Bajwa
- Community Medicine, King Edward Medical University, Lahore, PAK
| | - Khunsa Junaid
- Community Medicine, Services Institute of Medical Sciences, Lahore, PAK
| | - Muhammad Awais
- Community Medicine, King Edward Medical University, Lahore, PAK
| | - Ayesha Amin
- Community Medicine, Institute of Public Health, Lahore, PAK
| | - Isma Haleem
- Community Medicine, King Edward Medical University, Lahore, PAK
| | - Sikander H Rasool
- Community Medicine, Shaikh Khalifa Bin Zayed Al-Nahyan Medical and Dental College, Lahore, PAK
| | - Saira Afzal
- Public Health and Preventive Medicine, King Edward Medical University, Lahore, PAK
- Community Medicine, King Edward Medical University, Lahore, PAK
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Joshi S, Karki A, Rushton S, Koirala B, Basnet S, Rijal B, Karki J, Pohl G, Baidya M, Chater T, Green D, Lee A. Gender and caste inequalities in primary healthcare usage by under-5 children in rural Nepal: an iterative qualitative study into provider perspectives and the potential role of implicit bias. BMJ Open 2023; 13:e069060. [PMID: 37369413 PMCID: PMC10410982 DOI: 10.1136/bmjopen-2022-069060] [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: 10/10/2022] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVE This study explored provider perspectives on: (1) why inequalities in health service usage persist; and (2) their knowledge and understanding of the role of patient experience and implicit bias (also referred to as unconscious bias). DESIGN A three stage, iterative qualitative study was conducted involving two rounds of in-depth interviews and a training session with healthcare staff. Interview transcripts were analysed using a reflexive thematic approach in relation to the study's aims. SETTING Participants were recruited from rural hill districts (Mugu, Humla, Bajura, Gorkha and Sindhupalchok) of Nepal. PARTICIPANTS Clinical staff from 22 rural health posts. RESULTS Healthcare providers had high levels of understanding of the cultural, educational and socioeconomic factors behind inequalities in healthcare usage in their communities. However, there was less knowledge and understanding of the role of patient experience-and no recognition at all of the concept of implicit bias. CONCLUSION It is highly likely that implicit bias affects provider behaviours in Nepal, just as it does in other countries. However, there is currently not a culture of thinking about the patient experience and how that might impact on future usage of health services. Implicit bias training for health students and workers would help create greater awareness of unintended discriminatory behaviours. This in turn may play a part in improving patient experience and future healthcare usage, particularly among disadvantaged groups.
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Affiliation(s)
| | | | - Simon Rushton
- Department of Politics and International Relations, The University of Sheffield, Sheffield, UK
| | | | | | | | - Jiban Karki
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | | | - Tim Chater
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Dan Green
- College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Andrew Lee
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
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Dwomoh D, Sewor C, Annim SK, Stranges S, Kandala NB, Amegah AK. Do dietary practices and household environmental quality mediate socio-economic inequalities in child undernutrition risk in West Africa? Public Health Nutr 2023; 26:1022-1033. [PMID: 36259140 PMCID: PMC10346084 DOI: 10.1017/s1368980022002269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 09/13/2022] [Accepted: 10/04/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We investigated the relationship between socio-economic status and child undernutrition in West Africa (WA), and further examined the mediating role of dietary practices (measured as minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet (MAD)) and household environmental quality (HEQ) in the observed relationship. DESIGN Thirteen countries were included in the study. We leveraged the most recent Demographic and Health Surveys datasets ranging from 2010 to 2019. Poisson regression model with robust standard errors was used to estimate prevalence ratios and their corresponding 95 % CI. Structural equation modelling was used to conduct the mediation analysis. SETTING West Africa. PARTICIPANTS 132 448 under-five children born within 5 years preceding the survey were included. RESULTS Overall, 32·5 %, 8·2 %, 20·1 % and 71·7 % of WA children were stunted, wasted, underweight and anaemic, respectively. Prevalence of undernutrition decreased with increasing maternal education and household wealth (Trend P-values < 0·001). Secondary or higher maternal education and residence in rich households were associated with statistically significant decrease in the prevalence of stunting, wasting, underweight and anaemia among children in WA. MAD was found to mediate the association of low maternal education and poor household wealth with childhood stunting and underweight by 35·9 % to 44·5 %. MDD, MMF and HEQ did not mediate the observed relationship. CONCLUSIONS The study findings enables an evaluation and improvement of existing intervention strategies through a socio-economic lens to help address the high burden of child undernutrition in WA and other developing regions.
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Affiliation(s)
- Duah Dwomoh
- Public Health Research Group, Department of Biomedical Sciences, University of Cape Coast, Cape Coast, Ghana
- Department of Biostatistics, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Christian Sewor
- Public Health Research Group, Department of Biomedical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Samuel K Annim
- Department of Applied Economics, School of Economics, University of Cape Coast, Cape Coast, Ghana
- Ghana Statistical Service, Accra, Ghana
| | - Saverio Stranges
- Department of Epidemiology and Biostatistics and Africa Institute, Western University, London, ON, Canada
- Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Ngianga-Bakwin Kandala
- Department of Epidemiology and Biostatistics and Africa Institute, Western University, London, ON, Canada
- University of Warwick, Division of Health Sciences, Warwick Medical School, Coventry, UK
- University of the Witwatersrand, Division of Epidemiology and Biostatistics, School of Public Health, Johannesburg, South Africa
| | - A Kofi Amegah
- Public Health Research Group, Department of Biomedical Sciences, University of Cape Coast, Cape Coast, Ghana
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Hinnant B, Buckhalt JA, Brigham EF, Gillis BT, El-Sheikh M. Socioeconomic Disparities, Nighttime Bedroom Temperature, and Children's Sleep. JOURNAL OF APPLIED DEVELOPMENTAL PSYCHOLOGY 2023; 86:101530. [PMID: 37035841 PMCID: PMC10081498 DOI: 10.1016/j.appdev.2023.101530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
We investigated associations between family income-to-needs, nighttime bedroom temperature (NBT), and children's sleep. Using a sample of 46 children (M age = 11.5), we recorded NBT and objective sleep parameters via actigraphy nightly for one week to evaluate within- (night-to-night) and between-person associations. We found consistent evidence for a curvilinear association between NBT and sleep variables at the between-person level, indicating that children who slept in rooms that were "too hot" or "too cold" experienced poorer sleep. Moreover, children in lower income-to-needs families had more extreme NBTs. There was some evidence that family income-to-needs is indirectly related to sleep via NBT, but with interpretational caveats. These findings point to NBT as a potentially modifiable variable, which has implications for practical applications to mitigate effects of socioeconomic disparities on children's sleep.
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Affiliation(s)
- Ben Hinnant
- Department of Human Development and Family Science, 261 Mell Street, Auburn University, Auburn, AL 36849
| | - Joseph A. Buckhalt
- Department of Human Development and Family Science, 261 Mell Street, Auburn University, Auburn, AL 36849
| | - Emily F. Brigham
- Department of Human Development and Family Science, 261 Mell Street, Auburn University, Auburn, AL 36849
| | - Brian T. Gillis
- Department of Human Development and Family Science, 261 Mell Street, Auburn University, Auburn, AL 36849
| | - Mona El-Sheikh
- Department of Human Development and Family Science, 261 Mell Street, Auburn University, Auburn, AL 36849
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Mitchell R, Gordon J, Bhoi GK, Nisbett N. Applying the 'Candidacy' Model to understand access to key nutrition, food & health services in LMIC contexts: a qualitative study in Odisha, India. Food Secur 2023; 15:649-660. [PMID: 37223753 PMCID: PMC10072021 DOI: 10.1007/s12571-023-01357-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 01/17/2023] [Indexed: 04/07/2023]
Abstract
In order to make progress towards Sustainable Development Goal 2 - Zero Hunger - we must acquire a better understanding of what continues to hamper achieving food security, particularly in contexts where progress has been achieved, but has then faltered. This article investigates access to nutrition and food services in three of the Indian state of Odisha's traditionally poorer districts, where a large number of the state's most marginalised populations live. Semi-structured interviews were carried out in 11 villages. The Dixon-Woods Candidacy Model was employed to provide greater insight into the experiences of access to health and nutrition services, from both the supply and the demand sides. We found that there are many points along the journey that hamper access. We identified two levels of gatekeepers that can create (or remove) barriers, the first as front-line service providers and the second as high-level officials. The candidacy model shows that marginalisation caused by identity, poverty and education disparities hampers progress throughout this journey. This article aims to provide a view to improve our understanding of access to health, food and nutrition services, to improve food security, and to show the value of the candidacy model applied to an LMIC health setting.
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Silveira VNDC, do Nascimento JBM, Cantanhede NAC, Frota MTBA, Chagas DCD, de Carvalho CA, Viola PCDAF. Racial and regional inequality in the temporal trend of stunting and excess weight in Brazilian children under five years of age. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2023; 26:e230004. [PMID: 36629616 PMCID: PMC9838232 DOI: 10.1590/1980-549720230004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/10/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To analyze the occurrence of racial and regional inequality in the temporal trend of the prevalence of stunting and overweight in Brazilian children under five years of age over the years 2008-2018. METHODS An ecological time-series study with data from the Food and Nutrition Surveillance System on the prevalence of stunting and overweight in children under five years old according to race/skin color, region, and year. To assess differences between median prevalence per year of outcomes, the Kruskal-Wallis test was performed. Linear regression analyses were proposed to assess trends in the prevalence of outcomes over the years. RESULTS In Brazil, black children tended to be overweight (β=4.611; p=0.042). Among black children, there was an increase over the years in stunting in the Southeast (β=3.960; p=0.014) and a decrease in the South (β=-4.654; p=0.022). In Brazil and in most regions, the median prevalence of stunting was higher in black children than in white ones (12.86 vs. 11.54%, p<0.001). In the Southeast and South, black children also had the highest prevalence of overweight (15.48 and 15.99%, respectively). CONCLUSION Children from less developed regions of Brazil and of black skin color/race were more vulnerable to a double burden of malnutrition.
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Silveira VNDC, Nascimento JBMD, Cantanhede NAC, Frota MTBA, Chagas DCD, Carvalho CAD, Viola PCDAF. Racial and regional inequality in the temporal trend of stunting and excess weight in Brazilian children under five years of age. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2023. [DOI: 10.1590/1980-549720230004.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
ABSTRACT Objective: To analyze the occurrence of racial and regional inequality in the temporal trend of the prevalence of stunting and overweight in Brazilian children under five years of age over the years 2008–2018. Methods: An ecological time-series study with data from the Food and Nutrition Surveillance System on the prevalence of stunting and overweight in children under five years old according to race/skin color, region, and year. To assess differences between median prevalence per year of outcomes, the Kruskal-Wallis test was performed. Linear regression analyses were proposed to assess trends in the prevalence of outcomes over the years. Results: In Brazil, black children tended to be overweight (β=4.611; p=0.042). Among black children, there was an increase over the years in stunting in the Southeast (β=3.960; p=0.014) and a decrease in the South (β=-4.654; p=0.022). In Brazil and in most regions, the median prevalence of stunting was higher in black children than in white ones (12.86 vs. 11.54%, p<0.001). In the Southeast and South, black children also had the highest prevalence of overweight (15.48 and 15.99%, respectively). Conclusion: Children from less developed regions of Brazil and of black skin color/race were more vulnerable to a double burden of malnutrition.
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Socio-economic inequalities in the effect of public policies and the COVID-19 pandemic on exclusive breastfeeding in Chile. Public Health 2023; 214:61-68. [PMID: 36521273 PMCID: PMC9640405 DOI: 10.1016/j.puhe.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 10/27/2022] [Accepted: 11/01/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess the impact of the addition of 12 maternity leave (ML) weeks (2011), a pay for performance (P4P) exclusive breastfeeding (EBF) promotion strategy (2015), and the COVID-19 pandemic in EBF inequalities in Chile. STUDY DESIGN Interrupted time-series analyses (ITSAs). METHODS Aggregated national EBF data by municipality and month were collected from 2009 to 2020. We assess the impact of the three events in EBF inequalities using two procedures: 1. ITSA stratified by municipal SES quintiles (Q1-Q5); 2. Calculating the EBF slope index of inequality (SII). RESULTS The EBF prevalence was higher in lower SES municipalities before and after the three time-events. No impact in EBF inequalities was observed after the extended ML. The P4P strategy increased EBF at six months in all SES quintiles (effect size between 4% and 5%), but in a higher level in poorer municipalities (SII: -0.36% and -1.05%). During COVID-19, wealthier municipalities showed a slightly higher EBF at six months prevalence (SII: 1.44%). CONCLUSION The null impact of the extended ML in EBF inequalities could be explained by a low access to ML among affiliated to the public health system (20%). The P4P strategy includes multiple interventions that seemed effective in increasing EBF across all SES quintiles, but further in lower quintiles. The restrictions in healthcare access in poorer municipalities could explain EBF inequalities during COVID-19.
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Wagner AL, Mathew JL, Carlson BF, Kachoria AG, Bharti B, Suri V, Boulton ML. Measles Vaccination Immunogenicity and Association with Caste in Chandigarh, India. Am J Trop Med Hyg 2022; 107:1129-1131. [PMID: 36191873 PMCID: PMC9709014 DOI: 10.4269/ajtmh.22-0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 07/29/2022] [Indexed: 11/07/2022] Open
Abstract
Measles affects those of lower socioeconomic status disproportionately. This study evaluated the impact of measles vaccination on antibody titers 3 months after vaccination across different socioeconomic groups, with a focus on caste. In total, 169 infants in Chandigarh, India, had serum samples collected immediately prior to vaccination at 9 months of age and 3 months later. Overall, 126 infants (76%) were seropositive (antibody titers > 12 mIU/mL), 26 (16%) were borderline (8-12 mIU/mL), and 14 (8%) were seronegative (< 8 mIU/mL). Seropositivity (versus borderline/seronegative infants) was 0.78 times as high among individuals from the historically marginalized scheduled castes/scheduled tribes compared with the others caste grouping (95% CI, 0.62-0.98). Antibody response was not tied to anthropometric measures but was attenuated among scheduled castes/scheduled tribes with higher incomes. This study provides observational evidence that social structures can be associated with individual immune responses.
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Affiliation(s)
- Abram L. Wagner
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | | | - Bradley F. Carlson
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Aparna G. Kachoria
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | | | - Vanita Suri
- Department of Obstetrics & Gynecology, PGIMER Chandigarh, India
| | - Matthew L. Boulton
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
- Department of Internal Medicine, Division of Infectious Disease, University of Michigan Medical School, Ann Arbor, Michigan
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Vulnerability in maternal, new-born, and child health in low- and middle-income countries: Findings from a scoping review. PLoS One 2022; 17:e0276747. [DOI: 10.1371/journal.pone.0276747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 10/12/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives
To identify and synthesise prevailing definitions and indices of vulnerability in maternal, new-born and child health (MNCH) research and health programs in low- and middle-income countries.
Design and setting
Scoping review using Arksey and O’Malley’s framework and a Delphi survey for consensus building.
Participants
Mothers, new-borns, and children living in low- and middle-income countries were selected as participants.
Outcomes
Vulnerability as defined by the authors was deduced from the studies.
Results
A total of 61 studies were included in this scoping review. Of this, 22 were publications on vulnerability in the context of maternal health and 40 were on new-born and child health. Definitions used in included studies can be broadly categorised into three domains: biological, socioeconomic, and environmental. Eleven studies defined vulnerability in the context of maternal health, five reported on the scales used to measure vulnerability in maternal health and only one study used a validated scale. Of the 40 included studies on vulnerability in child health, 19 defined vulnerability in the context of new-born and/or child health, 15 reported on the scales used to measure vulnerability in child health and nine reported on childhood vulnerability indices. As it was difficult to synthesise the definitions, their keywords were extracted to generate new candidate definitions for vulnerability in MNCH.
Conclusion
Included studies paid greater attention to new-born/ child vulnerability than maternal vulnerability, with authors defining the terms differently. A definition which helps in improving the description of vulnerability in MNCH across various programs and researchers was arrived at. This will further help in streamlining research and interventions which can influence the design of high impact MNCH programs.
Scoping review registration
The protocol for this review was registered in the open science framework at the registered address (https://osf.io/jt6nr).
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Mussa FM, Massawe HP, Bhalloo H, Moledina S, Assenga E. Magnitude and associated factors of anti-retroviral therapy adherence among children attending HIV care and treatment clinics in Dar es Salaam, Tanzania. PLoS One 2022; 17:e0275420. [PMID: 36178915 PMCID: PMC9524636 DOI: 10.1371/journal.pone.0275420] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 09/17/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction The HIV pandemic continues to contribute significantly towards childhood mortality and morbidity. The up-scaling of the Anti-retroviral therapy (ART) access has seen more children surviving and sanctions great effort be made on ensuring adherence. Adherence is a dynamic process that changes over time and is determined by variable factors. This necessitates the urgency to conduct studies to determine the potential factors affecting adherence in our setting and therefore achieve the 90-90-90 goal of sustainable viral suppression. Objectives To assess the magnitude and associated factors of ART adherence among children (1–14 years) attending HIV care and treatment clinics during the months of July to November 2018 in Dar es Salaam. Methods A cross-sectional clinic-based study, conducted in three selected HIV care and treatment clinics in urban Dar es Salaam; Muhimbili National Hospital (MNH), Temeke Regional Referral Hospital (TRRH), Infectious Disease Centre- DarDar Paediatric Program (IDC-DPP) HIV clinics during the months of July to November 2018. HIV-infected children aged 1–14 years who had been on treatment for at least six months were consecutively enrolled until the sample size was achieved. A structured questionnaire was used for data collection. Four-day self-report, one-month self-recall report and missed clinic appointments were used to assess adherence. Frequencies and percentages were used to describe categorical data. The odds ratio was used to analyse the possible factors affecting ART adherence Logistic regression models were used to determine the factors associated with ART adherence. Analysis was conducted using SPSS version 20.0 and p-value <0.05 were considered statistically significant. Results 333 participants were recruited. The overall good adherence (≥95%) was approximated to be 60% (CI-54.3–65.1) when subjected to all three measures. On multivariable logistic regression, factors associated with higher odds of poor adherence were found to be caregivers aged 17–25 years [AOR = 3.5, 95%CI-(1.5–8.4)], children having an inter-current illness [AOR = 10.8, 95%CI-(2.3–50.4)], disbelief in ART effectiveness [AOR = 5.495; 95%CI-(1.669–18.182)] and advanced clinical stage [AOR = 1.972; 95% CI-(1.119–3.484)]. The major reasons reported by caregivers for missing medications included forgetfulness (41%), high pill burden (21%), busy schedule (11%) and long waiting hours at the clinic (9%). Conclusion and recommendations In the urban setting of Dar es Salaam, ART adherence among children was found to be relatively low when combined adherence measures were used. Factors associated with poor ART adherence found were younger aged caregivers, and child intercurrent illness, while factors conferring good adherence were belief in ART effectiveness and lower HIV clinical stage. More attention and support should be given to younger aged caregivers, children with concomitant illness and advanced HIV clinical stages. Educating caregivers on ART effectiveness may also aid in improving adherence.
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Affiliation(s)
- Fatima M. Mussa
- Department of Paediatrics and Child Health, Muhimbili University of Health Sciences, Dar es Salaam, Tanzania
- * E-mail:
| | - Higgins P. Massawe
- Department of Paediatrics and Child Health, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | | | - Sibtain Moledina
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Evelyne Assenga
- Department of Paediatrics and Child Health, Muhimbili University of Health Sciences, Dar es Salaam, Tanzania
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Shirisha P, Muraleedharan VR, Vaidyanathan G. Wealth related inequality in women and children malnutrition in the state of Chhattisgarh and Tamil Nadu. BMC Nutr 2022; 8:86. [PMID: 35996127 PMCID: PMC9394049 DOI: 10.1186/s40795-022-00580-1] [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: 05/03/2022] [Accepted: 08/11/2022] [Indexed: 11/21/2022] Open
Abstract
Background Child and maternal malnutrition are the most serious health risks in India, accounting for 15% of the country’s total disease burden. Malnutrition in children can manifest as ‘stunting’ (low height in relation to age) or ‘wasting’ (low weight in relation to height) or both and underweight or obesity among women. Other nutritional indicators show that India lags behind, with high levels of anaemia in women of reproductive age. The study aims to analyse the wealth related inequalities in the nutrition status among women and children of different wealth quintiles in a high focus state (Chhattisgarh; CG) and a non-high focus state (Tamil Nadu; TN) in India. Methods We used National Family Health Survey-3rd (2005–06) & 4th (2015–16) to study the trends and differentials of inequalities in the nutrition status. We have used two summary indices. - absolute inequalities using the slope index of inequality (SII), and relative inequalities using the concentration index (CIX). Results There is reduction in wealth related inequality in nutrition status of women and children from all wealth quintiles between 2005–06 and 2015–16. However the reduction in inequality in some cases such as that of severe stunting among children was accompanied by increase among children from better off households The values of SII and CIX imply that malnutrition except obesity is still concentrated among the poor. The prevalence of anaemia (mild, moderate and severe) has reduced among women and children in the past decade. The converging pattern observed with respect to prevalence of mild and moderate anaemia is not only due to reduction in prevalence of anaemia among women from poor households but an increase in prevalence in rich households. Conclusion Malnutrition remains a major challenge in India, despite encouraging progress in maternal and nutrition outcomes over the last decade. Our study findings indicate the importance of looking at the change in inequalities of nutrition status of women and children of different wealth quintiles sub nationally. Given the country’s rapidly changing malnutrition profile, with progress across several indicators of under nutrition but rapidly rising rates of overweight/obesity, particularly among adults, appropriate strategies needs to be devised to tackle the double burden of malnutrition.
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Affiliation(s)
- P Shirisha
- Humanities and Social Sciences Block, Indian Institute of Technology, Madras, India.
| | - V R Muraleedharan
- Humanities and Social Sciences Block, Indian Institute of Technology, Madras, India
| | - Girija Vaidyanathan
- Humanities and Social Sciences Block, Indian Institute of Technology, Madras, India
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Trends in undernutrition mortality among children under five years of age and adults over 60. BIOMÉDICA 2022; 42:41-53. [PMID: 35471169 PMCID: PMC9048577 DOI: 10.7705/biomedica.5937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Indexed: 11/21/2022]
Abstract
Introduction: Children under five years of age living in poor areas and with low availability of healthy food have a higher risk of undernutrition-related mortality. However, this relationship has not been well established among older adults. Objective: To analyse socioeconomic inequality trends related to undernutrition mortality in children under five years of age and adults over 60 in Colombian municipalities during 2003-2009 and 2010-2016. Materials and methods: We conducted an ecological study of trends between 2003 and 2016. The study population consisted of children under five years of age and adults over 60 residing in the Colombian municipalities during the study period. We estimated smoothed and standardized mortality rates by fitting a hierarchical Bayesian model and explored their relationship with five socioeconomic area-level variables. Results: In most of the municipalities, undernutrition-related mortality was three times higher in older adults compared to children. Moreover, the difference in the risk of undernutrition-related mortality between municipalities showed a marked reduction. Finally, the poor and less developed municipalities had higher rates of undernutrition-related mortality in children; conversely, wealthier territories had higher rates in older adults. Conclusions: Although in most of the municipalities the mortality rates due to undernutrition in children under five and older adults have decreased, their socioeconomic conditions influence in different ways the risk of mortality for these two populations so there is the need to develop age-specific strategies to close social gaps considering the structural conditions of the areas.
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Nisbett N, Harris J, Backholer K, Baker P, Jernigan VBB, Friel S. Holding no-one back: The Nutrition Equity Framework in theory and practice. GLOBAL FOOD SECURITY 2022; 32:100605. [PMID: 36873709 PMCID: PMC9983632 DOI: 10.1016/j.gfs.2021.100605] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Equity remains poorly conceptualised in current nutrition frameworks and policy approaches. We draw on existing literatures to present a novel Nutrition Equity Framework (NEF) that can be used to identify priorities for nutrition research and action. The framework illustrates how social and political processes structure the food, health and care environments most important to nutrition. Central to the framework are processes of unfairness, injustice and exclusion as the engine of nutrition inequity across place, time and generations, ultimately influencing both nutritional status and people's space to act. The NEF illustrates conceptually how action on the socio-political determinants of nutrition is the most fundamental and sustainable way of improving nutrition equity for everyone everywhere, through 'equity-sensitive nutrition'. Efforts must ensure, in the words of the Sustainable Development Goals, that not only is "no one left behind" but also that the inequities and injustices we describe do not hold anyone back from realising their right to healthy diets and good nutrition.
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Affiliation(s)
- Nicholas Nisbett
- Institute of Development Studies at the University of Sussex, UK
| | - Jody Harris
- Institute of Development Studies at the University of Sussex, UK.,World Vegetable Centre, Thailand
| | - Kathryn Backholer
- Deakin University, Geelong, Institute for Health Transformation, Victoria, Australia
| | - Philip Baker
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | | | - Sharon Friel
- School of Regulation and Global Governance, Australian National University, Australia
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Yayo Negasi M. Dynamics of inequality in child under-nutrition in Ethiopia. Int J Equity Health 2021; 20:182. [PMID: 34391432 PMCID: PMC8364097 DOI: 10.1186/s12939-021-01478-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 05/20/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Although Ethiopia has already achieved a remarkable progress in reducing under-five mortality in the last decades, undernutrition among children is still a common problem in this country. Socioeconomic inequalities in health outcomes in Ethiopia have been thus of focus in academia and policy spheres for a while now. This study provides new evidence on child undernutrition inequalities in Ethiopia using longitudinal perspective. METHOD Using three round of household panel survey (from 2012 to 2016), we use concentration index (associated curve), different mobility index approaches for measuring inequalities and its dynamics, and decomposition method to identify contributing factors. RESULTS In all concentration index computing approaches and socioeconomic status ranking variables, the concentration indices are significant with negative value. This implies that in either of short-run or long-run inequality estimates, the burden of unequal distribution of undernutrition remains on the poor with significant difference across regions. While employing different SES ranking variables, the difference in the concentration indices is only found significant in case of Height-for-age Z-score. It signifies that relatively higher inequality is measured using consumption as ranking variable. Significant difference in inequality is also shown across regions. With respect to dynamics of inequalities, results on mobility indices computed based on Allanson et al. (Longitudinal analysis of income-related health inequality. Dundee Discussion Working Paper No. 214, 2010) approach show that inequality remain stable (persistent) in Height-for- age Z-score, and reduction of inequality in Weight-for- age Z-score while in case of Weight-for- height Z-score, there is no clear trend over subsequent waves. Results on decomposition of inequalities show that the major contributors are wealth index, consumption and mother's education. CONCLUSION The argument of the choice of welfare indicator can have a large and significant impact on measured socioeconomic inequalities in a health variable which it depends on the variable examined. Employing longitudinal perspective rather than weighted average of cross-sectional data is justifiable to see the dynamic of inequality in child malnutrition. In both socioeconomic status ranking variables, the bulk of inequality in malnutrition is caused by inequality in socioeconomic status in which it disfavours the poor in both cases. This calls for enhancing the policy measures that narrow socioeconomic gaps between groups in the population and targeting on early childhood intervention and nutrition sensitive.
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Affiliation(s)
- Mengesha Yayo Negasi
- Department of Business and Management, Addis Ababa Science and Technology University, P.O.Box: 16417, Addis Ababa, Ethiopia.
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Trends in social inequalities in breastfeeding and infant formulas in Latin American countries between the 1990 and 2010 decades. Public Health Nutr 2021; 24:5471-5480. [PMID: 33500006 DOI: 10.1017/s1368980021000392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To analyse trends of social inequality in breastfeeding and infant formula (IF) use in Latin America between 1990 and 2010 decades. DESIGN Time-series cross-sectional study with data from Demographic and Health Surveys. We described the prevalence of exclusive breastfeeding (EBF), breastfeeding between 6 and 12 months (BF6-12) and IF for infants under 6 months (IF < 6) and between 6 and 12 months (IF6-12). Social inequalities were assessed using the slope index of inequality (SII) and concentration index (CIX). Trends in the prevalence of breastfeeding, IF and index of social inequality were analysed by a linear regression model with weighted least squares variance. SETTING Bolivia, Colombia, Dominican Republic, Guatemala, Haiti and Peru. PARTICIPANTS 51·358 alive infants younger than 12 months. RESULTS Five countries showed an increasing trend for EBF and BF6-12, four increased for IF < 6 and six for IF6-12. Simultaneous decrease in IF < 6 (Colombia: -0·3/year; Haiti: -0·02/year) and increase in EBF (Colombia: +2·0/year; Haiti: +1·9/year) were observed only in two countries. EBF prevalence was high in the lowest income quintiles in five countries, and IF prevalence was high in the highest income quintiles in all countries and over the decades. For BF6-12, a decrease in inequality (prevalence increased in the highest quintile) was observed in Guatemala (SII1995 = -0·42; SII2015 = -0·28) and the Dominican Republic (SII1996 = -0·54; SII2013 = -0·26). Guatemala was the only country showing a decrease in inequality for BF (SII = -0·005; CIX = -0·0035) and an increase for IF (SII = 0·022; CIX = 0·01). CONCLUSIONS The inequality in BF and IF remained over time. However, inequality in IF < 6 has decreased because low-income infants have increased use and high-income infants have decreased.
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Parvez SM, Rahman MJ, Azad R, Rahman M, Unicomb L, Ashraf S, Mondol MH, Jahan F, Winch PJ, Luby SP. Achieving equitable uptake of handwashing and sanitation by addressing both supply and demand-based constraints: findings from a randomized controlled trial in rural Bangladesh. Int J Equity Health 2021; 20:16. [PMID: 33407549 PMCID: PMC7789645 DOI: 10.1186/s12939-020-01353-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/09/2020] [Indexed: 11/10/2022] Open
Abstract
Background Supply driven programs that are not closely connected to community demand and demand-driven programs that fail to ensure supply both risk worsening inequity. Understanding patterns of uptake of behaviors among the poorest under ideal experimental conditions, such as those of an efficacy trial, can help identify strategies that could be strengthened in routine programmatic conditions for more equitable uptake. WASH Benefits Bangladesh was a randomized controlled efficacy trial that provided free-of cost WASH hardware along with behavior change promotion. The current paper aimed to determine the impact of the removal of supply and demand constraints on the uptake of handwashing and sanitation behaviors across wealth and education levels. Methods The current analysis selected 4 indicators from the WASH Benefits trial— presence of water and soap in household handwashing stations, observed mother’s hand cleanliness, observed visible feces on latrine slab or floor and reported last child defecation in potty or toilet. A baseline assessment was conducted immediately after enrolment and endline assessment was conducted approximately 2 years later. We compared change in uptake of these indicators including wealth quintiles (Q) between intervention and control groups from baseline to endline. Results For hand cleanliness, the poorest mothers improved more [Q1 difference in difference, DID: 16% (7, 25%)] than the wealthiest mothers [Q5 DID: 7% (− 4, 17%)]. The poorest households had largest improvements for observed presence of water and soap in handwashing station [Q1 DID: 82% (75, 90%)] compared to the wealthiest households [Q5 DID: 39% (30, 50%)]. Similarly, poorer household demonstrated greater reductions in visible feces on latrine slab or floor [Q1DID, − 25% (− 35, − 15) Q2: − 34% (− 44, − 23%)] than the wealthiest household [Q5 DID: − 1% (− 11, 8%). For reported last child defecation in potty or toilet, the poorest mothers showed greater improvement [Q1–4 DID: 50–54% (44, 60%)] than the wealthier mothers [Q5 DID: 39% (31, 46%). Conclusion By simultaneously addressing supply and demand-constraints among the poorest, we observed substantial overall improvements in equity. Within scaled-up programs, a separate targeted strategy that relaxes constraints for the poorest can improve the equity of a program. Trial registration WASH Benefits Bangladesh: ClinicalTrials.gov, identifier: NCT01590095. Date of registration: April 30, 2012 ‘Retrospectively registered’. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-020-01353-7.
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Affiliation(s)
- Sarker Masud Parvez
- Environmental Intervention Unit, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
| | - Musarrat Jabeen Rahman
- Environmental Intervention Unit, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Rashidul Azad
- Environmental Intervention Unit, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mahbubur Rahman
- Environmental Intervention Unit, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Leanne Unicomb
- Environmental Intervention Unit, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sania Ashraf
- University of Pennsylvania, Philadelphia, PA, USA
| | | | - Farjana Jahan
- Environmental Intervention Unit, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Peter J Winch
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
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Christian AK, Agula C, Jayson-Quashigah PN. Correlates and spatial distribution of the co-occurrence of childhood anaemia and stunting in Ghana. SSM Popul Health 2020; 12:100683. [PMID: 33204808 PMCID: PMC7649523 DOI: 10.1016/j.ssmph.2020.100683] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 10/18/2020] [Accepted: 10/18/2020] [Indexed: 11/24/2022] Open
Abstract
Childhood anaemia and stunting are major public health concerns in Ghana. Using the 2014 Ghana Demographic and Health Survey, we evaluated whether childhood anaemia (Haemoglobin concentration < 110 g/L) and stunting (height-for-age z score < -2) co-occur beyond what is expected in Ghana, and employed spatial analysis techniques to determine if their co-occurrence is spatially correlated. There was no statistically significant difference between the observed and expected frequency of co-occurrence. Among 24-35 month and 36-59-month-old children, belonging to a high wealth household compared to low wealth household was associated with lower odds of the co-occurrence of childhood anaemia and stunting (OR, 95% CI: 0.3[0.1, 0.8] and 0.2[0.1, 0.5], respectively). Children aged 6-23 months with caregivers who had formerly been in union compared to their counterparts with caregivers who have never been in union had higher odds of co-occurrence of anaemia and stunting (5.1, [1.1, 24.3]). Overall, households with high wealth and having a mother with secondary or more education were associated with lower odds of the co-occurrence of childhood anaemia and stunting (OR, 95% CI: 0.4[0.2, 0.8] and 0.5[0.3, 0.9], respectively). There was substantial spatial clustering of co-occurrence, particularly in the northern region of the country. Interventions purposed to improve linear growth and anaemia must identify the specific factors or context which contribute to childhood anaemia and stunting.
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Affiliation(s)
- Aaron Kobina Christian
- Regional Institute for Population Studies (RIPS), University of Ghana, Legon, P.O. Box LG 96, Accra, Ghana
| | - Caesar Agula
- Regional Institute for Population Studies (RIPS), University of Ghana, Legon, P.O. Box LG 96, Accra, Ghana
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Pinhas-Hamiel O, Reichman B, Afek A, Derazne E, Tzur D, Hamiel U, Bader T, Muhsen K, Twig G. Socioeconomic inequalities and severe obesity-Sex differences in a nationwide study of 1.12 million Israeli adolescents. Pediatr Obes 2020; 15:e12681. [PMID: 32558366 DOI: 10.1111/ijpo.12681] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 02/05/2023]
Abstract
INTRODUCTION In a nationwide population of adolescents, we investigated the sex-specific association of socioeconomic position (SEP) with severe obesity, and trends over time. METHODS The cohort comprises all Israeli adolescents (mean ± SD age 17.3 ± 0.5 years) who were medically examined, before mandatory military service during 2000 to 2015. Of 1 120 362 adolescents, 239 816 (21.4%) were classified with overweight or with obesity classes I to III using the International Obesity Task Force criteria. Data were compared between 2000 to 2009 and 2010 to 2015. RESULTS Considering more advantaged residential SEP as the reference group, the respective odds ratios (ORs ± 95%CI) of less advantaged SEP for obesity classes I to III in 2010 to 2015 were 1.48 (1.40-1.56), 1.66 (1.51-1.83), and 1.73 (1.45-2.08) for males; and 1.72 (1.60-1.84), 1.89 (1.66-2.15), and 2.62 (2.04-3.37) for females. All point estimates were higher than in the preceding decade. Considering female inductees from the more advantaged SEP as the reference group, ORs were higher for males in the more advantaged SEP group, for overweight, 1.31 (1.27-1.36); class I obesity, 1.29 (1.20-1.38); class II obesity, 1.34 (1.18-1.53); and class III obesity, 1.60 (1.24-2.07). Similarly, in the less and medium advantaged SEP groups, increased ORs for males compared with females were observed in all obesity groups. Results persisted using United States Centers for Disease Control and Prevention growth charts. CONCLUSIONS Adolescents with less rather than more advantaged residential SEP are at greater risk of severe obesity. Adolescent males, of all residential SEP groups had higher odds than females for all classes of obesity.
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Affiliation(s)
- Orit Pinhas-Hamiel
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Brian Reichman
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.,The Women and Children's Health Research Unit, Gertner Institute, Tel Hashomer, Israel
| | - Arnon Afek
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Central Management, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Estela Derazne
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Dorit Tzur
- Surgeon General Headquarters, Israel Defense Forces, Ramat Gan, Israel
| | - Uri Hamiel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Department of Pediatrics, Assaf Harofeh Medical Center, Israel
| | - Tarif Bader
- Surgeon General Headquarters, Israel Defense Forces, Ramat Gan, Israel.,Department of Military Medicine, Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem, Israel
| | - Khitam Muhsen
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Gilad Twig
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Surgeon General Headquarters, Israel Defense Forces, Ramat Gan, Israel.,Department of Military Medicine, Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem, Israel.,Department of Medicine, Sheba Medical Center, Tel Hashomer, Israel
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Asuman D, Ackah CG, Fenny AP, Agyire-Tettey F. Assessing socioeconomic inequalities in the reduction of child stunting in sub-Saharan Africa. J Public Health (Oxf) 2020. [DOI: 10.1007/s10389-019-01068-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Gholampour T, Noroozi M, Zavoshy R, Mohammadpoorasl A, Ezzeddin N. Relationship Between Household Food Insecurity and Growth Disorders in Children Aged 3 to 6 in Qazvin City, Iran. Pediatr Gastroenterol Hepatol Nutr 2020; 23:447-456. [PMID: 32953640 PMCID: PMC7481058 DOI: 10.5223/pghn.2020.23.5.447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 06/02/2020] [Accepted: 06/04/2020] [Indexed: 11/14/2022] Open
Abstract
PURPOSE Food insecurity, which is the inability to obtain food or inadequate food consumption in terms of quality and quantity, has physical and psychological consequences on children's health. This study aimed to investigate the relationship between children's growth disorders and food insecurity in Qazvin city, Iran. METHODS A case-control study was conducted on 177 cases and 355 controls of children aged 3 to 6 years, who were referred to health centers in Qazvin city. The case group consisted of children with growth disorders. Data were obtained with the 18-item US Department of Agriculture questionnaire, a household socioeconomic questionnaire, a and growth monitoring card. The data were analyzed with using IBM SPSS Version 22.0, by independent sample t-test, chi-square test, and logistic regression. RESULTS A significant relationship was found between children's growth disorders and household food insecurity with (p<0.05, odds ratio [OR]=17.0, confidence interval [CI]=5.9, 48.8) and without hunger (p<0.05, OR=2.69, CI=1.4, 4.9). There were also significant relationships between children's growth disorders and socioeconomic status (p<0.05, OR=3.4, CI=1.4, 8.5), the duration of breastfeeding (p<0.05, OR=0.94, CI=0.9, 0.98), and children's ages (p<0.05, OR=0.94, CI=0.92, 0.96). Sex and birth order, and the age of the parents was not found to be significantly related with growth disorders. CONCLUSION Lower socioeconomic status and household food insecurity were the important predictors of children's growth disorders. Policymakers should focus more on promoting steady employment and income among family members. Nutritional education for mothers is also recommended, in order to better meet the nutritional needs of the children.
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Affiliation(s)
- Tooba Gholampour
- Department of Human Nutrition, School of Health, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Mostafa Noroozi
- Children Growth Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Rosa Zavoshy
- Department of Human Nutrition, School of Health, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Asghar Mohammadpoorasl
- Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Neda Ezzeddin
- Department of Community Nutrition, Faculty of Nutrition Science and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Adegbosin AE, Stantic B, Sun J. Efficacy of deep learning methods for predicting under-five mortality in 34 low-income and middle-income countries. BMJ Open 2020; 10:e034524. [PMID: 32801191 PMCID: PMC7430449 DOI: 10.1136/bmjopen-2019-034524] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 06/01/2020] [Accepted: 07/07/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To explore the efficacy of machine learning (ML) techniques in predicting under-five mortality (U5M) in low-income and middle-income countries (LMICs) and to identify significant predictors of U5M. DESIGN This is a cross-sectional, proof-of-concept study. SETTINGS AND PARTICIPANTS We analysed data from the Demographic and Health Survey. The data were drawn from 34 LMICs, comprising a total of n=1 520 018 children drawn from 956 995 unique households. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measure was U5M; secondary outcome was comparing the efficacy of deep learning algorithms: deep neural network (DNN); convolution neural network (CNN); hybrid CNN-DNN with logistic regression (LR) for the prediction of child's survival. RESULTS We found that duration of breast feeding, number of antenatal visits, household wealth index, postnatal care and the level of maternal education are some of the most important predictors of U5M. We found that deep learning techniques are superior to LR for the classification of child survival: LR sensitivity=0.47, specificity=0.53; DNN sensitivity=0.69, specificity=0.83; CNN sensitivity=0.68, specificity=0.83; CNN-DNN sensitivity=0.71, specificity=0.83. CONCLUSION Our findings provide an understanding of determinants of U5M in LMICs. It also demonstrates that deep learning models are more efficacious than traditional analytical approach.
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Affiliation(s)
| | - Bela Stantic
- School of Information and Communication Technology, Griffith University, Nathan, Queensland, Australia
| | - Jing Sun
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
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Romanelli R, Cecchi N, Carbone MG, Dinardo M, Gaudino G, Miraglia Del Giudice E, Umano GR. Pediatric obesity: prevention is better than care. Ital J Pediatr 2020; 46:103. [PMID: 32709246 PMCID: PMC7379757 DOI: 10.1186/s13052-020-00868-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/14/2020] [Indexed: 02/06/2023] Open
Abstract
Pediatric obesity is one of the most relevant health issues of the last century. Obesity-related short and long-term consequences are responsible of a large amount of economic cost. In addition, the different therapeutic strategies, such as lifestyle correction, drug, and bariatric surgery have displayed low effectiveness. Considering this evidence, prevention appears to be more promising than treatment in contrasting obesity epidemic. In this review, we summarize obesity pathogenesis with the aim of highlight the main obesity risk factors that can be addressed as target of preventive interventions. Moreover, we report the evidence about effectiveness of different interventions targeting family, school, and community. A multiple-component intervention, addressing different targets and settings, might be desirable, however more studies are needed to confirm long-term efficacy and to direct policy interventions.
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Affiliation(s)
- Roberta Romanelli
- Clinical Nutrition Unit -Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Nicola Cecchi
- Clinical Nutrition Unit -Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Maria Grazia Carbone
- Clinical Nutrition Unit -Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Michele Dinardo
- Clinical Nutrition Unit -Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Giuseppina Gaudino
- Department of the Woman, of the Child, of General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Via L. de Crecchio, 2, 80138, Naples, Italy
| | - Emanuele Miraglia Del Giudice
- Department of the Woman, of the Child, of General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Via L. de Crecchio, 2, 80138, Naples, Italy
| | - Giuseppina Rosaria Umano
- Department of the Woman, of the Child, of General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Via L. de Crecchio, 2, 80138, Naples, Italy.
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Pedraza DF, Olinda RAD, Bezerra TA. Estado nutricional de crianças residentes em área de vulnerabilidade social: estudo longitudinal. SAÚDE EM DEBATE 2020. [DOI: 10.1590/0103-1104202012409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivou-se analisar a variação dos parâmetros antropométricos, ao longo de dois anos, de crianças menores de cinco anos residentes em uma área de vulnerabilidade, segundo perfil demográfico e de saúde. Realizou-se um estudo longitudinal de 55 famílias com crianças menores de cinco anos e algum membro ex-catador de materiais recicláveis residentes nas proximidades do lixão desativado de Campina Grande, Paraíba. O estado nutricional das crianças foi analisado a partir dos índices Estatura/Idade (E/I), Peso/Idade (P/I) e Peso/Estatura (P/E), considerando-se as variações dos Escore-Z como variáveis dependentes. Utilizou-se o modelo de efeitos mistos, próprio para avaliar tendência do crescimento em estudo de seguimento. O deficit de estatura prevaleceu nos meninos. A prevalência de baixa estatura na coorte diminuiu de 20,37% (IC 95%: 17,40-24,24), em 2012, para 9,26% (IC 95%: 7,54-10,58), em 2014, com diferença significativa. Crianças menores de 25 meses tiveram maior variação média de Escore-Z de E/I (p = 0,01), e os meninos apresentaram maior variação no Escore-Z de E/I (p = 0,01) e de P/E (p = 0,04). Houve diferenças no crescimento das crianças segundo suas características demográficas quando modificadas as condições ambientais insalubres.
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Singh S, Srivastava S, Upadhyay AK. Socio-economic inequality in malnutrition among children in India: an analysis of 640 districts from National Family Health Survey (2015-16). Int J Equity Health 2019; 18:203. [PMID: 31881899 PMCID: PMC6935164 DOI: 10.1186/s12939-019-1093-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 11/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite a fast-growing economy and the largest anti-malnutrition programme, India has the world's worst level of child malnutrition. Despite India's 50% increase in GDP since 1991, more than one third of the world's malnourished children live in India. Among these, half of the children under age 3 years are underweight and a third of wealthiest children are over-nutrient. One of the major causes for malnutrition in India is economic inequality. Therefore, using the data from the fourth round of National Family Health Survey (2015-16), present study aims to examine the socio-economic inequality in childhood malnutrition across 640 districts of India. METHOD Concentration curve and generalized concentration index were used to examine the socioeconomic inequalities in malnutrition. However, regression-based decomposition methodology was used to decomposes the causes of inequality in childhood malnutrition. RESULT Result shows that about 38% children in India were stunted and 35% were underweight during 2015-16. Prevalence of stunting and underweight children varies considerably across Indian districts (13 to 65% and 7 to 67% respectively). Districts having the higher share of undernourished children is coming from the particular regions like central, east and west part of the country. On an average about 35% of household in a district having the access of safe drinking water and 42% of household in a district exposed to open defecation. The study found the inverse relationship between district's economic development with childhood stunting and underweight. The concentration of stunted as well as underweight children were found in least developed districts of India. Decomposition approach found that practice of open defecation is positively influenced the inequality in stunting and underweight. Further, inequality in undernutrition is accelerated by the height and education of the mother, and availability of safe drinking water in a district. CONCLUSIONS The districts that lied out in a spectrum of developmental diversity are required some specific set of information's that covering socio-economic, demographic and health-related quality of life of people in those backward districts. More generally, policies to avail improved water and sanitation facility to public and female literacy should be continued. It is also important to see that the benefits of both infrastructure and more general economic development are spread more evenly across districts.
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Affiliation(s)
- Shrikant Singh
- Department of Mathematical Demography and Statistics, International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, 400088, India
| | - Swati Srivastava
- International Institute of Population Sciences, Govandi Station Road, Deonar, Mumbai, 400088, India.
| | - Ashish Kumar Upadhyay
- International Institute of Population Sciences, Govandi Station Road, Deonar, Mumbai, 400088, India
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Di Cesare M, Sorić M, Bovet P, Miranda JJ, Bhutta Z, Stevens GA, Laxmaiah A, Kengne AP, Bentham J. The epidemiological burden of obesity in childhood: a worldwide epidemic requiring urgent action. BMC Med 2019; 17:212. [PMID: 31760948 PMCID: PMC6876113 DOI: 10.1186/s12916-019-1449-8] [Citation(s) in RCA: 471] [Impact Index Per Article: 94.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 10/23/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND In recent decades, the prevalence of obesity in children has increased dramatically. This worldwide epidemic has important consequences, including psychiatric, psychological and psychosocial disorders in childhood and increased risk of developing non-communicable diseases (NCDs) later in life. Treatment of obesity is difficult and children with excess weight are likely to become adults with obesity. These trends have led member states of the World Health Organization (WHO) to endorse a target of no increase in obesity in childhood by 2025. MAIN BODY Estimates of overweight in children aged under 5 years are available jointly from the United Nations Children's Fund (UNICEF), WHO and the World Bank. The Institute for Health Metrics and Evaluation (IHME) has published country-level estimates of obesity in children aged 2-4 years. For children aged 5-19 years, obesity estimates are available from the NCD Risk Factor Collaboration. The global prevalence of overweight in children aged 5 years or under has increased modestly, but with heterogeneous trends in low and middle-income regions, while the prevalence of obesity in children aged 2-4 years has increased moderately. In 1975, obesity in children aged 5-19 years was relatively rare, but was much more common in 2016. CONCLUSIONS It is recognised that the key drivers of this epidemic form an obesogenic environment, which includes changing food systems and reduced physical activity. Although cost-effective interventions such as WHO 'best buys' have been identified, political will and implementation have so far been limited. There is therefore a need to implement effective programmes and policies in multiple sectors to address overnutrition, undernutrition, mobility and physical activity. To be successful, the obesity epidemic must be a political priority, with these issues addressed both locally and globally. Work by governments, civil society, private corporations and other key stakeholders must be coordinated.
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Affiliation(s)
| | - Maroje Sorić
- University of Zagreb, Trg Republike Hrvatske 14, 10000, Zagreb, Croatia.,University of Ljubljana, Kongresni trg 12, 1000, Ljubljana, Slovenia
| | - Pascal Bovet
- Center for Primary Care and Public Health, Secteur Croisettes/Bâtiment SC-B, Route de la Corniche 2, 1066 Epalinges, Lausanne, Switzerland.,Ministry of Health, Hospital Road, Victoria, Republic of Seychelles
| | - J Jaime Miranda
- Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martín de Porres, 15102, Lima, Peru
| | - Zulfiqar Bhutta
- Aga Khan University, National Stadium Rd, Karachi, 74800, Pakistan
| | - Gretchen A Stevens
- Independent consultant, Los Angeles, USA.,c/o: School of Mathematics, Statistics and Actuarial Science, University of Kent, Giles Lane, Canterbury, CT2 7NZ, UK
| | - Avula Laxmaiah
- ICMR-National Institute of Nutrition, Beside Tarnaka Metro Station, Osmania University PO, Hyderabad, Telangana, 500007, India
| | - Andre-Pascal Kengne
- South African Medical Research Council, Francie Van Zijl Dr, Parow Valley, Cape Town, 7501, South Africa
| | - James Bentham
- University of Kent, Giles Lane, Canterbury, CT2 7NZ, UK.
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Sohail H, Neupane S. Prevalence of and factors associated with under-5 mortality in South Asia. Int Health 2019; 11:119-127. [PMID: 30285111 DOI: 10.1093/inthealth/ihy065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 08/09/2018] [Accepted: 09/20/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study investigated the prevalence of and the factors associated with under-5 mortality across five South Asian countries. METHODS Cross-sectional pooled data from 1999 through 2014 collected from the Demographic and Health Survey (DHS) in five South Asian countries (Bangladesh, India, Maldives, Nepal and Pakistan) were used. Associations of under-5 mortality with sociodemographic characteristics and maternal and child factors were studied using the Cox proportional-hazard method. The estimates were presented as hazard ratios (HR) and their 95% CIs. Kaplan-Meier survival curves were used to describe time-to-event of under-5 survival patterns. RESULTS Overall, 15-year prevalence of under-5 mortality in South Asian countries was 10%, with Nepal having the highest prevalence (11.1%) and the Maldives the lowest (5%). In a multivariable model in pooled data, older age of mother (HR 0.70, 95% CI 0.68-0.72), being employed (HR 1.09, 95% CI 1.07-1.12), having a higher level of education (HR 0.36, 95%, CI 0.32-0.40) and having a husband with higher level of education (HR 0.74, 95% CI 0.70-0.78) were significantly associated with under-5 mortality. Factors associated with under-5 mortality were mostly common across countries. CONCLUSION The prevalence of under-5 mortality is still high in South Asia. Most of the studied sociodemographic factors were associated with under-5 mortality and were common across South Asian countries.
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Affiliation(s)
- Hasan Sohail
- Faculty of Social Sciences, Health Sciences, FI-33014, University of Tampere, Tampere
| | - Subas Neupane
- Faculty of Social Sciences, Health Sciences, FI-33014, University of Tampere, Tampere, Finland
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Abstract
AbstractObjective:To describe malnutrition (undernutrition and excess weight) by income, education and race/ethnicity in the Brazilian population.Design:Cross-sectional study.Setting:Brazil.Participants:Children aged <5 years (n 14 580), adolescents aged 11–19 years (n 31 892) and adults aged 20–49 years (n 84 660).Results:Among children, prevalence of excess weight, wasting and stunting was 16·9, 2·8 and 6·0 %, respectively. Differences related to income, education and race/ethnicity were verified, except for prevalence of wasting by education level. Girls and boys presented 18·4 and 20·5 % of excess weight, 2·8 and 3·7 % of underweight and 5·5 and 7·3 % of stunting, respectively. Prevalence of excess weight was lower among poorer, lower-educated (only for boys) and white adolescents, while stunting was lower among higher-income, higher-educated and white adolescents. Over three-quarters of women and almost half of men presented excess weight. Among adults, 3·9 % of women and 1·7 % of men were underweight, and 5·7 % of women and 0·2 % of men presented short stature. Prevalence of excess weight for women was higher among lower education and black, while for men it was higher among higher income and education and white. Short stature was more prevalent among black and mixed-race, low-educated and low-income women. Underweight prevalence was higher among low-educated, black and mixed-race women.Conclusions:In Brazil, the prevalence of excess weight was at least threefold higher than that of undernutrition for children and adolescents and at least sevenfold higher for adults. Social inequalities were observed in the distribution of malnutrition across the lifespan and by gender.
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Nguyen PH, Avula R, Headey D, Tran LM, Ruel MT, Menon P. Progress and inequalities in infant and young child feeding practices in India between 2006 and 2016. MATERNAL AND CHILD NUTRITION 2019; 14 Suppl 4:e12663. [PMID: 30499255 PMCID: PMC6518921 DOI: 10.1111/mcn.12663] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/12/2018] [Accepted: 07/19/2018] [Indexed: 01/24/2023]
Abstract
Limited evidence exists on socio‐economic status (SES) inequalities in infant and young child feeding (IYCF) in India. We examine trends and changes in inequalities for IYCF practices over 2006–2016 and identify factors that may explain differences in IYCF across SES groups. We use data from the 2015–2016 and 2005–2006 National Family Health Surveys (n = 112,133 children < 24 months). We constructed SES quintiles (Q) and assessed inequalities using concentration and slope indices. We applied path analyses to examine the relationship between SES inequalities, intermediate determinants, and IYCF. Breastfeeding improved significantly over 2006–2016: from 23% to 42% for early initiation of breastfeeding (EIBF) and 46% to 55% for exclusive breastfeeding (EBF). Minimum dietary diversity (MDD) improved modestly (15% to 21%), but adequate diet did not change (~9%). Large SES gaps (Q5–Q1) were found for EIBF (8–17%) and EBF (−15% to −10%) in 2006; these gaps closed in 2016. The most inequitable practices in 2006 were MDD and iron‐rich foods (Q5 ~ 2–4 times higher than Q1); these gaps narrowed in 2016, but levels are low across SES groups. Factors along the path from SES inequalities to IYCF practices included health and nutrition services, information access, maternal education, number of children < 5 years, and urban/rural residence. The improvements in breastfeeding and narrowing of equity gaps in IYCF practices in India are significant achievements. However, ensuring the health and well‐being of India's large birth cohort will require more efforts to further improve breastfeeding, and concerted actions to address all aspects of complementary feeding across SES quintiles.
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Affiliation(s)
- Phuong Hong Nguyen
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Rasmi Avula
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Derek Headey
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | | | - Marie T Ruel
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Purnima Menon
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
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Orellana JDY, Marrero L, Alves CLM, Ruiz CMV, Hacon SS, Oliveira MW, Basta PC. Association of severe stunting in indigenous Yanomami children with maternal short stature: clues about the intergerational transmission. CIENCIA & SAUDE COLETIVA 2019; 24:1875-1883. [PMID: 31166520 DOI: 10.1590/1413-81232018245.17062017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 08/16/2017] [Indexed: 12/17/2022] Open
Abstract
This study evaluates the nutritional status of children and women of an indigenous Yanomamigroup, and seeks to clarify associated factors. It was a cross-sectional study, carried out in 17 villages, in 2014. For evaluation of nutritional status we used 2006 growth standards to assign height-for-age (stunting)Z-scores (Z), weight-for-age Z (underweight) and weight-for-height Z (wasting and overweight), using the software WHO-Anthro and WHO-AnthroPlus. Short stature (SS) was defined as values lower 145cm for mothers over the age of 18. The Poisson regression was made in R software. Among children under 60 months the prevalences were: stunting 83.8%; underweight 50%; wasting 5.4%; and overweight 2.7%. In 59.5% of the children there was severe stunting, and 68.1% of the mothers were SS. Prevalence ratio (PR) for severe stunting was higher in age group 36-59 months, in comparison with age group 0.1-23 (PR = 1.3; CI 95%: 1.1-2.3), as did also children of mothers with SS, when compared to the children of mothers without SS (PR = 2.1; CI 95%; 1.2-3.6). The alarming rates of stunting and severe stunting reveal the seriousness of the nutritional situation children. The association of severe stunting in infants and in mothers reflects the intergenerational nature of the problem.
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Affiliation(s)
| | - Lihsieh Marrero
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas. Manaus AM Brasil
| | | | | | - Sandra Souza Hacon
- Escola Nacional de Saúde Pública Sergio Arouca, Fiocruz. Rio de Janeiro RJ Brasil
| | | | - Paulo Cesar Basta
- Escola Nacional de Saúde Pública Sergio Arouca, Fiocruz. Rio de Janeiro RJ Brasil
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Keats EC, Akseer N, Bhatti Z, Macharia W, Ngugi A, Rizvi A, Bhutta ZA. Assessment of Inequalities in Coverage of Essential Reproductive, Maternal, Newborn, Child, and Adolescent Health Interventions in Kenya. JAMA Netw Open 2018; 1:e185152. [PMID: 30646326 PMCID: PMC6324360 DOI: 10.1001/jamanetworkopen.2018.5152] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Previous work has underscored subnational inequalities that could impede additional health gains in Kenya. OBJECTIVE To provide a comprehensive assessment of the burden, distribution, and change in inequalities in reproductive, maternal, newborn, child, and adolescent health (RMNCAH) interventions in Kenya from 2003 to 2014. DESIGN, SETTING, AND PARTICIPANTS This population-based cross-sectional study used data from the 2003, 2008, and 2014 Kenya Demographic and Health Surveys. The study included women of reproductive age (ages 15-49 years) and children younger than years, with national, regional, county, and subcounty level representation. Data analysis was conducted from April 2018 to November 2018. EXPOSURES Socioeconomic position that was derived from asset indices and presented as wealth quintiles. Urban and rural residence and regions of Kenya were also considered. MAIN OUTCOMES AND MEASURES Absolute and relative measures of inequality in coverage of RMNCAH interventions. RESULTS For this analysis, representative samples of 31 380 women of reproductive age and 29 743 children younger than 5 years from across Kenya were included. The RMNCAH interventions examined demonstrated pro-rich and bottom inequality patterns. The most inequitable interventions were skilled birth attendance, family planning needs satisfied, and 4 or more antenatal care visits, whereby the absolute difference in coverage between the wealthiest (quintile 5) and poorest quintiles (quintile 1) was 61.6% (95% CI, 60.1%-63.1%), 33.4% (95% CI, 31.9%-34.9%), and 31.0% (95% CI, 30.5%-31.6%), respectively. The most equitable intervention was early initiation of breastfeeding, with an absolute difference (quintile 5 minus quintile 1) of -7.9% (95% CI, -11.1% to -4.8%), although antenatal care (1 visit) and diphtheria-tetanus-pertussis immunization (3 doses) demonstrated the best combination of high coverage and low inequalities. Our geospatial analysis revealed significant socioeconomic disparities in the northern and eastern regions of Kenya that have translated to suboptimal intervention coverage. A significant gap remains for rural, disadvantaged populations. CONCLUSIONS AND RELEVANCE Coverage of RMNCAH interventions has improved over time, but wealth and geospatial inequalities in Kenya are persistent. Policy and programming efforts should place more emphasis on improving the accessibility of health facility-based interventions, which generally demonstrate poor coverage and high inequalities, and focus on integrated approaches to maternal health service delivery at the community level when access is poor. Scaling up of health services for the urban and, in particular, rural poor areas and those residing in Kenya's former north eastern province will contribute toward achievement of universal health coverage.
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Affiliation(s)
- Emily Catherine Keats
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nadia Akseer
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | - Zulfiqar Ahmed Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Aga Khan University, Karachi, Pakistan
- Aga Khan University, Nairobi, Kenya
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Corsi DJ, Perkins JM, Subramanian SV. Child anthropometry data quality from Demographic and Health Surveys, Multiple Indicator Cluster Surveys, and National Nutrition Surveys in the West Central Africa region: are we comparing apples and oranges? Glob Health Action 2018. [PMID: 28641057 PMCID: PMC5496063 DOI: 10.1080/16549716.2017.1328185] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND There has been limited work comparing survey characteristics and assessing the quality of child anthropometric data from population-based surveys. OBJECTIVE To investigate survey characteristics and indicators of quality of anthropometric data in children aged 0-59 months from 23 countries in the West Central Africa region. METHODS Using established methodologies and criteria to examine child age, sex, height, and weight, we conducted a comprehensive assessment and scoring of the quality of anthropometric data collected in 100 national surveys. RESULTS The Multiple Indicator Cluster Surveys (MICS) and Demographic and Health Surveys (DHS) collected data from a greater number of younger children than older children while the opposite was found for the National Nutrition Surveys (NNS). Missing or implausible height/weight data proportions were 12% and 8% in MICS and DHS compared to 3% in NNS. Average data quality scores were 14 in NNS, 33 in DHS, and 41 in MICS. CONCLUSIONS Although our metric of data quality suggests that data from the NNS appear more consistent and robust, it is equally important to consider its disadvantages related to access and lack of broader socioeconomic information. In comparison, the DHS and MICS are publicly-accessable for research and provide socioeconomic context essential for assessing and addressing the burden of undernutrition within and between countries. The strengths and weaknesses of data from these three sources should be carefully considered when seeking to determine the burden of child undernutrition and its variation within countries.
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Affiliation(s)
- Daniel J Corsi
- a OMNI Research Group , Ottawa Hospital Research Institute , Ottawa , ON , Canada.,b Center for Population & Development Studies , Harvard School of Public Health , Cambridge , MA , USA
| | - Jessica M Perkins
- b Center for Population & Development Studies , Harvard School of Public Health , Cambridge , MA , USA.,c MGH Global Health , Massachusetts General Hospital , Boston , MA , USA
| | - S V Subramanian
- b Center for Population & Development Studies , Harvard School of Public Health , Cambridge , MA , USA.,d Department of Social and Behavioral Sciences , Harvard T.H. Chan School of Public Health , Boston , MA , USA
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Linhares AO, Linhares RDS, Cesar JA. Inequality in iron sulfate supplementation among pregnant women in Southern Brazil. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2018; 20:650-660. [PMID: 29267750 DOI: 10.1590/1980-5497201700040008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 07/17/2017] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The use of ferrous sulfate is recommended for all pregnant women from the 20th week of gestation to the 3rd month after delivery. OBJECTIVE To evaluate the coverage of ferrous sulfate among pregnant women and differentials according to demographic and socioeconomic variables. METHOD A cross-sectional population-based study with women who had children in Rio Grande, Rio Grande do Sul, Brazil, from January 1st to December 31st, 2013. Ferrous sulfate coverage was assessed according to maternal age, schooling, family income, and type of prenatal care. Statistical analysis included Pearson's χ2 test and Poisson regression. RESULTS 2,685 postpartum women (97% of the total) were interviewed and the ferrous sulfate coverage was 63%. The largest relative differences were between the extreme maternal schooling groups (50%) and the type of medical care in prenatal care (72%). Women aged between 13 and 19 years were significantly associated with the use of supplement (RP = 1.16; 95%CI 1.08 - 1.25) when compared to women aged ≥ 30 years. Those who used the public service in prenatal care were more strongly associated with the outcome when compared to those who used the private system (PR = 1.61; 95%CI 1.49 - 1.74). CONCLUSION Considering that there are unusual situations in the health sector in which disadvantaged groups are privileged, these findings are rare and indicate the presence of inequality in a way that is opposite to what was expected. The supplement should consider all women, especially older women, with higher education and better socioeconomic status.
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Gosdin L, Martorell R, Bartolini RM, Mehta R, Srikantiah S, Young MF. The co-occurrence of anaemia and stunting in young children. MATERNAL & CHILD NUTRITION 2018; 14:e12597. [PMID: 29468825 PMCID: PMC6866136 DOI: 10.1111/mcn.12597] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 01/11/2018] [Accepted: 01/16/2018] [Indexed: 01/02/2023]
Abstract
Anaemia and stunting are prevalent nutritional problems among children of low-income countries that have profound effects on development, morbidity, and mortality. Many use a single conceptual framework to identify the basic determinants of these and other forms of malnutrition. One would expect that problems with matching underlying determinants should co-occur in affected individuals to a greater degree than by chance. In 2 populations of children-ages 6-18 months in Bihar, India, (n = 5,664) and 6-36 months in Lambayeque, Peru (n = 688)-we measured the frequency of the co-occurrence of anaemia and stunting. We compared this value with the value expected by chance, the product of the prevalence of anaemia and stunting, using a chi-square test. We also built logistic regression models for each condition. The frequency of co-occurrence in the Indian population was 21.5%, and in the Peruvian population, it was 30.4%, which are similar to frequencies expected by chance, 21.3% (p = .97) and 31.5% (p = .85). In Peru, anaemia was associated with age and consumption of treated water. Stunting was associated with age, sex, dietary diversity, hand washing, language spoken, and wealth. In India, anaemia was associated with age, sex, caste, dietary diversity, and household hunger. Stunting was associated with age, sex, caste, wealth, and maternal illiteracy. Despite some basic shared factors, anaemia and stunting are more independent than commonly assumed. Interventions that target children based on 1 condition may miss children with the other form of malnutrition.
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Affiliation(s)
- Lucas Gosdin
- Hubert Department of Global Health, Rollins School of Public HealthEmory UniversityAtlantaGeorgiaUSA
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate SchoolEmory UniversityAtlantaGeorgiaUSA
| | - Reynaldo Martorell
- Hubert Department of Global Health, Rollins School of Public HealthEmory UniversityAtlantaGeorgiaUSA
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate SchoolEmory UniversityAtlantaGeorgiaUSA
| | | | - Rukshan Mehta
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate SchoolEmory UniversityAtlantaGeorgiaUSA
| | | | - Melissa F. Young
- Hubert Department of Global Health, Rollins School of Public HealthEmory UniversityAtlantaGeorgiaUSA
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate SchoolEmory UniversityAtlantaGeorgiaUSA
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Cooper CG, Burns JL, Koster JM, Perri AR, Richards MP. Economic and demographic predictors of dietary variation and nutritional indicators in Nicaragua. Am J Hum Biol 2018; 30:e23125. [PMID: 29637643 DOI: 10.1002/ajhb.23125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 08/11/2017] [Accepted: 03/12/2018] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVES We measured carbon and nitrogen isotopic ratios in a contemporary population, and tested how the isotopic variability relates to measures of socioeconomic status (e.g., household wealth) and anthropometric measures (e.g., standardized height-for-age and weight-for-age z-scores). METHODS Hair samples from individuals living in the Bosawas Biosphere Reserve in Nicaragua were analyzed for δ13 C and δ15 N, and these data were examined in relation to individual (e.g., age, sex, anthropometrics) and household (e.g., household size, wealth) variables. RESULTS We found through mixed-effects modeling that δ13 C and δ15 N varied predictably with individual age and household wealth. δ13 C and δ15 N did not, however, improve models predicting variation in individual anthropometric measures. CONCLUSION These results indicate that, although there is a relationship between diet (δ13 C and δ15 N) and socioeconomic variables, these dietary differences are not the main cause of health differences in this population.
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Affiliation(s)
| | - Jessica L Burns
- The University of British Columbia, Vancouver, BC, V6T 1Z1, Canada
| | - Jeremy M Koster
- The University of British Columbia, Vancouver, BC, V6T 1Z1, Canada
| | - Angela R Perri
- The University of British Columbia, Vancouver, BC, V6T 1Z1, Canada
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Hinnig PDF, Monteiro JS, de Assis MAA, Levy RB, Peres MA, Perazi FM, Porporatti AL, Canto GDL. Dietary Patterns of Children and Adolescents from High, Medium and Low Human Development Countries and Associated Socioeconomic Factors: A Systematic Review. Nutrients 2018; 10:E436. [PMID: 29601553 PMCID: PMC5946221 DOI: 10.3390/nu10040436] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 03/14/2018] [Accepted: 03/28/2018] [Indexed: 01/07/2023] Open
Abstract
The purpose of this systematic review is to assess the associations among education, income and dietary pattern (DP) in children and adolescents from high, medium and low human development countries (HHDC, MHDC and LHDC, respectively). Observational studies that evaluated the association between family income or education with the DP are obtained through electronic database searches. Forty articles are selected for review. In HHDC, education is inversely associated with "unhealthy" DP and positively associated with "healthy" DP. In cross-sectional studies from HHDC, higher income is negatively associated with "unhealthy" DP. In MHDC, there is no association between the socioeconomic variables (SE) and the DPs, although, in some studies, the unhealthy diet is positively associated with SE. Only one study conducted in LHDC showed an inverse association between income/education with "unhealthy" DP and there is no association between the SE and "healthy" DP. In conclusion, children and adolescents living in HHDC with high parental education tend to have a healthier diet. In MHDC, although an unhealthy diet is found among the high-income and educated population, the associations are not clear. Additional research is needed to clarify the associations between income and education with "unhealthy" and "healthy" DPs in MHDC and LHDC.
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Affiliation(s)
- Patrícia de Fragas Hinnig
- Postgraduate Program in Nutrition, Health Sciences Center, Federal University of Santa Catarina, CCS/UFSC, Campus Trindade, Florianopolis 88040-900, Brazil.
| | - Jordanna Santos Monteiro
- Postgraduate Program in Human Nutrition, Faculty of Health Sciences, University of Brasília (UnB), Brasilia-DF 70910-900, Brazil.
| | - Maria Alice Altenburg de Assis
- Postgraduate Program in Nutrition, Health Sciences Center, Federal University of Santa Catarina, CCS/UFSC, Campus Trindade, Florianopolis 88040-900, Brazil.
| | - Renata Bertazzi Levy
- Preventive Medicine Department, University of São Paulo (FMUSP), São Paulo 01246-903, Brazil.
| | - Marco Aurélio Peres
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, SA 5005, Australia.
| | - Fernanda Machado Perazi
- Postgraduate Program in Nutrition, Health Sciences Center, Federal University of Santa Catarina, CCS/UFSC, Campus Trindade, Florianopolis 88040-900, Brazil.
| | - André Luís Porporatti
- Brazilian Centre for Evidence-Based Research Department of Dentistry, Federal University of Santa Catarina CCS/UFSC, Campus Trindade, Florianopolis 88040-900, Brazil.
| | - Graziela De Luca Canto
- Brazilian Centre for Evidence-Based Research Department of Dentistry, Federal University of Santa Catarina CCS/UFSC, Campus Trindade, Florianopolis 88040-900, Brazil.
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Oakley L, Benova L, Macleod D, Lynch CA, Campbell OMR. Early breastfeeding practices: Descriptive analysis of recent Demographic and Health Surveys. MATERNAL AND CHILD NUTRITION 2017; 14:e12535. [PMID: 29034551 PMCID: PMC5900960 DOI: 10.1111/mcn.12535] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 07/19/2017] [Accepted: 09/11/2017] [Indexed: 11/28/2022]
Abstract
The aim of this study was to describe early breastfeeding practices (initiation within 1 hr of birth, no prelacteal feeding, and a combination of both—“optimal” early breastfeeding) according to childbirth location in low‐ and middle‐income countries. Using data from the most recent Demographic and Health Survey (2000–2013) for 57 countries, we extracted information on the most recent birth for women aged 15–49 with a live birth in the preceding 24 months. Childbirth setting was self‐reported by location (home or facility) and subtype (home delivery with or without a skilled birth attendant; public or private facility). We produced overall world and four region‐level summary statistics by applying national population adjusted survey weights. Overall, 39% of children were breastfed within 1 hr of birth (region range 31–60%), 49% received no prelacteal feeding (41–65%), and 28% benefited from optimal early breastfeeding (21–46%). In South/Southeast Asia and Sub‐Saharan Africa, early breastfeeding outcomes were more favourable for facility births compared to home births; trends were less consistent in Latin America and Middle East/Europe. Among home deliveries, there was a higher prevalence of positive breastfeeding practices for births with a skilled birth attendant across all regions other than Latin America. For facility births, breastfeeding practices were more favourable among those taking place in the public sector. This study is the most comprehensive assessment to date of early breastfeeding practices by childbirth location. Our results suggest that skilled delivery care—particularly care delivered in public sector facilities—appears positively correlated with favourable breastfeeding practices.
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Affiliation(s)
- Laura Oakley
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Lenka Benova
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - David Macleod
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Caroline A Lynch
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Oona M R Campbell
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Langer-Gould A, Wu J, Lucas R, Smith J, Gonzales E, Amezcua L, Haraszti S, Chen LH, Quach H, James JA, Barcellos LF, Xiang AH. Epstein-Barr virus, cytomegalovirus, and multiple sclerosis susceptibility: A multiethnic study. Neurology 2017; 89:1330-1337. [PMID: 28855411 DOI: 10.1212/wnl.0000000000004412] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 06/30/2017] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To determine whether Epstein-Barr virus (EBV) or cytomegalovirus (CMV) seropositivity is associated with multiple sclerosis (MS) in blacks and Hispanics and to what extent measures of the hygiene hypothesis or breastfeeding could explain these findings. EBV and CMV have been associated with MS risk in whites, and the timing and frequency of both viruses vary by factors implicated in the hygiene hypothesis. METHODS Incident cases of MS or its precursor, clinically isolated syndrome (CIS), and matched controls (blacks, 111 cases/128 controls; Hispanics, 173/187; whites, 235/256) were recruited from the membership of Kaiser Permanente Southern California. Logistic regression models accounted for HLA-DRB1*1501 status, smoking, socioeconomic status, age, sex, genetic ancestry, and country of birth. RESULTS Epstein-Barr nuclear antigen-1 (EBNA-1) seropositivity was independently associated with an increased odds of MS/CIS in all 3 racial/ethnic groups (p < 0.001 for blacks and whites, p = 0.02 for Hispanics). In contrast, CMV seropositivity was associated with a lower risk of MS/CIS in Hispanics (p = 0.004) but not in blacks (p = 0.95) or whites (p = 0.96). Being born in a low/middle-income country was associated with a lower risk of MS in Hispanics (p = 0.02) but not after accounting for EBNA-1 seropositivity. Accounting for breastfeeding did not diminish the association between CMV and MS in Hispanics. CONCLUSIONS The consistency of EBNA-1 seropositivity with MS across racial/ethnic groups and between studies points to a strong biological link between EBV infection and MS risk. The association between past CMV infection and MS risk supports the broader hygiene hypothesis, but the inconsistency of this association across racial/ethnic groups implies noncausal associations.
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Affiliation(s)
- Annette Langer-Gould
- From Department of Research & Evaluation (A.L.-G., J.W., J.S., E.G., S.H., L.H.C., A.H.X.), Kaiser Permanente Southern California, Pasadena; Neurology Department (A.L.-G.), Southern California Permanente Medical Group, Los Angeles Medical Center; Biology & Environment (R.L.), National Centre for Epidemiology and Population Health, College of Medicine, Australian National University, Canberra; Department of Neurology (L.A.), Keck School of Medicine, University of Southern California, Los Angeles; QB3 Genetic Epidemiology and Genomics Laboratory (H.Q., L.F.B.), School of Public Health, University of California, Berkeley; and Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center (J.A.J.), Oklahoma City. S. Haraszti is now at Philadelphia College of Osteopathic Medicine, PA.
| | - Jun Wu
- From Department of Research & Evaluation (A.L.-G., J.W., J.S., E.G., S.H., L.H.C., A.H.X.), Kaiser Permanente Southern California, Pasadena; Neurology Department (A.L.-G.), Southern California Permanente Medical Group, Los Angeles Medical Center; Biology & Environment (R.L.), National Centre for Epidemiology and Population Health, College of Medicine, Australian National University, Canberra; Department of Neurology (L.A.), Keck School of Medicine, University of Southern California, Los Angeles; QB3 Genetic Epidemiology and Genomics Laboratory (H.Q., L.F.B.), School of Public Health, University of California, Berkeley; and Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center (J.A.J.), Oklahoma City. S. Haraszti is now at Philadelphia College of Osteopathic Medicine, PA
| | - Robyn Lucas
- From Department of Research & Evaluation (A.L.-G., J.W., J.S., E.G., S.H., L.H.C., A.H.X.), Kaiser Permanente Southern California, Pasadena; Neurology Department (A.L.-G.), Southern California Permanente Medical Group, Los Angeles Medical Center; Biology & Environment (R.L.), National Centre for Epidemiology and Population Health, College of Medicine, Australian National University, Canberra; Department of Neurology (L.A.), Keck School of Medicine, University of Southern California, Los Angeles; QB3 Genetic Epidemiology and Genomics Laboratory (H.Q., L.F.B.), School of Public Health, University of California, Berkeley; and Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center (J.A.J.), Oklahoma City. S. Haraszti is now at Philadelphia College of Osteopathic Medicine, PA
| | - Jessica Smith
- From Department of Research & Evaluation (A.L.-G., J.W., J.S., E.G., S.H., L.H.C., A.H.X.), Kaiser Permanente Southern California, Pasadena; Neurology Department (A.L.-G.), Southern California Permanente Medical Group, Los Angeles Medical Center; Biology & Environment (R.L.), National Centre for Epidemiology and Population Health, College of Medicine, Australian National University, Canberra; Department of Neurology (L.A.), Keck School of Medicine, University of Southern California, Los Angeles; QB3 Genetic Epidemiology and Genomics Laboratory (H.Q., L.F.B.), School of Public Health, University of California, Berkeley; and Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center (J.A.J.), Oklahoma City. S. Haraszti is now at Philadelphia College of Osteopathic Medicine, PA
| | - Edlin Gonzales
- From Department of Research & Evaluation (A.L.-G., J.W., J.S., E.G., S.H., L.H.C., A.H.X.), Kaiser Permanente Southern California, Pasadena; Neurology Department (A.L.-G.), Southern California Permanente Medical Group, Los Angeles Medical Center; Biology & Environment (R.L.), National Centre for Epidemiology and Population Health, College of Medicine, Australian National University, Canberra; Department of Neurology (L.A.), Keck School of Medicine, University of Southern California, Los Angeles; QB3 Genetic Epidemiology and Genomics Laboratory (H.Q., L.F.B.), School of Public Health, University of California, Berkeley; and Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center (J.A.J.), Oklahoma City. S. Haraszti is now at Philadelphia College of Osteopathic Medicine, PA
| | - Lilyana Amezcua
- From Department of Research & Evaluation (A.L.-G., J.W., J.S., E.G., S.H., L.H.C., A.H.X.), Kaiser Permanente Southern California, Pasadena; Neurology Department (A.L.-G.), Southern California Permanente Medical Group, Los Angeles Medical Center; Biology & Environment (R.L.), National Centre for Epidemiology and Population Health, College of Medicine, Australian National University, Canberra; Department of Neurology (L.A.), Keck School of Medicine, University of Southern California, Los Angeles; QB3 Genetic Epidemiology and Genomics Laboratory (H.Q., L.F.B.), School of Public Health, University of California, Berkeley; and Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center (J.A.J.), Oklahoma City. S. Haraszti is now at Philadelphia College of Osteopathic Medicine, PA
| | - Samantha Haraszti
- From Department of Research & Evaluation (A.L.-G., J.W., J.S., E.G., S.H., L.H.C., A.H.X.), Kaiser Permanente Southern California, Pasadena; Neurology Department (A.L.-G.), Southern California Permanente Medical Group, Los Angeles Medical Center; Biology & Environment (R.L.), National Centre for Epidemiology and Population Health, College of Medicine, Australian National University, Canberra; Department of Neurology (L.A.), Keck School of Medicine, University of Southern California, Los Angeles; QB3 Genetic Epidemiology and Genomics Laboratory (H.Q., L.F.B.), School of Public Health, University of California, Berkeley; and Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center (J.A.J.), Oklahoma City. S. Haraszti is now at Philadelphia College of Osteopathic Medicine, PA
| | - Lie Hong Chen
- From Department of Research & Evaluation (A.L.-G., J.W., J.S., E.G., S.H., L.H.C., A.H.X.), Kaiser Permanente Southern California, Pasadena; Neurology Department (A.L.-G.), Southern California Permanente Medical Group, Los Angeles Medical Center; Biology & Environment (R.L.), National Centre for Epidemiology and Population Health, College of Medicine, Australian National University, Canberra; Department of Neurology (L.A.), Keck School of Medicine, University of Southern California, Los Angeles; QB3 Genetic Epidemiology and Genomics Laboratory (H.Q., L.F.B.), School of Public Health, University of California, Berkeley; and Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center (J.A.J.), Oklahoma City. S. Haraszti is now at Philadelphia College of Osteopathic Medicine, PA
| | - Hong Quach
- From Department of Research & Evaluation (A.L.-G., J.W., J.S., E.G., S.H., L.H.C., A.H.X.), Kaiser Permanente Southern California, Pasadena; Neurology Department (A.L.-G.), Southern California Permanente Medical Group, Los Angeles Medical Center; Biology & Environment (R.L.), National Centre for Epidemiology and Population Health, College of Medicine, Australian National University, Canberra; Department of Neurology (L.A.), Keck School of Medicine, University of Southern California, Los Angeles; QB3 Genetic Epidemiology and Genomics Laboratory (H.Q., L.F.B.), School of Public Health, University of California, Berkeley; and Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center (J.A.J.), Oklahoma City. S. Haraszti is now at Philadelphia College of Osteopathic Medicine, PA
| | - Judith A James
- From Department of Research & Evaluation (A.L.-G., J.W., J.S., E.G., S.H., L.H.C., A.H.X.), Kaiser Permanente Southern California, Pasadena; Neurology Department (A.L.-G.), Southern California Permanente Medical Group, Los Angeles Medical Center; Biology & Environment (R.L.), National Centre for Epidemiology and Population Health, College of Medicine, Australian National University, Canberra; Department of Neurology (L.A.), Keck School of Medicine, University of Southern California, Los Angeles; QB3 Genetic Epidemiology and Genomics Laboratory (H.Q., L.F.B.), School of Public Health, University of California, Berkeley; and Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center (J.A.J.), Oklahoma City. S. Haraszti is now at Philadelphia College of Osteopathic Medicine, PA
| | - Lisa F Barcellos
- From Department of Research & Evaluation (A.L.-G., J.W., J.S., E.G., S.H., L.H.C., A.H.X.), Kaiser Permanente Southern California, Pasadena; Neurology Department (A.L.-G.), Southern California Permanente Medical Group, Los Angeles Medical Center; Biology & Environment (R.L.), National Centre for Epidemiology and Population Health, College of Medicine, Australian National University, Canberra; Department of Neurology (L.A.), Keck School of Medicine, University of Southern California, Los Angeles; QB3 Genetic Epidemiology and Genomics Laboratory (H.Q., L.F.B.), School of Public Health, University of California, Berkeley; and Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center (J.A.J.), Oklahoma City. S. Haraszti is now at Philadelphia College of Osteopathic Medicine, PA
| | - Anny H Xiang
- From Department of Research & Evaluation (A.L.-G., J.W., J.S., E.G., S.H., L.H.C., A.H.X.), Kaiser Permanente Southern California, Pasadena; Neurology Department (A.L.-G.), Southern California Permanente Medical Group, Los Angeles Medical Center; Biology & Environment (R.L.), National Centre for Epidemiology and Population Health, College of Medicine, Australian National University, Canberra; Department of Neurology (L.A.), Keck School of Medicine, University of Southern California, Los Angeles; QB3 Genetic Epidemiology and Genomics Laboratory (H.Q., L.F.B.), School of Public Health, University of California, Berkeley; and Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center (J.A.J.), Oklahoma City. S. Haraszti is now at Philadelphia College of Osteopathic Medicine, PA
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Bof de Andrade F, Drumond Andrade FC, Noronha K. Measuring socioeconomic inequalities in the use of dental care services among older adults in Brazil. Community Dent Oral Epidemiol 2017; 45:559-566. [PMID: 28745803 DOI: 10.1111/cdoe.12323] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/09/2016] [Accepted: 06/18/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The primary objectives are to assess socioeconomic inequality in the use of dental care among older Brazilian adults and to analyse the extent to which certain determinants contribute to that inequality. METHODS A cross-sectional study using data from the National Oral Health Survey conducted in 2010. All individuals answered a structured questionnaire containing questions on their use of dental care and socioeconomic conditions and underwent a clinical oral examination by a dentist. Concentration indices were decomposed to determine the contribution of socioeconomic factors to inequalities. RESULTS Being in the fifth wealth, quintile was associated with higher odds of having recently visited a dentist (reference: 1st quintile, odds-ratio (OR) 2.26, 95% confidence interval (CI) 1.51-3.38). In addition, being in the top two quintiles of wealth was negatively associated with the use of public dental services. Having eight or more years of schooling was associated with higher odds of both having a recent dental visit and receiving preventive care (relative to having 0-3 years of education), and negatively associated with using public dental services. Results indicate pro-rich inequalities in recent dental visits and preventive dental care. Further, there was a pro-poor inequality in the use of public dental care services. CONCLUSIONS The recent use of dental care and the use of preventive care are disproportionately concentrated among wealthier older adults, whereas the use of public services is more common among poorer individuals. Wealth inequalities in dental care use were mainly explained by socioeconomic factors, such as wealth and education, rather than oral health factors, such as needing treatment or a dental prosthesis.
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Affiliation(s)
| | | | - Kenya Noronha
- Center for Development and Regional Planning, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Child Refugees in Europe and Infectious Diseases: Threat or Threatened. INTERNATIONAL JOURNAL OF SCHOOL HEALTH 2017. [DOI: 10.5812/intjsh.57923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Pedraza DF. Preditores de riscos nutricionais de crianças assistidas em creches em município de porte médio do Brasil. ACTA ACUST UNITED AC 2017. [DOI: 10.1590/1414-462x2017000100xx] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Resumo Objetivos Identificar variáveis preditoras do estado nutricional (déficit de estatura, excesso de peso) de crianças assistidas em creches públicas municipais de Campina Grande, Paraíba, Brasil. Metodologia Estudo transversal que analisou a associação de variáveis das crianças, maternas e socioeconômicas com o déficit de estatura e o excesso de peso de crianças assistidas em creches. Os dados antropométricos foram obtidos obedecendo às recomendações da Organização Mundial da Saúde. Resultados Das 793 crianças estudadas, 6,4% foram diagnosticadas com déficit de estatura e 31,8% com excesso de peso. Maiores prevalências de déficit de estatura foram encontradas, em relação às respectivas categorias de referência, nos casos de crianças que nasceram com baixo peso, de mães com baixa estatura, de domicílios sem coleta de lixo e de famílias numerosas. Domicílios com consumo de água para beber não tratada e sem rede de esgoto foram preditores do excesso de peso. Conclusões O estado nutricional de crianças assistidas em creches caracteriza-se pela manutenção da baixa estatura que coexiste com prevalências maiores de excesso de peso, diagramado pelas condições socioeconômicas e por antecedentes como o baixo peso ao nascer e a baixa estatura materna.
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Akseer N, Bhatti Z, Rizvi A, Salehi AS, Mashal T, Bhutta ZA. Coverage and inequalities in maternal and child health interventions in Afghanistan. BMC Public Health 2016; 16 Suppl 2:797. [PMID: 27634540 PMCID: PMC5025831 DOI: 10.1186/s12889-016-3406-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Afghanistan has made considerable gains in improving maternal and child health and survival since 2001. However, socioeconomic and regional inequities may pose a threat to reaching universal coverage of health interventions and further health progress. We explored coverage and socioeconomic inequalities in key life-saving reproductive, maternal, newborn and child health (RMNCH) interventions at the national level and by region in Afghanistan. We also assessed gains in child survival through scaling up effective community-based interventions across wealth groups. Methods Using data from the Afghanistan Multiple Indicator Cluster Survey (MICS) 2010/11, we explored 11 interventions that spanned all stages of the continuum of care, including indicators of composite coverage. Asset-based wealth quintiles were constructed using standardised methods, and absolute inequalities were explored using wealth quintile (Q) gaps (Q5-Q1) and the slope index of inequality (SII), while relative inequalities were assessed with ratios (Q5/Q1) and the concentration index (CIX). The lives saved tool (LiST) modeling used to estimate neonatal and post-neonatal deaths averted from scaling up essential community-based interventions by 90 % coverage by 2025. Analyses considered the survey design characteristics and were conducted via STATA version 12.0 and SAS version 9.4. Results Our results underscore significant pro-rich socioeconomic absolute and relative inequalities, and mass population deprivation across most all RMNCH interventions studied. The most inequitable are antenatal care with a skilled attendant (ANCS), skilled birth attendance (SBA), and 4 or more antenatal care visits (ANC4) where the richest have between 3.0 and 5.6 times higher coverage relative to the poor, and Q5-Q1 gaps range from 32 % - 65 %. Treatment of sick children and breastfeeding interventions are the most equitably distributed. Across regions, inequalities were highest in the more urbanised East, West and Central regions of the country, while they were lowest in the South and Southeast. About 7700 newborns and 26,000 post-neonates could be saved by scaling up coverage of community outreach interventions to 90 %, with the most gains in the poorest quintiles. Conclusions Afghanistan is a pervasively poor and conflict-prone nation that has only recently experienced a decade of relative stability. Though donor investments during this period have been plentiful and have contributed to rebuilding of health infrastructure in the country, glaring inequities remain. A resolution to scaling up health coverage in insecure and isolated regions, and improving accessibility for the poorest and marginalised populations, should be at the forefront of national policy and programming efforts. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3406-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nadia Akseer
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Zaid Bhatti
- Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan
| | - Arjumand Rizvi
- Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan
| | - Ahmad S Salehi
- London School of Hygiene & Tropical Medicine, London, UK.,Afghanistan Ministry of Labor, Social Affairs, Martyrs and Disabled, Kabul, Afghanistan.,Former Ministry of Public Health, Kabul, Afghanistan
| | - Taufiq Mashal
- Former Ministry of Public Health, Kabul, Afghanistan
| | - 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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Pedraza DF. Linear growth of children attending public daycare centers in the municipality of Campina Grande, Paraíba, Brazil. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2016; 19:451-63. [PMID: 27532765 DOI: 10.1590/1980-5497201600020019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 07/14/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To identify variables predictors of linear growth in preschool children attending public child day care centers of Campina Grande, Paraíba. METHODS A cross-sectional study on a probabilistic sample of 335 children attending child day care centers. Were obtained information about socioeconomic, maternal and children's characteristics. The height/age (Z-score) was analyzed as continuous dependent variable. Anthropometric data were obtained in compliance with the recommendations of the World Health Organization. The Multicentre Growth Reference Study was used as the reference population. The data were subjected to multiple linear regression analysis using the hierarchical model. RESULTS Children who slept in rooms with at least two people, households without garbage collection, households with no refrigerator, rural zone, illiterate mothers, mothers of short stature, low birth weight and stay in child day care center at part time were the conditions associated with worse height/age of children. CONCLUSION There is a clear difference in linear growth with multicausal characteristic in which the low birth weight, as an expression of adverse history, and the socioeconomic conditions, as an expression of health inequities, profiling the genetic potential of growth.
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Pedraza DF, Oliveira MMD, Cardoso MVLML, Araujo EMND, Rocha ACD. Índices antropométricos de crianças assistidas em creches e sua relação com fatores socioeconômicos, maternos e infantis. CIENCIA & SAUDE COLETIVA 2016; 21:2219-32. [DOI: 10.1590/1413-81232015217.11712015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 08/22/2015] [Indexed: 11/21/2022] Open
Abstract
Resumo Os índices antropométricos peso/estatura e peso/idade destacam-se, respectivamente, por sua importância na identificação de mudanças recentes de peso e de alterações no estado nutricional de forma precoce. O objetivo deste estudo foi analisar fatores associados ao peso/estatura e peso/idade em crianças pré-escolares. Trata-se de um estudo transversal com amostra probabilística que analisou 299 crianças assistidas em creches públicas municipais. As informações foram obtidas por meio de entrevista com as mães, mediante aplicação de um questionário com informações socioeconômicas, maternas e infantis. O peso e a estatura/comprimento das crianças foram medidos seguindo as recomendações da Organização Mundial de Saúde. Os resultados evidenciaram que nenhuma das variáveis maternas associou-se ao estado nutricional das crianças e que apenas o peso ao nascer, dentre as variáveis infantis, apresentou associação aos escores de peso/estatura (p = 0,0030) e peso/idade (p = 0,0018). O bloco de variáveis socioeconômicas, por sua vez, mostrou-se como o mais representativo fator de variação dos resultados encontrados, sobretudo no peso/idade. Conclui-se sobre a relevância do peso ao nascer no peso/estatura e peso/idade das crianças, bem como das condições socioeconômicas, marcadamente, no peso/idade .
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Mariapun J, Hairi NN, Ng CW. Are the Poor Dying Younger in Malaysia? An Examination of the Socioeconomic Gradient in Mortality. PLoS One 2016; 11:e0158685. [PMID: 27362581 PMCID: PMC4928844 DOI: 10.1371/journal.pone.0158685] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 06/20/2016] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Socioeconomic inequalities in health represent unfairness in the health distribution of a population. Efforts to produce information on mortality distributions in many low and middle income countries (LMICs) are mostly hampered by lack of data disaggregated by socioeconomic groups. In this paper we describe how mortality statistics obtained from multiple data sources were combined to provide an evaluation of the socioeconomic distribution of mortality in Malaysia, a LMIC located in the Asia Pacific region. METHODS This study has an ecological design. As a measure of socioeconomic status, we used principal component analysis to construct a socioeconomic index using census data. Districts were ranked according to the standardised median index of households and assigned to each individual in the 5-year mortality data. The mortality indicators of interest were potential years of life lost (PYLL), standardised mortality ratio (SMR), infant mortality rate (IMR) and under-5 mortality rate (U5MR). Both socioeconomic status and mortality outcomes were used compute the concentration index which provided the summary measure of the magnitude of inequality. RESULTS Socially disadvantaged districts were found to have worse mortality outcomes compared to more advantaged districts. The values of the concentration index for the overall population of the Peninsula are C = -0.1334 (95% CI: -0.1605 to -0.1063) for the PYLL, C = -0.0685 (95% CI: -0.0928 to -0.0441) for the SMR, C = -0.0997 (95% CI: -0.1343 to -0.0652) for the IMR and C = -0.1207 (95% CI: -0.1523 to -0.0891) for the U5MR. Mortality outcomes within ethnic groups were also found to be less favourable among the poor. CONCLUSION The findings of this study suggest that socioeconomic inequalities disfavouring the poor exist in Malaysia.
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Affiliation(s)
- Jeevitha Mariapun
- Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Noran N. Hairi
- Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Chiu-Wan Ng
- Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
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Kabudula CW, Houle B, Collinson MA, Kahn K, Tollman S, Clark S. Assessing Changes in Household Socioeconomic Status in Rural South Africa, 2001-2013: A Distributional Analysis Using Household Asset Indicators. SOCIAL INDICATORS RESEARCH 2016; 133:1047-1073. [PMID: 28931968 PMCID: PMC5579134 DOI: 10.1007/s11205-016-1397-z] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/18/2016] [Indexed: 06/07/2023]
Abstract
Understanding the distribution of socioeconomic status (SES) and its temporal dynamics within a population is critical to ensure that policies and interventions adequately and equitably contribute to the well-being and life chances of all individuals. This study assesses the dynamics of SES in a typical rural South African setting over the period 2001-2013 using data on household assets from the Agincourt Health and Demographic Surveillance System. Three SES indices, an absolute index, principal component analysis index and multiple correspondence analysis index, are constructed from the household asset indicators. Relative distribution methods are then applied to the indices to assess changes over time in the distribution of SES with special focus on location and shape shifts. Results show that the proportion of households that own assets associated with greater modern wealth has substantially increased over time. In addition, relative distributions in all three indices show that the median SES index value has shifted up and the distribution has become less polarized and is converging towards the middle. However, the convergence is larger from the upper tail than from the lower tail, which suggests that the improvement in SES has been slower for poorer households. The results also show persistent ethnic differences in SES with households of former Mozambican refugees being at a disadvantage. From a methodological perspective, the study findings demonstrate the comparability of the easy-to-compute absolute index to other SES indices constructed using more advanced statistical techniques in assessing household SES.
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Affiliation(s)
- Chodziwadziwa W. Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Brian Houle
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Demography, The Australian National University, Canberra, Australia
- Institute of Behavioral Science, University of Colorado at Boulder, Boulder, CO USA
| | - Mark A. Collinson
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
- Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
- Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
- Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Samuel Clark
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Institute of Behavioral Science, University of Colorado at Boulder, Boulder, CO USA
- INDEPTH Network, Accra, Ghana
- Department of Sociology, University of Washington, Seattle, WA USA
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Palma N, Gomes C, Riveros M, García W, Martínez-Puchol S, Ruiz-Roldán L, Mateu J, García C, Jacobs J, Ochoa TJ, Ruiz J. Virulence factors profiles and ESBL production in Escherichia coli causing bacteremia in Peruvian children. Diagn Microbiol Infect Dis 2016; 86:70-5. [PMID: 27345125 DOI: 10.1016/j.diagmicrobio.2016.05.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 05/17/2016] [Accepted: 05/24/2016] [Indexed: 11/19/2022]
Abstract
The presence of 25 virulence genes (VGs), genetic phylogroups, quinolone-resistance and Extended Spectrum β-lactamase (ESBL)-production was assessed in 65 Escherichia coli isolates from blood cultures in children <5 years in Peru. The most frequent VGs were fimA (89.2%), iutA (83.1%), agn43 (72.3%), iucA (67.7%), and fyuA (49.2%). The isolates belonged to D (47.7%), A (26.1%), B1 (21.5%), and B2 (4.6%) phylogroups. D + B2 isolates presented a high number of fimA, hly, papC, sat, and fyuA genes. Quinolone-susceptible (22 isolates - 33.8%) and ESBL-negative (31 isolates - 47.7%) isolates carried more VGs that their respective counterparts (5.7 vs. 4.7 and 5.3 vs. 4.4 respectively); the frequency of the fyuA, aat, aap, and hly genes significantly differed between quinolone-resistant and quinolone-susceptible isolates. Neonatal sepsis isolates tended to be more quinolone-resistant (P = 0.0697) and ESBL-producers (P = 0.0776). Early-onset neonatal sepsis isolates possessed a high number of VGs (5.2 VGs), especially in neonates of ≤1 day (5.9 VGs).
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Affiliation(s)
- Noemí Palma
- Barcelona Institute for Global Health, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Cláudia Gomes
- Barcelona Institute for Global Health, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Maribel Riveros
- Instituto de Medicina Tropical Alexander von Humboldt - Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Wilfredo García
- Instituto de Medicina Tropical Alexander von Humboldt - Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Sandra Martínez-Puchol
- Barcelona Institute for Global Health, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Lidia Ruiz-Roldán
- Barcelona Institute for Global Health, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Judit Mateu
- Barcelona Institute for Global Health, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Coralith García
- Instituto de Medicina Tropical Alexander von Humboldt - Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jan Jacobs
- Institute of Tropical Medicine, Antwerp, Belgium; Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Theresa J Ochoa
- Instituto de Medicina Tropical Alexander von Humboldt - Universidad Peruana Cayetano Heredia, Lima, Peru; University of Texas, Texas School of Public Health, Houston, TX, USA
| | - Joaquim Ruiz
- Barcelona Institute for Global Health, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
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Sousa CPDC, de Olinda RA, Pedraza DF. Prevalence of stunting and overweight/obesity among Brazilian children according to different epidemiological scenarios: systematic review and meta-analysis. SAO PAULO MED J 2016; 134:251-62. [PMID: 27355800 PMCID: PMC10496595 DOI: 10.1590/1516-3180.2015.0227121] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 11/12/2015] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Within the Brazilian nutritional panorama, coexistence of antagonistic nutritional disorders can be seen, especially the increasing prevalence of overweight and the persistence of significant rates of chronic malnutrition in vulnerable groups of the population. Because these are major public health problems, this study aimed to ascertain the prevalence of stunting and overweight/obesity among Brazilian children according to different epidemiological scenarios. DESIGN AND SETTING This was a systematic review of prevalence studies, developed at the State University of Paraíba. METHODS The SciELO, Lilacs and PubMed databases were searched for articles, using specific keywords. Articles published between 2006 and 2014 were selected. The review was conducted by two reviewers who worked independently. A systematic review with meta-analysis was conducted, for which the studies were grouped within different epidemiological settings. RESULTS Among the 33 articles recovered, 9 involved samples from daycare centers, 4 had samples from public healthcare services or social registers, 5 related to populations in situations of social inequity and 15 were population-based. Higher chances of stunting were found in populations in situations of social inequity and in those at public healthcare services or on social registers, in relation to reference populations. For overweight/obesity, none of the scenarios had a higher chance than the reference. CONCLUSION Among Brazilian children, stunting continues to be a socially determined public health problem that mainly affects marginalized populations. This problem coexists with significant rates of overweight/obesity affecting all social groups.
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Affiliation(s)
| | - Ricardo Alves de Olinda
- PhD. Professor in the Department of Statistics, Universidade Estadual da Paraíba (UEPB), Campina Grande, PB, Brasil.
| | - Dixis Figueroa Pedraza
- PhD. Professor in the Department of Nursing and Postgraduate Public Health Program, Universidade Estadual da Paraíba (UEPB), Campina Grande, PB, Brasil.
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PEDRAZA DFIGUEROA. Crescimento linear das crianças brasileiras: reflexões no contexto da equidade social. REV NUTR 2016. [DOI: 10.1590/1678-98652016000200011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
O artigo teve por objetivo refletir a respeito do crescimento linear das crianças no contexto da equidade social e sistematizou, primeiramente, os resultados das pesquisas que analisaram fatores associados ao declínio do deficit de estatura das crianças menores de cinco anos no Brasil. Posteriormente, os resultados foram contextualizados do ponto de vista da equidade social. Os nove artigos revisados mostraram variação temporal positiva do deficit de estatura, com valores nacionais que oscilaram de 37,1 a 7,1%; na região Nordeste a variação foi de 33,9 a 5,9%. Quatro razões principais explicaram o declínio do deficit de estatura: 1) aumento do poder aquisitivo/renda familiar nos lares de baixo poder aquisitivo; 2) melhoria da escolaridade materna; 3) expansão da rede pública de saneamento básico, e 4) expansão dos cuidados básicos de saúde. Porém, destacam-se disparidades que marcam a persistência das iniquidades sociais relacionadas ao deficit de estatura no País, as quais prejudicam populações marginalizadas. Enfoca-se a necessidade de refletir a baixa estatura na perspectiva da influência mediada pela situação da segurança alimentar, do estado nutricional de micronutrientes e dos modos de vida contemporâneos. Na perspectiva das políticas públicas, ressalta-se a importância do trabalho intersetorial. Em conclusão, sugere-se que apesar do declínio do deficit de estatura no Brasil, como reflexo do impacto das políticas públicas, ainda persistem iniquidades com vulnerabilidade marcada em grupos socioculturais desfavorecidos. Assim, o enfrentamento desta conjuntura torna imprescindível o direcionamento das pesquisas e das ações para esses segmentos populacionais.
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Abstract
AbstractObjectiveIn many countries of the world millions of people are not registered at birth. However, in order to assess children’s nutritional status it is necessary to have an exact knowledge of their age. In the present paper we discuss the effects of insufficient or imprecise age data on estimates of undernutrition prevalence.DesignBirth registration rates and levels of stunting, underweight and wasting were retrieved from Multiple Indicator Cluster Surveys and Demographic and Health Surveys of thirty-seven sub-Saharan African countries, considering the subdivision in wealth quintiles. The composition of the cross-sectional sample used for nutritional evaluation was analysed using a permutation test. Logistic regression was applied to analyse the relationship between birth registration and undernutrition. The 95 % probability intervals and Student’s t test were used to evaluate the effect of age bias and error.ResultsHeterogeneous sampling designs were detected among countries, with different percentages of children selected for anthropometry. Further, registered children were slightly more represented within samples used for nutritional analysis than in the total sample. A negative relationship between birth registration and undernutrition was recognized, with registered children showing a better nutritional status than unregistered ones, even within each wealth quintile. The over- or underestimation of undernutrition in the case of systematic over- or underestimation of age, respectively, the latter being more probable, was quantified up to 28 %. Age imprecision was shown to slightly overestimate undernutrition.ConclusionsSelection bias towards registered children and underestimation of children’s age can lead to an underestimation of the prevalence of undernutrition.
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