Parental Smoking and Under-Five Child Mortality in Southeast Asia: Evidence from Demographic and Health Surveys

Determinants of prematurity in urban Indonesia: a meta-analysis

OBJECTIVES

Indonesia is the fifth country with the highest number of preterm births worldwide. More than a third of neonatal deaths in Indonesia were attributed to preterm birth. Residential areas affected the occurrence of preterm birth due to differing socioeconomic and environmental conditions. Many studies have investigated the determinants of prematurity in Indonesia, however, most of them were performed in rural areas. This study is the first meta-analysis describing the determinants of preterm birth in urban Indonesia, which aimed to become the foundation upon implementing the most suitable preventative measure and policy to reduce the rate of preterm birth.

METHODS

We collected all published papers investigating the determinants of preterm birth in urban Indonesia from PubMed MEDLINE and EMBASE, using keywords developed from the following key concepts: "preterm birth", "determinants", "risk factors", "Indonesia" and the risk factors, such as "high-risk pregnancy", "anemia", "pre-eclampsia", and "infections". Exclusion criteria were multicenter studies that did not perform a specific analysis on the Indonesian population or did not separate urban and rural populations in their analysis, and articles not available in English or Indonesian. The Newcastle Ottawa Scale was used to assess the risk of bias. This systematic review was registered in PROSPERO.

RESULTS

Sixteen articles were included in the analysis and classified into five categories: genetic factors, nutrition, smoking, pregnancy characteristics or complications, and disease-related characteristics.

CONCLUSIONS

Our meta-analysis revealed adolescent pregnancy, smoking, eclampsia, bacterial vaginosis, LC-PUFA, placental vitamin D, and several minerals as the significant determinants of preterm birth in urban Indonesia.

Prevalence and risk factors associated with under-five mortality in the Solomon Islands: an investigation from the 2015 Solomon Islands demographic and health survey data

Background

Annually, over five million children die before their fifth birthday worldwide, with 98% of these deaths occurring in low-and middle-income countries. The prevalence and risks for under-five mortality are not well-established for the Solomon Islands.

Methods

We used the Solomon Islands Demographic and Health Survey 2015 data (SIDHS 2015) to estimate the prevalence and risk factors associated with under-five mortality.

Findings

Neonatal, infant, child and under-five mortality prevalence were 8/1000, 17/1000, 12/1000 and 21/1000 live births, respectively. After adjustment for potential confounders, neonatal mortality was associated with no breastfeeding [aRR 34.80 (13.60, 89.03)], no postnatal check [aRR 11.36 (1.22, 106.16)], and Roman Catholic [aRR 3.99 (1.34, 11.88)] and Anglican [aRR 2.78 (0.89, 8.65); infant mortality to no breastfeeding [aRR 11.85 (6.15, 22.83)], Micronesian [aRR 5.54 (1.67, 18.35)], and higher birth order [aRR 2.00 (1.03, 3.88)]; child mortality to multiple gestation [aRR 6.15 (2.08, 18.18)], Polynesian [aRR 5.80 (2.48, 13.53)], and Micronesian [aRR 3.65 (1.46, 9.10)], cigarette and tobacco [aRR 1.77 (0.79, 3.96)] and marijuana use [aRR 1.94 (0.43, 8.73)] and rural residence [aRR 1.85 (0.88, 3.92)]; under-five mortality to no breastfeeding [aRR 8.65 (4.97, 15.05)], Polynesian [aRR 3.23 (1.09, 9.54)], Micronesian [aRR 5.60 (2.52, 12.46)], and multiple gestation [aRR 3.34 (1.26, 8.88)]. Proportions of 9% for neonatal and 8% of under-five mortality were attributable to no maternal tetanus vaccination.

Interpretation

Under-five mortality in the Solomon Islands from the SIDHS 2015 data was attributable to maternal health, behavioural, and sociodemographic risk factors. We recommended future studies to confirm these associations.

Funding

No funding was declared to support this study directly.

Determinants of under-five mortality in Indonesia: A nationwide study

BACKGROUND

The mortality rate for infants and children under five in Indonesia is an ongoing challenge for the government, with figures exceeding the targets set for the country by the Sustainable Development Goals (SDGs).

OBJECTIVES

This study aims to discover the factors causing under-five mortality in Indonesia.

METHODS

This study will employ a cross-sectional study design with data sourced from the 2017 Indonesian Demographic and Health Survey (IDHS) between July and September 2017. The sample included 10,014 women who had given birth in the five years prior to the survey. The data was analyzed using Binary logistic regression with a significance level of p < 0.05.

RESULTS

The significant factors relating to under-five mortality in Indonesia are: mother's age at birth (AOR = 2.04; 95% CI 95% = 1.11-3.77); birth weight (AOR = 7.60; 95% CI 95% = 5.17-11.19); the sex of the child (AOR = 1.80; 95% CI 95% = 1.28-2.52); frequency of using the internet (AOR = 1.13; 95% CI 95% = 0.02-0.95); residence (AOR = 0.64; 95% CI 95% = 0.33-0.94); and birth interval (AOR = 0.52; 95% CI 95% = 0.29-0.92). Birth weight is the more likely cause for under-five mortality in Indonesia.

CONCLUSIONS

This study revealed that the characteristics of mothers, children, the area of residence, and the behavior of the mother affect the under-five mortality.

PRACTICE IMPLICATIONS

Pediatric nurses can have a role to play in developing knowledge about health for both mothers and families. Additionally, accessible health education on issues from planning a pregnancy to childcare should be promoted in both rural and urban areas as well as a campaign on proper hygiene practices.

Attributable risk of household solid fuel use and second-hand smoke associated with under-5 mortality in 46 low- and lower-middle-income countries, 2010-2020

BACKGROUND

Household solid fuel use (including indoor and outdoor) and second-hand smoke (SHS) are considered to be major contributors of under-5 mortality (U5M) in low- and lower-middle-income countries (LMICs). This study provides a comprehensive assessment of their odds ratios and attributable mortality in LMICs.

METHODS

We used the Demographic Health Surveys data for under-5 children in 46 LMICs (n = 778,532) from 2010 to 2020. Mixed effect multilevel logistic regressions were conducted to estimate the pooled adjusted odds ratio (aOR) for U5M due to solid fuel use, SHS and their combination compared to no exposure to them in 46 LMICs. The attributable mortality of solid fuel use, SHS, and their combination were assessed for each LMIC.

FINDINGS

The pooled aOR of solid fuel use and SHS for U5M was estimated to be 1.27 (95% Confidence Interval (CI): 1.19-1.36) and 1.13 (95%CI: 1.06-1.25), respectively, whereas those of their combination was 1.40 (95%CI: 1.31-1.50). U5M attributable to indoor and outdoor solid fuel use was the highest in Myanmar (18.0%) and the Gambia (16.5%), respectively, while those attributable to SHS was the highest in Indonesia (9.8%). U5M attributable to the combination of solid fuel use and SHS was the highest in Timor-Leste (22.7%).

INTERPRETATION

The combined effect of exposure to solid fuel and SHS had a higher risk of U5M than the individual risk. The use of clean fuel and tobacco control measures should be integrated with other child health promotion policies.

FUNDING

This research was partially supported by a research grant from the Ministry of Education, Culture, Sports, Science and Technology of Japan (21H03203).

The Association of Passive Smoking and Dyslipidemia Among Adolescence in Japan: Results From A-CHILD Study

CONTEXT

Passive smoking in childhood has been reported to be associated with dyslipidemia in Western countries. However, this association in Asian countries remains unclear. Further, no study has investigated the sex difference of the association.

OBJECTIVE

This study aimed to elucidate the association between passive smoking and dyslipidemia in adolescent boys and girls in Japan.

METHODS

We used a cross-sectional data of junior high school students in the Adachi Child Health Impact of Living Difficulty (A-CHILD) study in Adachi City, Tokyo, Japan in 2016 and 2018. Of the 1431 available students, 1166 students and their parents responded to the survey, including frequency of passive smoking (response rate 81.5%). We assessed dyslipidemia using total cholesterol (TC) levels, low-density lipoprotein cholesterol (LDL-C) levels and high-density lipoprotein cholesterol (HDL-C) levels. The association between passive smoking and dyslipidemia was evaluated by using multivariate regression analyses adjusted for socioeconomic status and lifestyle factors stratified by boys (N = 564) and girls (N = 602).

RESULTS

Among boys, HDL-C levels were significantly lower if exposed to passive smoking frequently, compared with those not exposed (β = -3.19; 95% CI, -5.84 to -0.55). However, this trend does not hold true among girls. Passive smoking was not associated with TC levels and LDL-C levels in either boys or girls.

CONCLUSION

We found that exposure to passive smoking was associated with HDL-C level among boys in Japan, but not in girls. Further longitudinal study is needed to confirm the association between passive smoking and dyslipidemia among boys in Japan.

Uncontrolled hypertension among tobacco-users: women of prime childbearing age at risk in India

BACKGROUND

Uncontrolled hypertension and tobacco use are two major public health issues that have implications for reproductive outcomes. This paper examines the association between tobacco-use status and uncontrolled hypertension among prime childbearing age (20-35) women in India.

METHODS

We used the India National Family Health Survey (NFHS-4) 2015-2016 to obtain data on hypertension status and tobacco use for 356,853 women aged 20-35. We estimated multivariate logistic regressions to obtain the adjusted odds ratio for tobacco users in favor of having uncontrolled hypertension. We examined the adjusted odds at different wealth index quintiles, at different educational attainment, and at different level of nutritional status measured by body mass index.

RESULTS

We found that the odds of having uncontrolled hypertension for the tobacco user women in India was 1.1 (95% CI: 1.01-1.19) times that of tobacco non-users at prime childbearing age. The odds were higher for tobacco-users at the poorest quintile (1.27, 95% CI: 1.14-1.42) and with no education (1.22, 95% CI: 1.10-1.34). The odds were also higher for tobacco-users who were overweight (1.88, 95% CI: 1.57-2.29) or obese (2.82, 95% CI: 1.88-4.24).

CONCLUSIONS

Our findings highlight the disproportionate dual risk of uncontrolled hypertension and tobacco use among lower-income women of prime childbearing age, identifying an opportunity for coordinated tobacco control and hypertension prevention initiatives to ensure better health of reproductive-age women in India.

Exposures influencing the developing central autonomic nervous system

Autonomic nervous system function is critical for transition from in-utero to ex-utero life and is associated with neurodevelopmental and neuropsychiatric outcomes later in life. Adverse prenatal and neonatal conditions and exposures can impair or alter ANS development and, as a result, may also impact long-term neurodevelopmental outcomes. The objective of this article is to provide a broad overview of the impact of factors that are known to influence autonomic development during the fetal and early neonatal period, including maternal mood and stress during and after pregnancy, fetal growth restriction, congenital heart disease, toxic exposures, and preterm birth. We touch briefly on the typical development of the ANS, then delve into both in-utero and ex-utero maternal and fetal factors that may impact developmental trajectory of the ANS and, thus, have implications in transition and in long-term developmental outcomes. While many types of exposures and conditions have been shown to impact development of the autonomic nervous system, there is still much to be learned about the mechanisms underlying these influences. In the future, more advanced neuromonitoring tools will be required to better understand autonomic development and its influence on long-term neurodevelopmental and neuropsychological function, especially during the fetal period.