Differential effects of young maternal age on child growth

Predictive role of NICU-related stress, postpartum depression trajectory and family coping on growth trajectory of moderate-to-late preterm infants: A longitudinal study

AIMS

To describe the changes in moderate-to-late preterm infants' (MLPIs) growth during 12 months of corrected age (CA) and to examine the predictive role of NICU-related stress, postpartum depression trajectory and family coping ability on the physical developmental trajectory of MLPIs.

DESIGN

A prospective longitudinal study.

METHODS

There were 237 mother-infant dyads with at least two follow-up data records included. General characteristics and NICU-related stress were recorded from medical records at baseline. Infants' physical growth was measured at 40 weeks, 1, 3, 6, 9 and 12 months CA during outpatient follow-up. Maternal postpartum depressive symptoms and family coping ability were assessed by questionnaires at 1, 3, 6, 9 and 12 months CA and 1 month CA respectively. We investigated the modifiable factors inside and outside of NICU on the trajectories of physical growth in the first year in MLPIs, mainly by using latent growth curve models with time-varying covariates.

RESULTS

The curved trajectories of weight, length and head circumference in the first year in MLPIs demonstrated gradually slowed growth rates and these infants were above the WHO growth standards for the same age and sex. The latent growth curve models indicated that more NICU-related stress was negatively associated with the weight and length at 40 weeks CA, and family coping ability (parent-child relationship) at 1 month CA was associated with the growth rate of weight. Besides, more NICU-related stress predicted faster length growth rate. The infants of mothers who were in the group of high-level postpartum depression trajectory had a slower growth rate of head circumference.

CONCLUSIONS

Our study identified the modifiable factors along the care continuum influencing the trajectory of MLPIs' physical growth. Nurses should receive more training about infant stress measurement and family-centred care to work in partnership with parents so that MLPIs can reach their full developmental potential. Also, multidisciplinary interventions including stress reduction strategies, close psychological monitoring and education improving parent-infant relationships should be further developed to achieve optimizing growth in the first year of MLPIs.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

It is recommended that nurses pay attention to the long-term physical growth status of MLPIs, and closely support their families. Quantifying NICU-related stress and developing reduction strategies should be the priority for clinical staff during hospitalization. After discharge, persistent screening of depressive symptoms, psychological intervention and education about the parent-child relationship need to be included in the follow-up visits.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution. The study only included patients who were research participants.

Nutritional status and dietary intake among Nigerian adolescent: a systematic review

INTRODUCTION

The prevailing nutritional conditions and the triple challenge of malnutrition faced by adolescents have adverse consequences for both the present and future generations' health and nutrition. Summarizing the available research on the nutritional status and dietary habits of adolescents in Nigeria is crucial.

OBJECTIVE

This study aims to systematically evaluate available literature on the nutritional status of adolescent aged 10 to 19years in Nigeria.

METHODOLOGY

A systematic search using PRISMA guideline was conducted. Three electronic databases were searched i.e., PubMed, Web of Science and Scopus using specific terms and keywords for online articles published between 2013 and 2023. After applying specified inclusion and exclusion criteria, 51 articles were selected for data extraction, synthesis and quality assessment.

RESULTS

Of the 51 included studies, 78.4% were conducted in the Southern Nigeria, 11.8% in the Northern Nigeria and 9.8% included both regions. The prevalence of overweight ranged between 0.8 and 31% and obesity ranged between 0.1 and 14%. The prevalence of thinness, stunting and underweight ranged between 3 and 31%, 0.4 to 41.6%, 0.3 to 73.3% respectively. The review also identified an inadequate intake of essential nutrients including iron, zinc, calcium, vitamin A, C, D, niacin, thiamin, riboflavin, cobalamin, and folate, with vitamin A deficiency prevalence ranges from 44 to 96%. The dietary patterns were characterized by a high consumption of cereals grains and starchy foods, low animal proteins, fast-food with soft drinks, and limited consumption of fruits and vegetables along with meal skipping.

CONCLUSION

These findings portray a complex picture of the nutritional challenges faced by this demographic group, highlighting both undernutrition and overnutrition, poor eating behaviour and micronutrient deficiency as significant concerns. The review revealed regional disparities in research representation, with a concentration of studies in Southern Nigeria. This highlights the importance of directing research efforts toward the northern regions, where the prevalence of nutritional issues is equally severe, but less studied.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42023481095.

Trends, patterns and predictors of high-risk fertility behaviour among Indian women: evidence from National Family Health Survey

BACKGROUND

Numerous studies have demonstrated that high-risk fertility behaviour (HRFB), which includes maternal age below 18 or above 34 years, short birth intervals (less than 24 months), and high parity (birth order above 4), is associated with adverse maternal and child health outcomes. There is a substantial research gap in the domain of high-risk fertility behaviour in the Indian context. Therefore, this study is designed to investigate the current trends and patterns in the prevalence of high-risk births among Indian women, with a primary focus on identifying contributing factors associated with this prevalence.

METHODS

The study utilized data from the nationally representative National Family Health Survey (NFHS), which has been conducted in five rounds since 1992-93. Data from all rounds were used to assess the overall trend. However, data from the most recent round of NFHS, conducted during 2019-21, were employed to evaluate current levels and patterns of HRFB prevalence and to identify socio-economic and demographic predictors of HRFB using binomial and multinomial logistic regression models.

RESULTS

The prevalence of HRFB has exhibited a consistent decreasing pattern from 1992 to 93 to 2019-21 in India. However, 29.56% of married women continue to experience high-risk births with notably higher rates in several states (e.g., 49.85% in Meghalaya and 46.41% in Bihar). Furthermore, socio-demographic factors like wealth index, educational level, social group, religion, mass media exposure, family size, age at marriage, type and region of residence, and reproductive factors like birth intention, place and type of delivery, ANC visits and current contraceptive use were identified as significant predictors of high-risk births among women in India.

CONCLUSION

Despite a 20.4 percentage point decline in HRFB prevalence over the past three decades, a significant proportion of women in specific regions and demographic subgroups continue to experience high-risk births. Therefore, the present study recommends interventions aimed at preventing high-risk births among women in India, with particular emphasis on states with high HRFB prevalence and women from socioeconomically disadvantaged backgrounds.

Trends of risk factors associated with childhood stunting and anaemia in Ghana: evidence from the Demographic Health Survey and Multiple Indicator Cluster Survey (2003-2017)

OBJECTIVE

This study investigated the trend of effect estimates of the key risk factors of childhood stunting and anaemia between 2003 and 2017.

DESIGN

A secondary analysis of the Demographic Health Survey (DHS) and Multiple Indicator Cluster Survey (MICS) data for the Ghanaian population between 2003 and 2017. Associations of selected socio-demographic (child age and gender; maternal age and education), economic (household wealth), environmental, dietary (minimum dietary diversity and iodine use) and health system (place of delivery and vaccination) factors were explored using the Poisson regression model. Trend analysis was explored using a fitted linear regression line on a time series plot.

SETTING

Ghana.

PARTICIPANTS

Children under 5 years.

RESULTS

The results showed a reduction in the prevalence of stunting and anaemia over the 15-year duration. These health outcomes were found to be negatively associated with a wide array of socio-demographic (child age and gender, maternal age and education, residency), economic (household wealth), dietary (iodised salt use) and health service (place of delivery and vaccination) factors; however, the most consistent statistically significant association was observed between child's age and belonging to the poor wealth quintile.

CONCLUSION

In order to prevent these indicators of child malnutrition, key consideration must be given to the early developmental stages of life. Child health policies must focus on addressing the key contextual factors of child malnutrition.

Adolescent pregnancy is associated with child undernutrition: Systematic review and meta-analysis

Adolescent pregnancy is associated with poor fetal growth and development which, in turn, increases the risk of childhood wasting and underweight. However, evidence on how young maternal age affects childhood anthropometry beyond the neonatal period is limited. This systematic review and meta-analysis examined associations between adolescent pregnancy and child wasting and underweight and explored potential underlying social and biological factors. Peer-reviewed literature published in English since 1990 was systematically searched. Eligible studies presented data on wasting and/or underweight in children (≤59 months) born to adolescent mothers (10-19, or ≤24 years where applicable) from low- and middle-income countries. Data extraction used a predefined extraction sheet. Both meta-analysis and qualitative synthesis were performed. Of 92 identified studies, 57 were included in the meta-analysis. The meta-analysis showed that children born to adolescent versus adult mothers were at a higher risk of moderate (odds ratio [OR]: 1.12, 95% confidence interval [CI]: 1.00-1.26 p = 0.04) and severe underweight (OR: 1.21, 95% CI: 1.08-1.35 p < 0.01). Associated risk of wasting was not statistically significant: (OR: 1.05, 95% CI: 0.98-1.12 p = 0.17); severe wasting (OR: 1.16, 95% CI: 0.68-1.96 p = 0.59). These findings were supported by the qualitative synthesis. Evidence on the potential role of biological/social factors was limited, but suggested an intermediary role of maternal nutritional status which warrants further exploration. Particularly in contexts where adolescent pregnancy remains common, interventions to both delay adolescent pregnancy and improve adolescent nutritional status could help reduce the risk of undernutrition in children and contribute to breaking the intergenerational cycle of malnutrition.

Predictors of height in Romanian infants 6-23 months old: findings from a national representative sample

BACKGROUND

The research explored the association between infants' height and various demographic factors in Romania, a country where such critical information has been lacking.

METHODS

This study was conducted on a nationally representative sample and used a family physicians database to determine a sample of 1532 children (713 girls and 819 boys) 6-23 months of age (M = 14.26; SD = 5.15). Infants' height-for-age z-scores (HAZ) were calculated using the World Health Organization's computing algorithm. A multiple regression analysis was conducted to investigate whether certain risk factors, such as infant mother's age, location, marital status, socioeconomic status (SES), as well as infant's term status at birth, age, anemia, minimum dietary diversity (MDD) and birth order, could significantly predict the HAZ.

RESULTS

The study identified several significant predictors of height. Specifically, lower HAZ was associated with rural living, preterm birth, age 18-23 months, unmarried mothers, anemia, lack of MDD and being third or later born in the family. In contrast, higher HAZ was associated with medium or high maternal SES and older maternal age.

CONCLUSIONS

The study underscores the importance of addressing these significant risk factors through distinct interventions to improve height outcomes in at-risk Romanian populations.

Nutritional status of young children born with low birthweight in a low resource setting: an observational study

OBJECTIVE

Every year, an estimated 20 million babies are born with low birthweight and this number is increasing globally. Survivors are at risk of lifelong morbidities like undernutrition. We assessed the growth and nutritional status for children born with low birthweight at Mulago Hospital, Uganda.

METHODS

We conducted a cross sectional study to describe the nutritional status of children aged between 22 and 38 months and born weighing ≤ 2000 g. Anthropometric measurements; weight for height, height for age and weight for age z-scores were generated based on the World Health Organization standards to define wasting, stunting and underweight respectively. Data was collected using a structured questionnaire and analysis was done using STATA version 14.

RESULTS

Of the 251 children, 129 (51.4%) were male, mean age was 29.7 months SD 4.5) and maternal mean age was 29.9 (SD 5.3). A total of 101(40.2%) had normal nutritional status. The prevalence of wasting, underweight and stunting were: 8 (3.2%), 36 (14.4%) and 106 (42.2%) respectively.

CONCLUSION

Six of ten children born with low birthweight were at risk of undernutrition in early childhood: underweight and stunting were higher than the national prevalence. Targeted interventions are needed for children with very low birth weight.

Evaluation of malnutrition and screening tools in hospitalized children

BACKGROUND & AIMS

Detecting malnutrition and its related risk factors are crucial, in hospitalized children. Anthropometric z scores are used to assess malnutrition. Screening tools also aim to detect the presence of malnutrition and the developing risk of malnutrition in hospitalized children to determine who may benefit from nutritional support. Therefore, the aims of the study are to detect malnutrition and its related demographic and clinical risk factors in hospitalized children and determining the sensitivity of Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP) and Pediatric Yorkhill Malnutrition Score (PYMS) screening tools.

METHODS

A total of 130 hospitalized children aged between 0 and 18 years were included in to study. A survey including demographic and clinical characteristics, STAMP and PYMS were applied to parents of the children. Patients were classified into nutritional risk groups through screening tools. Anthropometric measurements (body weight, length/height, and middle upper arm circumference (MUAC) of the children were taken. Body mass index-for-age and height-for-age z scores were calculated to assess acute and chronic malnutrition prevalence. MUAC-for-age z scores were calculated as well. To detect independent risk factors for acute and chronic malnutrition multivariable logistic regression models were constructed.

RESULTS

A total of 14.6% of hospitalized children had acute malnutrition, 21.5% of children had chronic malnutrition and 27.7% of them had low MUAC standard deviation score (SDS) (less than -2). The independent risk factors for acute malnutrition were younger maternal age at birth and long length of stay (p < 0.05). The independent risk factors for chronic malnutrition were being female, younger maternal age at birth, longer illness duration and having urological or allergy and immunological diseases (p < 0.05). However, MUAC for age SDS groups were not related to any demographic and clinical factors, in children of all ages (p > 0.05). Regarding the screening tools, PYMS displayed 100% sensitivity against acute malnutrition. While PYMS displayed better sensitivity to identify acute malnutrition than STAMP, STAMP was more sensitive than PYMS to detect chronic malnutrition and low MUAC SDS.

CONCLUSIONS

Low MUAC for age SDS was not related to any demographic and clinical factors, in hospitalized children of all ages, unlike acute and chronic malnutrition, in this study. Pediatric screening tools mainly PYMS did not have high sensitivity to detect chronic malnutrition and low MUAC SDS, in hospitalized children. Therefore, the tools have to be used along with z scores of anthropometric parameters.

The trajectories of physical growth in 4 months postnatal corrected age among preterm infants discharged from neonatal intensive care units and associated factors: A prospective study

Objectives

Growth retardation is a risk for premature infants. In addition to demographic and perinatal factors, preterm infants' physical growth may be affected by neonatal intensive care unit (NICU) stress, maternal postpartum depression, and mother-infant interaction. This study aimed to investigate the trajectories of physical growth in 4 months corrected age among preterm infants discharged from the NICU and the impactors on these trajectories.

Methods

A prospective study was conducted among 318 preterm infants from September 2019 to April 2021 in Shanghai, China. Latent growth modeling was applied to identify the weight, length, and head circumference growth trajectories in 4 months corrected age and explore the effects of demographic and medical characteristics, infant stress during NICU stay, maternal postpartum depression, and mother-infant interaction on each trajectory.

Results

Unconditional latent growth models showed curve trajectories with increasingly slower growth in weight, length, and head circumference until 4 months of corrected age. Conditional latent growth models showed that a longer length of stay in the NICU and more skin punctures were negatively associated with weight at 40 weeks corrected gestational age (β = -0.43 and -0.19, respectively, P < 0.05). The maternal postpartum depression between 40 weeks corrected gestational age and 1 month corrected postnatal age was associated with a lower growth rate of length (β = -0.17, P = 0.040), while between 2 and 3 months corrected postnatal age, there were lower growth rates of weight and head circumference (β = -0.15 and -0.19, respectively, P < 0.05). The mother-infant interaction scores between 40 weeks corrected gestational age and 1 month corrected postnatal age negatively predicted the growth rate of weight (β = -0.19, P = 0.020).

Conclusion

The physical growth trajectories of preterm infants discharged from the NICU were influenced by infant stress during the NICU stay, maternal postpartum depression and mother-infant interaction.

Association of maternal risk factors with fetal aneuploidy and the accuracy of prenatal aneuploidy screening: a correlation analysis based on 12,186 karyotype reports

BACKGROUND

NIPT is becoming increasingly important as its use becomes more widespread in China. More details are urgently needed on the correlation between maternal risk factors and fetal aneuploidy, and how these factors affect the accuracy of prenatal aneuploidy screening.

METHODS

Information on the pregnant women was collected, including maternal age, gestational age, specific medical history and results of prenatal aneuploidy screening. Additionally, the OR, validity and predictive value were also calculated.

RESULTS

A total of 12,186 analysable karyotype reports were collected with 372 (3.05%) fetal aneuploidies, including 161 (1.32%) T21, 81 (0.66%) T18, 41 (0.34%) T13 and 89 (0.73%) SCAs. The OR was highest for maternal age less than 20 years (6.65), followed by over 40 years (3.59) and 35-39 years (2.48). T13 (16.95) and T18 (9.40) were more frequent in the over-40 group (P < 0.01); T13 (3.62/5.76) and SCAs (2.49/3.95) in the 35-39 group (P < 0.01). Cases with a history of fetal malformation had the highest OR (35.94), followed by RSA (13.08): the former was more likely to have T13 (50.65) (P < 0.01) and the latter more likely to have T18 (20.50) (P < 0.01). The sensitivity of primary screening was 73.24% and the NPV was 98.23%. The TPR for NIPT was 100.00% and the respective PPVs for T21, T18, T13 and SCAs were 89.92, 69.77, 53.49 and 43.24%, respectively. The accuracy of NIPT increased with increasing gestational age (0.81). In contrast, the accuracy of NIPT decreased with maternal age (1.12) and IVF-ET history (4.15).

CONCLUSIONS

①Pregnant patients with maternal age below 20 years had higher risk of aneuploidy, especially in T13; ②A history of fetal malformations is more risky than RSA, with the former more likely to have T13 and the latter more likely to have T18; ③Primary screening essentially achieves the goal of identifying a normal karyotype, and NIPT can accurately screen for fetal aneuploidy; ④A number of maternal risk factors may influence the accuracy of NIPT diagnosis, including older age, premature testing, or a history of IVF-ET. In conclusion, this study provides a reliable theoretical basis for optimizing prenatal aneuploidy screening strategies and improving population quality.

The Effect of Parenting Peer Education Interventions for Young Mothers on the Growth and Development of Children under Five

One of the contributing factors in the growth and development of children under five is the mother's ability to provide childcare, but young mothers do not have enough parenting skills. The goal of the current study was to examine the effect of the parenting peer education (PPE) programme on young mothers' parenting self-efficacy and behaviour, and the growth and development of children under five. There were two groups, which were a control group (without intervention) and an intervention group, in which there were 15 participants in each group. Analysis covariance with the pre-test scores as covariates was used in this study. The results showed that, compared with the control group, the intervention group reported significantly better parenting self-efficacy, parenting behaviour, children's growth, and children's development, including cognitive, language, and motoric aspects. The PPE programme can exchange the young mothers' experiences on how their children grow and develop, and the mothers will also receive psychological support. In conclusion, the PPE programme affected the young mothers' parenting self-efficacy and parenting behaviour and the children's growth and development.

Cord blood epigenome-wide meta-analysis in six European-based child cohorts identifies signatures linked to rapid weight growth

BACKGROUND

Rapid postnatal growth may result from exposure in utero or early life to adverse conditions and has been associated with diseases later in life and, in particular, with childhood obesity. DNA methylation, interfacing early-life exposures and subsequent diseases, is a possible mechanism underlying early-life programming.

METHODS

Here, a meta-analysis of Illumina HumanMethylation 450K/EPIC-array associations of cord blood DNA methylation at single CpG sites and CpG genomic regions with rapid weight growth at 1 year of age (defined with reference to WHO growth charts) was conducted in six European-based child cohorts (ALSPAC, ENVIRONAGE, Generation XXI, INMA, Piccolipiù, and RHEA, N = 2003). The association of gestational age acceleration (calculated using the Bohlin epigenetic clock) with rapid weight growth was also explored via meta-analysis. Follow-up analyses of identified DNA methylation signals included prediction of rapid weight growth, mediation of the effect of conventional risk factors on rapid weight growth, integration with transcriptomics and metabolomics, association with overweight in childhood (between 4 and 8 years), and comparison with previous findings.

RESULTS

Forty-seven CpGs were associated with rapid weight growth at suggestive p-value <1e-05 and, among them, three CpGs (cg14459032, cg25953130 annotated to ARID5B, and cg00049440 annotated to KLF9) passed the genome-wide significance level (p-value <1.25e-07). Sixteen differentially methylated regions (DMRs) were identified as associated with rapid weight growth at false discovery rate (FDR)-adjusted/Siddak p-values < 0.01. Gestational age acceleration was associated with decreasing risk of rapid weight growth (p-value = 9.75e-04). Identified DNA methylation signals slightly increased the prediction of rapid weight growth in addition to conventional risk factors. Among the identified signals, three CpGs partially mediated the effect of gestational age on rapid weight growth. Both CpGs (N=3) and DMRs (N=3) were associated with differential expression of transcripts (N=10 and 7, respectively), including long non-coding RNAs. An AURKC DMR was associated with childhood overweight. We observed enrichment of CpGs previously reported associated with birthweight.

CONCLUSIONS

Our findings provide evidence of the association between cord blood DNA methylation and rapid weight growth and suggest links with prenatal exposures and association with childhood obesity providing opportunities for early prevention.

WNT5A, β‑catenin and SUFU expression patterns, and the significance of microRNA deregulation in placentas with intrauterine growth restriction

Placental insufficiency is a common cause of intrauterine growth restriction (IUGR). It affects ~10% of pregnancies and increases fetal and neonatal morbidity and mortality. Although Wnt and Hh pathways are crucial for embryonic development and placentation, their role in the pathology of IUGR is still not sufficiently explored. The present study analyzed the expression of positive regulators of the Wnt pathway, WNT5A and β‑catenin, and the expression of the Hh pathway negative regulator suppressor of fused (SUFU). Immunohistochemical and reverse transcription‑quantitative PCR (RT‑qPCR) assays were performed on 34 IUGR and 18 placental tissue samples from physiologic singleton‑term pregnancies. Epigenetic mechanisms of SUFU gene regulation were also investigated by methylation‑specific PCR analysis of its promoter and RT‑qPCR analysis of miR‑214‑3p and miR‑378a‑5p expression. WNT5A protein expression was higher in endothelial cells of placental villi from IUGR compared with control tissues. That was also the case for β‑catenin protein expression in trophoblasts and endothelial cells and SUFU protein expression in trophoblasts from IUGR placentas. The SUFU gene promoter remained unmethylated in all tissue samples, while miR‑214‑3p and miR‑378a‑5p were downregulated in IUGR. The present results suggested altered Wnt and Hh signaling in IUGR. DNA methylation did not appear to be a mechanism of SUFU regulation in the pathogenesis of IUGR, but its expression could be regulated by miRNA targeting.

Understanding the associations between maternal high-risk fertility behaviour and child nutrition levels in India: evidence from the National Family Health Survey 2015-2016

Anthropometric markers are the most important aspect of a child's health assessment. Using large-scale nationally representative data from the National Family Health Survey (NFHS-4), 2015-2016, this study aimed to investigate the relationship between children born to women with high-risk fertility behaviours and children's health outcomes. The sample consisted of 2,55,726 children of currently married women aged 15-49 years in India. The key explanatory variable, high-risk fertility behaviour was defined by women's age at birth (below 18 or above 34 years), birth interval (less than 24 months), and higher birth orders (four and above). The key outcome variables for assessing child health outcomes were stunting, wasting, and underweight in children aged 0-59 months. We used descriptive statistics, Pearson's chi-square test and logistic regression models to analyse the objectives. Approximately 33% of children were born with any single high-risk condition in the last 5 years in India. The bivariate analysis showed that all three components of child health, stunting, wasting, and underweight, were higher among children born to women with high-risk fertility behaviour. The findings from the multivariable analysis suggest that children born with a high risk fertility behaviour were suffering from stunting (AOR = 1.30; 95% CI 1.27-1.33) and underweight (AOR = 1.23; 95% CI 1.20-1.27). In addition, children born to women of multiple high-risk categories had higher odds of stunting (AOR = 1.53; 95% CI 1.46-1.59) and underweight (AOR = 1.38; 95% CI 1.32-1.44) as compared to children born to women with no risk. Our findings highlight an urgent need for effective legislation to prevent child marriage that would be helpful in increasing the maternal age at birth. The government should also focus on the interventions in health education and improvement of reproductive healthcare to promote optimal birth spacing.

Maternal Risk Factor on Incidence of Stunting in South Sumatera

BACKGROUND: Stunting is an adverse result condition of unfulfilled nutritional intake during pregnancy and early childhood, which affects the children’s maximum height and optimal cognitive potential. Stunting is influenced by numerous factors, both from the mother and children. Research has proven that factors related to mothers of children under 5 have essential roles in the incidence of stunting. AIM: This study intends to analyze the influence of maternal risk factors on the incidence of stunting in children under 5 in districts/cities in South Sumatra. METHODS: This study is quantitative research with a cross-sectional design, with secondary data sources from Basic Health Research 2018, carried out in 17 districts/cities in South Sumatra. RESULTS: The mothers’ characteristics most significantly related to stunting in children under 5 in the South Sumatra region are the mother’s height and mother’s education. Mothers with a height <150 cm have a 1.547 times higher risk of having stunting children (95% CI: 1.281–1.868), and mothers with low education have a 1.521 times higher risk of having stunting children (95% CI: 1.094–2.116). Moreover, mothers with secondary education are at 1.473 times higher risk of having stunting children (95% CI: 1.073–2.020). CONCLUSION: The maternal risk factors most associated with stunting in children under five in South Sumatra are maternal height and mother’s education.

Is there any association between undesired children and health status of under-five children? Analysis of a nationally representative sample from Bangladesh

BACKGROUND

Child health, especially childhood mortality, is one of the critical indicators of human development. No child mortality is desirable, but it is still high in Bangladesh. We aimed to assess the effect of the child's desired status on childhood morbidity and mortality in Bangladesh.

METHODS

We used the data from the nationally representative cross-sectional Bangladesh Demographic and Health Survey (BDHS) 2017-18 and restricted the analyses to children born in the past five years preceding the survey. We estimated the undesired status (excess in boy, girl, both, and parity) by subtracting an ideal number of children from the total live birth. We measured childhood mortality (perinatal, early neonatal, neonatal, post-neonatal, infant, child, and under-five mortality), morbidity (fever, diarrhea, cough, and acute respiratory infectious-ARI), nutritional problems (stunting, wasting, underweight, and low birth weight), and treatments (postnatal care, treatment for fever, diarrhea/cough, and vitamin A supplementation). Finally, we utilized the chi-square test and multilevel mixed-effects logistic regression analyses.

RESULTS

The prevalence of undesired children was 19.2%, 21.5%, 3.7%, and 25.4% for boys, girls, both boys and girls, and parity, respectively. Age, education, residence, division, and wealth index were significantly associated with undesired children. The prevalence of under-five mortality was 3.3% among desired children, almost double (5.4%) among undesired children. The likelihood of under-five mortality was [adjusted odds ratio (aOR): 2.05, p ≤ 0.001] higher among undesired children. Despite lower under-five mortality among higher socioeconomic status, the relative contribution of undesired children to under-fiver mortality was substantial. The undesired girl children were associated with an increased likelihood of moderately wasting (aOR: 1.28, p = 0.072), severely underweight (aOR: 1.41, p = 0.066), and low birth weight (aOR: 1.50, p ≤ 0.05). Moreover, the undesired children were 19% (p ≤ 0.05) more likely to be infected with fever. The undesired children had lower treatment for diarrhea and fever/cough and were less likely to get vitamin A supplementation (aOR: 0.71, p ≤ 0.001).

CONCLUSIONS

The share of childhood morbidity, mortality, and malnutrition were higher among undesired children. Every child should be wanted, and no unwanted pregnancies are desirable; thereby, the government should reemphasize the proper use of family planning methods to reduce child mortality and malnutrition.

Household structure, maternal characteristics and children's stunting in sub-Saharan Africa: evidence from 35 countries

BACKGROUND

Adequate nutrition in early childhood is a necessity to achieve healthy growth and development, as well as a strong immune system and good cognitive development. The period from conception to infancy is especially vital for optimal physical growth, health and development. In this study we examined the influence of household structure on stunting in children <5 yrs of age in sub-Saharan Africa (SSA) countries.

METHODS

Demographic and Health Survey data from birth histories in 35 SSA countries were used in this study. The total sample of children born within the 5 yrs before the surveys (2008 and 2018) was 384 928. Children whose height-for-age z-score throughout was <-2 SDs from the median of the WHO reference population were considered stunted. Percentages and χ2 tests were used to explore prevalence and bivariate associations of stunting. In addition, a multivariable logistic regression model was fitted to stunted children. All statistical tests were conducted at a p<0.05 level of significance.

RESULTS

More than one-third of children in SSA countries were reportedly stunted. The leading countries include Burundi (55.9%), Madagascar (50.1%), Niger (43.9%) and the Democratic Republic of the Congo (42.7%). The percentage of stunted children was higher among males than females and among rural children than their urban counterparts in SSA countries. Children from polygamous families and from mothers who had been in multiple unions had a 5% increase in stunting compared with children from monogamous families and mothers who had only one union (AOR 1.05 [95% CI 1.02 to 1.09]). Furthermore, rural children were 1.23 times as likely to be stunted compared with urban children (AOR 1.23 [95% CI 1.16 to 1.29]). Children having a <24-mo preceding birth interval were 1.32 times as likely to be stunted compared with first births (AOR 1.32 [95% CI 1.26 to 1.38]). In addition, there was a 2% increase in stunted children for every unit increase in the age (mo) of children (AOR 1.02 [95% CI 1.01 to 1.02]). Multiple-birth children were 2.09 times as likely to be stunted compared with a singleton (AOR 2.09 [95% CI 1.91 to 2.28]).

CONCLUSIONS

The study revealed that more than one-third of children were stunted in SSA countries. Risk factors for childhood stunting were also identified. Effective interventions targeting factors associated with childhood stunting, such as maternal education, advanced maternal age, male sex, child's age, longer birth interval, multiple-birth polygamy, improved household wealth and history of mothers' involvement in multiple unions, are required to reduce childhood stunting in the region.

Effect of adolescent pregnancy on child mortality in 46 countries

INTRODUCTION

Adolescent pregnancy is a known health risk to mother and child. Statements and reports of health outcomes typically group mothers under 20 years old together. Few studies examined this risk at a finer age resolution, none of them comprehensively, and with differing results.

METHODS

We analysed Demographic and Health Surveys data from 2004 to 2018 in sub-Saharan Africa (SSA) and South Asia, on firstborn children of mothers 25 years old or younger. We examined the association between maternal age and stillbirths, and neonatal mortality rate (NNMR), infant mortality rate (IMR) and under-5 mortality rate (U5MR), using mixed-effects logistic regression adjusting for major demographic variables and exploring the impact of maternal health-seeking.

RESULTS

In both regions and across all endpoints, mortality rates of children born to mothers aged <16 years, 16-17 years and 18-19 years at first birth were about 2-4 times, 1.5-2 times and 1.2-1.5 times higher, respectively, than among firstborn children of mothers aged 23-25. Absolute mortality rates declined over time, but the age gradient remained similar across time periods and regions. Adjusting for rural/urban residence and maternal education, in SSA in 2014-2018 having a <16-year-old mother was associated with ORs of 3.71 (95% CI: 2.50 to 5.51) for stillbirth, 1.92 (1.60-2.30) for NNMR, 2.13 (1.85-2.46) for IMR and 2.39 (2.13-2.68) for U5MR, compared with having a mother aged 23-25. In South Asia, in 2014-2018 ORs were 5.12 (2.85-9.20) for stillbirth, 2.46 (2.03-2.97) for NNMR, 2.62 (2.22-3.08) for IMR and 2.59 (2.22-3.03) for U5MR. Part of the effect on NNMR and IMR may be mediated by a lower maternal health-seeking rate.

CONCLUSIONS

Adolescent pregnancy is associated with dramatically worse child survival and mitigated by health-seeking behaviour, likely reflecting a combination of biological and social factors. Refining maternal age reporting will avoid masking the increased risk to children born to very young adolescent mothers. Collection of additional biological and social data may better reveal mediators of this relationship. Targeted intervention strategies to reduce unintended pregnancy at earlier ages may also improve child survival.

Understanding Discrepancies in Nutritional Outcomes Among Under-Fives in Laos: A Mixed-Methods Study Using the Positive Deviance Approach

BACKGROUND

Stunting is one of the main contributing factors in the under-five mortality rate worldwide. In Laos, the prevalence of stunting remains high, particularly in mountainous rural areas. To prevent stunting, insight into positive deviant behaviors can help understand how people can cope or adapt in resource-poor settings.

OBJECTIVE

This study aims to analyze the practices and underlying factors that explain discrepancies in nutritional outcomes in children under the age of 5 in remote mountainous areas in Laos.

METHODS

This mixed-methods study included all children under the age of 5 living in 6 selected villages. Anthropometric measurements were taken, and a Z-score for stunting was calculated to select the positive and negative deviant children. To identify the causes of discrepancies in childhood stunting, household questionnaires, focus group discussions, observations, and individual interviews with family members and health workers were conducted.

RESULTS

Fifty-five percent of children were stunted. Inappropriate care and feeding practices were observed such as providing unbalanced diets and not attending health facilities. Positive deviant mothers were less likely to follow inappropriate practices, experienced less food insecurity, and had higher motivation and autonomy, which resulted in prioritizing their children's health. An active role of fathers seemed to benefit positive practices within households.

CONCLUSIONS

The combination of many different practices in which positive deviant families are doing slightly better resulted in less stunting of children. Those practices are related to the household resources, such as access to food and social support; and the mother's motivation, autonomy, and perspectives on child health.

Maternal age at marriage and child nutritional status and development: evidence from Serbian Roma communities

OBJECTIVE

This study aimed to assess whether maternal age at first marriage is associated with nutritional and developmental penalties in Roma children.

DESIGN

Roma nationally representative population-based study. Proxies for child nutritional outcomes included children's individual-level height-for-age z (HAZ) and weight-for-age z (WAZ) scores, HAZ and WAZ scores below two standard deviations from the median of WHO's reference population (children aged 0-59 months), and Early Child Development (children aged 36-59 months). Multiple and logistic regressions were used to estimate the association between maternal age at marriage and the outcomes, and other sociodemographic determinants as possible confounders.

SETTING

Aggregated data from UNICEF's fifth and sixth Multiple Indicator Cluster Surveys for Serbian Roma settlements.

SUBJECTS

Children (n= 2652) aged 0-59 months born to ever-married women aged 15-48.

RESULTS

64% of women married before age 18, 19% of children were stunted, 9% wasted, and Early Child Development score was low. Maternal age at first marriage was not associated with either nutritional status or early development of Roma children. Weight at birth (children aged 0-24) emerged as the main predictor of children's nutritional status. Boys were more likely to be shorter, more stunted and wasted than girls. Child's age, maternal parity and unimproved toilet facility negatively impacted nutritional status, while maternal literacy mitigated against poor nutritional and developmental outcomes.

CONCLUSIONS

Roma children up to 5 years of age bear no negative consequences of maternal early marriage. The underlying determinants of children's wellbeing include improved sanitation, child characteristics, maternal literacy and reproductive behavior, and parental investment.

Factors associated with adverse nutritional status of children in sub-Saharan Africa: Evidence from the Demographic and Health Surveys from 31 countries

Undernutrition is linked to almost half of all deaths in under-five children. In 2019, 144 million under-five children suffered from stunting and 47 million suffered from wasting. This study examined the factors that influence adverse nutritional status of children in sub-Saharan Africa. The study used data from the Demographic and Health Surveys (DHS) of 31 countries, which involved 189,195 children under age 5. Binary logistic regression was used to examine the relationships between the independent variables and adverse nutritional status of children. About 26% of the children in the 31 countries in sub-Saharan Africa considered in this study are stunted, 6% are wasted and 21% are underweight. Close to 31% of children whose mothers have no education are stunted, 9% are wasted and 28% are underweight. Adverse nutritional status of children is significantly associated with maternal age, education, household wealth, residence, antenatal care attendance, mass media exposure, child's sex and size of child at birth. This study has shown that adverse nutritional status of children is a major challenge in sub-Saharan Africa. Efforts at improving nutritional status of children should include poverty alleviation initiatives at individual and household levels, increase in women's educational level and improvement in living conditions in rural areas.

Determinants of normal nutrition among 0-59-month-old Filipino children living in low-income households

BACKGROUND

An alternative concept in understanding malnutrition among 0 to 59-month-old children from low-income households is to look at and understand factors contributing to their good nutritional status.

AIM

(a) Compared nutritional status of children across age groups in terms of weight-for-age, length/height-for-age, weight-for-length/height and body mass index-for-age z scores; (b) determined and compared selected characteristics of children and mothers across age; (c) identified factors affecting normal nutritional status of these children.

METHODS

Cross-sectional data from the Philippines' 8th National Nutrition Survey among 1,990 children. Differences in mean values measured using analysis of variance; chi-square test for assessing significance of association between children with normal nutritional status across child and maternal characteristics; and multivariate logistic regression to calculate adjusted odds ratio (AORs).

RESULTS

Younger (AOR =1.63-2.54), female children (AOR=1.20), mothers neither pregnant nor lactating (AOR=1.18), have high school, vocational (AOR=1.65) or college level education (AOR=2.02), household use of water-sealed toilet (AOR=1.26), having nuclear family types (AOR=1.25) indicated protection against undernutrition. Behavior-related factors that significantly predict normal nutrition among the children were "acceptable" food consumption score among households (0 to 5 and 6 to 23 months old), delivery in health facilities (6 to 23 months old) and household use of water-sealed toilets (24 to 59 months).

CONCLUSION

Based on the findings, activities and programs can be tailored around the behavior-related factors identified depending on the target age group, and pursued in crafting interventions to maintain normal nutrition among the children.

Description of an mHealth tool for breastfeeding support: LactApp. Analysis of how lactating mothers seek support at critical breastfeeding points and according to their infant's age

Interventions in mHealth have had positive effects on establishing and maintaining breastfeeding, but we still do not know what content women consult when downloading a breastfeeding mobile application. We conducted an observational, descriptive, and retrospective study using the data recorded by LactApp in 2019. The most frequently consulted topics were those related to breastfeeding technique, infant sleep, human milk management and storage, breastfeeding myths, breastfeeding stages, complementary feeding, infant care, and returning to work. Our study results suggest that LactApp's support seems to develop with mothers' needs according to their infant's development stage. The first breastfeeding days include more physiological answers. Between 15 days and 3 months, mothers look for support in topics like breastfeeding crisis/complications and returning to work. At 3 months to 1 year, answers are related to complementary feeding and weaning. When the user's infant is 1 year of age, mothers seek support for weaning, weaning management, and tandem breastfeeding.

A success story of reduction in childhood stunting and underweight in India: analysis of pooled data from three rounds of Indian Demographic and Health Surveys (1998-2016)

This study used a series of individual-level datasets from National Family Health Surveys conducted in 1998-99, 2005-06 and 2015-16 to assess the factors behind the reduction in childhood stunting and underweight in India between the years 1998-99 and 2015-16. A multivariable decomposition regression analysis was performed. Results showed that the prevalence of childhood stunting declined from 49.4% in 1998-99 to 34.9% in 2015-16. Over the same period, the prevalence of childhood underweight declined from 41.9% in 1998-99 to 33.1% in 2015-16. The reduction in the prevalence of stunting was found to be contributed largely by a reduction in the combined prevalence of stunting and underweight (60%), followed by stunted only (21%) and the combined prevalence of stunting, underweight and wasting (19%). Likewise, the reduction in the prevalence of underweight was contributed by a reduction in the combined prevalence of stunting and underweight and the combined prevalence of stunting, underweight and wasting. Results of the decomposition analysis showed that over the period 1998-99 to 2015-16, improvement in wealth status and maternal education led to 13% and 12% declines, respectively, in childhood stunting and to 31% and 19% declines, respectively, in childhood underweight. Furthermore, reductions in childhood stunting and underweight were due to an increased average number of antenatal care visits, lower average birth order, decreased share of children with below-average birth size, increased use of clean fuel for cooking and a reduction in the practice of open defecation. These findings suggest that further reduction in the prevalence of childhood stunting and underweight could be attained through more equitable household economic growth, investment in girl's education, greater access to improved toilet facilities, more widespread use of clean fuel for cooking, reduction in average birth order, increased antenatal care visits and greater consumption of IFA tablets by pregnant women. Policymakers need to prioritize these measures to further reduce malnutrition among Indian children.

Stunting of children under two from repeated pregnancy among young mothers

Repeated pregnancy leaves young mothers nutritionally deprived which may in turn lead to poor infant growth. We measure the occurrence and persistence of stunting among offspring of young mothers who experienced repeated pregnancies using data from the Cebu Longitudinal Health and Nutrition Survey. We selected mothers aged 14-24 years (n = 1,033) with singleton birth. We determined the length-for-age z scores (LAZ) at 12 and 24 months of the index child using the World Health Organisation 2007 growth standard. We fitted LAZ, stunting occurrence (i.e. LAZ < - 2) and persistence from 12 to 24 months into regression models and tested for the mediating effect of low birthweight and feeding practices. In these models, repeated pregnancy was analysed in an ordinal approach using number of past pregnancies of young mothers at birth of the index child. Compared to infants born to young mothers aged 14-24 years who had no previous pregnancies, those born to young mothers with repeated pregnancies have at least 0.15 (95% CI - 0.23, - 0.08) LAZ lower and are at higher chance of stunting by at least 40% (95% CI 1.19, 1.67) at 12 and 24 months. Similar cohorts of infants showed an elevated risk of persistent stunting from 12 through 24 months with a relative risk ratio of 1.51 (95% CI 1.21, 1.88). Optimal feeding practices substantially mediated stunting outcomes by further reducing the effects of repeated pregnancy to stunting occurrence and persistence by 19.95% and 18.09% respectively. Mediation tests also showed low birthweight in the causal pathway between repeated pregnancy and stunting. Repeated pregnancy in young mothers is a predictor of stunting among children under 2 years. Secondary pregnancy prevention measures and addressing suboptimal feeding practices are beneficial to mitigate the negative impact of repeated adolescent pregnancy on children.

Spatial prediction of childhood malnutrition across space in Nigeria based on point-referenced data: an SPDE approach

Malnutrition remains a leading cause of child mortality in Nigeria. The spatial analysis based on areal level approaches could, in reality, conceal variations at smaller units. Using point-referenced data from Nigeria Demographic and Health Survey, we quantify the prevalence of malnutrition among under-five children in Nigeria at 1.63 by 1.63 km spatial resolution, and compute the exceedance probability maps for stunting, wasting and underweight at 20% threshold level using the stochastic partial differential equation approach with Bayesian inference based on integrated nested Laplace approximation. Results show divergence prevalence of the malnutrition indicators among children living in neighbouring locations and that the prevalence of stunting and underweight increase with age. The prevalence of stunting was uneven among children living in Kebbi, Zamfara, Sokoto, Kaduna, Kano, Katsina, Bauchi, Gombe and Taraba states with more concentrations in the northern fringes of some of the states. Except for few locations in about three states, the probability is more than 90% that the prevalence of stunting in all parts of the country exceeds 20% but this was not the case for wasting. The findings can assist in location-specific policy formulation and implementations.

Perceived Conflicting Desires to Delay the First Birth: A Household-Level Exploration in Nepal

CONTEXT

It is accepted as the norm that couples in South Asia begin childbearing immediately after marriage and that, even if they would like to delay, they are pressured to have children by household members. Little research, however, has explored the desire to delay childbearing among newly married couples and their household members in Nepal-a setting with changing marriage formation patterns, increasing women's education and falling fertility.

METHODS

To explore the dynamics of current childbearing desires, in-depth interviews of 20 intact triads of newly married women, their husbands and their mothers-in-law were conducted in one district of Nepal in February-March 2017. Using thematic analysis, interviews were read and coded separately by type (wives, husbands, mothers-in-law), and then the triads were read together and coded to determine household-level patterns and themes.

RESULTS

Most newly married women and men want to delay their first birth, but have not communicated with each other about this. Even though couples are often in agreement about delaying, they feel pressured by in-laws and society to bear children early. Contrary to expectations, some mothers-in-law support delaying childbearing to allow their daughter-in-law to mature, continue her education or earn wages; however, they too perceive societal pressure. Male migration for work also contributes to early childbearing pressure.

CONCLUSIONS

Helping couples to sort through conflicting fertility norms and desires may be important to delay childbearing when desired. Programs should engage all household members, and work to increase couples' and household communication to address misperceptions about fertility desires.

The association between exposure to interferon-beta during pregnancy and birth measurements in offspring of women with multiple sclerosis

Background

Interferon-beta (IFN-beta) is a commonly used treatment for multiple sclerosis (MS). Current guidelines recommend cessation of treatment during pregnancy, however the results of past studies on the safety of prenatal exposure to IFN-beta have been conflicting. A large scale study of a population of MS women is therefore warranted.

Objectives

To assess whether, among those born to women with MS, infants prenatally exposed to IFN-beta show evidence of smaller size at birth relative to infants which were not prenatally exposed to any MS disease modifying drugs.

Methods

Swedish and Finnish register data was used. Births to women with MS in Sweden and Finland between 2005–2014 for which a birth measurement for weight, height, and head circumference was available were included. The exposure window was from 6 months prior to LMP to the end of pregnancy.

Results

In Sweden, 411 pregnancies were identified as exposed to IFN-beta during the exposure window, and 835 pregnancies were counted as unexposed to any MS DMD. The corresponding numbers for Finland were 232 and 331 respectively. Infants prenatally exposed to interferon-beta were on average 28 grams heavier (p = 0.17), 0.01 cm longer (p = 0.95), and had head circumferences 0.14 cm larger (p = 0.13) in Sweden. In Finland, infants were 50 grams lighter (p = 0.27), 0.02 cm shorter (p = 0.92) and had head circumferences 0.22 cm smaller (p = 0.15) relative to those unexposed.

Conclusions

This study provides evidence that exposure to IFN-beta during pregnancy does not influence birth weight, length, or head circumference.

Prevalence of child marriage and its impact on fertility outcomes in 34 sub-Saharan African countries

Background

The issue of child marriage is a form of human rights violation among young women mainly in resource-constrained countries. Over the past decades, child marriage has gained attention as a threat to women’s health and autonomy. This study explores the prevalence of child marriage among women aged 20–24 years in sub-Saharan Africa countries and examines the association between child marriage and fertility outcomes.

Methods

Latest DHS data from 34 sub-Saharan African countries were used in this study. Sixty thousand two hundred and fifteen women aged 20–24 years were included from the surveys conducted 2008–2017. The outcome variables were childbirth within the first year of marriage (early fertility), first preceding birth interval less than 24 months (rapid repeat of childbirth), unintended pregnancy, lifetime pregnancy termination, the use of modern contraceptive methods, lifetime fertility and any childbirth. The main explanatory variable was child marriage (< 18 years) and the associations between child marriage and fertility outcomes were examined from the ever-married subsample to estimate odds ratios (ORs) and 95% CIs using binary logistic regression models.

Results

In the study population, the overall prevalence of women who experience child marriage was 54.0% while results showed large disparities across sub-Saharan African countries ranging from 16.5 to 81.7%. The prominent countries in child marriage were; Niger (81.7%), Chad (77.9%), Guinea (72.8%), Mali (69.0%) and Nigeria (64.0%). Furthermore, women who experience child marriage were 8.00 times as likely to have ≥3 number of children ever born (lifetime fertility), compared to women married at ≥18 years (OR = 8.00; 95%CI: 7.52, 8.46). Women who experience child marriage were 1.13 times as likely to use modern contraceptive methods, compared to adult marriage women (OR = 1.13; 95%CI: 1.09, 1.19). Those who married before the legal age were 1.27 times as likely to have lifetime terminated pregnancy, compared to women married at ≥18 years (OR = 1.27; 95%CI: 1.20, 1.34). Also women married at < 18 years were more likely to experience childbirth, compared to women married later (OR = 5.83; 95%CI: 5.45, 6.24). However, women married at < 18 years had a reduction in early childbirth and a rapid repeat of childbirth respectively.

Conclusion

Implementing policies and programmmes against child marriage would help to prevent adverse outcomes among women in sub-Saharan Africa. Also, social change programmes on child-marriage would help to reduce child marriage, encourage the use of modern contraceptive, which would minimize lifetime terminated pregnancy and also children ever born.

Competition for nutrients in pregnant adolescents: consequences for maternal, conceptus and offspring endocrine systems

The competition for nutrients that arises when pregnancy coincides with continuing or incomplete growth in young adolescent girls increases the risk of preterm delivery and low birthweight with negative after-effects for mother and child extending beyond the perinatal period. Sheep paradigms involving nutritional management of weight and adiposity in young, biologically immature adolescents have allowed the consequences of differential maternal growth status to be explored. Although nutrient reserves at conception play a modest role, it is the dietary manipulation of the maternal growth trajectory thereafter which has the most negative impact on pregnancy outcome. Overnourishing adolescents to promote rapid maternal growth is particularly detrimental as placental growth, uteroplacental blood flows and fetal nutrient delivery are perturbed leading to a high incidence of fetal growth restriction and premature delivery of low birthweight lambs, whereas in undernourished adolescents further maternal growth is prevented, and depletion of the maternal body results in a small reduction in birthweight independent of placental size. Maternal and placental endocrine systems are differentially altered in both paradigms with downstream effects on fetal endocrine systems, organ development and body composition. Approaches to reverse these effects have been explored, predominantly targeting placental growth or function. After birth, growth-restricted offspring born to overnourished adolescents and fed to appetite have an altered metabolic phenotype which persists into adulthood, whereas offspring of undernourished adolescents are largely unaffected. This body of work using ovine paradigms has public health implications for nutritional advice offered to young adolescents before and during pregnancy, and their offspring thereafter.

Relationship between early-life nutrition and ages at menarche and first pregnancy, and childbirth rates of young adults: Evidence from APCAPS in India

India's Integrated Child Development Services (ICDS) provides daily supplementary nutrition and other public health services to women and children. We estimated associations between exposure to early‐childhood ICDS nutrition and adult reproductive outcomes. During 1987–1990, a balanced protein–calorie supplement called “upma”—made from locally available corn–soya ingredients—was rolled out by subdistricts near Hyderabad and offered to pregnant women and children under age 6 years. In a controlled trial, 15 villages received the supplement and 14 did not. We used data from a 2010–2012 resurvey of adults born during the trial (n = 715 in intervention and n = 645 in control arms). We used propensity score matching methods to estimate the associations between birth in an intervention village and menarcheal age, age at first pregnancy, and fertility of adults. We found that women born in the intervention group during the trial, as compared with the control group, had menarche 0.45 (95% confidence interval [CI: 0.22, 0.68]; p < .001) years later and first pregnancy 0.53 (95% CI [0.04, 1.02]; p < .05) years later. Married women from the intervention group had menarche 0.36 (95% CI [0.09, 0.64]; p < .01) years later, first cohabitation with partner 0.8 (95% CI [0.27, 1.33]; p < .01) years later, and first pregnancy 0.53 (95% CI [0.04, 1.02]; p < .05) years later than married women in the control group. There was no significant difference between intervention and control group women regarding whether they had at least one childbirth or the total number of children born. The findings were similar when we employed inverse propensity score weighted regression models.

Exploring the Use of Technology for Sexual Health Risk-Reduction among Ecuadorean Adolescents

BACKGROUND

There is a lack of sexual health knowledge and resource access among youth in Latin America, along with rising rates of teenage pregnancy and STD transmission.

OBJECTIVE

To determine baseline sexual health knowledge and the acceptance of a technology based sexual health risk-reduction program among Ecuadorean adolescents.

METHODS

We used mixed methods to determine the sexual health knowledge and practices, and technology use among 204 adolescents from two schools in Cumbayá and Lumbisí, Ecuador. Quantitative data was collected through surveys and qualitative through single-gender focus groups.

FINDINGS

Nearly every participant (96.6%) expressed interest in a sexual health education program using technology and social media. A majority of participants indicated that they consulted parents (58.3%) regarding sexual health questions. Only a few participants had access to physicians outside of appointments (3.9%), and most desired more sexual health information (87.3%). Although approximately one-quarter of participants were sexually active (27%), most lacked baseline knowledge regarding contraceptives and STDs. Facebook (91%) and WhatsApp (53%) were the most frequently used and requested social media for an educational program. Students indicated a strong desire to be involved in the design stages of a sexual health risk-reduction program, rather than use a pre-established program.

CONCLUSIONS

There is strong interest in a technology based sexual health risk-reduction program through Facebook and WhatsApp, which could establish communication between health providers and Ecuadorian youth to disseminate health information and answer private inquiries. Findings from this study, the first of its kind among South American adolescents, introduces a novel idea: involving participants from initial design stages of a text-messaging health education program. Future studies should focus on engaging families as well as physicians' willingness to participate.Implications and Contributions: This paper is the first acceptability study of a technology based sexual health risk-reduction program among low-income South American adolescents. Findings enhance understanding of pregnancy and STD prevention interventions by demonstrating participants' desire for self-design and implementation, and highlight their importance through a lack of baseline adolescent sexual health knowledge.

A brief study on the knowledge and choice of contraception methods in married adolescent girls

INTRODUCTION

The fertility rate is 0.25% for 15-19-year-old girls and 16% for 19-year-old girls who are mothers or pregnant with their first child. Fifty-two percent of married adolescents did not have affective contraception. To encourage using the right contraceptive methods in married adolescents, it is essential to examine the behaviors of this group, the level of contraceptive knowledge and the choices they make regarding contraceptive use.

MATERIALS AND METHODS

One hundred and ten married adolescent females, less than 20 years of age, who visited a gynecology and obstetrics clinic between January 2015 and October 2016 were enrolled in this prospective study.

RESULTS

Of them 96.4% were unemployed. At the time of the study, 70% of them were pregnant. Of these pregnancies, 46.4% was a first, 19.1% a second and 8.2% a third pregnancy. The abortion rate in this study was 18.3%, and stillbirth was 2.8%. The interval between pregnancies was 20.9 months. The unplanned pregnancy rate was 45.5% and 37.3% of these unplanned pregnancies resulted in at least one healthy child. The most common contraceptive method was the use of condoms (10.9%). Changes in contraceptive methods resulted in pregnancy in 66.7% of the cases. Although 20.9% of the husbands in the study used contraceptive methods, 40.9% of them felt that their husbands should be using contraception. Of the participants 43.5% received their knowledge regarding family planning and contraceptive methods from local health clinics.

DISCUSSION

Teen marriage, pregnancy and teen parents result in socio-economic and educational difficulties. It is essential to support the adolescent parents using affective contraceptive methods and adolescent-friendly health clinics.

Adolescent pregnancy and linear growth of infants: a birth cohort study in rural Ethiopia

BACKGROUND

Evidences indicate that the risk of linear growth faltering is higher among children born from young mothers. Although such findings have been documented in various studies, they mainly originate from cross-sectional data and demographic and health surveys which are not designed to capture the growth trajectories of the same group of children. This study aimed to assess the association between young maternal age and linear growth of infants using data from a birth cohort study in Ethiopia.

METHODS

A total of 1423 mother-infant pairs, from a birth cohort study in rural Ethiopia were included in this study. They were followed for five time points, with three months interval until the infants were 12 months old. However, the analysis was based on 1378 subjects with at least one additional follow-up measurement to the baseline. A team of data collectors including nurses collected questionnaire based data and anthropometric measurements from the dyads. We fitted linear mixed-effects model with random intercept and random slope to determine associations of young maternal age and linear growth of infants over the follow-up period after adjusting for potential confounders.

RESULTS

Overall, 27.2% of the mothers were adolescents (15-19 years) and the mean ± SD age of the mothers was 20 ± 2 years. Infant Length for Age Z score (LAZ) at birth was negatively associated with maternal age of 15-19 years (β = - 0.24, P = 0.032). However, young maternal age had no significant association with linear growth of the infants over the follow-up time (P = 0.105). Linear growth of infants was associated positively with improved maternal education and iron-folate intake during pregnancy and negatively with infant illness (P < 0.05).

CONCLUSION

Young maternal age had a significant negative association with LAZ score of infants at birth while its association over time was not influential on their linear growth. The fact that wide spread socio economic and environmental inequalities exist among mothers of all ages may have contributed to the non-significant association between young maternal age and linear growth faltering of infants. This leaves an opportunity to develop comprehensive interventions targeting for the infants to attain optimal catch-up growth.

Exploring Differences Between Adolescents and Adults With Perinatal Depression-Data From the Expanding Care for Perinatal Women With Depression Trial in Nigeria

Background: Depression is common among women in the perinatal period. Although pregnancy and motherhood among adolescents are global public health issues, little is known about how adolescents differ from adults in the occurrence and correlates of perinatal depression. Methods: Data were derived from a cluster randomized controlled trial of psychosocial interventions for perinatal depression in primary maternal care in Nigeria (the Expanding Care for Perinatal Women with Depression trial). Adolescents and adult participants recruited during pregnancy and followed up till 6-month postpartum were compared: proportions with depression [screening positive to depression on the Edinburgh Postnatal Depression Scale (score ≥ 12) and meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria using the short form of the Composite International Diagnostic Interview]; adjustment and attitude to pregnancy and motherhood (using the Maternal Adjustment and Maternal Attitudes scale); and parenting skills (measured on Infant-Toddler version of the Home Inventory for Measurement of the Environment). Infant and fetal growth were assessed by measures of weight and head circumference at birth and upper mid-upper arm circumference (MUAC) at 6 months. Results: Of 8,580 adults screened, 6.9% had major depression compared with 17.7% of 772 screened adolescents (p < 0.001). Adolescents had significantly poorer adjustment and attitudes to pregnancy, lower mean fetal gestational age at birth, and a smaller mean baby's birth weight. At 6-month postpartum, there were no significant differences in the rates of remission from depression between adolescent and adult women (Edinburgh Postnatal Depression Scale score <6). Adolescent mothers continued to have poorer maternal attitudes and parenting skills indicated by significantly lower scores on the Infant-Toddler version of the Home Inventory for Measurement of the Environment responsivity and involvement subscales. Infants of adolescent mothers had a higher rate of undernutrition (defined as MUAC < 12.5 cm) compared with those of adult mothers: 14.8 and 6.3%, respectively (p = 0.008), with the mean MUAC remaining significantly lower for infants of adolescent mothers after adjusting for their lower birth weight (p = 0.04). Conclusion: Perinatal depression is more common and is associated with poorer maternal attitudes and parenting skills in adolescents compared with those in adults. Evidence from this exploratory study suggests that in improving outcomes in infants of adolescent mothers with perinatal depression, depression treatment may need to be supplemented with specific approaches to improve parenting skills.

Young maternal age is a risk factor for child undernutrition in Tamale Metropolis, Ghana

OBJECTIVE

Malnutrition is a common cause of morbidity and mortality in children. The aim of this study was to compare the nutritional status of children under 5 years of teenage and adult mothers in Tamale Metropolis, Ghana. A case-control study involving 300 (150 cases, 150 controls) mother-child pairs was carried out. A questionnaire was used to collect data on socio-demographic characteristics of mothers and children and anthropometry was used to assess the nutritional status of children. Anthropometric z-scores derived based on WHO Child Growth Standards were used to determine stunting, wasting and underweight statuses of children. Logistic regression analysis was used to compare the nutritional status of children of teenage and adult mothers.

RESULTS

Children of teenage mothers, compared to those of adult mothers, were 8 times more likely to be stunted [Adjusted Odds Ratio (AOR) = 7.56; 95% confidence interval (CI) 4.20-13.63], 3 times more likely to be wasted (AOR = 2.90; 95% CI 1.04-8.04), and 13 times more likely to be underweight (AOR = 12.78; 95% CI 4.69-34.81) after adjusting for potential confounders. The risk of child malnutrition increases with young maternal age; interventions should be targeted at teenage mothers and their children to reduce the risk of malnutrition.

Lacking in abundance: undernutrition in a Peri-urban fishing community in Coastal Ghana

Background

Malnutrition is a major problem in the world, especially in developing countries such as Ghana. Malnutrition is directly and indirectly responsible for over a million deaths in under-fives worldwide. In spite of the abundance of protein from fish and other staples in fishing communities, they are not spared of the problem of undernutrition. The study sought to assess the prevalence undernutrition among children under-five years in a fishing community in Ghana.

Methods

We conducted a community-based cross-sectional study in Ekumfi Narkwa. We assessed the nutritional status of 250 children aged 6–59 months using anthropometric methods. A structured questionnaire was also used to gather socio-demographic data on the children. We generated nutritional indices with Microsoft Excel 2010 and WHO Anthro software version 3.2.2. We generate frequencies and percentages and ran a simple logistic regression to determine factors associated with malnutrition using STATA software version 13.

Results

About 80%(198/250) of the children were reported to have consumed fish products more than three times in the past week whiles 85%(214/250) consumed staples more than three times in the past week. More than one-quarter (26.4%) of the children were under-nourished. The prevalence of stunting, wasting and underweight were 17.6% (44/250), 4.4% (11/250) and 12% (30/250) respectively. Age of caregiver was found to be associated with a child being underweight. The age group of the caregiver was found to be associated with undernutrition (OR:1.53; 95%CI:1.07–219).

Conclusions

These findings suggest a high prevalence of under-five undernutrition in the fishing community in spite of the abundance of fish and its presence in their diet. Malnutrition interventions should therefore be extended to these communities. These interventions in fishing communities need to be tailored towards caregiver utilization of fish and other food sources available in order to improve nutrition of the children.

Understanding the determinants of adolescent nutrition in Bangladesh

Evidence on the nutritional status and diets of adolescents in low- and middle-income countries is scant. We characterized the nutritional status (body mass index Z-scores (BMIZs)) and nutrient intakes of adolescent boys and girls in rural areas in Bangladesh using the 2011-2012 BIHS data, used regression models to identify the socioeconomic determinants of these outcomes, and household fixed effects models to assess whether the gap between boys and girls changed with women's education and empowerment and household wealth. The adolescents' BMIZ and adequacy of their nutrient intakes were suboptimal. Gender differences varied by outcome and were not systematically in favor of boys. Household wealth was associated with higher BMIZ and probability of adequate energy and micronutrient intakes. Women's education and empowerment were mostly not associated with the study outcomes and did not modify gender differences. There is an urgent need to invest in improving the diets of adolescent boys and girls in Bangladesh. The limited role of women's education and empowerment in improving adolescent nutrition suggests that resources may be too constrained. It may also reflect deeply rooted beliefs about adolescent nutrition and differences between boys and girls that would need to be addressed to improve their nutrition.

Teenage pregnancy - a study in São Tomé and Príncipe

Introduction The increasing number of pregnant teenagers in São Tomé and Príncipe (STP) represents a serious public health issue. The aim of this study was to characterize the population of pregnant adolescents followed in a health facility dedicated to maternal health in STP. Methods A cross-sectional survey was conducted among pregnant teenagers that attended the Mother and Child Protection Center during the first quarter of 2017. The survey contained questions on sociodemographic characteristics, sexual and risk behaviors, family, partners and health support. Results The mean age of the 51 pregnant teenagers included was 16.37 ± 0.8 years. Eight girls reported that they had planned to fall pregnant. Teenagers whose pregnancy was unplanned usually present with a previous family history of adolescent pregnancy. About 59% of girls engaged in sexual activity before 16 years of age with a mean number of sexual partners of 1.84 ± 0.88. In this study, 51% of the girls do not use any contraceptive method, usually because their partner refuses to do so. The preferred contraceptive method are condoms. Information on contraception is given mainly at school. Pregnant girls' first medical consultation was at a mean gestational age of 6 weeks. Abortion was considered by 51% of girls after pregnancy was confirmed. Conclusion Teenage pregnancy imposes health problems for the mother and child and contributes to educational and socioeconomic disadvantages. The collaboration of healthcare providers, teachers and parents is needed to enhance sexual health education. This is the first study in STP on teenage pregnancy; although the sample is small, the authors believe that the results are representative of the general population.