Effectiveness of interventions to reduce household air pollution from solid biomass fuels and improve maternal and child health outcomes in low- and middle-income countries: A systematic review and meta-analysis

Interventions to reduce household air pollution (HAP) are key to reducing associated morbidity and mortality in low- and middle- income countries (LMICs); especially among pregnant women and young children. This systematic review aims to determine the effectiveness of interventions aimed to reduce HAP exposure associated with domestic solid biomass fuel combustion, compared to usual cooking practices, for improving health outcomes in pregnant women and children under five in LMIC settings. A systematic review and meta-analysis was undertaken with searches undertaken in MEDLINE, EMBASE, CENTRAL, GIM, ClinicalTrials.gov, and Greenfile in August 2020. Inclusion criteria were experimental, non-experimental, or quasi-experimental studies investigating the impact of interventions to reduce HAP exposure and improve associated health outcomes among pregnant women or children under 5 years. Study selection, data extraction, and quality assessment using the Effective Public Health Practice Project tool were undertaken independently by two reviewers. Seventeen out of 7293 retrieved articles (seven pregnancy, nine child health outcome; 13 studies) met the inclusion criteria. These assessed improved cookstoves (ICS; n = 10 studies), ethanol stoves (n = 1 study), and Liquefied Petroleum Gas (LPG; n = 2 studies) stoves interventions. Meta-analysis showed no significant effect of ICS interventions compared to traditional cooking for risk of preterm birth (n = 2 studies), small for gestational age (n = 2 studies), and incidence of acute respiratory infections (n = 6 studies). Although an observed increase in mean birthweight was observed, this was not statistically significant (n = 4). However, ICS interventions reduced the incidence of childhood burns (n = 3; observations = 41 723; Rate Ratio: 0.66 [95% CI: 0.45-0.96]; I² : 46.7%) and risk of low birth weight (LBW; n = 4; observations = 3456; Odds Ratio: 0.73 [95% CI: 0.61-0.87]; I² : 21.1%). Although few studies reported health outcomes, the data indicate that ICS interventions were associated with reduced risk of childhood burns and LBW. The data highlight the need for the development and implementation of robust, well-reported and monitored, community-driven intervention trials with longer-term participant follow-up.

Impact of Nurse-Led Asthma Intervention on Child Health Outcomes: A Scoping Review

Given the leading role school nurses occupy within the school setting, they are often the most suited health care professionals to lead asthma programs. However, most school-based asthma programs have been conducted by researchers outside the school setting. Thus, we aim to determine what is currently known about the type of school nurse-led asthma intervention programs and their impact on children’s asthma-related outcomes. This article describes published literature on school nurse-led asthma intervention programs for the school-aged population using Arksey and O’Malley’s scoping review framework. A search strategy was developed and implemented in six electronic databases from 1980 to 2020. Results showed that school nurse-led asthma programs were predominantly educational interventions. Yet given the positive outcomes of school nurse-led asthma interventions reported across the articles reviewed, it is important to emphasize the leadership role school nurses assume in asthma programs, to promote more positive asthma-related outcomes in school children.

Father's Health Status and Inequalities in Physical and Mental Health of U.S. Children: A Population-Based Study

Introduction: Father-and-child-health risk relationship is poorly studied and understood. We examine the impact of father's physical and mental health status and sociodemographic characteristics on the physical and mental outcomes of U.S. children 0–17 years of age.

Methods: The 2011–2012 National Survey of Children's Health (N=75,879) was analyzed to estimate prevalence and odds of poor physical and mental health among children according to father's physical and mental health status and sociodemographic characteristics.

Results: Overall, 3.2% of U.S. children had poor physical health; and 6.0% of U.S. children had emotional or behavioral problems. The adjusted odds of having poor overall health was 3.1 times higher among children of fathers with poor overall health. Children of fathers with poor mental health had 2.6 times higher adjusted odds of having poor mental health.

Discussion: Results underscore the significant role of fathers in the physical and mental well-being of children. Engaging fathers in child health may provide a potential opportunity to reduce mental and emotional health problems among children.

Assessing levels and trends of child health inequality in 88 developing countries: from 2000 to 2014

Background: Reducing child mortality was one of the Millennium Development Goals. In the current Sustainable Development Goals era, achieving equity is prioritized as a major aim.

Objective: This study aims to provide a comprehensive and updated picture of inequalities in child health intervention coverage and child health outcomes by wealth status, as well as their trends between 2000 and 2014.

Methods: Using data from Demographic Health Surveys and Multiple Indicator Cluster Surveys, we adopted three measures of inequality, including one absolute inequality indicator and two relative inequality indicators, to estimate the level and trends of inequalities in three child health outcome variables and 17 intervention coverages in 88 developing countries.

Results: While improvements in child health outcomes and coverage of interventions have been observed between 2000 and 2014, large inequalities remain. There was a high level of variation between countries’ progress toward reducing child health inequalities, with some countries significantly improving, some deteriorating, and some remaining statistically unchanged. Among child health interventions, the least equitable one was access to improved sanitation (The absolute difference in coverages between the richest quintile and the poorest quintile reached 49.5% [42.7, 56.2]), followed by access to improved water (34.1% [29.5, 38.6]), and skilled birth attendant (SBA) (34.1% [28.8, 39.4]). The most equitable intervention coverage was insecticide-treated bed net for children (1.0% [−3.9, 5.9]), followed by oral rehydration therapy for diarrhea ((8.0% [5.2, 10.8]), and vitamin A supplement (8.4% [5.1, 11.7]). These findings were robust to various inequality measurements.

Conclusions: Although child health outcomes and coverage of interventions have improved largely over the study period for almost all wealth quintiles, insufficient progress was made in reducing child health inequalities between the poorest and richest wealth quintiles. Future efforts should focus on reaching the poorest children by increasing investments toward expanding the coverage of interventions in resource-limited settings.

Health outcomes for children born to teen mothers in Cape Town, South Africa

This paper analyzes whether children born to teen mothers in Cape Town, South Africa are disadvantaged in terms of their health outcomes because their mother is a teen. Exploiting the longitudinal nature of the Cape Area Panel Study, we assess whether observable differences between teen mothers and slightly older mothers can explain why first-born children of teen mothers appear disadvantaged. Our balanced regressions indicate that observed characteristics cannot explain the full extent of disadvantage of being born to a teen mother, with children born to teen mothers continuing to have significantly worse child health outcomes, especially among coloured children. In particular, children born to teens are more likely to be underweight at birth and to be stunted with the disadvantage for coloured children four times the size for African children.

Effects of prenatal care on child health at age 5

The broad goal of contemporary prenatal care is to promote the health of the mother, child, and family through the pregnancy, delivery, and the child's development. Although the vast majority of mothers giving birth in developed countries receive prenatal care, past research has not found compelling evidence that early or adequate prenatal care has favorable effects on birth outcomes. It is possible that prenatal care confers health benefits to the child that do not become apparent until after the perinatal period. Using data from a national urban birth cohort study in the US, we estimate the effects of prenatal care on four markers of child health at age 5-maternal-reported health status, asthma diagnosis, overweight, and height. Prenatal care, defined a number of different ways, does not appear to have any effect on the outcomes examined. The findings are robust and suggest that routine health care encounters during the prenatal period could potentially be used more effectively to enhance children's health trajectories. However, future research is needed to explore the effects of prenatal care on additional child health and developmental outcomes as well as the effects of preconceptional and maternal lifetime healthcare on child health.

Impact of caregiver literacy on children's oral health outcomes

OBJECTIVE

The objective of this study was to examine the relationship of primary caregivers' literacy with children's oral health outcomes.

METHODS

We performed a cross-sectional study of children who were aged < or =6 years and presented for an initial dental appointment in the teaching clinics at the University of North Carolina at Chapel Hill School of Dentistry. Caregiver literacy was measured using the Rapid Estimate of Adult Literacy in Dentistry (REALD-30). The outcome measures included oral health knowledge, oral health behaviors, primary caregiver's reports of their child's oral health status, and the clinical oral health status of the child as determined by a clinical examination completed by trained, calibrated examiners.

RESULTS

Among the 106 caregiver-child dyads enrolled, 59% of the children were male, 52% were white, and 86% of caregivers were the biological mothers. The bivariate results showed no significant relationships between literacy and oral health knowledge (P = .16) and behaviors (P = .24); however, there was an association between literacy and oral health status (P < .05). The multivariate analysis controlled for race and income; this analysis revealed a significant relationship between caregiver literacy scores and clinical oral health status as determined by using a standardized clinical examination. Caregivers of children with mild to moderate treatment needs were more likely to have higher REALD-30 scores than those with severe treatment needs (odds ratio: 1.14 [95% confidence interval: 1.05-1.25]; P = .003).

CONCLUSIONS

Caregiver literacy is significantly associated with children's dental disease status.

The health and cost impact of care delay and the experimental impact of insurance on reducing delays

OBJECTIVE

To examine whether delays in seeking care are associated with worse health outcomes or increased treatment costs in children, and then assess whether insurance coverage reduces these delays.

STUDY DESIGN

We use data on 4070 children younger than 5 years from the Quality Improvement Demonstration Study, a randomized controlled experiment assessing the effects of increasing insurance coverage. We examined whether delay in care, defined as greater than 2 days between the onset of symptoms and admission to the study district hospitals, is associated with wasting or having positive C-reactive protein levels on discharge, and with total charge for hospital admission; we also evaluated whether increased benefit coverage and enrollment reduced the likelihood of delay.

RESULTS

Delay is associated with 4.2% and 11.2% percentage point increases in the likelihood of wasting (P = .08) and having positive C-reactive protein levels (P = .03), respectively, at discharge. On average, hospitalization costs were 1.9% higher with delay (P = .04). Insurance intervention results in 5 additional children in 100 not delaying going to the hospital (P = .02).

CONCLUSIONS

In this population, delayed care is associated with worse health outcomes and higher costs. Access to insurance reduced delays; thus insurance interventions may have positive effects on health outcomes.