Excluding infants under 6 months of age from surveys: impact on prevalence of pre-school undernutrition

AbstractObjectiveInfants aged 0–5 months are not systematically included in assessments of child nutritional status and are generally excluded from surveys conducted in emergencies. We estimated the impact of excluding 0–5-month-old infants on the prevalence of stunting, wasting and underweight among children under 5 years (U5) and under 3 years (U3) of age.DesignComparison of the prevalence of stunting, wasting and underweight in U5 and U3 with or without inclusion of the age group 0–5 months.SettingDemographic and Health Surveys and Multiple Indicator Cluster Surveys from 76 developing countries and countries in transition.SubjectsChildren under 3 or under 5 years of age included in the surveys.ResultsExcluding 0–5-month-old infants resulted in an overestimation of the prevalence of stunting, wasting and underweight in U5 of 3.0, 0.3 and 2.6 percentage points, respectively, and of 4.8, 1.0 and 5.2 percentage points, respectively, in U3. The overestimation for wasting was negligible. The regions showing the highest overestimations for stunting and underweight were Asia and sub-Saharan Africa. Overall, countries with high prevalences of stunting and underweight showed especially large overestimations. The prevalence of underweight in infants aged 0–5 months was correlated with the prevalence of low maternal body mass index.ConclusionAll surveys, even in situations of nutrition emergency, should include 0–5-month-old infants. Strictly comparable age ranges are essential in nutrition surveys for monitoring trends and evaluating programme impact. Greater awareness of prenatal and early child undernutrition is needed among policy-makers.

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Impact of Orphanhood on Underweight Prevalence in Sub-Saharan Africa

Food and Nutrition Bulletin ◽

10.1177/156482650802900104 ◽

2008 ◽

Vol 29 (1) ◽

pp. 32-42 ◽

Cited By ~ 10

Author(s):

Jonathan Rivers ◽

John Mason ◽

Eva Silvestre ◽

Stuart Gillespie ◽

Mary Mahy ◽

...

Keyword(s):

Household Wealth ◽

Household Structure ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

Wealth Status ◽

Orphan Status ◽

Confounding Variables ◽

Multiple Indicator ◽

Sub Saharan ◽

Child Nutritional Status

Background In Africa, approximately 25 million people live with HIV/AIDS and 12 million children are orphaned. Although evidence indicates that orphans risk losing opportunities for adequate education, health care, and future employment, the immediate effects of orphanhood on child nutritional status remain poorly understood. Objective This paper assesses the nutritional impact of orphanhood, with particular emphasis on taking account of various factors potentially confounding or masking these impacts. Methods Child anthropometry and orphan status were examined in 23 Multiple Indicator Cluster Surveys and Demographic and Health Surveys throughout sub-Saharan Africa, which were subsequently merged into larger, region-specific datasets (East, West, and Southern Africa). To compare orphans and nonorphans, linear regression and probit models were developed, taking account of orphan status and type, presence of a surviving parent in the household, household structure, child age and sex, urban versus rural residence, and current wealth status. Results Few differences emerged between orphans and nonorphans in controlled and uncontrolled comparisons, regardless of orphan type, presence of surviving parent, or household structure. Age differentials did confound nutritional comparisons, although in the counterintuitive direction, with orphans (who were 8 months older on average) becoming less malnourished when age differences were taken into account. Wealth did appear to be associated with orphanhood status, although it did not significantly confound nutritional comparisons. Conclusions Orphans were not consistently more malnourished than nonorphans, even when potential confounding variables were examined. Since household wealth status is likely to change after becoming affected by HIV, ruling out wealth as a potential confounder would require more detailed, prospective studies.

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Water and sanitation influence on child health in Namibia: using demographic and health surveys

Journal of Water Sanitation and Hygiene for Development ◽

10.2166/washdev.2021.186 ◽

2021 ◽

Author(s):

Mona Abdelhady ◽

Anna Alfeus ◽

Ndinomholo Hamatui

Keyword(s):

Child Health ◽

Health Surveys ◽

Child Death ◽

Healthcare Services ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

Under Five ◽

Sub Saharan ◽

Child's Death ◽

The Impact

Abstract Important milestones in reducing child mortality rates have been achieved internationally and in Africa. With 76 deaths per 1,000 live births, sub-Saharan Africa (SSA) continues to have the world's highest under-five mortality (U5M) rate. In SSA, one child in every 13 dies from preventable causes before reaching their fifth birthday. This study sought to determine the impact of demographic, socio-economic, and environmental determinants on child health in Namibia, using the Namibian demographic and health surveys (NDHS) from 2006 and 2013. A logistic regression model was used to determine the association between improved sanitary facilities and water sources and U5M in Namibia. Improved access to sanitation facilities in Namibia is associated with less U5M rate, according to the 2013 survey. No significant association was observed between improved access to safe water and child's death. In 2013, the greater the mother's level of education, the lower the chance of child death. Finally, the findings demonstrate that mothers with HIV-positive are more likely to experience under-five death. Hence, the Namibian government should increase sanitation facilities and promote maternal healthcare services for less fortunate households to lower the U5M rate.

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Impact of caesarean section on breastfeeding indicators: within-country and meta-analyses of nationally representative data from 33 countries in sub-Saharan Africa

BMJ Open ◽

10.1136/bmjopen-2018-027497 ◽

2019 ◽

Vol 9 (9) ◽

pp. e027497

Author(s):

Engida Yisma ◽

Ben W Mol ◽

John W Lynch ◽

Lisa G Smithers

Keyword(s):

Caesarean Section ◽

Exclusive Breastfeeding ◽

Meta Analysis ◽

Early Initiation ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

Early Initiation Of Breastfeeding ◽

Sub Saharan ◽

The Impact ◽

Initiation Of Breastfeeding

ObjectiveTo examine the impact of caesarean section on breastfeeding indicators—early initiation of breastfeeding, exclusive breastfeeding under 6 months and children ever breastfed (at least once)—in sub-Saharan Africa.DesignSecondary analysis of Demographic and Health Surveys (DHS).SettingThirty-three low-income and middle-income countries with a survey conducted between 2010 and 2017/2018.ParticipantsWomen aged 15–49 years with a singleton live last birth during the 2 years preceding the survey.Main outcome measuresWe analysed the DHS data to examine the impact of caesarean section on breastfeeding indicators using the modified Poisson regression models for each country adjusted for potential confounders. For each breastfeeding indicator, the within-country adjusted prevalence ratios (aPR) were pooled in random-effects meta-analysis.ResultsThe within-country analyses showed, compared with vaginal birth, caesarean section was associated with aPR for early initiation of breastfeeding that ranged from 0.24 (95% CI 0.17 to 0.33) in Tanzania to 0.89 (95% CI 0.78 to 1.00) in South Africa. The aPR for exclusive breastfeeding under 6 months ranged from 0.58 (95% CI 0.34 to 0.98) in Angola to 1.93 (95% CI 0.46 to 8.10) in Cote d'Ivoire, while the aPR for children ever breastfed ranged from 0.91 (95% CI 0.82 to 1.02) in Gabon to 1.02 (95% CI 0.99 to 1.04) in Gambia. The meta-analysis showed caesarean section was associated with a 46% lower prevalence of early initiation of breastfeeding (pooled aPR, 0.54 (95% CI 0.48 to 0.60)). However, meta-analysis indicated little association with exclusive breastfeeding under 6 months (pooled aPR, 0.94 (95% CI 0.88 to 1.01)) and children ever breastfed (pooled aPR, 0.98 (95% CI 0.98 to 0.99)) among caesarean versus vaginally born children.ConclusionsCaesarean section had a negative influence on early initiation of breastfeeding but showed little difference in exclusive breastfeeding under 6 months and children ever breastfed in sub-Saharan Africa.

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OP101 The impact of caesarean section on breastfeeding indicators in sub-saharan africa: a meta-analysis of demographic and health surveys

10.1136/jech-2019-ssmabstracts.104 ◽

2019 ◽

Author(s):

E Yisma ◽

B Mol ◽

J Lynch ◽

L Smithers

Keyword(s):

Caesarean Section ◽

Health Surveys ◽

Meta Analysis ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

Sub Saharan ◽

The Impact

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1159Inequities in on-time childhood vaccination: Evidence from sub-Saharan Africa

International Journal of Epidemiology ◽

10.1093/ije/dyab168.467 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

Author(s):

Martin Mutua

Keyword(s):

Rural Communities ◽

Vaccination Coverage ◽

Maternal Education ◽

Household Wealth ◽

Sub Saharan Africa ◽

Childhood Vaccination ◽

Demographic And Health Surveys ◽

Place Of Residence ◽

Multiple Indicator ◽

Sub Saharan

Abstract Introduction Vaccination coverage has improved over the past decade but inequalities persist; the poorest, least educated, and rural communities are left behind. Programming has focused on increasing coverage and reaching the hardest to reach children but vaccination timeliness is equally important as delays leave children vulnerable to infections. This study examines the levels and inequities of on-time vaccination in the sub-Saharan African (SSA) region. Methods: The most recent Demographic and Health Surveys or Multiple Indicator Clusters Surveys since 2000 from SSA were used to assess on-time vaccination and inequalities by household wealth, maternal education, and place of residence. Inequalities were quantified using slope index of inequality and concentration index. Results The analysis included 153,632 children aged 12-36 months from 40 SSA countries. Median on-time vaccination coverage was below 50% in all four sub-regions. Differences in on-time vaccination were observed by place of residence in Southern (20.8 pp, 95%CI (0.8; 40.8)), West (17.5 pp, 95%CI (5.1; 29.9)), and Eastern (20.9 pp, 95%CI (6.5; 35.2)) regions. Wealth-related inequities were observed in Southern (22.6 pp, 95%CI (4.0; 41.2)), West (30.6 pp, 95%CI (19.1; 42.1)), and Eastern (26.1 pp, 95%CI (8.2; 44.0)) regions. Significant education-related differences in on-time vaccination were observed in West (20.7 pp, 95%CI (10.9; 30.5)), and Eastern (21.2 pp, 95%CI (7.0; 35.4)) regions. Conclusions On-time vaccination coverage was low in all sub-regions and nearly all countries. Inequalities in on-time immunization by household wealth, place of residence, and education existed in most countries. Concrete strategies to improve levels of timeliness are needed

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WHO child growth standards for Pygmies: one size fits all?

10.1101/591172 ◽

2019 ◽

Author(s):

Stephan M. Funk ◽

Belén Palomo Guerra ◽

Amy Ickowitz ◽

Nicias Afoumpam Poni ◽

Mohamadou Aminou Abdou ◽

...

Keyword(s):

Growth Dynamics ◽

Severe Anaemia ◽

Child Growth ◽

Sub Saharan Africa ◽

Severe Malnutrition ◽

Sympatric Populations ◽

Growth Standards ◽

Child Undernutrition ◽

Sub Saharan ◽

The Impact

AbstractBackgroundAfrican Pygmies exhibit a unique, genetically determined child growth dynamics and adult stature but the impact on assessing undernutrition remains unknown. Baka Pygmy health is highly compromised compared to sympatric populations. Evaluating child undernutrition is an important step to address this health quandry. We estimate stunting and wasting in Cameroon’s Baka children and investigate the applicability of the standards for Pygmy people.MethodsAnthropometric and health data from 685 2-to12 year old children were collected at 25 health centres in southern Cameroon. Growth was analysed using both, WHO Child Growth Standards and the population itself as reference to define frequencies of stunting, wasting and obesity.FindingsBaka children revealed with 68.4% the highest recorded level globally of stunting relative to the WHO child growth standard in 2-to-4 year olds. Wasting was at 8.2% in the upper third range in Sub-Saharan Africa. Obesity was with 6.5% similar to wasting, but no comparable data have been published for Sub-Saharan Africa. When referenced to the Baka population itself, values for stunting were dramatically lower at 1.0% and 2.9% for 2-to-4 and 5-to-12 year olds, respectively. Wasting was also lower at 2.8% and 1.8% and was exceeded by obesity at 3.4% and 3.5%, respectively. Brachial perimeters and oedemas indicated rare severe malnutrition (< 2%) whilst moderate and severe anaemia were frequent (26.6% and 3.3%, respectively).InterpretationWHO child growth standards for stunting are clearly not applicable to Pygmies thus contradicting the widespread emphasis of their ethnicity-independent applicability. The inferred values for wasting and obesity are also difficult to interpret and are likely overestimated by the WHO criteria. To achieve UN Sustainable Development Goals and to fulfil our humanitarian responsibility for fellow man, we recommend that Pygmy specific growth standards are developed for the genetically differing Pygmy tribes.

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Conflicts in Biafra, Katanga and Cabinda as a result of the geopolitical legacy of colonialism

OOO Zhurnal Voprosy Istorii ◽

10.31166/voprosyistorii202010statyi60 ◽

2020 ◽

Vol 2020 (10-3) ◽

pp. 238-246

Author(s):

Olga Dzhenchakova

Keyword(s):

Democratic Republic ◽

Economic Factor ◽

Colonial Period ◽

Sub Saharan Africa ◽

Negative Consequences ◽

Post Colonial ◽

Republic Of The Congo ◽

Sub Saharan ◽

The Republic ◽

The Impact

The article considers the impact of the colonial past of some countries in sub-Saharan Africa and its effect on their development during the post-colonial period. The negative consequences of the geopolitical legacy of colonialism are shown on the example of three countries: Nigeria, the Democratic Republic of the Congo and the Republic of Angola, expressed in the emergence of conflicts in these countries based on ethno-cultural, religious and socio-economic contradictions. At the same time, the focus is made on the economic factor and the consequences of the consumer policy of the former metropolises pursuing their mercantile interests were mixed.

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