Prevalence and determinants of anaemia among children aged 0–59 months in a rural region of Armenia: a case–control study

AbstractObjectiveDespite the trend of increasing prevalence of childhood anaemia in Armenia, no studies exploring its risk factors have been conducted in the country. The present study aimed to investigate the prevalence and determinants of childhood anaemia in rural Armenia.DesignBlood Hb level was measured among a representative sample of children using the HemoCue Hb201+ analyser. The revealed cases with anaemia were compared with randomly selected non-anaemic controls. Mothers of cases and controls were interviewed. Logistic and linear regression models were fitted to identify the risk factors of anaemia and low Hb level, respectively.SettingTalin communities, Aragatsotn Province, Armenia.SubjectsChildren under 5 years of age in Talin region.ResultsOf the 729 studied children, 32·4 % were anaemic with 14·7 % having moderate/severe anaemia. Infants were the most affected group with 51·1 % being anaemic before 6 months and 67·9 % at 6–12 months of age. Fitted regression models identified the following predictors of anaemia: younger age, male gender, shorter birth length, anaemia during pregnancy, lower meal frequency per day, lack of meat in the diet, using dung cakes for heating and living in a community that received an incomplete set of nutrition interventions.ConclusionsThe study identified several modifiable risk factors that could be targeted to reduce childhood anaemia in rural Armenia and, possibly, in rural areas in other low-/middle-income countries. The suggested interventions include prevention and treatment of anaemia during pregnancy, provision of adequate complementary feeding to children with inclusion of meat in their daily diet and reduction of their exposure to biomass fuel smoke.

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Early life risk factors of motor, cognitive and language development: a pooled analysis of studies from low/middle-income countries

BMJ Open ◽

10.1136/bmjopen-2018-026449 ◽

2019 ◽

Vol 9 (10) ◽

pp. e026449 ◽

Cited By ~ 6

Author(s):

Ayesha Sania ◽

Christopher R Sudfeld ◽

Goodarz Danaei ◽

Günther Fink ◽

Dana C McCoy ◽

...

Keyword(s):

Risk Factors ◽

Child Development ◽

Motor Development ◽

Early Life ◽

Grey Literature ◽

Linear Regression Models ◽

Middle Income ◽

Middle Income Countries ◽

Low Middle Income Countries ◽

Meta Analyses

ObjectiveTo determine the magnitude of relationships of early life factors with child development in low/middle-income countries (LMICs).DesignMeta-analyses of standardised mean differences (SMDs) estimated from published and unpublished data.Data sourcesWe searched Medline, bibliographies of key articles and reviews, and grey literature to identify studies from LMICs that collected data on early life exposures and child development. The most recent search was done on 4 November 2014. We then invited the first authors of the publications and investigators of unpublished studies to participate in the study.Eligibility criteria for selecting studiesStudies that assessed at least one domain of child development in at least 100 children under 7 years of age and collected at least one early life factor of interest were included in the study.AnalysesLinear regression models were used to assess SMDs in child development by parental and child factors within each study. We then produced pooled estimates across studies using random effects meta-analyses.ResultsWe retrieved data from 21 studies including 20 882 children across 13 LMICs, to assess the associations of exposure to 14 major risk factors with child development. Children of mothers with secondary schooling had 0.14 SD (95% CI 0.05 to 0.25) higher cognitive scores compared with children whose mothers had primary education. Preterm birth was associated with 0.14 SD (–0.24 to –0.05) and 0.23 SD (–0.42 to –0.03) reductions in cognitive and motor scores, respectively. Maternal short stature, anaemia in infancy and lack of access to clean water and sanitation had significant negative associations with cognitive and motor development with effects ranging from −0.18 to −0.10 SDs.ConclusionsDifferential parental, environmental and nutritional factors contribute to disparities in child development across LMICs. Targeting these factors from prepregnancy through childhood may improve health and development of children.

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Risk Factors of Mortality Among Patients with Stroke in Low Middle-Income Countries: A Series of 180 Patients

SSRN Electronic Journal ◽

10.2139/ssrn.3566238 ◽

2020 ◽

Author(s):

Larrey Kamabu ◽

Hervé Monka Lekuya ◽

Bienvenu Muhindo Kasusula ◽

Nicole Kavugho Mutimani ◽

Louange Maha Kathaka ◽

...

Keyword(s):

Risk Factors ◽

Middle Income ◽

Middle Income Countries ◽

Low Middle Income Countries

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Seroprevalence of SARS CoV-2 infection in Low and Middle-Income Countries and risk classification in the context of rolling out vaccine candidate across these countries : Protocol for a systematic review and meta-analysis

10.21203/rs.3.rs-578481/v1 ◽

2021 ◽

Author(s):

Martin Ackah ◽

Louise Ameyaw ◽

Kwadwo Owusu Akuffo ◽

Cynthia Osei Yeboah ◽

Nana Esi Wood ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Vaccine Candidate ◽

Meta Analysis ◽

Cochrane Library ◽

Research Database ◽

Middle Income ◽

Middle Income Countries ◽

Low Middle Income Countries ◽

Low And Middle Income

Abstract Background Seroprevalence of SARS Cov-2 provides a good indication of the extent of exposure and spread in the population, as well as those likely to benefit from a vaccine candidate. To date, there is no published or ongoing systematic review on the seroprevalence of COVID-19 in Low- and Middle-Income Countries (LMICs). This systematic review and meta-analysis will estimate SARS Cov-2 seroprevalence and the risk factors for SARS Cov-2 infection in LMICs.Methods We will search PubMed, EMBASE, WHO COVID-19 Global research database, Google Scholar, the African Journals Online, LILAC, HINARI, medRxiv, bioRxiv and Cochrane Library for potentially useful studies on seroprevalence of COVID-19 in LMICs from December 2019 to December 2020 without language restriction. Two authors will independently screen all the articles, select studies based on pre-specified eligibility criteria and extract data using a pre-tested data extraction form. Any disagreements will be resolved through discussion between the authors. The pooled seroprevalence of SARS CoV-2 for people from LMICs will be calculated. Random effects model will be used in case of substantial heterogeneity in the included studies, otherwise fixed-effect model will be used. A planned subgroup, sensitivity and meta-regression analyses will be performed. For comparative studies, the analyses will be performed using Review Manager v 5.4; otherwise, STATA 16 will be used. All effect estimates will be presented with their confidence intervals.Discussion The study will explore and systematically review empirical evidence on SARS Cov-2 seroprevalence in LMICs, and to assess the risk factors for SARS Cov-2 infection in Low Middle Income Countries in the context of rolling out vaccines in these countries. Finally, explore risk classifications to help with the rolling out of vaccines in LMICs.Systematic review registration: The protocol for this review has been registered in PROSPERO (CRD422020221548).

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Classification of stillbirth by relative condition at death (Re Co De) at various trimesters of pregnancy: a rural tertiary teaching hospital based study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20173482 ◽

2017 ◽

Vol 6 (8) ◽

pp. 3550 ◽

Cited By ~ 1

Author(s):

V. Meera Rajagopal ◽

Kalpana Betha ◽

Satya Priya G.

Keyword(s):

Risk Factors ◽

Teaching Hospital ◽

Rural Areas ◽

Gestational Hypertension ◽

Economic Status ◽

Mode Of Delivery ◽

Middle Income ◽

Low Middle Income Countries ◽

Tertiary Teaching ◽

Tertiary Teaching Hospital

Background: New global health figures show India to have the highest rates of stillbirth in the world. While maternal and under 5 child mortality rates have halved, stillbirth remains a neglected global endemic. To reduce stillbirths, the prevalence, risk factors and causes must be known. The aim of the present study is to know the prevalence and classify stillbirths by ReCoDe classification system at different trimesters of pregnancy.Methods: This was a retrospective study done between January 2013 to March 2017 at MediCiti Institute of Medical Sciences, a rural tertiary teaching hospital, Telangana, India. A total of 112 cases of stillbirths were included. Data was obtained on demographic variables, risk factors such as preeclampsia, etc. Data regarding mode of delivery, fetal asphyxia, were recorded.Results: Stillbirth rate was 12.1/1000 births. Fifty four percent of the women were unbooked. Preterm stillbirths were a majority (67%). The intra-partum still birth rate was low (15.1%) contrary to what is seen in low middle-income countries. Gestational hypertension/Pre-eclampsia, abruptio placenta, fetal growth restriction and oligohydramnios were the leading causes of stillbirths.Conclusions: Pregnant women from rural background with low socio-economic status are prone for stillbirths. As stillbirths were more among unbooked cases, the study highlights the importance of counselling, creating awareness in the rural areas regarding the importance of regular antenatal checkups. Identifying risk factors like pre-eclampsia, anemia etc., at early weeks will enable us to initiate appropriate strategies to improve pregnancy outcome.

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Knowledge on tuberculosis and utilization of DOTS service by tuberculosis patients in Lalitpur District, Nepal

PLoS ONE ◽

10.1371/journal.pone.0245686 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0245686

Author(s):

Nirmal Gautam ◽

Rewati Raj Karki ◽

Rasheda Khanam

Keyword(s):

Rural Areas ◽

Age Groups ◽

Directly Observed Therapy ◽

Middle Income ◽

Public Health Burden ◽

The Public ◽

Middle Income Countries ◽

Adequate Knowledge ◽

Short Course ◽

Younger Age

Background Tuberculosis is one of the major infectious diseases and is both complex and serious. It is spread from person to person through the air, causing a public health burden, especially in low- and middle-income countries. This study aims to assess the knowledge on tuberculosis and the utilization of Directly-Observed Therapy, Short Course (DOTS) service from the public DOTS centers in Lalitpur district of Nepal. Method A structured questionnaire was used to collect data from 23 DOTS centers in Lalitpur district. Univariate and multivariate logistic regression was applied to assess the knowledge on tuberculosis and utilization of DOTS among people living with tuberculosis. Results Among 390 respondents, 80% of patients had knowledge of tuberculosis and 76.92% utilized the DOTS service from the DOTS center. People of higher age (50–60 years) [aOR; 13.96, 95% CI 4.79,40.68], [aOR; 10.84,95% CI 4.09,28.76] had significantly more knowledge on TB and utilization of the DOTS service compared to the younger group. Additionally, those who completed twelfth class [aOR; 2.25, 95% CI 0.46,11.07] and [aOR;2.47, 95% CI 0.51,11.28] had greater knowledge of Tuberculosis and utilization of DOTS compared to those who had not completed twelfth class. Likewise, compared to urban residents, respondents in rural areas (aOR; 0.51, 95% CI 0.27,0.97) had less knowledge of tuberculosis, (aOR; 0.57, 95% CI 0.32,1) and less chance of utilization of the DOTS service from the DOTS center. Conclusion Approximately one quarter of patients did not have adequate knowledge of tuberculosis and were not utilizing the DOTS service, particularly in younger age groups, people living in a combined family, with no education, poor economic position, and from rural areas. Findings of this study revealed that some specific programs are needed for enhancing the knowledge and utilization of DOTS, particularly for those patients whose economic situations extended from low to mid range.

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The incidence of and risk factors for late presentation of childhood chronic kidney disease: A systematic review and meta-analysis

PLoS ONE ◽

10.1371/journal.pone.0244709 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0244709

Author(s):

Lucy Plumb ◽

Emily J. Boother ◽

Fergus J. Caskey ◽

Manish D. Sinha ◽

Yoav Ben-Shlomo

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Kidney Failure ◽

Meta Analysis ◽

Late Presentation ◽

Cochrane Library ◽

Middle Income ◽

Middle Income Countries ◽

Low Middle Income Countries

Background When detected early, inexpensive measures can slow chronic kidney disease progression to kidney failure which, for children, confers significant morbidity and impacts growth and development. Our objective was to determine the incidence of late presentation of childhood chronic kidney disease and its associated risk factors. Methods We searched MEDLINE, Embase, PubMed, Web of Science, Cochrane Library and CINAHL, grey literature and registry websites for observational data describing children <21 years presenting to nephrology services, with reference to late presentation (or synonyms thereof). Independent second review of eligibility, data extraction, and risk of bias was undertaken. Meta-analysis was used to generate pooled proportions for late presentation by definition and investigate risk factors. Meta-regression was undertaken to explore heterogeneity. Results Forty-five sources containing data from 30 countries were included, comprising 19,339 children. Most studies (37, n = 15,772) described children first presenting in kidney failure as a proportion of the chronic kidney disease population (mean proportion 0.43, 95% CI 0.34–0.54). Using this definition, the median incidence was 2.1 (IQR 0.9–3.9) per million age-related population. Risk associations included non-congenital disease and older age. Studies of hospitalised patients, or from low- or middle-income countries, that had older study populations than high-income countries, had higher proportions of late presentation. Conclusions Late presentation is a global problem among children with chronic kidney disease, with higher proportions seen in studies of hospitalised children or from low/middle-income countries. Children presenting late are older and more likely to have non-congenital kidney disease than timely presenting children. A consensus definition is important to further our understanding and local populations should identify modifiable barriers beyond age and disease to improve access to care.

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Pregnant Women in Four Low-Middle Income Countries Have a High Prevalence of Inadequate Dietary Intakes That Are Improved by Dietary Diversity

Nutrients ◽

10.3390/nu11071560 ◽

2019 ◽

Vol 11 (7) ◽

pp. 1560 ◽

Cited By ~ 7

Author(s):

Rebecca Lander ◽

K. Hambidge ◽

Jamie Westcott ◽

Gabriela Tejeda ◽

Tshilenge Diba ◽

...

Keyword(s):

Pregnant Women ◽

Rural Areas ◽

Dietary Diversity ◽

Reproductive Age ◽

Dietary Intakes ◽

Middle Income ◽

Total N ◽

Middle Income Countries ◽

Low Middle Income Countries ◽

Dietary Data

Background: Up-to-date dietary data are required to understand the diverse nutritional challenges of pregnant women living in low-middle income countries (LMIC). To that end, dietary data were collected from 1st trimester pregnant women in rural areas of Guatemala, India, Pakistan, and Democratic Republic of the Congo (DRC) participating in a maternal lipid-based nutrient supplement (LNS) Randomized Controlled Trial to examine dietary diversity (DD), usual group energy and nutrient intakes, and prevalence of inadequate dietary intakes. Methods: Two 24-h dietary recalls were conducted in ~240 pregnant women/site (total n = 966) prior to 12-week gestation. Adequate DD was assessed, i.e., ≥5 major food groups consumed within the past 24 h. Median, Q1, Q3 intakes (without LNS) of energy, macronutrients, 12 micronutrients, and phytate were examined. The “at risk” prevalence of inadequate intakes were based on international guidelines for pregnant women. Results: Dietary patterns varied widely among sites, with adequate DD reported: 20% (Pakistan), 25% (DRC), 50% (Guatemala), and 70% (India). Significantly higher intakes of most key nutrients were observed in participants with adequate DD. More than 80% of women in all sites had inadequate intakes of folate, vitamin B12, and choline, and >80% of women in India and DRC also had inadequate intakes of calcium, thiamine, riboflavin, and vitamin B6. Conclusions: Our data highlight the likely need for micronutrient supplementation in pregnancy, specifically multi-micronutrient interventions, and support the value of increasing DD as part of sustainable long-term nutrition programs for women of reproductive age in these poor rural settings in LMIC.

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Infant malnutrition in low- and middle-income countries: assessment and prevalence of small and nutritionally at-risk infants aged under 6 months in 54 Demographic & Health Survey datasets

10.1101/2021.12.23.21268306 ◽

2021 ◽

Author(s):

Marko Kerac ◽

Philip Thomas James ◽

Marie McGrath ◽

Eilise Brennan ◽

Charles Opondo ◽

...

Keyword(s):

Risk Factors ◽

At Risk ◽

Logistic Regression ◽

Data Quality ◽

Regression Models ◽

Middle Income ◽

Logistic Regression Models ◽

Middle Income Countries ◽

Low Weight ◽

Weight For Age

Background There is increasing global focus on malnutrition in infants aged under 6 months (u6m) but evidence on how best to identify and manage at-risk individuals is sparse. Our objectives were to: explore data quality of commonly used anthropometric indicators; describe prevalence and disease burden of infant u6m malnutrition; compare wasting and underweight as measures of malnutrition by determining the strength and consistency of associations with biologically plausible risk factors. Methods We performed a cross-sectional secondary analysis of Demographic and Health Survey (DHS) datasets, focussing on infants u6m. We calculated underweight (low weight-for-age), wasting (low weight-for-length), stunting (low length-for-age), and concurrent wasting and stunting. We explored data quality by recording extreme (flagged, as per standard criteria) or missing values. We calculated the population-weighted prevalence of each type of malnutrition and extrapolated the burden to all low- and middle- income countries (LMICs). We explored associations between infant, maternal and household risk factors with underweight and wasting using logistic regression models. Results We analysed 54 DHS surveys. Data quality in terms of refusals and missingness was similar for both weight and length. There were more extreme (flagged) values for length-based measures (6.1% flagged for weight-for-length, 4.8% for length-for-age) than for weight-for-age (1.0% flagged). Overall, 20.1% of infants (95% CI: 19.5, 20.7) were underweight, 21.3% (95% CI: 20.7, 22.3) were wasted, 17.6% (95% CI: 17.0, 18.2) were stunted, and 2.0% (95% CI: 1.8, 2.2) were concurrently wasted and stunted. This corresponds to an estimated burden in LMICs of 23.8m underweight infants, 24.5m wasted infants, 21.5m stunted infants and 2.2m concurrently wasted and stunted. Logistic regression models showed that numerous risk factors were associated with wasting and underweight. Effect sizes of risk factors tended to be stronger and more consistently associated with underweight compared to wasting. Conclusion Malnutrition in infants u6m is a major problem in LMICs. This is true whether assessed by underweight, wasting or stunting. Our data build on other evidence suggesting that underweight may be a better anthropometric case definition than wasting: data quality is better when length is not involved; biologically plausible risk factors are better reflected by an infant being underweight. Future research, ideally from intervention trials, should further explore how best to identify malnourished (small and nutritionally at-risk) infants u6m. For now, treatment programmes should note that many factors might underlie problems in this age group: services should thus consider how to address maternal health and wider social circumstances as well as caring for infants themselves.

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Cardiovascular Disease Risk Prediction Models in Haiti: Implications for Primary Prevention in Low-Middle Income Countries

10.1101/2021.07.29.21261344 ◽

2021 ◽

Author(s):

Lily D Yan ◽

Jean Lookens Pierre ◽

Vanessa Rouzier ◽

Michel Theard ◽

Alexandra Apollon ◽

...

Keyword(s):

Risk Factors ◽

High Risk ◽

Risk Prediction ◽

Prediction Models ◽

Risk Groups ◽

Cvd Risk ◽

Middle Income ◽

Risk Prediction Models ◽

Middle Income Countries ◽

Low Middle Income Countries

Background Cardiovascular diseases (CVD) are rapidly increasing in low-middle income countries (LMICs). Accurate risk assessment is essential to reduce premature CVD by targeting primary prevention and risk factor treatment among high-risk groups. Available CVD risk prediction models are built on predominantly Caucasian, high-income country populations, and have not been evaluated in LMIC populations. Objective To compare the predicted 10-year risk of CVD and identify high-risk groups for targeted prevention and treatment in Haiti. Methods We used cross-sectional data within the Haiti CVD Cohort Study, including 653 adults ≥ 40 years without known history of CVD and with complete data. Six CVD risk prediction models were compared: pooled cohort equations (PCE), adjusted PCE with updated cohorts, Framingham CVD Lipids, Framingham CVD Body Mass Index (BMI), WHO Lipids, and WHO BMI. Risk factors were measured during clinical exams. Primary outcome was continuous and categorical predicted 10-year CVD risk. Secondary outcome was statin eligibility. Results Seventy percent were female, 65.5% lived on a daily income of ≤1 USD, 57.0% had hypertension, 14.5% had hypercholesterolemia, 9.3% had diabetes mellitus, 5.5% were current smokers, and 2.0% had HIV. Predicted 10-year CVD risk ranged from 3.9% in adjusted PCE (IQR 1.7-8.4) to 9.8% in Framingham-BMI (IQR 5.0-17.8), and Spearman rank correlation coefficients ranged from 0.87 to 0.98. The percent of the cohort categorized as high risk using the uniform threshold of 10-year CVD risk ≥ 7.5% ranged from 28.8% in the adjusted PCE model to 62.0% in the Framingham-BMI model (χ2 = 331, p value < 0.001). Statin eligibility also varied widely. Conclusions In the Haiti CVD Cohort, there was substantial variation in the proportion identified as high-risk and statin eligible using existing models, leading to very different treatment recommendations and public health implications depending on which prediction model is chosen. There is a need to design and validate CVD risk prediction tools for low-middle income countries that include locally relevant risk factors.

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Prevalence of intestinal parasites and related risk factors in rural localities from Pampa del Indio, Chaco, Argentina

UF Journal of Undergraduate Research ◽

10.32473/ufjur.v21i1.107939 ◽

2019 ◽

Vol 21 (1) ◽

Author(s):

Lindsay Renee Richards ◽

Cintia Delgado ◽

Marcia Goy ◽

Song Liang ◽

Maria V. Periago

Keyword(s):

Risk Factors ◽

Rural Areas ◽

Intestinal Parasites ◽

Parasite Prevalence ◽

Infection Prevalence ◽

Middle Income ◽

Middle Income Countries ◽

Related Risk ◽

Stool Samples ◽

Human Infections

Intestinal parasites are a significant cause of morbidity in endemic areas in many low- and middle-income countries (LMICs). Infections with intestinal parasites have been reported in multiple locations throughout Argentina, but infection prevalence is still unknown in many areas. The aim of this study was to determine the prevalence of intestinal parasites in rural areas surrounding Pampa del Indio, Chaco, Argentina, and to identify risk factors for human infections. In the current study, a survey of three rural neighborhoods surrounding the town of Pampa del Indio was conducted in July 2018. A total of 24 households were surveyed. A questionnaire to assess socio-economic and household variables was administered and fecal samples were collected. Of the 62 stool samples analyzed, an intestinal parasite prevalence of 46.8% (29 cases) was found. The most common parasite identified was Endolimax nana (22.6%), followed by Giardia lamblia (17.7%), and Entamoeba coli (16.1%). Most of the intestinal parasites found were protozoa, but three cases of helminths (4.8%) were also identified. Participants were polyparasitized at a rate of 19.4%.

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