Association between anemia and household water source or sanitation in preschool children: the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project

ABSTRACT Background The associations between anemia and household water source and sanitation remain unclear. Objectives We aimed to assess the associations between anemia and household water source or sanitation in preschool children (PSC; age 6–59 mo) using population-based surveys from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project. Methods We analyzed national and subnational data from 21 surveys, representing 19 countries (n = 35,963). Observations with hemoglobin (Hb) and ≥1 variable reflecting household water source or sanitation were included. Anemia was defined as an altitude-adjusted Hb concentration <110 g/L. Household water source and sanitation variables were dichotomized as “improved” or “unimproved.” Poisson regressions with robust variance estimates were conducted for each survey, adjusting for child sex, age, household socioeconomic status, maternal education, and type of residence. Results Access to an improved water source and improved sanitation ranged from 29.9% (Burkina Faso) to 98.4% (Bangladesh, 2012), and from 0.2% (Kenya, 2007) to 97.4% (Philippines), respectively. Prevalence of anemia ranged from 20.1% (Nicaragua) to 83.5% (Bangladesh, 2010). Seven surveys showed negative associations between anemia and improved sanitation. Three surveys showed association between anemia and improved water, with mixed directions. Meta-analyses suggested a protective association between improved household sanitation and anemia [adjusted prevalence ratio (aPR) = 0.88; 95% CI: 0.79, 0.98], and no association between improved household water and anemia (aPR = 1.00; 95% CI: 0.91, 1.10). There was heterogeneity across surveys for sanitation (P < 0.01; I2 = 66.3%) and water (P < 0.01; I2 = 55.8%). Conclusions Although improved household sanitation was associated with reduced anemia prevalence in PSC in some surveys, this association was not consistent. Access to an improved water source in general had no association with anemia across surveys. Additional research could help clarify the heterogeneity between these conditions across countries to inform anemia reduction programs.

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Association Between Water and Sanitation with Anemia in Preschool Children: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) Project (P10-087-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz034.p10-087-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Emma Xinchun Yu ◽

Anne Williams ◽

O Yaw Addo ◽

Parminder Suchdev ◽

Junjue Guo ◽

...

Keyword(s):

Preschool Children ◽

Survey Design ◽

Hemoglobin Concentration ◽

Water Source ◽

Population Based ◽

Drinking Water Source ◽

Chi Square ◽

Household Water ◽

Improved Sanitation ◽

Logistic Regressions

Abstract Objectives We aimed to assess the associations between water source and sanitation with anemia in preschool children (age: 6–59 months) in 16 population-based surveys. Methods We analyzed data from the BRINDA project. Sixteen surveys, representing 15 countries (n = 25,214), that had measures of hemoglobin, household water source and sanitation, type of residence, and socioeconomic (SES) status were included in this analysis. Anemia was defined as altitude-adjusted hemoglobin concentration <110 g/L. Water source and sanitation were defined as improved household drinking water source and improved toilet facility, respectively. Bivariate analyses were done using Rao-Scott chi-square test (except for age, a continuous predictor using logistic regressions). Multivariable logistic regressions were conducted to examine associations between anemia and water source and sanitation, adjusting for age, sex, rural-urban location, and SES. All analyses were conducted with SAS 9.4, accounting for complex survey design. Results The prevalence of anemia ranged from 20.0% in Nicaragua to 72.1% in Kenya 2010. The prevalence of improved water source and improved sanitation ranged from 44.1% in Laos to 98.4% in Bangladesh, and from 0.1% in Kenya 2007 to 93.7% in Ecuador, respectively. Improved water source alone was protective of anemia in two surveys. Improved sanitation alone was protective of anemia in three surveys. Improved water source alone was negatively associated with anemia in one survey. Improved water source and sanitation combined was protective of anemia in 4 out of 16 surveys, specifically Afghanistan (adjusted OR = 0.55, 95% CI: 0.31–0.96), Azerbaijan (adjusted OR = 0.55, 95% CI: 0.31–0.999), Bangladesh (adjusted OR = 0.03, 95% CI: 0.002–0.28), and Laos (adjusted OR = 0.37, 95% CI: 0.17–0.80). Conclusions Improved household water source and sanitation was inversely associated with anemia in some settings. However, results were not consistent across surveys, and there may be thresholds at which water source and sanitation impacts anemia. Further research is warranted to evaluate the potential mechanisms that explain links between water source and sanitation with anemia. Funding Sources Bill & Melinda Gates Foundation.

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ENVIRONMENTAL, DEMOGRAPHIC, AND SOCIO-ECONOMIC CORRELATES OF ACCESS TO IMPROVED SANITATION: EMPIRICAL EVIDENCE FROM PAPUA AND WEST PAPUA PROVINCES

Jurnal Kependudukan Indonesia ◽

10.14203/jki.v10i1.52 ◽

2015 ◽

Vol 10 (1) ◽

pp. 11

Author(s):

Sri Irianti ◽

Puguh Prasetyoputra

Keyword(s):

Household Head ◽

Water Source ◽

Household Wealth ◽

Probit Regression ◽

Policy Makers ◽

Multiple Indicator Cluster Survey ◽

Household Water ◽

West Papua ◽

Improved Sanitation ◽

Multiple Indicator

Papua and West Papua provinces are two of many lagging provinces in Indonesia in terms of access to adequate sanitation. Hence, this paper aims to reveal determinants of access to improved sanitation by investigating the environmental, demographic, and socio-economic correlation in both provinces. Data from the 2011 Multiple Indicator Cluster Survey (MICS) were used to determine the demographic and socio-economic correlates of households access to improved sanitation facilities. Probit regression models were fitted to the data. The results suggest that district, place or residence, type and location of household water source, household size, age of household head, education of household head, and household wealth have significant correlation with access to improved sanitation. These corroborate previous findings and more importantly, it can be used to inform policy makers in Indonesia especially in Papua and West Papua Provinces.

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Maternal Determinants Mediating the Impact of Household Poverty on the Nutritional Status of Children Under 5 Years of Age in Bangladesh

Food and Nutrition Bulletin ◽

10.1177/0379572121999016 ◽

2021 ◽

pp. 037957212199901

Author(s):

Probir Kumar Ghosh ◽

Pritimoy Das ◽

Doli Rani Goswam ◽

Ausraful Islam ◽

Sukanta Chowdhury ◽

...

Keyword(s):

Higher Education ◽

Nutritional Status ◽

Maternal Education ◽

Prevalence Ratio ◽

Household Wealth ◽

Population Based ◽

Maternal Factors ◽

Household Poverty ◽

Maternal Determinants ◽

The Impact

Objectives: We explored the maternal determinants that mediate the effect of household poverty on childhood undernutrition. Methods: We used the population-based Bangladesh Demographic Health Survey data from 2014 for demographic characteristics, child and maternal factors. Results: Of the 7173 under-5 children, 3456 (48.2%) had undernutrition. The prevalence of undernutrition was less common in wealthy households (poorest vs richest: adjusted prevalence ratio [aPR] = 1.37), mothers having history of antenatal care (ANC) visits (no visit vs ≥4 visits: aPR = 1.22), maternal higher education (no education vs higher education: aPR = 1.54), and mothers with good nutritional status (underweight vs healthy: aPR = 1.13). The risk of undernutrition (37.1%) was attributed to household wealth, mediated 55% by maternal factors; of which 20% by maternal education, 21% by ANC visits, and 14% by maternal nutritional status. Conclusions: Our study findings outlined higher maternal education, ≥4 ANC visits and maternal good nutritional status in mediating the impact of household wealth on childhood nutrition.

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Are children’s stools in Ghana disposed of safely? Evidence from the 2014 Ghana demographic and health survey

BMC Public Health ◽

10.1186/s12889-021-10155-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Abdul-Aziz Seidu

Keyword(s):

Drinking Water ◽

Health Survey ◽

Water Source ◽

Demographic And Health Survey ◽

Outcome Variable ◽

Drinking Water Source ◽

Safe Disposal ◽

Toilet Facility ◽

Improved Sanitation ◽

Northern Zone

Abstract Background Safe disposal of children’s faeces has always been one of the main challenges to good hygiene in Ghana. Although it has been proven that children’s faeces are more likely to spread diseases than adults’ faeces, people usually mistake them for harmlessness. This study, therefore, sought to determine the prevalence and factors associated with safe disposal of children’s faeces in Ghana. Methods Data from the 2014 Ghana Demographic and Health Survey was used for the analysis. A sample size of 2228 mother-child pairs were used for the study. The outcome variable was disposal of children stools. Both bivariate and multivariable logistic regression analyses were performed to identify the factors with safe child stool disposal. Results The prevalence of safe child stool disposal in Ghana was 24.5%. Women in the middle [Adjusted odds ratio (AOR) = 4.62; Confidence Interval (CI) = 3.00–7.10], Coastal Zone [AOR = 4.52; CI = 2.82–7.22], mothers whose children were aged 12–17 [AOR = 1.56; CI = 1.15–2.13] and 18–23 months [AOR = 1.75; CI = 1.29–2.39], and mothers whose household had improved type of toilet facility [AOR = 2.04; CI = 1.53–2.73] had higher odds of practicing safe children’s faeces disposal. However, women from households with access to improved source of drinking water [AOR = 0.62; CI = 0.45–2.7] had lower odds of practicing safe children’s faeces disposal. Conclusion Approximately only about 25 out of 100 women practice safe disposal of their children’s faeces in Ghana. The age of the child, ecological zone, the type of toilet facilities, and the type of drinking water source are associated with the disposal of child faeces. These findings have proven that only improved sanitation (i.e. drinking water and toilet facilities) are not enough for women to safely dispose of their children’s faeces. Therefore, in addition to provision of toilet facilities especially in the northern zone of Ghana, there is also the need to motivate and educate mothers on safe disposal of children’s stools especially those with children below 12 months. More so, mothers without access to improved toilet facility should also be educated on the appropriate ways to bury their children’s stools safely.

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Association between Adherence with Recommended Antenatal Care in Low-Risk, Uncomplicated Pregnancy, and Maternal and Neonatal Adverse Outcomes: Evidence from Italy

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18010173 ◽

2020 ◽

Vol 18 (1) ◽

pp. 173

Author(s):

Giovanni Corrao ◽

Anna Cantarutti ◽

Anna Locatelli ◽

Gloria Porcu ◽

Luca Merlino ◽

...

Keyword(s):

Antenatal Care ◽

Prevalence Ratio ◽

Population Based ◽

Adverse Outcomes ◽

Low Risk ◽

Neonatal Outcomes ◽

Lombardy Region ◽

Uncomplicated Pregnancy ◽

Maternal And Neonatal Outcomes ◽

Estimate Prevalence

Antenatal care (ANC) aims of monitoring wellbeing of mother and foetus during pregnancy. We validate a set of indicators aimed of measuring the quality of ANC of women on low-risk, uncomplicated pregnancy through their relationship with maternal and neonatal outcomes. We conducted a population-based cohort study including 122,563 deliveries that occurred between 2015 and 2017 in the Lombardy Region, Italy. Promptness and appropriateness of number and timing of gynaecological visits, ultrasounds and laboratory tests were evaluated. We assessed several maternal and neonatal outcomes. Log-binomial regression models were used to estimate prevalence ratio (PR), and corresponding 95% confidence interval (95% CI), for the exposure→outcome association. Compared with women who adhered with recommendations, those who were no adherent had a significant higher prevalence of maternal intensive care units admission (PR: 3.1, 95%CI: 1.2–7.9; and 2.7, 1.1–7.0 respectively for promptness of gynaecological visits, and appropriateness of ultrasound examinations), low Apgar score (1.6, 1.1–1.2; 1.9, 1.3–2.7; and 2.1, 1.5–2.8 respectively for appropriateness and promptness of gynaecological visits, and appropriateness of ultrasound examinations), and low birth weight (1.8, 1.5–2.3 for appropriateness of laboratory test examinations). Benefits for mothers and newborn are expected from improving adherence to guidelines-driven recommendations regarding antenatal care even for low-risk, uncomplicated pregnancies.

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Fixation Preference and Visual Acuity Testing in a Population-based Cohort of Preschool Children with Amblyopia Risk Factors

Ophthalmology ◽

10.1016/j.ophtha.2008.08.031 ◽

2009 ◽

Vol 116 (1) ◽

pp. 145-153 ◽

Cited By ~ 28

Author(s):

Susan A. Cotter ◽

Kristina Tarczy-Hornoch ◽

Erin Song ◽

Jesse Lin ◽

Mark Borchert ◽

...

Keyword(s):

Risk Factors ◽

Visual Acuity ◽

Preschool Children ◽

Population Based ◽

Visual Acuity Testing ◽

Fixation Preference

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Prevalence of health services usage and associated factors in the Amazon region of Brazil: a population-based cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2017-017966 ◽

2017 ◽

Vol 7 (11) ◽

pp. e017966 ◽

Cited By ~ 9

Author(s):

Maria Elizete A Araujo ◽

Marcus T Silva ◽

Tais F Galvao ◽

Mauricio G Pereira

Keyword(s):

Health Services ◽

Associated Factors ◽

Prevalence Ratio ◽

The Elderly ◽

Population Based ◽

Cross Sectional Study ◽

Metropolitan Region ◽

Medical Attention ◽

Cross Sectional ◽

Physician Visits

ObjectivesTo estimate the prevalence of healthcare use and associated factors in the Manaus metropolitan region and to describe the reasons for lack of access.DesignCross-sectional population-based study.SettingA survey conducted between May and August of 2015 in eight cities from Manaus metropolitan region, Amazonas, Brazil.Participants4001 adults ≥18 years of age.Primary outcomes measuresPhysician visits, dentist visits and hospitalisations in the last 12 months were the primary outcomes. Associated factors were investigated through the calculation of prevalence ratio (PR) obtained by hierarchical Poisson regression modelling.Results4001 adults were included in the study, 53% of whom were women. The self-reported prevalence of medical visits was 77% (95% CI 75% to 77%); dentist visits, 36% (95% CI 34% to 37%) and hospital admission, 7% (95% CI 6% to 7%). Physician visits were higher in women PR=1.18 (95% CI 1.14 to 1.23), the elderly PR=1.18 (95% CI 1.10 to 1.26) and people with health insurance PR=1.14 (95% CI 1.10 to 1.19). Dentist visits declined with older age PR=0.38 (95% CI 0.30 to 0.49), lower education level PR=0.62 (95% CI 0.51 to 0.74) and lower economic class PR=0.65 (95% CI 0.57 to 0.75). Hospitalisations were found to be twice as frequent for women than for men and three times as frequent among those who reported very poor health status. Among the individuals who did not receive medical attention in the previous 2 weeks, 58% reported lack of facilities or appointment unavailable and 14% reported lack of doctors.ConclusionWhile more than half visited the doctor in the last year, a lower proportion of people with socioeconomic inequities visited the dentist. Organisational and service policies are needed to increase equity in health services in the region.

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Abstract WP199: Higher Stroke Prevalence Rates among Ribeirinhos Compared to Townsmen in the Brazilian Amazon.

Stroke ◽

10.1161/str.44.suppl_1.awp199 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Tiotrefis G Fernandes ◽

Isabela M Bensenor ◽

Paulo A Lotufo

Keyword(s):

Urban Area ◽

Health Workers ◽

Prevalence Ratio ◽

Epidemiological Studies ◽

Population Based ◽

Cerebrovascular Diseases ◽

Prevalence Rates ◽

Family Health Program ◽

Stroke Prevalence ◽

The Family

There is a lack of epidemiological studies addressing cerebrovascular diseases in remote places as the Amazon river basin. We aimed to calculate the stroke prevalence rates among "ribeirinhos", rural inhabitants who living in riverbanks fishing and extracting fruit and nuts, in the rainforest comparing to townsmen in the same municipality. Methods: From May to October 2011, 6216 residents aged over 35 years in the of Coari, a municipality that is coverage by the Family Health Program with of 76 000 inhabitants, 35% of them are "ribeirinhos”. We trained all community health workers to carry out a door-to-door application of the “Stroke Symptom Questionnaire” for people over 35 years-old. This tool was applied first for the family for stroke screening and further for the index stroke case, including questions about six key functional impairment. It was previously translated to Portuguese and validated by a neurologist. Results: From a total of of 4897 respondents of urban area and 1028 "ribeirinhos", we calculated crude prevalence of stroke of 6.3% (95% CI; 5.0-7.7) among the "ribeirinhos" and of 3.7% (95% CI; 3.3-4.1) among townsmen. This difference was maintained after sex-age-adjustment. The female:male prevalence ratio was 1.37 (95% CI; 1.02-1.85) in urban area and the rural area of 0.93 (95% CI; 0.57-1.52). Among stroke suffers, the "ribeirinhos" were those with less access to medical care (32.1% vs. 52.5%, p=0.01) and a lower proportion of stroke survivors requiring help with least 1 activity of daily living (16.9% vs. 39.3%, p=0.001) in comparison to townsmen. Conclusion: To our knowledge it was the first study that provided a population-based stroke survey in the Amazon rainforest revealing a higher stroke prevalence among "ribeirinhos" compared to townsmen of the same municipality.

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Prevalence of household falls in long-lived adults and association with extrinsic factors

Revista Latino-Americana de Enfermagem ◽

10.1590/1518-8345.1646.2900 ◽

2017 ◽

Vol 25 (0) ◽

Cited By ~ 7

Author(s):

Silviane Galvan Pereira ◽

Claudia Benedita dos Santos ◽

Marlene Doring ◽

Marilene Rodrigues Portella

Keyword(s):

Older Adults ◽

Prevalence Ratio ◽

Household Survey ◽

Population Based ◽

Multiple Model ◽

Human Beings ◽

Extrinsic Factors ◽

Cross Sectional ◽

Factors Associated ◽

Selection Of Variables

Resume Objective: to identify the prevalence of falls among older adults and the extrinsic factors associated with them. Method: population-based cross-sectional study with 350 older adults. A household survey was conducted using a questionnaire addressing socio-demographic, clinical, and environmental characteristics. Data were analyzed using Stata Software V.10. Pearson’s chi-square test and logistic regression analysis were used with stepwise criteria for selection of variables in the model, with measures of effect expressed in Prevalence Ratio. For input into the multiple model, the variables with p ≤ 0.20 were considered. All ethical care regarding research on human beings has been observed and respected. Results: the prevalence of falls was 46.9%. The extrinsic factors associated with falls were: stairs, uneven floor and pets in the main entrance, lack of anti-slip loose throw rugs and slippery floor in the kitchen, lack of anti-slip loose throw rugs and objects on the floor in the room, lack of grab bars in the shower, lack of grab bars in the toilet and switch away from the bathroom door (p <0.05). Conclusion: falls are frequent in long-lived adults. The identification of the extrinsic factors associated with the occurrence of this event can help in its prevention.

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