scholarly journals No Magic Bullets: Insights on Drivers of Stunting Decline from an Analysis of Subnational Success Cases in India

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 803-803
Author(s):  
Rasmi Avula ◽  
Phuong Nguyen ◽  
Neha Kohli ◽  
Shubhada Kanani ◽  
Purnima Menon
Keyword(s):  
Civil Society ◽  
Maternal Education ◽  
National Level ◽  
Decomposition Analysis ◽  
Political Leadership ◽  
State Level ◽  
Well Being ◽  
Child Growth ◽  
Drivers Of Change ◽  
Gates Foundation

Abstract Objectives Global attention to reducing childhood stunting has increased the demand for guidance on translating policies into impact. Evidence from national-level success cases is emerging but little is known about how subnational entities can accelerate change. In India, despite a common national framework of programs/policies targeting many determinants of child growth, stunting reduction has varied across states. We aimed to understand drivers of change in stunting at state-level and to identify programmatic, social and political factors that contributed to these changes. Methods We studied three states that had achieved substantial stunting declines between 2005 and 2016 [Chhattisgarh (CG) 14 percentage points (pp); Gujarat (GJ) 13pp; Odisha (OD) 11 pp]. We used regression-decomposition analysis to assess contributions of various determinants of height-for-age Z-score (HAZ) using two rounds of national data. We reviewed nutrition-relevant policies and programs linked to these drivers of change and interviewed stakeholders in government, development partners (DPs), academia and civil society (n = 61) to understand how change occurred. Results Main contributors to gains in HAZ were coverage of health and nutrition interventions (21% CG; 11% GJ; 25% OD), household assets (10% CG; 13% GJ; 18% OD), and sanitation (7% CG; 6% GJ; 5% OD). Maternal education, age at marriage, community-level hygiene, and electrification also contributed. Political leadership and an outcome-focused vision were crucial for action. Although vision varied, capable administrators were able to secure adequate finances, strengthen implementation systems, and invest in state-specific innovations, creating an enabling environment for change. Varied actors, including civil society and DPs, played a catalytic role in spurring action through advocacy, technical and financial inputs, and vigilance. Conclusions Similar drivers were responsible for stunting reduction in 3 states. Ingredients for success highlight the importance of political leadership, targeting multiple determinants and improving implementation systems. Supportive civil society, political and bureaucratic leadership motivated by the well-being of communities remain crucial. Funding Sources Bill & Melinda Gates Foundation through POSHAN, led by IFPRI.

scholarly journals Exploratory Graph Analysis of the Strengths and Difficulties Questionnaire for Aboriginal and/or Torres Strait Islander Children

2021 ◽  
Vol 12 ◽  
Author(s):  
Pedro Henrique Ribeiro Santiago ◽  
Davi Manzini Macedo ◽  
Dandara Haag ◽  
Rachel Roberts ◽  
Lisa Smithers ◽  
...  
Keyword(s):  
Graphical Models ◽  
Torres Strait Islander ◽  
External Validation ◽  
National Level ◽  
State Level ◽  
Well Being ◽  
Strengths And Difficulties Questionnaire ◽  
Graph Analysis ◽  
Strengths And Difficulties ◽  
Torres Strait

In Australia, one of the most frequently used measures for assessing social and emotional well-being (SEWB) of Aboriginal and/or Torres Strait Islander children is the Strengths and Difficulties Questionnaire (SDQ). Previous studies on state-level validations have indicated the problems associated with the original five-factor SDQ structure, especially in the dimension of Peer Problems. The aim of this study was to use a novel psychometric methodology, namely Exploratory Graph Analysis (EGA), to evaluate the dimensionality of caregiver-informant SDQ version 4–10 years at a national level in Australia. Data for this study were retrospectively collected from two independent longitudinal studies: the Longitudinal Study of Indigenous Children (LSIC) and South Australian Aboriginal Birth Cohort (SAABC). The caregiver-informed SDQ version 4–10 years was applied across several study waves, including more than 4,000 responses. To conduct EGA, Gaussian graphical models (GGMs) were estimated using the Least Absolute Shrinkage and Selection Operator. About 2,500 bootstrap samples were also employed to investigate dimensions and item stability. The findings indicated robust evidence against the construct validity of the original five-factor SDQ structure. Future studies should conduct a direct external validation of the findings with Aboriginal and/or Torres Strait Islander parents/carers and community groups to develop the guidelines for future use of the instrument among Aboriginal and/or Torres Strait Islander children in Australia.

Conceptual Principles of the Civil Society Research

2017 ◽  
pp. 214-221
Author(s):  
Oleksandra Demianenko
Keyword(s):  
Civil Society ◽  
Social Relations ◽  
Information Technologies ◽  
Local Level ◽  
National Level ◽  
Historical Context ◽  
State Level ◽  
Three Dimensions ◽  
Political Reality ◽  
Economic Landscape

The article attempts to analyze the conceptual foundations of the study of civil society (theoretical and methodological foundations) comprehensively in order to generalize research material on this subject. Different approaches to the concept and phenomenon of civil society in the historical context of their formation are analyzed and systematized. Taking into account complex content and the form of a civil society as a subject of research, the author offers an approach to its analysis, providing three dimensions of the study: a theoretical; a historical; and a practical one. The emphasis is on the importance of the economic component in the emergence of the phenomenon of a civil society in the socio-political reality and the significance of changes in the economic realm to update goals and objectives, as well as the structure of a civil society. Contemporary investigation of civil society involves research of information technologies that affect the level of openness and mobility of any knowledge and information; globalization processes that shape the new economic landscape of the world and, therefore, become the subject of civil society due to inevitable social-economic conflicts and contradictions; migration processes that affect the value system of both migrants and settled population, which leads to the formation of completely new subjects and objects of influence of civil society; ecological problems, which do not have a pronounced nationality and directly affect humanity as a whole, which leads to the emergence of international environmental movements. A separate problem in considering the theory of civil society is the level of personal interactions in modern conditions. The emergence of planetary problems and, accordingly, the interests of people allow distinguishing three levels of social relations, which have their own characteristics and directly affect the approaches to the implementation of civil society. Such levels are local level of interrelations (within the framework of separate communities, professional or cultural communities); national level of interrelations (at the state level or interstate regional interrelations); supranational level of interrelations (environmental issues, war and peace issues, disarmament, etc.). Keywords: Civil society, capitalism, labor market, mass movements, economic inequality, justice, conflict of interests, institutionalization

scholarly journals The role of the state government, civil society and programmes across sectors in stunting reduction in Chhattisgarh, India, 2006–2016

2020 ◽  
Vol 5 (7) ◽  
pp. e002274
Author(s):  
Neha Kohli ◽  
Phuong H Nguyen ◽  
Rasmi Avula ◽  
Purnima Menon
Keyword(s):  
Civil Society ◽  
State Government ◽  
Decomposition Analysis ◽  
Family Health ◽  
State Level ◽  
Political Stability ◽  
Shared Vision ◽  
The State ◽  
Regression Decomposition ◽  
Childhood Stunting

IntroductionChildhood stunting has declined in India between 2006 and 2016, but not uniformly across all states. Little is known about what helped some states accelerate progress while others did not. Insights on subnational drivers of progress are useful not just for India but for other decentralised policy contexts. Thus, we aimed to identify the factors that contributed to declines in childhood stunting (from 52.9% to 37.6%) between 2006 and 2016 in the state of Chhattisgarh, a subnational success story in stunting reduction in India.MethodsWe examined time trends in determinants of stunting using descriptive and regression decomposition analysis of National Family Health Survey data from 2005 to 2006 and 2015–2016. We reviewed nutrition-relevant policies and programmes associated with the drivers of change to construct a policy timeline. Finally, we interviewed multiple stakeholders in the state to understand the changes in the drivers of undernutrition.ResultsThe regression decomposition analysis shows that multiple factors explain 66% of the change in stunting between 2006 and 2016. Improvements in three key drivers—health and nutrition services, household assets, and sanitation and hygiene—explained 47% of the change in stunting. A shared vision for impact, political stability and capable bureaucracy, state-level innovations, support from development partners and civil society, and community mobilisation were found to contribute to improvements in programmes for health, poverty and sanitation.ConclusionChange in multiple sectors is important for stunting reduction and can be achieved in subnational contexts. More work lies ahead to close gaps in various determinants of stunting.

scholarly journals Stories of Change in Nutrition in Ghana: a focus on stunting and anemia among children under-five years (2009 – 2018)

Food Security ◽  
2021 ◽  
Author(s):  
Richmond Aryeetey ◽  
Afua Atuobi-Yeboah ◽  
Lucy Billings ◽  
Nicholas Nisbett ◽  
Mara van den Bold ◽  
...  
Keyword(s):  
Health Care Access ◽  
Maternal Education ◽  
Social Protection ◽  
Care Service ◽  
National Level ◽  
Decomposition Analysis ◽  
Household Wealth ◽  
Quantitative Evidence ◽  
Stakeholder Relationships ◽  
Policies And Programs

AbstractThe current study aimed to understand why child stunting and anemia (CS&A) rates declined in Ghana between 2009 and 2018, and which priority policies and programs will further improve nutrition outcomes. Trends and potential drivers of stunting (height-for-age z-score < -2.0 SD) and anemia (hemoglobin < 11.0 g/dL), and decomposition analysis of DHS data (2003 to 2014) were conducted. The quantitative evidence was triangulated with Net-Map analysis of nutrition stakeholder relationships and influence, desk review of policies and programs 2009–2019, and in-depth interviews with 25 stakeholders who provided additional insights to explain CS&A trends. Declines in stunting (29.6%) and anemia (14.1%) in children were observed at the national level, but with important subgroup variations. Decomposition analyses identified changes in the household, maternal, and child characteristics (including wealth, use of antenatal services, maternal education, and immunization) as correlates of anemia reduction. Stunting reduction was linked with changes in bed-net utilization, household wealth, and pregnancy care service utilization. Additionally, multiple policies and programs initiated/implemented across multiple sectors were considered potentially relevant to CS&A reduction over time, including those focused on infant and young child feeding, water and sanitation, social protection, and health care access. Initiation/strengthening of these interventions was stimulated by awareness creation and subsequently increased prioritization of stunting. However, program delivery was limited by deficits in government funding, perceived low priority of child anemia, low implementation capacity and coverage, and weak coherence across sectors. Reduced CS&A resulted from improved access to services implemented across multiple sectors, albeit limited by implementation scale and capacity. Further reduction in CS&A requires enhanced multi-sectorally coordinated actions and capacity.

scholarly journals Drivers of stunting reduction in Peru: a country case study

2020 ◽  
Vol 112 (Supplement_2) ◽  
pp. 816S-829S ◽  
Author(s):  
Luis Huicho ◽  
Elisa Vidal-Cárdenas ◽  
Nadia Akseer ◽  
Samanpreet Brar ◽  
Kaitlin Conway ◽  
...  
Keyword(s):  
Civil Society ◽  
Program Analysis ◽  
Parental Education ◽  
Health Sector ◽  
Political Leadership ◽  
Child Growth ◽  
Food Supplementation ◽  
Demographic And Health Surveys ◽  
Child Stunting ◽  
Key Drivers

ABSTRACT Background Peru reduced its under-5 child stunting prevalence notably from 31.3% in 2000 to 13.1% in 2016. Objectives We aimed to study factors and key enablers of child stunting reduction in Peru from 2000–2016. Methods Demographic and Health Surveys were used to conduct descriptive analyses [height-for-age z scores (HAZ) means and distributions, equity analysis, predicted child growth curves through polynomial regressions] and advanced regression analyses. An ecological (at department level) multilevel regression analysis was conducted to identify the major predictors of stunting decline from 2000 to 2016, and Oaxaca–Blinder decomposition was conducted to identify the relative contribution of each factor to child HAZ change. A systematic literature review, policy and program analysis, and interviews with relevant stakeholders were conducted to understand key drivers of stunting decline in Peru. Results The distribution of HAZ scores showed a slight rightward shift from 2000 to 2007/2008, and a greater shift from 2007/2008 to 2016. Stunting reduction was higher in the lowest wealth quintile, in rural areas, and among children with the least educated mothers. Decomposing predicted changes showed that the most important factors were increased maternal BMI and maternal height, improved maternal and newborn health care, increased parental education, migration to urban areas, and reduced fertility. Key drivers included the advocacy role of civil society and political leadership around poverty and stunting reduction since the early 2000s. Key enablers included the economic growth and the consolidation of democracy since the early 2000s, and the acknowledgement that stunting reduction needs much more than food supplementation. Conclusions Peru reduced child stunting owing to improved socioeconomic determinants, sustained implementation of out-of-health-sector and within-health-sector changes, and implementation of health interventions. These efforts were driven through a multisectoral approach, strong civil society advocacy, and keen political leadership. Peru's experience offers useful lessons on how to tackle the problem of stunting under differing scenarios, with the participation of multiple sectors.

scholarly journals The Timing of Growth Faltering in India Has Changed Significantly over 1992–2016, with Variations in Prenatal and Postnatal Improvement (P10-005-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Derek Headey ◽  
Purnima Menon ◽  
Phuong Nguyen
Keyword(s):  
Maternal Nutrition ◽  
Food Policy ◽  
National Level ◽  
Policy Research ◽  
State Level ◽  
Postnatal Growth ◽  
Child Growth ◽  
Survey Period ◽  
Growth Faltering ◽  
Over Time

Abstract Objectives India accounts for a third of the global population of stunted preschoolers. However, very few studies have documented the timing of growth faltering in India, its evolution over time, or its variation over India's diverse regions. This study develops an approach for estimating the speed of growth faltering and applies it to multiple rounds of national and state-level data. Methods National Family Health Surveys (NHFS) in 1993, 1999, 2006 and 2016, representative both at national and state-level (pooled N = 328,818), were used to estimate mean height-for-age Z scores (HAZ) for children 0–59 m of age. We plotted HAZ by age curves for each survey period and used spline-based regressions to estimate monthly HAZ loss over the prenatal period (conception to 1 m of age) and three postnatal periods (1–6 m, 6–20 m and 20 m onwards) in each survey round for each state. We used multivariate regressions to compare differences in the determinants of HAZ change between states that saw a predominantly prenatal HAZ improvement and states that saw a predominantly postnatal HAZ improvement. Results Over 1993–2006 there was a significant improvement in neonatal HAZ from -0.81 to -0.53 (P < 0.001) at the national level, but no significant improvement in postnatal HAZ loss. However, from 2006 to 2016 most of the increase in HAZ resulted from slower postnatal growth faltering: in the 1–6 m period monthly HAZ loss fell by 50% (P = 0.002) while in the 6–20 m period it declined by 17% (P < 0.001). Across states, however, there were marked differences in HAZ-by-age trends over 2006–16; most states were characterized by significant postnatal growth improvements, but in a few states we observe significant prenatal growth improvements. In the postnatal improvers, changes in household socioeconomic status explained most of the HAZ change. A notable feature of the prenatal improvers is that they saw larger improvements in access to public antenatal care services. Conclusions Patterns of child growth faltering in India are characterized by both small size at birth (poor maternal nutrition) and rapid postnatal growth faltering (poor feeding and care practices). Despite overall improvements over time, the timing and speed of growth faltering vary markedly by state, with important implications for national and state-level nutrition strategies. Funding Sources Bill & Melinda Gates Foundation through POSHAN, led by International Food Policy Research Institute. Supporting Tables, Images and/or Graphs

scholarly journals Diffusion of Democracy among Civil Society Actors in Guangdong Province

2019 ◽  
Vol 7 ◽  
pp. 30-51
Author(s):  
Gustav Johan Sundqvist
Keyword(s):  
Hong Kong ◽  
Civil Society ◽  
Local Level ◽  
Research Question ◽  
National Level ◽  
State Level ◽  
Guangdong Province ◽  
Primary Interest ◽  
Survival And Growth ◽  
Civil Society Networks

In recent years, a great number of studies have convincingly shown that diffusion influences states’ probability to democratise. The primary interest of most of these studies has been on how diffusion influences democracy at the national level. The effect of democratic diffusion on the local level has largely been neglected. This paper thus investigates how and to what extent diffusion influences the density and conflict orientation of non-governmental labour organisations (LNGOs), comprising a typical case of civil society groups channelling democratic freedoms, in China’s Guangdong province. Since the province is close to the relatively liberal city of Hong Kong, there is reason to believe that support from international civil society groups based in Hong Kong may be critical for the survival and growth of conflict-oriented LNGOs in Guangdong. In the article, the research question is studied by both comparative analysis of cross-regional data and qualitative analysis of interview data. Both methods confirm that diffusion – or, more precisely, diffusion through international civil society networks – is a prominent factor for explaining the density and conflict orientation of LNGOs in Guangdong. The study demonstrates that democratic diffusion not only has an impact at the state level but also on the regional, intrastate level.

scholarly journals Paths Linking Maternal Resources for Care to Child Growth and Early Childhood Development in Bangladesh (P11-125-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Sulochana Basnet ◽  
Edward Frongillo ◽  
Phuong Nguyen ◽  
Spencer Moore ◽  
Mandana Arabi
Keyword(s):  
Child Development ◽  
Motor Development ◽  
Growth And Development ◽  
Maternal Education ◽  
Child Outcomes ◽  
Well Being ◽  
Child Growth ◽  
Perceived Support ◽  
Maternal Resources ◽  
Mental Well Being

Abstract Objectives The study aimed to determine the paths through which resources for care were associated with child growth and development. We hypothesized that resources could have been directly associated with child outcomes or indirectly through care behaviors. Child growth could also have mediated the association between care resources and development. Methods We used the baseline Alive & Thrive data from Bangladesh (n = 803 mothers and their 12–23.9-month children). Child outcomes were height-for-age z score (HAZ) and motor and language development. Care resources were maternal education, knowledge, height, body mass index (BMI), mental well-being, decision-making autonomy, employment, support in chores, and perceived support. Care included dietary diversity, cleanliness, immunization, stimulation, and adequate care. Path analyses accounting for potential confounders and clustering were used. Results Education, knowledge, health, autonomy and support were associated with child outcomes. Height (β = 0.054), BMI (β = 0.033), and mental well-being (β = 0.024) had direct associations with child HAZ. Knowledge (β = 0.0038) and perceived support (β = 0.013) were associated HAZ via immunization. Height (β = 0.034) and mental well-being (β = 0.015) were associated with motor development via HAZ. Knowledge (β = 0.0024) and perceived support (β = 0.0075) were associated with motor development via immunization and then HAZ. Autonomy (β = 0.085) and perceived support (β = -0.24) had a direct association with language. Education was associated with language via cleanliness (β = 0.011). Knowledge and perceived support had associations with language via cleanliness, and immunization and then HAZ. Height (β = 0.016), BMI (β = 0.0094), and mental well-being (β = 0.0070) were associated with language via HAZ. Conclusions Care resources were associated with growth and development directly and via care. Child growth mediated the associations between resources and child development. Strengthening various maternal resources and integration of growth and development interventions may improve child outcomes. Funding Sources Bill & Melinda Gates Foundation and the governments of Canada and Ireland through Alive & Thrive, managed by FHI 360, and the Patrice L. Engle Dissertation Grant in Global Early Child Development.

Applicability of management guidelines for surfing resources in California

Shore & Beach ◽  
2020 ◽  
pp. 53-64
Author(s):  
Edward Atkin ◽  
Dan Reineman ◽  
Jesse Reiblich ◽  
David Revell
Keyword(s):  
New Zealand ◽  
National Level ◽  
State Level ◽  
The United States ◽  
Management Guidelines ◽  
For Profit ◽  
Aotearoa New Zealand ◽  
Coastal Marine ◽  
Management Measures ◽  
Legal Frameworks

Surf breaks are finite, valuable, and vulnerable natural resources, that not only influence community and cultural identities, but are a source of revenue and provide a range of health benefits. Despite these values, surf breaks largely lack recognition as coastal resources and therefore the associated management measures required to maintain them. Some countries, especially those endowed with high-quality surf breaks and where the sport of surfing is accepted as mainstream, have recognized the value of surfing resources and have specific policies for their conservation. In Aotearoa New Zealand surf breaks are included within national environmental policy. Aotearoa New Zealand has recently produced Management Guidelines for Surfing Resources (MGSR), which were developed in conjunction with universities, regional authorities, not-for-profit entities, and government agencies. The MGSR provide recommendations for both consenting authorities and those wishing to undertake activities in the coastal marine area, as well as tools and techniques to aid in the management of surfing resources. While the MGSR are firmly aligned with Aotearoa New Zealand’s cultural and legal frameworks, much of their content is applicable to surf breaks worldwide. In the United States, there are several national-level and state-level statutes that are generally relevant to various aspects of surfing resources, but there is no law or policy that directly addresses them. This paper describes the MGSR, considers California’s existing governance frameworks, and examines the potential benefits of adapting and expanding the MGSR in this state.

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