Are Data Available to Measure Progress in the Coverage of Essential Nutrition Actions in South Asia? A Review of Demographic and Health Surveys in Seven Countries, 2005–2018

Abstract Objectives South Asian countries carry the largest burden of undernutrition globally. The World Health Organization has recommended a set of Essential Nutrition Actions (ENA) to tackle all forms of malnutrition. Limited evidence exists on the availability of data in nationally representative surveys to analyse coverage patterns and to track progress on these actions. Methods We reviewed household and woman questionnaires from DHS surveys conducted in South Asia—Afghanistan (2014), Bangladesh (2011 and 2014), India (2006 and 2016), Maldives (2009 and 2017), Nepal (2011 and 2016), Pakistan (2013 and 2018), and Sri Lanka (2006 and 2016)—to assess the availability of data to track coverage of the ENAs in South Asia region. For each ENA, we examined questionnaires to identify the availability of questions that could be used to construct coverage indicators. Results For adolescents and women of reproductive age, DHS questionnaires ask about prenatal iron folic acid (IFA) supplementation in zero countries and use of iodized salt in five countries. For pregnant women, out of six recommended ENAs, five are measured in at least one country: health and nutrition education, energy and protein supplementation, IFA supplementation, calcium supplementation, and multiple micronutrients that contain IFA. For postpartum women, data on iron supplementation and breastfeeding counselling are collected in only four countries. For early childhood, DHS surveys only measure 6 of 25 ENAs; only vitamin A supplementation is being tracked in DHS across all seven countries, while children who were breastfed early, had immediate skin to skin contact and zinc supplementation are measured in most countries. Conclusions Data for more than half of the ENAs across the continuum of care are not collected in the South Asian DHS questionnaires; gaps exist both for interventions and among countries. Coverage data from household surveys are critical to enable countries to track progress towards national coverage goals and to examine equity in the reach of interventions. To support national efforts to scale-up the coverage of ENAs, national survey instruments should be reviewed to include indicators on the coverage of a broader set of ENA indicators. Funding Sources Data for Decisions to Expand Nutrition Transformation (DataDENT) project, supported by the Bill and Melinda Gates Foundation.

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An Analysis of Nutrition-Relevant National Policies in South Asia Reveals a Gap in Addressing the Essential Nutrition Actions Recommended by World Health Organization (WHO)

Current Developments in Nutrition ◽

10.1093/cdn/nzaa064_018 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1728-1728

Author(s):

Sumanta Neupane ◽

Manita Jangid ◽

Samuel Scott ◽

Phuong Nguyen ◽

Sunny Kim ◽

...

Keyword(s):

Policy Analysis ◽

Pregnant Women ◽

South Asia ◽

South Asian ◽

Adolescent Girls ◽

Reproductive Age ◽

World Health ◽

Postpartum Women ◽

Women Of Reproductive Age ◽

National Policies

Abstract Objectives The WHO recommends Essential Nutrition Actions (ENAs) throughout the life course to tackle malnutrition in all its forms. However, limited evidence exists on the availability of policies to support the implementation of ENAs in South Asia, a region with the highest burden of malnutrition globally. We conducted a policy analysis to assess the extent to which current policies address ENAs for adolescent girls, women, and children in South Asia. Methods We first identified the WHO ENAs targeting non-pregnant menstruating adolescent girls (1 ENA), non-pregnant women of reproductive age (2 ENAs), pregnant women (6 ENAs), postpartum women (2 ENAs), and children aged 0–5 years (25 ENAs). We then reviewed 40 health- and nutrition-relevant national policy and program documents, strategic plans, and guidelines for health workers from Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka. Using these documents, we identified policies that address the ENAs. We report the number of recommended ENAs addressed by the policies for each population group. Results National nutrition policies exist in all eight countries. Six countries have multi-sector nutrition plans or strategy. These documents primarily guide provisions for nutrition actions in the region. Six countries have policies that address the ENA for non-pregnant menstruating adolescent girls. Only two countries have policies that address both ENAs for non-pregnant women of reproductive age. For pregnant women, three countries address four of six ENAs, but no countries address all six ENAs. Seven countries have policies that address both ENAs for postpartum women. Five countries have policies that address more than 20 of 25 ENAs for children aged 0–5 years. Conclusions Our policy analysis identifies substantial gaps in national policies related to the ENAs among South Asian countries and gaps are more pronounced for non-pregnant women of reproductive age and for pregnant women. Policy revisions, including updating policies, implementation and financing plans, will be needed to deliver the ENAs at scale and with quality to enable the South Asian region to tackle malnutrition in all its forms. Funding Sources Bill and Melinda Gates Foundation through DataDENT.

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Wasting and Associated Factors among Children under 5 Years in Five South Asian Countries (2014–2018): Analysis of Demographic Health Surveys

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18094578 ◽

2021 ◽

Vol 18 (9) ◽

pp. 4578

Author(s):

Nidhi Wali ◽

Kingsley E. E. Agho ◽

Andre M. N. Renzaho

Keyword(s):

South Asia ◽

South Asian ◽

Health Surveys ◽

Associated Factors ◽

Common Factor ◽

Household Wealth ◽

Health Concern ◽

Demographic And Health Surveys ◽

Asian Countries ◽

Sampling Weights

Child wasting continues to be a major public health concern in South Asia, having a prevalence above the emergency threshold. This paper aimed to identify factors associated with wasting among children aged 0–23 months, 24–59 months, and 0–59 months in South Asia. A weighted sample of 564,518 children aged 0–59 months from the most recent demographic and health surveys (2014–2018) of five countries in South Asia was combined. Multiple logistic regression analyses that adjusted for clustering and sampling weights were used to examine associated factors. Wasting prevalence was higher for children aged 0–23 months (25%) as compared to 24–59 months (18%), with variations in prevalence across the South Asian countries. The most common factor associated with child wasting was maternal BMI [adjusted odds ratio (AOR) for 0–23 months = 2.02; 95% CI: (1.52, 2.68); AOR for 24–59 months = 2.54; 95% CI: (1.83, 3.54); AOR for 0–59 months = 2.18; 95% CI: (1.72, 2.77)]. Other factors included maternal height and age, household wealth index, birth interval and order, children born at home, and access to antenatal visits. Study findings suggest need for nutrition specific and sensitive interventions focused on women, as well as adolescents and children under 2 years of age.

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The Effect of Adolescent Pregnancy on Child Mortality in 46 Low- and Middle-Income Countries

10.1101/2021.06.10.21258227 ◽

2021 ◽

Author(s):

Navideh Noori ◽

Joshua L Proctor ◽

Yvette Efevbera ◽

Assaf P Oron

Keyword(s):

Infant Mortality ◽

South Asia ◽

Neonatal Mortality ◽

Child Mortality ◽

Adolescent Mothers ◽

Maternal Age ◽

Mortality Rates ◽

World Health ◽

Demographic And Health Surveys ◽

First Birth

Background The World Health Organization (WHO) has highlighted the health risks to adolescent mothers and their children. Statements and reports typically group all mothers aged under 20 together. Some studies have examined the risk variations within this age group, and several child health outcomes have yet to be examined. Methods We analyzed data from Demographic and Health Surveys (DHS) collected between 2004 and 2018 in Sub–Saharan Africa (SSA) and South Asia, on children born to mothers 25 years old or younger. We examined the association between maternal age at first birth and deaths of neonates, infants, under –5 years old, and stillbirths, using mixed effects logistic regression and adjusting for common demographic and health–seeking variables. Findings The mortality rates at all early–life stages of children born to mothers aged <16 years, 16–17 years, and 18–19 years at first birth were about 2–4 times, 1.5–2 times, and 1.2–1.3 times higher, respectively, than among children born to mothers aged 23–25 in both regions. Absolute mortality rates decreased over time, but the risk gradient versus age remained similar across time periods, regions, and most child mortality endpoints. After adjustment for rural/urban residence and maternal education, in SSA in 2014–2018 having a mother under 16 (10–15) years old was associated with stillbirth odds ratio (OR) 3.71 [95% CI 2.50–5.51], neonatal mortality OR 1.92 [1.60–2.30], infant mortality OR 2.13 [1.85–2.46], and under–5 mortality OR 2.39 [2.13–2.68]), compared with first children of mothers aged 23–25 years. For the same time period in South Asia ORs were stillbirths 5.12 [2.85–9.20], neonatal mortality 2.46 [2.03–2.97)], infant mortality 2.62 [2.22–3.08], and under–5 mortality 2.59 [2.22–3.03]. Adjustment for additional risk factors did not affect the estimates substantially. Interpretation Adolescent motherhood is associated with dramatically worse child survival, likely reflecting a combination of biological and social factors. Revising maternal age reporting conventions will help to highlight this burden. Targeted intervention strategies to eliminate underage pregnancy are warranted.

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Trends and Spatial Variation of Female Genital Mutilation among Reproductive Age Women in Ethiopia based on 2000, 2005, and 2016 Ethiopian Demographic and Health Surveys: Spatial-temporal and Multivariate Decomposition Analysis

10.21203/rs.2.16478/v1 ◽

2019 ◽

Author(s):

Getayeneh Antehunegn Tesema ◽

Achamyeleh Birhanu Teshale ◽

Chilot Desta Agegnehu ◽

Adugnaw Zeleke Alem ◽

Alemneh Mekuriaw Liyew ◽

...

Keyword(s):

Public Health ◽

Scale Up ◽

Decomposition Analysis ◽

Media Exposure ◽

Reproductive Age ◽

Scan Statistics ◽

Health Concern ◽

Demographic And Health Surveys ◽

The Difference ◽

The Government

Abstract Introduction: Even if FGM has been declined dramatically in the world, the rate of decline is far below the rate needed to achieve SDG in Ethiopia. FGM remains as a serious public health concern in Ethiopia and the prevalence has varied across and within countries. Therefore, this study aimed to assess the trends and geographic variation of FGM practice in Ethiopia based on EDHSs. Methods: The study used the data from the three DHSs conducted in Ethiopia. Trend and Logistic based decomposition analysis technique was used for analyzing the change in FGM practice overtime and factors contributing to the change in FGM practice. STATA 14 was used for data management and analysis. The Bernoulli model was fitted using spatial scan statistics version 9.6 to identify hotspot areas and ArcGIS version 10.6 to explore the spatial distribution FGM. Results : The prevalence of FGM practice was decreased from 79.9% in 2000 to 70.4% in 2016. The decomposition analysis indicated that about 95% of the overall decrease in FGM practice was due to the difference in the change in the behavior of FGM practice among urban residents, orthodox and Muslim followers, self-employed, education, and media exposure were significant factors contributed to the change in FGM over the study period. The SaTScan analysis identified 141 most likely clusters (LLR=711.9, p<0.001) in 2000, 175 (LLR=576.4, p<0.001) in 2005, and 220 (LLR= 243.6, p<0.001) in 2016 which was located in Somali, Somali, Harari, and border areas of Somali consistently over the three surveys. Conclusions: These results showed that FGM practice has been declined in Ethiopia. The decrease in FGM practice could be attributable to the difference in the change in effects of residence, media exposure; religion, region, and educational status. The spatial analysis provides further insight into differences in FGM practice within the country and highlights primary and secondary clusters. This could enable efficient and timely spatial targeting of hotspot areas of FGM practice to achieve the goals of eliminating FGM practice in Ethiopia by 2025 and the government should scale up the public health programs to improve the rate of reduction.

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«Имперский синдром»: концепция османского халифата на Ближнем Востоке и в Южной Азии (первая четверть XX в.)

Istoricheskii vestnik ◽

10.35549/hr.2019.2019.47860 ◽

2019 ◽

Author(s):

S.A. Kirillina ◽

A.L. Safronova ◽

V.V. Orlov

Keyword(s):

Middle East ◽

South Asia ◽

South Asian ◽

Political Role ◽

The Social ◽

The Difference ◽

Aspect Interaction ◽

Muhammad Rashid Rida ◽

Political Actions

Аннотация В статье изучены общие и специфические черты идейных воззрений, пропагандистской риторики и политических действий представителей халифатистского движения на Ближнем Востоке и в Южной Азии. В ретроспективном ключе прослеживается эволюция представлений о сущности и необходимости возрождения института халифата в трудах исламских идеологов, реформаторов и политиков Джамал ад-Дина ал-Афгани, Абд ар-Рахмана ал-Кавакиби, Мухаммада Рашида Риды, Абул Калама Азада. Внимание авторов сосредоточено на общественно-политических дискуссиях 2030-х годов XX столетия, а также на повестке дня халифатистских конгрессов и конференций этого периода. На них вырабатывались первые представления современников о пост-османском формате мусульманского единства и идейно-политической роли будущего халифата. Авторы демонстрируют различие между моделями реакции мусульман Ближнего Востока и Южной Азии на упразднение османского халифата республиканским руководством Турции. Установлена многоаспектная взаимосвязь между халифатистскими ценностями, проосманскими настроениями и формами самоотождествления, которые сложились в арабских и южноазиатских обществах. Отдельно намечено соотношение между подъемом халифатистских настроений и радикализацией антиколониальных действий мусульман Индостана.Abstract The article deals with analysis of common and specific features of ideas, propaganda, rhetoric and political actions taken by representatives of the movement for defense of the Caliphate in the Middle East and South Asia. The retrospection showing the transformation of conception of the Caliphate and the necessity of its revival in the works of eminent ideologists and politicians of the Muslim world Jamal al-Din al-Afghani, Abd al-Rahman al-Kawakibi, Muhammad Rashid Rida and Abul Kalam Azad, is also given in the article. The authors also focus on the social and political discussions of the 1920s 1930s, as well as on the agenda of Caliphatist congresses and conferences of this period. They helped to elaborate the early representations of post-Ottoman pattern of the Muslim unity and the ideological and political role of the future Caliphate. The authors demonstrate the difference between the forms of reaction of Muslims in the Middle East and South Asia to the repudiation of the Caliphate by the Republican leaders of Turkey. The article establishes a multi-aspect interaction between the Caliphatist values and forms of self-identification, emerged in Arab and South Asian societies. The correlation between the rise of Caliphatist attitudes and radicalization of anti-colonial actions of South Asian Muslims is also outlined.

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Emerging Trends of Artificial Intelligence in South Asia and its Implications for Pakistan

NUST Journal of International Peace and Stability ◽

10.37540/njips.v2i2.31 ◽

2019 ◽

Author(s):

Shaza Arif

Keyword(s):

Artificial Intelligence ◽

South Asia ◽

South Asian ◽

Counter Measures ◽

China And India ◽

Emerging Trends ◽

Military Modernization ◽

Offensive Realism ◽

Strategic Balance ◽

Full Swing

Artificial Intelligence (AI) has emerged as a breakthrough technology which is astonishingly impressive. Major world powers are rapidly integrating AI in their military doctrines. This trend of militarization of AI can be seen in the South Asian region as well. Following the theoretical approach of offensive realism, China and India are in full swing to revolutionize their militaries with this emerging trend in order to accumulate maximum power and to satisfy their various interests. Consequently, Indian military modernization has the potential to provoke Pakistan to take counter measures. Pakistan is already encountering a number of challenges in economic sector and will face the strenuous task of accommodating a handsome financial share for the development of its AI capabilities. South Asia is a very turbulent region characterized by arch rivals who are also nuclear powers and have repeatedly indulged in various crises over the years. Introduction of AI in South Asia will have significant repercussions as it will trigger an arms race and at the same time disturb the strategic balance in the region.

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The Baluch, Sunnism and the State in Iran

10.1093/oso/9780190655914.001.0001 ◽

2017 ◽

Cited By ~ 1

Author(s):

Stéphane A. Dudoignon

Keyword(s):

South Asia ◽

South Asian ◽

Social Life ◽

The State ◽

First Century ◽

Local Democracy ◽

Oasis Area ◽

Shed Light

Since 2002, Sunni jihadi groups have been active in Iranian Baluchistan without managing to plunge the region into chaos. This book suggests that a reason for this, besides Tehran’s military responses, has been the quality of Khomeini and Khamenei’s relationship with a network of South-Asia-educated Sunni ulama (mawlawis) originating from the Sarbaz oasis area, in the south of Baluchistan. Educated in the religiously reformist, socially conservative South Asian Deoband School, which puts the madrasa at the centre of social life, the Sarbazi ulama had taken advantage, in Iranian territory, of the eclipse of Baluch tribal might under the Pahlavi monarchy (1925-79). They emerged then as a bulwark against Soviet influence and progressive ideologies, before rallying to Khomeini in 1979. Since the turn of the twenty-first century, they have been playing the role of a rampart against Salafi propaganda and Saudi intrigues. The book shows that, through their alliance with an Iranian Kurdish-born Muslim-Brother movement and through the promotion of a distinct ‘Sunni vote’, they have since the early 2000s contributed towards – and benefitted from – the defence by the Reformist presidents Khatami (1997-2005) and Ruhani (since 2013) of local democracy and of the minorities’ rights. They endeavoured to help, at the same time, preventing the propagation of jihadism and Sunni radicalisation to Iran – at least until the ISIS/Daesh-claimed attacks of June 2017, in Tehran, shed light on the limits of the Islamic Republic’s strategy of reliance on Deobandi ulama and Muslim-Brother preachers in the country’s Sunni-peopled peripheries.

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The impact of coronavirus outbreak on breastfeeding guidelines among Brazilian hospitals and maternity services: a cross-sectional study

International Breastfeeding Journal ◽

10.1186/s13006-021-00377-1 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Walusa Assad Gonçalves-Ferri ◽

◽

Fábia Martins Pereira-Cellini ◽

Kelly Coca ◽

Davi Casale Aragon ◽

...

Keyword(s):

Cross Sectional Study ◽

World Health ◽

Breastfeeding Support ◽

Cross Sectional ◽

Maternity Services ◽

Community Needs ◽

Care Services ◽

Skin Contact ◽

Health Organization ◽

The Impact

Abstract Background The World Health Organization recognizes exclusive breastfeeding a safe source of nutrition available for children in most humanitarian emergencies, as in the current pandemic caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Despite the Brazilian national guideline protecting breastfeeding practices, there are many concerns about protecting infants from their infected mothers. This study aimed to analyze how the Brazilian hospitals and maternity services promote and support mothers suspected or diagnosed with coronavirus disease (COVID-19). Methods This is a descriptive cross-sectional and multicenter study which collected data from 24 Brazilian hospitals and maternity services between March and July 2020. Representatives of the institutions completed a questionnaire based on acts to promote and support breastfeeding, the Baby-Friendly Hospital Initiative, and Brazil’s federal law recommendations. Results The results showed that in delivery rooms, 98.5% of the services prohibited immediate and uninterrupted skin-to-skin contact between mothers and their infants and did not support mothers to initiate breastfeeding in the first hour. On the postnatal ward, 98.5% of the services allowed breastfeeding while implementing respiratory hygiene practices to prevent transmission of COVID-19. Companions for mothers were forbidden in 83.3% of the hospitals. Hospital discharge was mostly between 24 and 28 h (79.1%); discharge guidelines were not individualized. Additionally, a lack of support was noticed from the home environment’s health community network (83.3%). Hospital and home breast pumping were allowed (87.5%), but breast milk donation was not accepted (95.8%). There was a lack of guidance regarding the use of infant comforting strategies. Guidelines specific for vulnerable populations were not covered in the material evaluated. Conclusions In Brazil, hospitals have not followed recommendations to protect, promote, and support breastfeeding during the COVID-19 outbreak. The disagreement between international guidelines has been a major issue. The absence of recommendations on breastfeeding support during the pandemic led to difficulties in developing standards among hospitals in different regions of Brazil and other countries worldwide. The scientific community needs to discuss how to improve maternal and infant care services to protect breastfeeding in the current pandemic.

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Agroforestry to Achieve Global Climate Adaptation and Mitigation Targets: Are South Asian Countries Sufficiently Prepared?

Forests ◽

10.3390/f12030303 ◽

2021 ◽

Vol 12 (3) ◽

pp. 303

Author(s):

Shalini Dhyani ◽

Indu K Murthy ◽

Rakesh Kadaverugu ◽

Rajarshi Dasgupta ◽

Manoj Kumar ◽

...

Keyword(s):

South Asia ◽

South Asian ◽

Climate Adaptation ◽

Global Climate ◽

Well Being ◽

Agroforestry Systems ◽

Climate Mitigation ◽

Asian Countries ◽

Implementation Phase ◽

Adaptation And Mitigation

Traditional agroforestry systems across South Asia have historically supported millions of smallholding farmers. Since, 2007 agroforestry has received attention in global climate discussions for its carbon sink potential. Agroforestry plays a defining role in offsetting greenhouse gases, providing sustainable livelihoods, localizing Sustainable Development Goals and achieving biodiversity targets. The review explores evidence of agroforestry systems for human well-being along with its climate adaptation and mitigation potential for South Asia. In particular, we explore key enabling and constraining conditions for mainstreaming agroforestry systems to use them to fulfill global climate mitigation targets. Nationally determined contributions submitted by South Asian countries to the United Nations Framework Convention on Climate Change acknowledge agroforestry systems. In 2016, South Asian Association for Regional Cooperation’s Resolution on Agroforestry brought consensus on developing national agroforestry policies by all regional countries and became a strong enabling condition to ensure effectiveness of using agroforestry for climate targets. Lack of uniform methodologies for creation of databases to monitor tree and soil carbon stocks was found to be a key limitation for the purpose. Water scarcity, lack of interactive governance, rights of farmers and ownership issues along with insufficient financial support to rural farmers for agroforestry were other constraining conditions that should be appropriately addressed by the regional countries to develop their preparedness for achieving national climate ambitions. Our review indicates the need to shift from planning to the implementation phase following strong examples shared from India and Nepal, including carbon neutrality scenarios, incentives and sustainable local livelihood to enhance preparedness.

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High burden of anemia among pregnant women in Tanzania: a call to address its determinants

Nutrition Journal ◽

10.1186/s12937-021-00726-0 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Bruno F. Sunguya ◽

Yue Ge ◽

Linda Mlunde ◽

Rose Mpembeni ◽

Germana Leyna ◽

...

Keyword(s):

Food Insecurity ◽

Pregnant Women ◽

Reproductive Age ◽

Gis Mapping ◽

Demographic And Health Surveys ◽

Health Coverage ◽

Nutritional Knowledge ◽

Women Of Reproductive Age ◽

Anemia In Pregnancy ◽

In Pregnancy

Abstract Background Anemia in pregnancy is behind a significant burden of maternal mortality and poor birth outcomes globally. Efforts to address it need evidence on trends and its pertinent factors as they vary from one area to another. Methods We pooled data of 23,203 women of reproductive age whose hemoglobin levels were measured from two Tanzania Demographic and Health Surveys (TDHS). Of them, 2,194 women were pregnant. Analyses employed descriptive analyses to determine the burden of anemia, its characteristics, and severity; GIS mapping to determine the regional changes of anemia between 2005 and 2015; and logistic regression to determine the remaining determinants of anemia among pregnant women using Stata 15. Results The burden of anemia among pregnant women in Tanzania has remained unprecedently high, and varies between regions. There was no significant decline of anemia in general between the two periods after adjusting for individual, households, reproductive, and child characteristics [AOR = 0.964, 95% CI = 0.774–1.202, p = 0.747). Anemia is currently prevalent in 57% of pregnant women in Tanzania. The prevalence is more likely to be higher among women aged 15–19 years than those aged between 20–34 years. It is more likely to be prevalent among those within large families, with no formal education, food insecurity, lack of health insurance, had no antimalaria during pregnancy, and had low frequency of ANC attendance. On the other hand, delivery in a health facility may be potentially protective against anemia. Conclusions Anemia in pregnancy remained persistently high and prevalent among 57% of pregnant women in Tanzania. Efforts to address anemia are crucial and need to be focused in regions with increasing burden of anemia among pregnant women. It is imperative to address important risk factors such as food insecurity, strengthening universal health coverage, empowering women of reproductive age with education and especially nutritional knowledge and advocating for early antenatal booking, attendance, and facility delivery.

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