Dynamics of inequality in child under-nutrition in Ethiopia

Abstract Introduction Although Ethiopia has already achieved a remarkable progress in reducing under-five mortality in the last decades, undernutrition among children is still a common problem in this country. Socioeconomic inequalities in health outcomes in Ethiopia have been thus of focus in academia and policy spheres for a while now. This study provides new evidence on child undernutrition inequalities in Ethiopia using longitudinal perspective. Method Using three round of household panel survey (from 2012 to 2016), we use concentration index (associated curve), different mobility index approaches for measuring inequalities and its dynamics, and decomposition method to identify contributing factors. Results In all concentration index computing approaches and socioeconomic status ranking variables, the concentration indices are significant with negative value. This implies that in either of short-run or long-run inequality estimates, the burden of unequal distribution of undernutrition remains on the poor with significant difference across regions. While employing different SES ranking variables, the difference in the concentration indices is only found significant in case of Height-for-age Z-score. It signifies that relatively higher inequality is measured using consumption as ranking variable. Significant difference in inequality is also shown across regions. With respect to dynamics of inequalities, results on mobility indices computed based on Allanson et al. (Longitudinal analysis of income-related health inequality. Dundee Discussion Working Paper No. 214, 2010) approach show that inequality remain stable (persistent) in Height-for- age Z-score, and reduction of inequality in Weight-for- age Z-score while in case of Weight-for- height Z-score, there is no clear trend over subsequent waves. Results on decomposition of inequalities show that the major contributors are wealth index, consumption and mother’s education. Conclusion The argument of the choice of welfare indicator can have a large and significant impact on measured socioeconomic inequalities in a health variable which it depends on the variable examined. Employing longitudinal perspective rather than weighted average of cross-sectional data is justifiable to see the dynamic of inequality in child malnutrition. In both socioeconomic status ranking variables, the bulk of inequality in malnutrition is caused by inequality in socioeconomic status in which it disfavours the poor in both cases. This calls for enhancing the policy measures that narrow socioeconomic gaps between groups in the population and targeting on early childhood intervention and nutrition sensitive.

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Size-adjustment techniques of lumbar spine dual energy X-ray absorptiometry measurements in assessing bone mineralization in children on maintenance hemodialysis

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2021-0081 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Nanees Salem ◽

Ashraf Bakr

Keyword(s):

Bone Mineralization ◽

Dual Energy ◽

Maintenance Hemodialysis ◽

Z Score ◽

Normal Height ◽

X Ray ◽

Significant Difference ◽

Z Scores ◽

Size Adjustment ◽

Height For Age

Abstract Objectives Growing skeleton is uniquely vulnerable to impaired mineralization in chronic kidney disease (CKD). Continued debate exists about the optimal method to adjust for body size when interpreting dual energy X-ray absorptiometry (DXA) scans in children with CKD given the burden of poor growth. The study aimed to evaluate the clinical usefulness of size-adjustment techniques of lumber-spine DXA measurements in assessing bone mineralization in children with kidney failure on maintenance hemodialysis (HD). Methods Case-control study included 93 children on maintenance HD (9–18 years; 48 males). Participants were subjected to spinal-DXA-scan to obtain areal bone mineral density (aBMD; g/cm2). Volumetric-BMD (vBMD; g/cm3) was mathematically estimated. Z-scores of aBMD for chronological age (aBMDZ-CA), aBMD adjusted for height age (aBMDZ-HA), and vBMDZ-score were calculated using mean and SD values of age subgroups of 442 healthy controls (7–18 years). Results In short-for-age CKD patients, aBMDZ-CA was significantly lower than vBMDZ-score, while aBMDZ-HA was significantly higher than aBMDZ-CA and vBMDZ-score. In normal height-for-age CKD patients, no significant difference between aBMDZ-scores and vBMDZ-score was detected. aBMDZ-CA was significantly lower and aBMDZ-HA was significantly higher in short-for-age compared to normal height-for-age patients without significant differences in vBMDZ-score. We observed age-related decrements in the percentage of HD patients with normal densitometric Z-scores, the effect of age was less pronounced in aBMDZ-HA than vBMDZ-score. vBMDZ-score correlated negatively with age, but not with heightZ-score. Conclusions Estimated vBMD seems to be a convenient size-adjustment approach of spinal-DXA measurements in assessing BMD especially in older short-for-age children with CKD. aBMDZ-CA underestimates, while aBMDZ-HA overestimates BMD in such patients.

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PERBEDAAN KADAR SENG (ZN) RAMBUT BERDASARKAN DERAJAT STUNTING PADA ANAK USIA 6-9 TAHUN

Journal of Nutrition College ◽

10.14710/jnc.v1i1.421 ◽

2012 ◽

Vol 1 (1) ◽

pp. 365-372

Author(s):

Arindha Rahmawati ◽

Yekti Wirawanni

Keyword(s):

Zinc Deficiency ◽

Bivariate Analysis ◽

Growth Disorders ◽

Z Score ◽

Hair Zinc ◽

Cross Sectional ◽

Severe Stunting ◽

Significant Difference ◽

Zinc Concentrations ◽

Height For Age

Background: Stunting is a linear growth disorders are caused by chronic malnutrition especially zinc deficiency. Hair zinc concentrations can describe zinc status in the long term. The aim of this study is to investigate difference hair zinc concentrations based on degree of stunting in 6-9 years old children.Method: This cross sectional study was carried out on 57 school children aged 6-9 years. The subjects were chosen by stratified random sampling. Assessment degree of stunting are expressed by Height for Age Z-score (HAZ). Hair zinc concentrations was measured by Atomic Absorption Spectrophotometry (AAS) methods, the hair zinc concentrations less than 70 ppm was considered as chronic zinc deficiency. Bivariate analysis was using Kruskal Wallis, Mann-Whitney and Rank Spearman.Results: The prevalence of nonstunting (-1≤HAZ<2 SD), mild stunting (-2≤HAZ<-1 SD), moderate stunting (-3≤HAZ<-2 SD), and severe stunting (HAZ<-3SD) was 38,6%, 33,3%, 22,8%, and 5,3%, respectively. The median value hair zinc concentrations were 579,13 ppm. Out of 57 subjects, 26,3% had normal hair zinc concentrations, 73,7% had excess hair zinc concentrations, and no subject that experience of zinc deficiency. There is a significant difference on hair zinc concentrations based on degree of stunting (p=0,010) and positive correlation between hair zinc concentrations with Height for Age Z-score (HAZ) (r=0,303 ; p=0,022).Conclusion : There is a significant difference between hair zinc concentrations based on degree of stunting and significant correlation between hair zinc concentrations with Height for Age Z-score (HAZ). Hair zinc concentrations increased with increasing Height for Age Z-score (HAZ).Keywords : Degree of stunting, Height for Age Z-score (HAZ), Hair zinc concentrations, malnutrition, children

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Stunting Was Associated with Reported Morbidity, Parental Education and Socioeconomic Status in 0.5–12-Year-Old Indonesian Children

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17176204 ◽

2020 ◽

Vol 17 (17) ◽

pp. 6204

Author(s):

Moesijanti Y. E. Soekatri ◽

Sandjaja Sandjaja ◽

Ahmad Syauqy

Keyword(s):

Socioeconomic Status ◽

Parental Education ◽

Family Income ◽

Disease Incidence ◽

Z Score ◽

Severe Stunting ◽

Child Morbidity ◽

Respiratory Tract Illnesses ◽

Study Population ◽

Height For Age

Stunting is highly prevalent in Indonesian children. The objective of this study was to identify the associations of stunting with morbidity, parental education and socioeconomic status (SES) in Indonesian children. The study population was part of the South East Asian Nutrition Surveys (SEANUTS). A total of 2236 Indonesian children aged 0.5 to 12 years, who had participated in the SEANUTS, were included in this study. Stunting was defined as height for age Z-score (HAZ) ≤ −2 using WHO criteria and severe stunting as HAZ ≤ −3. Information on morbidity, parental education and family SES were collected by structured questionnaires. ANOVA was used for evaluating differences across groups, with or without correction for confounders. The results showed that the overall prevalence of stunting was 31.4%. HAZ in stunted children was associated with disease incidence, including frequency, parental education and family income. There were no significant differences in HAZ values in stunted children with one or more bouts of infectious, digestive tract or respiratory tract illnesses compared to stunted children with no reported illness. The prevalence of stunting in Indonesian children was high and was strongly associated with child morbidity, parental education and SES.

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Asymptomatic giardiasis and growth in young children; a longitudinal study in Salvador, Brazil

Parasitology ◽

10.1017/s0031182005007353 ◽

2005 ◽

Vol 131 (1) ◽

pp. 51-56 ◽

Cited By ~ 58

Author(s):

M. S. PRADO ◽

S. CAIRNCROSS ◽

A. STRINA ◽

M. L. BARRETO ◽

A. M. OLIVEIRA-ASSIS ◽

...

Keyword(s):

Young Children ◽

Child Growth ◽

Northeast Brazil ◽

Confounding Factors ◽

Z Score ◽

Significant Difference ◽

Height Gain ◽

Z Scores ◽

Stool Samples ◽

Height For Age

This study sought to assess the effect of giardiasis on growth of young children. In Salvador, northeast Brazil, 597 children initially aged 6 to 45 months were followed for a year in 1998/9, measured anthropometrically thrice, every 6 months, and monitored for diarrhoea prevalence twice weekly. Stool samples were collected and examined during the second round of anthropometry, and infected children were treated 39 days later, on average (S.D. 20 days). For each 6-month interval, the gains in z-scores of infected and uninfected children were compared, after adjustment for potential confounding factors, including longitudinal prevalence of diarrhoea. No significant difference was found for the first interval but in the second, the gain in adjusted height-for-age z-score was 0·09 less in infected than uninfected children, equivalent to a difference in height gain of 0·5 cm. The shortfall in growth was greater in children who remained free of diarrhoea, and was significantly correlated with the proportion of the second interval during which the child had remained untreated. We conclude that Giardia can impede child growth even when asymptomatic, presumably through malabsorption. This finding challenges the view that young children found to have asymptomatic giardiasis in developing countries should not be treated.

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Income and education inequalities in cervical cancer incidence in Canada, 1992–2010

Journal of Public Health ◽

10.1093/pubmed/fdaa128 ◽

2020 ◽

Author(s):

Carol Morriscey ◽

Mohammad Hajizadeh

Keyword(s):

Cervical Cancer ◽

Socioeconomic Status ◽

Cancer Incidence ◽

Concentration Index ◽

Household Survey ◽

Socioeconomic Inequalities ◽

Cervical Cancer Incidence ◽

Index Approach ◽

National Household Survey ◽

Over Time

ABSTRACT Background There is evidence of socioeconomic inequalities in cancer incidence in Canada and other countries globally, yet there is no study investigating socioeconomic inequalities in national cervical cancer incidence in Canada. Thus, the current study investigated income and education inequalities in the incidence of cervical cancer in Canada from 1992 to 2010. Methods Data were derived from a linked dataset that combined cervical cancer incidence from the Canadian Cancer Registry and demographic and socioeconomic information from the Canadian Census of Population and the National Household Survey. The Concentration index approach was used to measure income and education inequalities in the incidence of cervical cancer over time. Results National incidence of cervical cancer decreased significantly from 1992 to 2010. The age-standardized C was negative for the majority of years for both income and education inequalities, but the preponderance were not significant. Trend analyses of socioeconomic inequalities suggested an increasing concentration of cervical cancer incidence among less-educated females over the study period. Conclusions Over almost two decades, there were no pervasive socioeconomic inequalities in the incidence of cervical cancer in Canada. As such, policies aimed at reducing the incidence of cervical cancer should focus on the general population, irrespective of socioeconomic status.

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Imatinib Has a Negative Impact On Growth In Children With Previously Untreated Chronic Myeloid Leukaemia (CML) In Early Chronic Phase (CP): Results Of The French National Study

Blood ◽

10.1182/blood.v122.21.4001.4001 ◽

2013 ◽

Vol 122 (21) ◽

pp. 4001-4001 ◽

Cited By ~ 1

Author(s):

Frédéric Millot ◽

Joelle Guilhot ◽

Andre Baruchel ◽

Arnaud Petit ◽

Thierry Leblanc ◽

...

Keyword(s):

Standard Deviation ◽

Chronic Phase ◽

National Study ◽

Z Score ◽

Paired Data ◽

Pubertal Status ◽

Significant Difference ◽

Median Height ◽

Age And Sex ◽

Height For Age

Abstract Aims The French pediatric CML working group conducted a retrospective study analysing the growth of patients under 18 years with CML treated with imatinib front-line. Patients and Methods Data from 78 patients receiving imatinib (260 mg/m2) for newly diagnosed CML in chronic phase between July 2001 and August 2012 were collected. Height was expressed as standard deviation score (SDS). Height SDS was calculated using French growth standard, as patient height minus mean height for age and sex, divided by standard deviation of height for age and sex. Pre-pubertal age was defined as being younger than 9 years for girls or 11 years for boys. Results A gradual decrease in the median of the height SDS score is observed over time since the start of imatinib. Sixty three patients were assessable for paired analysis at onset of imatinib and 12 months later. The median height-SDS in this group of patients was significantly lower (p < 10-4) 12 months after the start of imatinib. Variance analysis was performed in 36 children at onset of imatinib, 12 months and 24 months later. The median height-Z score in this group of patients was significantly lower 12 months and 24 months after the start of imatinib (p < 10-4) compared to initial diagnosis. The 63 patients assessable for paired data analysis at onset of imatinib and 12 months later were classified by sex and pubertal status. The median height Z score in boys and girls was significantly (p < 10-4) lower 12 months after the start of imatinib. When the patients were analysed according to the pubertal status at onset of imatinib, the median height SDS score was significantly (p < 10-4) lower 12 months after the start of imatinib in the prepurbertal group as well as in the postpubertal group. A similar finding was observed in the subgroups of boys and girls starting imatinib at a prebubertal or postpubertal age. No significant difference was observed when the median M12 height SDS score in patients who started imatinib at a prepubertal stage or a pospubertal stage were compared. Moreover, no significant difference was observed when the median M12 height-Z score in boys and girls were compared. Conclusion This retrospective analysis revealed a statistically significant deceleration in growth during the first 2 years of imatinib treatment in children and adolescents with CML and an absence of influence of sex and pubertal status on the depth of growth deceleration. Disclosures: No relevant conflicts of interest to declare.

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Socioeconomic inequality in unhealthy lifestyles across low and middle income countries: a different case than in high income countries

10.21203/rs.2.12911/v1 ◽

2019 ◽

Author(s):

Charlotte Dieteren ◽

Igna Bonfrer

Keyword(s):

Alcohol Use ◽

Tobacco Use ◽

Concentration Index ◽

Lifestyle Factors ◽

Socioeconomic Inequalities ◽

High Income ◽

Unhealthy Lifestyle ◽

Middle Income ◽

Middle Income Countries ◽

The Poor

Abstract Background: The link between unhealthy lifestyle factors and non-communicable diseases is evident from a range of studies. Policy makers in high income settings have access to information identifying segments of the population where unhealthy lifestyles are most prevalent. However, this same information for low and middle income countries (LMICs)remains scarce, making it difficult to inform and target effective interventions. This study aims to quantify the prevalence and socioeconomic inequalities in unhealthy lifestyle factors in LMICs and to identify policy priority areas on the path towards the Sustainable Development Goal of reducing deaths from non-communicable diseases by one third in 2030. Methods: Self-reported data from 1,278,624 adults derived from the Demographics & Health Surveys in 22 LMICs between 2013 and 2018 were used to estimate crude prevalence rates and socioeconomic inequalities in BMI, tobacco use, alcohol use and harmful alcohol use. The variation in lifestyle factors across socioeconomic status is measured by means of the Erreygers concentration index. We identify whether countries that invest more in population health are less likely to exhibit large socioeconomic inequalities in unhealthy lifestyles by correlating the percentage of GDP spent on health with the Erreygers concentration index. We use a four quadrant model to identify countries that should be prioritized because of a “double disadvantage” i.e. both a skewed distribution of unhealthy lifestyles towards the poor and low spending on health nationwide. Results: Tobacco and alcohol use is largely concentrated among the poor, while overweight is heavily concentrated among the better-off in LMICs. Clustering of alcohol and tobacco use in individuals as shown for high income countries, is not found for LMICs. Conclusions: This study emphasized that unhealthy lifestyles play an important role in LMICs, and that different unhealthy lifestyle factors vary in their socioeconomic distribution. The targeting of interventions to reduce the burden from unhealthy lifestyles in LMICs should not be simply copied from high income countries but be tailored towards high-risk populations in LMICs. We identified Congo, Tanzania and Zambia as the most disadvantaged countries in our sample, implying that priority should be given to these populations, allowing for the largest health improvements.

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The prevalence of malnutrition in children with cleft lip and cleft palate: a case-control study

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20190448 ◽

2019 ◽

Vol 6 (2) ◽

pp. 445

Author(s):

Shashidhar V. ◽

Sharanabasappa S. Dhanwadkar ◽

Ashwini Kumari N. B. ◽

Ravikumar Kurle ◽

Rakesh A. Navale

Keyword(s):

Cleft Palate ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Economic Status ◽

P Value ◽

Z Score ◽

Anthropometric Parameters ◽

Significant Difference ◽

Height For Age ◽

Weight For Age

Background: Children with cleft lip and cleft palate come across lot of impediment, hurdles in society. There are several social factors which hinders the proper nourishment of CL only, CP or CLP children, so majority of them tend to suffer malnutrition due to lack of standard care especially from their parents and society. Due to even low socio-economic status, impact on growth of these children is vexatious. However potential risk of malnutrition is particularly more during early childhood. Moreover, till date there are not much significant data on malnutrition in CL only, CP or CLP children. The aim of the study was to assess the prevalence of malnutrition in non syndromic CL only, CP or CLP in south India.Methods: Anthropometric parameters weight for age z score (WAZ), height for age z score (HAZ), of children with CLP were compared with age matched controls.Results: Prevalence of PEM and stunting for cleft group were 40% and 21.3% respectively compared to 33.33% and 17.33% for the control. Differences in the underweight, and stunting between the two groups were not statistically significant (χ2=2.83, p value=0.58, and χ2=1.48, p value=0.69 respectively).Conclusions: There is no statistically significant difference in the occurrence of malnutrition in children with non- syndromic cleft lip and Palate compared with control.

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Development of LMS and Z Score Growth References for Egyptian Children From Birth Up to 5 Years

Frontiers in Pediatrics ◽

10.3389/fped.2020.598499 ◽

2021 ◽

Vol 8 ◽

Author(s):

Ali M. El Shafie ◽

Fady M. El-Gendy ◽

Dalia M. Allahony ◽

Hossam H. Hegran ◽

Zein A. Omar ◽

...

Keyword(s):

Nutritional Status ◽

Chronic Diseases ◽

Child Growth ◽

Z Score ◽

Egyptian Children ◽

Significant Difference ◽

Z Scores ◽

Growth References ◽

Height For Age ◽

Weight For Age

Background: The Lambda-Mu-Sigma (LMS) and Z score methods are important for assessment of growth and nutritional status. In Egypt, there is a lack of this tool for monitoring growth in preschool children.Objective: To develop LMS and Z score growth references for assessment of growth and nutritional status for Egyptian children from birth up to 5 years.Methods: A total of 27,537 children [13,888 boys (50.4%) and 13,649 girls (49.6%)] from birth up to 5 years were included in a multistage cross sectional randomized study from different Egyptian geographic districts to create LMS and Z score references for weight, length/height, and body mass index corresponding to age in addition to weight for length/height. Healthy term infants and children, exclusive breast feeding for at least 4 months and not suffering from any chronic diseases were included in this study. Children with dysmorphic features, preterm infants, admitted in neonatal or pediatric intensive care units and having any chronic diseases (hematological, cardiac, hepatic, and renal) were excluded. In addition any health condition that affects child growth including nutritional disorders was also excluded. Un-paired t-test was calculated to compare the means of weight for age, length/height for age, weight for length/height, and BMI for-age z scores of the Egyptian and WHO reference values.Results: Through detailed tables and graphs, LMS and Z scores for weight for age, length/height for age, weight for length/height, and BMI for age of both sexes were represented. Our findings showed no statistically significant difference between reference charts of WHO and Egyptian Z score charts (P > 0.05).Conclusion: This study provides the first reference for Egyptian children from birth up to 5 years based on Z score tool for assessment the growth and nutritional status in various clinical conditions and research, also allows comparison with references of other countries.

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Analysing Touchscreen Gestures: A Study Based on Individuals with Down Syndrome Centred on Design for All

Sensors ◽

10.3390/s21041328 ◽

2021 ◽

Vol 21 (4) ◽

pp. 1328

Author(s):

Jorge Martin-Gutierrez ◽

Marta Sylvia Del Rio Guerra

Keyword(s):

Socioeconomic Status ◽

Down Syndrome ◽

Cognitive Impairments ◽

Pairwise Comparison ◽

Success Rates ◽

Touch Gestures ◽

Design For All ◽

Significant Difference ◽

Collateral Effect ◽

Completion Times

There has been a conscious shift towards developing increasingly inclusive applications. However, despite this fact, most research has focused on supporting those with visual or hearing impairments and less attention has been paid to cognitive impairments. The purpose of this study is to analyse touch gestures used for touchscreens and identify which gestures are suitable for individuals living with Down syndrome (DS) or other forms of physical or cognitive impairments. With this information, app developers can satisfy Design for All (DfA) requirements by selecting adequate gestures from existing lists of gesture sets. Twenty touch gestures were defined for this study and a sample group containing eighteen individuals with Down syndrome was used. A tool was developed to measure the performance of touch gestures and participants were asked to perform simple tasks that involved the repeated use of these twenty gestures. Three variables are analysed to establish whether they influence the success rates or completion times of gestures, as they could have a collateral effect on the skill with which gestures are performed. These variables are Gender, Type of Down syndrome, and Socioeconomic Status. Analysis reveals that significant difference is present when a pairwise comparison is performed, meaning individuals with DS cannot perform all gestures with the same ease. The variables Gender and Socioeconomic Status do not influence success rates or completion times, but Type of DS does.

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