scholarly journals The relative importance of households as a source of variation in child malnutrition: a multilevel analysis in India

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Anoop Jain ◽  
Justin Rodgers ◽  
Rockli Kim ◽  
S. V. Subramanian
Keyword(s):  
Social Determinants ◽  
Low Birthweight ◽  
Child Growth ◽  
Adverse Outcomes ◽  
Child Malnutrition ◽  
Public Health Issue ◽  
Z Score ◽  
Poor Child ◽  
Household Level ◽  
Four Levels

Abstract Background Child malnutrition remains a major public health issue in India. Along with myriad upstream and social determinants of these adverse outcomes, recent studies have highlighted regional differences in mean child malnutrition rates. This research helps policy makers look between urban and rural communities and states to take a population-level approach to addressing the root causes of child malnutrition. However, one gap in this between-population approach has been the omission of households as a unit of analysis. Households could represent important sources of variation in child malnutrition within communities, districts, and states. Methods Using the fourth round of India’s National Family Health Survey from 2015 to 2016, we analyzed four and five-level multilevel models to estimate the proportion of variation in child malnutrition attributable to states, districts, communities, households, and children. Results Overall, we found that of the four levels that children were nested in (households, communities, districts, and states), the greatest proportion of variation in child height-for-age Z score, weight-for-age Z score, weight-for-height Z score, hemoglobin, birthweight, stunting, underweight, wasting, anemia, and low birthweight was attributable to households. Furthermore, we found that when the household level is omitted from models, the variance estimates for communities and children are overestimated. Conclusions These findings highlight the importance of households as an important source of clustering and variation in child malnutrition outcomes. As such, policies and interventions should address household-level social determinants, such as asset and social deprivations, in order to prevent poor child growth outcomes among the most vulnerable households in India.

scholarly journals Cohort Profile: Perinatal depression and child socioemotional development ; the Bachpan cohort study from rural Pakistan

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e025644 ◽  
Author(s):  
Siham Sikander ◽  
Ikhlaq Ahmad ◽  
Lisa M Bates ◽  
John Gallis ◽  
Ashley Hagaman ◽  
...  
Keyword(s):  
School Environment ◽  
Repeated Measures ◽  
Perinatal Depression ◽  
Child Growth ◽  
Socioemotional Development ◽  
Early Years ◽  
Poor Child ◽  
Household Level ◽  
Rural Pakistan

PurposeThis is a prospective pregnancy–birth cohort designed to investigate the effects of depression on socioemotional development of children. Perinatal depression is a risk factor for poor child development and for many it has a recurring chronic course. Thus, the exposure to depression can continue through the early years of the child with detrimental developmental outcomes.ParticipantsBetween October 2014 and February 2016, we recruited 1154 pregnant women from a rural subdistrict of Pakistan. Data include longitudinal and repeated measures of maternal psychosocial measures and child growth, cognitive and socioemotional measures. Follow-up include mother–child dyad assessments at 3rd, 6th, 12th, 24th and 36th months of child age. All these follow-ups are community based at the household level. We have competed baseline assessment.Findings to dateOf the eligible dyads, we followed 885 (76.6%), 929 (91%) and 940 (93.3%) at 3, 6 and 12 months post-childbirth. We include a subsample mother–child dyad DNA and inflammatory biomarkers, 73 and 104, respectively.Future plansWhile we continue to do 24-month and 36-month follow-up assessments, we plan to follow these mother–child dyads up to the age of 7–8 years with some children being exposed to at least 1 year of school environment. Investigators interested in learning more about the study can contact ([email protected]) and ([email protected]).

scholarly journals Exploring the relationships between wasting and stunting among a cohort of children under two years of age in Niger

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kristin Kohlmann ◽  
Christopher R. Sudfeld ◽  
Souna Garba ◽  
Ousmane Guindo ◽  
Rebecca F. Grais ◽  
...  
Keyword(s):  
Risk Factors ◽  
Low Birthweight ◽  
Household Wealth ◽  
Child Growth ◽  
Physical Growth ◽  
World Health ◽  
Maternal Body Mass Index ◽  
Z Score ◽  
Link Type ◽  
Rural Niger

Abstract Background Wasting and stunting, physical growth manifestations of child undernutrition, have historically been considered separately with distinct interventions at the program, policy, and financing levels despite similar risk factors, overlapping burdens and multiplicative risk of death when the conditions are concurrent. The aim of this study was to elucidate shared risk factors and the temporal relationship between wasting and stunting among children under 2 years of age in rural Niger. Methods From August 2014 to December 2019, anthropometric data were collected every 4 weeks from 6 to 8 weeks to 24 months of age for 6567 children comprising 139,529 visits in Madarounfa, Niger. Children were defined as wasted if they had a weight-for-length Z-score < − 2 and stunted if they had a length-for-age Z-score < − 2 using the 2006 World Health Organization child growth standards. Parental, child, and socioeconomic risk factors for wasting and stunting at 6 and 24 months of age and the relationship between episodes of wasting, stunting and concurrent wasting-stunting were assessed using general estimating equations. Results Half of children (50%) were female, and 8.3% were born low birthweight (< 2500 g). Overall, at 24 months of age, 14% of children were wasted, 80% were stunted and 12% were concurrently wasted-stunted. We found that maternal short stature, male sex, and low birthweight were risk factors for wasting and stunting at 6 and 24 months, whereas higher maternal body mass index and household wealth were protective factors. Wasting at 6 and 24 months was predicted by a prior episodes of wasting, stunting, and concurrent wasting-stunting. Stunting at 6 and 24 months was similarly predicted by prior episodes of stunting and concurrent wasting-stunting at any prior age but only by prior episodes of wasting after 6 months of age. Conclusions These data support a complex and dynamic bi-directional relationship between wasting and stunting in young children in rural Niger and an important burden of concurrent wasting-stunting in this setting. Further research to better understand the inter-relationships and mechanisms between these two conditions is needed in order to develop and target interventions to promote child growth. Trial registration ClinicalTrials.gov Identifier: NCT02145000.

scholarly journals Effectiveness of Community Nutrition-Specific Interventions on Improving Malnutrition of Children under 5 Years of Age in the Eastern Mediterranean Region: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 18 (15) ◽  
pp. 7844
Author(s):  
Delaram Ghodsi ◽  
Nasrin Omidvar ◽  
Bahareh Nikooyeh ◽  
Roshanak Roustaee ◽  
Elham Shakibazadeh ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Mediterranean Region ◽  
Eastern Mediterranean ◽  
Meta Analysis ◽  
Eastern Mediterranean Region ◽  
Child Malnutrition ◽  
Z Score ◽  
Community Based ◽  
Nutritional Status Of Children ◽  
Children Under 5

Childhood malnutrition remains an important public health and development problem in low- and middle-income countries. This study aimed to systematically review the community-based nutrition-specific interventions and their effectiveness and/or cost-effectiveness on the nutritional status of children under 5 years of age in the Eastern Mediterranean Region (EMR). A systematic literature search of the English electronic databases, including PubMed, Scopus, ISI Web of Knowledge, Ovid, EMBASE, as well as Persian databases (SID and Magiran) was performed up to May 2019. Studies regarding the effectiveness/cost-effectiveness of the community-based nutrition-specific programs and interventions targeted at under-five-year children in EMR countries were selected. The primary outcomes were mean of Weight-for-age z-score (WAZ), Height-for-Age z-score (HAZ), and Weight-for-Height z-score (WHZ) of children or prevalence of wasting, stunting, and/or underweight among the children. Meta-analysis was also performed on the selected articles and intervention effects (mean differences) were calculated for each outcome for each study and pooled using a weighted random effects model. Risk of bias (ROB) of each included study was assessed based on the Cochrane Handbook for Systematic Reviews. The study protocol was registered in PROSPERO (CRD42020172643). Of 1036 identified studies, eight met the inclusion criteria. Amongst these, seven were from Pakistan and one from Iran. Only one study conducted in Pakistan reported the cost-effectiveness of nutrition-specific interventions in the region. Nutrition education/consultation and cash-based interventions were the most common nutrition-specific strategies used for management of child malnutrition in the EMR countries. Out of these eight studies, four were included in the meta-analysis. When different interventions were pooled, they had resulted in a significant improvement in WHZ of children (MD: 0.26; 95% CI: 0.07 to 0.46, three studies, I2 82.40%). Considering the high prevalence of child malnutrition in a number of countries in the region, capacity building and investigation regarding the implementation of new approaches to improve nutritional status of children and their effect(s) and cost-effectiveness assessment are highly recommended.

scholarly journals Reducing youth suicide: systems modelling and simulation to guide targeted investments across the determinants

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Jo-An Occhipinti ◽  
Adam Skinner ◽  
Frank Iorfino ◽  
Kenny Lawson ◽  
Julie Sturgess ◽  
...  
Keyword(s):  
Mental Health ◽  
Social Determinants ◽  
Suicide Attempts ◽  
Expert Knowledge ◽  
Population Level ◽  
Modelling And Simulation ◽  
Decision Makers ◽  
Public Health Issue ◽  
Coordinated Care ◽  
Systems Modelling

Abstract Background Reducing suicidal behaviour (SB) is a critical public health issue globally. The complex interplay of social determinants, service system factors, population demographics, and behavioural dynamics makes it extraordinarily difficult for decision makers to determine the nature and balance of investments required to have the greatest impacts on SB. Real-world experimentation to establish the optimal targeting, timing, scale, frequency, and intensity of investments required across the determinants is unfeasible. Therefore, this study harnesses systems modelling and simulation to guide population-level decision making that represent best strategic allocation of limited resources. Methods Using a participatory approach, and informed by a range of national, state, and local datasets, a system dynamics model was developed, tested, and validated for a regional population catchment. The model incorporated defined pathways from social determinants of mental health to psychological distress, mental health care, and SB. Intervention scenarios were investigated to forecast their impact on SB over a 20-year period. Results A combination of social connectedness programs, technology-enabled coordinated care, post-attempt assertive aftercare, reductions in childhood adversity, and increasing youth employment projected the greatest impacts on SB, particularly in a youth population, reducing self-harm hospitalisations (suicide attempts) by 28.5% (95% interval 26.3–30.8%) and suicide deaths by 29.3% (95% interval 27.1–31.5%). Introducing additional interventions beyond the best performing suite of interventions produced only marginal improvement in population level impacts, highlighting that ‘more is not necessarily better.’ Conclusion Results indicate that targeted investments in addressing the social determinants and in mental health services provides the best opportunity to reduce SB and suicide. Systems modelling and simulation offers a robust approach to leveraging best available research, data, and expert knowledge in a way that helps decision makers respond to the unique characteristics and drivers of SB in their catchments and more effectively focus limited health resources.

scholarly journals Nutritional Status in Childhood Cancer Survivors with Solid Tumors: A Longitudinal Study

2021 ◽  
Author(s):  
Nancy Sacks ◽  
Wendy Hobbie ◽  
Laura Byham-Gray ◽  
Robert Denmark ◽  
Yuane Jia ◽  
...  
Keyword(s):  
Longitudinal Study ◽  
Nutritional Status ◽  
Solid Tumors ◽  
Weight Status ◽  
Nutritional Assessment ◽  
Childhood Cancer Survivors ◽  
Growth Patterns ◽  
Adverse Outcomes ◽  
Z Score ◽  
Large Tumor

Background: Malnutrition (under and overnutrition) occurs in children with solid tumors and has been linked with adverse outcomes during and after treatment. Assessment of nutritional status (NS) can be challenging due to large tumor burdens, atypical growth patterns and different methods for assessing NS. Methods: Retrospective longitudinal study of children with solid tumors (n=61). Anthropometric data assessed [(diagnosis, after diagnosis (1.5, 3, 6 and 12 months, 5 years), end of treatment (EOT), initial cancer survivorship program (CSP) visit]. Registered dietitian nutritionist nutritional assessment (NA) during treatment and Intensity of Treatment Rating (ITR) documented. Results: At diagnosis, prevalence of undernutrition [(Z-score -1.0 to -2.99)] and overnutrition (Z-score ≥ +2.0) were 13.8% and 8.6%, respectively; weight status categories, 8.6%, 6.9%/13.8% were underweight, overweight/obese, respectively. Weight loss and decreased weight-for-age Z-score (WAZ) occurred in 31.9% and 74.5% patients, respectively, at 1.5 months. At EOT, compared to diagnosis, WAZ and height-for-age Z-score (HAZ) decreased and BMIZ increased. From EOT to CSP visit, overweight/obesity doubled, 7.7%/5.8% and 15.2/11.9%, respectively. Thirty-one percent of patients received a NA, occurring at lowest WAZ. Over 50% had ITR of level 3 or 4 and 88.9% had NA in level 4. Conclusions: Suboptimal NS continues at diagnosis, during treatment and survivorship. Normalized measures, accounting for expected growth, should be used instead of raw numbers. More than one nutrition indicator will identify atypical growth patterns and a proactive approach would help prevent malnutrition. Evidence based research is essential and collaboration necessary to meet the needs of this population.

Obesity in obstetric and gynaecological practice

2020 ◽  
pp. 96-106
Author(s):  
Sukhwinder Sahota ◽  
Tahir Mahmood
Keyword(s):  
Public Health ◽  
Diabetes Mellitus ◽  
Cardiovascular Disease ◽  
Metabolic Syndrome ◽  
Well Being ◽  
Adverse Outcomes ◽  
Public Health Issue ◽  
Social Emotional ◽  
Major Public Health Issue ◽  
Health And Well Being

Obesity is a complex multifactorial disorder, which has reached epidemic proportions worldwide. It affects all aspects of an individual’s life: physical, social, emotional, and psychological. Although it is largely preventable, obesity is now a major public health issue and has a significant impact on the health and well-being of an individual throughout their lifespan. Obesity is associated with multiple adverse outcomes not only during the reproductive phase of a woman’s life but during the post-reproductive era as well. Obesity also increases risks for non-obstetrical and gynaecological illnesses such as diabetes mellitus, hypertension, metabolic syndrome, cardiovascular disease, and non-gynaecological cancers. Obesity thus is a cause of major societal economic burden.

Prediction and network modelling of self-harm through daily self-report and history of self-injury

2020 ◽  
pp. 1-11 ◽  
Author(s):  
Michael J. Kyron ◽  
Geoff R. Hooke ◽  
Andrew C. Page
Keyword(s):  
Risk Factors ◽  
Psychological Distress ◽  
Daily Basis ◽  
Adverse Outcomes ◽  
Self Report ◽  
Public Health Issue ◽  
Short Term ◽  
Wish To Die ◽  
History Of ◽  
Self Harm

Abstract Background Self-harm is a significant public health issue, and both our understanding and ability to predict adverse outcomes are currently inadequate. The current study explores how preventative efforts could be aided through short-term prediction and modelling of risk factors for self-harm. Methods Patients (72% female, Mage = 40.3 years) within an inpatient psychiatric facility self-reported their psychological distress, interpersonal circumstances, and wish to live and die on a daily basis during 3690 unique admissions. Hierarchical logistic regressions assessed whether daily changes in self-report and history of self-harm could predict self-harm, with machine learning used to train and test the model. To assess interrelationships between predictors, network and cross-lagged panel models were performed. Results Increases in a wish to die (β = 1.34) and psychological distress (β = 1.07) on a daily basis were associated with increased rates of self-harm, while a wish to die on the day prior [odds ratio (OR) 3.02] and a history of self-harm (OR 3.02) was also associated with self-harm. The model detected 77.7% of self-harm incidents (positive predictive value = 26.6%, specificity = 79.1%). Psychological distress, wish to live and die, and interpersonal factors were reciprocally related over the prior day. Conclusions Short-term fluctuations in self-reported mental health may provide an indication of when an individual is at-risk of self-harm. Routine monitoring may provide useful feedback to clinical staff to reduce risk of self-harm. Modifiable risk factors identified in the current study may be targeted during interventions to minimise risk of self-harm.

scholarly journals Household and area-level social determinants of multimorbidity: a systematic review

2020 ◽  
pp. jech-2020-214691 ◽  
Author(s):  
Elizabeth Ingram ◽  
Sarah Ledden ◽  
Sarah Beardon ◽  
Manuel Gomes ◽  
Sue Hogarth ◽  
...  
Keyword(s):  
Systematic Review ◽  
North America ◽  
General Population ◽  
Social Determinants ◽  
Household Income ◽  
Web Of Science ◽  
Household Composition ◽  
Living Alone ◽  
Study Quality ◽  
Household Level

BackgroundNo clear synthesis of evidence examining household and area-level social determinants of multimorbidity exists. This study aimed to systematically review the existing literature on associations between household and area-level social determinants of health (SDoH) and multimorbidity prevalence or incidence in the general population.MethodsSix databases (MedLine, EMBASE, PsychINFO, Web of Science, CINAHL Plus and Scopus) were searched. The search was limited to peer-reviewed studies conducted in high-income countries and published in English between 2010 and 2019. A second reviewer screened all titles with abstracts and a subset of full texts. Study quality was assessed and protocol pre-registered (CRD42019135281).Results41 studies spanning North America, Europe and Australasia were included. Household income and area-level deprivation were the most explored with fairly consistent findings. The odds of multimorbidity were up to 4.4 times higher for participants with the lowest level of income compared with the highest level. Those living in the most deprived areas had the highest prevalence or incidence of multimorbidity (pooled OR 1.42, 95% CI 1.41 to 1.42). Associations between deprivation and multimorbidity differed by age and multimorbidity type. Findings from the few studies investigating household tenure, household composition and area-level rurality were mixed and contradictory; homeownership and rurality were associated with increased and decreased multimorbidity, while living alone was found to be associated with a higher risk of multimorbidity and not associated.ConclusionImproving our understanding of broader social determinants of multimorbidity—particularly at the household level—could help inform strategies to tackle multimorbidity.

scholarly journals Association between intimate partner violence and poor child growth: results from 42 demographic and health surveys

2016 ◽  
Vol 94 (5) ◽  
pp. 331-339 ◽  
Author(s):  
Jeanne Chai ◽  
Günther Fink ◽  
Sylvia Kaaya ◽  
Goodarz Danaei ◽  
Wafaie Fawzi ◽  
...  
Keyword(s):  
Intimate Partner Violence ◽  
Partner Violence ◽  
Health Surveys ◽  
Intimate Partner ◽  
Child Growth ◽  
Demographic And Health Surveys ◽  
Poor Child

scholarly journals Relationships between Neonatal Nutrition and Growth to 36 Weeks’ Corrected Age in ELBW Babies–Secondary Cohort Analysis from the Provide Trial

Nutrients ◽  
2020 ◽  
Vol 12 (3) ◽  
pp. 760 ◽  
Author(s):  
Barbara E. Cormack ◽  
Yannan Jiang ◽  
Jane E. Harding ◽  
Caroline A. Crowther ◽  
Frank H. Bloomfield
Keyword(s):  
Head Circumference ◽  
Protein Intake ◽  
Neonatal Intensive Care ◽  
Low Birthweight ◽  
Controlled Trial ◽  
Cohort Analysis ◽  
Z Score ◽  
Total Protein Intake ◽  
Nutrition Practices ◽  
Randomised Controlled

A key modifiable factor for improving neurodevelopment in extremely low birthweight (ELBW) babies may be improving growth, especially head growth, by optimising nutrition in the early neonatal period. We aimed to investigate relationships between nutrient intakes in the 4 weeks after birth, and growth from birth to 36 weeks’ corrected age (CA) in ELBW babies. We undertook a prospective cohort study of 434 participants enrolled in a randomised controlled trial (ProVIDe) in eight New Zealand and Australian neonatal intensive care units. Macronutrient intakes from birth to 4 weeks and weight, length and head circumference measurements from birth to 36 weeks’ CA were collected. From birth to 36 weeks’ CA, the median (IQR) z-score changes were: weight −0.48 (−1.09, 0.05); length −1.16 (−1.86, −0.43), and head circumference −0.82 (−1.51, −0.19). Changes in z-score to 4 weeks and 36 weeks’ CA were correlated with protein intake. Each 1 g·Kg−1·d−1 total protein intake in week 2 was associated with 0.26 z-score increase in head circumference at 36 weeks’ CA. Both nutritional intake and change in z-scores to 36 weeks’ CA differed widely amongst sites. Correlations between nutrition and growth, and differences in these amongst sites, indicate there may be potential to improve growth with enhanced nutrition practices.

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