Socioeconomic, sex and area related inequalities in childhood stunting in Mauritania: Evidence from the Mauritania Multiple Indicator Cluster Surveys (2007–2015)

Introduction The prevalence of stunting in under five children is high in Mauritania. However, there is a paucity of evidence on the extent and the overtime alteration of inequality in stunting. To this end, we did this study to investigate stunting inequality and the change with time using three rounds of Mauritania Multiple Indicator Cluster Surveys. The evidence is important to inform implementation of equitable nutrition interventions to help narrow inequality in stunting between population groups. Methods World Health Organization’s (WHO) Health Equity Assessment Toolkit (HEAT) was used in the analysis of stunting inequality. Following standard equity analysis methods recommended by the WHO, we performed disaggregated analysis of stunting across five equity stratfiers: Wealth, education, residence, sex and sub-national regions. Then, we summarized stunting inequality through four measures of inequality: Difference, Ratio, Population Attributable Fraction and Population Attributable Risk. The point estimates of stunting were accompanied by 95% confidence intervals to measure the statistical significance of the findings. Results The national average of childhood stunting in 2007, 2011 and 2015 was 31.3%, 29.7% and 28.2%, respectively. Glaring inequalities in stunting around the five equity stratifiers were observed in all the studied periods. In the most recent survey included in our study (2015), for instance, we recorded substantial wealth (PAF = -33.60; 95% CI: -39.79, -27.42) and education (PAF = -5.60; 95% CI: -9.68, -1.52) related stunting inequalities. Overall, no substantial improvement was documented in wealth and sex related inequality in stunting between 2007 and 2011 while region-based inequality worsened during the same time periods. Conclusions The burden of stunting appeared to be heavily concentrated among children born to socioeconomically worse-off women, women who live in rural settings and certain subnational regions. Targeted nutrition interventions are required to address drivers of stunting embedded within geographic and socioeconomic contexts.

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Sub-regional disparities in the use of antenatal care service in Mauritania: findings from nationally representative demographic and health surveys (2011–2015)

BMC Public Health ◽

10.1186/s12889-021-11836-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Gebretsadik Shibre ◽

Betregiorgis Zegeye ◽

Bright Opoku Ahinkorah ◽

Dina Idriss-Wheeler ◽

Mpho Keetile ◽

...

Keyword(s):

Antenatal Care ◽

Maternal Mortality ◽

Statistical Significance ◽

Maternal Mortality Ratio ◽

Population Attributable Risk ◽

Population Attributable Fraction ◽

Regional Disparities ◽

World Health ◽

Demographic And Health Surveys ◽

Mortality Ratio

Abstract Background Skilled antenatal care (ANC) has been identified as a proven intervention to reducing maternal deaths. Despite improvements in maternal health outcomes globally, some countries are signaling increased disparities in ANC services among disadvantaged sub-groups. Mauritania is one of sub-Saharan countries in Africa with a high maternal mortality ratio. Little is known about the inequalities in the country’s antenatal care services. This study examined both the magnitude and change from 2011 to 2015 in socioeconomic and geographic-related disparities in the utilization of at least four antenatal care visits in Mauritania. Methods Using the World Health Organization’s Health Equity Assessment Toolkit (HEAT) software, data from the 2011 and 2015 Mauritania Multiple Indicator Cluster Surveys (MICS) were analyzed. The inequality analysis consisted of disaggregated rates of antenatal care utilization using four equity stratifiers (economic status, education, residence, and region) and four summary measures (Difference, Population attributable risk, Ratio and Population attributable fraction). A 95% Uncertainty Interval was constructed around point estimates to measure statistical significance. Results Substantial absolute and relative socioeconomic and geographic related disparities in attending four or more ANC visits (ANC4+ utilization) were observed favoring women who were richest/rich (PAR = 19.5, 95% UI; 16.53, 22.43), educated (PAF = 7.3 95% UI; 3.34, 11.26), urban residents (D = 19, 95% UI; 14.50, 23.51) and those living in regions such as Nouakchott (R = 2.1, 95% UI; 1.59, 2.56). While education-related disparities decreased, wealth-driven and regional disparities remained constant over the 4 years of the study period. Urban-rural inequalities were constant except with the PAR measure, which showed an increasing pattern. Conclusion A disproportionately lower ANC4+ utilization was observed among women who were poor, uneducated, living in rural areas and regions such as Guidimagha. As a result, policymakers need to design interventions that will enable disadvantaged subpopulations to benefit from ANC4+ utilization to meet the Sustainable Development Goal (SDG) of reducing the maternal mortality ratio (MMR) to 140/100, 000 live births by 2030.

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Regional variations and socio-economic disparities in neonatal mortality in Angola: a cross-sectional study using demographic and health surveys

Family Practice ◽

10.1093/fampra/cmaa083 ◽

2020 ◽

Vol 37 (6) ◽

pp. 785-792

Author(s):

Sanni Yaya ◽

Betregiorgis Zegeye ◽

Bright Opoku Ahinkorah ◽

Olanrewaju Oladimeji ◽

Gebretsadik Shibre

Keyword(s):

Neonatal Mortality ◽

Rural Areas ◽

Formal Education ◽

Statistical Significance ◽

Population Attributable Risk ◽

Population Attributable Fraction ◽

World Health ◽

Demographic And Health Surveys ◽

Gender Inequalities ◽

Cross Sectional

Abstract Background Inequalities in neonatal mortality rates (NMRs) in low- and middle-income countries show key disparities at the detriment of disadvantaged population subgroups. There is a lack of scholarly evidence on the extent and reasons for the inequalities in NMRs in Angola. Objective The aim of this study was to assess the socio-economic, place of residence, region and gender inequalities in the NMRs in Angola. Methods The World Health Organization Health Equity Assessment Toolkit software was used to analyse data from the 2015 Angola Demographic and Health Survey. Five equity stratifiers: subnational regions, education, wealth, residence and sex were used to disaggregate NMR inequality. Absolute and relative inequality measures, namely, difference, population attributable fraction (PAF), population attributable risk (PAR) and ratio, were calculated to provide a broader understanding of the inequalities in NMR. Statistical significance was calculated at corresponding 95% uncertainty intervals. Findings We found significant wealth-driven [PAR = −14.16, 95% corresponding interval (CI): −15.12, −13.19], education-related (PAF = −22.5%, 95% CI: −25.93, −19.23), urban–rural (PAF = −14.5%, 95% CI: −16.38, −12.74), sex-based (PAR = −5.6%, 95% CI: −6.17, −5.10) and subnational regional (PAF = −82.2%, 95% CI: −90.14, −74.41) disparities in NMRs, with higher burden among deprived population subgroups. Conclusions High NMRs were found among male neonates and those born to mothers with no formal education, poor mothers and those living in rural areas and the Benguela region. Interventions aimed at reducing NMRs, should be designed with specific focus on disadvantaged subpopulations.

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Inequalities in Stunting Prevalence Among Children Under Age 5 in Ghana Between 1998 and 2014

10.21203/rs.3.rs-151172/v1 ◽

2021 ◽

Author(s):

Collins Adu ◽

Edward Kwabena Ameyaw ◽

Pascal Agbadi ◽

Ebenezer Agbaglo ◽

Justice Kanor Tetteh ◽

...

Keyword(s):

Statistical Significance ◽

Population Attributable Risk ◽

Population Attributable Fraction ◽

Wealth Index ◽

Northern Region ◽

World Health ◽

Demographic And Health Surveys ◽

Children Under Five ◽

Under Five ◽

Summary Measures

Abstract BackgroundOver the years, Ghana has made significant improvements in the nutritional status of children, particularly concerning stunting. Though these improvements are commendable, there are concerns of inequalities in the prevalence of stunting among children under five. To this end, we examined the trends and inequalities in the determinants of stunting prevalence in children under five in Ghana, throughout 1998-2014.MethodsUsing the World Health Organization’s (WHO) Health Equity Assessment Toolkit (HEAT) software, we analysed data from the 1998-2014 Ghana Demographic and Health Surveys (GDHS). We approached the inequality analysis in two steps. First, we disaggregated stunting prevalence among children < 5 years by five equity stratifiers: wealth index, education, sex, residence, and region. Second, we measured the inequality through summary measures, namely Difference, Population Attributable Risk, Ratio, and Population Attributable Fraction. A 95% confidence interval was constructed for point estimates to measure statistical significance.ResultsConcerning economic status, only the simple summary measures (Difference [D], Ratio [R]) showed significant inequality in stunting. For instance, both D (23.40; 17.55-29.25) and R (2.43; 1.78-3.09) revealed substantial economic variation in stunting in 1998 and the same trend was noted across all the survey years. The complex summary measures, however, showed a significant but negative association. Both D (16.36; 12.13-20.60) and R (1.90; 1.51-2.28) revealed a positive significant disparity in favour of urban residents in 1998. The simple measures further indicated a significant disparity in stunting at the detriment of male children throughout the period studied. Finally, a significant disparity at the expense of children in the Northern Region was evident in 1998 (D=31.00; R=3.22), 2003 (D=37.21; R=3.17) and 2014 (D=22.73; R=3.19).ConclusionInequalities in stunting prevalence in Ghana is to the disadvantaged children of poorest wealth quintile, mothers with no formal education, male children, rural residents and the Northern Region of Ghana. We recommend the introduction and strengthening of equitable interventions focusing on nutrition on sub-populations in the country who suffer from a higher burden of stunting.

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Observed magnitude and trends in socioeconomic and geographic area inequalities in obesity prevalence among non-pregnant women in Chad: evidence from three waves of Chad demographic and health surveys

Archives of Public Health ◽

10.1186/s13690-021-00658-5 ◽

2021 ◽

Vol 79 (1) ◽

Author(s):

Gebretsadik Shibre ◽

Betregiorgis Zegeye ◽

Gashaw Garedew Woldeamanuiel ◽

Wassie Negash ◽

Gorems Lemma ◽

...

Keyword(s):

Pregnant Women ◽

Health Surveys ◽

Population Attributable Risk ◽

Population Attributable Fraction ◽

Overweight And Obesity ◽

World Health ◽

Demographic And Health Surveys ◽

Obesity Prevalence ◽

Place Of Residence ◽

Urban Rural

Abstract Background While the prevalence of obesity is increasing worldwide, the growing rates of overweight and obesity in developing countries are disquieting. Obesity is widely recognized as a risk factor for non-communicable diseases (NCDs), including diabetes, cancer and cardiovascular diseases. Available evidence on whether obesity has been more prevalent among higher or lower socioeconomic groups, across regions and urban-rural women’s are inconsistent. This study examined magnitude of and trends in socioeconomic, urban-rural and sub-national region inequalities in obesity prevalence among non-pregnant women in Chad. Method Using cross-sectional data from Chad Demographic and Health Surveys (DHSs) conducted in 1996, 2004 and 2014; we used the World Health Organization (WHO) Health Equity Assessment Toolkit (HEAT) to analyze socio-economic, urban-rural and regional inequalities in obesity prevalence among non-pregnant women aged 15–49 years. Inequalities were assessed using four equity stratifiers namely wealth index, educational level, place of residence and subnational region. We presented inequalities using simple and complex as well as relative and absolute summary measures such as Difference (D), Population Attributable Risk (PAR), Population Attributable Fraction (PAF) and Ratio (R). Results Though constant pattern overtime, both wealth-driven and place of residence inequality were observed in all three surveys by Difference measure and in the first and last surveys by Ratio measure. Similarly, including the recent survey (D = -2.80, 95% CI:-4.15, − 1.45, R = 0.37, 95% CI: 0.23, 0.50) absolute (in 1996 & 2014 survey) and relative (in all three surveys) educational status inequality with constant pattern were observed. Substantial absolute (PAR = -2.2, 95% CI: − 3.21, − 1.34) and relative (PAF = − 91.9, 95% CI: − 129.58, − 54.29) regional inequality was observed with increasing and constant pattern by simple (D) and complex (PAR, PAF) measures. Conclusion The study showed socioeconomic and area-based obesity inequalities that disfavored women in higher socioeconomic status and residing in urban areas. Prevention of obesity prevalence should be government and stakeholders’ priority through organizing the evidence, health promotion and prevention interventions for at risk population and general population.

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Trends in inequalities in childhood stunting in Ethiopia from 2000 to 2016: a cross sectional study

Journal of Public Health ◽

10.1093/pubmed/fdaa051 ◽

2020 ◽

Author(s):

Betregiorgis Zegeye ◽

Gebretsadik Shibre ◽

Dina Idriss-Wheeler ◽

Sanni Yaya

Keyword(s):

Rural Areas ◽

Economic Status ◽

Statistical Significance ◽

Population Attributable Risk ◽

Cross Sectional Study ◽

World Health ◽

Demographic And Health Surveys ◽

Uncertainty Interval ◽

Cross Sectional ◽

Agenda 2030

Abstract Background The decrease in the magnitude of stunting over the past 20 years has been slow in Ethiopia. To date, in Ethiopia, the trends in and extent of inequality in stunting have not been investigated using methods suitably developed for disparity studies. This paper investigated both the extent and overtime dynamics of stunting inequality in Ethiopia over the last 17 years. Methods Using the World Health Organization’s Health Equity Assessment Toolkit software, data from the Ethiopia Demographic and Health surveys (EDHS) were analyzed between 2000 and 2016. The inequality analysis consisted of disaggregated rates of stunting using five equity stratifiers (economic status, education, residence, region and sex) and four summary measures (Difference, Population Attributable risk, Ratio and Absolute Concentration Index). A 95% uncertainty interval was constructed around point estimates to measure statistical significance. Results The study showed that both absolute and relative inequalities in stunting exist in all the studied years in Ethiopia. The inequality disfavors children of mothers who are poor, uneducated and living in rural areas and specific regions such as Amhara. The pro-rich (R = 1.2; 1.1, 1.3 in 2000 to R = 1.7; 1.4, 2 in 2016) and pro-educated (R = 1.6; 95%UI = 1.3, 1.9 in 2000 and R = 2.3; 95%UI = 1.5, 3 in 2011) inequalities slightly increased with time. Male children bear a disproportionately higher burden of stunting, and the disparity increased between the first and the last time points (PAR = −1.5 95%UI = −2.5, −0.6 in 2000 and PAR = −2.9 95%UI = −3.9, −1.9) based on complex measures but remained constant with simple measures (R = 1; 95%UI = 0.9, 1.1 in 2000 and R = 1.1 95%UI = 1, 1.2 in 2016). Similarly, both the sub-national regional and residence-related stunting disparities generally widened over time according to some of the inequality measures. Conclusions Stunting appeared to be highly prevalent among certain sub-groups (i.e. poor, uneducated and living in rural regions). The subpopulations experiencing excessively high stunting prevalence should be the focus of policy makers’ attention as they work to achieve the WHO 40% reduction in stunting target by 2025 and the UN Agenda 2030 for Sustainable Development Goals.

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Time trends, geographical, socio-economic, and gender disparities in neonatal mortality in Burundi: evidence from the demographic and health surveys, 2010–2016

Archives of Public Health ◽

10.1186/s13690-020-00501-3 ◽

2020 ◽

Vol 78 (1) ◽

Author(s):

Sanni Yaya ◽

Betregiorgis Zegeye ◽

Bright Opoku Ahinkorah ◽

Edward Kwabena Ameyaw ◽

Abdul-Aziz Seidu ◽

...

Keyword(s):

Neonatal Mortality ◽

Urban Areas ◽

Economic Status ◽

Statistical Significance ◽

Population Attributable Risk ◽

Population Attributable Fraction ◽

Demographic And Health Surveys ◽

Live Births ◽

Urban Rural ◽

Over Time

Abstract Background Programmatic and research agendas surrounding neonatal mortality are important to help countries attain the child health related 2030 Sustainable Development Goal (SDG). In Burundi, the Neonatal Mortality Rate (NMR) is 25 per 1000 live births. However, high quality evidence on the over time evolution of inequality in NMR is lacking. This study aims to address the knowledge gap by systematically and comprehensively investigating inequalities in NMR in Burundi with the intent to help the country attain SDG 3.2 which aims to reduce neonatal mortality to at least as low as 12 per 1000 live births by 2030. Methods The Burundi Demographic and Health Survey (BDHS) data for the periods of 2010 and 2016 were used for the analyses. The analyses were carried out using the WHO’s HEAT version 3.1 software. Five equity stratifiers: economic status, education, residence, sex and subnational region were used as benchmark for measuring NMR inequality with time over 6 years. To understand inequalities from a broader perspective, absolute and relative inequality measures, namely Difference, Population Attributable Risk (PAR), Ratio, and Population Attributable Fraction (PAF) were calculated. Statistical significance was measured by computing corresponding 95% Confidence Intervals (CIs). Results NMR in Burundi in 2010 and 2016 were 36.7 and 25.0 deaths per 1000 live births, respectively. We recorded large wealth-driven (PAR = -3.99, 95% CI; − 5.11, − 2.87, PAF = -15.95, 95% CI; − 20.42, − 11.48), education related (PAF = -6.64, 95% CI; − 13.27, − 0.02), sex based (PAR = -1.74, 95% CI; − 2.27, − 1.21, PAF = -6.97, 95% CI; − 9.09, − 4.86), urban-rural (D = 15.44, 95% CI; 7.59, 23.29, PAF = -38.78, 95% CI; − 45.24, − 32.32) and regional (PAR = -12.60, 95% CI; − 14.30, − 10.90, R = 3.05, 95% CI; 1.30, 4.80) disparity in NMR in both survey years, except that urban-rural disparity was not detected in 2016. We found both absolute and relative inequalities and significant reduction in these inequalities over time - except at the regional level, where the disparity remained constant during the study period. Conclusion Large survival advantage remains to neonates of women who are rich, educated, residents of urban areas and some regions. Females had higher chance of surviving their 28th birthday than male neonates. More extensive work is required to battle the NMR gap between different subgroups in the country.

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Socio-economic and geographical inequalities in adolescent fertility rate in Ghana, 1993–2014

Archives of Public Health ◽

10.1186/s13690-021-00644-x ◽

2021 ◽

Vol 79 (1) ◽

Author(s):

Bright Opoku Ahinkorah ◽

Eugene Budu ◽

Henry Ofori Duah ◽

Joshua Okyere ◽

Abdul-Aziz Seidu

Keyword(s):

Adolescent Girls ◽

Population Attributable Risk ◽

Population Attributable Fraction ◽

Fertility Rate ◽

Sub Saharan Africa ◽

World Health ◽

Demographic And Health Surveys ◽

Fertility Rates ◽

Adolescent Fertility ◽

Sub Saharan

Abstract Background Despite public health interventions to control adolescent fertility, it remains high in sub-Saharan Africa. Ghana is one of the countries in sub-Saharan Africa with the highest adolescent fertility rates. We examined the trends and socio-economic and geographical patterns of disparities in adolescent fertility in Ghana from 1993 to 2014. Methods Using the World Health Organization’s (WHO) Health Equity Assessment Toolkit (HEAT) software, data from the 1993–2014 Ghana Demographic and Health surveys were analyzed. First, we disaggregated adolescent fertility rates (AFR) by four equity stratifiers: wealth index, education, residence and region. Second, we measured the inequality through summary measures, namely Difference (D), Population Attributable Risk (PAR), Ratio (R) and Population Attributable Fraction (PAF). A 95 % confidence interval was constructed for point estimates to measure statistical significance. Results We observed substantial absolute and relative wealth-driven inequality in AFR (PAR=-47.18, 95 % CI; -49.24, -45.13) and (PAF= -64.39, 95 % CI; -67.19, -61.59) respectively in favour of the economically advantaged subpopulations. We found significant absolute (D = 69.56, 95 % CI; 33.85, 105.27) and relative (R = 3.67, 95 % CI; 0.95, 6.39) education-based inequality in AFR, with higher burden of AFR among disadvantaged subpopulations (no formal education). The Ratio measure (R = 2.00, 95 % CI; 1.53, 2.47) indicates huge relative pro-urban disparities in AFR with over time increasing pattern. Our results also show absolute (D, PAR) and relative (R, PAF) inequality in AFR across subnational region, between 2003 and 2014. For example, in the 2014 survey, the PAR measure (D=-28.22, 95 % CI; -30.58, -25.86) and the PAF measure (PAF=-38.51, 95 % CI; -41.73, -35.29) indicate substantial absolute and relative regional inequality. Conclusions This study has indicated the existence of inequality in adolescent fertility rate in Ghana, with higher ferlitiy rates among adolescent girls who are poor, uneducated, rural residents and those living in regions such as Northern, Brong Ahafo, and Central region, with increasing disparity over the time period of the study. There is the need for policy interventions that target adolescent girls residing in the rural areas and those in the low socioeconomic subgroups to enable the country to avert the high maternal/newborn morbidity and mortality usually associated with adolescent childbearing.

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Time trends in socio-economic, urban-rural and regional disparities in prevalence of obesity among non-pregnant women in Lesotho: evidence from Lesotho demographic and health surveys (2004–2014)

BMC Public Health ◽

10.1186/s12889-021-10571-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Betregiorgis Zegeye ◽

Gebretsadik Shibre ◽

Gashaw Garedew Woldeamanuel

Keyword(s):

Pregnant Women ◽

Health Surveys ◽

Educational Inequality ◽

Statistical Significance ◽

World Health ◽

Demographic And Health Surveys ◽

Obesity Prevalence ◽

Urban Rural ◽

Prevalence Of Obesity ◽

Health Organization

Abstract Background The growing rates of obesity in developing countries are alarming. There is a paucity of evidence about disparities of obesity in Lesotho. This study examined socioeconomic and area-based inequalities in obesity among non-pregnant women in Lesotho. Methods Data were extracted from the 2004, 2009 and 2014 Lesotho Demographic and Health Surveys (LDHS) and analyzed through the recently updated Health Equity Assessment Toolkit (HEAT) of the World Health Organization. Obesity prevalence was disaggregated by four equity stratifiers, namely education, wealth, residence and sub-national region. For each equity stratifier, simple and complex as well as relative and absolute summary measures were calculated. A 95% confidence interval was used to measure statistical significance of findings. Results We noticed substantial wealth-driven (D = -21.10, 95% CI; − 25.94, − 16.26), subnational region (PAR = -11.82, 95%CI; − 16.09, − 7.55) and urban-rural (− 9.82, 95% CI; − 13.65, − 5.99) inequalities in obesity prevalence without the inequalities improved over time in all the studied years. However, we did not identify educational inequality in obesity. Conclusions Wealth-driven and geographical inequalities was identified in Lesotho in all the studied time periods while education related inequalities did not appear during the same time period. All population groups in the country need to be reached with interventions to reduce the burden of obesity in the country.

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Clinicopathological features of Egyptian colorectal cancer patients regarding somatic genetic mutations especially in KRAS gene and microsatellite instability status: a pilot study

Egyptian Journal of Medical Human Genetics ◽

10.1186/s43042-019-0028-z ◽

2019 ◽

Vol 20 (1) ◽

Author(s):

Neemat M. Kassem ◽

Gamal Emera ◽

Hebatallah A. Kassem ◽

Nashwa Medhat ◽

Basant Nagdy ◽

...

Keyword(s):

Colorectal Cancer ◽

Microsatellite Instability ◽

Cpg Island ◽

Human Cancer ◽

Statistical Significance ◽

Public Health Problem ◽

World Health ◽

Cpg Island Methylator Phenotype ◽

Number Of Patients ◽

The Impact

Abstract Background Colorectal cancer (CRC) is the third most common cause of cancer-related deaths which contributes to a significant public health problem worldwide with 1.8 million new cases and almost 861,000 deaths in 2018 according to the World Health Organization. It exhibits 7.4% of all diagnosed cancer cases in the region of the Middle East and North Africa. Molecular changes that happen in CRCs are chromosomal instability, microsatellite instability (MSI), and CpG island methylator phenotype. The human RAS family (KRAS, NRAS, and HRAS) is the most frequently mutated oncogenes in human cancer appearing in 45% of colon cancers. Determining MSI status across CRCs offers the opportunity to identify patients who are likely to respond to targeted therapies such as anti-PD-1. Therefore, a method to efficiently determine MSI status for every cancer patient is needed. Results KRAS mutations were detected in 31.6% of CRC patients, namely in older patients (p = 0.003). Codons 12 and 13 constituted 5/6 (83.3%) and 1/6 (16.7%) of all KRAS mutations, respectively. We found three mutations G12D, G12C, and G13D which occur as a result of substitution at c.35G>A, c.34G>T, and c.38G>A and have been detected in 4/6 (66.6%), 1/6 (16.7%), and 1/6 (16.7%) patients, respectively. Eleven (57.9%) patients had microsatellite instability-high (MSI-H) CRC. A higher percentage of MSI-H CRC was detected in female patients (p = 0.048). Eight patients had both MSI-H CRC and wild KRAS mutation with no statistical significance was found between MSI status and KRAS mutation in these studied patients. Conclusion In conclusion, considering that KRAS mutations confer resistance to EGFR inhibitors, patients who have CRC with KRAS mutation could receive more tailored management by defining MSI status. MSI-high patients have enhanced responsiveness to anti-PD-1 therapies. Thus, the question arises as to whether it is worth investigating this association in the routine clinical setting or not. Further studies with a larger number of patients are needed to assess the impact of MSI status on Egyptian CRC care.

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The Potential Contribution of the Health System to Reducing Stunting in SUN Countries

Food and Nutrition Bulletin ◽

10.1177/0379572121998127 ◽

2021 ◽

pp. 037957212199812

Author(s):

Talata Sawadogo-Lewis ◽

Shannon E. King ◽

Tricia Aung ◽

Timothy Roberton

Keyword(s):

Health System ◽

Universal Coverage ◽

Reproductive Age ◽

World Health ◽

Potential Contribution ◽

Nutrition Interventions ◽

Lives Saved Tool ◽

Potential Impact ◽

Nutrition Sensitive ◽

Global Nutrition

Background: The global nutrition community has called for a multisectoral approach to improve nutritional outcomes. While most essential nutrition interventions are delivered through the health system, nutrition-sensitive interventions from other sectors are critical. Objective: We modeled the potential impact that Scaling Up Nutrition (SUN) interventions delivered by the health system would have on reaching World Health Assembly (WHA) stunting targets. We also included results for targets 2, 3, and 5. Methods: Using all available countries enrolled in the SUN movement, we identified nutrition interventions that are delivered by the health system available in the Lives Saved Tool. We then scaled these interventions linearly from 2012 up to nearly universal coverage (90%) in 2025 and estimated the potential impact that this increase would have with regard to the WHA targets. Results: Our results show that only 16 countries out of 56 would reach the 40% reduction in the number of stunted children by 2025, with a combined total reduction of 32% across all countries. Similarly, only 2 countries would achieve the 50% reduction in anemia for women of reproductive age, 41 countries would reach at least 50% exclusive breastfeeding in children under 6 months of age, and 0 countries would reach the 30% reduction in low birth weight. Conclusions: While the health system has an important role to play in the delivery of health interventions, focusing investments and efforts on the health system alone will not allow countries to reach the WHA targets by 2025. Concerted efforts across multiple sectors are necessary.

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