scholarly journals Beyond personal factors: Multilevel determinants of childhood stunting in Indonesia

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0260265
Author(s):  
Tri Mulyaningsih ◽  
Itismita Mohanty ◽  
Vitri Widyaningsih ◽  
Tesfaye Alemayehu Gebremedhin ◽  
Riyana Miranti ◽  
...  
Keyword(s):  
Parental Education ◽  
Household Wealth ◽  
Mixed Effects ◽  
Mixed Effects Model ◽  
Community Level ◽  
Major Public Health Problem ◽  
Personal Factors ◽  
Household Level ◽  
Province Level ◽  
Childhood Stunting

Background Stunting is still a major public health problem in low- and middle-income countries, including Indonesia. Previous studies have reported the complexities associated with understanding the determinants of stunting. This study aimed to examine the household-, subdistrict- and province-level determinants of stunting in Indonesia using a multilevel hierarchical mixed effects model. Methods We analyzed data for 8045 children taken from the 2007 and 2014 waves of the Indonesian Family and Life Surveys (IFLS). We included individual-, family-/household- and community-level variables in the analyses. A multilevel mixed effects model was employed to take into account the hierarchical structure of the data. Moreover, the model captured the effect of unobserved household-, subdistrict- and province-level characteristics on the probability of children being stunted. Results Our findings showed that the odds of childhood stunting vary significantly not only by individual child- and household-level characteristics but also by province- and subdistrict-level characteristics. Among the child-level covariates included in our model, dietary habits, neonatal weight, a history of infection, and sex significantly affected the risk of stunting. Household wealth status and parental education are significant household-level covariates associated with a higher risk of stunting. Finally, the risk of stunting is higher for children living in communities without access to water, sanitation and hygiene. Conclusions Stunting is associated with not only child-level characteristics but also family- and community-level characteristics. Hence, interventions to reduce stunting should also take into account family and community characteristics to achieve effective outcomes.

scholarly journals Undernutrition and Associated Factors among Adolescent Girls in Damot Sore District, Southern Ethiopia

2020 ◽  
Vol 2020 ◽  
pp. 1-11
Author(s):  
Degu Demissie Gagebo ◽  
Amene Abebe Kerbo ◽  
Thilagavathi Thangavel
Keyword(s):  
Adolescent Girls ◽  
Associated Factors ◽  
Parental Education ◽  
Wealth Index ◽  
Household Wealth ◽  
Sub Saharan Africa ◽  
Southern Ethiopia ◽  
Major Public Health Problem ◽  
Mother Education ◽  
Damot Sore

Background. Adolescent girls were given little health and nutrition attention. Focusing on adolescent girls’ nutrition prior to conception is one way to break the intergenerational cycle of malnutrition. Therefore, the aim of this study was to assess the prevalence of undernutrition and associated factors among adolescent girls in rural Damot Sore District, Southern Ethiopia. Methods. A community-based cross-sectional study was conducted from February to March 2017. Multistage sampling technique was used to select 729 adolescent girls. Structured interviewer-administered questionnaire was used to collect information on different variables. Weight and height were measured by using a well-calibrated digital Seca scale and portable stadiometer by trained data collectors. Height-for-age (HFA) and body mass index-for-age (BMIFA) z-scores were calculated using WHO AnthroPlus software as indicators of stunting and thinness, respectively. Wealth index was generated by using principal component analysis (PCA), and based on the results, household wealth index/status was converted into tertiles and categorized as higher/rich, medium, and lower/poor. Descriptive statistics, bivariable, and multivariable logistic regression analysis were done. Strength of association of variables was presented by odds ratio along with its 95% CI. Results. The prevalence of stunting and thinness among adolescent girls was 29.6% (95% CI = 26.6%, 32.8%) and 19.5% (95% CI = 16.7%, 22.3%), respectively. Being in older adolescence (AOR = 2.06, 95% CI = 1.08, 3.92), mother occupation (farmer and government employee) ((AOR = 2.38, 95% CI = 1.31, 4.33) and (AOR = 3.05, 95% CI = 1.35, 6.92)), mother education (secondary and above) ((AOR = 0.53, 95% CI = 0.28, 0.98) and (AOR = 0.25, 95% CI = 0.09, 0.69)), and household wealth index (poor) (AOR = 1.94, 95% CI = 1.29, 2.92) were significantly associated with stunting. Father education (primary and secondary) ((AOR = 0.48, 95% CI = 0.31, 0.77) and (AOR = 0.45, 95% CI = 0.26, 0.78)), mother education (primary) (AOR = 0.56, 95% CI = 0.37, 0.87), and meal frequency (<2/day) (AOR = 1.87, 95% CI = 1.12, 3.13) were significantly associated with thinness. Conclusion. The prevalence of stunting and thinness among adolescent girls was moderate, when compared to the prevalence reported in Sub-Saharan Africa. However, it was a major public health problem, when compared to the national nutrition baseline survey reports in Ethiopia. Parental education was a significant predictor of both stunting and thinness among adolescent girls. Thus, initiation of routine screening, promotion of education, and implementation of evidence based community nutrition programmes required to be improved.

scholarly journals Hispanic/Latino‐Serving Hospitals Provide Less Targeted Temperature Management Following Out‐of‐Hospital Cardiac Arrest

2021 ◽  
Author(s):  
Nicholas A. Morris ◽  
Michael Mazzeffi ◽  
Patrick McArdle ◽  
Teresa L. May ◽  
Greer Waldrop ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Ethnic Disparities ◽  
The United States ◽  
Mixed Effects ◽  
Mixed Effects Model ◽  
Targeted Temperature Management ◽  
Community Level ◽  
Temperature Management ◽  
Hospital Cardiac Arrest ◽  
White Patients

Abstract Background Variation exists in outcomes following out‐of‐hospital cardiac arrest (OHCA), but whether racial and ethnic disparities exist in post‐arrest provision of targeted temperature management (TTM) is unknown. Methods and Results We performed a retrospective analysis of a prospectively collected cohort of patients who survived to admission following OHCA from the Cardiac Arrest Registry to Enhance Survival, whose catchment area represents ~50% of the United States from 2013‐2019. Our primary exposure was race/ethnicity and primary outcome was utilization of TTM. We built a mixed‐effects model with both state of arrest and admitting hospital modeled as random intercepts to account for clustering. Among 96,695 patients (24.6% Black, 8.0% Hispanic/Latino, 63.4% White), a smaller percentage of Hispanic/Latino patients received TTM than Black or White patients (37.5% vs. 45.0 % vs 43.3%, P < .001) following OHCA. In the mixed‐effects model, Black patients (Odds Ratio [OR] 1.153, 95% Confidence Interval [CI] 1.102‐1.207, P < .001) and Hispanic/Latino patients (OR 1.086, 95% CI 1.017‐1.159, P < .001) were slightly more likely to receive TTM compared to White patients, perhaps due to worse admission neurological status. We did find community level disparity as Hispanic/Latino‐serving hospitals (defined as the top decile of hospitals that cared for the highest proportion of Hispanic/Latino patients) provided less TTM (OR 0.587, 95% CI 0.474 to 0.742, P < .001). Conclusions Reassuringly, we did not find evidence of intrahospital or interpersonal racial or ethnic disparity in the provision of TTM. However, we did find inter‐hospital, community level disparity. Hispanic/Latino‐serving hospitals provided less guideline‐recommended TTM after OHCA.

scholarly journals Individual and community level associates of contraceptive use in Ethiopia: a multilevel mixed effects analysis

2019 ◽  
Vol 77 (1) ◽  
Author(s):  
Masrie Getnet Abate ◽  
Amare Abera Tareke
Keyword(s):  
Fixed Effects ◽  
Contraceptive Use ◽  
Household Wealth ◽  
Mixed Effects ◽  
Community Level ◽  
Reproductive Age ◽  
Safe Motherhood ◽  
Sampled Data ◽  
Individual Level ◽  
Factors Associated

Abstract Background Family planning is one of the four pillars of safe motherhood initiative to reduce maternal death in developing countries. Despite progress in contraceptive use, unmet needs are wide open and fertility remains high. Ethiopia have a higher fertility rate which contributes to maternal and child health destitution, putting pressure on the already weak health system. This study examined individual and community-level factors associated with contraceptive use in Ethiopia. Methods Data from Ethiopian Demographic and Health Survey 2016 were used to identify individual and community level associated factors among reproductive-age women. Non-pregnant, fecund and sexually active women aged 15–49 were included. Six hundred forty-two communities and 6854 women were involved from this two-stage cluster sampled data. The analysis was done using two-level mixed-effects logistic regression to determine fixed effects of individual and community-level factors and random intercept of between characteristics. Results From the total eligible women for contraceptive use 2393 (34.9%) of them were users. Injectables were the commonest of all contraceptive methods. Various individual-level variables were associated with contraceptive use. Household wealth index, women’s age, number of living children, husband’s occupation, ever experience of a terminated pregnancy, current working status of the women, number of births in the last 3 years, and hearing of FP messages through different media were significantly associated individual-level variables after adjusting other factors. Community characteristics like region, place of residence, religion, and community-level wealth were the factors associated with contraceptive use. Conclusion Both individual and community-level characteristics were significant predictors of use of contraceptives in Ethiopian women. Besides the individual-level factors, interventions should also consider community-level associates.

scholarly journals Predictors of stunting among children age 6–59 months in Ethiopia using Bayesian multi-level analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Amare Muche ◽  
Lemma Derseh Gezie ◽  
Adhanom Gebre-egzabher Baraki ◽  
Erkihun Tadesse Amsalu
Keyword(s):  
Nutrition Education ◽  
Maternal Education ◽  
Maternal Nutrition ◽  
Sampling Technique ◽  
Household Wealth ◽  
Community Level ◽  
Cluster Sampling ◽  
Wealth Status ◽  
Public Health Burden ◽  
Childhood Stunting

AbstractIn developing countries including Ethiopia stunting remained a major public health burden. It is associated with adverse health consequences, thus, investigating predictors of childhood stunting is crucial to design appropriate strategies to intervene the problem stunting. The study uses data from the Ethiopian Demographic and Health Survey (EDHS) conducted from January 18 to June 27, 2016 in Ethiopia. A total of 8117 children aged 6–59 months were included in the study with a stratified two stage cluster sampling technique. A Bayesian multilevel logistic regression was fitted using Win BUGS version 1.4.3 software to identify predictors of stunting among children age 6–59 months. Adjusted odds ratio (AOR) with 95% credible intervals was used to ascertain the strength and direction of association. In this study, increasing child’s age (AOR = 1.022; 95% CrI 1.018–1.026), being a male child (AOR = 1.16; 95%CrI 1.05–1.29), a twin (AOR = 2.55; 95% CrI 1.78–3.56), having fever (AOR = 1.23; 95%CrI 1.02–1.46), having no formal education (AOR = 1.99; 95%CrI 1.28–2.96) and primary education (AOR = 83; 95%CrI 1.19–2.73), birth interval less than 24 months (AOR = 1.40; 95% CrI 1.20–1.61), increasing maternal BMI (AOR = 0.95; 95% CrI 0.93–0.97), and poorest household wealth status (AOR = 1.78; 95% CrI 1.35–2.30) were predictors of childhood stunting at individual level. Similarly, region and type of toilet facility were predictors of childhood stunting at community level. The current study revealed that both individual and community level factors were predictors of childhood stunting in Ethiopia. Thus, more emphasize should be given by the concerned bodies to intervene the problem stunting by improving maternal education, promotion of girl education, improving the economic status of households, promotion of context-specific child feeding practices, improving maternal nutrition education and counseling, and improving sanitation and hygiene practices.

scholarly journals A flexible nonlinear mixed effects model for HIV viral load rebound after treatment interruption

2020 ◽  
Vol 39 (15) ◽  
pp. 2051-2066 ◽  
Author(s):  
Rui Wang ◽  
Ante Bing ◽  
Cathy Wang ◽  
Yuchen Hu ◽  
Ronald J. Bosch ◽  
...  
Keyword(s):  
Viral Load ◽  
Treatment Interruption ◽  
Mixed Effects ◽  
Mixed Effects Model ◽  
Nonlinear Mixed Effects ◽  
Hiv Viral Load ◽  
Nonlinear Mixed Effects Model ◽  
Viral Load Rebound

scholarly journals The state of Spanish /s/ variation in Concepción, Chile: Linguistic and social trends

2020 ◽  
Vol 6 (1) ◽  
pp. 132-153
Author(s):  
Brandon M. A. Rogers
Keyword(s):  
Social Factors ◽  
Central City ◽  
Mixed Effects ◽  
The State ◽  
Mixed Effects Model ◽  
Proportional Odds ◽  
Random Factor ◽  
Social Trends ◽  
Southern Central ◽  
Social Demographics

AbstractThe current study examines /s/ variation in the southern-central city of Concepción, Chile and its relation to a variety of linguistic and social factors. A proportional-odds mixed effects model, with the random factor of “speaker”, was used to treat the categorically coded data on a continuum of acoustical variation ([s] > [h] > ∅). The results presented show that contrary to the previous assertions, heavy sibilant reduction, especially elision, in Concepción, Chile is the rule, rather than the exception, to the extent that it is no longer a marker of certain social demographics as has been reported previously. Furthermore, based on the trends reported, it is likely that this has been the case for several decades. Finally, the overall observed trends are indicative that the rates of /s/ elision will continue to increase across social demographics and different phonetic and phonological contexts in Concepción, Chile.

Estimating local arterial stiffness using mixed-effects model-based residuals: a novel approach

2021 ◽  
Author(s):  
Avinash Chandran ◽  
Derek W. Brown ◽  
Gabriel H. Zieff ◽  
Zachary Y. Kerr ◽  
Daniel Credeur ◽  
...  
Keyword(s):  
Arterial Stiffness ◽  
Mixed Effects ◽  
Mixed Effects Model ◽  
Model Based ◽  
Novel Approach

scholarly journals Less than one-fifth of the mothers practised exclusive breastfeeding in the emerging regions of Ethiopia: a multilevel analysis of the 2016 Ethiopian demographic and health survey

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tsegaye Gebremedhin ◽  
Demiss Mulatu Geberu ◽  
Asmamaw Atnafu
Keyword(s):  
Health Survey ◽  
Exclusive Breastfeeding ◽  
Household Wealth ◽  
Community Level ◽  
Wealth Status ◽  
Individual Level ◽  
Factors Associated ◽  
Breastfeeding Practices ◽  
The Individual ◽  
Low Coverage

Abstract Background The burden of low coverage of exclusive breastfeeding (EBF) has a significant impact on the health of a newborn and also on the family and social economy in the long term. Even though the prevalence of EBF practices in Ethiopia is low, the practices in the pastoral communities, in particular, are significantly low and affected by individual and community-level factors. Besides, its adverse outcomes are mostly unrecognised. Therefore, this study aimed to assess the individual and community-level factors of low coverage of EBF practices in the emerging regions of Ethiopia. Methods In this analysis, data from 2016 Ethiopian Demographic and Health Survey (EDHS) were used. A two-stage stratified sampling technique was used to identify 1406 children aged 0 to 23 months in the emerging regions of Ethiopia. A multilevel mixed-effect binary logistic regression analysis was used to determine the individual and community level factors associated with exclusive breastfeeding practices. In the final model, variables with a p-value of < 0.05 and Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were found to be statistically significant factors that affect exclusive breastfeeding practices. Results Overall, 17.6% (95% CI: 15.6–19.6) of the children aged 0 to 23 months have received exclusive breastfeeding. Employed mothers (AOR: 0.33, 95% CI: 0.21–0.53), richer household wealth status (AOR: 0.39, 95% CI: 0.16–0.96), mothers undecided to have more children (AOR: 2.29, 95% CI: 1.21–4.29), a child with a history of diarrhoea (AOR: 0.31, 95% CI: 0.16–0.61) were the individual-level factors, whereas Benishangul region (AOR: 2.63, 95% CI: 1.44–4.82) was the community-level factors associated with the exclusive breastfeeding practices. Conclusions Less than one-fifth of the mothers have practised exclusive breastfeeding in the emerging regions of Ethiopia. The individual-level factors such as mother’s employment status, household wealth status, desire for more children, presence of diarrhoea and community-level factors such as region have contributed to the low coverage of exclusive breastfeeding. Therefore, the federal and regional health bureaus and other implementers should emphasise to those emerging regions by creating awareness and strengthening the existing community-based health extension program to enhance exclusive breastfeeding practices.

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