Exclusive Breastfeeding and Under-Five Mortality, 2006-2014: A Cross-National Analysis of 57 Low- and-Middle Income Countries

AbstractSeveral studies have documented the burden and risk factors associated with diarrhoea in low and middle-income countries (LMIC). To the best of our knowledge, the contextual and compositional factors associated with diarrhoea across LMIC were poorly operationalized, explored and understood in these studies. We investigated multilevel risk factors associated with diarrhoea among under-five children in LMIC. We analysed diarrhoea-related information of 796,150 under-five children (Level 1) nested within 63,378 neighbourhoods (Level 2) from 57 LMIC (Level 3) using the latest data from cross-sectional and nationally representative Demographic Health Survey conducted between 2010 and 2018. We used multivariable hierarchical Bayesian logistic regression models for data analysis. The overall prevalence of diarrhoea was 14.4% (95% confidence interval 14.2–14.7) ranging from 3.8% in Armenia to 31.4% in Yemen. The odds of diarrhoea was highest among male children, infants, having small birth weights, households in poorer wealth quintiles, children whose mothers had only primary education, and children who had no access to media. Children from neighbourhoods with high illiteracy [adjusted odds ratio (aOR) = 1.07, 95% credible interval (CrI) 1.04–1.10] rates were more likely to have diarrhoea. At the country-level, the odds of diarrhoea nearly doubled (aOR = 1.88, 95% CrI 1.23–2.83) and tripled (aOR = 2.66, 95% CrI 1.65–3.89) among children from countries with middle and lowest human development index respectively. Diarrhoea remains a major health challenge among under-five children in most LMIC. We identified diverse individual-level, community-level and national-level factors associated with the development of diarrhoea among under-five children in these countries and disentangled the associated contextual risk factors from the compositional risk factors. Our findings underscore the need to revitalize existing policies on child and maternal health and implement interventions to prevent diarrhoea at the individual-, community- and societal-levels. The current study showed how the drive to the attainment of SDGs 1, 2, 4, 6 and 10 will enhance the attainment of SDG 3.

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Is trade liberalisation a vector for the spread of sugar-sweetened beverages? A cross-national longitudinal analysis of 44 low- and middle-income countries

Social Science & Medicine ◽

10.1016/j.socscimed.2016.11.001 ◽

2017 ◽

Vol 172 ◽

pp. 21-27 ◽

Cited By ~ 22

Author(s):

Ana Mendez Lopez ◽

Rachel Loopstra ◽

Martin McKee ◽

David Stuckler

Keyword(s):

Longitudinal Analysis ◽

Trade Liberalisation ◽

Sugar Sweetened Beverages ◽

Middle Income ◽

Middle Income Countries ◽

Sweetened Beverages ◽

Cross National ◽

Low And Middle Income

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Improving exclusive breastfeeding in low and middle‐income countries: A systematic review

Maternal and Child Nutrition ◽

10.1111/mcn.12788 ◽

2019 ◽

Vol 15 (3) ◽

Cited By ~ 5

Author(s):

Tolulope Florence Olufunlayo ◽

Alero Ann Roberts ◽

Christine MacArthur ◽

Neil Thomas ◽

Kofoworola Abimbola Odeyemi ◽

...

Keyword(s):

Systematic Review ◽

Exclusive Breastfeeding ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

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Impact of maternal mental health interventions on child-related outcomes in low- and middle-income countries: a systematic review and meta-analysis

Epidemiology and Psychiatric Sciences ◽

10.1017/s2045796020000864 ◽

2020 ◽

Vol 29 ◽

Author(s):

W. A. Tol ◽

M. C. Greene ◽

M. E. Lasater ◽

K. Le Roch ◽

C. Bizouerne ◽

...

Keyword(s):

Mental Health ◽

Exclusive Breastfeeding ◽

Home Visiting ◽

Health Workers ◽

Maternal Mental Health ◽

Meta Analysis ◽

Middle Income ◽

Middle Income Countries ◽

Child Height ◽

Low And Middle Income

Abstract Aims Observational studies have shown a relationship between maternal mental health (MMH) and child development, but few studies have evaluated whether MMH interventions improve child-related outcomes, particularly in low- and middle-income countries. The objective of this review is to synthesise findings on the effectiveness of MMH interventions to improve child-related outcomes in low- and middle-income countries (LMICs). Methods We searched for randomised controlled trials conducted in LMICs evaluating interventions with a MMH component and reporting children's outcomes. Meta-analysis was performed on outcomes included in at least two trials. Results We identified 21 trials with 28 284 mother–child dyads. Most trials were conducted in middle-income countries, evaluating home visiting interventions delivered by general health workers, starting in the third trimester of pregnancy. Only ten trials described acceptable methods for blinding outcome assessors. Four trials showed high risk of bias in at least two of the seven domains assessed in this review. Narrative synthesis showed promising but inconclusive findings for child-related outcomes. Meta-analysis identified a sizeable impact of interventions on exclusive breastfeeding (risk ratio = 1.39, 95% confidence interval (CI): 1.13–1.71, ten trials, N = 4749 mother–child dyads, I2 = 61%) and a small effect on child height-for-age at 6-months (std. mean difference = 0.13, 95% CI: 0.02–0.24, three trials, N = 1388, I2 = 0%). Meta-analyses did not identify intervention benefits for child cognitive and other growth outcomes; however, few trials measured these outcomes. Conclusions These findings support the importance of MMH to improve child-related outcomes in LMICs, particularly exclusive breastfeeding. Given, the small number of trials and methodological limitations, more rigorous trials should be conducted.

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PP124 Health Technology Assessment And Feedback For Healthy Workplace Culture In Malaria Care In Low And Middle Income Countries

International Journal of Technology Assessment in Health Care ◽

10.1017/s026646231800260x ◽

2018 ◽

Vol 34 (S1) ◽

pp. 114-114

Author(s):

Patrick Okwen ◽

Raphael Cheabum ◽

Etienne Che ◽

Joy Ngwemsi Mbunu ◽

Miriam Nkangu

Keyword(s):

Workplace Culture ◽

Evidence Based ◽

Middle Income ◽

Mortality And Morbidity ◽

Children Under Five ◽

Under Five ◽

Middle Income Countries ◽

Percent Improvement ◽

Evidence Based Care ◽

Low And Middle Income

Introduction:Malaria is a leading cause of mortality and morbidity in children under five in low and middle income countries (LMICs). Management of malaria in children under five years of age is challenging. One challenge faced by clinical practice in LMICs is lack of evidence to guide practice. This challenge is further compounded by different training backgrounds of team members. In the management of malaria in Cameroon, conflicts usually arise between clinicians, lab technicians and pharmacists resulting in over diagnosis and treatment of malaria. The patient's view is usually not considered. This leads to over diagnosis and over prescriptions for malaria in children under five years of age.Methods:We used the Joanna Briggs Institute (JBI) approach of getting research into practice to organize stakeholder meetings, assess existing evidence in malaria care, develop evidence criteria for management based on levels of evidence, assess the gamut of care for malaria, provide feedback to clinicians and re-assess practice. We used the JBI practical application of clinical evidence system (PACES) and getting research into practice (GRiP) evidence implementation tools in the process to facilitate teamwork, collaboration on evidence and provide feedback.Results:A collaborative approach to assessments and feedback including all healthcare stakeholders significantly improved workplace culture of evidence-based care and staff-to-staff relationships as well as staff-to-patient relationships. Over a period of twelve months, we reported eighty-four percent fewer conflicts between staff and ninety-eight percent fewer conflicts between staff and patients. For malaria management, overall criteria showed a thirty-one percent improvement in compliance with best practice recommendations with evidence levels of Grade 1.Conclusions:The project demonstrated that local leadership and evidence-based care can significantly improve practice in resource limited settings.

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