SickKids Centre for Global Child Health - Chronic Child Malnutrition Project Placement

I completed a 16-week practicum at the SickKids Centre for Global Child Health where I was a part of the stunting team led by Dr. Nadia Akseer under the research portfolio of Dr. Zulfiqar A. Bhutta. Linear growth stunting, or low height-for-age, is a visible and easily measurable physical manifestation of chronic malnutrition. Children who are stunted have higher rates of mortality and morbidity, as well as experience suboptimal cognitive and motor development. At the time of my placement, one of the team's main projects was a mixed-methods study involving an in-depth evaluation of policies, programs, and factors that have contributed to the decline of under-5 stunting in Ethiopia from 2000-2016. I worked on a variety of components of the manuscript for this study. These included narratives for country demographics, background statistics as well as migration and remittance trends. I also contributed to a literature review on factors that have contributed to a reduction in stunting in Ethiopia in relation to an adapted version of UNICEF's conceptual framework for malnutrition. In addition to the manuscript, I conducted a multivariable analysis of the 2016 determinants of under-5 wasting in Ethiopia. Wasting, or low weight for height, is a form of acute malnutrition and is also a risk factor for mortality. I applied a hierarchical analysis to wasting indicators such as disease, household wealth, maternal education and access to health services. I used Ethiopia's 2016 Demographic and Health Survey data and additional data sources provided through various Ethiopian government ministries. Overall my practicum was a rich interdisciplinary learning experience which allowed me to develop my quantitative and qualitative research skills. I also gained a deeper understanding of global health research processes and the multi-sectoral nature of combating child malnutrition.

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Political Economy, Capability Development, and Fundamental Cause: Integrating Perspectives on Child Health in Developing Countries

Journal of World-Systems Research ◽

10.5195/jwsr.2017.639 ◽

2017 ◽

Vol 23 (1) ◽

pp. 62-92 ◽

Cited By ~ 1

Author(s):

Rebekah Burroway

Keyword(s):

Political Economy ◽

Developing Countries ◽

Child Health ◽

Maternal Education ◽

Well Being ◽

Household Wealth ◽

Child Malnutrition ◽

Demographic And Health Surveys ◽

Individual Level ◽

Fundamental Cause

Several dominant theoretical perspectives attempt to account for health disparities in developing countries, including political economy, the capability approach, and fundamental cause. This study combines the perspectives in a multi-level analysis of child malnutrition and diarrhea in order to gain a more comprehensive understanding of who faces increased health risks and who is shielded from them. Using the Demographic and Health Surveys and World Bank data, I estimate a series of models that predict the likelihood of child malnutrition and diarrhea, based on a set of country- and individual-level explanatory variables. Results suggest that at the individual-level, household wealth and maternal education are the most robust predictors of child health. These social factors are even more important than more proximate factors like clean water or sanitation. At the country-level, gross domestic product (GDP) per capita reduces malnutrition, but does not significantly affect incidence of diarrhea. Contrary to the predominant economic development paradigm, health care and education are more important in accounting for the prevalence of diarrhea than GDP. Finally, trade in and of itself is not harmful to well-being in developing countries. It is when countries become too dependent on one or a few commodities that trade starts to have detrimental costs. Thus, a synthesis of theoretical frameworks best illustrates the complex web of social structural factors that manifest as unequal life chances for children.

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Two decades of regional trends in vaccination completion and coverage among children aged 12-23 months: an analysis of the Uganda Demographic Health Survey data from 1995 to 2016

BMC Health Services Research ◽

10.1186/s12913-021-07443-8 ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Gerald Okello ◽

Jonathan Izudi ◽

Immaculate Ampeire ◽

Frehd Nghania ◽

Carine Dochez ◽

...

Keyword(s):

Child Health ◽

Health Survey ◽

Maternal Education ◽

Statistical Significance ◽

Public Health Intervention ◽

Household Wealth ◽

Childhood Vaccination ◽

Demographic Health Survey ◽

Health Card ◽

Vaccination Completion

Abstract Background Childhood vaccination is an important public health intervention but there is limited information on coverage, trends, and determinants of vaccination completion in Uganda at the regional level. We examined trends in regional vaccination coverage and established the determinants of vaccination completion among children aged 12-23 months in Uganda. Methods We analyzed data from the women’s questionnaire for the 1995-2016 Uganda Demographic Health Survey (UDHS). Vaccine completion was defined as having received a dose of Bacillus-Calmette Guerin (BCG) vaccine; three doses of diphtheria, pertussis, and tetanus (DPT) vaccine; three doses of oral polio vaccine (OPV) (excluding OPV given at birth); and one dose of measles vaccine. We performed Chi-square tests to compare vaccination completion by socio-demographic factors stratified by 10 sub-regions: Eastern, East Central, Central 1, Central 2, Kampala, Karamoja, North, Western, West Nile, and Southwest. We performed logistic regression analysis for each of the regions to identify factors associated with vaccination completion at 5% level of statistical significance. Results Overall vaccination completion was 48.6% (95%CI, 47.2, 50.1) and ranged from 17.3% in Central 1 to 65.9% in Southwest. Vaccination completion rates declined significantly by 10.4% (95% confidence interval (CI), − 16.1, − 4.6) between 1995 and 2000, and increased significantly by 10.0% (95% CI, 4.6, 15.4) between 2000 and 2006, and by 5.4% (95% CI, 0.2, 10.6) between 2006 and 2011. Maternal education (secondary or higher level), receipt of tetanus toxoid (TT) during pregnancy, and possession of a child health card were associated with vaccination completion across all the sub-regions. Other factors like place of residence, religious affiliation, household wealth, maternal age, childbirth order, size of child at birth, and place of delivery were associated with vaccination completion but differed between the 10 sub-regions. Conclusion Besides considerable regional variations, the vaccination completion rate among children aged 12-23 months in Uganda remains suboptimal despite the availability of vaccines. Maternal education, receipt of TT, and possession of a child health card are associated with a higher likelihood of vaccination completion among children aged 12-23 months in all the regions of Uganda. Interventions to improve the utilization of vaccination services in Uganda should consider these factors.

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The influence of economic development level, household wealth and maternal education on child health in the developing world

Social Science & Medicine ◽

10.1016/j.socscimed.2006.04.034 ◽

2006 ◽

Vol 63 (8) ◽

pp. 2242-2254 ◽

Cited By ~ 115

Author(s):

Michael H. Boyle ◽

Yvonne Racine ◽

Katholiki Georgiades ◽

Dana Snelling ◽

Sungjin Hong ◽

...

Keyword(s):

Economic Development ◽

Child Health ◽

Maternal Education ◽

Developing World ◽

Household Wealth ◽

Development Level

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Faktor sosial, ekonomi, dan pemanfaatan posyandu dengan kejadian stunting balita keluarga miskin penerima PKH di Palembang

Jurnal Gizi Klinik Indonesia ◽

10.22146/ijcn.49696 ◽

2020 ◽

Vol 17 (1) ◽

pp. 23

Author(s):

Nur Farida Rahmawati ◽

Nur Alam Fajar ◽

Haerawati Idris

Keyword(s):

Birth Order ◽

Motor Development ◽

Maternal Education ◽

Protective Factor ◽

Social Economic ◽

Family Members ◽

Cash Transfer ◽

Transfer Program ◽

Access To Health Services ◽

Poor Families

Social, economic factors, and utilization of posyandu towards stunting among toddlers of poor families of PKH recipients in PalembangBackground: Stunting is a nutritional problem caused by chronic malnutrition. Stunting can result in decreased concentration, memory damage, decreased learning, and school performance, decreased cognitive function, impaired motor development, and has a long-term impact on reducing productivity, thus inhibiting economic growth and causing intergenerational poverty. Stunting can be influenced by social, economic, and access to health services factors. Objective: To analyze the correlation of social, economic, and utilization of integrated services post (pos pelayanan terpadu/posyandu) with the incidence of stunting of under-fives in poor families in Palembang. Methods: This study used a quantitative method with a cross-sectional design in March-April 2019. The population was toddlers aged 24-59 months from poor families in Palembang, with the criteria receiving the cash transfer program from the Indonesian Government, called Program Keluarga Harapan (PKH). Samples were 100 people were chosen by proportional sampling. Data were analyzed by using the Chi-Square test and regression logistic test. Results: The proportion of stunting among toddlers in poor families of PKH recipients in Palembang was 29%. Multiple logistic regression test shows 4 (four) independent variables have a significant correlation to the incidence of stunting simultaneously. Those variable are maternal education (p=0.003, OR=7.278, 95% CI: 1.928-27.474), birth order (p=0.013, OR=0.144, 95% CI: 0.031-0.664), number of family members (p=0.013, OR=10.809, 95% CI: 1.639-71.278),irregular utilization of Posyandu (p=0.041, OR=3.524, 95% CI:1.055-11.768), and never using Posyandu (p=0.019, OR=5.282, 95% CI: 1.313-21.239). Low maternal education, huge family members (more than 4), irregularly and never use Posyandu increase risk of stunting 7.2 times, 10.8 times, 3.5, and 5.2 times, otherwise first or second birth order was a protective factor of stunting. Conclusions: Maternal education and utilization of Posyandu are protective factors, meanwhile huge family members (more than 4) and third or more birth order can increase stunting incidence among toddlers of poor families of PKH recipients.

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Father Presence, Father Engagement, and Specific Health and Developmental Outcomes of Mongolian Pre-School Children

Children ◽

10.3390/children8070584 ◽

2021 ◽

Vol 8 (7) ◽

pp. 584

Author(s):

Lesley A. Pablo ◽

Ryenchindorj Erkhembayar ◽

Colleen M. Davison

Keyword(s):

Child Health ◽

Maternal Education ◽

Environmental Changes ◽

Child Outcomes ◽

Household Wealth ◽

Cross Sectional ◽

Father Engagement ◽

Child Illness ◽

Preschool Attendance ◽

Father Presence

This study explored father involvement as a social determinant of child health within the context of macro-environmental changes in Mongolia. Using data for children aged 3–4 from UNICEF’s Multiple Indicator Cluster Surveys, this cross-sectional analysis examined the association between father presence and engagement with child health and educational outcomes. Multivariate regression modeling was employed to identify associations between father presence, engagement, and child outcomes including fever, respiratory illness, diarrhea and preschool attendance. In unadjusted analyses, father engagement was associated with higher odds of preschool attendance (Odds Ratio (OR) = 1.12; 95% Confidence Interval (CI) 1.04–1.20) but not with child illness (OR = 1.04; 95% CI 0.95–1.14). Father engagement was no longer associated with preschool attendance after controlling for potentially confounding variables (ORadj = 0.95; 95% CI 0.88–1.03). Unadjusted and adjusted analyses showed that father presence was not associated with acute illness or preschool attendance. Results also suggest that a larger proportion of children were engaged in activities by their mother compared to their father or other adults. Data indicate that father presence and engagement were not associated with child illness or preschool attendance. Factors such as maternal education, household wealth, and region of residence are stronger predictors of preschool attendance and should continue to be considered for promoting child health and development in Mongolia.

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Accelerating Kenya’s progress to 2030: understanding the determinants of under-five mortality from 1990 to 2015

BMJ Global Health ◽

10.1136/bmjgh-2017-000655 ◽

2018 ◽

Vol 3 (3) ◽

pp. e000655 ◽

Cited By ~ 10

Author(s):

Emily C Keats ◽

William Macharia ◽

Neha S Singh ◽

Nadia Akseer ◽

Nirmala Ravishankar ◽

...

Keyword(s):

Child Health ◽

Reproductive Health ◽

Linear Regression Analysis ◽

Multivariable Analysis ◽

Household Wealth ◽

User Fees ◽

Demographic And Health Surveys ◽

Dramatic Improvement ◽

Development Goal ◽

Under Five

IntroductionDespite recent gains, Kenya did not achieve its Millennium Development Goal (MDG) target for reducing under-five mortality. To accelerate progress to 2030, we must understand what impacted mortality throughout the MDG period.MethodsTrends in the under-five mortality rate (U5MR) were analysed using data from nationally representative Demographic and Health Surveys (1989–2014). Comprehensive, mixed-methods analyses of health policies and systems, workforce and health financing were conducted using relevant surveys, government documents and key informant interviews with country experts. A hierarchical multivariable linear regression analysis was undertaken to better understand the proximal determinants of change in U5MR over the MDG period.ResultsU5MR declined by 50% from 1993 to 2014. However, mortality increased between 1990 and 2000, following the introduction of facility user fees and declining coverage of essential interventions. The MDGs, together with Kenya’s political changes in 2003, ushered in a new era of policymaking with a strong focus on children under 5 years of age. External aid for child health quadrupled from 40 million in 2002 to 180 million in 2012, contributing to the dramatic improvement in U5MR throughout the latter half of the MDG period. Our multivariable analysis explained 44% of the decline in U5MR from 2003 to 2014, highlighting maternal literacy, household wealth, sexual and reproductive health and maternal and infant nutrition as important contributing factors. Children living in Nairobi had higher odds of child mortality relative to children living in other regions of Kenya.ConclusionsTo attain the Sustainable Development Goal targets for child health, Kenya must uphold its current momentum. For equitable access to health services, user fees must not be reintroduced in public facilities. Support for maternal nutrition and reproductive health should be prioritised, and Kenya should acknowledge its changing demographics in order to effectively manage the escalating burden of poor health among the urban poor.

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Early life risk exposure and stunting in urban South African 2-year old children

Journal of Developmental Origins of Health and Disease ◽

10.1017/s2040174417000034 ◽

2017 ◽

Vol 8 (3) ◽

pp. 301-310 ◽

Cited By ~ 1

Author(s):

W. Slemming ◽

J. Kagura ◽

H. Saloojee ◽

L. M. Richter

Keyword(s):

Birth Weight ◽

South African ◽

Odds Ratio ◽

Maternal Education ◽

Multivariable Analysis ◽

Health Concern ◽

Risk Exposure ◽

Birth Cohort Study ◽

Mortality And Morbidity ◽

Urban South

Stunting is a measure of overall nutritional status and is a major public health concern because of its association with child mortality and morbidity and later adult performance. This study examined the effects of pregnancy events, birth characteristics and infant risk exposure on stunting at age 2 years. The study, established in 1990 in Soweto, an urban South African township, included 1098 mother–infant pairs enroled in the Birth to Twenty Plus longitudinal birth cohort study. In total, 22% of children were stunted at age 2 years, with males at greater risk than females [24.8 v. 19.4%, odds ratio (OR)=1.38; 95% confidence interval (CI): 1.03, 1.83]. In unadjusted analysis, male sex, household socio-economic status (SES), overcrowding, maternal age, maternal education, single motherhood, ethnicity, birth weight, gestational age and duration of infant breastfeeding were all significantly associated with stunting. In multivariable analysis, higher birth weight was protective against stunting for both sexes. Higher maternal education was protective for females only (adjusted odds ratio (AOR)=0.35; 95% CI: 0.14, 0.87), whereas wealthier household SES protected males (AOR for richest SES group=0.39; 95% CI: 0.16, 0.92). In this and other similar settings, current stunting prevention efforts focussing on primarily providing targeted proximal interventions, such as food supplements, risk undermining the critical importance of addressing key distal determinants of stunting such as SES and maternal education.

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Father Presence, Father Engagement, and Child Outcomes in Mongolia

10.20944/preprints202105.0416.v1 ◽

2021 ◽

Author(s):

Lesley Pablo ◽

Ryenchindorj Erkhembayar ◽

Colleen M Davison

Keyword(s):

Child Health ◽

Maternal Education ◽

Environmental Changes ◽

School Attendance ◽

Child Outcomes ◽

Household Wealth ◽

Father Engagement ◽

Child Illness ◽

Preschool Attendance ◽

Father Presence

This study explored father involvement as a social determinant of child health within the context of macro-environmental changes in Mongolia. Using data for children aged 3-4 from UNICEF’s Multiple Indicator Cluster Surveys, this cross-sectional analysis examined the association between father presence and engagement with child health and educational outcomes. Multivariate regression modeling was employed to identify associations between father presence, engagement, and child outcomes including fever, respiratory illness, diarrhea and preschool attendance. In unadjusted analyses, father engagement was associated with higher odds of pre-school attendance (OR=1.12; 95% CI 1.04-1.20) but not with child illness (OR=1.04; 95% CI 0.95-1.14). Father engagement was no longer associated with pre-school attendance after controlling for potentially confounding variables (ORadj = 0.95; 95% CI 0.88-1.03). Unadjusted and adjusted analyses showed that father presence was not associated with acute illness or preschool attendance. Results also suggest that a larger proportion of children were engaged in activities by their mother compared to their father or other adults. Data indicate that father presence and engagement were not associated with child illness or pre-school attendance. Factors such as maternal education, household wealth, and region of residence are stronger predictors of preschool attendance and should continue to be considered for promoting child health and development in Mongolia.

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