Independent Associations of Maternal Education and Household Wealth with Malaria Risk in Children

AbstractObjectiveTo examine trends in stunting and overweight in Peruvian children, using 2006 WHO Multicentre Growth Reference Study criteria.DesignTrend analyses using nationally representative cross-sectional surveys from Demographic and Health Surveys (1991–2011). We performed logistic regression analyses of stunting and overweight trends in sociodemographic groups (sex, age, urban–rural residence, region, maternal education and household wealth), adjusted for sampling design effects (strata, clusters and sampling weights).SettingPeru.SubjectsChildren aged 0–59 months surveyed in 1991–92 (n 7999), 1996 (n 14 877), 2000 (n 11 754), 2007–08 (n 8232) and 2011 (n 8186).ResultsChild stunting declined (F(1, 5149) = 174·8, P ≤ 0·00) and child overweight was stable in the period 1991–2011 (F(1, 5147) = 0·4, P ≤ 0·54). Over the study period, levels of stunting were highest in rural compared with urban areas, the Andean and Amazon regions compared with the Coast, among children of low-educated mothers and among children living in households in the poorest wealth quintile. The trend in overweight rose among males in coastal areas (F(1, 2250) = 4·779, P ≤ 0·029) and among males in the richest wealth quintile (F(1, 1730) = 5·458, P ≤ 0·020).ConclusionsThe 2011 levels of stunting and overweight were eight times and three and a half times higher, respectively, than the expected levels from the 2006 WHO growth standards. The trend over the study period in stunting declined in most sociodemographic subgroups. The trend in overweight was stable in most sociodemographic subgroups.

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Urban-Rural Gaps in Breastfeeding Practices: Evidence From Lao People’s Democratic Republic

International Journal of Public Health ◽

10.3389/ijph.2021.1604062 ◽

2021 ◽

Vol 66 ◽

Author(s):

Jordyn T. Wallenborn ◽

Camille B. Valera ◽

Sengchanh Kounnavong ◽

Somphou Sayasone ◽

Peter Odermatt ◽

...

Keyword(s):

Confidence Intervals ◽

Maternal Education ◽

Democratic Republic ◽

Household Wealth ◽

World Health ◽

Lao People’S Democratic Republic ◽

Lao People's Democratic Republic ◽

Breastfeeding Practices ◽

Urban Rural ◽

Rural Residences

Objectives: Breastfeeding rates are decreasing rapidly in many low and middle-income countries, disproportionately affecting urban residences. We use data from Lao People’s Democratic Republic to identify primary mechanisms underlying the urban-rural gap in breastfeeding practices.Methods: We used data from the 2017 Lao Social Indicator Survey II. Residence was categorized as large-urban (>1 million), small-urban (<1 Million), and rural. Multivariable logistic regression provided odds ratios and 95% confidence intervals (CI) to identify factors attributing to the urban-rural differences in complying with World Health Organization’s breastfeeding recommendations for children <24 months.Results: Mothers in large-urban residences had 3.78 (95% confidence intervals: 1.19, 11.95) and 4.67 (95% CI: 2.30, 9.46) higher odds of non-compliance with exclusive and complementary breastfeeding recommendations, respectively, than mothers living in rural areas in bivariate models. Breastfeeding differentials between small urban and rural residences were largely explained by differences in maternal education and household wealth.Conclusion: Results of our paper suggest large disparities in breastfeeding practices between large-urban, small-urban, and rural residences.

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The trend of full vaccination coverage in infants and inequalities by wealth quintile and maternal education: Analysis from four recent Demographic and Health Surveys in Nepal

10.21203/rs.2.13937/v3 ◽

2019 ◽

Author(s):

Kiran Acharya ◽

Yuba Raj Paudel ◽

Dinesh Dharel

Keyword(s):

Vaccination Coverage ◽

Maternal Education ◽

Immunization Coverage ◽

Wealth Quintile ◽

Educational Status ◽

Household Wealth ◽

Demographic And Health Surveys ◽

Relative Index ◽

Index Of Inequality ◽

Over Time

Abstract Background Despite policy intention to reach disadvantaged populations, inequalities in child health care use and health outcomes persist in Nepal. The current study aimed to investigate the trend of full vaccination coverage among infants and its equity gaps between Nepal Demographic and Health Surveys (NDHS) 2001 and 2016.Methods Using data from NDHS conducted in 2001, 2006, 2011 and 2016, we investigated the trend of coverage of six antigens:Bacille Calmette Guerin (BCG), Diptheria, Pertussis, Tetanus (DPT), Polio, and Measles during their infancy among children aged 12-23 months. We presented trends and correlates of vaccination coverage by different socio-demographic factors. We measured inequalities in full vaccination coverage by wealth quintile and maternal education using absolute measure (slope index of inequality) and relative measures (Relative index of inequality, concentration index) of inequalities.Results Full immunization coverage among infants steadily increased from 65.6% in 2001 to 87.0% in 2011; however, it decreased to 77.8% in 2016. Province 2 had a significantly lower full vaccination coverage compared to Province1.Although decreasing over time, there were significant inequalities by household wealth quintiles and maternal educational status. The slope index of inequality (SII) for wealth quintiles decreased from -32.3 [-45.5,-19.1] in 2001 to an SII of-8.4 [-18.6,-1.7] in 2016. Similarly, the SII for education decreased from -61.8 [-73.5,-50.1] in 2001 to an SII of -30.5 [-40.7,-20.2] in 2016. Similarly, the relative index of inequality (RII) also showed an improvement over time, indicating the narrowing equity gap. Additionally, concentration index on full immunization coverage by wealth quintiles dropped from 0.21 (0.12-0.28) in 2001 to 0.054 (-0.01-0.12) in 2016. Absolute and relative inequalities were persistently larger by maternal educational status compared to household wealth quintiles throughout the study period.Conclusion Full vaccination coverage in Nepal increased from 2001 until 2011 but saw a significant decrement away from the national target after 2011. However, the equity gap by household wealth quintile and maternal education status has narrowed over time. National Immunization programs need to give higher emphasis to infants born to mothers with less education, those born in the poorer wealth quintile households, and those living in Province 2.

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Efficacy of deep learning methods for predicting under-five mortality in 34 low-income and middle-income countries

BMJ Open ◽

10.1136/bmjopen-2019-034524 ◽

2020 ◽

Vol 10 (8) ◽

pp. e034524

Author(s):

Adeyinka Emmanuel Adegbosin ◽

Bela Stantic ◽

Jing Sun

Keyword(s):

Neural Network ◽

Deep Learning ◽

Low Income ◽

Maternal Education ◽

Household Wealth ◽

Secondary Outcome ◽

Cross Sectional ◽

Middle Income ◽

Under Five ◽

Middle Income Countries

ObjectivesTo explore the efficacy of machine learning (ML) techniques in predicting under-five mortality (U5M) in low-income and middle-income countries (LMICs) and to identify significant predictors of U5M.DesignThis is a cross-sectional, proof-of-concept study.Settings and participantsWe analysed data from the Demographic and Health Survey. The data were drawn from 34 LMICs, comprising a total of n=1 520 018 children drawn from 956 995 unique households.Primary and secondary outcome measuresThe primary outcome measure was U5M; secondary outcome was comparing the efficacy of deep learning algorithms: deep neural network (DNN); convolution neural network (CNN); hybrid CNN-DNN with logistic regression (LR) for the prediction of child’s survival.ResultsWe found that duration of breast feeding, number of antenatal visits, household wealth index, postnatal care and the level of maternal education are some of the most important predictors of U5M. We found that deep learning techniques are superior to LR for the classification of child survival: LR sensitivity=0.47, specificity=0.53; DNN sensitivity=0.69, specificity=0.83; CNN sensitivity=0.68, specificity=0.83; CNN-DNN sensitivity=0.71, specificity=0.83.ConclusionOur findings provide an understanding of determinants of U5M in LMICs. It also demonstrates that deep learning models are more efficacious than traditional analytical approach.

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Trends and determinants of undernutrition among young Kenyan children: Kenya Demographic and Health Survey; 1993, 1998, 2003 and 2008–2009

Public Health Nutrition ◽

10.1017/s1368980012002856 ◽

2012 ◽

Vol 15 (9) ◽

pp. 1715-1727 ◽

Cited By ~ 40

Author(s):

Peninah K Masibo ◽

Donald Makoka

Keyword(s):

Health Survey ◽

Urban Areas ◽

Child Nutrition ◽

Maternal Education ◽

Sampling Technique ◽

Household Wealth ◽

Demographic And Health Survey ◽

Demographic And Health Surveys ◽

Double Burden ◽

Percentage Points

AbstractObjectiveTo report on the trends and determinants of undernutrition among children <5 years old in Kenya.DesignData from four nationwide Kenya Demographic and Health Surveys, conducted in 1993, 1998, 2003 and 2008–2009, were analysed. The Demographic and Health Survey utilizes a multistage stratified sampling technique.SettingNationwide covering rural and urban areas in Kenya.SubjectsThe analysis included 4757, 4433, 4892 and 4958 Kenyan children aged <5 years in 1993, 1998, 2003 and 2009–2009, respectively.ResultsThe prevalence of stunting decreased by 4·6 percentage points from 39·9 % in 1993 to 35·3 % in 2008–2009, while underweight decreased by 2·7 percentage points from 18·7 % in 1993 to 16·0 % in 2008–2009. The effects of household wealth, maternal education and current maternal nutritional status on child nutrition outcomes have changed dynamically in more recent years in Kenya. Inadequate hygiene facilities increased the likelihood of chronic undernutrition in at least three of the surveys. Small size of the child at birth, childhood diarrhoea and male gender increased the likelihood of undernutrition in at least three of the surveys. Childhood undernutrition occurred concurrently with maternal overnutrition in some households.ConclusionsThe analysis reveals a slow decline of undernutrition among young children in Kenya over the last three decades. However, stunting and underweight still remain of public health significance. There is evidence of an emerging trend of a malnutrition double burden demonstrated by stunted and underweight children whose mothers are overweight.

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Early Life Child Micronutrient Status, Maternal Reasoning, and a Nurturing Household Environment have Persistent Influences on Child Cognitive Development at Age 5 years: Results from MAL-ED

Journal of Nutrition ◽

10.1093/jn/nxz055 ◽

2019 ◽

Vol 149 (8) ◽

pp. 1460-1469 ◽

Cited By ~ 2

Author(s):

Benjamin J J McCormick ◽

Stephanie A Richard ◽

Laura E Caulfield ◽

Laura L Pendergast ◽

Jessica C Seidman ◽

...

Keyword(s):

Cognitive Development ◽

Early Life ◽

Maternal Education ◽

Burden Of Illness ◽

Household Wealth ◽

Cognitive Reasoning ◽

Micronutrient Status ◽

Multivariable Models ◽

Diet Intake ◽

Child Cognitive Development

ABSTRACT Background Child cognitive development is influenced by early-life insults and protective factors. To what extent these factors have a long-term legacy on child development and hence fulfillment of cognitive potential is unknown. Objective The aim of this study was to examine the relation between early-life factors (birth to 2 y) and cognitive development at 5 y. Methods Observational follow-up visits were made of children at 5 y, previously enrolled in the community-based MAL-ED longitudinal cohort. The burden of enteropathogens, prevalence of illness, complementary diet intake, micronutrient status, and household and maternal factors from birth to 2 y were extensively measured and their relation with the Wechsler Preschool Primary Scales of Intelligence at 5 y was examined through use of linear regression. Results Cognitive T-scores from 813 of 1198 (68%) children were examined and 5 variables had significant associations in multivariable models: mean child plasma transferrin receptor concentration (β: −1.81, 95% CI: −2.75, −0.86), number of years of maternal education (β: 0.27, 95% CI: 0.08, 0.45), maternal cognitive reasoning score (β: 0.09, 95% CI: 0.03, 0.15), household assets score (β: 0.64, 95% CI: 0.24, 1.04), and HOME child cleanliness factor (β: 0.60, 95% CI: 0.05, 1.15). In multivariable models, the mean rate of enteropathogen detections, burden of illness, and complementary food intakes between birth and 2 y were not significantly related to 5-y cognition. Conclusions A nurturing home context in terms of a healthy/clean environment and household wealth, provision of adequate micronutrients, maternal education, and cognitive reasoning have a strong and persistent influence on child cognitive development. Efforts addressing aspects of poverty around micronutrient status, nurturing caregiving, and enabling home environments are likely to have lasting positive impacts on child cognitive development.

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THE ENIGMA OF ETHIOPIAN SEX RATIOS AT BIRTH

Journal of Biosocial Science ◽

10.1017/s0021932016000407 ◽

2016 ◽

Vol 49 (5) ◽

pp. 611-622

Author(s):

Michel Garenne

Keyword(s):

Sex Ratio ◽

Urban Areas ◽

Maternal Education ◽

Sex Ratios ◽

Household Wealth ◽

Poor Nutritional Status ◽

Linguistic Groups ◽

Children Ever Born ◽

Using Data ◽

The Many

SummaryThis study analysed sex ratios at birth (defined as the number of male births per 100 female births) using data on children ever-born from three censuses conducted in Ethiopia in 1984, 1994 and 2007. The results showed very high values by any standard, with an average of 108.4 for a sample of some 8.2 million births, with somewhat lower values in urban areas. Analysis of socioeconomic correlates revealed that the sex ratio varied very much by household wealth, from about 110 for very poor women to about 102 for wealthier women. The high value of the sex ratio at birth in Ethiopia could be explained by poverty, used as a proxy for poor nutritional status. In multivariate analysis, the effects of living in urban areas and of maternal education were less important than household wealth. Among the many ethno-linguistic groups, the Nilotic family had higher sex ratios than other groups. The results were confirmed using data from DHS surveys conducted in the country, and by the analysis of children still living at time of census.

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Using National Survey Data From Nigeria to Assess Maternal-Child Dietary Concordance and Inform Nutrition Program Strategy

Current Developments in Nutrition ◽

10.1093/cdn/nzab038_001 ◽

2021 ◽

Vol 5 (Supplement_2) ◽

pp. 389-389

Author(s):

Nadia Akseer ◽

Rebecca A Heidkamp ◽

Andrew Thorne-Lyman

Keyword(s):

Maternal Education ◽

Fruits And Vegetables ◽

Dietary Diversity ◽

Maternal Diet ◽

Food Group ◽

Household Wealth ◽

Demographic And Health Surveys ◽

Food Groups ◽

Diet Diversity ◽

Maternal Child

Abstract Objectives Improving child diet diversity is a policy priority in many settings. Multiple factors influence complementary feeding practices in low-income countries including household food access, caregiver-level factors and cultural practices. Child's dietary data is often available in national surveys (i.e., Demographic and Health Surveys, DHS), but they typically lack diet data from adults. The 2018 Nigeria DHS was among the first to measure food group intake in both young children and women. We describe the relationship between child and maternal diet diversity in Nigeria and highlight implications for design of infant and young child feeding (IYCF) programs. Methods Using the Nigeria DHS 2018 dataset, we estimated consumption of individual food groups in the previous 24 hours as well as minimum dietary diversity for children 6–23 months (MDD-C) and their mothers, women 15–49 years (MDD-W) using WHO-UNICEF definitions. We compare rates of concordance and discordance between n = 8975 mother-child pairs for individual food groups and MDD using McNemar's tests. Probit regression was used to identify drivers of MDD-C. Results Nationally, 22% of children achieve MDD-C; 51% of mothers achieve MDD-W. For both populations, the most commonly consumed group is grains, roots and tubers (>80%) Dairy and eggs are the least consumed. Maternal-child (age 12–23 months) discordance is highest for consumption of legumes and nuts (36%), vitamin A rich fruits and vegetables (39%) and other fruits and vegetables (57%); mothers consume these more frequently. Children are more likely than mothers to consume dairy (19% vs 8%) and eggs (8% vs 4%). Maternal-child food group discordance is consistently higher for children 6–11months than children 12–23 months. Results vary at state level and by maternal age group. Children's MDD probability is increased by MDD-W (27%, P < 0.001), higher maternal education (8%, P < 0.01) and household wealth (7%, P < 0.01). Conclusions Maternal and child diet diversity is suboptimal in Nigeria. Maternal diet is a primary driver of child diet in Nigeria. Legumes and nuts and fruits and vegetables are available but not consistently fed to children; an important finding for IYCF program design. The forthcoming DHS-8 core questionnaire will provide child and maternal diet data for more than 90 countries. Funding Sources Bill & Melinda Gates Foundation.

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Associated Factors of Caesarean Section in Ethiopia Using 2016 Demographic Health Survey Data; Community Based Cross Sectional Study

10.21203/rs.2.13771/v1 ◽

2019 ◽

Author(s):

Abebaw Gedef Azene ◽

Abiba Mihret Aragaw ◽

Mihretie Gedefaw

Keyword(s):

Caesarean Section ◽

Associated Factors ◽

Maternal Education ◽

Multiple Pregnancy ◽

Wealth Index ◽

Household Wealth ◽

Cross Sectional Study ◽

Community Based ◽

Cross Sectional ◽

Health Survey Data

Abstract Objective:The rate of caesarean section is increasing in Ethiopia, recently. Identifying associated demographic health factors was the aim of this study.Results:More educated mothers were more delivering by C-section compared with those illiterate. Those mother having higher body mass index were more likely to deliver with caesarean section (p = 0.0001). C-section was increased when mothers go to elder (p = 0.0001). Maternal education, birth order, preceding birth interval, multiple pregnancy, maternal age and interaction effect BMI with household wealth index statistically significantly associated factors to increase the rate of C-section. Residence and region were community level factors to increase caesarean section.Therefore; community awareness creation towards C-section with its side effect is essential in Ethiopia.

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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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