Background predictors of time to death in infancy: evidence from a survival analysis of the 2018 Nigeria DHS data

Background Nigeria’s child health profile is quite concerning with an infant mortality rate of 67 deaths per 1000 live births and a significant slowing down in progress towards improving child health outcomes. Nigeria’s 2018 Demographic and Health Survey (DHS) suggests several bio-demographic risk factors for child death, including mother’s poor education, poverty, sex of child, age of mother, and location (rural vs urban) but studies are yet to explore the predictive power of these variables on infant survival in Nigeria. Methods The study extracted data for all births in the last 12 months preceding the 2018 Nigeria DHS and used the Cox proportional hazard model to predict infant survival in Nigeria. Failure in this analysis is death with two possible outcomes – dead/alive – while the survival time variable is age at death. We censored infants who were alive at the time of the study on the day of the interview. Covariates in the analysis were: age of mother, education of mother, wealth quintile, sex of child, location, region, place of delivery, and age of pregnancy. Results The study found that a higher education of a mother compared to no education (β = .429; p-value < 0.05); belonging to a household in the richer wealth quintile (β = .618; p-value < 0.05) or the highest quintile (β = .553; p-value < 0.05), compared to the lowest wealth quintile; and living in North West (β = 1.418; p-value < 0.05) or South East zone (β = 1.711; p-value < 0.05), significantly predict infant survival. Conclusion Addressing Nigeria’s infant survival problem requires interventions that give attention to the key drivers – education, socio-economic status, and socio-cultural contextual issues. We therefore recommend full implementation of the universal basic education policy, and child health education programs targeted at mothers as long- and short-term solutions to the problem of poor child health outcomes in Nigeria. We also argue in favor of better use of evidence in policy and program development in Nigeria.

The Metempiricism of Margins: Professor Anthony Aṣiwaju and the Circumference of Knowledge

Professor Anthony Aṣiwaju has written his memoir, Bridging Boundaries, to commemorate his 80th birthday, thus giving us a treasure to behold, a legacy to cherish, and a history to keep. This is about his past, from humble beginnings to a remarkable career; about the educational system of Nigeria, in particular, the discipline of History; and about the crucial interconnectivity between ideas and practical policies. There is so much to be learned from this book—history, memory, wisdom—all the chemistry of ideas to navigate complicated journeys. Let me begin this journey from Paris, and not from Imeko, the starting point in this engaging frontier of scholarship. It was in the elegant living room of Professor Ọlábìyí Yai, the then Ambassador of the Republic of Benin to UNESCO. As we enjoyed a peaceful pre- àmàlà drinking moment, we launched into a conversation that invoked Professor Aṣiwaju’s name and experience. His Excellency, Ambassador Yai, made the remark that the Yoruba had always been diasporic, moving like a river, connecting multiple points, passing through valleys and plateaus, between mountains, across vegetation. This conversation came back to me as I composed this short piece. My mind also went back to the frontier towns of Imeko and Ifonyin, to the journeys I took from Igboho to Cotonou via the scenic route far away from the chaotic Lagos-Badagry road. Onwards to the Ewe, thereafter passing through the domains of the Akan, and at one time ending in Abidjan, all on roads—no bounds in space; no mental bounding lines; and seamless frontiers, one merging with the other, as the next unfolds. Professor Aṣiwaju does these diasporic 244 Profile trips as well—barefoot, bicycles, cars, and on airplanes—and, maybe, also in dreams. He sees the boundaries, then dissolves them, recreating them in a new world order, a world without boundaries. I think Professor Aṣiwaju’s life breaks the rules, creating a frame much larger than his beginnings. Contrary to the man-confining adage of “cut your coat according to your cloth/size,” the autobiography of Professor Aṣiwaju has exemplified that the Supreme God cuts and designs coat without the delimitations or regard of one’s size or cloth. If not, it would not have been possible for a child born without any medical attention and care on bare ground to rise into a nationally and internationally celebrated icon. Incontrovertibly, his destiny was predestined even before birth, what the Yoruba call àyànmọ, ́ although the Odù Ifá code was never revealed to him. Thus, God designed the coat of his excellence above the odds of a humble and subaltern beginning of a poor child, now the prosperous Baba at 80. How time flies! Generous in his account, expansive in his details and meticulous in remembrance, the scope of his life is exposed to us in its minor canvas and major perimeter. Bridging Boundaries is a chronological account of the author’s life from birth to date on the one hand, as well as the history of borderland studies in Nigeria and Africa, which is inseparable from his autobiography. The life of the author, Aṣiwaju, becomes the account of the aṣíwájú of the borderlands, the leader of the bold and courageous to discover the confines of space, like Ogún, the Yoruba god of iron, who forges new paths and abodes from the forest to the savanna for people to occupy. Strikingly, the inseparability of the man’s life from his career path appears to be synonymous with the bond between a snail and its shell: his origin and horizon live within the same shell. No doubt, his origin became the bedrock of his successful career. A scholar from cross-border parents with an upbringing in a borderland who specializes in borderland studies, which was initially focused on the Nigeria/Benin limitrophe states, then blossomed continentally and intercontinentally. Evident in his story is that a poor background neither limits nor determines the factor for the level of success one can attain; rather, it is a starting point, a background to project possibilities of whatever one can become unto, a launching pad into life’s enduring legacy.

Maternal Exposure to Intimate Partner Violence and Child Immunisation: Insights from a Population-based Study in India

Child immunisation is regarded as one of the most essential public health interventions for reducing morbidity and mortality among children. Despite several public healthcare initiatives, a considerable proportion of children are yet to be covered under vaccination service in India. This study attempts to examine the association between maternal exposure to intimate partner violence (IPV) and childhood immunisation in India. Data were drawn from the fourth round of the National Family Health Survey (NFHS-4), conducted in 2015–16. Bivariate and multivariate logistic regression models were employed to assess the associations. About 65% of sample children aged 11–23 months were fully vaccinated. After adjusting for socio-demographic factors, women’s exposure to emotional IPV was significantly associated with a lower likelihood of full immunisation (adjusted odds ratio [AOR]: 0.74, 95% confidence interval [CI]: 0.61–0.90) among children. However, physical and sexual IPV had no significant association with childhood immunisation status in the adjusted analysis. The findings suggest preventive measures against domestic violence to reduce the risk of poor child healthcare services. Furthermore, efforts should be taken for effective reproductive and child healthcare programmes, especially among socio-economically vulnerable women and children, to improve child vaccination coverage.

The relative importance of households as a source of variation in child malnutrition: a multilevel analysis in India

Background Child malnutrition remains a major public health issue in India. Along with myriad upstream and social determinants of these adverse outcomes, recent studies have highlighted regional differences in mean child malnutrition rates. This research helps policy makers look between urban and rural communities and states to take a population-level approach to addressing the root causes of child malnutrition. However, one gap in this between-population approach has been the omission of households as a unit of analysis. Households could represent important sources of variation in child malnutrition within communities, districts, and states. Methods Using the fourth round of India’s National Family Health Survey from 2015 to 2016, we analyzed four and five-level multilevel models to estimate the proportion of variation in child malnutrition attributable to states, districts, communities, households, and children. Results Overall, we found that of the four levels that children were nested in (households, communities, districts, and states), the greatest proportion of variation in child height-for-age Z score, weight-for-age Z score, weight-for-height Z score, hemoglobin, birthweight, stunting, underweight, wasting, anemia, and low birthweight was attributable to households. Furthermore, we found that when the household level is omitted from models, the variance estimates for communities and children are overestimated. Conclusions These findings highlight the importance of households as an important source of clustering and variation in child malnutrition outcomes. As such, policies and interventions should address household-level social determinants, such as asset and social deprivations, in order to prevent poor child growth outcomes among the most vulnerable households in India.

Association between Adverse Childhood Experiences and Time Spent Playing Video Games in Adolescents: Results from A-CHILD Study

Background: Excessive time spent playing video games is associated with adverse health outcomes in adolescents. Although poor child–parent relationship and social relations with peers are considered as possible predictors, little is known as to whether adverse childhood experiences (ACEs) are associated with time spent playing video games. The aim is to examine the association between ACEs and time spent playing video games in adolescents. Methods: We used pooled data from the Adachi Child Health Impact of Living Difficulty (A-CHILD) study in 2016 and 2018, which is a population-based cross-sectional study in Adachi City, Tokyo, Japan (N = 6799, 4th, 6th, and 8th-grade students). Adolescents answered questionnaires examining the time spent playing video games, per day, on weekdays (“less than 1 h”, “less than 3 h”, and “more than 3 h”) and ACEs (eight types). Results: The results of the ordinal logistic regression analysis showed a positive association between ACE total score and time spent playing video games after adjusting for covariates (1 ACE: OR = 1.28, 95% CI = 1.10–1.48; 2 ACEs: OR = 1.25, 95% CI = 1.06–1.48; 3 + ACEs: OR = 1.44, 95% CI = 1.14–1.82, p for trend < 0.001). Regarding each type of ACE, the experiences of single parenthood, parental history of psychiatric disorders, and peer isolation were independently positively associated with time spent playing video games. Conclusions: Health policy to address ACEs might be important to shorten the time spent playing video games.

P024 Children’s sleep and fathers’ health and wellbeing: a systematic review

Introduction Night-waking is typical across infancy and early childhood. Although mothers are traditionally primary carers for children overnight, child sleep may impact others in the household, such as co-dwelling fathers. Despite expectations of more ‘hands on’ fathering, the relationship between children’s sleep and fathers’ health and wellbeing has not been previously synthesised. Methods This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement and registered with the Prospective Register of Systematic Reviews (PROSPERO). Focusing on fathers, this review synthesised evidence pertaining to effects of children’s sleep (from birth to 12 years) on fathers’ health and wellbeing. Results From 4,421 records, 29 studies met inclusion criteria. Findings showed: (1) child sleep was associated with father’s sleep when child sleep was measured through father-report or objective measurement; (2) poorer child sleep was associated with poorer general health and wellbeing among fathers, however, associations of poor child sleep with depression were fewer; and (3) poor child sleep was negatively associated with quality of within-couple and parent-child relationships. Discussion Results suggested two principal issues: (1) Systematic variation in measures and findings underscores importance of objective measurement. Yoked actigraphy techniques are vital for understanding inter-relationships of family sleep and attendant outcomes. (2) Different patterns of child sleep and parent outcomes suggest direct and indirect pathways of effect. Understanding patterns of overnight caregiving, and factors underpinning parent decisions, are important for understanding mechanisms linking child sleep to fathers’ outcomes and for designing effective interventions to support parents.

INNOCENCE AT THREAT: A STUDY OF CHILD LABOUR IN INDIA

In this article I have found out that, how a child labour is the exclusionary form of social practice in our society, for which the child is too young to deal with such exploitation intelligently. I revealed how their innocence is in threat with the presence of various forms exploitation or human rights violation due to child labour.Besides this I also revealed about the presence of lack of awareness in the society about the child rights which allows them to employ the poor child as they find them as cheap labourand hence they can be paid half of what an adult worker would need to be paid.

The direct and indirect effects of parental trauma on child adjustment for resettled refugees in Australia

Purpose Understanding the effects trauma has on refugee parents and consequently, their children, is the first step in interrupting the intergenerational transmission of trauma. This study aims to investigate the impacts of parental exposure to trauma pre-settlement on parent and child reports of developmental difficulties as mediated by parental post-traumatic stress symptomology and harsh parenting. Design/methodology/approach The study included 414 refugee children (age M = 14.04, SD = 2.00; 48.3% female) and their caregivers (age M = 41.78, SD = 5.24, 77% female). The sample was drawn from the Building a New Life in Australia study, a large, representative cohort study of resettled refugees in Australia. Only data collected where both parents and their children could be matched were used in this study. Findings Results indicated that trauma was significantly associated with increased parental post-traumatic stress disorder (PTSD) symptoms in all models and was negatively, albeit weakly, associated with lower levels of harsh parenting in the overall model which combined parent and child reports. Trauma also had a weak, positive indirect effect on developmental difficulties via parental PTSD in both the overall model and the model assessing parent-rated developmental difficulties. In all models, harsh parenting was associated with increased developmental difficulties, although harsh parenting did not act as a significant mediator of the effects of trauma or parental PTSD. Originality/value Results suggest that prior traumas had less of an adverse effect on parenting and child adjustment as was expected. Parenting, however, was strongly associated with poor child adjustment, indicating that this may be a key factor to encourage positive adjustment for refugee children.

Effect of health systems context on infant and child mortality in sub-Saharan Africa from 1995 to 2015, a longitudinal cohort analysis

Each year, > 3 million children die in sub-Saharan Africa before their fifth birthday. Most deaths are preventable or avoidable through interventions delivered in the primary healthcare system. However, evidence regarding the impact of health system characteristics on child survival is sparse. We assembled a retrospective cohort of > 250,000 children in seven countries in sub-Saharan Africa. We described their health service context at the subnational level using standardized surveys and employed parametric survival models to estimate the effect of three major domains of health services—quality, access, and cost—on infant and child survival, after adjusting for child, maternal, and household characteristics. Between 1995 and 2015 we observed 13,629 deaths in infants and 5149 in children. In fully-adjusted models, the largest effect sizes were related to fees for services. Immunization fees were correlated with poor child survival (HR = 1.20, 95% CI 1.12–1.28) while delivery fees were correlated with poor infant survival (HR = 1.11, 95% CI 1.01–1.21). Accessibility of facilities and greater concentrations of private facilities were associated with improved infant and child survival. The proportion of facilities with a doctor was correlated with increased risk of death in children and infants. We quantify the impact of health service environment on survival up to five years of age. Reducing health care costs and improving the accessibility of health facilities should remain a priority for improving infant and child survival. In the absence of these fundamental investments, more specialized interventions may not achieve their desired impact.

Child Development in a Region of Madagascar With High Child Undernutrition

Objectives The Vakinankaratra region of Madagascar has a high burden of child undernutrition, a strong risk factor for poor child development. The purpose of this preliminary study was to assess the household stimulation environment and to evaluate the development of 11 to 13 month-old toddlers from this agriculturally-productive area with some of the highest young-child stunting rates in the world. Methods Stunting (length-for-age z-score &lt; -2) and underweight (weight-for-age z-score &lt; -2) were determined using the 2006 WHO growth standards. Household stimulation environment was evaluated using the Family Care Indicators scales. The Bayley Scales of Infant and Toddler Development III were used to directly evaluate development of 36 toddlers (mean age 11.9 mo). Age-appropriate, increasingly difficult tasks are provided by the Bayley Scales to assess cognition, language, and motor skills. Socioemotional development also was evaluated using a questionnaire individually administered to the primary caregivers of 76 toddlers (mean age 11.7 mo). Results More than two-thirds (69%) of young children in the sample were stunted and 11% were underweight. Most mothers used household objects (75%) and materials from outside the house (71%) as children's toys such as makeshift balls made of plastic wraps. Common adult-infant interactions were talking and playing. In most households, adults told stories or read a book to children only once a week at most. However, these interactions were limited by other responsibilities of the parents. Scoring of the Bayley scales is adjusted to provide composite scores with a mean of 100 for each domain for each age group. Below average scores were determined in our sample as follows: cognitive [mean (SD): 60 (10.3)], motor [61.9 (13.4)], language [62 (13.2)], and socioemotional [85.1 (17.9]). Although in this small sample there were no statistical differences based on nutritional status, development scores for fine motor, cognitive, and receptive and expressive language were correlated [0.4 &lt; r &lt; 0.7, p &lt; 0.05]. Conclusions The very high stunting rates and very low cognitive, motor, language, and socioemotional scores of young children in the Vakinankaratra region require urgent attention. Funding Sources This study was funded by the Marilynn Thoma Chair in Human Sciences at Oklahoma State University.