247 research outputs found
Maternal and Child Health and Nutrition in Afghanistan
No full textAfghanistan is an impoverished conflict-prone nation with some of the worst documented maternal and child health and survival indicators worldwide. Entering a period of relative stability after the 2001 US-led upheaval of Taliban governance, Afghanistan had, for the first time in decades, an opportunity for redevelopment and growth. Government, along with development partners, funders, civil society, NGOs and the global community, came together to rapidly expand basic infrastructure, strengthen the health care system, and to scale-up health services throughout the overwhelmingly rural population. This dissertation’s aim was to systematically document progress and determinants of maternal and child health intervention utilization and nutrition during the 2001 to 2014 time period, and to identify remaining geographical and socioeconomic inequalities. First, I examine determinants of improvements in two critical markers of maternal and newborn health and survival (skilled birth attendance and institutional deliveries) from 2003 to 2011 using nationally-representative survey data. Next, a thorough assessment of the socioeconomic and regional inequalities in essential reproductive, maternal, newborn and child health (RMNCH) interventions in Afghanistan is presented. Finally, I conduct modeling exercises of the basic, underlying and immediate determinants of undernutrition among children (Ph.D
Maternal and Child Health and Nutrition in Afghanistan
No full textAfghanistan is an impoverished conflict-prone nation with some of the worst documented maternal and child health and survival indicators worldwide. Entering a period of relative stability after the 2001 US-led upheaval of Taliban governance, Afghanistan had, for the first time in decades, an opportunity for redevelopment and growth. Government, along with development partners, funders, civil society, NGOs and the global community, came together to rapidly expand basic infrastructure, strengthen the health care system, and to scale-up health services throughout the overwhelmingly rural population. This dissertation’s aim was to systematically document progress and determinants of maternal and child health intervention utilization and nutrition during the 2001 to 2014 time period, and to identify remaining geographical and socioeconomic inequalities. First, I examine determinants of improvements in two critical markers of maternal and newborn health and survival (skilled birth attendance and institutional deliveries) from 2003 to 2011 using nationally-representative survey data. Next, a thorough assessment of the socioeconomic and regional inequalities in essential reproductive, maternal, newborn and child health (RMNCH) interventions in Afghanistan is presented. Finally, I conduct modeling exercises of the basic, underlying and immediate determinants of undernutrition among children (Ph.D
Examining the potential application of childhood stature in assessing adolescent overweight and obesity
No full textBackground: Increasing Overweight and Obesity (OwOb) prevalence in
pediatric populations is becoming a public health concern in many countries. The
purpose of this study was to determine if childhood stature components,
particularly the Leg Length Index (LLI = [height - sitting height]! height), were
useful in assessing risk of OwOb in adolescence.
Methods: Data was from a longitudinal study conducted in south Ontario since
2004. Approximately 2360 students had body composition measurements
including sitting height and standing height at baseline. Among them, 1167
children (573 girls, 594 boys) who had weight and height measured at the 5
th
year follow-up, were included in this analysis. OwOb was defined using age and
sex specific BMI (kg!m
2
) cut-off points corresponding to adults' BMI ~ 25.
Results: Overall, 34% (n=298) of adolescents were considered as OwOb. The
results from logistic regression analysis indicated that with 1 unit increase in LLI
the odds of OwOb decreased 24% (Odds Ratio, [95% Confidence Interval], 0.76,
[0.66-0.87]) after adjusted for age, sex and baseline waist circumference. Further
adjusting for birth weight, birth order, breastfeeding, child's physical activity,
maternal smoking, education, mother's age at birth and mother's BMI, did not
change the relationship. Our results also indicated that mother's smoking status
is associated with LLI.
Discussion: Although LLI measured at childhood in this study is related to
OwOb risk in adolescents, the underlying mechanism is unclear and further study
is needed
Stunting in childhood: An overview of global burden, trends, determinants, and drivers of decline
No full textBackground: Progress has been made worldwide in reducing chronic undernutrition and rates of linear growth stunting in children under 5 y of age, although rates still remain high in many regions. Policies, programs, and interventions supporting maternal and child health and nutrition have the potential to improve child growth and development.Objective: This article synthesizes the available global evidence on the drivers of national declines in stunting prevalence and compares the relative effect of major drivers of stunting decline between countries.Methods: We conducted a systematic review of published peer-reviewed and gray literature analyzing the relation between changes in key determinants of child linear growth and contemporaneous changes in linear growth outcomes over time.Results: Among the basic determinants of stunting assessed within regression-decomposition analyses, improvement in asset index score was a consistent and strong driver of improved linear growth outcomes. Increased parental education was also a strong predictor of improved child growth. Of the underlying determinants of stunting, reduced rates of open defecation, improved sanitation infrastructure, and improved access to key maternal health services, including optimal antenatal care and delivery in a health facility or with a skilled birth attendant, all accounted for substantially improved child growth, although the magnitude of variation explained by each differed substantially between countries. At the immediate level, changes in several maternal characteristics predicted modest stunting reductions, including parity, interpregnancy interval, and maternal height.Conclusions: Unique sets of stunting determinants predicted stunting reduction within countries that have reduced stunting. Several common drivers emerge at the basic, underlying, and immediate levels, including improvements in maternal and paternal education, household socioeconomic status, sanitation conditions, maternal health services access, and family planning. Further data collection and in-depth mixed-methods research are required to strengthen recommendations for those countries where the stunting burden remains unacceptably high
Risk stratification of immunocompromised children, including pediatric transplant recipients at risk of severe respiratory syncytial virus disease
No full textRespiratory syncytial virus (RSV) infection is associated with increased morbidity and mortality in immunocompromised patients. Our goal was to develop a framework for risk stratifying immunocompromised patients, including transplant patients, for RSV prophylaxis.
Risk factors for severe RSV disease in immunocompromised patients were identified in the literature and by an expert panel via survey. Experts assigned a probability of developing severe disease (0 to 100 scale) to the risk factors for each immunocompromised population. The results were validated using a clinical dataset. Linear mixed models adjusted for within-expert clustering of ranks were used to estimate average scores, and differences were tested using paired t tests. Logistic regression was utilized to identify important determinants of severe RSV disease.
The survey was emailed to twenty-seven experts and thirteen responded (48%). Across all transplant groups, age <2 years (mean 77.1, 95% CI 71.7, 82.5) and day care attendance (mean 72.8, 95% CI 67.3, 78.3) were assigned the highest risk of severe disease. The highest risk groups were lung transplant recipients (mean 73.2, 95% CI 67.6, 78.8), combined lung and heart transplant recipients (mean 75.2, 95% CI 69.6, 80.7), allogeneic stem cell transplant (mean 76.0, 95% CI 70.4, 81.6), and severe combined immunodeficiency (mean 74.7, 95% CI 69.1, 80.3).
The results provide a logical validity to current practice and provide guidance for prioritizing patients to receive prophylactic agents to prevent severe RSV disease. The results will facilitate the development of a risk stratification tool for RSV prophylaxis for immunocompromised patients
COVID-19 pandemic and mitigation strategies: Implications for maternal and child health and nutrition
No full textCoronavirus disease 2019 (COVID-19) continues to ravage health and economic metrics globally, including progress in maternal and child nutrition. Although there has been focus on rising rates of childhood wasting in the short term, maternal and child undernutrition rates are also likely to increase as a consequence of COVID-19 and its impacts on poverty, coverage of essential interventions, and access to appropriate nutritious foods. Key sectors at particular risk of collapse or reduced efficiency in the wake of COVID-19 include food systems, incomes, and social protection, health care services for women and children, and services and access to clean water and sanitation. This review highlights key areas of concern for maternal and child nutrition during and in the aftermath of COVID-19 while providing strategic guidance for countries in their efforts to reduce maternal and child undernutrition. Rooted in learnings from the exemplars in Global Health\u27s Stunting Reduction Exemplars project, we provide a set of recommendations that span investments in sectors that have sustained direct and indirect impact on nutrition. These include interventions to strengthen the food-supply chain and reducing food insecurity to assist those at immediate risk of food shortages. Other strategies could include targeted social safety net programs, payment deferrals, or tax breaks as well as suitable cash-support programs for the most vulnerable. Targeting the most marginalized households in rural populations and urban slums could be achieved through deploying community health workers and supporting women and community members. Community-led sanitation programs could be key to ensuring healthy household environments and reducing undernutrition. Additionally, several COVID-19 response measures such as contact tracing and self-isolation could also be exploited for nutrition protection. Global health and improvements in undernutrition will require governments, donors, and development partners to restrategize and reprioritize investments for the COVID-19 era, and will necessitate data-driven decision making, political will and commitment, and international unity
Protocol: Dietary Intake and Nutritional Status of School-Aged Children in Sindh and Punjab, Pakistan
No full textCOVID-19 pandemic and mitigation strategies: implications for maternal and child health and nutrition
No full textConcordance and determinants of mothers’ and children’s diets in Nigeria: an in-depth study of the 2018 Demographic and Health Survey
No full textObjectives Improving the diversity of the diets in young children 6–23 months is a policy priority in Nigeria and globally. Studying the relationship between maternal and child food group intake can provide valuable insights for stakeholders designing nutrition programmes in low-income and middle-income countries.Design We examined the relationship between maternal and child dietary diversity among 8975 mother–child pairs using the Nigeria 2018 Demographic and Health Survey (DHS). We assessed concordance and discordance between maternal and child food group intake using the McNemar’s χ2 test, and the determinants of child minimum dietary diversity (MDD-C) including women MDD (MDD-W) using hierarchical multivariable probit regression modelling.Setting Nigeria.Participants 8975 mother–child pairs from the Nigeria DHS.Primary and secondary outcome measures MDD-C, MDD-W, concordance and discordance in the food groups consumed by mothers and their children.Results MDD increased with age for both children and mothers. Grains, roots and tubers had high concordance in mother–child dyads (90%); discordance was highest for legumes and nuts (36%), flesh foods (26%), and fruits and vegetables (39% for vitamin-A rich and 57% for other). Consumption of animal source food (dairy, flesh foods, eggs) was higher for dyads with older mothers, educated mothers and more wealthy mothers. Maternal MDD-W was the strongest predictor of MDD-C in multivariable analyses (coef 0.27; 95% CI 0.25 to 0.29, p<0.000); socioeconomic indicators including wealth (p<0.000), mother’s education (p<0.000) were also statistically significant in multivariable analyses and rural residence (p<0.000) was statistically significant in bivariate analysis.Conclusion Programming to address child nutrition should be aimed at the mother–child dyad as their food consumption patterns are related and some food groups appear to be withheld from children. Stakeholders including governments, development partners, non-governmental organizations, donors and civil society can act on these findings in their efforts to address undernutrition in the global child population
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