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Adebusoye FT, Tan JK, Awuah WA, Bharadwaj HR, Naeem W, Ferreira T, Roy S, Abdul-Rahman T, Lychko V. From adversity to advancement: leveraging war-tested approaches for the post-conflict reformation of the Ukrainian healthcare landscape. Postgrad Med J 2023; 99:1217-1219. [PMID: 37664899 DOI: 10.1093/postmj/qgad075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 07/30/2023] [Accepted: 08/03/2023] [Indexed: 09/05/2023]
Abstract
The Russo-Ukrainian Conflict has had significant repercussions on Ukraine's healthcare system, resulting in civilian casualties and damage to healthcare institutions. The disruption of personnel, medical supplies, and patient transportation has created considerable challenges for healthcare services. However, there are successful approaches from comparable contexts that can serve as a catalyst for post-conflict healthcare reformation in Ukraine. Key strategies include improving healthcare accessibility for marginalized populations through standardized essential health and surgical care packages, rehabilitating damaged facilities, strengthening primary care provisions, and supporting war survivors with disabilities. By adopting these proven practices, Ukraine can strengthen its healthcare system and facilitate a sustainable recovery, contributing to the country's resilience and ensuring essential healthcare services for its population.
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Affiliation(s)
| | - Joecelyn Kirani Tan
- School of Medicine, University of St Andrews, North Haugh, St Andrews KY16 9TF, Scotland, United Kingdom
| | - Wireko Andrew Awuah
- Faculty of Medicine, Sumy State University, Sanatoria Street, Sumy 40000, Ukraine
| | - Hareesha Rishab Bharadwaj
- Faculty of Biology, Medicine and Health, The University of Manchester, 46 Grafton Street, Manchester M13 9NT, United Kingdom
| | - Wara Naeem
- King Edward Medical University, Nelagumbad, Anarkali, Lahore 54000, Pakistan
| | - Tomas Ferreira
- School of Clinical Medicine, University of Cambridge, Robinson Way, Cambridge CB2 0PY, United Kingdom
| | - Sakshi Roy
- School of Medicine, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, United Kingdom
| | - Toufik Abdul-Rahman
- Faculty of Medicine, Sumy State University, Sanatoria Street, Sumy 40000, Ukraine
| | - Volodymyr Lychko
- Faculty of Medicine, Sumy State University, Sanatoria Street, Sumy 40000, Ukraine
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Makinde OA, Olamijuwon E, Mgbachi I, Sato R. Childhood exposure to armed conflict and nutritional health outcomes in Nigeria. Confl Health 2023; 17:15. [PMID: 36978100 PMCID: PMC10053485 DOI: 10.1186/s13031-023-00513-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 03/19/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Armed conflicts are associated with an increased risk of food insecurity, the leading cause of malnutrition in low-and-middle-income countries. Multiple studies have uncovered significant influences of childhood malnutrition on children's overall health and development. As a result, it is increasingly important to understand how childhood experience of armed conflict intersects with childhood malnutrition in conflict-prone countries like Nigeria. This study examined the association between different measures of childhood experiences of armed conflicts and the nutritional health outcomes of children aged 36-59 months. METHODS We used data from the Nigeria Demographic and Health Survey linked with Uppsala Conflict Data Program Geo-Referenced Events Dataset using geographic identifiers. Multilevel regression models were fitted on a sample of 4226 children aged 36-59 months. RESULTS The prevalence of stunting, underweight and wasting was 35%, 20% and 3%, respectively. Armed conflicts were mostly recorded in the North-eastern states of Borno (222 episodes) and Adamawa (24 episodes). Exposure to armed conflicts ranged from 0 (no experience of armed conflict) to 3.75 conflicts per month since the child's birth. An increase in the frequency of armed conflicts is associated with increased odds of childhood stunting [AOR = 2.52, 95%CI: 1.96-3.25] and underweight [AOR = 2.33, 95%CI: 1.19-4.59] but not wasting. The intensity of armed conflict was only marginally associated with stunting and underweight but not wasting. Longer conflicts that occurred in the last year were also associated with the odds of stunting [AOR = 1.25, 95%CI: 1.17-1.33] and underweight [AOR = 1.19, 95%CI: 1.11-1.26] but not wasting. CONCLUSION Childhood exposure to armed conflict is associated with long-term malnutrition in children aged 36-59 months in Nigeria. Strategies that aim to end childhood malnutrition could target children exposed to armed conflicts.
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Affiliation(s)
- Olusesan Ayodeji Makinde
- Viable Knowledge Masters, Plot C114, First Avenue, Gwarimpa, Abuja, Federal Capital Territory, Nigeria
- Viable Helpers Development Organization, Abuja, Federal Capital Territory, Nigeria
| | - Emmanuel Olamijuwon
- School of Geography and Sustainable Development, University of St Andrews, St Andrews, KY16 9AL, UK.
| | - Ifeanyi Mgbachi
- Viable Helpers Development Organization, Abuja, Federal Capital Territory, Nigeria
| | - Ryoko Sato
- Harvard University, 677 Huntington Ave, Boston, MA, 02115, USA
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Nicholas K, Campbell L, Paul E, Skeltis G, Wang W, Gray C. Climate anomalies and childhood growth in Peru. POPULATION AND ENVIRONMENT 2021; 43:39-60. [PMID: 34456407 PMCID: PMC8389738 DOI: 10.1007/s11111-021-00376-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/08/2021] [Indexed: 06/06/2023]
Abstract
Climate change has been linked to poor childhood growth and development through maternal stress, nutritional insults related to lean harvests, and exposure to infectious diseases. Vulnerable populations are often most susceptible to these stressors. This study tested whether susceptibility to linear growth faltering is higher among Peruvian children from indigenous, rural, low-education, and low-income households. High-resolution weather and household survey data from Demographic and Health Survey 1996-2012 were used to explore height-for-age z-scores (HAZ) at each year of life from 0 to 5. Rural, indigenous children at age 0-1 experience a HAZ reduction of 0.35 units associated with prenatal excess rainfall which is also observed at age 4-5. Urban, non-indigenous children at age 4-5 experience a HAZ increase of 0.07 units associated with postnatal excess rainfall, but this advantage is not seen among rural, indigenous children. These findings highlight the need to consider developmental stage and social predictors as key components in public health interventions targeting increased climate change resilience.
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Affiliation(s)
- Khristopher Nicholas
- Carolina Population Center, University of North Carolina At Chapel Hill, Chapel Hill, NC,, USA
- Department of Nutrition, University of North Carolina At Chapel Hill, 123 W Franklin St, Chapel Hill, NC 27516, USA
| | - Leah Campbell
- Department of City and Regional Planning, University of North Carolina At Chapel Hill, Chapel Hill, NC,, USA
| | - Emily Paul
- Department of City and Regional Planning, University of North Carolina At Chapel Hill, Chapel Hill, NC,, USA
- Department of Health Behavior, University of North Carolina At Chapel Hill, Chapel Hill, NC,, USA
| | - Gioia Skeltis
- Department of Anthropology, University of North Carolina At Chapel Hill, Chapel Hill, NC,, USA
| | - Wenbo Wang
- Department of Biostatistics, University of North Carolina At Chapel Hill, Chapel Hill, NC,, USA
| | - Clark Gray
- Carolina Population Center, University of North Carolina At Chapel Hill, Chapel Hill, NC,, USA
- Department of Geography, University of North Carolina At Chapel Hill, Chapel Hill, NC,, USA
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Balhara KS, Silvestri DM, Tyler Winders W, Selvam A, Kivlehan SM, Becker TK, Levine AC. Impact of nutrition interventions on pediatric mortality and nutrition outcomes in humanitarian emergencies: A systematic review. Trop Med Int Health 2017; 22:1464-1492. [PMID: 28992388 DOI: 10.1111/tmi.12986] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Malnutrition contributes to paediatric morbidity and mortality in disasters and complex emergencies, but summary data describing specific nutritional interventions in these settings are lacking. This systematic review aimed to characterise such interventions and their effects on paediatric mortality, anthropometric measures and serum markers of nutrition. METHODS A systematic search of OVID MEDLINE, Cochrane Library and relevant grey literature was conducted. We included all randomised controlled trials and observational controlled studies evaluating effectiveness of nutritional intervention(s) on defined health outcomes in children and adolescents (0-18 years) within a disaster or complex emergency. We extracted study characteristics, interventions and outcomes data. Study quality was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. RESULTS A total of 31 studies met inclusion criteria. Most were conducted in Africa (17), during periods of conflict or hunger gaps (14), and evaluated micronutrient supplementation (14) or selective feeding (10). Overall study quality was low, with only two high and four moderate quality studies. High- and medium-quality studies demonstrated positive impact of fortified spreads, ready-to-use therapeutic foods, micronutrient supplementation, and food and cash transfers. CONCLUSION In disasters and complex emergencies, high variability and low quality of controlled studies on paediatric malnutrition limit meaningful data aggregation. If existing research gaps are to be addressed, the inherent unpredictability of humanitarian emergencies and ethical considerations regarding controls may warrant a paradigm shift in what constitutes adequate methods. Periodic hunger gaps may offer a generalisable opportunity for robust trials, but consensus on meaningful nutritional endpoints is needed.
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Affiliation(s)
- Kamna S Balhara
- Department of Emergency Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - David M Silvestri
- Department of Emergency Medicine, Harvard Affiliated Emergency Medicine Residency, Brigham and Women's Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - W Tyler Winders
- Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Anand Selvam
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Sean M Kivlehan
- Department of Emergency Medicine, Harvard Medical School, Division of International Emergency Medicine and Humanitarian Programs, Brigham and Women's Hospital, Boston, MA, USA
| | - Torben K Becker
- Department of Emergency Medicine, University of Florida, Gainesville, FL, USA
| | - Adam C Levine
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
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Belesova K, Gasparrini A, Sié A, Sauerborn R, Wilkinson P. Household cereal crop harvest and children's nutritional status in rural Burkina Faso. Environ Health 2017; 16:65. [PMID: 28633653 PMCID: PMC5477741 DOI: 10.1186/s12940-017-0258-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 05/11/2017] [Indexed: 06/10/2023]
Abstract
BACKGROUND Reduction of child undernutrition is one of the Sustainable Development Goals for 2030. Achievement of this goal may be made more difficult in some settings by climate change through adverse impact on agricultural productivity. However, there is only limited quantitative evidence on the link between household crop harvests and child nutrition. We examined this link in a largely subsistence farming population in rural Burkina Faso. METHODS Data on the middle-upper arm circumference (MUAC) of 975 children ≤5 years of age, household crop yields, and other parameters were obtained from the Nouna Health and Demographic Surveillance System. Multilevel modelling was used to assess the relationship between MUAC and the household crop harvest in the year 2009 estimated in terms of kilocalories per adult equivalent per day (kcal/ae/d). RESULTS Fourteen percent of children had a MUAC <125 mm (a value indicative of acute undernutrition). The relationship between MUAC and annual household food energy production adjusted for age, sex, month of MUAC measurement, household wealth, whether a household member had a non-agricultural occupation, garden produce, village infrastructure and market presence, suggested a decline in MUAC below around 3000 kcal/ae/d. The mean MUAC was 2.49 (95% CI 0.45, 4.52) mm less at 1000 than at 3000 kcal/ae/d. CONCLUSIONS Low per capita household crop production is associated with poorer nutritional status of children in a rural farming population in Burkina Faso. This and similar populations may thus be vulnerable to the adverse effects of weather on agricultural harvest, especially in the context of climate change.
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Affiliation(s)
- Kristine Belesova
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
| | - Antonio Gasparrini
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
| | - Ali Sié
- Centre de Recherche en Santé de Nouna, Rue Namory Keïta, Nouna, Kossi province, Boucle du Mouhoun region Burkina Faso
| | - Rainer Sauerborn
- Institute of Public Health, Heidelberg University, Im Neuenheimer Feld, Heidelberg, 324 69120 Germany
| | - Paul Wilkinson
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
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Dabiri D, Fontana M, Kapila Y, Eckert G, Sokal-Gutierrez K. Community-based assessment and intervention for early childhood caries in rural El Salvador. Int Dent J 2016; 66:221-8. [DOI: 10.1111/idj.12228] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Schramm S, Kaducu FO, Smedemark SA, Ovuga E, Sodemann M. Gender and age disparities in adult undernutrition in northern Uganda: high-risk groups not targeted by food aid programmes. Trop Med Int Health 2016; 21:807-17. [PMID: 27102720 DOI: 10.1111/tmi.12708] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the prevalence of adult malnutrition and associated risk factors in a post-conflict area of northern Uganda. METHODS A cross-sectional community survey was performed from September 2011 to June 2013. All registered residents in Gulu Health and Demographic Surveillance System aged 15 years and older were considered eligible. Trained field assistants collected anthropometric measurements (weight and height) and administered questionnaires with information on sociodemographic characteristics, food security, smoking and alcohol. Nutritional status was classified by body mass index. RESULTS In total, 2062 men and 2924 women participated and were included in the analyses. The prevalence of underweight was 22.3% for men and 16.0% for women, whereas the prevalence of overweight was 1.5% for men and 7.6% for women. In men, underweight was associated with younger (15-19 years) and older age (>55 years) (P < 0.001), being divorced/separated [odds ratio (OR) = 1.91 (95% confidence interval (CI): 1.21-2.99] and smoking (OR = 2.13, 95% CI: 1.67-2.73). For women, underweight was associated with older age (P < 0.001) and hungry-gap rainy season (May-July) (OR = 1.33, 95% CI: 1.04-1.69). Widowed or divorced/separated women were not more likely to be underweight. No association was found between education, alcohol consumption or food security score and underweight. CONCLUSIONS Our findings are not in line with the conventional target groups in nutritional programmes and highlight the importance of continuous health and nutritional assessments of all population groups that reflect local social determinants and family structures.
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Affiliation(s)
- Stine Schramm
- Centre for Global Health, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Felix Ocaka Kaducu
- Department of Public Health, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Siri Aas Smedemark
- Centre for Global Health, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Emilio Ovuga
- Department of Mental Health, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Morten Sodemann
- Centre for Global Health, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
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Systematic review of current efforts to quantify the impacts of climate change on undernutrition. Proc Natl Acad Sci U S A 2015. [PMID: 26216952 DOI: 10.1073/pnas.1409769112] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Malnutrition is a challenge to the health and productivity of populations and is viewed as one of the five largest adverse health impacts of climate change. Nonetheless, systematic evidence quantifying these impacts is currently limited. Our aim was to assess the scientific evidence base for the impact of climate change on childhood undernutrition (particularly stunting) in subsistence farmers in low- and middle-income countries. A systematic review was conducted to identify peer-reviewed and gray full-text documents in English with no limits for year of publication or study design. Fifteen manuscripts were reviewed. Few studies use primary data to investigate the proportion of stunting that can be attributed to climate/weather variability. Although scattered and limited, current evidence suggests a significant but variable link between weather variables, e.g., rainfall, extreme weather events (floods/droughts), seasonality, and temperature, and childhood stunting at the household level (12 of 15 studies, 80%). In addition, we note that agricultural, socioeconomic, and demographic factors at the household and individual levels also play substantial roles in mediating the nutritional impacts. Comparable interdisciplinary studies based on primary data at a household level are urgently required to guide effective adaptation, particularly for rural subsistence farmers. Systemization of data collection at the global level is indispensable and urgent. We need to assimilate data from long-term, high-quality agricultural, environmental, socioeconomic, health, and demographic surveillance systems and develop robust statistical methods to establish and validate causal links, quantify impacts, and make reliable predictions that can guide evidence-based health interventions in the future.
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Fuster M, Messer E, Houser RF, Deman H, De Fulladolsa PP, Bermudez OI. Local Notions of Healthy Eating and National Dietary Guidelines: A Comparison in Vulnerable Salvadoran Communities. FOOD AND FOODWAYS 2013. [DOI: 10.1080/07409710.2013.850002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Jeharsae R, Sangthong R, Wichaidit W, Chongsuvivatwong V. Growth and development of children aged 1-5 years in low-intensity armed conflict areas in Southern Thailand: a community-based survey. Confl Health 2013; 7:8. [PMID: 23556430 PMCID: PMC3621604 DOI: 10.1186/1752-1505-7-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 01/13/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A low-intensity armed conflict has been occurring for nearly a decade in southernmost region of Thailand. However, its impact on child health has not yet been investigated. This study aimed to estimate the prevalence of delayed child growth and development in the affected areas and to determine the association between the violence and health among children aged 1-5 years. METHODS A total of 498 children aged 1-5 years were recruited. Intensity of conflict for each sub-district was calculated as the 6-year average number of incidents per 100,000 population per year and classified into quartiles. Growth indices were weight-for-age, height-for-age, and weight-for-height, while development was measured by the Denver Development Screening Test II (Thai version). Food insecurity, child-rearing practice, health service accessibility, household sanitation, and depression among the caregivers were assessed using screening scales and questionnaires. Contextual information such as average income and numbers of violent events in each sub-district was obtained from external sources. RESULTS Growth retardation was highly prevalent in the area as reported by rates of underweight, stunting, and wasting at 19.3%, 27.6% and 7.4%, respectively. The prevalence of developmental delay was also substantially high (37.1%). Multi-level analysis found no evidence of association between insurgency and health outcomes. However, children in areas with higher intensity of violence had a lower risk of delay in personal-social development (OR = 0.4; 95% CI = 0.2 - 0.9; p-value = 0.05). CONCLUSION Unlike war refugees and internally-displaced persons in camp-like settings, the relationship between level of armed conflict and growth and developmental delay among children aged 1-5 years could not be demonstrated in the community setting of this study where food supply had been minimally perturbed.
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Affiliation(s)
- Rohani Jeharsae
- Faculty of Nursing (Establishment Project), Prince of Songkla University, Pattani Campus, Pattani, Thailand
- Epidemiology Unit, Prince of Songkla University, Hat Yai Campus, Hat Yai, Thailand
| | - Rassamee Sangthong
- Epidemiology Unit, Prince of Songkla University, Hat Yai Campus, Hat Yai, Thailand
| | - Wit Wichaidit
- Epidemiology Unit, Prince of Songkla University, Hat Yai Campus, Hat Yai, Thailand
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Stowers SL. Gastronomic Nostalgia: Salvadoran Immigrants' Cravings for Their Ideal Meal. Ecol Food Nutr 2012; 51:374-93. [DOI: 10.1080/03670244.2012.696008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Del Cura I, Huertas R. Public health and nutrition after the Spanish Civil War. An intervention by the Rockefeller Foundation. Am J Public Health 2009; 99:1772-9. [PMID: 19696398 PMCID: PMC2741518 DOI: 10.2105/ajph.2007.124875] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2009] [Indexed: 11/04/2022]
Abstract
We describe a nutritional intervention by the Rockefeller Foundation's International Health Division in Spain after the Spanish Civil War, delineating the relationships between the technicians sent by the Rockefeller Foundation and the Spanish health authorities. We analyze reports of the nutritional situation in Spain in the early 1940s and the design and outcomes of a nutrition survey conducted in a district of Madrid by American and Spanish nutritionists. This nutritional survey, which was based on food intake interviews and was complemented with anthropometric measurements, clinical examinations, and blood tests, found several symptoms and signs of malnutrition. The Rockefeller Foundation's nutritional research was an important historical precedent for later studies made in emergency situations or armed conflicts. Similar surveys have been carried out in the last several decades by distinguished academic departments of public health and epidemiology and by humanitarian aid agencies.
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Affiliation(s)
- Isabel Del Cura
- Consejo Superior de Investigaciones Científicas, C/ Albasanz 26-28, Madrid, Spain.
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Abstract
In Latin America and the Caribbean, malnutrition still represents a health concern expressed mainly as stunting and micronutrient deficiencies, lessening the attention given to acute malnutrition (moderate and severe); however, the latter has a high fatality rate. Ending these avoidable deaths represents a major health and ethical challenge in the region. Acute malnutrition plus infections (mainly diarrhea and pneumonia) determine an important fraction of the fatality rate due to malnutrition in most regions, especially those with higher poverty and social instability. Application of the World Health Organization guidelines for the treatment of children with acute severe malnutrition reduces the fatality rate significantly. Among the many possibilities for treatment, systems based on day care centers and at home should be promoted. Training in the application of the World Health Organization guidelines should be incorporated into the curricula of health-related professions in countries where malnutrition is prevalent.
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Armed conflict and poverty in Central America: the convergence of epidemiology and human rights advocacy. Epidemiology 2007; 18:673-7. [PMID: 18049183 DOI: 10.1097/ede.0b013e3181570c24] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Several armed conflicts took place in Central America during the last 3 decades of the 20th century. In this commentary, we discuss (1) studies describing the interrelationships among health, violence, and poverty during and after these conflicts and (2) some important lessons learned from these studies. We hope that those lessons help epidemiologists and others who must confront, and describe, similar situations elsewhere.
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15
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Deliège DA. Height of young men. Health Place 2003; 9:183-92. [PMID: 12810326 DOI: 10.1016/s1353-8292(02)00038-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We analysed the height of young men in Belgium, using 613 257 records of medical examinations made prior to their conscription into the army (about 68% of the male population concerned). All analyses showed very significant associations. Height differed according to the region (-1.24cm in Wallonia, French-speaking and poorer) compared to Flanders (Dutch-speaking and richer), when "age-class" and year are taken into account. The smallest men lived in Hainaut (a deprived area), the tallest ones in Walloon Brabant (wealthy green suburbs of the capital). Height increased across time (+1.11cm, 1978-1990) and with "age-class" (+2.66cm, 18-26years), controlling for other factors. The increase in Brussels stops in 1983, probably due to other socio-demographic evolutions.
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Affiliation(s)
- Denise A Deliège
- Health Systems Research School of Public Health, Catholic University of Louvain, Clos Chapelle-aux-Champs 30.41, 1200, Brussels, Belgium.
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Civil war and child health: regional and ethnic dimensions of child immunization and malnutrition in Angola. Soc Sci Med 2003; 56:2515-27. [PMID: 12742614 DOI: 10.1016/s0277-9536(02)00286-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This study arises from a general proposition that different levels and types of exposure to war are crucial in shaping health outcomes in a population under war-induced duress. We analyze civil war-related regional and ethnolinguistic differentials in age-adequate immunization (complete vaccination for age) and levels of malnutrition in Angola. Our analysis is based on data from a nationally representative survey conducted in 1996, some 2 years after the end of one of the most destructive periods of hostilities in the history of Angolan civil war. The data show that despite Angola's unique mineral wealth, the nation's levels of child age-adequate immunization is lower and malnutrition rates are higher than in most of sub-Saharan Africa. To examine age-adequate immunization and chronic malnutrition we fit logistic regression models that include the regional degree of war impact and ethnolinguistic group, in addition to rural-urban differences and other conventional sociodemographic characteristics. The tests reveal a significant disadvantage of rural children relative to urban children in both immunization and chronic malnutrition. Net of the rural-urban differences, we also detect a significant disadvantage of children residing in parts of the country that had been most affected by the fighting. The tests also point to a lower level of immunization and higher level of chronic malnutrition among children from the ethnolinguistic group commonly identified with the opposition. These associations tend to be stronger among children who were born and/or grew up during war than among children who were born after peace was re-established.
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