A one-year community study of under-fives in rural Ethiopia: health and behavioural determinants of morbidity

Individual and contextual factors associated with childhood stunting in Nigeria: a multilevel analysis

Stunting, a form of undernutrition, is the best measure of child health inequalities as it captures multiple dimensions of children's health, development and the environment where they live. The aim of this study was to quantify the predictors of childhood stunting in Nigeria. This study used data obtained from the 2008 Nigeria Demographic and Health Survey (NDHS). A total of 28 647 children aged 0-59 months included in NDHS in 2008 were analysed in this study. We applied multilevel multivariate logistic regression analysis in which individual-level factors were at the first level and community-level factors at the second level. The percentage change in variance of the full model accounted for about 46% in odds of stunting across the communities. The present study found that the following predictors increased the odds of childhood stunting: male gender, age above 11 months, multiple birth, low birthweight, low maternal education, low maternal body mass index, poor maternal health-seeking behaviour, poor household wealth and short birth interval. The community-level predictors found to have significant association with childhood stunting were: child residing in community with high illiteracy rate and North West and North East regions of the country. In conclusion, this study revealed that both individual- and community-level factors are significant determinants of childhood stunting in Nigeria.

Dark adaptation pattern of pregnant women as an indicator of functional disturbance at acceptable serum vitamin A levels

BACKGROUND

As a result of lack of precise guidelines, nutritional surveys on adults and high-risk groups are using diverse reference values as a dividing line between normal and deficient vitamin A status.

OBJECTIVE

To investigate whether pregnant women at marginally normal serum retinol status exhibit functional alteration that are characteristic of a deficiency state.

SETTING

Antenatal clinic, Gondar teaching hospital.

SUBJECTS

Ninety-six healthy pregnant women were recruited for the study at the antenatal clinic.

INTERVENTION

The dark adaptation time was tested in 48 pregnant women with marginal serum retinol level. The time lapse to see successive light stimuli of diminishing luminescence grade and change in retinal sensitivity pattern was measured using dark adaptometer. Results were compared with the results of a control group of women of similar age, parity and gestational period but with serum retinol values above 35 microg/dl.

RESULTS

The mean serum retinol levels of cases and controls were 23.35 microg/dl and 40.47 microg/dl respectively (P<0.008). Cases have a lower dark adaptation than their controls, shown by their remarkably reduced sensitivity to light. For instance at mean final light threshold was -2.20+/-0.11 log cd/m(2) in cases as compared to -2.88+/-0.1 log cd/m(2) in the normal group (P<0.001).

CONCLUSION

During pregnancy, dark adaptation was strongly associated with serum retinol concentration and women with marginal vitamin A concentration had lower dark adaptation. Hence marginally normal serum retinol levels should be categorized as a deficiency state, at least in pregnant women.

Epidemiology of respiratory infectious diseases

Respiratory infections are a frequent burden to health despite the fact that cost-effective methods for their prevention and cure are available. Acute respiratory infections in children under 5 years of age are the most frequent cause of death from lung disease globally, causing more than 4 million deaths annually. Tuberculosis is the most frequent cause of death from a single pathogen in persons aged 15 to 49 years (a total of 2 million to 3 million deaths annually). Respiratory infections are the most frequent complications of immune deficiency (whether due to HIV infection or induced by chemotherapy). Where a "carrier state" occurs (as with many bacterial pathogens), the level of immune function is the key determinant in appearance of disease. Where there is no carrier state (as with many viruses), exposure is the key determinant. Characteristics of the pathogen, including virulence and bacterial load where there is a carrier state, also determine the probability of respiratory infections. Modifiers of these determinants include allergy and toxic exposures including tobacco smoke and ambient pollution.