Spatial variations and determinants of anemia among under-five children in Ethiopia, EDHS 2005-2016

BACKGROUND

Anemia has severe public health significance in sub-Saharan Africa. In Ethiopia, anemia has been increasing in the last two decades, reaching the highest national level in 2016, however, the geospatial distribution and determinants of anemia in children weren't well explored at a national level.

METHODS

We used the Ethiopian Demographic and Health Survey(EDHS) data from 2005-2016. The data consists of samples of households (HHs) obtained through a two-stage stratified sampling procedure. Our analysis included 19,699 children. Descriptive statistics, geospatial analysis, and Generalized Linear Mixed Model (GLMMs) were used.

RESULTS

The overall prevalence of anemia was 51.5%; the spatial distribution of anemia significantly different across clusters in each survey. Children from 6 to 11 months had higher odds of anemia compared to 24-59 months (Adjusted Odds ratio (AOR) = 3.4, 95%Confidence level (CI): 2.99-3.76). Children with the first and second birth order were less likely to be anemic compared to fifth and above (AOR = 0.60, 95%CI: 0.38-0.95, and AOR = 0.83, 95%C: 0.73-0.93) respectively. Mothers' age 15 to 24 years was associated with higher odds of anemia compared to 35 to 49 years (AOR = 1.37, 95%CI: 1.20-1.55). Children from HHs with the poorest and poorer wealth category showed a higher odds of anemia compared to the richest (AOR = 1.67, 95%CI: 1.45-1.93, and AOR = 1.25, 95%CI: 1.08-1.45) respectively. Moreover, children from HHs with one to two under-five children were less likely to be anemic compared to those three and more (AOR = 0.83, 95%CI: 0.76-0.91).

CONCLUSIONS

The geospatial distribution of anemia among children varies in Ethiopia; it was highest in the East, Northeast, and Western regions of the country. Several factors were associated with anemia; therefore, interventions targeting the hotspots areas and specific determinant factors should be implemented by the concerned bodies to reduce the consequences of anemia on the generation.

Planning of births and childhood undernutrition in Nepal: evidence from a 2016 national survey

BACKGROUND

Childhood undernutrition is a significant public health issue in low-and middle-income countries, including Nepal. However, there is limited evidence showing the association between the planning of birth (PoB) and childhood undernutrition (stunting and underweight). We aimed to investigate the relationship between PoB and childhood undernutrition in the current study.

METHODS

We used the Nepal Demographic and Health Survey (NDHS) 2016 data, a nationally representative cross-sectional household survey. We used two anthropometric indicators of childhood undernutrition as the outcome of this study. PoB is the main predictor. We used binary logistic regression with sampling weights to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) to examine the association between the PoB and childhood undernutrition. Unless stated, the significant association between the variables is calculated with p < 0.001.

RESULTS

The overall prevalence of stunting was 35.8%, and underweight was 27.1% in children under 5 years of age in Nepal. We found a higher rate of stunting (52.7%) and underweight (41.1%) in children with birth order > 3 and < 2 years of the interval between birth and subsequent birth (IBBSB). The association between the children's birth order and the prevalence of undernutrition had strong statistical significance. Mother's age at marriage (p = 0.001), underweight mother, mother's education, father's education, wealth quintile, no exposure to mass media, children's age, and place of residence(p = 0.001) were significantly associated with childhood undernutrition. The result of the multiple logistic regression showed that children with birth order one and 12-24 months of the interval between marriage and first birth (IBMFB) had significantly decreased odds of stunting than those children with birth order one and < 12 months of IBMFB (OR 0.6, 95% CI 0.4-0.9).

CONCLUSION

The findings of the study demonstrate that PoB has a protective effect on childhood undernutrition. Delaying of childbirth until 12-24 months after marriage was found to be associated with reduced childhood stunting odds. To mitigate childhood undernutrition, Nepal's government needs to promote delayed childbearing after marriage while focusing on uplifting the household economics status and wide coverage of and utilization of mass media.

Nutrition status of nulliparous married Indian women 15-24 years: Decadal trends, predictors and program implications

In India, 66% of 8 million married adolescents (~5.3 million) are nulliparous and likely to conceive soon. Among married young women aged 20–24 years about 9.1 million are nulliparous. This group remains relatively less reached in maternal nutrition programs. Current estimates of their nutritional status and predictors of body mass index (BMI) are unavailable. Thinness (BMI <18.5 kg/m²), severe thinness (BMI <16 kg/m²), overweight or obesity (BMI ≥ 23kg/m²) prevalence estimates are presented based on a sample of 11,265 married nulliparous adolescents (15–19 years, married, no parity) and 15,358 young women (20–24 years, married, no parity) drawn from the National Family Health Surveys 2005–06 and 2015–16. Trends by age, time and state were analysed. Predictors of BMI were investigated using linear regression. Using BMI for age z score (BAZ) as standard reference, BMI cut-off was calculated for thinness (-2SD) and overweight or obesity (+1SD) among married nulliparous adolescents as recommended for population under 19 years. 35% sampled adolescents and 26% young women were thin; 4%-5% severely thin. Overweight or obesity was higher among married nulliparous young women than married nulliparous adolescents (21% versus 11%). Eight in 1000 were short, thin and young and six in 1000 were short, thin, anemic and young. At 15 years of age, prevalence of thinness based on BMI was 46.5% while based on BAZ, 7.6%. At 24 years of age thinness was 22.5%. Decadal reduction in thinness was half among married nulliparous adolescents (4% points) compared with married nulliparous young women (8% points). Decadal increase in overweight/ obesity ranged from 4% to 5% in both age groups. Western states had high prevalence of thinness; Tamil Nadu had highest prevalence of overweight or obesity. Incremental increase in age and wealth increased BMI among young women more than adolescents. BMI was lower among adolescents and young women wanting a child later than soon [β -0.28 (CI -0.49- -0.07), β -0.33(CI -0.56- -0.093), respectively]. BMI cut-off 16.49 kg/m² and 24.12 kg/m² had a high sensitivity (100%, 99.7%) and specificity (98.9%, 98.5%) to screen thin and overweight or obese adolescents, respectively. Owing to the high prevalence of both thinness and overweight/obesity among nulliparous married adolescents and women, nutritional anthropometry based screening should be initiated for this target group, along with a treatment package in states with high and persistent malnutrition. Family planning services should be integrated in nutrition programs for this target group to achieve normal nutritional status before conception.

Planning of births and maternal, child health, and nutritional outcomes: recent evidence from India

OBJECTIVES

In an effort to provide recommendation for maximizing synergy between maternal, infant, and young children's nutrition and family planning in India, this study makes a comprehensive assessment of the effects of the planning of births in terms of timing, spacing and limiting childbearing on maternal and child health outcomes.

STUDY DESIGN

This study used the latest National Family Health Survey data of India that is globally known as the Demographic and Health Survey. A robust two-stage systematic random sampling was used for selecting representative samples for measuring demographic and health indicators.

METHODS

Maternal and child health outcomes are measured by body mass index (grouped as normal, underweight, and overweight) and anemia for mothers, and stunting, underweight, anemia, and under-five mortality for the children. Logistic regression and Cox proportional hazard models were applied.

RESULTS

Women with a higher number of births and among those with first-order births with fewer than 2 years between marriage and first birth, the risk of being underweight and having anemia was significantly higher compared with their counterparts. In addition, the probability of being underweight and risk of stunting, anemia, and mortality was higher among the children from women with a higher number of births and with fewer than 3 years of spacing between births than that of their counterparts.

CONCLUSIONS

The findings from this study support the importance of birth planning in improving maternal, child health, and nutritional outcomes. The proper planning of births could help to achieve the Sustainable Development Goal-3 of good health and well-being for all by 2030 in India, where a significant proportion of women still participate in early marriages, early childbearing, and a large number of births with close spacing.

Integrating reproductive and child health services enables access to modern contraception in Sierra Leone

BACKGROUND

From mid-2015, reproductive and child health interventions were integrated into a routine 6-month contact point: vitamin A supplementation, nutrition counseling with the mother's participation in the preparation of a complementary food, and confidential family planning counseling with provision of modern forms of contraceptives. By mid-2017, these services had reached 28% of health facilities nationwide.

OBJECTIVE

To evaluate awareness and uptake of modern contraception and complementary feeding practices.

METHODS

All health facilities were visited, and the health worker "in-charge" were interviewed to ascertain their training status and supply chains. Within each catchment, community mothers of children 6 to 23 months of age were interviewed.

RESULTS

Interviews were conducted with 321 "in-charges" and 670 mothers. Advantages and different types of contraception were understood by 99.0% of mothers, and 52.7% reported they were utilizing depot injections, hormonal implants, or oral contraceptive pills (45.1%, 34.6%, and 20.6% of users, respectively). Uptake was higher among Christians (62.1%) versus Muslims (48.6%) and among those with secondary/tertiary (61.5%) or primary education (60.5%) versus no education (43.3%) (P < 0.005 and P < 0.05, respectively). Complementary feeding practices included minimal meal diversity, 49.2% (fed three or more of six food groups), and recommended minimal meal frequency appropriate for age, 52.6%. Health workers reported frequent stockouts of vitamin A capsules (8%), male condoms (1%), oral contraceptives (10%), depot injections (20%), and hormonal implants (30%).

CONCLUSION

In communities served by these integrated services, awareness and uptake of modern contraception exceeded national targets despite weak supply chains, and complementary feeding practices were favorable compared with the national survey.

Does planning of births affect childhood undernutrition? Evidence from demographic and health surveys of selected South Asian countries

OBJECTIVE

The prevalence of child undernutrition in South Asia is high, as is also the unmet need for family planning. In previous literature, the biodemographic relationship of family planning, particularly birth order and birth spacing, and nutritional status of children have been assessed separately. The aim of this study was to work on the hypothesis that the planning of births comprising timing, spacing, and number of births improves child undernutrition, especially in the areas with high prevalence of stunting and underweight.

METHODS

We used recent Demographic and Health Survey data from four selected South Asian countries. Binary logistic regression models were applied to estimate the adjusted percentage of stunting and underweight by identified independent factors.

RESULTS

Findings suggested that after controlling for other socioeconomic factors, children in the first birth order with >24 mo of interval between marriage and first birth have a lower risk for stunting (20%; p <0.01) and underweight (14%; p <0.05), respectively, than other scenarios of the planning of births. The probability of child undernutrition is lower among children born with >24 mo of birth spacing than its counterpart in all birth orders, but the significance of birth spacing reduces with increasing birth orders.

CONCLUSION

Appropriate planning of births using family planning methods in countries with high birth rates has the potential to reduce childhood undernutrition. Thus, the planning of births emerges as an important biodemographic approach to eradicate childhood undernutrition especially in developing regions like South Asia and thereby to achieve sustainable development goals by 2030.