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Dusingizimana T, Ramilan T, Weber JL, Iversen PO, Mugabowindekwe M, Ahishakiye J, Brough L. Predictors for achieving adequate antenatal care visits during pregnancy: a cross-sectional study in rural Northwest Rwanda. BMC Pregnancy Childbirth 2023; 23:69. [PMID: 36703102 PMCID: PMC9878946 DOI: 10.1186/s12884-023-05384-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 01/16/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Inadequate antenatal care (ANC) in low-income countries has been identified as a risk factor for poor pregnancy outcome. While many countries, including Rwanda, have near universal ANC coverage, a significant proportion of pregnant women do not achieve the recommended regimen of four ANC visits. The present study aimed to explore the factors associated with achieving the recommendation, with an emphasis on the distance from household to health facilities. METHODS A geo-referenced cross-sectional study was conducted in Rutsiro district, Western province of Rwanda with 360 randomly selected women. Multiple logistic regression analysis including adjusted odd ratio (aOR) were performed to identify factors associated with achieving the recommended four ANC visits. RESULTS The majority (65.3%) of women had less than four ANC visits during pregnancy. We found a significant and negative association between distance from household to health facility and achieving the recommended four ANC visits. As the distance increased by 1 km, the odds of achieving the four ANC visits decreased by 19% (aOR = 0.81, P = 0.024). The odds of achieving the recommended four ANC visits were nearly two times higher among mothers with secondary education compared with mothers with primary education or less (aOR = 1.90, P = 0.038). In addition, mothers who responded that their household members always seek health care when necessary had 1.7 times higher odds of achieving four ANC visits compared with those who responded as unable to seek health care (aOR = 1.7, P = 0.041). Furthermore, mothers from poor households had 2.1 times lower odds of achieving four ANC visits than mothers from slightly better-off households (aOR = 2.1, P = 0.028). CONCLUSIONS Findings from the present study suggest that, in Rutsiro district, travel distance to health facility, coupled with socio-economic constraints, including low education and poverty can make it difficult for pregnant women to achieve the recommended ANC regimen. Innovative strategies are needed to decrease distance by bringing ANC services closer to pregnant women and to enhance ANC seeking behaviour. Interventions should also focus on supporting women to attain at least secondary education level as well as to improve the household socioeconomic status of pregnant women, with a particular focus on women from poor households.
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Affiliation(s)
- Theogene Dusingizimana
- grid.10818.300000 0004 0620 2260Department of Food Science and Technology, College of Agriculture, Animal Sciences and Veterinary Medicine, University of Rwanda, P.O. Box 210, Musanze, Rwanda
| | - Thiagarajah Ramilan
- grid.148374.d0000 0001 0696 9806School of Agriculture and Environment, Massey University, Tennent Drive, Palmerston North, 4442 New Zealand
| | - Janet L. Weber
- grid.148374.d0000 0001 0696 9806School of Food and Advanced Technology, Massey University, Tennent Drive, Palmerston North, 4442 New Zealand
| | - Per Ole Iversen
- grid.5510.10000 0004 1936 8921Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, 0317 Norway ,grid.55325.340000 0004 0389 8485Department of Haematology, Oslo University Hospital, Oslo, 0424 Norway ,grid.11956.3a0000 0001 2214 904XDivision of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, 7505 South Africa
| | - Maurice Mugabowindekwe
- grid.5254.60000 0001 0674 042XDepartment of Geosciences and Natural Resource Management, University of Copenhagen, Copenhagen, Denmark ,grid.10818.300000 0004 0620 2260Centre for Geographic Information Systems and Remote Sensing, College of Science and Technology, University of Rwanda, P.0. Box 3900, Kigali, Rwanda
| | - Jeannine Ahishakiye
- grid.10818.300000 0004 0620 2260Human Nutrition and Dietetics Department, College of Medicine and Health Sciences, University of Rwanda, P.O. Box 3286, Kigali, Rwanda
| | - Louise Brough
- grid.148374.d0000 0001 0696 9806School of Food and Advanced Technology, Massey University, Tennent Drive, Palmerston North, 4442 New Zealand
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Rathnayake S, Gray D, Reid J, Ramilan T. The impacts of the COVID-19 shock on sustainability and farmer livelihoods in Sri Lanka. Curr Res Environ Sustain 2022; 4:100131. [PMID: 35992577 PMCID: PMC9377147 DOI: 10.1016/j.crsust.2022.100131] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 02/10/2022] [Accepted: 02/15/2022] [Indexed: 06/15/2023]
Abstract
The COVID-19 pandemic and its handling in Sri Lanka has affected vegetable farmers in numerous ways and these impacts will constrain the country's move towards sustainable development. A field level study with vegetable farmers and key informants was carried out using exploratory research to understand, describe and analyze the impact of COVID-19 on the livelihoods of vegetable farmers and its relevance in achieving SDG 1. Data were supplemented by an extensive literature review. The analysis showed that the pandemic's impact on vegetable farmers in Sri Lanka is multidimensional and will increase vulnerability among vegetable farmers, for the long run. Adapting alternative inputs and marketing strategies, provision of immediate financial support, promoting innovative technology and service provision, and implementing intervention strategies tailored to farmer heterogeneity will improve farmer livelihoods and the prosperity of the sector.
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Affiliation(s)
- Sanduni Rathnayake
- School of Agriculture and Environment, College of Sciences, Massey University, Private Bag 11 222, Palmerston North 4410, New Zealand
- Department of Agricultural Extension, Faculty of Agriculture, University of Peradeniya, Peradeniya, Sri Lanka
| | - David Gray
- School of Agriculture and Environment, College of Sciences, Massey University, Private Bag 11 222, Palmerston North 4410, New Zealand
| | - Janet Reid
- School of Agriculture and Environment, College of Sciences, Massey University, Private Bag 11 222, Palmerston North 4410, New Zealand
| | - Thiagarajah Ramilan
- School of Agriculture and Environment, College of Sciences, Massey University, Private Bag 11 222, Palmerston North 4410, New Zealand
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Jin Y, Coad J, Zhou SJ, Skeaff S, Ramilan T, Brough L. Prevalence of thyroid dysfunction in postpartum women with suboptimal iodine and selenium and adequate iron status. Clin Endocrinol (Oxf) 2021; 95:873-881. [PMID: 34008190 DOI: 10.1111/cen.14502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 05/03/2021] [Accepted: 05/14/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Postpartum women experience thyroid dysfunction at twice the prevalence of the general population. Adequate biosynthesis of thyroid hormones depends on three trace elements: iodine, selenium and iron. This study aimed to investigate thyroid dysfunction within a cohort of women at six months postpartum in relation to iodine, selenium and iron status. DESIGN This cross-sectional study was part of an observational longitudinal cohort Mother and Infant Nutrition Investigation; data obtained at six months postpartum are reported. SUBJECTS Mother-infant pairs (n = 87) were recruited at three months postpartum and followed up at six months postpartum (n = 78). MEASUREMENTS Thyroid hormones (free triiodothyronine, free thyroxine, thyroid-stimulating hormone) and thyroid peroxidase antibodies were measured. Urinary iodine concentration, breast milk iodine concentration, serum thyroglobulin, plasma selenium, serum ferritin and serum soluble transferrin receptors were determined. Nonparametric data were expressed as median (25th, 75th percentile). RESULTS Thyroid dysfunction was found in 18% of women, and 4% of women had iron deficiency. Median urinary iodine concentration was 85 (43, 134) µg/L, median breast milk iodine concentration was 59 (39, 109) µg/L, and median serum thyroglobulin at 11.4 (8.6, 18.6) µg/L, indicating iodine deficiency. Median plasma selenium concentration was 105.8 (95.6, 115.3) µg/L. Women with marginally lower plasma selenium concentration were 1.12% times more likely to have abnormal TSH concentrations (p = .001). CONCLUSIONS There was a high prevalence of thyroid dysfunction. Plasma selenium concentration was the only significant predictor of the likelihood that women had thyroid dysfunction within this cohort, who were iodine deficient and mostly had adequate iron status. Strategies are required to improve both iodine and selenium status to better support maternal thyroid function.
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Affiliation(s)
- Ying Jin
- School of Health Sciences, College of Health, Massey University, Palmerston North, New Zealand
| | - Jane Coad
- Nutrition Science, School of Food and Advanced Technology, College of Sciences, Massey University, Palmerston North, New Zealand
| | - Shao J Zhou
- School of Agriculture, Food and Wine, Faculty of Sciences & Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - Sheila Skeaff
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Thiagarajah Ramilan
- School of Agriculture and Environment, College of Sciences, Massey University, Palmerston North, New Zealand
- School of Agriculture and Food, The University of Melbourne, Victoria, Australia
| | - Louise Brough
- Nutrition Science, School of Food and Advanced Technology, College of Sciences, Massey University, Palmerston North, New Zealand
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Duan Y, Ramilan T, Luo J, French N, Guan N. Risk assessment approaches for evaluating cumulative exposures to multiple pesticide residues in agro-products using seasonal vegetable monitoring data from Hainan, China: a case study. Environ Monit Assess 2021; 193:578. [PMID: 34398280 DOI: 10.1007/s10661-021-09328-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 07/17/2021] [Indexed: 06/13/2023]
Abstract
Risks from combined exposure to multiple chemicals in food have prompted a growing concern for their effect on human health. Risk management of chemical mixtures should be based on developing and harmonizing methodologies to scientifically evaluate their cumulative adverse effects. In this study, a simplified tiered approach of cumulative exposure assessment is described along with a case study of vegetables in China's Hainan province during 2012-2014. This case study could be a reference for the Chinese National Risk Assessment Programs for vegetable and fruit products. In the proposed assessment approach, Tier 1 acts as a screening tier to categorize and evaluate chemicals under a conservative scenario, and it prioritizes the pesticides of most concern. Tier 2 refines the grouping of substances from Tier 1 and normalizes the toxic potency of the chemicals to sum the exposure of chemical mixtures in a given assessment group. Tier 3 applies the refined exposure model and the input parameter distribution to create probabilistic models using Monte Carlo simulation. This approach will be helpful in the cumulative exposure assessment where data on pesticide residues are sufficient, but the individual dietary consumption is inadequate.
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Affiliation(s)
- Yun Duan
- Analysis and Test Center, Chinese Academy of Tropical Agricultural Sciences, Haikou, China
- Laboratory of Quality and Safety Risk Assessment for Tropical Products of Ministry of Agriculture and Rural Affairs, Haikou, China
- Hainan Provincial Key Laboratory of Quality and Safety for Tropical Fruits and Vegetables, Haikou, China
- Hopkirk Research Institute, Massey University, Palmerston North, New Zealand
- New Zealand Food Safety Science & Research Center, Palmerston North, New Zealand
| | - Thiagarajah Ramilan
- New Zealand Food Safety Science & Research Center, Palmerston North, New Zealand.
- School of Agriculture and Environment, Massey University, Palmerston North, New Zealand.
| | - Jinhui Luo
- Analysis and Test Center, Chinese Academy of Tropical Agricultural Sciences, Haikou, China
- Laboratory of Quality and Safety Risk Assessment for Tropical Products of Ministry of Agriculture and Rural Affairs, Haikou, China
- Hainan Provincial Key Laboratory of Quality and Safety for Tropical Fruits and Vegetables, Haikou, China
| | - Nigel French
- Hopkirk Research Institute, Massey University, Palmerston North, New Zealand.
- New Zealand Food Safety Science & Research Center, Palmerston North, New Zealand.
| | - Ni Guan
- National Engineering Research Center for Non-Food Bio-Refinery, Guangxi Academy of Science, Nanning, China
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Dusingizimana T, Weber JL, Ramilan T, Iversen PO, Brough L. A Mixed-Methods Study of Factors Influencing Access to and Use of Micronutrient Powders in Rwanda. Glob Health Sci Pract 2021; 9:274-285. [PMID: 34048359 PMCID: PMC8324192 DOI: 10.9745/ghsp-d-20-00422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 02/18/2021] [Indexed: 01/27/2023]
Abstract
Gaps in complementary feeding practices hinder the use of multiple micronutrients powder (MNP) in Rutsiro district in Rwanda. Successful MNP program implementation requires uninterrupted availability and accessibility to the product, as well as greater understanding of health benefits of the MNP. The World Health Organization recommends point-of-use fortification with multiple micronutrients powder (MNP) for foods consumed by children aged 6–23 months in populations where anemia prevalence among children under 2 years or under 5 years of age is 20% or higher. In Rwanda, anemia affects 37% of children under 5 years. The MNP program was implemented to address anemia, but research on factors affecting the implementation of the MNP program is limited. We conducted a mixed-methods study to examine the factors influencing access to and use of MNP among mothers (N=379) in Rutsiro district, northwest Rwanda. Inductive content analysis was used for qualitative data. Logistic regression analysis was used to determine factors associated with the use of MNP. Qualitative results indicated that the unavailability of MNP supplies and distribution issues were major barriers to accessing MNP. Factors influencing the use of MNP included mothers' perceptions of side effects and health benefits of MNP, as well as inappropriate complementary feeding practices. Mothers of older children (aged 12–23 months) were more likely to use MNP than those of younger children (aged 6–11 months) (adjusted odds ratio [aOR]=3.63, P<.001). Mothers whose children participated in the supplementary food program were nearly 3 times more likely to use MNP than those whose children had never participated in the program (aOR=2.84, P=.001). Increasing household hunger score was significantly associated with lower odds of using MNP (aOR=0.80, P=.038). Mechanisms to monitor MNP supply and program implementation need to be strengthened to ensure mothers have access to the product. MNP program implementers should address gaps in complementary feeding practices and ensure mothers have access to adequate complementary foods.
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Affiliation(s)
- Theogene Dusingizimana
- School of Food and Advanced Technology, Massey University, Palmerston North, New Zealand. .,Department of Food Science and Technology, College of Agriculture, Animal Sciences and Veterinary Medicine, University of Rwanda, Musanze, Rwanda
| | - Janet L Weber
- School of Food and Advanced Technology, Massey University, Palmerston North, New Zealand
| | - Thiagarajah Ramilan
- School of Agriculture and Environment, Massey University, Palmerston North, New Zealand
| | - Per Ole Iversen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,Department of Hematology, Oslo University Hospital, Oslo, Norway.,Division of Human Nutrition, Faculty of Medical Health Sciences, Stellebosh University, Tygerberg, South Africa
| | - Louise Brough
- School of Food and Advanced Technology, Massey University, Palmerston North, New Zealand
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Fernando S, Garnevska E, Ramilan T, Shadbolt N. Organisational attributes of cooperatives and farmer companies. Journal of Co-operative Organization and Management 2021. [DOI: 10.1016/j.jcom.2021.100132] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Farrell L, Tozer P, Kenyon P, Ramilan T, Cranston L. Producing higher value wool through a transition from Romney to Merino crossbred i: Flock dynamics, feed demand, and production of lambs and wool. Small Rumin Res 2020. [DOI: 10.1016/j.smallrumres.2020.106212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Chandrakumar C, Malik A, McLaren SJ, Owsianiak M, Ramilan T, Jayamaha NP, Lenzen M. Setting Better-Informed Climate Targets for New Zealand: The Influence of Value and Modeling Choices. Environ Sci Technol 2020; 54:4515-4527. [PMID: 32119772 DOI: 10.1021/acs.est.9b06991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Quantifying greenhouse gas (GHG) emissions and setting GHG emissions budgets for anthropogenic systems are influenced by several value and modeling choices. This study, for the first time, quantified the influence of choice of GHG accounting approach, GHG metric, time horizon, climate threshold, global emissions budget calculation method, and effort-sharing approach, taking New Zealand (NZ) as a case study. First, NZ's production- and consumption-based emissions were quantified using multiregional input-output analysis and applying different GHG metrics (global warming and temperature potentials) and time horizons (20 and 100 years). Second, global emissions budgets for 1.5 °C, 2 °C, and 1 W m-2 climate thresholds were estimated. Budget shares were then assigned to NZ using two effort-sharing approaches (grandfathering and economic value), and emissions were benchmarked against the assigned shares. Finally, the analysis was undertaken at the NZ sector level. The results showed that, for each GHG accounting approach, NZ's total emissions exceeded their budget shares, irrespective of the choices; the largest source of uncertainty was the choice of global emissions budget calculation method, followed by GHG metric, climate threshold, effort-sharing approach, and reference year for the grandfathering approach. The sector-level analysis showed that, while most sectors exceeded their budget shares, some performed within them. The ranking of uncertainty sources was quite different at the sector level, with the choice of effort-sharing approach providing the largest source of uncertainty. Overall, the study indicates the importance of handling value and modeling choices in a transparent way when quantifying GHG emissions and setting emissions budgets for anthropogenic systems.
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Affiliation(s)
- Chanjief Chandrakumar
- New Zealand Life Cycle Management Centre, Massey University, Palmerston North 4442, New Zealand
- School of Agriculture and Environment, Massey University, Palmerston North 4442, New Zealand
| | - Arunima Malik
- ISA, School of Physics, The University of Sydney, Sydney, New South Wales 2006, Australia
- Sydney Business School, The University of Sydney, Sydney, New South Wales 2006, Australia
| | - Sarah J McLaren
- New Zealand Life Cycle Management Centre, Massey University, Palmerston North 4442, New Zealand
- School of Agriculture and Environment, Massey University, Palmerston North 4442, New Zealand
| | - Mikołaj Owsianiak
- Division for Quantitative Sustainability Assessment, Department of Management Engineering, Technical University of Denmark, Produktionstorvet 424, 2800 Kongens Lyngby, Denmark
| | - Thiagarajah Ramilan
- School of Agriculture and Environment, Massey University, Palmerston North 4442, New Zealand
- School of Agriculture and Food, The University of Melbourne, Melbourne, Victoria 3010, Australia
| | - Nihal P Jayamaha
- School of Food and Advanced Technology, Massey University, Palmerston North 4442, New Zealand
| | - Manfred Lenzen
- ISA, School of Physics, The University of Sydney, Sydney, New South Wales 2006, Australia
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