Early childhood development (ECD) is crucial for better health and well-being throughout life, but few studies have examined how ECD relates to child malnutrition. This is mainly due to lack of reliable and disaggregated data on ECD. We estimated the prevalence of ECD delays (communication, fine motor, gross motor, problem-solving and personal-social) and examined how different ECD domains were associated with child nutritional status in urban Ethiopia. Using a community-based cross-sectional survey design, 627 mother-child (12-36 months old) pairs were included in the study. The ECD was assessed using the Age and Stage Questionnaire (ASQ-3), and the nutritional status was assessed using anthropometric measurements. The association between the ECD domains and nutritional status was analysed using ordinal logistic regression, adjusting for confounding variables. Delays in ECD domains were common, especially in fine motor domain (41.9%); and more than half of the children were stunted (52.8%). Stunting and underweight were associated with ECD delays, while wasting was not. Accordingly, stunted children were more likely to have worst ECD delays in fine motor (odds ratios [OR] = 1.54; 95% confidence interval [CI]: 1.11; 2.15), gross motor (OR = 1.47; 95% CI: 1.05; 2.04) and problem-solving (OR = 1.41; 95% CI: 1.02; 1.96) domains compared to non-stunted children. Similarly, underweight children were more likely to have worse ECD delays in gross motor (OR = 1.91; 95% CI: 1.20; 3.04) and fine motor (OR = 1.90; 95% CI: 1.15; 3.15) domains compared to normal children. Coordinated and targeted ECD interventions, such as nurturing care, should be promoted and implemented widely to improve ECD outcomes and child nutrition.
BACKGROUND: The benefits of childhood vaccines are critically dependent on vaccination coverage. We used a vaccine registry (as gold standard) in Kenya to quantify errors in routine coverage methods (surveys and administrative reports), to estimate the magnitude of survivor bias, contrast coverage with timeliness and use both measures to estimate population immunity. METHODS: Vaccination records of children in the Kilifi Health and Demographic Surveillance System (KHDSS), Kenya were combined with births, deaths, migration and residence data from 2010 to 17. Using inverse survival curves, we estimated up-to-date and age-appropriate vaccination coverage, calculated mean vaccination coverage in infancy as the area under the inverse survival curves, and estimated the proportion of fully immunised children (FIC). Results were compared with published coverage estimates. Risk factors for vaccination were assessed using Cox regression models. RESULTS: We analysed data for 49,090 infants and 48,025 children aged 12-23 months in 6 birth cohorts and 6 cross-sectional surveys respectively, and found 2nd year of life surveys overestimated coverage by 2% compared to birth cohorts. Compared to mean coverage in infants, static coverage at 12 months was exaggerated by 7-8% for third doses of oral polio, pentavalent (Penta3) and pneumococcal conjugate vaccines, and by 24% for the measles vaccine. Surveys and administrative coverage also underestimated the proportion of the fully immunised child by 10-14%. For BCG, Penta3 and measles, timeliness was 23-44% higher in children born in a health facility but 20-37% lower in those who first attended during vaccine stock outs. CONCLUSIONS: Standard coverage surveys in 12-23 month old children overestimate protection by ignoring timeliness, and survivor and recall biases. Where delayed vaccination is common, up-to-date coverage will give biased estimates of population immunity. Surveys and administrative methods also underestimate FIC prevalence. Better measurement of coverage and more sophisticated analyses are required to control vaccine preventable diseases.
Ifedayo Adetifa, Boniface Karia, Alex Mutuku et al.
Maternal education is often considered an important determinant of children's early development. However, there is little empirical evidence on whether it is maternal education that contributes to better developmental outcomes or other ecological factors that relate to both education and children's development. This study used data on 4,874 mother-child (M age = 47.7 months) dyads from Uganda of the 2016 Demographic and Health Survey to assess the effects of maternal education on parenting and children's development. Taking advantage of a natural experiment with an instrumental variables approach, the study identified positive causal impacts of maternal schooling on children's development. Additional years of schooling also increased maternal engagement in stimulating activities, children's attendance to early childhood education programs, and reduced harsh corporal punishment. A mediation analysis suggested that increases in maternal stimulation and children's attendance to early childhood education programs and reductions in harsh corporal punishment partially explain the effects of maternal education on children's development. The positive impacts of education on parenting and child development indicate the need for more efforts to expand access to education in Uganda and other low- and- middle-income countries, including the abolishment of school fees for primary education. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
OBJECTIVE: To assess the association between the maternal continuum of healthcare and child immunisation in East Africa using propensity score matching (PSM). DESIGN: Cross-sectional study using Demographic and Health Survey data. SETTING: This study was conducted in East African countries. PARTICIPANTS: This study included a weighted sample of 13 488 women with children aged 12-23 months. OUTCOME MEASURE: Child immunisation was the outcome variable of this study. RESULTS: The PSM estimates indicate that the average treatment effect on the treated for complete child immunisation was 0.0583, meaning that children of mothers who received a complete maternal continuum of care had a 5.83% higher probability of being fully immunised compared with children of mothers with incomplete care. Expressed relative to the treated group's mean, this corresponds to a 7.48% increase. Additionally, our results indicated that the population average treatment effect was 0.0629. This means that, on average, a complete continuum of maternal healthcare increases the probability of full child immunisation by approximately 6.29% across the entire population. CONCLUSION: The study highlights that children whose mothers receive comprehensive maternal healthcare are more likely to complete their childhood immunisations. This finding underscores the need to integrate immunisation services into maternal healthcare programmes to enhance vaccination coverage and promote better child health. To maximise this connection, improving access to maternal healthcare, especially in underserved regions, is crucial, along with ensuring that immunisation is a regular part of maternal care.
Alemayehu Kasu Gebrehana, Angwach Abrham Asnake, Beminate Lemma Seifu et al.
BACKGROUND: Ethiopia is a priority country of Gavi, the Vaccine Alliance to improve vaccination coverage and equitable uptake. The Ethiopian National Expanded Programme on Immunisation (EPI) and the Global Vaccine Action Plan set coverage goals of 90% at national level and 80% at district level by 2020. This study analyses full vaccination coverage among children in Ethiopia and estimates the equity impact by socioeconomic, geographic, maternal and child characteristics based on the 2016 Ethiopia Demographic and Health Survey dataset. METHODS: Full vaccination coverage (1-dose BCG, 3-dose DTP3-HepB-Hib, 3-dose polio, 1-dose measles (MCV1), 3-dose pneumococcal (PCV3), and 2-dose rotavirus vaccines) of 2,004 children aged 12-23 months was analysed. Mean coverage was disaggregated by socioeconomic (household wealth, religion, ethnicity), geographic (area of residence, region), maternal (maternal age at birth, maternal education, maternal marital status, sex of household head), and child (sex of child, birth order) characteristics. Concentration indices estimated wealth and education-related inequities, and multiple logistic regression assessed associations between full vaccination coverage and socioeconomic, geographic, maternal, and child characteristics. RESULTS: Full vaccination coverage was 33.3% [29.4-37.2] in 2016. Single vaccination coverage ranged from 49.1% [45.1-53.1] for PCV3 to 69.2% [65.5-72.8] for BCG. Wealth and maternal education related inequities were pronounced with concentration indices of 0.30 and 0.23 respectively. Children in Addis Ababa and Dire Dawa were seven times more likely to have full vaccination compared to children living in the Afar region. Children in female-headed households were 49% less likely to have full vaccination. CONCLUSION: Vaccination coverage in Ethiopia has a pro-advantaged regressive distribution with respect to both household wealth and maternal education. Children from poorer households, rural regions of Afar and Somali, no maternal education, and female-headed households had lower full vaccination coverage. Targeted programmes to reach under-immunised children in these subpopulations will improve vaccination coverage and equity outcomes in Ethiopia.
Abstract To reach global immunization goals, national programs need to balance routine immunization at health facilities with vaccination campaigns and other outreach activities (e.g. vaccination weeks), which boost coverage at particular times and help reduce geographic inequalities. However, where routine immunization is weak, an overreliance on vaccination campaigns may lead to heterogeneous coverage. Here, we assessed the impact of a health system strengthening (HSS) intervention on the relative contribution of routine immunization and outreach activities to reach immunization goals in rural Madagascar.We obtained data from health centers in Ifanadiana district on the monthly number of recommended vaccines (BCG, measles, DTP and Polio) delivered to children, during 2014-2018. We also analyzed data from a district-representative cohort carried out every two years in over 1500 households in 2014-2018. We compared changes inside and outside the HSS catchment in the delivery of recommended vaccines, population-level vaccination coverage, geographic and economic inequalities in coverage, and timeliness of vaccination. The impact of HSS was quantified via mixed-effects logistic regressions. The HSS intervention was associated with a significant increase in immunization rates (Odds Ratio between 1.22 for measles and 1.49 for DTP), which diminished over time. Outreach activities were associated with a doubling in immunization rates, but their effect was smaller in the HSS catchment. Analysis of cohort data revealed that HSS was associated with higher vaccination coverage (Odds Ratio between 1.18 per year of HSS for measles and 1.43 for BCG), a reduction in economic inequality, and a higher proportion of timely vaccinations. Yet, the lower contribution of outreach activities in the HSS catchment was associated with persistent inequalities in geographic coverage, which prevented achieving international coverage targets. Investment in stronger primary care systems can improve vaccination coverage, reduce inequalities and improve the timeliness of vaccination via increases in routine immunizations. Key questions What is already known? - Reaching the minimum recommended vaccination coverage of 90% for childhood illnesses remains a substantial challenge for low and middle income countries (LMICs). - Understanding how vaccine delivery strategies can be improved to achieve coverage targets in rural areas of LMICs is essential due to the fragility of health systems and associated health budgets. - While evidence exists on the impact of outreach activities and other targeted interventions aimed at improving immunization coverage, it is unclear how strengthening local health systems can help improve key indicators of vaccination coverage, via its different impacts on routine and outreach immunizations. What are the new findings? - A health systems strengthening (HSS) intervention in a rural district of Madagascar improved overall vaccination coverage, reduced economic inequalities in vaccination coverage, and increased the proportion of timely vaccinations via an increase in routine immunizations. - The contribution of outreach activities was lower in the HSS catchment area than in the rest of the district, which was associated with a persistence of geographic inequalities in vaccination coverage. What do the new findings imply? - Strengthening local health systems can help improve key indicators of vaccination coverage in rural, low resource settings, even when those interventions do not target specifically vaccine improvements themselves. - Explicit efforts are still necessary in areas undergoing HSS to vaccinate children in remote areas so that immunization goals can be reached.
Elinambinina Rajaonarifara, Matthew H. Bonds, Ann C Miller et al.
In many developing countries, supermarkets are spreading rapidly, complementing and partly replacing traditional food markets and grocery stores. Changing retail environments can affect consumer diets and nutritional outcomes. Previous research suggested that supermarkets may contribute to rising rates of obesity. However, most existing research looked at adult populations. Here, we analyze effects of supermarkets on child nutrition with panel data from urban Kenya. Buying food in supermarkets increases child height-for-age, weight-for-age, and weight-for-height Z-scores. The effects on child height are larger than the effects on weight, which is a welcome finding because child stunting (low height-for-age) remains a major nutritional problem that is declining more slowly than child underweight. Supermarkets do not seem to be a driver of childhood obesity in this setting. The positive effects of supermarkets on child nutrition are channeled through improvements in food variety and dietary diversity.
Bethelhem Legesse Debela, Kathrin Demmler, Stephan Klasen et al.
Abstract Child malnutrition remains widespread in Ethiopia. Women's nutrition knowledge and empowerment are emphasized as key impact pathways for nutrition‐sensitive programs and interventions. This paper examines effects of women's nutrition knowledge and empowerment on child nutrition outcomes using survey data from rural Ethiopia. Employing econometric strategies that account for potential endogeneity concerns, nutrition knowledge, and empowerment are found to have strong and significant effects on children's dietary diversity and stunting. Their interaction is significantly correlated only with stunting, perhaps suggesting the importance of the interaction between nutrition knowledge and empowerment for long‐term nutrition outcomes. A disaggregated analysis of empowerment reveals that empowering women in household agricultural decisions and increasing their access to and control of economic resources are more promising for improving child nutrition. Overall, the findings suggest that efforts targeting to improve child nutrition in Ethiopia need to be complemented by efforts to improve women's nutrition knowledge and empowerment.
Abstract This study traces the causal effects of extreme weather events on nutritional and health outcomes among rural children in Uganda using four waves of individual child survey data (2009–2014). A simultaneous regression model was applied for causal inference while also accounting for households’ adaptive responses. The study finds the evidence of a significant negative relationship between extreme weather events and availability of calories and nutrients for children. In particular, droughts reduced calorie, protein and zinc supply, and overall diet diversity by 67%, 37%, 28% and 30%, respectively. We further traced the effects of this reduced calorie and nutrient availability on child health indicators. A 10% decrease in zinc supply decreased height-for-age z-scores (HAZ) by around 0.139 - 0.164 standard deviations (SD), and increased probability of stunting ranging from 3.1 to 3.5 percentage points. Both boys and girls HAZ and stunting rates were sensitive to nutrient inadequacies. Different coping and adaptation strategies significantly influenced rural households’ ability to safeguard children’s nutrition and health against the effects of extreme weather. The findings of this study provide specific insights for building ex-ante resilience against extreme weather events, particularly when compared to ex-post, unsustainable, and often costlier relief actions.
Emily Injete Amondo, Emmanuel Nshakira‐Rukundo, Alisher Mirzabaev
Nearly half of all deaths among children under five (U5) years in low- and middle-income countries are a result of under nutrition. This study examined the relationship between maternal employment and nutrition status of U5 children in Uganda using the 2016 Uganda Demographic and Health Survey (UDHS) data. We used a weighted sample of 3531 children U5 years born to working women age 15-49. Chi-squared tests and multivariate logistic regressions were used to examine the relationship between maternal employment and nutritional outcomes while adjusting for other explanatory factors. Results show that children whose mothers had secondary education had lower odds of stunting and underweight compared with children whose mothers had no formal education. Children who had normal birth weight had lower odds of stunting, wasting and being underweight compared with children with low birth weight. Children whose mothers engaged in agriculture and manual work had higher odds of stunting compared with those whose mothers engaged in professional work. Additionally, children whose mothers were employed by nonfamily members had higher odds of wasting and being underweight compared with children whose mothers were employed by family members. Other determinants of child nutritional status included region, age of the mother, and age and sex of the child. Interventions aimed at improving the nutritional status of children of employed women should promote breastfeeding and flexible conditions in workplaces, target those of low socio-economic status and promote feeding programs and mosquito net use for both mothers and children.
