Parental tobacco and indoor secondhand smoking exposure and the risk of offspring under‐five mortality in low‐ and middle‐income countries

Indoor Air ◽  
2021 ◽  
Author(s):  
Han Wu ◽  
Jiahong Sun ◽  
Bo Xi
Keyword(s):  
Middle Income ◽  
Under Five ◽  
Middle Income Countries ◽  
Secondhand Smoking ◽  
Smoking Exposure ◽  
Low And Middle Income

scholarly journals Hierarchical disentanglement of contextual from compositional risk factors of diarrhoea among under-five children in low- and middle-income countries

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Adeniyi Francis Fagbamigbe ◽  
A. Olalekan Uthman ◽  
Latifat Ibisomi
Keyword(s):  
Risk Factors ◽  
National Level ◽  
Cross Sectional ◽  
Middle Income ◽  
Contextual Risk ◽  
Under Five ◽  
Factors Associated ◽  
Under Five Children ◽  
Middle Income Countries ◽  
Low And Middle Income

AbstractSeveral studies have documented the burden and risk factors associated with diarrhoea in low and middle-income countries (LMIC). To the best of our knowledge, the contextual and compositional factors associated with diarrhoea across LMIC were poorly operationalized, explored and understood in these studies. We investigated multilevel risk factors associated with diarrhoea among under-five children in LMIC. We analysed diarrhoea-related information of 796,150 under-five children (Level 1) nested within 63,378 neighbourhoods (Level 2) from 57 LMIC (Level 3) using the latest data from cross-sectional and nationally representative Demographic Health Survey conducted between 2010 and 2018. We used multivariable hierarchical Bayesian logistic regression models for data analysis. The overall prevalence of diarrhoea was 14.4% (95% confidence interval 14.2–14.7) ranging from 3.8% in Armenia to 31.4% in Yemen. The odds of diarrhoea was highest among male children, infants, having small birth weights, households in poorer wealth quintiles, children whose mothers had only primary education, and children who had no access to media. Children from neighbourhoods with high illiteracy [adjusted odds ratio (aOR) = 1.07, 95% credible interval (CrI) 1.04–1.10] rates were more likely to have diarrhoea. At the country-level, the odds of diarrhoea nearly doubled (aOR = 1.88, 95% CrI 1.23–2.83) and tripled (aOR = 2.66, 95% CrI 1.65–3.89) among children from countries with middle and lowest human development index respectively. Diarrhoea remains a major health challenge among under-five children in most LMIC. We identified diverse individual-level, community-level and national-level factors associated with the development of diarrhoea among under-five children in these countries and disentangled the associated contextual risk factors from the compositional risk factors. Our findings underscore the need to revitalize existing policies on child and maternal health and implement interventions to prevent diarrhoea at the individual-, community- and societal-levels. The current study showed how the drive to the attainment of SDGs 1, 2, 4, 6 and 10 will enhance the attainment of SDG 3.

PP124 Health Technology Assessment And Feedback For Healthy Workplace Culture In Malaria Care In Low And Middle Income Countries

2018 ◽  
Vol 34 (S1) ◽  
pp. 114-114
Author(s):  
Patrick Okwen ◽  
Raphael Cheabum ◽  
Etienne Che ◽  
Joy Ngwemsi Mbunu ◽  
Miriam Nkangu
Keyword(s):  
Workplace Culture ◽  
Evidence Based ◽  
Middle Income ◽  
Mortality And Morbidity ◽  
Children Under Five ◽  
Under Five ◽  
Middle Income Countries ◽  
Percent Improvement ◽  
Evidence Based Care ◽  
Low And Middle Income

Introduction:Malaria is a leading cause of mortality and morbidity in children under five in low and middle income countries (LMICs). Management of malaria in children under five years of age is challenging. One challenge faced by clinical practice in LMICs is lack of evidence to guide practice. This challenge is further compounded by different training backgrounds of team members. In the management of malaria in Cameroon, conflicts usually arise between clinicians, lab technicians and pharmacists resulting in over diagnosis and treatment of malaria. The patient's view is usually not considered. This leads to over diagnosis and over prescriptions for malaria in children under five years of age.Methods:We used the Joanna Briggs Institute (JBI) approach of getting research into practice to organize stakeholder meetings, assess existing evidence in malaria care, develop evidence criteria for management based on levels of evidence, assess the gamut of care for malaria, provide feedback to clinicians and re-assess practice. We used the JBI practical application of clinical evidence system (PACES) and getting research into practice (GRiP) evidence implementation tools in the process to facilitate teamwork, collaboration on evidence and provide feedback.Results:A collaborative approach to assessments and feedback including all healthcare stakeholders significantly improved workplace culture of evidence-based care and staff-to-staff relationships as well as staff-to-patient relationships. Over a period of twelve months, we reported eighty-four percent fewer conflicts between staff and ninety-eight percent fewer conflicts between staff and patients. For malaria management, overall criteria showed a thirty-one percent improvement in compliance with best practice recommendations with evidence levels of Grade 1.Conclusions:The project demonstrated that local leadership and evidence-based care can significantly improve practice in resource limited settings.

scholarly journals Secondhand Smoking and Obesity Among Nonsmoking Adolescents Aged 12–15 Years From 38 Low- and Middle-Income Countries

2020 ◽  
Vol 22 (11) ◽  
pp. 2014-2021
Author(s):  
Ai Koyanagi ◽  
Lee Smith ◽  
Hans Oh ◽  
Lin Yang ◽  
Sarah E Jackson ◽  
...  
Keyword(s):  
Secondhand Smoke ◽  
Child Growth ◽  
Cross Sectional ◽  
Middle Income ◽  
Daily Exposure ◽  
Middle Income Countries ◽  
Secondhand Smoking ◽  
Country Study ◽  
Meta Analyses ◽  
Low And Middle Income

Abstract Introduction Secondhand smoking (SHS) may be a risk factor for obesity in adolescence, but data on the association between SHS and obesity are scarce, especially from low- and middle-income countries (LMICs). Therefore, the aim of this study was to assess the association between SHS and obesity among adolescents aged 12–15 years from 38 LMICs. Methods Cross-sectional data from 38 LMICs that participated in the Global School-based Student Health Survey (GSHS) were analyzed. Body mass index was calculated based on measured weight and height. The 2007 WHO Child Growth reference was used to define obesity. SHS was categorized as no exposure, non-daily exposure (ie, 1–6 days), and daily exposure (ie, 7 days) based on the number of days exposed to secondhand smoke in the past 7 days. Multivariable logistic regression and meta-analyses were conducted to assess the associations. Results The analyzed sample consisted of 88 209 adolescents aged 12–15 years who never smoked. The overall prevalence of non-daily and daily SHS was 34.2% and 15.7%, respectively. After adjustment for potential confounders, compared with no SHS, there was no significant association between non-daily SHS and obesity (odds ratio [OR] = 0.94; 95% confidence interval [CI] = 0.86–1.02), but adolescents who reported daily SHS were significantly more likely to have obesity (OR = 1.19; 95% CI = 1.06–1.34). Conclusions The prevalence of SHS was high among adolescents in LMICs, and daily SHS was associated with a significant increase in odds of obesity. Future studies with longitudinal designs are warranted to assess causality and whether prevention of SHS can reduce the risk of obesity in adolescence. Implications In the present large multi-country study on adolescents aged 12–15 years from LMICs, nearly half of the students were exposed to non-daily or daily secondhand smoke. Overall, while non-daily SHS was not significantly associated with obesity, adolescents who reported daily SHS had a significant 1.19 (95% CI = 1.06–1.34) times higher odds of obesity than those who reported no exposure to secondhand smoke. To the best of our knowledge, this is the first multi-country study on SHS and obesity from LMICs, and also the largest study on this topic to date.

scholarly journals Incidence and etiology of clinically-attended, antibiotic-treated diarrhea among children under five years of age in low- and middle-income countries: evidence from the Global Enteric Multicenter Study

2020 ◽  
Author(s):  
Joseph A Lewnard ◽  
Elizabeth T Rogawski McQuade ◽  
James A Platts-Mills ◽  
Karen L Kotloff ◽  
Ramanan Laxminarayan
Keyword(s):  
Multicenter Study ◽  
Incidence Rates ◽  
Sub Saharan Africa ◽  
Molecular Diagnostic ◽  
Middle Income ◽  
Children Under Five ◽  
Under Five ◽  
Middle Income Countries ◽  
Stool Specimens ◽  
Low And Middle Income

Background: Diarrhea is a leading cause of antibiotic consumption among children in low- and middle-income countries. While vaccines may prevent diarrhea infections for which children often receive antibiotics, the contribution of individual enteropathogens to antibiotic use is minimally understood. We used data from the Global Enteric Multicenter Study (GEMS) to estimate pathogen-specific incidence of antibiotic-treated diarrhea among children under five years old residing in six countries of sub-Saharan Africa and South Asia before rotavirus vaccine implementation. Methods and findings: GEMS was an age-stratified, individually-matched case-control study. Stool specimens were obtained from children presenting to sentinel health clinics with newly-onset, acute diarrhea (including moderate-to-severe and less-severe diarrhea) as well as matched community controls without diarrhea. We used data from conventional and quantitative molecular diagnostic assays applied to stool specimens to estimate the proportion of antibiotic-treated diarrhea cases attributable to each pathogen. Antibiotics were administered or prescribed to 9,606 of 12,109 moderate-to-severe cases and 1,844 of 3,174 less-severe cases. Across all sites, incidence rates of clinically-attended, antibiotic-treated diarrhea were 12.2 (95% confidence interval: 9.0-17.8), 10.2 (7.4-13.9) and 1.9 (1.3-3.0) episodes per 100 child-years at risk at ages 6 weeks to 11 months, 12-23 months, and 24-59 months, respectively. Based on the recommendation for antibiotic treatment to be reserved for cases with dysentery, we estimated a ratio of 12.6 (8.6-20.8) inappropriately-treated diarrhea cases for each appropriately-treated case. Rotavirus, adenovirus serotypes 40/41, Shigella, sapovirus, Shiga toxin-producing Escherichia coli, and Cryptosporidium were the leading antibiotic-treated diarrhea etiologies. Rotavirus caused 29.2% (24.5-35.2%) of antibiotic-treated cases, including the largest share in both the first and second years of life. Shigella caused 14.9% (11.4-18.9%) of antibiotic-treated cases, and was the leading etiology at ages 24-59 months. Conclusions: Our findings should inform the prioritization of vaccines with the greatest potential to reduce antibiotic exposure among children.

scholarly journals Decomposing the educational inequalities in the risk factors of severe acute malnutrition among under-five children in low and middle-income countries

2019 ◽  
Author(s):  
Adeniyi Francis Fagbamigbe ◽  
Ngianga- Bakwin Kandala ◽  
Olalekan Uthman
Keyword(s):  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Educational Inequalities ◽  
Middle Income ◽  
Under Five ◽  
Under Five Children ◽  
Middle Income Countries ◽  
Individual Household ◽  
The Individual ◽  
Low And Middle Income

Abstract Background Low- and Middle-income countries (LMIC) are still plagued with the burden of severe acute malnutrition (SAM). While studies have identified factors that influence SAM, efforts have not been made to decompose the educational inequalities across the individual, neighbourhood and national levels in LMIC. This study aims to decompose educational-related inequalities in the prevalence of SAM across LMIC.Methods We pooled successive secondary data from the Demographic and Health Survey (DHS) conducted between 2010 and 2018 in 51 LMIC. We analysed data of 532,680 under-five children nested within 55,823 neighbourhoods. Severe acute malnutrition was the outcome variable while the literacy status of mothers (literate vs illiterate) was the main exposure variable. The explanatory variables cut across the individual-, household and neighbourhood-level factors of the mothers-children pair. Oaxaca-Blinder decomposition method was used to analyse the educational gap in the factors associated with SAM.Results Mothers with no formal education ranged from 0.1% in Armenia and Kyrgyz to as much as 86.1% in Niger. The overall prevalence of SAM in the group of children whose mothers had no education was 5.8% compared with 4.2% among those whose mothers were educated. Thirteen countries had statistically significant pro-illiterate inequality (i.e. SAM concentrated among uneducated mothers) while none of the countries showed statistically significant pro-literate inequality. There were variations in the important factors responsible for the educational inequalities across the countries. On average, neighbourhood socioeconomic status disadvantage, location of residence were the most important factors in most countries. Other contributors to the explanation of educational inequalities are birth weight, maternal age and toilet type.Conclusions We identified that SAM is prevalent in most LMIC with wide educational inequalities. The occurrence of SAM was explained by the individual, household and community-level factor. A potential strategy to reduce the burden of SAM to reduce educational inequalities among mothers in the low- and middle-income countries through the promotion of women education.

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