RESUMO
BACKGROUND: If effective interventions are to be used to address child mortality and malnutrition, then it is important that we understand the different pathways operating within the framework of child health. More attention needs to be given to understanding the contribution of social influences such as intimate partner violence (IPV). AIM: To investigate the relationship between maternal exposure to IPV and child mortality and malnutrition using data from five developing countries. METHODS: Population data from Egypt, Honduras, Kenya, Malawi and Rwanda were analysed. Logistic regression analysis was used to generate odds ratios of the associations between several categories of maternal exposure to IPV since the age of 15 and three child outcomes: under-2-year-old (U2) mortality and moderate and severe stunting (<-2 Z-score height-for-age and <-3 Z-score height-for-age) in 6-59-month-old children. Analyses were adjusted for potential confounders, and the role of mediating factors was explored. RESULTS: The prevalence of physical and/or sexual IPV since the age of 15 years ranged from 15.5% (Honduras) to 46.2% (Kenya). For child stunting, prevalence ranged from 25.4% (Egypt) to 58.0% (Malawi) and for U2 mortality from 3.6% (Honduras) to 15.2% (Rwanda). In Kenya, maternal exposure to IPV was associated with higher U2 mortality (adjusted odds ratio (OR)=1.42, 95% CI 1.18 to 1.71) and child stunting (adjusted OR=1.36, 95% CI 1.16 to 1.61). In Malawi and Honduras, marginal associations were observed between IPV and severe stunting and U2 mortality, respectively, with strength of associations varying by type of violence. CONCLUSION: The relationship between IPV and U2 mortality and stunting in Kenya, Honduras and Malawi suggests that, in these countries, IPV plays a role in child malnutrition and mortality. This contributes to a growing body of evidence that broader public health benefits may be incurred if efforts to address IPV are incorporated into a wider range of maternal and child health programmes; however, the authors highlight the need for more research that can establish temporality, use data collected on the basis of the study's objectives, and further explore the causal framework of this relationship using more advanced statistical analysis.
Assuntos
Mortalidade da Criança , Transtornos da Nutrição Infantil/epidemiologia , Violência Doméstica , Adolescente , Adulto , África/epidemiologia , Pré-Escolar , Violência Doméstica/estatística & dados numéricos , Feminino , Inquéritos Epidemiológicos , Honduras/epidemiologia , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Razão de Chances , Adulto JovemRESUMO
OBJECTIVE: To compare differences in child nutritional status and the prevalence of wasting, stunting, and underweight between the new World Health Organization (WHO) standards based on healthy optimally fed children from different cultures and the international National Centre for Health Statistics (NCHS)/WHO references using empirical data from the first round of a longitudinal panel study. MATERIALS AND METHODS: Three cross-sectional data sets from the Young Lives longitudinal study were analysed from India (Andhra Pradesh state), Peru, and Vietnam. Around 2000, children between 6 and 17.9 months old from each country were weighed and measured. Mean z scores for weight-for-length, weight-for-age, and length-for-age-and the prevalence of wasting, stunting, and underweight-were calculated using the new WHO growth standards and compared with the results calculated using NCHS/WHO references. RESULTS: Compared with the NCHS reference, the mean weight-for-length and weight-for-age z scores for all countries were higher, and the mean length-for-age z scores were similar, using the WHO standards. The mean z score for weight-for-age was closer to zero, compared with NCHS, in all 3 countries, indicating that the WHO standard curves better reflect the pattern of ponderal growth in these populations. Using WHO standards, wasting was more prevalent in India and Peru but less prevalent in Vietnam. In all 3 countries a higher proportion of children were stunted and fewer children classified as underweight. CONCLUSIONS: Using the new WHO standards resulted in differences in mean z scores for weight-for-length and weight-for-age and changes in the prevalence of wasting, stunting, and underweight. The direction and magnitude of difference are not consistent.
Assuntos
Transtornos da Nutrição Infantil/diagnóstico , Crescimento , Transtornos da Nutrição do Lactente/diagnóstico , Estado Nutricional , Organização Mundial da Saúde , Fatores Etários , Estatura/fisiologia , Peso Corporal/fisiologia , Transtornos da Nutrição Infantil/epidemiologia , Fenômenos Fisiológicos da Nutrição Infantil , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Índia/epidemiologia , Lactente , Transtornos da Nutrição do Lactente/epidemiologia , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido , Estudos Longitudinais , Masculino , Peru/epidemiologia , Prevalência , Valores de Referência , Vietnã/epidemiologiaRESUMO
BACKGROUND: Nearly four million children die during the first four weeks of life every year, yet known and effective interventions exist. Neonatal mortality has to be addressed to reach the millennium development goal for child survival. AIMS: To determine the extent of within-country inequities in neonatal mortality and effective intervention coverage. METHODS: Neonatal, infant and child (under 2 years) mortality rates were calculated from empirical data from Demographic and Health Surveys for eight countries using direct estimation techniques. Wealth groups were constructed using the World Bank wealth index; neonatal mortality inequities were evaluated by comparing low:high quintile ratios; concentration indices were calculated for intervention coverage rates. RESULTS: The proportion of under-2 deaths occurring in the neonatal period ranged from 24.3% (Malawi) to 49.4% (Bangladesh). In all countries (excluding Haiti) inequities in neonatal mortality and intervention coverage were evident across wealth groups with more deaths and less coverage in the poorest, compared with the richest, quintile; the largest mortality differential was 2.1 (Nicaragua) and the smallest was 1.2 (Eritrea). In Nicaragua 33% of the poorest women had a skilled delivery compared with 98% of the richest; in Cambodia for antenatal care this was 18% (poorest) and 71% (richest). Low coverage of interventions tended to show top inequity patterns whereas high coverage tended to show bottom inequity patterns. CONCLUSIONS: Reducing inequity is a necessary step in reducing neonatal deaths and also total child deaths. Intervention efforts need to begin to integrate approaches relevant to equity in programme design, implementation, monitoring and evaluation.
Assuntos
Mortalidade Infantil , Vigilância da População/métodos , África/epidemiologia , Ásia/epidemiologia , Comparação Transcultural , Parto Obstétrico/normas , Países em Desenvolvimento , Feminino , Haiti/epidemiologia , Acessibilidade aos Serviços de Saúde , Humanos , Lactente , Recém-Nascido , Nicarágua/epidemiologia , Cuidado Pós-Natal/métodos , Pobreza , Cuidado Pré-Natal/métodos , Classe Social , Fatores Socioeconômicos , Toxoide Tetânico/uso terapêuticoRESUMO
BACKGROUND: In most low-income countries, several child-survival interventions are being implemented. We assessed how these interventions are clustered at the level of the individual child. METHODS: We analysed data from Bangladesh, Benin, Brazil, Cambodia, Eritrea, Haiti, Malawi, Nepal, and Nicaragua. A co-coverage score was obtained by adding the number of interventions received by each child (including BCG, diphtheria-pertussis-tetanus, and measles vaccines), tetanus toxoid for the mother, vitamin A supplementation, antenatal care, skilled delivery, and safe water. Socioeconomic status was assessed through principal components analysis of household assets, and concentration indices were calculated. FINDINGS: The percentage of children who did not receive a single intervention ranged from 0.3% (14/5495) in Nicaragua to 18.8% (1154/6144) in Cambodia. The proportions receiving all available interventions varied from 0.8% (48/6144) in Cambodia to 13.3% (733/5495) in Nicaragua. There were substantial inequities within all countries. In the poorest wealth quintile, 31% of Cambodian children received no interventions and 17% only one intervention; in Haiti, these figures were 15% and 17%, respectively. Inequities were inversely related to coverage levels. Countries with higher coverage rates tended to show bottom inequity patterns, with the poorest lagging behind all other groups, whereas low-coverage countries showed top inequities with the rich substantially above the rest. INTERPRETATION: The inequitable clustering of interventions at the level of the child raises the possibility that the introduction of new technologies might primarily benefit children who are already covered by existing interventions. Packaging several interventions through a single delivery strategy, while making economic sense, could contribute to increased inequities unless population coverage is very high. Co-coverage analyses of child-health surveys provide a way to assess these issues.