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BACKGROUND: The WHO-UNICEF minimum dietary diversity (MDD) indicator for children aged 6-23 mo is a global monitoring indicator used to track multi-year population-level changes in dietary quality, but the influence of seasonality on MDD estimates remains unclear. OBJECTIVES: To examine how seasonality of data collection may influence population-level MDD estimates and inferences about MDD changes over multiple survey years. METHODS: We selected countries with 3 or more consecutive years of MDD data collection, including continuous national Demographic Health Surveys in Senegal (2012-2017; n = 12,183) and Peru (2005-2016; n = 35,272) and the Policy and Science for Health, Agriculture, and Nutrition sentinel site seasonal surveys (covering 3 seasons/y) in Nepal (2013-2016; n = 1309). The MDD prevalence (≥5 of 8 food groups) and an 8-item continuous Food Group Score (FGS) and 95% CIs were estimated by month and compared for lean and non-lean seasons using ordinary least squares regression with dummy variables for year. RESULTS: The national prevalence of MDD was higher in Peru (75.4%) than in Nepal (39.1%) or in Senegal (15.7%). Children in Peru were 1.8% (coefficient, -0.0179; 95% CI, -0.033 to -0.002) less likely to achieve MDD during the lean season. Similar seasonal magnitudes were observed in Senegal (coefficient, -0.0347; 95% CI, -0.058 to -0.011) and Nepal (coefficient, -0.0133; 95% CI, -0.107 to 0.081). The FGS was about 0.1 item lower during the lean season in all 3 countries. In comparison, MDD increased by an average rate of only 4.2 and 4.4 percentage points per 5 y in Peru and Senegal, respectively. Intakes of specific food groups were stable across months in all countries, with the provitamin A-rich food group exhibiting the most seasonality. CONCLUSIONS: The magnitude of seasonal variation in MDD prevalence was smaller than expected but large relative to longer-term changes. If large-scale surveys are not conducted in the same season, biased conclusions about trends are possible.
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INTRODUCTION: Measuring quality of care in low-income and middle-income countries is complicated by the lack of a standard, universally accepted definition for 'quality' for any particular service, as well as limited guidance on which indicators to include in measures of quality of care, and how to incorporate those indicators into summary indices. The aim of this paper is to develop, characterise and compare a set of antenatal care (ANC) indices for facility readiness and provision of care. METHODS: We created nine indices for facility readiness using three methods for selecting items and three methods for combining items. In addition, we created three indices for provision of care using one method for selecting items and three methods for combining items. For each index, we calculated descriptive statistics, categorised the continuous index scores using tercile cut points to assess comparability of facility classification, and examined the variability and distribution of scores. RESULTS: Our results showed that, within a country, the indices were quite similar in terms of mean index score, facility classification, coefficient of variation, floor and ceiling effects, and the inclusion of items in an index with a range of variability. Notably, the indices created using principal components analysis to combine the items were the most different from the other indices. In addition, the index created by taking a weighted average of a core set of items had lower agreement with the other indices when looking at facility classification. CONCLUSIONS: As improving quality of care becomes integral to global efforts to produce better health outcomes, demand for guidance on creating standardised measures of service quality will grow. This study provides health systems researchers with a comparison of methodologies commonly used to create summary indices of ANC service quality and it highlights the similarities and differences between methods.
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Avaliação de Resultados em Cuidados de Saúde/métodos , Cuidado Pré-Natal , Indicadores de Qualidade em Assistência à Saúde , Haiti , Pesquisas sobre Atenção à Saúde , Humanos , Malaui , Avaliação de Processos e Resultados em Cuidados de Saúde/estatística & dados numéricos , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/organização & administração , Cuidado Pré-Natal/normas , Melhoria de Qualidade/organização & administração , Indicadores de Qualidade em Assistência à Saúde/normas , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/normas , Qualidade da Assistência à Saúde/estatística & dados numéricos , TanzâniaRESUMO
Haiti's national nutrition policy prioritises breastfeeding, but limited data are available to inform strategy. We examined national trends in early initiation of breastfeeding (ErIBF) and exclusive breastfeeding (EBF) over a 10-year period using data from three Haitian Demographic and Health Surveys (1994-1995, 2000 and 2005-2006). We used multivariate regression methods to identify determinants of ErIBF and EBF in the 2005-2006 data set and to examine relationships to growth. There was no change in ErIBF across surveys [1994-1995: 36.6%, 95% confidence interval (CI) 29.9-43.9; 2000: 49.4%, 95% CI 44.1-54.8; 2005-2006: 43.8%, 95% CI 40.5-47.1]. EBF among 0-5-month-olds increased sharply (1994-18995: 1.1%, 95% CI 0.4-3.2; 2000: 22.4%, 95% CI 16.5-29.5; 2005-2006: 41.2%, 95% CI 35.4-47.2). The proportion of breastfeeding children 0-5 months who received soft, solid or semi-solid foods decreased (1994-1995: 68.5%, 95% CI 57.3-77.9; 2000: 46.3%, 95% CI 39.3-53.4; 2005-2006: 30.9%, 95% CI 25.9-36.5). Child age at time of survey [odds ratio (OR) 1.73; P = 0.027], lower maternal education (OR = 2.14, P = 0.004) and residence in the Artibonite Department (OR 0.31; P = 0.001) were associated with ErIBF among children 0-23 months. Age group and department were significant predictors of EBF among children 0-5 months. ErIBF was associated with higher weight-for-age z-scores [effect size (ES) 0.22; P = 0.033] and height-for-age z-scores (ES 0.20; P = 0.044). There was no statistically significant relationship between EBF and growth. The 10-year ErIBF and EBF trends in Haiti echo global and regional trends. ErIBF and EBF are related practices but with different determinants in the Haitian context. These differences have implications for intervention delivery.
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Aleitamento Materno/estatística & dados numéricos , Desenvolvimento Infantil , Inquéritos Epidemiológicos , Adolescente , Adulto , Aleitamento Materno/tendências , Estudos Transversais , Bases de Dados Factuais , Feminino , Haiti , Humanos , Lactente , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Fatores Socioeconômicos , Adulto JovemRESUMO
The Haitian National Nutrition Policy identifies the promotion of optimal complementary feeding (CF) practices as a priority action to prevent childhood malnutrition. We analysed data from the nationally representative 2005-2006 Haiti Demographic Health Survey using the World Health Organization 2008 infant and young child feeding indicators to describe feeding practices among children aged 6-23 months and thus inform policy and programme planning. Multivariate regression analyses were used to identify the determinants of CF practices and to examine their association with child growth outcomes. Overall, 87.3% of 6-8-month-olds received soft, solid or semi-solid foods in the previous 24 h. Minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet (MAD) were achieved in 29.2%, 45.3% and 17.1% of children aged 6-23 months, respectively. Non-breastfed children were more likely to achieve MDD than breastfed children of the same age (37.3% vs. 25.8%; P < 0.001). The proportion of children achieving MMF varied significantly by age (P < 0.001). Children with overweight mothers were more likely to achieve MDD, MMF and MAD [odds ratio (OR) 2.08, P = 0.012; OR 1.81, P = 0.02; and OR 2.4, P = 0.01, respectively] than children of normal weight mothers. Odds of achieving MDD and MMF increased with household wealth. Among mothers with secondary or more education, achieving MDD or MAD was significantly associated with lower mean weight-for-age z-score and height-for-age z-score (P-value <0.05 for infants and young child feeding indicator × maternal education interaction). CF practices were mostly inadequate and contributed to growth faltering among Haitian children 6-23 months old.
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Desenvolvimento Infantil , Fenômenos Fisiológicos da Nutrição do Lactente , Índice de Massa Corporal , Peso Corporal , Aleitamento Materno , Estudos Transversais , Demografia , Comportamento Alimentar , Feminino , Haiti , Inquéritos Epidemiológicos , Humanos , Lactente , Alimentos Infantis , Masculino , Desnutrição/prevenção & controle , Análise Multivariada , Recomendações Nutricionais , Fatores Socioeconômicos , Organização Mundial da SaúdeRESUMO
Between 1995 and 2012, many surveys including child and maternal nutrition indicators were conducted in Haiti. While many questions emerged from the results of those surveys, they have remained unanswered, in particular as they pertain to the determinants of poor children's and women's nutrition in Haiti. The purpose of this paper is to fill that gap and provide policymakers, program managers, and readers interested in nutrition issues in Haiti with information on (1) the trends and determinants of infant and young child feeding and food practices; (2) micronutrient deficiencies among children and women; (3) the status of severe acute malnutrition in children; (4) associations among women's empowerment, access to health care, water, and sanitation and child nutrition; (5) the current community-based early child care and nutrition initiatives; and (6) the status of nutrition governance in the country. By looking at many sources of data, including previously published and new data, we provide insight into major predictors of child malnutrition and associations among child feeding practices, maternal nutrition, and child growth outcomes. We also show that important progress has been made recently in the governance of nutrition programs and in child and maternal nutrition indicators, a result of effective evidence-based advocacy, partnerships, and design, implementation, and scale-up of nutrition-specific and sensitive interventions.
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Fenômenos Fisiológicos da Nutrição Infantil , Fenômenos Fisiológicos da Nutrição Materna , Adolescente , Adulto , Criança , Transtornos da Nutrição Infantil/epidemiologia , Pré-Escolar , Feminino , Haiti/epidemiologia , Humanos , Lactente , Estudos Longitudinais , Desnutrição/epidemiologia , Pessoa de Meia-Idade , Estado Nutricional , Adulto JovemRESUMO
INTRODUCTION: To our knowledge, there was no record of Vibrio cholerae in Haiti until the 2010 post earthquake outbreak. METHODOLOGY: This study describes the analysis of 301 stool samples from 117 infants in Port-au-Prince, Haiti, who participated in a pediatric nutrition study between July 2008 and October 2009. RESULTS: Nine samples were identified positive with both SYBR Green and Taqman-MGB probe based molecular assays targeting V. cholerae hlyA and toxR, respectively (Ct = 33-40), but none were O1 or O139. CONCLUSIONS: Our results from multiple molecular assays demonstrate the presence of non-O1/O139 V. cholerae DNA in stools collected from nine asymptomatic Haitian infants two years prior to the 2010 earthquake.
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Cólera/epidemiologia , Cólera/microbiologia , Terremotos , Vibrio cholerae não O1/isolamento & purificação , DNA Bacteriano/genética , Fezes/microbiologia , Feminino , Haiti/epidemiologia , Humanos , Lactente , Masculino , Sondas de Oligonucleotídeos/genética , Vibrio cholerae não O1/classificação , Fatores de Virulência/genéticaRESUMO
Undernutrition, a chief child killer in developing countries, has been a major public health problem in Haiti. Following the 2010 disasters (earthquake and cholera) and the intensive relief efforts to address them, we sought to determine the trends of child undernutrition in Haiti using data from the 2005-06 Haiti Demographic and Health Survey (HDHS) and from a Standardized Monitoring and Assessment of Relief and Transitions (SMART) survey in 2012. Growth data analyses included 2,463 (HDHS) and 4,727 (SMART) children ages 0-59 months. We calculated the prevalence of stunting, wasting, and underweight for each survey using World Health Organization 2006 growth standards. To account for sampling design, probability weights were applied to all analyses. Statistical significance was determined by non-overlapping confidence intervals around estimates. Stunting prevalence declined from 28.5% (95% confidence interval [CI]â=â25.9, 31.3) in 2005-06 to 22.2% (95% CIâ=â20.2, 24.3) in 2012; wasting, from 10.1% (95% CIâ=â8.2, 12.7) to 4.3% (95% CIâ=â3.6, 5.2); and underweight, from 17.7 % (95% CIâ=â15.6, 20.1) to 10.5% (95% CIâ=â9.3, 11.9). Additionally, stunting declined more in rural areas, from 33.6% (95% CIâ=â30.1, 37.2) in 2005-06 to 25% (95% CIâ=â23.4, 26.7) in 2012, than in urban areas, from 18.6% (95% CIâ=â15.3, 22.5) in 2005-06 to 18.4% (95% CIâ=â16.7, 20.1) in 2012, for reasons that remain unknown. Results of the 2012 HDHS confirmed the observed trends. Thus, undernutrition among Haitian children under 5 declined significantly between 2005-06 and 2012. Our results should be interpreted in view of investments and changes that occurred in different sectors (within and outside health and nutrition) before and after the earthquake.
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BACKGROUND: The Haitian National Nutrition Policy prioritizes prevention and treatment of anemia among mothers and young children, but there are few available data to support planning for scale-up of anemia interventions. OBJECTIVE: To describe the prevalence and predictors of anemia among Haitian women (15 to 49 years) and children (6 to 59 months) and to draw implications for national nutrition programming. METHODS: Descriptive and univariate analyses and multivariate logistic regression models were performed using data from the nationally representative Haitian Demographic Health Survey 2005/06. RESULTS: The prevalence of mild (hemoglobin 11.0 to 11.9 g/dL), moderate (hemoglobin 8.0 to 10.9 g/dL), and severe (hemoglobin < 8.0 g/dL) anemia was 19.2%, 21.7%, and 4.4%, respectively, among women aged 15 to 49 years and 22.9%, 33.9%. and 2.2% among children aged 6 to 59 months. Unexpectedly anemia was more prevalent in urban women (54.4 %) and children (65.1%) than in rural women (43.1%, p < .001) and children (55.7%, p = .004). In multivariate regression models, factors associated with anemia among urban women (birth spacing, p = .027; overweight BMI, p < .001; education level, p = .022) were different from those in rural women (wealth quintile, p < .05; employment, p = .003). Anemia in urban and rural children aged 6 to 59 months increased with child age (p < .05) and maternal anemia status (p = .004; p < .001). Female sex (p = .007) and maternal overweight (p = .009) were associated with reduced risk of anemia in rural children only. CONCLUSIONS: Anemia among Haitian young children and women of childbearing age is a severe public health problem. The findings suggest the need for context-specific rural and urban strategies, reinforcement of anemia prevention in health services reaching women of childbearing age, and targeted interventions for young children.
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Anemia/epidemiologia , Adolescente , Adulto , Anemia/diagnóstico , Anemia/prevenção & controle , Intervalo entre Nascimentos/estatística & dados numéricos , Índice de Massa Corporal , Pré-Escolar , Escolaridade , Feminino , Haiti/epidemiologia , Hemoglobinas/análise , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Política Nutricional , População Rural , População Urbana , Adulto JovemRESUMO
The integration of nutrition support for infants of HIV-infected mothers is a recognized need; however, the evidence for effective programmatic solutions is weak. The objective of our study was to implement and evaluate a new infant feeding support intervention for HIV-exposed, uninfected, non-breast-fed infants 6-12 mo of age attending the Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO) pediatric clinic in Port-au-Prince, Haiti. The 24-wk intervention included a lipid-based nutrient supplement, education, promotion of existing clinical services, and social support. We compared growth outcomes among intervention participants (n = 73) at start (wk 0) and end (wk 24) of intervention to a historical control group of HIV-exposed infants seen at the GHESKIO in the year prior to the intervention who would have met the intervention entrance criteria (n = 294). The intervention and historical control groups did not differ significantly at age 6 mo (wk 0). At age 12 mo (wk 24), the intervention group had a lower prevalence of underweight and stunting than the historical control group (weight-for-age Z-score < -2 SD: 6.8 vs. 20.8%, P = 0.007; length-for-age Z-score < -2 SD: 9.6 vs. 21.2%, P = 0.029). Wasting tended to be lower in the intervention group than the historical control (weight-for-length Z-score < -2 SD: 2.9 vs. 8.9%, P = 0.11). Implementation of the intervention was associated with reduced risk of growth faltering in HIV-exposed uninfected children from 6 to 12 mo of age. This is a promising intervention model that can be adapted and scaled-up to other HIV care contexts.