Ophthalmologists' Perspective on Barriers to Cataract Surgery and Surgical Productivity in Ethiopia, Ghana, and Zambia: A Descriptive, Mixed-Methods Survey.

PURPOSE: While progress was made towards the Vision 2020: The Right to Sight goals, Ethiopia, Ghana, and Zambia fell short of the recommended cataract surgical rate (CSR) on a national level. Post-operative cataract surgical outcomes are also lower compared to other regions. This study aimed to describe perceived barriers to cataract surgical uptake, factors related to surgeon surgical productivity, and surgical offerings in each of these countries. METHODS: An online survey was sent to ophthalmologists practicing in Ethiopia, Ghana, and Zambia. Responses were collected between June 25, 2021 and January 30, 2022. RESULTS: Responses were received from 122 ophthalmologists from Ethiopia, Ghana, and Zambia. The estimated participation rate was 47% (122/257). Distance to cataract surgical centres, lack of surgical centres, and lack of surgical equipment were among the top 10 most agreed upon barriers by respondents within each country. Many respondents reported that current financial reimbursement does not incentivise maximum productivity in themselves (56%, 68/122) or their staff (61%, 74/122). Surgeons proposed several ways to improve productivity incentives. Private practice was perceived to have the best reimbursement incentives (77%, 94/122), whereas government hospitals were least agreed upon (4%, 5/122). Discrepancies in timely post-operative refraction and eyeglasses disbursement were reported. CONCLUSIONS: Overcoming the identified barriers, improving surgeon productivity, and addressing identified deficits in cataract care will likely reduce the backlog of cataract blindness while ensuring increasingly improved patient outcomes.

The Impact of a Large-Scale Social and Behavior Change Communication Intervention in the Lake Zone Region of Tanzania on Knowledge, Attitudes, and Practices Related to Stunting Prevention.

BACKGROUND: Large-scale social and behavioral change communication (SBCC) approaches can be beneficial to achieve improvements in knowledge, attitudes, and practices (KAP). Addressing Stunting in Tanzania Early (ASTUTE) included a significant SBCC component and targeted precursors to stunting including KAP related to maternal and child health, antenatal care, WASH, childhood development, and male involvement. METHODS: Baseline, midline, and endline surveys were conducted for a total of 14,996 female caregivers and 6726 male heads of household in the Lake Zone region of Tanzania. Regression analyses were used to estimate differences in KAP from baseline to midline and endline. RESULTS: Women's knowledge of handwashing and infant/child feeding practices, and attitudes related to male involvement, consistently improved from baseline to midline and baseline to endline. Women's practices related to antenatal care, breastfeeding, and early child development improved from baseline to midline and baseline to endline. Improvements in KAP among male heads of household were varied across indicators with consistent improvement in practices related to child feeding practices from baseline to midline and baseline to endline. CONCLUSION: Many changes in KAP were observed from baseline to midline and baseline to endline and corresponded with SBCC programming in the region. These results provide support for the value of large SBCC interventions. Public health efforts in settings such as Tanzania may benefit from adopting these approaches.

A National Communications Campaign to decrease childhood stunting in Tanzania: an analysis of the factors associated with exposure.

BACKGROUND: Childhood stunting is a major problem in Tanzania, affecting an estimated 2.7 million children under 5 years of age. The purpose of this study was to examine the factors associated with exposure to mass media (radio and television) and IPC (interpersonal communication) components integrated in a national communications campaign aiming to decrease stunting in Tanzania. METHODS: A cross-sectional survey was conducted among 3082 men and 4996 women dyads after the campaign. The average age of men was 34.7 years (SD = 8.9) and 28.1 years (SD = 6.9) for women. Several factors affecting exposure to the campaign were studied. Comparisons were made between radio, TV, and IPC exposure. RESULTS: Mothers who reported i) higher wealth, ii) being the primary decision-makers in the home, iii) receiving support from their husbands, iv) frequent access to radio and TV and, v) ownership of a cell phone, were more likely to report exposure to the mass media component of the communications campaign. Contrarily, the same factors were not predictors of exposure to the IPC component. Fathers who reported: i) higher wealth and education, ii) ownership of a cell phone, iii) recently listened to the radio, iv) that the mother made the decisions in the home and v) helping at home, were more likely to be exposed to the mass media component. CONCLUSION: Significant factors affecting exposure to the communications campaign were varied but not consistent between mass media and IPC. Because of the high frequency of exposure to the campaign overall, both media and IPC components are important in a large-scale, health-related communications campaign.

Tanzanian men's engagement in household chores is associated with improved antenatal care seeking and maternal health.

BACKGROUND: Male support for partners' antenatal care (ANC) has the potential to improve women's care-seeking and maternal health outcomes. This study describes factors that are associated with men's involvement in household tasks and explores the relationship between men's help with tasks and women's ANC-seeking, diet and workload during pregnancy as well as other health behaviors. METHODS: This study was conducted in five Lake Zone regions of Tanzania. Cross-sectional surveys were carried out among approximately 10,000 households that had children under the age of 2 years. Surveys were administered to mothers of children less than 2 years and where available, their male partners. Data were collected between December 2015 and May 2020, in conjunction with a large-scale campaign aimed at reducing childhood stunting by changing the behavior of mothers, caregivers, and decision makers. Data analysis included bivariate analysis and logistic regression modeling. RESULTS: Men's engagement in household activities was significantly associated with living in an urban setting, being younger, having at least some formal schooling, early verbal interactions with their children, and male involvement in healthcare decisions. Additionally, mothers of male partners that were engaged in household activities were significantly older and more likely to have at least some secondary school education. Relative to households where men only infrequently helped out with chores or not at all, women from households where men frequently helped were significantly more likely to have taken iron tablets during pregnancy, report having eaten more than usual, lessening their household workload during their most recent pregnancy, and more likely to have played with their child in the week prior to the survey. CONCLUSION: Male's participation in household tasks is associated with a general improvement in mother's ANC behaviors. Implicit in these findings is that general primary education for both men and women has health benefits that transcend socioeconomic class and that future interventions aimed to engage males in household tasks may target older males with less education living in rural areas.

National Nutrition Communication Campaign in Indonesia: a cross-sectional study of factors associated with exposure.

BACKGROUND: Reducing childhood stunting continues to be a priority in Indonesia. In 2015, the National Nutrition Communication Campaign (NNCC) implemented mass media and interpersonal communication (IPC) interventions to disseminate stunting-related information. Whereas other studies of the NNCC's impact on attitudes and behaviors are currently underway, the purpose of this study was to better understand the factors associated with exposure to the media and IPC components of the NNCC. METHODS: A cross-sectional survey was conducted following the NNCC media and IPC campaigns in rural Indonesia. The final study sample included 1734 mothers. Survey data was collected from each participant by trained interviewers using an electronic tablet. Responses relating to demographic and socioeconomic factors, use of social media and WhatsApp, and electronic device ownership were analyzed. Logistic regression analyses, using SAS version 9.4, were conducted to evaluate the relationship between technology-related items and exposure to both the media and the IPC interventions. RESULTS: Owning an internet device (OR = 1.643, CI = 1.237-2.183, p < 0.001), accessing social media (OR = 1.81, CI = 1.32-2.49, p < 0.001), using a device to access health information (OR = 2.068, CI = 1.469-2.911, p < 0.0001), and accessing WhatsApp (OR = 1.663, CI = 1.175-2.355, p < 0.05) were positively related to exposure to NNCC messages meant to change behavior to decrease stunting. In separate analyses, owning an internet device (OR = 0.609, CI = 0.459-0.81, p < 0.001) accessing social media (OR = 0.626, CI = 0.459-0.854, p < 0.05), using a device to access health information (OR = 0.528, CI = 0.377-0.740, p < 0.001), and accessing WhatsApp (OR = 0.688, CI = 0.489-0.968, p < 0.05) were negatively related to IPC exposure. Mothers with access to internet-accessible devices were more likely to be exposed to the media campaign component to decrease stunting while mothers without access to internet-accessible devices were more likely to be exposed through IPC. CONCLUSIONS: Mothers who owned devices that could access the internet were more likely to have been exposed to the media campaign component to decrease stunting by behavior change but were less likely to participate in IPC activities. The opposite was true for mothers who did not have access to internet-accessible devices. These findings may be used to inform future community health efforts in rural Indonesia and similar regions that may be considering the use of both mass media and interpersonal interventions to influence health behaviors in order to decrease stunting.

Health facility-based counselling and community outreach are associated with maternal dietary practices in a cross-sectional study from Tanzania.

BACKGROUND: Anemia and underweight among women are major public health challenges. Access to health services can improve dietary behaviors and women's nutritional status. We examined whether exposure to health services is associated with women's dietary practices in Tanzania. METHODS: Data come from a cross-sectional baseline survey among 5000 female primary caregivers who were randomly selected via two-stage sampling, prior to implementing a maternal and child nutrition program. We ran frequencies on women's exposure to existing health facility-based counselling, community health worker visits, and attendance at women's support groups. We examined associations between exposure to these interventions and maternal diets and adjusted for sociodemographic covariates using ordinary least squares regression and ordered logistic regression. RESULTS: A third of the sample (34.1%) had received any antenatal care (ANC) during their most recent pregnancy or had been advised by anyone about nutrition (37.0%). 68.0% had never had a community health worker (CHW) speak to them about their children's health and 9.4% had participated in a women's group. Only 8.0% of mothers ate more than usual during pregnancy and 7.1% ate more types of foods. After adjusting for mother's age, education and household assets, women who received nutrition advice were 1.3 times (95% CI: 1.1, 1.7) more likely than mothers who did not to eat more during pregnancy. Receiving antenatal care (ANC) and advice on nutrition before, during, and after pregnancy and delivery were highly associated with the mother eating more types of foods. Hearing from a CHW about children's health but not support group attendance was often associated with various dietary practices. Almost all measures of access to health services were significantly associated with mothers' frequency of eating in the previous 24 h. Receiving advice on nutrition during pregnancy and after giving birth and CHW contact were associated with mothers' dietary diversity in the previous 24 h. CONCLUSIONS: Several program exposure variables-especially being counselled about nutrition-were associated with improved dietary practices. Improving service delivery at scale may contribute to improved dietary behaviors in larger populations, given the associations we describe, along with findings from the existing literature.

Understanding female and male empowerment in Burkina Faso using the project-level Women's Empowerment in Agriculture Index (pro-WEAI): a longitudinal study.

BACKGROUND: Achieving gender equality and women's empowerment is a major global priority. The purpose of this study was to determine whether the Building the Resilience of Vulnerable Communities in Burkina Faso (BRB) project, an agricultural development program, improved women's empowerment, as measured by the project-level Women's Empowerment in Agriculture Index (pro-WEAI). METHODS: This study used a longitudinal, quasi-experimental study design. Participants included both treatment and comparison groups (total N = 751) comprising female members of savings groups and their husbands or main male household member in Burkina Faso. All participants completed the pro-WEAI questionnaire at both baseline and endline. The treatment group received a comprehensive intervention package consisting of agriculture loans and services, microenterprise loans, and education, nutrition education, and women's empowerment programs including gender-based discussions designed to facilitate personalized changes in gender relations. RESULTS: The proportion of the treatment group achieving empowerment did not change from baseline for women, but improved substantially for men. Women from the comparison group saw an increase in empowerment at endline while men saw a substantial decrease. Gender parity was high for women in both groups at baseline and increased slightly at endline. Women were more likely to have adequate empowerment in input in productive decisions, group membership, and membership in influential groups than men while men were more likely to have adequate empowerment in attitudes about domestic violence, control over use of income, and work balance than women. Participants from the treatment group reported an increase in the average number of empowerment indicators that they were adequate in while the comparison group saw a decrease in average adequacy over time (p = 0.002) after controlling for age, sex, and level of education. CONCLUSION: Despite starting at an empowerment disadvantage, the treatment group experienced gains in individual indicators of empowerment while the comparison group men and women experienced mixed results, with the women gaining, and the men losing empowerment. This research suggests that the BRB intervention may have provided some protection for the treatment group when they faced an economic down-turn prior to the endline, indicative of household resilience. Future research should consider and strengthen relationships between resilience and empowerment.

Association between WASH-Related Behaviors and Knowledge with Childhood Diarrhea in Tanzania.

BACKGROUND: Diarrhea remains a major cause of morbidity and mortality among children in Tanzania. The purpose of this study was to explore associations between diarrheal disease and water, sanitation, and hygiene (WASH) related behaviors and determine care-seeking predictors for diarrheal disease. METHODS: Data from 9996 female primary caregivers were collected as part of a larger integrated nutrition program. Logistic regression was used to measure associations between predictor and dependent variables and diarrheal and care-seeking outcomes. RESULTS: Knowledge of the importance of handwashing after assisting a child who has defecated (OR 0.79, CI 0.72-0.87), before preparing food (OR 0.88, CI 0.80-0.97), and before feeding a child (OR 0.89, CI 0.81-0.99) were each associated with not having a child with diarrhea in the past two weeks. Fathers or male caregivers (OR 0.65, CI 0.48-0.89) were less likely to seek medical care for a child with diarrhea. No associations were found between WASH-related knowledge or behavior and seeking medical care for a child with diarrhea. CONCLUSIONS: Findings indicate that knowledge of handwashing importance was significant in washing hands after assisting a child who has defecated, before preparing food, and prior to feeding a child. These findings demonstrate the value of parental involvement to lower morbidity and mortality among children.

Use of Technology to Access Health Information/Services and Subsequent Association With WASH (Water Access, Sanitation, and Hygiene) Knowledge and Behaviors Among Women With Children Under 2 Years of Age in Indonesia: Cross-sectional Study.

BACKGROUND: Water access, sanitation, and hygiene (WASH) remain a public health concern in Indonesia. Proper WASH practices can decrease risk of stunting, wasting, and disease in children under the age of 2. OBJECTIVE: The purpose of our study is to examine if using technology to access health information and services among Indonesian women affects knowledge and behaviors regarding handwashing and defecation practices. METHODS: Our study is an interview-based cross-sectional survey. Participants included 1734 mothers of children under 2 years of age. These women were randomly selected and interviewed as part of a 3-stage cluster sampling technique. Our study uses data regarding WASH knowledge which includes benefits of handwashing with soap, 5 critical times of handwashing, risks of open defecation, media of disease transmission, defecation locations, and risks of open defecation. Data regarding WASH behaviors were also included: handwashing with soap, type of latrine used at home, and where defecation took place. This investigation used adjusted and unadjusted logistic and linear regression models to determine differences in WASH outcomes between those who use technology to access health information and services and those who did not. RESULTS: One result is that Indonesian women with children under 2 years of age who use technology to access health information and services are more likely to know the advantages of proper handwashing (odds ratio [OR] 2.603, 95% CI 1.666-4.067) and know the 5 critical times of handwashing (OR 1.217, 95% CI 0.969-1.528). Women who use technology to access health information are also more likely to know the risks of open defecation (OR 1.627, 95% CI 1.170-2.264) and use a type of toilet (such as a gooseneck or squat toilet) that limits risk (OR 3.858, 95% CI 2.628-5.665) compared to women who did not use technology to access health information. CONCLUSIONS: Using technology to access health information and services was associated with an increase in handwashing and defecation knowledge. In the future, promoting mothers of children under 2 years of age to access health information through technology might be used to increase handwashing and defecation knowledge as well as safe defecation practices. However, further research should be done to determine how technology may increase the frequency of recommended handwashing behaviors.

Interpersonal communication campaign promoting knowledge, attitude, intention, and consumption of iron folic acid tablets and iron rich foods among pregnant Indonesian women.

BACKGROUND AND OBJECTIVES: Indonesia's community health delivery system offers services such as prenatal care and supplementation. Despite accessibility to these services, compliance with supplementation is low, and childhood stunting rates remain high. To address undernutrition, a National Nutrition Communication Campaign (NNCC) - using interpersonal communication (IPC) strategies - was implemented to promote consumption of iron-folic acid (IFA) supplements and iron-rich foods (ATIKA). The purpose of this study was to understand how participation in IPC activities influenced knowledge, attitude/intention, and consumption of IFA supplements and ATIKA among pregnant Indonesian women. METHODS AND STUDY DESIGN: Cross-sectional data came from 766 pregnant women that participated in a survey that was based on the constructs from the Theory of Planned Behavior and Health Belief Model. Adjusted linear and logistic regression models were conducted to analyze the differences between self-reported IPC participants and non-IPC participants. Approximately 20% of women were exposed to the IFA portion of the IPC campaign, and 18% were exposed to the ATIKA portion. RESULTS: Women that were exposed to the campaign reported significantly higher knowledge of IFA tablets and ATIKA, and improved attitudes/intentions towards IFA, compared to non-exposed women. Exposure was not associated with actual consumption behaviors. CONCLUSIONS: These findings suggest that exposure to a low-intensity intervention can increase knowledge but may not be sufficient to impact behavior. As such, future efforts to reduce stunting through improved maternal nutrition should seek to increase exposure, address barriers, understand perceived susceptibility, and improve self-efficacy in order to expand intervention reach in Indonesia.

An interpersonal nutrition campaign and maternal knowledge and childhood feeding practices: a case study from mothers in rural Indonesia.

BACKGROUND: The purpose of this study was to examine the extent to which a national nutrition communication campaign (NNCC) intervention providing interpersonal communication (IPC) was associated with improved knowledge and behaviors related to feeding practices among mothers with children under two years of age in rural Indonesia. METHODS: Data came from a follow-up, cross-sectional survey of 1734 mothers. Key outcomes of interest were minimum meal frequency, minimum dietary diversity and minimum acceptable diet, as defined by the World Health Organization. Associations between exposure to the NNCC intervention and infant and young child feeding (IYCF) knowledge and behaviors were analyzed using adjusted linear and logistic regression, controlling for age, education, and income. RESULTS: A total of 525 mothers reported exposure to IPC interventions (30.3%). Participation in IPC was associated with increased knowledge of feeding practices (p < .0001). Separately, knowledge of feeding practices was related to achieving recommended behavioral practices of minimum meal frequency (p = 0.019), dietary diversity (p = 0.013), adequate diet (p < .001). CONCLUSION: These findings underscore the value of increasing maternal knowledge of IYCF practices through IPC interventions as a way to improve behavioral practices and address stunting in rural Indonesia.

Are Household Expenditures on Food Groups Associated with Children's Future Heights in Ethiopia, India, Peru, and Vietnam?

Household expenditure surveys, routinely conducted in low-and middle-income countries (LMICs), usually include questions pertaining to recent household expenditures on key food groups. When child anthropometrics are also available, such expenditure data can provide insights into household food purchasing patterns that are associated with subsequent child growth measures. We used data from 6993 children, born around 2001, from Ethiopia, India, Peru, and Vietnam, from the Young Lives younger cohort. We compared associations between two weeks of household food expenditures (in PPP-Purchasing Power Parity adjusted dollars) on food groups and child height-for-age-Z score (HAZ) at subsequent time points to assess longitudinal associations. Total food expenditures, rural/urban residence, maternal and paternal schooling, and child sex were included in our adjusted models because they may affect the relations between household food group expenditures and future child HAZ. In Ethiopia, India, and Peru every extra PPP$ spent on fats was associated with 0.02-0.07 higher future HAZ. In Vietnam every extra PPP$ spent on starches, was significantly associated with a 0.01 lower future HAZ. Across countries, different patterns of food expenditure and procurement may be differentially critical for predicting child HAZ. Our results demonstrate how expenditures on specific food groups can be associated with children's linear growth. This study provides additional evidence of the utility of longitudinal household food expenditure data in understanding child nutritional status.

A National Communication Campaign in Indonesia Is Associated with Improved WASH-Related Knowledge and Behaviors in Indonesian Mothers.

Background: Water, sanitation, and hygiene (WASH) behaviors play a significant role in stunting. Knowledge and behaviors regarding WASH among caregivers are critical to providing children with chances to survive and thrive. The purpose of this study is to determine if exposure to a national communication campaign using media and interpersonal communication (IPC) is associated with WASH-related knowledge and behaviors among Indonesian mothers with children under the age of two. Methods: Data came from a cross-sectional survey of 1734 mothers with children under the age of two. The measures included exposure to two different interventions: media messages (media) and interpersonal communication strategies (IPC) and WASH-related knowledge and behavior. Multiple logistic regression was used to examine the association between intervention exposure and study variables. Results: Exposure to both media and IPC interventions was associated with participants having a higher knowledge of appropriate defecation practices (p < 0.001), higher knowledge of proper handwashing practices (p < 0.001), and higher self-reported handwashing at critical times (p < 0.001) but was not associated with reported practicing of appropriate defecation (OR = 0.780, 95% CI: 0.566-1.101). Mothers exposed to only media interventions were more likely to have knowledge of appropriate defecation practices (p < 0.001) and to have reported practicing appropriate defecation behaviors (OR = 1.539, 95% CI: 1.173-2.019). Mothers exposed to only IPC interventions were more likely to have reported handwashing at critical times (p = 0.009). Conclusions: Exposure to both media and IPC interventions was associated with increased knowledge and optimal behaviors related to WASH. These findings demonstrate the value of communications campaigns that use mass media coupled with IPC to improve WASH knowledge and behavior.

Pedal-Assist Mountain Bikes: A Pilot Study Comparison of the Exercise Response, Perceptions, and Beliefs of Experienced Mountain Bikers.

BACKGROUND: Mountain biking is an aerobic physical activity that has experienced rapid growth. The emergence of the electric pedal-assist mountain bike (eMTB), while not without its critics, presents the potential for an even larger segment of the population to enjoy the health benefits of mountain biking. Although the research focused on the use of e-bikes generally is growing, there is limited research specifically targeting eMTB use. Research is needed exploring the potential exercise response of riding an eMTB, together with the beliefs and perceptions of mountain bikers who have and have not experienced eMTB riding. OBJECTIVE: This study aimed to compare conventional mountain bike and eMTB use. This was done by investigating 2 questions: (1) What proportion of exercise response is retained for an experienced mountain biker while using an eMTB when compared with a conventional mountain bike? and (2) What are the perceptions and beliefs of experienced mountain bikers toward eMTBs both before and after riding an eMTB? METHODS: A convergent mixed methods data collection approach was used in the study. Participants completed both a pre- and postride questionnaire, and data regarding heart rate were collected. Heart rates from each ride were compared against each other. RESULTS: The average heart rate during eMTB use was 94% (31/33) of the average heart rate during conventional mountain bike use. Therefore, eMTB use in this study achieved a majority of the exercise response and exceeded established biometric thresholds for cardiovascular fitness. Paired t test statistics were calculated to compare beliefs of conventional mountain bikes and eMTBs and to compare mean heart rate and speed between conventional mountain bike and eMTB use on the study loop. Participants overwhelmingly perceived the potential impact of eMTB use to be positive on both pre- and post-eMTB ride questionnaires. CONCLUSIONS: Despite the measured benefit, participants' perceived exertion while riding the eMTB was low.

Media Access is Associated with Knowledge of Optimal Water, Sanitation and Hygiene Practices in Tanzania.

The importance of water, sanitation and hygiene (WASH) behaviors in low- and middle-income countries in preventing childhood illness is well established. Tanzania is known to have high rates of chronic malnutrition and childhood stunting-both of which have been linked to poor WASH practices. Interviews were conducted with 5000 primary caregivers of children aged 0-23 months. Four composite WASH knowledge variables were created to assess the relationship between WASH knowledge and access to different forms of media, such as television, radio, and mobile phones. WASH knowledge variables measure knowledge of when to wash hands, the need for soap when washing hands, when to wash a baby's hands, and how eating soil or chicken feces can affect a baby's health. Logistic and linear regression analyses were conducted to measure the association between media access and WASH knowledge. Having watched television was positively associated with higher WASH knowledge indicators (all p < 0.05). Higher WASH knowledge was positively associated with more frequent handwashing after cleaning a baby's bottom (all p < 0.0001). The quantity of media access also had a positive linear effect on handwashing; more media items owned was associated with increases in handwashing. Study findings indicate media access is associated with WASH knowledge among caregivers in resource-poor settings.

Maternal Employment Status and Minimum Meal Frequency in Children 6-23 Months in Tanzania.

As women in developing world settings gain access to formal work sectors, it is important to understand how such changes might influence child nutrition. The purpose of this paper is to examine the relationship between maternal employment status and minimum meal frequency (MMF) among children in Tanzania. Interviews were conducted with 5000 mothers of children ages 0⁻23 months. The questionnaire used in these interviews was developed by adopting questions from Tanzania's latest Demographic and Health Survey (2015⁻2016) where possible and creating additional questions needed for programmatic baseline measurements. MMF was used as proxy for child nutrition. Logistic regression analyses were used to identify associations between employment status and parenting practices of Tanzanian mothers and MMF of their children. After adjusting for confounders, informal maternal employment [OR = 0.58], lack of financial autonomy [OR = 0.57] and bringing the child with them when working away from home [OR = 0.59] were negatively associated with meeting MMF. Payment in cash [OR = 1.89], carrying food for the child [OR = 1.34] and leaving food at home for the child [OR = 2.52] were positively associated with meeting MMF. Informal maternal employment was found to be negatively associated with meeting MMF among Tanzanian children. However, behaviors such as bringing or leaving prepared food, fiscal autonomy and payment in cash showed significant positive associations. These findings could help direct future programs to reduce child stunting.

Increasing Active Transportation Through E-Bike Use: Pilot Study Comparing the Health Benefits, Attitudes, and Beliefs Surrounding E-Bikes and Conventional Bikes.

BACKGROUND: The emergence of electric pedal-assist bicycles (e-bikes) presents an opportunity to increase active transportation by minimizing personal barriers of engaging in physical activity. OBJECTIVES: The aim of this study was to assess the beliefs of individuals using e-bikes for active transport and report preliminary biometric measurements while using e-bikes for physical activity compared with conventional bikes. METHODS: Participants used both conventional bicycles and e-bikes to compare energy expenditure while riding on the study route. Apple smart watches were used to track each participant's heart rate, distance, speed, and time while riding both bicycles. A total of 3 survey instruments were used to estimate beliefs: one administered before riding the bicycles, a second administered after riding a conventional bike, and the final survey completed after riding an e-bike. Survey instruments were constructed using constructs from the theory of planned behavior. RESULTS: The study sample (N=33) included adults aged between 19 and 28 years. Paired t test analysis revealed that participants believed a conventional bike was more likely than an e-bike to benefit their physical health (P=.002) and save them money (P=.005), while an e-bike was perceived to be more likely than a conventional bike to save them time (P<.001). Paired t test analysis revealed participants significantly agreed more with the statement that they could ride an e-bike most days (P=.006) compared with a conventional bike. After participants traveled approximately 10 miles on each type of bicycle, participants' mean average heart rate while riding the e-bike was 6.21 beats per minute lower than when riding the conventional bike (P=.04), but both were significantly higher than resting heart rate (P<.001). CONCLUSIONS: This pilot study suggests that e-bikes are an active form of transportation capable of providing much of the cardiovascular health benefits obtained during conventional bike use. E-bikes may help reduce some of the obstacles to conventional bike use, such as increased transportation time, decreased convenience, and physical fatigue.

Linear Growth through 12 Years is Weakly but Consistently Associated with Language and Math Achievement Scores at Age 12 Years in 4 Low- or Middle-Income Countries.

Background: Whether linear growth through age 12 y is associated with language and math achievement at age 12 y remains unclear. Objective: Our objective was to investigate associations of linear growth through age 12 y with reading skill, receptive vocabulary, and mathematics performance at age 12 y in 4 low- or middle-income countries (LMICs). Methods: We analyzed data from the Young Lives Younger Cohort study in Ethiopia (n = 1275), India (n = 1350), Peru (n = 1402), and Vietnam (n = 1594). Age 1, 5, 8, and 12 y height-for-age z scores (HAZ) were calculated. Language and math achievement at age 12 y was assessed with the use of country-specific adaptations of the Peabody Picture Vocabulary Test, the Early Grades Reading Assessment, and a mathematics test; all test scores were standardized by age within country. We used path analysis to examine associations of HAZ with achievement scores. Twelve models were examined at each age (3 tests across 4 countries). Results: Mean HAZ in each country was <-1.00 at all ages. Overall, linear growth through age 12 y was associated with 0.4-3.4% of the variance in achievement scores. HAZ at 1 y was positively and significantly associated with the test score in 11 of the 12 models. This association was significantly mediated through HAZ at 5, 8, and 12 y in 9 of the models. HAZ at 5, 8, and 12 y was positively and significantly associated with test scores in 8, 8, and 6 models, respectively. These associations were mediated through HAZ at older ages in 6 of the HAZ at 5-y models and in 6 of the HAZ at 8-y models. Conclusion: Child relative linear growth between ages 1 and 12 y was weakly but consistently associated with language and math achievement at age 12 y in 4 LMICs.

Mental and Emotional Self-Help Technology Apps: Cross-Sectional Study of Theory, Technology, and Mental Health Behaviors.

BACKGROUND: Mental and emotional self-help apps have emerged as potential mental illness prevention and treatment tools. The health behavior theory mechanisms by which these apps influence mental health-related behavior change have not been thoroughly examined. OBJECTIVE: The objective of this study was to examine the association between theoretical behavior change mechanisms and use of mental and emotional self-help apps and whether the use of such apps is associated with mental health behaviors. METHODS: This study utilized a cross-sectional survey of 150 users of mental or emotional health apps in the past 6 months. Survey questions included theory-based items, app engagement and likeability items, and behavior change items. Stata version 14 was used to calculate all statistics. Descriptive statistics were calculated for each of the demographic, theory, engagement, and behavior variables. Multiple regression analysis was used to identify factors associated with reported changes in theory and separately for reported changes in actual behavior after controlling for potentially confounding variables. RESULTS: Participants reported that app use increased their motivation, desire to set goals, confidence, control, and intentions to be mentally and emotionally healthy. Engagement (P<.001) was positively associated with the reported changes in theory items, whereas perceived behavior change was positively associated with theory (P<.001), engagement (P=.004), frequency of use of apps (P=.01), and income (P=.049). CONCLUSIONS: Participants reported that app use increased their motivation, desire to set goals, confidence, control, and intentions to be mentally and emotionally healthy. This increase in perceptions, beliefs, and attitudes surrounding their mental and emotional health was considerably associated with perceived change in behavior. There was a positive association between the level of engagement with the app and the impact on theory items. Future efforts should consider the value of impacting key theoretical constructs when designing mental and emotional health apps. As apps are evaluated and additional theory-based apps are created, cost-effective self-help apps may become common preventative and treatment tools in the mental health field.

Intergenerational Transmission of Poverty and Inequality: Parental Resources and Schooling Attainment and Children's Human Capital in Ethiopia, India, Peru, and Vietnam.

Academic and policy literatures on intergenerational transmissions of poverty and inequality suggest that improving schooling attainment and income for parents in poor households will lessen poverty and inequality in their children's generation through increased human capital accumulated by their children. However, magnitudes of such effects are unknown. We use data on children born in the 21st century in four developing countries to simulate how changes in parents' schooling attainment and consumption would affect poverty and inequality in both the parent's and their children's generations. We find that increasing minimum schooling or income substantially reduces poverty and inequality in the parent's generation, but does not carry over to reducing poverty and inequality substantially in the children's generation. Therefore, while reductions in poverty and inequality in the parents' generation are desirable in themselves to improve welfare among current adults, they are not likely to have large impacts in reducing poverty and particularly in reducing inequality in human capital in the next generation.