The geo-spatial distribution of childhood diarrheal disease in West Africa, 2008-2013: A covariate-adjusted cluster analysis.

Diarrhea is a major cause of morbidity and mortality among children in West Africa. To determine whether there are areas of heightened risk and if so, how they may be influenced by household and climatic variables, we describe the geo-spatial distribution of childhood diarrhea in ten countries of West Africa for the period 2008-2013 using data from Demographic and Health Surveys. The purely spatial scan statistic was applied, where the observed diarrhea cases were modeled as a Poisson variable and were compared to expected cases predicted from non-spatial logistic regression. Covariate-adjusted cluster analysis detected statistically significant clusters (p < 0.05) in ten cities and thirteen largely rural areas. Areas with particularly high relative risk included Cotonou, Benin (7.16), and Kaduna, Nigeria (7.21). The study demonstrates the importance of development and adaptation measures to protect child health, and that these interventions should be tailored to meet the needs of specific populations.

The impact of the Boko Haram insurgency in Northeast Nigeria on childhood wasting: a double-difference study.

BACKGROUND: This research examines the relationship between violent conflict and childhood wasting in Northeast Nigeria, where residents have been subjected to fighting between the Nigerian government and Boko Haram - an extremist Islamist movement - since 2009. METHODS: Using two Demographic and Health Surveys from before and after the Boko Haram insurgency started, a double-difference (difference-in-difference) approach is used to assess the impact of the conflict on mean weight-for-height z-scores and the likelihood of wasting. RESULTS: Results suggest that if children exposed to the conflict had not been exposed, their mean weight-for-height z-score would be 0.49 standard deviations higher (p < 0.001) than it is, increasing from - 0.74 to - 0.25. Additionally, the likelihood of wasting would be 13 percentage points lower (mean z-statistic - 4.2), bringing the proportion down from 23% to 10%. CONCLUSION: Descriptive evidence suggests that poor child health outcomes in the conflict areas of Northeast Nigeria may be due to disruptions to social services and increased food insecurity in an already resource poor area. Although other unidentified factors may contribute to both conflict and wasting, the findings underscore the importance of appropriate programs and policies to support children in conflict zones.

Connectedness, social support and internalising emotional and behavioural problems in adolescents displaced by the Chechen conflict.

The study investigated factors associated with internalising emotional and behavioural problems among adolescents displaced during the most recent Chechen conflict. A cross-sectional survey (N=183) examined relationships between social support and connectedness with family, peers and community in relation to internalising problems. Levels of internalising were higher in displaced Chechen youth compared to published norms among non-referred youth in the United States and among Russian children not affected by conflict. Girls demonstrated higher problem scores compared to boys. Significant inverse correlations were observed between family, peer and community connectedness and internalising problems. In multivariate analyses, family connectedness was indicated as a significant predictor of internalising problems, independent of age, gender, housing status and other forms of support evaluated. Sub-analyses by gender indicated stronger protective relationships between family connectedness and internalising problems in boys. Results indicate that family connectedness is an important protective factor requiring further exploration by gender in war-affected adolescents.