Impact of maternal mental health interventions on child-related outcomes in low- and middle-income countries: a systematic review and meta-analysis.

AIMS: Observational studies have shown a relationship between maternal mental health (MMH) and child development, but few studies have evaluated whether MMH interventions improve child-related outcomes, particularly in low- and middle-income countries. The objective of this review is to synthesise findings on the effectiveness of MMH interventions to improve child-related outcomes in low- and middle-income countries (LMICs). METHODS: We searched for randomised controlled trials conducted in LMICs evaluating interventions with a MMH component and reporting children's outcomes. Meta-analysis was performed on outcomes included in at least two trials. RESULTS: We identified 21 trials with 28 284 mother-child dyads. Most trials were conducted in middle-income countries, evaluating home visiting interventions delivered by general health workers, starting in the third trimester of pregnancy. Only ten trials described acceptable methods for blinding outcome assessors. Four trials showed high risk of bias in at least two of the seven domains assessed in this review. Narrative synthesis showed promising but inconclusive findings for child-related outcomes. Meta-analysis identified a sizeable impact of interventions on exclusive breastfeeding (risk ratio = 1.39, 95% confidence interval (CI): 1.13-1.71, ten trials, N = 4749 mother-child dyads, I2 = 61%) and a small effect on child height-for-age at 6-months (std. mean difference = 0.13, 95% CI: 0.02-0.24, three trials, N = 1388, I2 = 0%). Meta-analyses did not identify intervention benefits for child cognitive and other growth outcomes; however, few trials measured these outcomes. CONCLUSIONS: These findings support the importance of MMH to improve child-related outcomes in LMICs, particularly exclusive breastfeeding. Given, the small number of trials and methodological limitations, more rigorous trials should be conducted.

Alcohol use and intimate partner violence among women and their partners in sub-Saharan Africa.

BACKGROUND: Alcohol use is a well-documented risk factor for intimate partner violence (IPV); however, the majority of research comes from high-income countries. METHODS: Using nationally representative data from 86 024 women that participated in the Demographic and Health Surveys, we evaluated the relationship between male partner alcohol use and experiencing IPV in 14 countries in sub-Saharan Africa (SSA). Using multilevel mixed-effects models, we calculated the within-country, between-country, and contextual effects of alcohol use on IPV. RESULTS: Prevalence of partner alcohol use and IPV ranged substantially across countries (3-62 and 11-60%, respectively). Partner alcohol use was associated with a significant increase in the odds of reporting IPV for all 14 countries included in this analysis. Furthermore, the relationship between alcohol use and IPV, although largely explained by partner alcohol use, was also attributable to overall prevalence of alcohol use in a given country. The partner alcohol use-IPV relationship was moderated by socioeconomic status (SES): among women with a partner who used alcohol those with lower SES had higher odds of experiencing IPV than women with higher SES. CONCLUSIONS: Results of this study suggest that partner alcohol use is a robust correlate of IPV in SSA; however, drinking norms may independently relate to IPV and confound the relationship between partner alcohol use and IPV. These findings motivate future research employing experimental and longitudinal designs to examine alcohol use as a modifiable risk factor of IPV and as a novel target for treatment and prevention research to reduce IPV in SSA.

Phytoremediation of small-scale oil spills in fresh marsh environments: a mesocosm simulation.

Research was conducted to assess the impact of oiling on fresh-marsh plant communities and to test the efficacy of techniques that may be used to enhance the bioremediation of crude oil spills in these environments while minimizing secondary anthropogenic impacts. To emulate field conditions, a mesocosm facility was used that houses 120 mesocosm vessels, each of 200-1 capacity. A five-way factorial treatment arrangement was used that included two substrates (inorganic, organic), two nutrient regimes (fertilized, not fertilized), two aeration levels (substrate aeration, no aeration), three oiling concentrations (0-, 5-, 10-1 m(-2) of South Louisiana Sweet Crude oil), and four vascular plant species (Alternanthera philoxeroides, Panicum hemitomon, Phragmites australis, Sagittaria lancifolia, and an unplanted control). Under the 5- and 10-1 m(-2) oiling concentrations, S. lancifolia displayed a short-term response of increased productivity, whereas P. hemitomon had the highest biomass production and photosynthetic rates at the end of the 18-month experiment. Overall plant growth and productivity, as well as oil degradation, were significantly higher in the inorganic substrate, indicating that biodegradation of oil spills in organic substrates may require a longer time period. Time-released fertilizer also stimulated plant productivity and resulted in higher soil respiratory quotients, suggestive of greater microbial activity, particularly in aerated mesocosms. The amount of oil remaining after 18 months was lowest in aerated and fertilized mesocosms containing either P. hemitomon or S. lancifolia and a substrate of low organic matter content.

Effect of exercise on lipid metabolism and dietary intake in hemodialysis patients.

In conclusion, a 10 wk exercise conditioning program in stable chronic hemodialysis patients resulted in improved exercise endurance without apparent adverse effects on nutritional status or lipid metabolism. Changes were observed suggesting a beneficial effect on carbohydrate and bone metabolism. The exercise-induced rise in serum creatinine may reflect an increase in muscle mass.