Does air pollution increase child mortality? Evidence from 58 developing countries.

This study aims to investigate the effects of air quality on child mortality in developing countries. We consider annual data covering the period from 2010 to 2016 of 58 countries and estimate the empirical models using recently developed panel quantile regression with the method of moments (MM-QR). It is found that outdoor air quality (measured by the concentration of PM2.5 in the air) has a positive and significant effect on total child mortality, post-neonatal mortality, and under-five child mortality. However, its effect on neonatal mortality is not statistically significant at lower quantiles. Furthermore, Household air pollution (HAP) also has a positive and significant effect on total child mortality, neonatal mortality, and under-five child mortality. The effect of HAP on post-neonatal mortality is not significant in most cases. Overall, the adverse effect of HAP is larger than the PM2.5. For instance, a 1% increase of PM2.5 concentration in the outdoor causes 0.231% total child mortality due to respiratory diseases at [Formula: see text], while a 1% increase of HAP causes 0.532% total child mortality at the same quantile. In many cases, the coefficients of PM2.5 and HAP increase at the higher quantiles, supporting asymmetric effects of pollutants on child mortality. However, per capita income, access to basic drinking water and sanitation facilities, and domestic and external health expenditures significantly reduce child mortality. On the contrary, open defecation increases mortality. Consequently, policymakers should take adequate measures to improve indoor and outdoor air quality to combat child mortality due to respiratory diseases in developing countries. They should also take initiatives to enhance per capita income, basic drinking water, and sanitation facilities, domestic and external health expenditures, and public awareness against open defecation.

Rhabdomyosarcoma of the common bile duct mimicking choledochal cyst: a rare cause of obstructive jaundice / 中国当代儿科杂志

Extrahepatic biliary tract tumors are rare and among them rhabdomyosarcoma is most common. Rhabdomyosarcoma is a soft tissue malignant musculoskeletal tumor and is a very rare malignancy of the common bile duct in children. It usually presents as obstructive jaundice and/or pruritus. If there is no local invasion to the adjacent tissues, the radiological appearance of the tumor lesion is like a choledochal cyst. So the diagnosis is usually made at surgery or by preoperative biopsy. It is important to diagnose early and differentiate it from choledochal cyst and start treatment as early as possible for long time survival of the patient. This case report presented a case of a 10-year-old boy with recurrent onset of obstructive jaundice and fever preoperatively who was diagnosed as choledochal cyst and postoperatively as embryonal rhabdomyosarcoma of the common bile duct. After surgical resection and postoperative chemotherapy, the child had a good prognosis. So it is crucial to know that this rare tumor can mimic congenital choledochal cyst and it should be considered in the differential diagnosis of obstructive jaundice in children.

Human Capital Investment and the Gender Division of Labor in a Brawn-Based Economy.

We use a model of human capital investment and activity choice to explain facts describing gender differentials in the levels and returns to human capital investments. These include the higher return to and level of schooling, the small effect of healthiness on wages, and the large effect of healthiness on schooling for females relative to males. The model incorporates gender differences in the level and responsiveness of brawn to nutrition in a Roy-economy setting in which activities reward skill and brawn differentially. Empirical evidence from rural Bangladesh provides support for the model and the importance of the distribution of brawn.

Why does nutrition deteriorate rapidly among children under 2 years of age? Using qualitative methods to understand community perspectives on complementary feeding practices in Bangladesh.

BACKGROUND: Child undernutrition remains high in South Asian and sub-Saharan African countries. Rapid declines in nutritional status occur before the age of 2 years, particularly during the period of complementary feeding. Improving complementary feeding practices is a neglected area in nutrition programs. OBJECTIVE: To understand community perspectives on complementary feeding practices in order to inform the design of future interventions for improved complementary feeding. METHODS: From May through August 2009, data were collected in two rural locations and one urban location in Bangladesh through semistructured interviews, food attributes exercises, 24-hour dietary recalls, opportunistic observations, and trials of improved practices (TIPs). Key informant interviews and focus group discussions were also carried out among family members and community opinion leaders. RESULTS: Lay perceptions about complementary feeding differ substantially from international complementary feeding recommendations. A large proportion of children do not consume sufficient amounts of complementary foods to meet their energy and micronutrient needs. There was a gap in knowledge about appropriate complementary foods in terms of quality and quantity and strategies to convert family foods to make them suitable for children. Complementary feeding advice from family members, peers, and health workers, the importance given to feeding young children, and time spent by caregivers in feeding influenced the timing, frequency, types of food given, and ways in which complementary feeding occurred. CONCLUSIONS: Perceptions and practices related to complementary feeding need to be effectively addressed to improve the levels of child undernutrition. Lack of understanding of children's nutritional needs and insufficient time for feeding children are key barriers to complementary feeding.

Breastfeeding in infancy: identifying the program-relevant issues in Bangladesh.

BACKGROUND: In Bangladesh, many programs and projects have been promoting breastfeeding since the late 1980 s. Breastfeeding practices, however, have not improved accordingly. METHODS: For identifying program-relevant issues to improve breastfeeding in infancy, quantitative data were collected through visits to households (n = 356) in rural Chittagong and urban slums in Dhaka, and qualitative data from sub-samples by applying semi-structured in-depth interviews (n = 42), focus group discussions (n = 28), and opportunistic observations (n = 21). Trials of Improved Practices (TIPs) (n = 26) were conducted in the above sites and rural Sylhet to determine how best to design further interventions. Our analysis focused on five breastfeeding practices recommended by the World Health Organization: putting baby to the breast within the first hour of birth, feeding colostrum and not giving fluids, food or other substances in the first days of life, breastfeeding on demand, not feeding anything by bottle, and exclusive breastfeeding for the first six months. RESULTS: The biggest gaps were found to be in putting baby to the breast within the first hour of birth (76% gap), feeding colostrum and not giving other fluids, foods or substances within the first three days (54% gap), and exclusive breastfeeding from birth through 180 days (90% gap). Lack of knowledge about dangers of delaying initiation beyond the first hour and giving other fluids, foods or substances, and the common perception of "insufficient milk" were main reasons given by mothers for these practices. Health workers had talked to only 8% of mothers about infant feeding during antenatal and immunization visits, and to 34% of mothers during sick child visits. The major providers of infant feeding information were grandmothers (28%). CONCLUSIONS: The findings showed that huge gaps continue to exist in breastfeeding behaviors, mostly due to lack of awareness as to why the recommended breastfeeding practices are beneficial, the risks of not practicing them, as well as how to practice them. Health workers' interactions for promoting and supporting optimal breastfeeding are extremely low. Counseling techniques should be used to reinforce specific, priority messages by health facility staff and community-based workers at all contact points with mothers of young infants.

Apparent efficacy of food-based calcium supplementation in preventing rickets in Bangladesh.

To determine whether increased Ca intakes can prevent rickets in a susceptible group of children living in a rickets-endemic area of Bangladesh, we conducted a 13-month long, double-blind, clinical trial with 1-to 5-year-old children who did not present with rickets but ranked in the upper decile of plasma alkaline phosphatase (AP) activity of a screening cohort of 1,749 children. A total of 158 children were randomized to a milk-powder-based dietary supplement given daily, 6 days/week, and providing either 50, 250, or 500 mg Ca, or 500 mg Ca plus multivitamins, iron, and zinc. Upon initial screening, 194 healthy children presented with no rachitic leg signs and had serum AP in the upper decile (>260 u/dl) of the cohort. When 183 of those subjects were re-screened after a 7-month pre-trial period, 23 (12.6%) had developed rachitic leg signs, suggesting an annual risk of 21.5% in this cohort. Of those still not presenting with leg signs and completing 13 months of dietary intervention, none showed rachitic leg signs, none showed significant radiological evidence of active rickets, and all showed carpal ossification normal for age after that intervention. These results are consistent with even the lowest amount of supplemental Ca (50 mg/day) being useful in supporting normal bone development in this high-risk population.

Estimated nutrient intakes and adequacies in Bangladesh change when newer values for vitamin A, iron and calcium in commonly consumed foods are applied.

A food consumption survey was conducted in rural Bangladesh in January-March 1996 using a 24-h food weighing method. Intakes and adequacies of energy, vitamin A, vitamin C, iron and calcium were estimated for 81 children (aged 24-71 months) and 182 women (aged 18-45 years) using three sets of food composition tables. The local food composition table was modified with newer values for nutrient contents of foods identified as important for the contribution of vitamin A and iron. Significant differences in estimated dietary intakes and adequacies were found for vitamin A and iron when different sets of food composition values were used. This study shows that up-to-date chemical analyses of foods selected on the basis of a high frequency of consumption and a large contribution of the nutrients in focus is a useful approach in improving the quality of food composition tables, resulting in greater accuracy of estimates of nutrient intakes and adequacies.

Rice-based diets in rural Bangladesh: how do different age and sex groups adapt to seasonal changes in energy intake?

BACKGROUND: Seasonality has been recognized as a key determinant of human energy balance, especially in low-income countries. OBJECTIVE: The objective was to test the hypothesis that, in rural Bangladesh, different age and sex groups adapt similarly to seasonal changes in energy intake (EI). DESIGN: A prospective study was carried out in 2 rural Bangladeshi villages in the lean and peak seasons. Data on anthropometric measures (weight, height, and midupper arm circumference) and dietary food intake (collected with the use of a 24-h food weighing method) were obtained from all subjects from 304 households. RESULTS: The average EI increased from a least-squares mean (+/- SE) of 7.87 +/- 0.10 MJ x person(-1) x d(-1) in the lean season to 9.47 +/- 0.13 MJ x person(-1) x d(-1) in the peak season. In children and adolescents aged < 18 y of age, the prevalence of underweight (weight-for-age) was not significantly different (56%) in the 2 seasons. Among adults, a significantly higher prevalence of chronic energy deficiency [body mass index (in kg/m(2)) < 18.5] was observed in the peak season (67%) than in the lean season (61%), despite a higher EI in the peak season. Other determinants of seasonal nutritional status are presented. CONCLUSIONS: Seasonal fluctuations in EI were substantial in all age and sex groups. Children and adolescents showed no significant seasonal changes in the prevalence of underweight, which indicated that they adapted to changes in EI. In adults, the season in which EI was high coincided with average weight loss, which indicated that adults did not adapt fully to seasonal fluctuations in EI and that seasonal energy expenditure is probably a major determinant of nutritional status.