Trends of risk factors associated with childhood stunting and anaemia in Ghana: evidence from the Demographic Health Survey and Multiple Indicator Cluster Survey (2003-2017).

OBJECTIVE: This study investigated the trend of effect estimates of the key risk factors of childhood stunting and anaemia between 2003 and 2017. DESIGN: A secondary analysis of the Demographic Health Survey (DHS) and Multiple Indicator Cluster Survey (MICS) data for the Ghanaian population between 2003 and 2017. Associations of selected socio-demographic (child age and gender; maternal age and education), economic (household wealth), environmental, dietary (minimum dietary diversity and iodine use) and health system (place of delivery and vaccination) factors were explored using the Poisson regression model. Trend analysis was explored using a fitted linear regression line on a time series plot. SETTING: Ghana. PARTICIPANTS: Children under 5 years. RESULTS: The results showed a reduction in the prevalence of stunting and anaemia over the 15-year duration. These health outcomes were found to be negatively associated with a wide array of socio-demographic (child age and gender, maternal age and education, residency), economic (household wealth), dietary (iodised salt use) and health service (place of delivery and vaccination) factors; however, the most consistent statistically significant association was observed between child's age and belonging to the poor wealth quintile. CONCLUSION: In order to prevent these indicators of child malnutrition, key consideration must be given to the early developmental stages of life. Child health policies must focus on addressing the key contextual factors of child malnutrition.

Intersectional inequalities in exclusive breastfeeding practices in India: analysis of national family health survey-4.

BACKGROUND: Exclusive breastfeeding in the initial six months of infancy plays a significant role in the physical and cognitive development of the child. One in two children below six months of age in India is not receiving exclusive breastfeeding, with the rates varying considerably between and within states. In this study, we investigated the effect of intersecting inequalities in exclusive breastfeeding practice amongst children below six months in India. METHODS: Data from the fourth National Family Health Survey (NFHS-4) was used for the study. The study used a weighed sample of 211,145 infants below six months. Exclusive breastfeeding practice was assessed based on the previous 24-hours feeding practice of the child. Intersecting social categories were created based on place of residence, religion, wealth index, and mothers' education. A binary logistic regression model was used to explore inequalities in the practice of exclusive breastfeeding based on the intersecting social categories. RESULTS: Exclusive breastfeeding practices varied significantly between the intersecting categories of religion, place of residence, wealth index, and education of the mother. Exclusive breastfeeding practice prevalence was the highest amongst children born in the Urban-Secondary-Poor-Others group (57.9%) and lowest amongst the Rural-Primary-Rich-Others category (34.5). In comparison to children in the most disadvantaged category (Rural-Primary-Poor-Others), children born in the Rural-Secondary-Poor-Others category had the highest odds [OR (odds ratio) 1.213; 95% CI 1.024, 1.437] of being exclusively breastfed, whilst children within the Rural-Primary-Rich-Others category had the lowest odds (OR 0.494; 95% CI 0.345, 0.708). Wide disparities were observed in the odds of engaging in exclusive breastfeeding practice amongst the middle groups than between the most advantaged and the most disadvantaged groups. The inequality indices show varied distribution of exclusive breastfeeding prevalence across the intersecting groups with higher exclusive breastfeeding prevalence noted amongst disadvantaged groups. CONCLUSIONS: The study found that intersecting inequalities in exclusive breastfeeding exist in India. In order to improve exclusive breastfeeding practice, targeted interventions must acknowledge and adopt a comprehensive approach that addresses inherent inequalities resulting from the intersection of various axes of social stratification.

Intraindividual double burden of malnutrition among women (15-49 years) in India, Myanmar, and Nepal: evidence from the recent Demographic and Health Surveys.

BACKGROUND: There is a concurrent increase in anaemia and overweight/obesity among women in the South and South East Asia regions. Despite these, studies on the co-existence of anaemia and overweight/obesity in these countries are abysmally limited. This secondary analysis sought to estimate the burden of the intraindividual double burden of malnutrition (IDBM), i.e., co-existence of anaemia and overweight/obesity among women of reproductive age (15-49 years) in India, Myanmar, and Nepal, and explore the impact of socio-demographic and economic factors on this health outcome. METHODS: A secondary analysis of the Demographic and Health Surveys (DHS) of India (2019-2021), Myanmar (2015-2016), and Nepal (2016) was conducted. A descriptive analysis of the health outcomes and the risk factors was done with frequencies and percentages. The association between selected socio-demographic (women's age, education status, number of children and place of residence) and economic (occupation status, and wealth quintile) variables with IDBM was found with binary logistic regression analysis. RESULTS: Around one in ten women of reproductive age group in India and Myanmar had IDBM. In Nepal, it occurs in one in nearly 15 women. Maternal age, education, household wealth, number of children, place of residence, and occupation were found to be significant predictors of IDBM. CONCLUSION: There is a high prevalence of IDBM in South Asian women and it varies substantially across different socio-demographic and economic predictors. Sufficient evidence from prospective studies is needed to establish causal association and also to implement need-based prevention and curative strategies.

Prevalence of Acute Pesticide Poisoning among Pesticide Applicators in Cardamom Plantations: A Cross-Sectional Study from Idukki District, Kerala.

BACKGROUND: Pesticide poisoning is a burning occupational health issue across the world. The pesticide use in the cardamom plantations of Idukki district, Kerala, India is one of the world's highest. However, limited studies addressed its ill effects on the health of pesticide applicators. AIMS: To assess the magnitude of acute pesticide poisoning (APP) among pesticide applicators and understand the nature of severity based on their occupational characteristics. SETTINGS AND DESIGN: A descriptive cross-sectional study was conducted in 2018. A total of 300 pesticide applicators with minimum 1-year experience (79.3% males) were selected from 30 randomly selected cardamom plantations in Udumbanchola Taluk. METHODS: WHO Field Surveys of Exposure to Pesticides Standard Protocol and Murphy's method of Farmer Self-Surveillance system of pesticide poisoning were used for assessing pesticide exposure and APP, respectively. Statistical analysis used: Descriptive (frequencies) and exploratory statistical analyses (Pearson's Chi-square test) were done using IBM SPSS 23.0. RESULTS: The prevalence of APP in this study was 100% as all the pesticide applicators reported at least one sign and/or symptom of APP. The mild APP was more prevalent (80.7%), followed by moderate (18.7) and severe (0.60). Decrease in duration and frequency of spraying, use of motor pump sprayer, safe storage and disposal of pesticides, and proper personal hygiene were found to reduce the severity of APP. CONCLUSION: All the pesticide applicators in cardamom plantations of Idukki are at risk of APP. It is important to train them about the measures to prevent the same.

The Catch-Up Growth in Stunted Children: Analysis of First and Second India Human Development Survey Data.

CONTEXT: Change in stunting as the children grow older is rarely found in published literature. AIMS: The present paper compares the change in the prevalence of stunting among children as they grow from 0-4 years to 7-11 years. SETTINGS AND DESIGN: The present paper is a secondary analysis of India Human Development Survey-I (IHDS-I) (2005) and IHDS-II (2012) data for Kerala. METHODS AND MATERIALS: In total, 411 children of age 0-4 years and 390 children of age 7-11 years with anthropometric measurements were included in the present study, respectively, from IHDS-I and IHDS-II. STATISTICAL ANALYSIS USED: The statistical analyses were done using SPSS 21.0. The prevalence of stunting was estimated. Bivariate and multivariate analyses were performed using the Pearson Chi-square test. RESULTS: The prevalence of stunting among children has been drastically reduced (50.4% to 20.3%) while growing older from 0-4 years to 7-11 years. CONCLUSIONS: More than half of the stunted children below 5 years regained normal growth, as they grow older.

The double burden of malnutrition: an assessment of 'stunted child and overweight/obese mother (SCOWT) pairs' in Kerala households.

A double burden of malnutrition (DBM) is the coexistence of under-nutrition and over-nutrition in a single household that has been reported from many developing countries. We performed a secondary analysis on India Human Development Survey (IHDS-II) data assessing 'stunted child and overweight/obese mother (SCOWT) pairs' in Kerala households. We included 344 pairs of children below 5 years of age and their mothers, with anthropometric measurements. We also performed the Pearson's Chi-square test to study the association of SCOWT pairs with socio-economic variables. The prevalence of SCOWT pairs was 10.7% for Kerala. The bivariate analysis showed no significant association for SCOWT pairs, irrespective of their socio-economic status. It is clear that the DBM is prevalent in Kerala and cannot be addressed exclusively by policies focusing on over-nutrition.

Nutritional status of Mid-Day Meal programme beneficiaries: A cross-sectional study among primary schoolchildren in Kottayam district, Kerala, India.

BACKGROUND: The efficiency of Mid-Day Meal (MDM) Programme in India to ensure the optimum nutritional status of its beneficiaries is rarely studied. OBJECTIVE: This study assessed the nutritional status of 6-10-year-old schoolchildren who were the beneficiaries of MDM and the child-related factors affecting their nutritional status. METHODS: A cross-sectional study was performed among 322 children from 12 randomly selected primary schools in one block panchayat of Kerala state. The background information was collected from children and their parents, and anthropometric measurements of the children were observed. The prevalence of undernutrition was estimated using conventional indices (stunting, underweight, and wasting) and composite index of anthropometric failure (CIAF). Logistic regression analysis was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: The prevalence of CIAF was 45.7% (95% CI: 40.3%-51.1%) and that of stunting, underweight, and wasting were 13.4% (9.7%-17.1%), 38.8% (33.5%-44.1%), and 30.7% (25.7%-35.7%), respectively. The prevalence of wasting (42.6% vs. 28.4%, P = 0.039) and severe underweight (20.4% vs. 7.1%, P = 0.002) was statistically significantly high among occasional/never users compared to regular users of MDM Programme. Children born with <2.5 kg showed an OR of 1.76 (95% CI: 0.99-3.11) for being undernourished compared to children born with normal weight (≥2.5 kg) when adjusted for age, sex, birth order, and illness in the past 2 weeks. CONCLUSION: This study showed a higher prevalence of undernutrition among school-age children who were the beneficiaries of MDM Programme, and this indicates the need for continuous nutritional interventions and surveillance among these children.

Home-based Palliative Services under Two Local Self-government Institutions of Kerala, India: An Assessment of Compliance with Policy and Guidelines to Local Self-government Institutions.

BACKGROUND: In contrast to India's poor performance in palliative and end-of-life care, the state of Kerala has gained considerable attention for its palliative care (PC) policy. This study tried to understand the structure, organization, and delivery of the program currently offered to the rural population, and its conformity to the state's PC policy and guidelines for Local Self-government Institutions (LSGIs). MATERIALS AND METHODS: A descriptive research design involving a review of Kerala palliative policy and guidelines for LSGIs was followed by direct field observation and interviews of stakeholders. Two LSGIs in rural Kerala served also by a nongovernmental organization (NGO), were selected. Data were collected from health workers (doctors, nurses, and PC nurses), government stakeholders (LSGI members and representatives of the National Health Mission), and the health workers and officials of NGO. RESULTS: The program in two LSGIs varies considerably in terms of composition of the palliative team, infrastructure and human resource, cost, and type of service provided to the community. A comparative assessment with a nongovernmental service provider shows that the services offered by the LSGIs seemed to be restricted in scope to meet the needs of the resource-stricken community. Compliance with policy guidelines seems to be poor for both the LSGIs. CONCLUSIONS: Despite a robust policy, the palliative program lacks a public health approach to end-of-life care. A structural reconfiguration of the delivery system is needed, involving greater state responsibility and political will in integrating PC within a broader social organization of care.