Child marriage among displaced populations - a 2019 study in Kurdistan Region of Iraq.

BACKGROUND: Many of the factors that increase risk of child marriage are common among refugees and internally displaced persons (IDPs). We sought to address the gaps in knowledge surrounding child marriage in displaced and host populations in the Kurdistan Region of Iraq (KRI). METHODS: A multistage cluster sample design was employed collecting data of KRI host communities, Iraqi IDPs, and Syrian refugees. Interviews were conducted in eligible households, requiring at least one adult female and one female adolescent present, addressing views of marriage, demographics and socioeconomic factors. Household rosters were completed to assess WHO indicators, related to child marriage including completed child marriage in females 10-19 and completed risk of previously conducted child marriages in females 20-24. RESULTS: Interviews were completed in 617 hosts, 664 IDPs, and 580 refugee households, obtaining information on 10,281 household members and 1,970 adolescent females. Overall, 10.4% of girls age 10-19 were married. IDPs had the highest percentage of married 10-19-year-old females (12.9%), compared to the host community (9.8%) and refugees (8.1%). Heads of households with lower overall education had higher percentages of child marriage in their homes; this difference in prevalence was most notable in IDPs and refugees. When the head of the household was unemployed, 14.5% of households had child marriage present compared to 8.0% in those with employed heads of household. Refugees and IDPs had larger percentages of child marriage when heads of households were unemployed (refugees 13.1%, IDPs 16.9%) compared to hosts (11.9%). When asked about factors influencing marriage decisions, respondents predominately cited family tradition (52.5%), family honor (15.7%), money/resources (9.6%), or religion (8.0%). Over a third of those interviewed (38.9%) reported a change in influencing factors on marriage after displacement (or after the arrival of refugees in the area for hosts). CONCLUSIONS: Being an IDP in Iraq, unemployment and lower education were associated with an increase in risk for child marriage. Refugees had similar percentages of child marriage as hosts, though the risk of child marriage among refugees was higher in situations of low education and unemployment. Ultimately, child marriage remains a persistent practice worldwide, requiring continued efforts to understand and address sociocultural norms in low socioeconomic and humanitarian settings.

Comparison of a physical activity recall questionnaire with accelerometry in children and adolescents with obesity: a pilot study.

This study aimed to determine the validity of the Habitual Activity Estimation Scale (HAES) for assessing physical activity (PA) in children and adolescents with severe obesity. Data were obtained from participants (n = 17) in the High Impact Strategies Toward Overweight Reduction in Youth study at the Hospital for Sick Children in Toronto. Objective measurement of PA was recorded with accelerometers and interpreted using counts-per-minute (CPM) cut-points developed for children and adolescents. Self-report measurement of PA was collected using the HAES questionnaire. Pearson correlations revealed HAES significantly overestimated average daily duration of vigorous (+48 ± 64 min, p < 0.001) and moderate-light activity (+114 ± 129 min, p < 0.001) but not inactivity (+38 ± 158 min, p = 0.17). This disagreement may be explained by increased perceived exertion in obese participants when performing PA. Thus, the HAES should not be used to assess PA in obese youth. Further work to validate accelerometer CPM cut-points for obese children and adolescents calibrated to energy consumption and perceived exertion during PA in this group is warranted.

Adolescent bariatric surgery: the Canadian perspective.

Canada faces a similar epidemic of obesity in their adolescent population as other Western countries. However, the development of programs to treat obesity and manage its sequelae has evolved in a unique way. This is in part due to differences in health care funding, population distribution, public demand, and availability of expertise and resources. In this article, we will describe the evolution of adolescent bariatric care in Canada and describe the current programs and future directions. The focus will be on the province of Ontario, the site of the first adolescent bariatric program in the country.

Hypothalamic Obesity following Craniopharyngioma Surgery: Results of a Pilot Trial of Combined Diazoxide and Metformin Therapy.

Objective. To assess the effect of combined diazoxide-metformin therapy in obese adolescents treated for craniopharyngioma. Design. A prospective open-label 6-month pilot treatment trial in 9 obese subjects with craniopharyngioma. Diazoxide (2 mg/kg divided b.i.d., maximum 200 mg/day) and metformin (1000 mg b.i.d.). Whole body insulin sensitivity index (WBISI) and area-under-the-curve insulin (AUC(ins)) were calculated. Results. Seven subjects completed: 4M/3F, mean ± SD age 15.4 ± 2.9 years, weight 99.7 ± 26.3 kg, BMI 35.5 ± 5.6 kg/m(2), and BMI SDS 2.3 ± 0.3. Two were withdrawn due to vomiting and peripheral edema. Of participants completing the study, the mean ± SD weight gain, BMI, and BMI SDS during the 6 months were reduced compared to the 6 months prestudy (+1.2 ± 5.9 versus +9.5 ± 2.7 kg, P = .004; -0.3 ± 2.3 versus +2.2 ± 1.5 kg/m(2), P = .04; -0.04 ± 0.15 versus +0.11 ± 0.08, P = .021, resp.). AUC(ins) correlated with weight loss (r = 0.82, P = .02) and BMI decrease (r = 0.96, P = .009). Conclusion. Combined diazoxide-metformin therapy was associated with reduced weight gain in patients with hypothalamic obesity. AUC(ins) at study commencement predicted effectiveness of the treatment.

MEALTRAIN: what do inpatient hospitalized children choose to eat?

Data from the menu ordering system was used to calculate servings/child/day of food groups ordered by pediatric inpatients. The children ordered a mean of 5.0 +/- 0.56 servings of fruits and vegetables/day, which decreased to 3.5 +/- 0.27 servings when juice was removed. "Foods-to-limit" were ordered 3.8 +/- 0.31 times/day. Interventions to improve healthier choices are warranted.

Evaluation of a comprehensive care clinic model for children with brain tumor and risk for hypothalamic obesity.

The objectives of this study were to evaluate outcomes of a comprehensive care clinic (CCC) for children with hypothalamic obesity due to treatment for brain tumors by assessing weight parameters; health-related quality of life (HRQoL); and perception of health status, disease burden, care satisfaction, and physical activity. Thirty-nine patients (16 males) were reviewed. While attending the CCC the median %weight gain and percent ideal body weight (%IBW) of patients was lower (8.5%/year (range -3 to -14) and -4%/year (141.7-34), respectively) than the median %weight gain and %IBW (21.4% (15.8-32.0) and 19.9% (-18.7 to 149.2)) while treated in standard care. Rate of increase in %BMI slowed (4.5 kg/m(2) %/year (-17.8 to 8.4) vs. 8.4 kg/m(2) %/year (-3.1 to 28.1)) in patients attending the clinic compared to their before treatment in standard care. There was no change in blood pressure, fasting glucose, triglycerides or low-density lipoprotein cholesterol, and a significant increase in high-density lipoprotein cholesterol (1.09 +/- 0.33 to 1.24 +/- 0.04). After attending the CCC for a year, significant increases for child reported total HRQoL (63.7 +/- 18.4-71.3 +/- 13.3; P < 0.017), physical functioning (65.3 +/- 15.9-69.5 +/- 15.9; P < 0.045) and school functioning (61.1 +/- 21.0-71.1 +/- 16.5; P < 0.051) were found. Parents reported no significant change in HRQoL over the same period. Parents had significantly improved responses in areas of coordination of health care and understanding of their child's disease. Patients attending the CCC gained less weight while attending the clinic and exhibited improved HRQoL. Parents noticed improvements in various areas of their child's medical care.