Trends and patterns of stunted only and stunted-underweight children in Malawi: A confirmation for child nutrition practitioners to continue focusing on stunting.

Aim: To analyse the trends and patterns of stunted only and stunted-underweight children in Malawi between the 2000 and 2015. Methods: The study used the 2000 and 2015 Malawi Demographic and Health Survey data and employed bivariate and multivariate statistical analysis techniques to explore the difference in the levels of stunted only and stunted-underweight children and key socio-economic factors between 2000 and 2015 and identify key attributes of being stunted only and being stunted-underweight. Results: The percentage of stunted only was 37.2% in 2000 and 26.8% in 2015 and the stunted-underweight percentage was 14.5% in 2000 and 8.8% in 2015. Out of the 6.9% children classified as wasted, 2.4% were also underweight and stunted, 2.4% were underweight and 2.1% did not have any other forms of undernutrition. The analysis did not identify any children that were both stunted and wasted. Only 0.7% in 2000 and 0.4% in 2015 were underweight and free of any other forms of undernutrition. There were improvements in mother education level and mother weight during this time-period which may explain the improvements in child nutritional status. Conclusion: The most common form of undernutrition is stunting and nearly all children that are underweight are also stunted. Child nutrition practitioners and health professionals should consider focusing on tackling child stunting.

Culture and domestic violence amongst ever-married women in Malawi: an analysis of emotional, sexual, less-severe physical and severe physical violence.

Nearly 42% of ever-married women in Malawi have experienced some form of physical, sexual or emotional violence perpetrated by their current or most recent spouse - higher than the global estimate of 35%. This study used national-level data for ever-married women aged 15-49 years from the 2015 Malawi Demographic and Health Survey to explore the association between cultural factors and the likelihood of women experiencing sexual, physical and emotional violence after controlling for socioeconomic factors using multilevel logistic regression modelling. Key cultural factors found to be associated with violence against ever-married women in Malawi were type of marriage (polygynous or monogamous), age at marriage, religion and ethnicity. Husband's consumption of alcohol also emerged as a very important factor in violence against married women. Interventions to tackle violence against married women in Malawi should aim at promoting monogamous marriages and discouraging polygynous marriages, and address the culture of heavy alcohol consumption amongst husbands. Future studies could explore further if there are key lessons that families can learn from Muslim families and across ethnic groups.

Married Women's Experience of Domestic Violence in Malawi: New Evidence From a Cluster and Multinomial Logistic Regression Analysis.

Violence against women is a global issue with estimates indicating that 35% of all women worldwide have experienced either physical and/or sexual intimate partner violence or nonpartner violence in their life time. In Malawi, 42% of ever-married women have experienced some form of violence perpetrated by their current or most recent spouse. A number of studies have investigated intimate partner violence in Malawi within the context of HIV/AIDS, girls' sexual abuse, and psychological distress, and a few studies report on the role of sociocultural factors in influencing gender-based violence. No study has used cluster analysis to systematically analyze different levels of abuse among married women in Malawi. Using the 2015 Malawi Demographic and Health Survey data, we employed cluster analysis and multinomial logistic regression to analyze the distribution of different levels of abuse among married women in Malawi and the key attributes associated with each level of abuse. Correlates of domestic violence significantly differ by levels of abuse and are distributed as follows: controlling behavior (11.8%), general controlling behavior (GCB; 27.1%), moderate physical and emotional abuse (27.2%), and the high and complete abuse (8.5%). Alcohol consumption, ethnicity, and women working status were significantly associated with all four levels of abuse, but age and religion were only associated with controlling behavior and generalized controlling behavior. The strength of association between husband's alcohol consumption, woman's working status, and marriage type and domestic violence increased by level of abuse. On each of these factors, the odds of experiencing violence were lowest in the controlling behavior group and highest in the high physical and emotional abuse group. Policies and programs that are designed to tackle violence against married women in Malawi should incorporate strategies that discourage excessive alcohol consumption, promote messages that women can be bread winners, and discourage polygamous marriage.

Under-five mortality according to maternal survival: a systematic review and meta-analysis.

OBJECTIVE: To investigate, within so-called general populations, the relationship between maternal survival and mortality of children younger than five years. METHODS: We conducted a systematic review of literature published between January 1990 and November 2016 that reported maternal vital status and the corresponding mortality of children younger than five years. Seven studies were included in a qualitative analysis and four in a random-effects meta-analysis. Summary estimates of the odds of dying by maternal survival were obtained and statistical heterogeneity estimated. Quality of the included studies and evidence was assessed using a Cochrane tool for assessing risk of bias and the Grading of Recommendations Assessment, Development and Evaluation criteria, respectively. FINDINGS: Among children younger than five years, those whose mother had died were found to be 4.09 times (95% confidence interval, CI: 2.40-6.98) more likely to die than those with surviving mothers. Due to heterogeneity (I2: 83%), further pooled estimates were not possible. For children that were motherless as a result of maternal mortality, the increased odds of dying ranged from 1.40 (95% CI: 0.47-4.21) to 2.92 (95% CI: 1.21-7.04) among those aged between two and four years, 6.1 (95% CI: 2.27-16.77) to 33.78 (95% CI: 24.21-47.14) for those younger than one year and 4.39 (95% CI: 3.34-5.78) to 51.68 (95% CI: 20.26-131.80) for those younger than six months. CONCLUSION: The loss of a mother was associated with increased mortality among children, especially when maternal death occurred in the first year of the child's life.

HIV-free survival at 12-24 months in breastfed infants of HIV-infected women on antiretroviral treatment.

OBJECTIVE: To provide estimates of HIV-free survival at 12-24 months in breastfed children by maternal ART (6 months or lifelong) to inform WHO HIV and Infant Feeding guidelines. METHODS: Eighteen studies published 2005-2015 were included in a systematic literature review (1295 papers identified, 156 abstracts screened, 55 full texts); papers were analysed by narrative synthesis and meta-analysis of HIV-free survival by maternal ART regimen in a random effects model. We also grouped studies by feeding modality. Study quality was assessed using a modified Newcastle-Ottawa Scale (NOS) and GRADE. RESULTS: The pooled estimates for 12-month HIV-free survival were 89.8% (95% confidence interval, CI: 86.5%, 93.2%) for infants of mothers on ART for 6 months post-natally (six studies) and 91.4% (95% CI 87.5%, 95.4%) for infants of mothers on lifelong ART (three studies). Eighteen-month HIV-free survival estimates were 89.0% (95% CI 83.9%, 94.2%) with 6 months ART (five studies) and 96.1% (95% CI 92.8%, 99.0%) with lifelong ART (three studies). Twenty-four-month HIV-free survival for infants whose mothers were on ART to 6 months post-natally (two studies) was 89.2% (95% CI 79.9%, 98.5%). Heterogeneity was considerable throughout. In four studies, HIV-free survival in breastfed infants ranged from 87% (95% CI 78%, 92%) to 96% (95% CI 91%, 98%) and in formula-fed infants from 67% (95% CI 35.5%, 87.9%) to 97.6% (95% CI 93.0%, 98.2%). CONCLUSION: Our results highlight the importance of breastfeeding for infant survival and of ART in reducing the risk of mother-to-child HIV transmission and support the WHO recommendation to initiate ART for life immediately after HIV diagnosis.

Trends and protective factors of female genital mutilation in Burkina Faso: 1999 to 2010.

BACKGROUND: The practice of Female Genital Mutilation (FGM) is common in several African countries and some parts of Asia. This practice is not only a violation of human rights, but also puts women at risk of adverse health outcomes. This paper analysed the trends in the prevalence of FGM in Burkina Faso and investigated factors that are associated with this practice following the enactment of an FGM law in 1996. METHODS: The study used the Burkina Faso Demographic and Health Survey (DHS) data sets from women aged 15 to 49 years undertaken in 1999, 2003 and 2010. Chi square tests were carried out to investigate whether there has been a change in the levels of FGM in Burkina Faso between 1999 and 2010 and multilevel logistic regression analysis were employed to identify factors that were significantly associated with undergoing FGM. RESULTS: The levels of FGM in Burkina Faso declined significantly from 83.6% in 1999 to 76.1% in 2010. The percentage of women circumcised between the ages of 0 to 5 years increased from 34.2% in 1999 to 69% in 2010. Significantly more women in 2010 than in 1999 were of the opinion that FGM should stop (90.6% versus 75.1%, respectively). In 2010, the odds of getting circumcised were lowest amongst women that were born in the period 1990 to 1995 (immediately before the FGM law was enacted) compared to women born in the period 1960-1965 [OR 0.16 (0.13,0.20)]. There was significant variation of FGM across communities. Other factors that were significantly associated with being circumcised were education level, religion, ethnicity, urban residence and age at marriage. CONCLUSIONS: Although the prevalence of FGM has declined in Burkina Faso, the levels are still high. In order to tackle the practice of FGM in Burkina Faso, the government of Burkina Faso and its development partners need to encourage girls' participation in education and target its sensitization campaigns against FGM towards Muslim women, women residing in rural areas and women of Mossi ethnic background.

Seasonal variation of child under nutrition in Malawi: is seasonal food availability an important factor? Findings from a national level cross-sectional study.

BACKGROUND: Child under nutrition is an underlying factor in millions of under-five child deaths and poor cognitive development worldwide. Whilst many studies have examined the levels and factors associated with child under nutrition in different settings, very little has been written on the variation of child under nutrition across seasons. This study explored seasonal food availability and child morbidity as influences of child nutritional status in Malawi. METHODS: The study used the 2004 Malawi Integrated Household Survey data. Graphical analysis of the variation of child under nutrition, child morbidity and food availability across the 12 months of the year was undertaken to display seasonal patterns over the year. Multivariate analysis was used to explore the importance of season after controlling for well-established factors that are known to influence a child's nutritional status. RESULTS: A surprising finding is that children were less likely to be stunted and less likely to be underweight in the lean cropping season (September to February) compared to the post-harvest season (March to August). The odds ratio for stunting were 0.80 (0.72, 0.90) and the odds ratio for underweight were 0.77 (0.66, 0.90). The season when child under nutrition levels were high coincided with the period of high child morbidity in line with previous studies. Children that were ill in the two weeks prior to survey were more likely to be underweight compared to children that were not ill 1.18 (1.01, 1.38). CONCLUSION: In Malawi child nutritional status varies across seasons and follows a seasonal pattern of childhood illness but not that of household food availability.

How important are community characteristics in influencing children׳s nutritional status? Evidence from Malawi population-based household and community surveys.

Using the 2004 data from the Malawi Integrated Household Survey and the Malawi Community Survey, this study investigates the influence of community characteristics on stunting among children under five years of age in a rural context. Multilevel logistic regression modelling on 4284 children with stunting as the dependent variable shows that availability of daily markets and lineage defined in terms of patrilineal or matrilineal communities were significant community determinants of childhood stunting in Malawi. There were significant differences in socio-economic status between household heads from matrilineal and patrilineal communities. Implementation of strategies that empower communities and households economically such as supporting the establishment of community daily markets and promoting household income generating opportunities can effectively reduce the burden of childhood stunting in Malawi.