Population-Modifiable Risk Factors Associated With Childhood Stunting in Sub-Saharan Africa.

Importance: Identifying modifiable risk factors associated with childhood stunting in sub-Saharan Africa (SSA) is imperative for the development of evidence-based interventions and to achieve the Sustainable Development Goals. Objective: To evaluate key modifiable risk factors associated with childhood stunting in SSA. Design, Setting, and Participants: This cross-sectional study examined the most recent (2014-2021) Demographic and Health Surveys data for children younger than 5 years from 25 SSA countries. Exposures: Modifiable risk factors included history of diarrhea within 2 weeks, consumption of dairy products, maternal body mass index, maternal educational level, antenatal care visits, place of birth, wealth index, type of toilet, and type of cooking fuel. Main Outcomes and Measures: Stunting and severe stunting, measured using the height-for-age z score, were the main outcomes. Children who scored below -2.0 SDs or -3.0 SDs were classified as having stunted or severely stunted growth, respectively. Relative risks and 95% CIs were computed using generalized linear latent and mixed models and log-binomial link functions. Population-attributable fractions (PAFs) were calculated using adjusted relative risks and prevalence estimates for key modifiable risk factors. Results: This study included 145 900 children from 25 SSA countries. The mean (SD) age of the children was 29.4 (17.3) months, and 50.6% were male. The highest PAFs of severe childhood stunting were observed for mothers lacking a formal education (PAF, 21.9%; 95% CI, 19.0%-24.8%), children lacking consumption of dairy products (PAF, 20.8%; 95% CI, 16.8%-24.9%), unclean cooking fuel (PAF, 9.5%; 95% CI, 2.6%-16.3%), home birth (PAF, 8.3%; 95% CI, 6.3%-10.0%), and low-income household (PAF, 5.8%; 95% CI, 3.4%-8.0%). These 5 modifiable risk factors were associated with 51.6% (95% CI, 40.5%-60.9%) of the severe childhood stunting in SSA. Conclusions and Relevance: This cross-sectional study identified 5 modifiable risk factors that were associated with 51.6% of severe childhood stunting in SSA. These factors should be a priority for policy makers when considering future child health interventions to address chronic malnutrition in SSA.

Interventions to improve the nutritional status of children under 5 years in Ethiopia: a systematic review.

OBJECTIVE: To conduct a systematic review of experimental or quasi-experimental studies that aimed to improve the nutritional status of children under 5 years of age in Ethiopia. DESIGN: Embase, MEDLINE/PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsychINFO, and Academic Search Database were used to locate peer-reviewed studies, and Google Scholar and Open Dissertation were used to locate grey literatures. All searches were conducted between 2000 and November 2022. SETTING: Ethiopia. PARTICIPANTS: Pregnant women and mothers with children aged 0-59 months. RESULTS: Ten cluster randomised controlled trials (RCT), six quasi-experimental studies and two individual RCT were included. Out of the identified eighteen studies, three studies targeted pregnant mothers. Our findings showed that almost two-thirds of published interventions had no impact on childhood stunting and wasting, and more than half had no impact on underweight. Some behaviour change communication (BCC) interventions, food vouchers, micronutrient supplementation and quality protein maize improved stunting. Similarly, BCC and fish oil supplementation showed promise in reducing wasting, while BCC and the provision of quality protein maize reduced underweight. Additionally, water, sanitation and hygiene (WaSH) interventions provided to pregnant mothers and children under 2 years of age were shown to significantly reduce childhood stunting. CONCLUSION: Future childhood nutritional interventions in Ethiopia should consider adopting an integrated approach that combines the positive effects of interdependent systems such as BCC, food supplemental programmes (e.g. boosting protein and micronutrients), health interventions (e.g. strengthening maternal and childcare), WaSH and financial initiatives (e.g. monetary support and income schemes).

Trends and Drivers of Unmet Need for Family Planning in Currently Married Tanzanian Women between 1999 and 2016.

The current study investigated the trends and factors associated with the unmet need for family planning (FP) for limiting and spacing births among married Tanzanian women between 1999 and 2016. The study used Tanzania Demographic and Health Survey (TDHS) data for the years 1999 (N = 2653), 2004-2005 (N = 2950), 2010 (N = 6412), and 2015-2016 (N = 8210). Trends in the unmet need for FP were estimated over the study period. Multivariable multinomial logistic regression models were used to investigate the association between community-level, predisposing, enabling, and need factors with the unmet need for FP in Tanzania. The results showed no significant change in percentage of married women with an unmet need for birth spacing between 1999 and 2016. The proportion of married women with an unmet need for limiting births decreased from 9.5% (95% confidence interval (CI): 7.9%, 10.6%) in 1999 to 6.6% (95% CI: 5.9%, 7.3%) in 2016. Residing in a rural area, parity between 1-4 and 5+, visiting a health facility for any health services within twelve months, and planning to have more children (after two years and/or undecided) were factors positively associated with the unmet need for FP-spacing. Women with parity of 5+ were more likely to experience an unmet need for FP-limiting. Women's age between 25-34 and 35-49 years, women's employment status, watching television, women's autonomy of not being involved in household decisions, and planning to have more children were factors associated with lower odds of having an unmet need for FP-spacing. Women's age between 25-34 years, watching television, autonomy, and planning to have more children were factors with lower odds of having an unmet need for FP-limiting. Improving FP uptake among married Tanzanian women can reduce the unmet need for FP. Therefore, reducing unmet needs for FP is attainable if government policies and interventions can target women residing in rural areas and other modifiable risk factors, such as parity, health facility visits, planning to having more children, employment, watching television, and women's autonomy.

Mapping Local Variations and the Determinants of Childhood Stunting in Nigeria.

INTRODUCTION: Understanding the specific geospatial variations in childhood stunting is essential for aligning appropriate health services to where new and/or additional nutritional interventions are required to achieve the Sustainable Development Goals (SDGs) and national targets. OBJECTIVES: We described local variations in the prevalence of childhood stunting at the second administrative level and its determinants in Nigeria after accounting for the influence of geospatial dependencies. METHODS: This study used the 2018 national Nigeria Demographic and Health Survey datasets (NDHS; N = 12,627). We used a Bayesian geostatistical modelling approach to investigate the prevalence of stunting at the second administrative level and its proximal and contextual determinants among children under five years of age in Nigeria. RESULTS: In 2018, the overall prevalence of childhood stunting in Nigeria was 41.5% (95% credible interval (CrI) from 26.4% to 55.7%). There were striking variations in the prevalence of stunting that ranged from 2.0% in Shomolu in Lagos State, Southern Nigeria to 66.4% in Biriniwa in Jigawa State, Northern Nigeria. Factors positively associated with stunting included being perceived as small at the time of birth and experience of three or more episodes of diarrhoea in the two weeks before the survey. Children whose mothers received a formal education and/or were overweight or obese were less likely to be stunted compared to their counterparts. Children who were from rich households, resided in households with improved cooking fuel, resided in urban centres, and lived in medium-rainfall geographic locations were also less likely to be stunted. CONCLUSION: The study findings showed wide variations in childhood stunting in Nigeria, suggesting the need for a realignment of health services to the poorest regions of Northern Nigeria.

Factors associated with inadequate receipt of components and non-use of antenatal care services in India: a regional analysis.

BACKGROUND: Failure to use antenatal care (ANC) and inadequate receipt of components of ANC pose a significant risk for the pregnant woman and the baby. This study aimed to examine a regional analysis of factors associated with receiving no ANC and inadequate receipt of components of ANC services among Indian women. METHOD: Information from 173,970 women of reproductive age 15-49 years from the 2019-21 India National Family Health Survey (NFSH-5) was analysed. Logistic regression analyses that adjusted for cluster and survey weights were conducted to assess the socio-demographic and other factors associated with receiving non-use of ANC and inadequate receipt of components of ANC, respectively, in the six regions and 28 states, and 8 union territories in India. RESULTS: Across regions in India, 7% of women reported no ANC, and the prevalence of inadequate and adequate receipt of components of ANC in all six regions ranged from 67 to 89% and 8% to 24%, respectively. Of all the 36 federated entities, the prevalence of inadequate receipt of ANC components was less than two-thirds in Tamil Nadu, Puducherry, Andaman and the Nicobar Islands, Odisha, and Gujarat. Our analyses revealed that associated factors vary by region, state, and union territories. Women from poor households reported increased odds of receiving no ANC in North, East and North-eastern regions. Women who reported no schooling in South, East and Central regions were associated with increased odds of receiving no ANC. Women from poor households in Himachal Pradesh, Bihar, Uttar Pradesh, Nagaland, Manipur, Uttar Pradesh, and Madhya Pradesh states reported significantly higher odds of inadequate components ANC than women from rich households. The receipt of inadequate components of ANC was significantly higher among women who never read magazines in Delhi, Ladakh, Karnataka, Telangana, Jharkhand, Maharashtra, Uttar Pradesh, Chhattisgarh, Arunachal Pradesh, Manipur, and Mizoram states in India. CONCLUSION: A better understanding of the factors associated with and incorporating them into the short- and long-term intervention strategies, including free financial support from the Indian government to encourage pregnant women from lower socioeconomic groups to use health services across all regions, states and union territories.

Infant and Young Child Feeding Practices among Adolescent Mothers and Associated Factors in India.

Adequate infant and young child feeding (IYCF) improve child survival and growth. Globally, about 18 million babies are born to mothers aged 18 years or less and have a higher likelihood of adverse birth outcomes in India due to insufficient knowledge of child growth. This paper examined factors associated with IYCF practices among adolescent Indian mothers. This cross-sectional study extracted data on 5148 children aged 0-23 months from the 2015-2016 India National Family Health Survey. Survey logistic regression was used to assess factors associated with IYCF among adolescent mothers. Prevalence of exclusive breastfeeding, early initiation of breastfeeding, timely introduction of complementary feeding, minimum dietary diversity, minimum meal frequency, and minimum acceptable diet rates were: 58.7%, 43.8%, 43.3%, 16.6%, 27.4% and 6.8%, respectively. Maternal education, mode of delivery, frequency of antenatal care (ANC) clinic visits, geographical region, child's age, and household wealth were the main factors associated with breastfeeding practices while maternal education, maternal marital status, child's age, frequency of ANC clinic visits, geographical region, and household wealth were factors associated with complementary feeding practices. IYCF practices among adolescent mothers are suboptimal except for breastfeeding. Health and nutritional support interventions should address the factors for these indicators among adolescent mothers in India.

Interventions to improve infant and young child feeding practices in Ethiopia: a systematic review.

OBJECTIVE: In Ethiopia, despite the implementation of several interventions to improve infant and young child feeding (IYCF) practices, no published studies have highlighted the most effective IYCF interventions in the country. This systematic review investigated the impacts of various interventions on IYCF in Ethiopia. SOURCE OF INFORMATION: A systematic search was conducted on seven computerised bibliographic databases (Embase, ProQuest Central, Scopus, PsycINFO, Web of Science, MEDLINE/PubMed and CINAHL) to locate experimental or quasi-experimental studies published between the year 2000 and May 2021. STUDY ELIGIBILITY CRITERIA: Interventional studies that measured IYCF indicators (early initiation of breast feeding (EIBF), exclusive breast feeding (EBF), the introduction of complementary foods, minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet) as outcome variables were included. STUDY APPRAISAL AND SYNTHESIS: All included studies were examined for biases related to interventional studies (ie, selection bias, performance bias, attrition bias, detection bias and reporting bias). Author reports of effect size measures were used to narratively report the findings of each study. RESULTS: Of the 23 eligible studies, 14 studies were quasi-experimental and 9 studies were cluster randomised trials (CRTs). Eight quasi-experimental studies had a serious risk of bias, while two CRTs had a high risk of bias. Four studies for EBF and six studies for EIBF showed significant impacts of policy advocacy, health service strengthening, interpersonal communication, community mobilisation and mass media campaigns. Six studies for MDD and three studies for MMF indicated significant effects of community-level and health facility complementary feeding promotions on infants and young children. Interventions that delivered in combination increased the impacts in improving EIBF, MDD and MMF compared with a single intervention. CONCLUSION: Our review showed that 12 out of 21 eligible studies that implemented in the form of community-level and health facility interventions improved EIBF, EBF, and/or MDD in Ethiopia. PROTOCOL REGISTRATION NUMBER: PROSPERO, CRD42020155519.

Mapping Geographical Differences and Examining the Determinants of Childhood Stunting in Ethiopia: A Bayesian Geostatistical Analysis.

Understanding the specific geographical distribution of stunting is essential for planning and implementing targeted public health interventions in high-burdened countries. This study investigated geographical variations in the prevalence of stunting sub-nationally, and the determinants of stunting among children under 5 years of age in Ethiopia. We used the 2016 Ethiopia Demographic and Health Survey (EDHS) dataset for children aged 0-59 months with valid anthropometric measurements and geographic coordinates (n = 9089). We modelled the prevalence of stunting and its determinants using Bayesian geospatially explicit regression models. The prevalence of stunting among children under five years was 36.3% (95% credible interval (CrI); 22.6%, 51.4%) in Ethiopia, with wide variations sub-nationally and by age group. The prevalence of childhood stunting ranged from 56.6% (37.4-74.6%) in the Mekelle Special zone of the Tigray region to 25.5% (10.5-48.9%) in the Sheka zone of the Southern Nations, Nationalities and Peoples region. Factors associated with a reduced likelihood of stunting in Ethiopia included non-receipt of breastmilk, mother's BMI (overweight/obese), employment status (employed), and higher household wealth, while the enablers were residence in the "arid" geographic areas, small birth size of the child, and mother's BMI (underweight). The prevalence and determinants of stunting varied across Ethiopia. Efforts to reduce the burden of childhood stunting should consider geographical heterogeneity and modifiable risk factors.

Prenatal HIV Test Uptake and Its Associated Factors for Prevention of Mother to Child Transmission of HIV in East Africa.

Identifying the socioeconomic and structural issues that act as enablers and/or barriers to HIV testing services is critical in combatting HIV/AIDS amongst mothers and children in Africa. In this study, we used a weighted sample of 46,645 women aged 15-49 who gave birth in the two years preceding the survey from the recent DHS dataset of ten East African countries. Multivariable logistic regression was used to investigate the factors associated with prenatal HIV test uptake in East Africa. The overall prenatal HIV test uptake for the prevention of mother-to-child transmission (PMTCT) of HIV was 80.8% (95% CI: 74.5-78.9%) in East Africa, with highest in Rwanda (97.9%, 95% CI: 97.2-98.3%) and lowest in Comoros (17.0%, 95% CI: 13.9-20.7%). Common factors associated with prenatal HIV test service uptake were higher maternal education level (AOR = 1.29; 95% CI: 1.10-1.50 for primary education and AOR = 1.96; 95% CI: 1.53-2.51 for secondary or higher education), higher partner education level (AOR = 1.24; 95% CI: 1.06-1.45 for primary education and AOR = 1.56; 95% CI: 1.26-1.94 for secondary or higher school), women from higher household wealth index (AOR = 1.29; 95% CI: 1.11-1.50 for middle wealth index; AOR = 1.57; 95% CL: 1.17-2.11 for rich wealth index), improved maternal exposure to the media, and increased awareness about MTCT of HIV. However, residents living in rural communities (AOR = 0.66; 95% CI: 0.51-0.85) and travelling long distances to the health facility (AOR = 0.8; 95% CI: 0.69-0.91) were associated with non-use of prenatal HIV test service in East African countries. In each East African country, factors associated with prenatal HIV test uptake for PMTCT varied. In conclusion, the pooled prenatal HIV test uptake for PMTCT of HIV was low in East Africa compared to the global target. Scaling up interventions to improve enablers whilst addressing barriers to the use of prenatal HIV test services are essential to end the HIV/AIDS epidemic in East African countries.

Understanding the Enablers and Barriers to Appropriate Infants and Young Child Feeding Practices in India: A Systematic Review.

Despite efforts to promote infant and young child feeding (IYCF) practices, there is no collective review of evidence on IYCF enablers and barriers in India. This review was conducted using 2015 Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. Six computerized bibliographic databases, Scopus, PubMed, PsycINFO, CINAHL, Embase, and Ovid MEDLINE, were searched for published studies on factors associated with IYCF practices in India from 1 January 1993, to 30 April 2020. IYCF practices examined were early initiation of breastfeeding, exclusive breastfeeding, continued breastfeeding at one year, introduction to solid semi-solid or soft foods, minimum dietary diversity, minimum meal frequency, minimum acceptable diet, continued breastfeeding at two years, predominant breastfeeding, and bottle feeding. In total, 6968 articles were retrieved, and 46 studies met the inclusion criteria. The common enablers of IYCF were higher maternal socioeconomic status (SES) and more frequent antenatal care visits (ANC) (≥3). Common barriers to IYCF practices were low SES and less frequent ANC. The review showed that the factors associated with IYCF practices in India are largely modifiable and multi-factorial. Improving IYCF practices would require the adoption of both facilities- and community-based policy interventions at the subnational and national levels in India.

Trends and predictors of the use of unskilled birth attendants among Ethiopian mothers from 2000 to 2016.

INTRODUCTION: Previous studies have shown that home delivery assisted by unskilled individuals contributes to maternal and neonatal deaths in developing countries. It also increases the risks of long-term maternal morbidities such as uterine prolapse, pelvic inflammatory disease, fistula, incontinence and infertility. This study aimed to determine the trends and predictors of the use of unskilled birth attendants among Ethiopian mothers from 2000 to 2016. METHODS: This study USED used the Ethiopia Demographic and Health Survey data for the years 2000 (n = 10,873), 2005 (n = 9,861), 2011 (n = 11,654) and 2016 (n = 10,641) to estimate the trends in the use of unskilled birth attendants. Multinomial logistic regression models with adjustment for clustering and sampling weights were used to investigate the association between the independent and outcome outcome variables. RESULTS: The analysis revealed that while births attended by Traditional Birth Attendants (TBAs) increased from 28% in 2000 to 42% in 2016, home deliveries decreased slightly from 94% to 73%. Rural residence is associated with increased odds of using unskilled birth attendants. High and middle household wealth, educational status of the women and their partners (>primary), four or more antenatal care (ANC) visits, having any form of employment and mass media engagement were significantly associated with decreased odds of unskilled birth attendant utilization during child birth in Ethiopia. CONCLUSIONS: The results of this analysis show that the proportion of Ethiopian women giving birth without a skilled attendant is high. Interventions aiming to improve skilled attendance during childbirth should focus on the individual, community and need factors of Anderson's behavioural model.

Breastfeeding Practices among Adolescent Mothers and Associated Factors in Bangladesh (2004-2014).

Optimal breastfeeding practices among mothers have been proven to have health and economic benefits, but evidence on breastfeeding practices among adolescent mothers in Bangladesh is limited. Hence, this study aims to estimate breastfeeding indicators and factors associated with selected feeding practices. The sample included 2554 children aged 0-23 months of adolescent mothers aged 12-19 years from four Bangladesh Demographic and Health Surveys collected between 2004 and 2014. Breastfeeding indicators were estimated using World Health Organization (WHO) indicators. Selected feeding indicators were examined against potential confounding factors using univariate and multivariate analyses. Only 42.2% of adolescent mothers initiated breastfeeding within the first hour of birth, 53% exclusively breastfed their infants, predominant breastfeeding was 17.3%, and 15.7% bottle-fed their children. Parity (2-3 children), older infants, and adolescent mothers who made postnatal check-up after two days were associated with increased exclusive breastfeeding (EBF) rates. Adolescent mothers aged 12-18 years and who watched television were less likely to delay breastfeeding initiation within the first hour of birth. Adolescent mothers who delivered at home (adjusted OR = 2.63, 95% CI:1.86, 3.74) and made postnatal check-up after two days (adjusted OR = 1.67, 95% CI: 1.21, 2.30) were significantly more likely to delay initiation breastfeeding within the first hour of birth. Adolescent mothers living in the Barisal region and who listened to the radio reported increased odds of predominant breastfeeding, and increased odds for bottle-feeding included male infants, infants aged 0-5 months, adolescent mothers who had eight or more antenatal clinic visits, and the highest wealth quintiles. In order for Bangladesh to meet the Sustainable Development Goals (SDGs) 2 and 3 by 2030, breastfeeding promotion programmes should discourage bottle-feeding among adolescent mothers from the richest households and promote early initiation of breastfeeding especially among adolescent mothers who delivered at home and had a late postnatal check-up after delivery.

Trends and determinants of underweight and overweight/obesity among urban Ethiopian women from 2000 to 2016.

BACKGROUND: Nutritional, epidemiological and demographic transitions have been associated with the emergence of the double burden of malnutrition globally. In Ethiopia, there has been no nationally representative investigation of trends and determinants of both underweight and overweight/obesity among urban women. This study examined the trends and determinants of underweight and overweight/obesity in urban Ethiopian women from 2000 to 2016. METHODS: Trends in the prevalence of underweight and overweight/obesity were investigated based on a series of the Ethiopia Demographic and Health Survey (EDHS) data for the years 2000 (n = 2559), 2005 (n = 1112), 2011 (n = 3569), and 2016 (n = 3106). Multivariable multinomial logistic regression was used to investigate the association between socioeconomic, demographic, behavioural, and community-level factors with underweight and overweight/obesity. RESULTS: The prevalence of underweight in urban Ethiopian women reduced significantly from 23.2% (95% confidence interval [CI]: 20.3, 26.3%) in 2000 to 14.8% (95% CI: 13.1, 16.7%) in 2016, while overweight/obesity increased significantly from 10.9% (95% CI: 9.1, 13.0%) in 2000 to 21.4% (95% CI: 18.2, 25.1%) in 2016. Urban women from rich households and those who had never married were less likely to be underweight. Urban women who were from wealthy households and those who attained at least secondary education were more likely to be overweight/obese. Women who were informally employed and listened to the radio were less likely to be overweight/obese compared to those who were unemployed and did not listen to the radio, respectively. CONCLUSION: The prevalence of overweight/obesity increased from 2000 to 2016, with a concurrent reduction in the prevalence of underweight. Interventions aiming to reduce overweight and obesity should target urban women with higher education, those who resided in wealthier households and those who watched the television.

Factors associated with underweight, overweight, and obesity in reproductive age Tanzanian women.

BACKGROUND: Underweight, overweight, and obesity are major public health challenges among reproductive-age women of lower- and middle-income countries (including Tanzania). In those settings, obesogenic factors (attributes that promote excessive body weight gain) are increasing in the context of an existing high burden of undernutrition. The present study investigated factors associated with underweight, overweight, and obesity among reproductive age women in Tanzania. METHODS: This study used 2015-16 Tanzania Demographic and Health Survey data (n = 11735). To account for the hierarchical nature of the data (i.e., reproductive age women nested within clusters), multilevel multinomial logistic regression models were used to investigate the association between individual-level (socioeconomic, demographic and behavioural) and community-level factors with underweight, overweight, and obesity. RESULTS: Reproductive age women who were informally employed (relative risk ratio [RRR] = 0.79; 95% confidence interval [CI]: 0.64, 0.96), those who were currently married (RRR = 0.59; 95% CI: 0.43, 0.82) and those who used contraceptives (RRR = 0.70; 95% CI: 0.54, 0.90) were less likely to be underweight. Reproductive age women who attained secondary or higher education (RRR = 1.48; 95% CI: 1.11, 1.96), those who resided in wealthier households (RRR = 2.31; 95% CI: 1.78, 3.03) and those who watched the television (RRR = 1.26; 95% CI: 1.06, 1.50) were more likely to be overweight. The risk of experiencing obesity was higher among reproductive age women who attained secondary or higher education (RRR = 1.79; 95% CI: 1.23, 2.61), those who were formally employed (RRR = 1.50; 95% CI: 1.14, 1.98), those who resided in wealthier households (RRR = 4.77; 95% CI: 3.03, 7.50), those who used alcohol (RRR = 1.43; 95% CI: 1.12, 1.82) and/or watched the television (RRR = 1.70; 95% CI: 1.35, 2.13). CONCLUSION: Our study suggests that relevant government jurisdictions need to identify, promote, and implement evidence-based interventions that can simultaneously address underweight and overweight/obesity among reproductive age women in Tanzania.

Regional Analysis of Associations between Infant and Young Child Feeding Practices and Diarrhoea in Indian Children.

Studies on the association between infant and young child feeding (IYCF) practices and diarrhoea across regional India are limited. Hence, we examined the association between IYCF practices and diarrhoea in regional India. A weighted sample of 90,596 (North = 11,200, South = 16,469, East = 23,317, West = 11,512, Central = 24,870 and North-East = 3228) from the 2015-2016 National Family Health Survey in India was examined, using multivariate logistic regressions that adjust for clustering and sampling weights. The IYCF indicators included early initiation of breastfeeding (EIBF), exclusive breastfeeding (ExcBF), predominant breastfeeding (PBF), bottle feeding (BotF), continued breastfeeding (BF) at one-year, continued BF at two years, children ever breastfed and the introduction of solid, semi-solid or soft foods (ISSSF). Diarrhoea prevalence was lower among infants who were BF within one-hour of birth and those who were exclusively breastfed. Multivariate analyses revealed that continued BF at one and two years, and infants who were introduced to complementary foods had a higher prevalence of diarrhoea. EIBF and ExcBF were protective against diarrhoea in the regions of North, East and Central India. PBF, BotF and ISSSF were risk factors for diarrhoea in Central India. Continued BF at two years was a risk factor for diarrhoea in Western India. Findings suggested that EIBF and ExcBF were protective against diarrhoea in Northern, Eastern and Central India, while PBF, BotF, continued BF at two years and ISSSF were risk factors for diarrhoea in various regions in India. Improvements in IYCF practices are likely to reduce the burden of diarrhoea-related morbidity and mortality across regions in India.

Trends and factors associated with the utilisation of antenatal care services during the Millennium Development Goals era in Tanzania.

BACKGROUND: A detailed understanding of trends, as well as what act as enablers and/or barriers to the utilisation of antenatal care (ANC) among Tanzanian women, is essential to policymakers and health practitioners to guide maternal health efforts. We investigated the trends and factors associated with ANC service use during the Millennium Development Goals (MDG) era in Tanzania between 1999 and 2016. METHODS: The study used the Tanzania Demographic and Health Survey (TDHS) data for the years 1999 (n = 2095), 2004-2005 (n = 5576), 2010 (n = 6903) and 2015-2016 (n = 5392). Multivariate multinomial logistic regression models were used to investigate the association between predisposing, enabling, need and community-level factors and frequency of ANC (1-3 and ≥ 4) visits in Tanzania. RESULTS: The proportion of women who made one to three ANC visits improved significantly from 26.4% in 1999 to 47.0% in 2016. The percentage of women who make four or more ANC visits declined from 71.1% in 1999 to 51.0% in 2016. Higher maternal education, belonging to wealthier households, being informally employed and listening to the radio were associated with four or more ANC visits. Women who did not desire pregnancy had a lower likelihood to attend four or more ANC visits. Women who had primary or higher education, those who resided in wealthier households and those who were informally employed were more likely to make between one and three ANC visits. CONCLUSION: The study showed that there was an improvement in the proportion of Tanzanian women who made one to three ANC visits, but it also indicated a concurrent decrease in the prevalence of four or more ANC visits. Improving uptake of ANC among Tanzanian women is achievable if national health policies and programmes also focus on key amenable maternal factors of education, household wealth and employment.

Associations between infant and young child feeding practices and acute respiratory infection and diarrhoea in Ethiopia: A propensity score matching approach.

BACKGROUND: Acute respiratory infection (ARI) and diarrhoea are the leading causes of childhood morbidity and mortality in Ethiopia. Understanding the associations between infant and young child feeding (IYCF) and ARI and diarrhoea can inform IYCF policy interventions and advocacy in Ethiopia. This study aimed to investigate the relationship between IYCF practices and ARI and diarrhoea in Ethiopian children. METHODS: This study used the Ethiopia Demographic and Health Survey (EDHS) data for the years 2000 (n = 3680), 2005 (n = 3528), 2011 (n = 4037), and 2016 (n = 3861). The association between IYCF practices and (i) ARI and (ii) diarrhoea were investigated using propensity score matching and multivariable logistic regression models. The IYCF practices include early initiation of breastfeeding, exclusive breastfeeding (EBF), predominant breastfeeding, introduction of complementary foods, continued breastfeeding at two years and bottle feeding. RESULTS: Infants and young children who were breastfed within 1-hour of birth and those who were exclusively breastfed had a lower prevalence of ARI. Infants who were exclusively and predominantly breastfed had a lower prevalence of diarrhoea. Early initiation of breastfeeding (Odds ratio [OR]: 0.81; 95% confidence interval [CI]: 0.72, 0.92) and EBF (OR: 0.65; 95% CI: 0.51, 0.83) were associated with lower risk of ARI. Bottle-fed children had higher odds of ARI (OR: 1.36; 95% CI: 1.10, 1.68). Early initiation of breastfeeding and EBF were associated with lower odds of diarrhoea (OR: 0.88; 95% CI: 0.79, 0.94 for Early initiation of breastfeeding and OR: 0.51; 95% CI: 0.39, 0.65 for EBF). Infants who were predominantly breastfed were less likely to experience diarrhoea (OR: 0.69; 95% CI: 0.53, 0.89). CONCLUSION: The recommended best practices for preventing ARI and diarrhoeal diseases in infants and young children namely: the early initiation of breastfeeding, EBF and avoidance of bottle feeding should be institutionalized and scale-up in Ethiopia as part of implementation science approach to cover the know-do-gaps.

Prevalence, Trends, and Drivers of the Utilization of Unskilled Birth Attendants during Democratic Governance in Nigeria from 1999 to 2018.

Comprehensive epidemiological data on prevalence, trends, and determinants of the use of unskilled birth attendants (traditional birth attendants (TBAs) and other unskilled birth attendants) are essential to policy decision-makers and health practitioners, to guide efforts and resource allocation. This study investigated the prevalence, trends, and drivers of the utilization of unskilled birth attendants during democratic governance in Nigeria from 1999 to 2018. The study used the Nigeria Demographic and Health Surveys data for the years 1999 (n = 3552), 2003 (n = 6029), 2008 (n = 28,647), 2013 (n = 31,482), and 2018 (34,193). Multivariate multinomial logistic regression was used to investigate the association between socioeconomic, demographic, health-service, and community-level factors with the utilization of TBAs and other unskilled birth attendants in Nigeria. Between 1999 and 2018, the study showed that the prevalence of TBA-assisted delivery remained unchanged (20.7%; 95% CI: 18.0-23.7% in 1999 and 20.5%; 95% CI: 18.9-22.1% in 2018). The prevalence of other-unskilled-birth-attendant use declined significantly from 45.5% (95% CI: 41.1-49.7%) in 2003 to 36.2% (95% CI: 34.5-38.0%) in 2018. Higher parental education, maternal employment, belonging to rich households, higher maternal age (35-49 years), frequent antenatal care (ANC) (≥4) visits, the proximity of health facilities, and female autonomy in households were associated with lower odds of unskilled birth attendants' utilization. Rural residence, geopolitical region, lower maternal age (15-24 years), and higher birth interval (≥2 years) were associated with higher odds of unskilled-birth-attendant-assisted deliveries. Reducing births assisted by unskilled birth attendants in Nigeria would require prioritized and scaled-up maternal health efforts that target all women, especially those from low socioeconomic backgrounds, those who do not attend antenatal care, and/or those who reside in rural areas.

Breastfeeding in the Community-How Can Partners/Fathers Help? A Systematic Review.

Support from partners/fathers and families can play a significant role in a mother's decision to initiate, continue or cease breastfeeding postnatally. This study systematically reviewed published studies to determine the impact of specific types of partner support on breastfeeding initiation, duration and exclusivity. We used the 2015 Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines for the review. Seven computerized bibliographic databases (Embase, ProQuest Central, Scopus, PsycINFO, Web of Science, MEDLINE/PubMed and CINAHL) were searched. Of a total of 695 articles retrieved from the databases, seven studies met the inclusion criteria and reported on breastfeeding initiation, duration and exclusivity. Four of the seven studies found that partner support in the form of verbal encouragement to new mothers increased breastfeeding duration and exclusivity. Other types of partner supportive actions that led to improved breastfeeding behavior included sensitivity of the partner to the nursing mother's needs, assistance in preventing and managing breastfeeding difficulties, and helping with household and child care duties. This review showed that specific supportive actions of partners/fathers in the community positively improved breastfeeding practices. To maximise the impact of breastfeeding policies and interventions among new mothers, breastfeeding programmes should consider the involvement of partners/fathers and their specific roles.