Your search found 67 Results
World Health Organization infant and young child feeding indicators and their associations with child anthropometry: a synthesis of recent findings.
Maternal and Child Nutrition. 2014 Jan; 10(1):1-17.As the World Health Organization (WHO) infant and young child feeding (IYCF) indicators are increasingly adopted, a comparison of country-specific analyses of the indicators’ associations with child growth is needed to examine the consistency of these relationships across contexts and to assess the strengths and potential limitations of the indicators. This study aims to determine cross-country patterns of associations of each of these indicators with child stunting, wasting, height-for-age z-score (HAZ) and weight-for-height z-score (WHZ). Eight studies using recent Demographic and Health Surveys data from a total of nine countries in sub-Saharan Africa (nine), Asia (three) and the Caribbean (one) were identified. The WHO indicators showed mixed associations with child anthropometric indicators across countries. Breastfeeding indicators demonstrated negative associations with HAZ, while indicators of diet diversity and overall diet quality were positively associated with HAZ in Bangladesh, Ethiopia, India and Zambia (P < 0.05).These same complementary feeding indicators did not show consistent relationships with child stunting. Exclusive breastfeeding under 6 months of age was associated with greater WHZ in Bangladesh and Zambia (P < 0.05), although CF indicators did not show strong associations with WHZ or wasting. The lack of sensitivity and specificity of many of the IYCF indicators may contribute to the inconsistent associations observed.The WHO indicators are clearly valuable tools for broadly assessing the quality of child diets and for monitoring population trends in IYCF practices over time. However, additional measures of dietary quality and quantity may be necessary to understand how specific IYCF behaviours relate to child growth faltering.
Positive indicators of child well-being: a conceptual framework, measures, and methodological issues.
Florence, Italy, UNICEF Innocenti Research Centre, 2009.  p. (Innocenti Working Paper No. IWP-2009-21)This paper highlights a number of frameworks for developing indicators that examine the positive well-being of children, rather than just indicators that reflect negative behavior (like drug use, smoking, and others).
Improving maternal health to achieve the Millennium Development Goals in the Eastern Mediterranean Region: a youth lens.
Eastern Mediterranean Health Journal. 2008; 14 Suppl:S97-106.The fifth Millennium Development Goal (MDG) aims to improve maternal health. The 2 targets set for this goal are to "reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio" and "achieve, by 2015, universal access to reproductive health". Six indicators have been selected to help track progress towards these targets: maternal mortality ratio; proportion of births attended by skilled health personnel; contraceptive prevalence rate; adolescent birth rate; antenatal care coverage (at least 1 visit and at least 4 visits); and unmet need for family planning. This paper briefly outlines the general situation in relation to maternal health in the Eastern Mediterranean Region of the World Health Organization (WHO) and goes on to focus on the perspective of adolescent pregnancy and reproductive health.
Comparison of the new World Health Organization growth standards and the National Center for Health Statistics growth reference regarding mortality of malnourished children treated in a 2006 nutrition program in Niger.
Archives of Pediatrics and Adolescent Medicine. 2009 Feb; 163(2):126-30.OBJECTIVE: To compare the National Centre for Health Statistics (NCHS) international growth reference with the new World Health Organization (WHO) growth standards for identification of the malnourished (wasted) children most at risk of death. DESIGN: Retrospective data analysis. SETTING: A Medecins Sans Frontieres (Doctors Without Borders) nutrition program in Maradi, Niger, in 2006 that treated moderately and severely malnourished children. PARTICIPANTS: A total of 53 661 wasted children aged 6 months to 5 years (272 of whom died) in the program were included. INTERVENTIONS: EpiNut (Epi Info 6.0; Centers for Disease Control and Prevention, Atlanta, Georgia) software was used to calculate the percentage of the median for the NCHS reference group, and the WHO (igrowup macro; Geneva, Switzerland) software was used to calculate z scores for the WHO standards group of the 53 661 wasted children. OUTCOME MEASURES: The main outcome measures are the difference in classification of children as either moderate or severely malnourished according to the NCHS growth reference and the new WHO growth standards, specifically focusing on children who died during the program. RESULTS: Of the children classified as moderately wasted using the NCHS reference, 37% would have been classified as severely wasted according to the new WHO growth standards. These children were almost 3 times more likely to die than those classified as moderately wasted by both references, and deaths in this group constituted 47% of all deaths in the program. CONCLUSIONS: The new WHO growth standards identifies more children as severely wasted compared with the NCHS growth reference, including children at high mortality risk who would potentially otherwise be excluded from some therapeutic feeding programs.
Washington, D.C., The National Academies Press, 2008 Dec 15.  p.At this historic moment, the incoming Obama administration and leaders of the U.S. Congress have the opportunity to advance the welfare and prosperity of people within and beyond the borders of the United States through intensified and sustained attention to better health. The United States can improve the lives of millions around the world, while reflecting America's values and protecting and promoting the nation's interests. The Institute of Medicine-with the support of four U.S. government agencies and five private foundations-formed an independent committee to examine the United States' commitment to global health and to articulate a vision for future U.S. investments and activities in this area.
International Family Planning Perspectives. 2008 Jun; 34(2):101-102.At the midpoint of the 15-year timetable for achieving the Millennium Development Goals, the majority of countries with high levels of maternal and child mortality are not on track to meet the targets for reductions in these outcomes by 2015, according to a recent analysis.1 Among the 68 countries that account for the vast majority of maternal and child deaths, only 16 are on track to reduce mortality among children younger than five to one-third of its 1990 level (Goal 4). Progress toward reducing maternal mortality by three-quarters (Goal 5) has been slow as well: In all 41 Sub-Saharan African countries included in the analysis, at least 300 maternal deaths occur per 100,000 live births. The research was conducted by Countdown to 2015, a collaboration of researchers, policymakers and other stakeholders that has been tracking progress toward the Millennium Development Goals in the 68 countries in which 97% of deaths among women of childbearing age and children younger than five occur. Researchers focused on determining coverage rates (the proportion of individuals in each country who need a service and are able to obtain it) for interventions that have been proven to avert maternal, newborn and child deaths, that can be widely implemented in resource-poor countries, and whose levels can be reliably estimated across countries and over time; these interventions include provision of contraceptive and STI services, skilled care during childbirth, and pre- and postnatal care. Most of the data were obtained through nationally representative household surveys. (excerpt)
Geneva, Switzerland, WHO, Department of Child and Adolescent Health and Development, 2008. 20 p.The first few days and weeks of life are among the most critical for child survival. Every year, an estimated 4 million children die during the first month of life. Almost all of these deaths (98%) occur in developing countries. Most neonatal deaths are due to ore-term birth, asphyxia and infections such as sepsis, tetanus and pneumonia. In 2006-2007, to support efforts by countries and regions to reduce newborn deaths, we worked to build capacity for the planning and delivery of improved newborn care services in health facilities and communities, to provide tools and guidance for extending population coverage, and to evaluate the impact of all those actions. (excerpt)
Population and Development Review. 2007 Dec; 33(4):839-843.Measured in terms of increases in average expectation of life country-by-country, the large majority of the world's population benefited from major improvements in health in the second part of the twentieth century. Notable exceptions to this favorable trend are most of the countries of sub-Saharan Africa and countries of the former Soviet Union. But the country averages conceal persistent and significant differences according to social status. The aim of the work of the Commission on Social Determinants of Health (CSDH) of the World Health Organization is to study these differences and to make recommendations for corrective action. Set up in March 2005, the 19-member Commission, chaired by Michael Marmot of University College London, published an Interim Report, titled "Achieving Health Equity: From Root Causes to Fair Outcomes," in September 2007. An excerpt from this 61-page report-the section on Health Inequality, Inequity, and Social Determinants of Health-is reproduced below. It presents a crisp statistical description of characteristic features of social differentials in health status commonly found in all countries, including those exhibiting the most favorable average expectancies of life. The presentation draws on emerging work on this topic, extensively cited in the report. (excerpt)
Monitoring the Declaration of Commitment on HIV / AIDS. Guidelines on construction of core indicators. 2008 reporting.
Geneva, Switzerland, UNAIDS, 2007 Apr. 139 p. (UNAIDS/07.12E; JC1318E)The primary purpose of this document is to provide key constituents who are actively involved in a country's response to AIDS with essential information on core indicators that measure the effectiveness of the national response. These guidelines will also help ensure the consistency and transparency of the process used by national governments. In addition, this information can be used by UNAIDS to prepare regional and global progress reports on implementation of the United Nations General Assembly Special Session (UNGASS) Declaration of Commitment on HIV/AIDS. Countries are strongly encouraged to integrate the core indicators into their ongoing monitoring and evaluation activities. These indicators are designed to help countries assess the current state of their national response while simultaneously contributing to a better understanding of the global response to the AIDS pandemic, including progress towards meeting the targets in the Declaration of Commitment on HIV/ AIDS. Given the dual purposes of the indicators, the guidelines in this document are designed to improve the quality and consistency of data collected at the country level, which will enhance the accuracy of conclusions drawn from the data at both national and global levels. This document also includes an overview of global indicators that will be used by UNAIDS and its partners to assess key components of the response that are best measured on a worldwide basis. (excerpt)
Towards universal access to prevention, treatment and care: experiences and challenges from the Mbeya region in Tanzania -- a case study.
Geneva, Switzerland, Joint United Nations Programme on HIV / AIDS [UNAIDS], 2007 Mar. 49 p. (UNAIDS Best Practice Collection; UNAIDS/07.11E; JC1291E)This study takes stock of the situation in Mbeya in 2005, documenting the region's continuing efforts to build on the Regional Programme's strong comprehensive prevention approaches to further increase their coverage while strengthening the new district focus, expanding multisectoral work and making available antiretroviral treatment. In doing so, this study describes Mbeya's progress towards universal access and identifies ongoing challenges. Through its comprehensive, decentralized and multisectoral approaches and the continuing efforts of a variety of actors, the region appears to be in a better position to reach universal access than other parts of Tanzania and Africa in general. The experiences of the Mbeya region to date can serve as lessons learnt to other parts of the country and, more broadly, the continent. This publication is neither a scientific study nor an evaluation of the Regional Programme. It is an analytical description of HIV control activities in the region to date and their status to date. Its focus is mainly on access. The programmes presented here follow national and international recommendations. The quality of the individual programmes, however, has not been assessed for the purpose of this publication. (excerpt)
Bulletin of the World Health Organization. 2007 Oct; 85(10):734.posited that the process of development entails changes in incomes over time. Larger income levels achieved via positive economic growth, appropriately discounted for population growth, would constitute higher levels of development. As many have noted, however, the income measure fails to adequately reflect development in that per-capita income, in terms of its levels or changes to it, does not sufficiently correlate with measures of (human) development, such as life expectancy, child/infant mortality and literacy. The United Nations Development Programme's (UNDP) human development index (HDI) constitutes an improved measure for development. HDI has been modified to be gender-sensitive with variants that reflect gender inequality. Various measures reflecting Sen's "capability" concept, such as civil and political rights, have also been incorporated. Countries where the level of poverty is relatively large tend also to exhibit low values of human development, thus lowering the mean values of the development measures. Where inequalities of development indicators are very large, however, the average values may not sufficiently reflect the conditions of the poor, requiring the need to concentrate on poverty per se. (excerpt)
African Population Studies/Etude de la Population Africaine. 2006; 21(1):19-36.Relatively scant knowledge is available on the situations of older persons in sub-Saharan Africa. Reliable and accessible demographic and health statistics are needed to inform policy making for the older population. The process and outcome of a project to create a minimum data set (MDS) on ageing and older persons to provide an evidence base to inform policy are described. The project was initiated by the World Health Organization and conducted in Ghana, South Africa, Tanzania and Zimbabwe. A set of indicators was established to constitute a sub-regional MDS, populated from data sources in the four countries; a national MDS was produced for each country. Major gaps and deficiencies were identified in the available data and difficulties were experienced in accessing data. Specific gaps, and constraints against the production and access of quality data in the subregion are examined. The project and outcome are evaluated and lessons are drawn. Tasks for future phases of the project to complete and maintain the MDS are outlined. (author's)
Standard deviation of anthropometric Z-scores as a data quality assessment tool using the 2006 WHO growth standards: A cross country analysis.
Bulletin of the World Health Organization. 2007 Jun; 85(6):441-448.Height- and weight-based anthropometric indicators are used worldwide to characterize the nutritional status of populations. Based on the 1978 WHO/National Center for Health Statistics (NCHS) growth reference, the World Health Organization has previously indicated that the standard deviation (SD) of Z-scores of these indicators is relatively constant across populations, irrespective of nutritional status. As such, the SD of Z-scores can be used as quality indicators for anthropometric data. In 2006, WHO published new growth standards. Here, we aim to assess whether the SD of height- and weight-based Z-score indicators from the 2006 WHO growth standards can still be used to assess data quality. We examined data on children aged 0-59 months from 51 Demographic and Health Surveys (DHS) in 34 developing countries. We used 2006 growth standards to assign height-for-age Z-scores (HAZ), weight-for-age Z-scores (WAZ), weight-for-height Z-scores (WHZ) and body-mass-index-for-age Z-scores (BMIZ). We also did a stratified analysis by age group. The SD for all four indicators were independent of their respective mean Z-scores across countries. Overall, the 5th and 95th percentiles of the SD were 1.35 and 1.95 for HAZ, 1.17 and 1.46 for WAZ, 1.08 and 1.50 for WHZ and 1.08 and 1.55 for BMIZ. Our results concur with the WHO assertion that SD is in a relatively small range for each indicator irrespective of where the Z-score mean lies, and support the use of SD as a quality indicator for anthropometric data. However, the ranges of SDs for all four indicators analysed were consistently wider than those published previously by WHO. (author's)
Monitoring and evaluating actions implemented to confront AIDS in Brazil: civil society's participation.
Revista de Saude Publica / Journal of Public Health. 2006 Apr; 40 Suppl:88-93.The United Nations Declaration of Commitment on HIV/AIDS recommends that governments conduct periodic analysis of actions undertaken in confronting the HIV/ AIDS epidemic that involve civil society's participation. Specific instruments and mechanisms should be created towards this end. This paper examines some of the responses of the Brazilian government to this recommendation. Analysis contemplates the Declaration's proposals as to civil society's participation in monitoring and evaluating such actions and their adequacy with respect to Brazilian reality. The limitations and potentials of MONITORAIDS, the matrix of indicators created by Brazil's Programa Nacional de DST/AIDS [National Program for STD/AIDS] to monitor the epidemic are discussed. Results indicate that MONITORAIDS's complexity hampers its use by the conjunction of actors involved in the struggle against AIDS. The establishment of mechanisms that facilitate the appropriation of this system by all those committed to confronting the epidemic in Brazil is suggested. (author's)
Revista de Saude Publica / Journal of Public Health. 2006 Apr; 40 Suppl:80-87.The paper critically analyzes, from the gender standpoint, official results presented in the Brazilian government report to the Joint United Nations Programme on HIV/ AIDS (UNAIDS). Specifically, the fulfillment of 2003 targets set forth in the United Nations Declaration of Commitment on HIV/AIDS, under the category of Human Rights and Reduction of the Economic and Social Impact of AIDS, are evaluated. Key concepts are highlighted, including indicators and strategies that may help civilian society better monitor these targets until 2010. (author's)
Revista de Saude Publica / Journal of Public Health. 2006 Apr; 40 Suppl:94-100.The objective of this study was to analyze, on the national level, the process of monitoring the proposed UNGASS indicators through the use of the Brazilian National Program for STD/AIDS's indicators. Two groups of proposed indicators were analyzed in 2002 and 2005 respectively, as part of the monitoring of the progress of the UNGASS Declaration of Commitment. The availability of information and limitations in calculating the proposed indicators in Brazil were analyzed and the appropriateness of the indicators for monitoring the epidemic in Brazil was discussed. Of the 13 quantitative indicators originally proposed by UNGASS, five were not included in the National Program. One was not included due to its qualitative nature. Two of the indicators were considered to be of little use and two were not included due to the lack of available data needed for their calculation. As the epidemic in Brazil is characterized as being concentrated, within the second group of proposed UNGASS indicators those that refer to the accompaniment of epidemic among high-risk population groups were prioritized. The study highlights that the National Program concentrates its efforts in the development, adaptation, and sharing of sampling methodologies for hard to reach populations. Such activities are geared towards estimating the size of vulnerable population groups, as well as obtaining more information regarding their knowledge, attitudes, and practices. The study concludes that by creating the possibility of international comparisons between advances achieved, the proposal of supranational indicators stimulates countries to discuss and make their construction viable. In a complementary way, the national monitoring systems should focus on program improvement by covering areas that permit the evaluation of specific control and intervention actions. (author's)
SCN News. 2006; (33):27-29.The rising prevalence of overweight and obesity has become a topical issue worldwide. Children have not been spared this problem as childhood obesity is on the increase, even in developing countries, where infectious disease and malnutrition continue to take their toll on children. Concern about childhood obesity stems from the fact that not only does it predict obesity in adult life but it is also associated with the development of unfavourable health outcomes. For example, type 2 diabetes is increasingly a problem among children. Thus, in tackling overweight and obesity, one must put in place an efficient growth monitoring system that would permit then early detection of growth deviation among young children at risk. (excerpt)
Food and Nutrition Bulletin. 2004; 25 Suppl 1:S53-S59.The World Health Organization (WHO) Multicentre Growth Reference Study (MGRS) South American site was Pelotas, Brazil. The sample for the longitudinal component was drawn from three hospitals that account for approximately 90% of the city's deliveries. The cross-sectional sample was drawn from a community survey based on households that participated in the longitudinal sample. One of the criteria for site selection was the availability of a large, community based sample of children whose growth was unconstrained by socioeconomic conditions. Local work done in 1993 demonstrated that children of families with incomes at least six times the minimum wage had a stunting rate of 2.5%. Special public relations and implementation activities were designed to promote the acceptance of the study by the community and its successful completion. Among the major challenges of the site were serving as the MGRS pilot site, low baseline breastfeeding initiation and maintenance rates, and reluctance among pediatricians to acknowledge the relevance of current infant feeding recommendations to higher socioeconomic groups. (author's)
Food and Nutrition Bulletin. 2004; 25 Suppl 1:S15-S26.The World Health Organization (WHO) Multicentre Growth Reference Study (MGRS) is a community-based, multicountry project to develop new growth references for infants and young children. The design combines a longitudinal study from birth to 24 months with a cross-sectional study of children aged 18 to 71 months. The pooled sample from the six participating countries (Brazil, Ghana, India, Norway, Oman, and the United States) consists of about 8,500 children. The study subpopulations had socioeconomic conditions favorable to growth, and low mobility, with at least 20% of mothers following feeding recommendations and having access to breastfeeding support. The individual inclusion criteria were absence of health or environmental constraints on growth, adherence to MGRS feeding recommendations, absence of maternal smoking, single term birth, and absence of significant morbidity. In the longitudinal study, mothers and newborns were screened and enrolled at birth and visited at home 21 times: at weeks 1, 2, 4, and 6; monthly from 2 to 12 months; and every 2 months in their second year. In addition to the data collected on anthropometry and motor development, information was gathered on socioeconomic, demographic, and environmental characteristics, perinatal factors, morbidity, and feeding practices. The prescriptive approach taken is expected to provide a single international reference that represents the best description of physiological growth for all children under five years of age and to establish the breastfed infant as the normative model for growth and development. (author's)
Measurement and standardization protocols for anthropometry used in the construction of a new international growth reference.
Food and Nutrition Bulletin. 2004; 25 Suppl 1:S27-S36.Thorough training, continuous standardization, and close monitoring of the adherence to measurement procedures during data collection are essential for minimizing random error and bias in multicenter studies. Rigorous anthropometry and data collection protocols were used in the WHO Multicentre Growth Reference Study to ensure high data quality. After the initial training and standardization, study teams participated in standardization sessions every two months for a continuous assessment of the precision and accuracy of their measurements. Once a year the teams were restandardized against the WHO lead anthropometrist, who observed their measurement techniques and retrained any deviating observers. Robust and precise equipment was selected and adapted for field use. The anthropometrists worked in pairs, taking measurements independently, and repeating measurements that exceeded preset maximum allowable differences. Ongoing central and local monitoring identified anthropometrists deviating from standard procedures, and immediate corrective action was taken. The procedures described in this paper are a model for research settings. (author's)
Food and Nutrition Bulletin. 2004; 25 Suppl 1:S37-S45.The objective of the Motor Development Study was to describe the acquisition of selected gross motor milestones among affluent children growing up in different cultural settings. This study was conducted in Ghana, India, Norway, Oman, and the United States as part of the longitudinal component of the World Health Organization (WHO) Multicentre Growth Reference Study (MGRS). Infants were followed from the age of four months until they could walk independently. Six milestones that are fundamental to acquiring self-sufficient erect locomotion and are simple to evaluate were assessed: sitting without support, hands-and-knees crawling, standing with assistance, walking with assistance, standing alone, and walking alone. The information was collected by both the children's caregivers and trained MGRS fieldworkers. The caregivers assessed and recorded the dates when the milestones were achieved for the first time according to established criteria. Using standardized procedures, the fieldworkers independently assessed the motor performance of the children and checked parental recording at home visits. To ensure standardized data collection, the sites conducted regular standardization sessions. Data collection and data quality control took place simultaneously. Data verification and cleaning were performed until all queries had been satisfactorily resolved. (author's)
Lancet. 2006 Nov 25; 368(9550):1868-1869.Exclusive breastfeeding for 6 months is the normal way to feed all infants. The new WHO growth reference released in April, 2006, is based on breastfed infants under optimum conditions. The sample is highly selected for the factors likely to promote growth in breastfed infants, and less than 10% of those initially surveyed were included in the final study. Most mothers and health professionals are concerned about their infants' growth, particularly for the first 6 months. If they believe their infants are not growing adequately, they are more likely to introduce supplementary foods, including "top-ups" with infant formula or even switching to formula completely. "Insufficient milk" is the most common reason for the early cessation of breastfeeding and mothers often self-diagnose this on the basis of perceived slower growth. (excerpt)
Lancet. 2006 Nov 25; 368(9550)The first African Regional Health Report, finally released this week more than a year after its initial launch target, is one of the first products to emerge from Luis Sambo's Directorship of WHO's African Regional Office. In his inaugural speech on Feb 1, 2005, Sambo urged his colleagues, in country offices and regional headquarters, to "intensify efforts at identifying the best practices in health" and "document and disseminate" them so they can be replicated. This regional health report is, he believes, a key step in upgrading WHO AFRO's stewardship role in the region. It is a disappointing effort, one that reveals WHO's weaknesses rather than its strengths. It is clearly intended as an overview rather than as a detailed analysis, but even so it still suffers from being light on facts and heavy on well-rehearsed rhetoric. Much is simply lifted from past World Health Reports that have emerged from Geneva headquarters, supplemented by data from the World Bank and other institutions. There are some useful asides: briefly reported successes, such as a remarkable reduction in road traffic deaths in Rwanda and improvements to health-service access in South Africa's rural areas. However, it will take much more than an assemblage of isolated anecdotes to create a strategy for Africa's renaissance. (excerpt)
[Geneva, Switzerland], World Health Organization [WHO], Commission on Social Determinants of Health, Measurement and Evidence Knowledge Network, 2006 May. 29 p.In 2005, the Director General of the WHO set up a global Commission on the Social Determinants of Health (CSDH). The objective of the Commission was to achieve policy change by learning from existing knowledge about the social determinants of health (SDH) and turning that learning into global and national political and economic action. To facilitate the learning a number of Knowledge Networks (KNs) were established by WHO to synthesize knowledge about the social determinants of health. This paper has been prepared by one of those knowledge networks viz. the Measurement and Evidence Knowledge Network. The purpose of this paper is to articulate a series of methodological, theoretical and epistemological principles that will help to inform the development of the evidence base about the social determinants of health which all the Knowledge Networks will be working to construct. (excerpt)