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Implication of new WHO growth standards on identification of risk factors and estimated prevalence of malnutrition in rural Malawian infants.
PLoS One. 2008 Jul; 3(7): p.BACKGROUND: The World Health Organization (WHO) released new Child Growth Standards in 2006 to replace the current National Center for Health Statistics (NCHS) growth reference. We assessed how switching from the NCHS to the newly released WHO Growth Standards affects the estimated prevalence of wasting, underweight and stunting, and the pattern of risk factors identified. METHODOLOGY/PRINCIPAL FINDINGS: Data were drawn from a village-informant driven Demographic Surveillance System in Northern Malawi. Children (n = 1328) were visited twice at 0-4 months and 11-15 months. Data were collected on the demographic and socio-economic environment of the child, health history, maternal and child anthropometry and child feeding practices. Weight-for-length, weight-for-age and length-for-age were derived in z-scores using the two growth references. In early infancy, prevalence estimates were 2.9, 6.1, and 8.5 fold higher for stunting, underweight, and wasting respectively using the WHO standards compared to NCHS reference (p<0.001 for all). At one year, prevalence estimates for wasting and stunting did not differ significantly according to reference used, but the prevalence of underweight was half that with the NCHS reference (p<0.001). Patterns of risk factors were similar with the two growth references for all outcomes at one year although the strength of association was higher with WHO standards. CONCLUSIONS/SIGNIFICANCE: Differences in prevalence estimates differed in magnitude but not direction from previous studies. The scale of these differences depends on the population's nutritional status thus it should not be assumed a priori. The increase in estimated prevalence of wasting in early infancy has implications for feeding programs targeting lactating mothers and ante-natal multiple micronutrients supplementation to tackle small birth size. Risk factors identified using WHO standards remain comparable with findings based on the NCHS reference in similar settings. Further research should aim to identify whether the young infants additionally diagnosed as malnourished by this new standard are more appropriate targets for interventions than those identified with the NCHS reference.
Social Science and Medicine. 2007 Jan; 64(2):287-291.This article builds on a previous study which found low numbers of patent applications for HIV antiretroviral drugs in African countries. A high level of variation was noted across individual countries, and consequently, the present study has sought to account for sources of the variation through statistical analyses. First, a correlation between the number of patents and HIV infection rate was observed (r = 0.448, p < 0.001). T-tests identified significantly higher numbers of patents in national members of two intellectual property organizations (IPOs)--African Regional Intellectual Property Orginisation (ARIPO) and the Organisation Africaine de la Proprie´ te´ Intellectualle (OAPI)--than in countries who did not belong to an intellectual property organization. The relationship between IPO membership and number of patents was also statistically significant in a multivariate Poisson regression. These findings demonstrate that higher numbers of patents are found in countries where they are more easily filed. This has important policy implications given the worldwide trend toward increased recognition of pharmaceutical patents. (author's)
New York, New York, UNICEF, 2005 Apr. 40 p.The objective of this study is to present available empirical evidence obtained through household surveys in order to estimate the prevalence of child marriage and to identify and understand the factors associated with child marriage and cohabitation. The presentation of the empirical evidence and analysis is structured around the indicators presented previously. The term 'child marriage' will be used to refer to both formal marriages and informal unions in which a girl lives with a partner as if married before the age of 18. The report presents a global assessment of child marriage levels, differentials in child marriage rates according to socio-economic and demographic variables, characteristics of the union, and knowledge and access to sexual and reproductive health information and materials. Statistical associations between indicators can reveal potential linkages in programming to promote the delay of marriage and point to opportunities to integrate advocacy and behaviour-change campaigns toward the prevention of child marriage and a multivariate analysis allows for the illumination of the net effect of each variable. Anomalies to general trends are often highlighted in the text in order to direct programmers and researchers towards case examples that may require further study or circumstances that may provide models for eradication efforts. (excerpt)
Lancet. 2004 Oct 30; 364:1603-1609.Only a few studies have investigated the link between human resources for health and health outcomes, and they arrive at different conclusions. We tested the strength and significance of density of human resources for health with improved methods and a new WHO dataset. We did cross-country multiple regression analyses with maternal mortality rate, infant mortality rate, and under-five mortality rate as dependent variables. Aggregate density of human resources for health was an independent variable in one set of regressions; doctor and nurse densities separately were used in another set. We controlled for the effects of income, female adult literacy, and absolute income poverty. Density of human resources for health is significant in accounting for maternal mortality rate, infant mortality rate, and under-five mortality rate (with elasticities ranging from –0.474 to –0.212, all p values = 0.0036). The elasticities of the three mortality rates with respect to doctor density ranged from –0.386 to –0.174 (all p values = 0.0029). Nurse density was not associated except in the maternal mortality rate regression without income poverty (p = 0.0443). In addition to other determinants, the density of human resources for health is important in accounting for the variation in rates of maternal mortality, infant mortality, and under-five mortality across countries. The effect of this density in reducing maternal mortality is greater than in reducing child mortality, possibly because qualified medical personnel can better address the illnesses that put mothers at risk. Investment in human resources for health must be considered as part of a strategy to achieve the Millennium Development Goals of improving maternal health and reducing child mortality. (author's)
Journal of Health and Population in Developing Countries. 2003 Jul 2;  p..The trend and predictors of infertility are not well known in sub-Saharan Africa. A nationally representative Demographic and Health Survey (TDHS) was conducted in Tanzania in 1991/92, 1996 and 1999, enabling a trend study of infertility. Logistic regression was used to determine the predictors of infertility. The prevalence of primary infertility was about 2.5%, and secondary infertility was about 18%. There was no change between the 1991/92, 1996 and 1999 TDHS. The risk of primary infertility was higher in the Dar es Salaam and Coast regions than in other regions and secondary infertility was higher in the Dar es Salaam region. The Dar es Salaam and Coast regions are known for also having elevated levels of HIV/AIDS. Because sexual practices and sexually transmitted diseases are strong predictors of pathological infertility and HIV infection in Africa, we recommend that concerted efforts be made to integrate the prevention of new incidences of infertility with the HIV/AIDS campaigns. (author's)
Vitamin A deficiency and increased mortality among human immunodeficiency virus-infected adults in Uganda.
Nutrition Research. 2003 May; 23(5):595-605.The specific aims of the study were to determine the prevalence of vitamin A deficiency and to examine the relationship between vitamin A deficiency and mortality among human immunodeficiency virus (HIV)-infected adults in sub-Saharan Africa. A prospective cohort study was conducted at the outpatient clinic of Mulago Hospital, Kampala, Uganda, among HIV-infected adults enrolled in the placebo arms of a randomized clinical trial to prevent Mycobacterium tuberculosis infection. Of 519 subjects at enrollment, 186 (36%) had serum vitamin A concentrations consistent with deficiency (<1.05 µmol/L). During follow-up (median 17 months), the mortality among subjects with and without vitamin A deficiency at enrollment was 30% and 17%, respectively (P = 0.01). In a multivariate model adjusting for CD4+ lymphocyte count, age, sex, anergy status, body mass index, and diarrhea, vitamin A deficiency was associated with a significantly elevated risk of death [relative risk (RR) = 1.78, 95% confidence interval (CI) 1.2-2.6]. Vitamin A deficiency is common among HIV-infected adults in this sub-Saharan population and is associated with higher mortality. (author's)
Medical Hypotheses. 2003 Jul; 61(1):21-22.According to the United Nations, global fertility has declined in the last century as reflected by a decline in birth rates. The earth’s surface air temperature has increased considerably and is referred to as global warming. Since changes in temperature are well known to influence fertility we sought to determine if a statistical relationship exists between long-term changes in global air temperatures and birth rates. The most complete and reliable birth rate data in the 20th century was available in 19 industrialized countries. Using bivariate and multiple regression analysis, we compared yearly birth rates from these countries to global air temperatures from 1900 to 1994. A common pattern of change in birth rates was noted for the 19 industrialized countries studied. In general, birth rates declined markedly throughout the century except during the baby boom period of approximately 1940 to 1964. An inverse relationship was found between changes in global temperatures and birth rates in all 19 countries. Controlling for the linear yearly decline in birth rates over time, this relationship remained statistically significant for all the 19 countries in aggregate and in seven countries individually (p <0:05). Conclusions. The results of our analyses are consistent with the underlying premise that temperature change affects fertility and suggests that human fertility may have been influenced by change in environmental temperatures. (author's)
The impact of mother's education on infant and child mortality in selected countries in the ESCWA region. Discussion note.
[Unpublished] 1992. Presented at the International Conference on Population and Development [ICPD], 1994, Expert Group Meeting on Population and Women, Gaborone, Botswana, June 22-26, 1992. 21 p. (ESD/P/ICPD.1994/EG.III/DN.13)A number of researchers have associated child and infant mortality in developing countries with maternal education. The correlation has remained strong even when proximate variables and other socioeconomic variables were controlled. Setting was considered key to refinement of the associations. The illustrations from Jordan and Egypt showed that a particular level of education was needed before fertility declined and urban-rural differences prevailed. Analysis of 1980 Egyptian Fertility Survey data indicated a strong association between child survival and maternal education. Children of women with a secondary education had the lowest infant and child mortality. The impact of maternal education was strongest in Cairo and Alexandria. Findings showed that the child mortality rate for rural women with secondary education was 38% of that for illiterate women; the rate for educated urban women was 61% of that for uneducated women. Analysis of Egyptian Fertility Survey data for 1980 found that child mortality at any age was inversely related to maternal educational level. The infant mortality rate for uneducated mothers was 89% greater than for mothers with 6 or more years of schooling; neonatal mortality was 91% greater, postneonatal mortality was 86% greater, and child mortality was 108% greater. Multivariate analysis indicated that maternal education of at least 6 years decreased postneonatal mortality by 46.2%. Infant mortality was reduced by 26% with at least 6 years of maternal schooling. Child mortality was not affected by maternal education in the multivariate analysis. Data analysis based on data from the Egypt Pregnancy Wastage and Infant Mortality Survey, 1980, revealed that probability of dying in infancy decreased with increased levels of maternal and paternal education. Neonatal mortality was most affected by parental educational status. Multivariate analysis of Jordanian Fertility Survey data for 1976 and 1981 showed that mortality was higher for mothers with less than 6 years of education. Maternal and paternal education had independent effects, but paternal education had the greater impact. Paternal education lasting 9 or more years had an impact on urban child mortality, whereas paternal education must reach at least 12 years in rural areas in order for the effect to be observed. Inconsistent results were found for the impact of spousal differences in education. Rural lack of education had the strongest impact on child survival.
Country estimates of maternal mortality: an alternative model. [Estimaciones nacionales de mortalidad materna: un modelo alternativo]
Statistics in Medicine. 2001 Dec 15; 20(23):3505-3524.Ever since the publication of country level estimates of maternal mortality for WHO and UNICEF, there has been some degree of controversy about these estimates. The recent publication of a 1995 revision based on the modification of the multivariate model used for 1990 has not managed to put this controversy to rest. Countries with national estimates of their own have generally protested against the higher figures resulting from the multivariate modelling approach used by WHO and UNICEF, but some experts have also objected to the model itself. As a result of earlier discussions with the WHO/UNICEF team, some adjustments were incorporated into their model, notably the age standardization of maternal mortality ratios (MMRs) and proportions maternal among deaths of females of reproductive age (PDMF) of demographic and health surveys (DHS) direct sisterhood data, as the use of unstandardized values was shown to cause systematic biases. However, a model feature that continued to be controversial was the use of the PMDF as the dependent variable. As will be shown in this paper, the use of this dependent variable has a number of conceptual and practical disadvantages, such as tits dependence on non-maternal deaths and the need for separate projections of births and deaths of women of reproductive age, in order to convert the estimated PMDF into a more conventional MMR. The latter greatly increases the uncertainty of the resulting MMR estimates, even though this additional variance is ignored in the WHO/UNICEF estimates of confidence intervals. On balance, the MMR, while also subject to some legitimate objections, is still considered preferable as an independent variable. This paper therefore derives alternative country estimates for 1995 based on a multivariate model of the MMR. The model is shown to lead to smaller root mean square relative errors of the MMR estimates. While the overall number of maternal deaths estimated worldwide is very similar to the number reacted by WHO/UNICEF, there are major disagreements with respect to particular countries. Finally, a discussion is included on the appropriate way to incorporate the DHS direct sisterhood data, as this affects the results substantially. (excerpt)
[Unpublished] 1989 May. ii, 39 p.The chief methods for assessing programme impact on fertility were codified in the 1970's through a collaboration between the U.N. Population Division and the IUSSP Committee on the Comparative Analysis of Fertility and Family Planning. Since then there has been no attempt to review their actual use in 1) programme assessment; 2) target setting, and 3) training. This paper identifies, through an inquiry to numerous institutions and individuals, as well as through a literature search, the ways in which these methods have been used. We also suggest reasons for non-use of certain of the methods, and we discuss their successes and failures in research, training and program evaluation at the country level. Several factors were identified as important in this regard: 1) the growing availability of fertility and family planning surveys drawn from nationally representative samples of reproductive aged women; 2) the improvements in the measurement of program effort; 3) the rapid dissemination of microcomputers, and 4) the growing interest in target setting for policy making at the country level. Conclusion emphasize the value of population-based methods of measuring net program impact (e.g, multivariate techniques and experimental designs), the importance of well designed and documented software and growing interest in family planning evaluation in Africa. (Author's modified)
New York, UNFPA, 1980. 169 p.Research plans for comparative analysis of World Fertility Survey (WFS) data of the Population Division of the UN are discussed. Introductory notes are on the aim and scope of the project, on the plan itself and on considerations concerning regional analysis. An exhaustive list of possible research topics which would use the WFS data is provided. The research plan is then described in detail. The 2nd section is entitled "Review of Characteristics, Measures and Other Indicators" and is a critical review of information considered for use as variables in the comparative analysis of WFS data. A glossary of variables is included. Both dependent and independent variables are explored. The 3rd section is entitled "Research Objectives, Hypotheses and Minimum Tabulation Plan." It consists of a critical review of the research objectives of each topic of the minimum program agreed on by the UN Working Group on Comparative Analysis of WFS Data. Hypotheses relevant to each topic are examined and a minimum tabulation plan appropriate for testing these hypotheses, which draws on the variables presented in Part 2, is proposed. The final part of this volume is called "A strategy for the comparative analysis of WFS data." A possible multivariate statistical approach to analyzing the WFS data is illustrated. Included are 1) a framework for comparative analysis using the WFS; 2) a discussion of the relationship of this model to the UN Minimum Research Program; 3) comparative analysis of parity by educational attainment by years since 1st marriage; 4) analysis of likelihood of contracepting among women who say they want no more children.
Washington, D.C., World Bank, Population, Health and Nutrition Dept., 1982 Oct. 46 p. (PHN Technical Notes RES 3)This paper uses data from the World Bank and UNFPA sponsored survey on the determinants of fertility decline in Sri Lanka. The multivariate analysis shows that whereas the traditionally strong influences on fertility, and hence contraceptive use, such as education, age, and labor force participation still exist among the older women, changes in the nature of delivery of family planning services are making these socioeconomic factors less salient among younger women, as well as among subgroups of older women. (author's)