Publications by authors named "Kingsley Emwinyore Agho"

29 Publications

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

Nutrients 2021 Mar 2;13(3). Epub 2021 Mar 2.

Translational Health Research Institute (THRI), Western Sydney University, Penrith, NSW 2571, Australia.

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.
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http://dx.doi.org/10.3390/nu13030825DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7998710PMC
March 2021

Misinformation About COVID-19 in Sub-Saharan Africa: Evidence from a Cross-Sectional Survey.

Health Secur 2021 Jan-Feb;19(1):44-56

Uchechukwu L. Osuagwu, PhD, is a Research Fellow, Diabetes, Obesity and Metabolism Translational Research Unit, School of Medicine; and Kingsley Emwinyore Agho, PhD, is an Associate Professor of Biostatistics, School of Health Sciences; both at Western Sydney University, Campbelltown, Australia. Chundung A. Miner is an Associate Professor, Department of Community Medicine, College of Health Sciences; Piwuna Christopher Goson, MBBS, is a Senior Lecturer, Department of Psychiatry, College of Health Sciences; and Tanko Ishaya, PhD, is a Professor, Department of Computer Science; all at the University of Jos, Plateau State, Nigeria. Dipesh Bhattarai, PhD, is an Associate Lecturer, School of Medicine, Faculty of Health, Deakin University, Victoria, Australia. Khathutshelo Percy Mashige, PhD, is a Professor, Discipline of Optometry, African Vision Research Institute, Westville Campus, University of KwaZulu-Natal, Durban, South Africa. Richard Oloruntoba, PhD, is an Associate Professor, Supply Chain Management, School of Management and Marketing, Faculty of Business and Law, Curtin University, Bentley, Western Australia. Emmanuel Kwasi Abu, PhD, is Dean, Department of Optometry and Vision Science, School of Allied Health Sciences, University of Cape Coast, Ghana. Bernadine Ekpenyong, PhD, is Senior Lecturer, Department of Public Health, Faculty of Allied Medical Sciences, College of Medical Sciences, University of Calabar, Cross River State, Nigeria. Timothy G. Chikasirimobi, MSc, is a Master's Student, Masinde Muliro University of Science and Technology, Kakamega, Kenya. Godwin O. Ovenseri-Ogbomo, PhD, is an Assistant Professor, Department of Optometry, College of Applied Medical Sciences, Qassim University, Saudi Arabia, and Department of Optometry, Faculty of Life Sciences, University of Benin, Benin City, Nigeria. Raymond Langsi, MBBS, is Head, Health Division, University of Bamenda, Bambili, Cameroon. Deborah Donald Charwe, MSc, is Senior Research Nutritionist, Tanzania Food and Nutrition Center, Dar es Salaam, Tanzania. Obinna Nwaeze, MBBS, is a Practicing Physician, County Durham and Darlington, National Health Service Foundation, United Kingdom. Uchechukwu L. Osuagwu, Bernadine Ekpenyong, Godwin O. Ovenseri-Ogbomo, and Kingsley Emwinyore Agho are also Conjoint Members, Discipline of Optometry, African Vision Research Institute, Westville Campus, University of KwaZulu-Natal, Durban, South Africa.

Misinformation about coronavirus disease 2019 (COVID-19) is a significant threat to global public health because it can inadvertently exacerbate public health challenges by promoting spread of the disease. This study used a convenience sampling technique to examine factors associated with misinformation about COVID-19 in sub-Saharan Africa using an online cross-sectional survey. A link to the online self-administered questionnaire was distributed to 1,969 participants through social media platforms and the authors' email networks. Four false statements-informed by results from a pilot study-were included in the survey. The participants' responses were classified as "Agree," "Neutral," and "Disagree." A multinomial logistic regression was used to examine associated factors. Among those who responded to the survey, 19.3% believed that COVID-19 was designed to reduce world population, 22.2% thought the ability to hold your breath for 10 seconds meant that you do not have COVID-19, 27.8% believed drinking hot water flushes down the virus, and 13.9% thought that COVID-19 had little effect on Blacks compared with Whites. An average of 33.7% were unsure whether the 4 false statements were true. Multivariate analysis revealed that those who thought COVID-19 was unlikely to continue in their countries reported higher odds of believing in these 4 false statements. Other significant factors associated with belief in misinformation were age (older adults), employment status (unemployed), gender (female), education (bachelor's degree), and knowledge about the main clinical symptoms of COVID-19. Strategies to reduce the spread of false information about COVID-19 and other future pandemics should target these subpopulations, especially those with limited education. This will also enhance compliance with public health measures to reduce spread of further outbreaks.
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http://dx.doi.org/10.1089/HS.2020.0202DOI Listing
February 2021

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

Nutrients 2021 Feb 8;13(2). Epub 2021 Feb 8.

Translational Health Research Institute (THRI), Campbelltown Campus, Western Sydney University, Sydney, NSW 2560, Australia.

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.
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http://dx.doi.org/10.3390/nu13020557DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7915163PMC
February 2021

Prevalence and Factors Associated with Mental and Emotional Health Outcomes among Africans during the COVID-19 Lockdown Period-A Web-based Cross-Sectional Study.

Int J Environ Res Public Health 2021 01 21;18(3). Epub 2021 Jan 21.

African Vision Research Institute (AVRI), Discipline of Optometry, University of KwaZulu-Natal, Westville Campus, Durban 3629, South Africa.

Mental health and emotional responses to the effects of COVID-19 lockdown in sub-Saharan Africa (SSA) are of serious public health concern and may negatively affect the mental health status of people. Hence, this study assessed the prevalence of mental health symptoms as well as emotional reactions among sub-Saharan Africans (SSAs) and associated factors among SSAs during the COVID-19 lockdown period. This was a web-based cross-sectional study on mental health and emotional features from 2005 respondents in seven SSA countries. This study was conducted between 17 April and 17 May 2020 corresponding to the lockdown period in most SSA countries. Respondents aged 18 years and above and the self-reported symptoms were feeling anxious, being worried, angry, bored and frustrated. These were the main outcomes and were treated as dichotomous variables. Univariate and multivariate logistic regression analyses were used to identify the factors associated with these symptoms. We found that over half (52.2%) of the participants reported any of the mental health symptoms and the prevalence of feeling bored was 70.5% followed by feeling anxious (59.1%), being worried (57.5%), frustrated (51.5%) and angry (22.3%) during the COVID-19 pandemic. Multivariate analysis revealed that males, those aged >28 years, those who lived in Central and Southern Africa, those who were not married, the unemployed, those living with more than six persons in a household, had higher odds of mental health and emotional symptoms. Similarly, people who perceived low risk of contracting the infection, and those who thought the pandemic would not continue after the lockdown had higher odds of mental health and emotional symptoms. Health care workers had lower odds for feeling angry than non-healthcare workers. During the COVID-19 lockdown periods in SSA, about one in two participants reported mental health and emotional symptoms. Public health measures can be effectively used to identify target groups for prevention and treatment of mental health and emotional symptoms. Such interventions should be an integral component of SSA governments' response and recovery strategies of any future pandemic.
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http://dx.doi.org/10.3390/ijerph18030899DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7908555PMC
January 2021

Shonjibon cash and counselling: a community-based cluster randomised controlled trial to measure the effectiveness of unconditional cash transfers and mobile behaviour change communications to reduce child undernutrition in rural Bangladesh.

BMC Public Health 2020 Nov 25;20(1):1776. Epub 2020 Nov 25.

Sydney School of Public Health, The University of Sydney, Sydney, Australia.

Background: Undernutrition is strongly associated with poverty - levels of undernutrition are higher in poor countries than in better-off countries. Social protection especially cash transfer is increasingly recognized as an important strategy to accelerate progress in improving maternal and child nutrition. A critical method to improve nutrition knowledge and influence feeding practices is through behaviour change communication intervention. The Shonjibon Cash and Counselling study aims to assess the effectiveness of unconditional cash transfers combined with a mobile application on nutrition counselling and direct counselling through mobile phone in reducing the prevalence of stunting in children at 18 months.

Method: The study is a longitudinal cluster randomised controlled trial, with two parallel groups, and cluster assignment by groups of villages. The cohort of mother-child dyads will be followed-up over the intervention period of approximately 24 months, starting from recruitment to 18 months of the child's age. The study will take place in north-central Bangladesh. The primary trial outcome will be the percentage of stunted children at 18 m as measured in follow up assessments starting from birth. The secondary trial outcomes will include differences between treatment arms in (1) Mean birthweight, percentage with low birthweight and small for gestational age (2) Mean child length-for age, weight for age and weight-for-length Z scores (3) Prevalence of child wasting (4) Percentage of women exclusively breastfeeding and mean duration of exclusive breastfeeding (5) Percentage of children consuming > 4 food groups (6) Mean child intake of energy, protein, carbohydrate, fat and micronutrients (7) Percentage of women at risk of inadequate nutrient intakes in all three trimesters (8) Maternal weight gain (9) Household food security (10) Number of events for child suffering from diarrhoea, acute respiratory illness and fever (11) Average costs of mobile phone BCC and cash transfer, and benefit-cost ratio for primary and secondary outcomes.

Discussion: The proposed trial will provide high-level evidence of the efficacy and cost-effectiveness of mobile phone nutrition behavior change communication, combined with unconditional cash transfers in reducing child undernutrition in rural Bangladesh.

Trial Registration: The study has been registered in the Australian New Zealand Clinical Trials Registry ( ACTRN12618001975280 ).
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http://dx.doi.org/10.1186/s12889-020-09780-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7686824PMC
November 2020

Exclusive Breastfeeding Rates and Associated Factors in 13 "Economic Community of West African States" (ECOWAS) Countries.

Nutrients 2019 Dec 9;11(12). Epub 2019 Dec 9.

Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571, Australia.

Exclusive breastfeeding (EBF) has important protective effects on child survival and also increases the growth and development of infants. This paper examined EBF rates and associated factors in 13 "Economic Community of West African States" (ECOWAS) countries. A weighted sample of 19,735 infants from the recent Demographic and Health Survey dataset in ECOWAS countries for the period of 2010-2018 was used. Survey logistic regression analyses that adjusted for clustering and sampling weights were used to determine the factors associated with EBF. In ECOWAS countries, EBF rates for infants 6 months or younger ranged from 13.0% in Côte d'Ivoire to 58.0% in Togo. EBF decreased significantly by 33% as the infant age (in months) increased. Multivariate analyses revealed that mothers with at least primary education, older mothers (35-49 years), and those who lived in rural areas were significantly more likely to engage in EBF. Mothers who made four or more antenatal visits (ANC) were significantly more likely to exclusively breastfeed their babies compared to those who had no ANC visits. Our study shows that EBF rates are still suboptimal in most ECOWAS countries. EBF policy interventions in ECOWAS countries should target mothers with no schooling and those who do not attend ANC. Higher rates of EBF are likely to decrease the burden of infant morbidity and mortality in ECOWAS countries due to non-exposure to contaminated water or other liquids.
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http://dx.doi.org/10.3390/nu11123007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6950341PMC
December 2019

Factors Associated with the Early Initiation of Breastfeeding in Economic Community of West African States (ECOWAS).

Nutrients 2019 Nov 14;11(11). Epub 2019 Nov 14.

School of Science and Health, University of Western Sydney, Locked Bag 1797, Penrith, NSW 1797, Australia.

The early initiation of breastfeeding (EIBF) within one hour after birth enhanced mother-newborn bonding and protection against infectious diseases. This paper aimed to examine factors associated with EIBF in 13 Economic Community of West African States (ECOWAS). A weighted sample of 76,934 children aged 0-23 months from the recent Demographic and Health Survey dataset in the ECOWAS for the period 2010 to 2018 was pooled. Survey logistic regression analyses, adjusting for country-specific cluster and population-level weights, were used to determine the factors associated with EIBF. The overall combined rate of EIBF in ECOWAS was 43%. After adjusting for potential confounding factors, EIBF was significantly lower in Burkina Faso, Cote d'Ivoire, Guinea, Niger, Nigeria, and Senegal. Mothers who perceived their babies to be average and large at birth were significantly more likely to initiate breastfeeding within one hour of birth than those mothers who perceived their babies to be small at birth. Mothers who had a caesarean delivery (AOR = 0.28, 95%CI = 0.22-0.36), who did not attend antenatal visits (ANC) during pregnancy, and delivered by non-health professionals were more likely to delay initiation of breastfeeding beyond one hour after birth. Male children and mothers from poorer households were more likely to delay introduction of breastfeeding. Infant and young child feeding nutrition programs aimed at improving EIBF in ECOWAS need to target mothers who underutilize healthcare services, especially mothers from lower socioeconomic groups.
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http://dx.doi.org/10.3390/nu11112765DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6893771PMC
November 2019

Determinants of trends in neonatal, post-neonatal, infant, child and under-five mortalities in Tanzania from 2004 to 2016.

BMC Public Health 2019 Sep 9;19(1):1243. Epub 2019 Sep 9.

Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Penrith, NSW, 2751, Australia.

Background: Under-five mortality is still a major health issue in many developing countries like Tanzania. To achieve the Sustainable Development Goal target of ending preventable child deaths in Tanzania, a detailed understanding of the risk factors for under-five deaths is essential to guide targeted interventions. This study aimed to investigate trends and determinants of neonatal, post-neonatal, infant, child and under-five mortalities in Tanzania from 2004 to 2016.

Methods: The study used combined data from the 2004-2005, 2010 and 2015-2016 Tanzania Demographic and Health Surveys, with a sample of 25,951 singletons live births and 1585 under-five deaths. We calculated age-specific mortality rates, followed by an assessment of trends and determinants (community, socioeconomic, individual and health service) of neonatal, postneonatal, infant, child and under-five mortalities in Cox regression models. The models adjusted for potential confounders, clustering and sampling weights.

Results: Between 2004 and 2016, we found that neonatal mortality rate remained unchanged, while postneonatal mortality and child mortality rates have halved in Tanzania. Infant mortality and under-five mortality rates have also declined. Mothers who gave births through caesarean section, younger mothers (< 20 years), mothers who perceived their babies to be small or very small and those with fourth or higher birth rank and a short preceding birth interval (≤2 years) reported higher risk of neonatal, postneonatal and infant mortalities.

Conclusion: Our study suggests that there was increased survival of children under-5 years in Tanzania driven by significant improvements in postneonatal, infant and child survival rates. However, there remains unfinished work in ending preventable child deaths in Tanzania.
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http://dx.doi.org/10.1186/s12889-019-7547-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6734430PMC
September 2019

Women's autonomy and utilisation of maternal healthcare services in 31 Sub-Saharan African countries: results from the demographic and health surveys, 2010-2016.

BMJ Open 2019 03 13;9(3):e023128. Epub 2019 Mar 13.

Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.

Objectives: To examine the association between women's autonomy and the utilisation of maternal healthcare services across 31 Sub-Saharan African countries.

Design, Setting And Participants: We analysed the Demographic and Health Survey (DHS) (2010-2016) data collected from married women aged 15-49 years. We used four DHS measures related to women's autonomy: attitude towards domestic violence, attitude towards sexual violence, decision making on spending of household income made by the women solely or jointly with husbands and decision making on major household purchases made by the women solely or jointly with husbands. We used multiple logistic regression analyses to examine the association between women's autonomy and the utilisation of maternal healthcare services adjusted for five potential confounders: place of residence, age at birth of the last child, household wealth, educational attainment and working status. Adjusted ORs (aORs) and 95% CI were used to produce the forest plots.

Outcome Measures: The primary outcome measures were the utilisation of ≥4 antenatal care visits and delivery by skilled birth attendants (SBA).

Results: Pooled results for all 31 countries (194 883 women) combined showed weak statistically significant associations between all four measures of women's autonomy and utilisation of maternal healthcare services (aORs ranged from 1.07 to 1.15). The strongest associations were in the Southern African region. For example, the aOR for women who made decisions on household income solely or jointly with husbands in relation to the use of SBAs in the Southern African region was 1.44 (95% CI 1.21 to 1.70). Paradoxically, there were three countries where women with higher autonomy on some measures were less likely to use maternal healthcare services. For example, the aOR in Senegal for women who made decisions on major household purchases solely or jointly with husbands in relation to the use of SBAs (aOR=0.74 95% CI 0.59 to 0.94).

Conclusion: Our results revealed a weak relationship between women's autonomy and the utilisation of maternal healthcare services. More research is needed to understand why these associations are not stronger.
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http://dx.doi.org/10.1136/bmjopen-2018-023128DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6429737PMC
March 2019

Gender differences in factors associated with prehypertension and hypertension in Nepal: A nationwide survey.

PLoS One 2018 13;13(9):e0203278. Epub 2018 Sep 13.

Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Penrith, New South Wales, Australia.

Background: Nepal has one of the highest prevalence of hypertension in South Asia. However, no national studies have examined the gender differences in the determinants of prehypertension and hypertension in the country to inform targeted interventions. This study aimed to investigate gender differences in factors associated with prehypertension and hypertension in Nepal using the 2016 Nepal Demographic and Health Survey (NDHS).

Methods: Sociodemographic, behavioural, anthropometric and health status data and information on hypertension were obtained from 14,857 (males: 6,245 and females: 8,612) individuals aged 15 years or above from the biomarker sample of the 2016 NDHS. Factors associated with prehypertension and hypertension by gender were investigated using generalized linear latent and mixed models (GLLAM) with the mlogit link and binomial family that adjusted for clustering and sampling weights.

Results: The overall prevalence of prehypertension and hypertension was 26.9% [95% confidence interval (CI): 25.7, 28.1] and 17.2% (95% CI 16.1, 18.3), respectively. Prehypertension was present in 30.4% (95%CI: 28.7, 32.2) of males and 24.3% (95% CI: 23.1, 25.6) of females, while hypertension was present in 20.4%, (95% CI 18.9, 22.0) of males and 14.8% (95% CI: 13.7, 16.0) of females. Key modifiable factors that were strongly associated with prehypertension and hypertension in both genders included overweight and obesity, caffeine intake, tobacco use, no schooling, previously informed of hypertension in a health facility, and alcohol consumption (for males). Other significant factors associated with prehypertension and hypertension included increasing age (> 30 years), ecological zone (Hill), Developmental zone (Western) and being married.

Conclusion: Our results suggest that prehypertension and hypertension were higher in males compared to females. Interventions to improve awareness, screening, treatment and control of prehypertension and hypertension in Nepal are warranted and should target key modifiable factors, as well as people aged 30 years and above.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0203278PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6136738PMC
February 2019

Stillbirth in the African Great Lakes region: A pooled analysis of Demographic and Health Surveys.

PLoS One 2018 29;13(8):e0202603. Epub 2018 Aug 29.

School of Social Sciences and Psychology, Western Sydney University, Penrith, New South Wales, Australia.

Background: The aim of this study was to estimate the rate and predisposing factors associated with stillbirth in the African Great Lakes region (Burundi, Congo Democratic Republic, Kenya, Rwanda, Tanzania and Uganda).

Methods And Findings: Cross-sectional data from the most recent Demographic and Health Surveys (DHS) of countries in the African Great Lakes region were used in this study. DHS from Congo Democratic Republic was not included in the analyses because data was not collected for stillbirth in the country survey. A pooled sample of 57046 pregnancies of 7+ months' duration and 1002 stillbirths were included in the final analysis. The analyses were restricted to stillbirths reported in the 5 years preceding the surveys. Stillbirth was defined as foetal death in the third trimester (≥ 28 weeks' gestation). Multilevel logistic regression analyses that adjusted for cluster and survey weights were used to determine the factors associated with stillbirth in the Africa Great Lakes region. Health service variables and maternal medical condition variables were not included in the analysis because DHS do not collect data on these variables for pregnancies that did not result in a live birth. Burundi had the highest stillbirth rate per 1000 births [23% (95% CI: 20, 25)] within the region. Factors associated with stillbirth across the region were: no schooling [1.85 (95%Cl: 1.44, 2.38)] and primary education [1.64 (1.32, 2.05)], advanced maternal age [2.39 (95% CI: 1.59, 3.59)], smoking [1.99 (95% CI: 1.19, 3.32)] and drinking water from unimproved sources [1.18 (95% CI: 1.01, 1.37)].

Conclusion: To achieve Every Newborn Action Plan (ENAP) stillbirth target of 12 per 1000 births or less by 2030, policy interventions to prevent stillbirth should focus on promoting community-based socio-educational programmes which encourages a healthy lifestyle especially among uneducated women in the advanced age spectrum.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0202603PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6114867PMC
February 2019

Association between health service use and diarrhoea management approach among caregivers of under-five children in Nepal.

PLoS One 2018 1;13(3):e0191988. Epub 2018 Mar 1.

Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.

Introduction: Diarrhoea among children under-five is a serious public health problem in many developing countries, including Nepal. This study aimed to examine the association between health service utilization and diarrhoea management approaches among children under-five years in Nepal.

Methods: The combined 2001, 2006 and 2011 Nepal Demographic and Health Survey (NDHS) data sets were examined and the sample included 2,655 children aged 0-59 months who had diarrhoea 2-weeks prior to the each survey. Multilevel logistic regression analyses that adjust for clustering and sampling weight were used to examine the association between health service utilization and diarrhoea management approaches (Oral Rehydration Solution, increased fluids and/or continued feeding).

Results: The prevalence of extra fluids decreased significantly from 27% in 2001 to 15% in 2011 while that of ORS increased significantly from 32% in 2001 to 40% in 2011. The prevalence of continued feeding fluctuated between 83-89%. Multivariate analysis revealed that caregivers whose children received treatment or advice from health care providers during diarrhoea were 5.78 times more likely to treat diarrhoea with Oral Rehydration Solution (ORS) [adjusted Odds Ratio (aOR) 5.78, 95% confidence interval (CI) 4.50, 7.44], 1.56 (aOR 1.56, 95% CI 1.19, 2.05) times more likely to offer extra fluids, and 2.25 (aOR 2.25, 95% CI 1.50, 3.39) times more likely to use continued feeding than those who did not seek advice.

Conclusions: Our findings indicate that health service utilization significantly improves diarrhoea management among under-five children. However, a broader national diarrhoeal disease control program to further reduce diarrhoea related morbidity and mortality in Nepal should focus on educating caregivers about the importance of the use of ORS as well as increase fluid intake to children under-five years with diarrhoea.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0191988PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5832205PMC
June 2018

Attributable risk and potential impact of interventions to reduce household air pollution associated with under-five mortality in South Asia.

Glob Health Res Policy 2018 18;3. Epub 2018 Jan 18.

2School of Science and Health, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571 Australia.

Background: Solid fuel use is the major source of household air pollution (HAP) and accounts for a substantial burden of morbidity and mortality in low and middle income countries. To evaluate and compare childhood mortality attributable to HAP in four South Asian countries.

Methods: A series of Demographic and Health Survey (DHS) datasets for Bangladesh, India, Nepal and Pakistan were used for analysis. Estimates of relative risk and exposure prevalence relating to use of cooking fuel and under-five mortality were used to calculate population attributable fractions (PAFs) for each country. Potential impact fractions (PIFs) were also calculated assessing theoretical scenarios based on published interventions aiming to reduce exposure prevalence.

Results: There are an increased risk of under-five mortality in those exposed to cooking fuel compared to those not exposed in the four South Asian countries (OR = 1.30, 95% CI = 1.07-1.57,  = 0.007). Combined PAF estimates for South Asia found that 66% (95% CI: 43.1-81.5%) of the 13,290 estimated cases of under-five mortality was attributable to HAP. Joint PIF estimates (assuming achievable reductions in HAP reported in intervention studies conducted in South Asia) indicates 47% of neonatal and 43% of under-five mortality cases associated with HAP could be avoidable in the four South Asian countries studied.

Conclusions: Elimination of exposure to use of cooking fuel in the household targeting valuable intervention strategies (such as cooking in separate kitchen, improved cook stoves) could reduce substantially under-five mortality in South Asian countries.
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http://dx.doi.org/10.1186/s41256-018-0059-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5772697PMC
January 2018

The impact of antenatal care, iron-folic acid supplementation and tetanus toxoid vaccination during pregnancy on child mortality in Bangladesh.

PLoS One 2017 1;12(11):e0187090. Epub 2017 Nov 1.

School of Science and Health, Western Sydney University, Penrith, New South Wales, Australia.

Background: Appropriate antenatal care (ANC) is an important preventive public health intervention to ensure women's and newborn health outcomes. The study aimed to investigate the impact of ANC, iron-folic acid (IFA) supplementation and tetanus toxoid (TT) vaccination during pregnancy on child mortality in Bangladesh.

Method: A cross-sectional study of three datasets from the Bangladesh Demographic and Health Surveys for the years 2004, 2007 and 2011 were pooled and used for the analyses. A total weighted sample of 16,721 maternal responses (5,364 for 2004; 4,872 for 2007 and 6,485 for 2011) was used. Multivariate logistic models that adjusted for cluster and sampling weights were used to examine the impact of ANC, IFA supplementation and TT vaccination during pregnancy on the death of a child aged 0-28 days (neonatal), 1-11 months (post-neonatal) and 12-59 months (child).

Results: Multivariable analyses revealed that the odds of postnatal and under-5 mortality was lower in mothers who had ANC [Odds Ratio (OR) = 0.60, 95% confidence interval (95% CI): 0.43-0.85], IFA supplementation [OR = 0.66, 95% CI: (0.45-0.98)] and ≥2 TT vaccinations (OR = 0.43, 95% CI: 0.49-0.78) for post-natal mortality; and for under-5 mortality, any form of ANC (OR = 0.69, 95% CI: 0.51-0.93), IFA supplementation (OR = 0.67, 95% CI: 0.48-0.94) and ≥2 TT vaccinations (OR = 0.50, 95% CI: 0.36-0.69). When combined, TT vaccination with IFA supplementation, and TT vaccination without IFA supplementation were protective across all groups.

Conclusion: The study found that ANC, IFA supplementation, and TT vaccination during pregnancy reduced the likelihood of child mortality in Bangladesh. The findings suggest that considerable gains in improving child survival could be achieved through ensuring universal coverage of ANC, promoting TT vaccination during pregnancy and IFA supplementation among pregnant women in Bangladesh.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0187090PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5665518PMC
December 2017

Prevalence of key breastfeeding indicators in 29 sub-Saharan African countries: a meta-analysis of demographic and health surveys (2010-2015).

BMJ Open 2017 Oct 24;7(10):e014145. Epub 2017 Oct 24.

School of Social Sciences and Psychology, Western Sydney University, Sydney, New South Wales, Australia.

Objectives: To carry out a meta-analysis to assess the prevalence of four key breastfeeding indicators in four subregions of 29 sub-Saharan African countries.

Design, Settings And Participants: The 29 countries were categorised into four subregions, and using cross-sectional data from the most recent Demographic and Health Surveys (2010-2015) of these countries prevalence of each of four key breastfeeding indicators was estimated for each of the subregions by carrying out a meta-analysis. Due to the presence of significant heterogeneity among the various surveys (I>50%), a random-effect analytic model was used, and sensitivity analysis was performed to examine the effects of outliers.

Main Outcome Variables: Early initiation of breast feeding, exclusive breast feeding, predominant breast feeding and bottle feeding.

Results: The overall prevalence of varied between a lowest of 37.84% (95% CI 24.62 to 51.05) in Central Africa to a highest of 69.31% (95% CI 67.65 to 70.97) in Southern Africa; the overall prevalence of ranged between a lowest of 23.70% (95% CI 5.37 to 42.03) in Central Africa to a highest of 56.57% (95% CI 53.50 to 59.95) in Southern Africa; the overall prevalence of ranged between a lowest of 17.63% (95% CI 12.70 to 22.55) in East Africa and a highest of 46.37% (95% CI 37.22 to 55.52) in West Africa; while the prevalence of varied between a lowest of 8.17% (95% CI 5.51 to 10.84) in West Africa and a highest of 30.05% (95% CI 28.42 to 31.69) in Southern Africa.

Conclusions: West Africa and Central Africa recorded lower overall prevalence of and than the WHO's recommended target of 50% by the year 2025. Intervention for improved breastfeeding practices in sub-Saharan Africa should target West and Central Africa, while intervention to minimise bottle feeding should target Southern Africa.
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http://dx.doi.org/10.1136/bmjopen-2016-014145DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5665288PMC
October 2017

Potential Impacts of Modifiable Behavioral and Environmental Exposures on Reducing Burden of Under-five Mortality Associated with Household Air Pollution in Nepal.

Matern Child Health J 2018 01;22(1):59-70

School of Science and Health, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2571, Australia.

Objectives Household air pollution (HAP) is one of the leading causes of respiratory illness and deaths among young children in low and lower-middle income countries. This study examines for the first time trends in the association between HAP from cooking fuel and under-five mortality and measures the potential impact of interventions to reduce HAP using Nepal Demographic and Health Survey datasets (2001-2011). Methods A total of 17,780 living children across four age-groups (neonatal 0-28 days, post-neonatal 1-11 months, child 12-59 months and under-five 0-59 months) were included and multi-level logistic regression models were used for analyses. Population attributable fractions of key risk factors and potential impact fractions assessing the impact of previous interventions to reduce exposure prevalence were also calculated. Results Use of cooking fuel was associated with total under-five mortality (OR 2.19, 95% CI 1.37-3.51, P = 0.001) in Nepal, with stronger associations evident for sub-group analyses of neonatal mortality (OR 2.67, 95% CI 1.47-4.82, P = 0.001). Higher association was found in rural areas and for households without a separate kitchen using polluting fuel for cooking, and in women who had never breastfed for all age-groups of children. PIF estimates, assuming a 63% of reduction of HAP based on previously published interventions in Nepal, suggested that a burden of 40% of neonatal and 33% of under-five mortality cases associated with an indoor kitchen using polluting fuel could be avoidable. Conclusion Improved infrastructure and behavioral interventions could help reduce the pollution from cooking fuel in the household resulting in further reduction in under-five mortality in Nepal.
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http://dx.doi.org/10.1007/s10995-017-2355-3DOI Listing
January 2018

Socio-economic predictors of stillbirths in Nepal (2001-2011).

PLoS One 2017 13;12(7):e0181332. Epub 2017 Jul 13.

Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.

Introduction: Stillbirth has a long-lasting impact on parents and families. This study examined socio-economic predictors associated with stillbirth in Nepal for the year 2001, 2006 and 2011.

Methods: The Nepalese Demographic and Health Survey (NDHS) data for the period (2001-2011) were pooled to estimate socio-economic predictors associated with stillbirths in Nepal using binomial logistic regression while taking clustering and sampling weights into account.

Results: A total of 18,386 pregnancies of at least 28 weeks gestation were identified. Of these pregnancies, 335 stillbirths were reported. Stillbirth increased significantly among women that lived in the hills ecological zones (aRR 1.38, 95% CI 1.02, 1.87) or in the mountains ecological zones (aRR 1.71, 95% CI 1.10, 2.66). Women with no schooling (aRR 1.72, 95% CI 1.10, 2.69), women with primary education (aRR 1.81, 95% CI 1.11, 2.97); open defecation (aRR 1.48, 95% CI 1.00, 2.18), and those whose major occupation was agriculture (aRR 1.80, 95% CI 1.16, 2.78) are more likely to report higher stillbirth.

Conclusions: Low levels of education, ecological zones and open defecation were found to be strong predictors of stillbirth. Access to antenatal care services and skilled birth attendants for women in the mountainous and hilly ecological zones of Nepal is needed to further reduce stillbirth and improved services should also focus on women with low levels of education.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0181332PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5509325PMC
September 2017

Household air pollution from use of cooking fuel and under-five mortality: The role of breastfeeding status and kitchen location in Pakistan.

PLoS One 2017 9;12(3):e0173256. Epub 2017 Mar 9.

School of Science and Health, Western Sydney University, Campbelltown Campus, Penrith, New South Wales, Australia.

Household air pollution (HAP) mainly from cooking fuel is one of the major causes of respiratory illness and deaths among young children in low and middle-income countries like Pakistan. This study investigates for the first time the association between HAP from cooking fuel and under-five mortality using the 2013 Pakistan Demographic and Health Survey (PDHS) data. Multi-level logistic regression models were used to examine the association between HAP and under-five mortality in a total of 11,507 living children across four age-groups (neonatal aged 0-28 days, post-neonatal aged 1-11 months, child aged 12-59 months and under-five aged 0-59 months). Use of cooking fuel was weakly associated with total under-five mortality (OR = 1.22, 95%CI = 0.92-1.64, P = 0.170), with stronger associations evident for sub-group analyses of children aged 12-59 months (OR = 1.98, 95%CI = 0.75-5.25, P = 0.169). Strong associations between use of cooking fuel and mortality were evident (ORs >5) in those aged 12-59 months for households without a separate kitchen using polluting fuels, and in children whose mother never breastfed. The results of this study suggest that HAP from cooking fuel is associated with a modest increase in the risk of death among children under five years of age in Pakistan, but particularly in those aged 12-59 months, and those living in poorer socioeconomic conditions. To reduce exposure to cooking fuel which is a preventable determinant of under-five mortality in Pakistan, the challenge remains to promote behavioural interventions such as breastfeeding in infancy period, keeping young children away from the cooking area, and improvements in housing and kitchen design.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0173256PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5344381PMC
September 2017

Stunting and severe stunting among children under-5 years in Nigeria: A multilevel analysis.

BMC Pediatr 2017 01 13;17(1):15. Epub 2017 Jan 13.

School of Social Sciences and Psychology, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.

Background: Stunting has been identified as one of the major proximal risk factors for poor physical and mental development of children under-5 years. Stunting predominantly occurs in the first 1000 days of life (0-23 months) and continues to the age of five. This study examines factors associated with stunting and severe stunting among children under-5 years in Nigeria.

Methods: The sample included 24,529 children aged 0-59 months from the 2013 Nigeria Demographic and Health Survey (NDHS). Height-for-age z-scores (HFAz), generated using the 2006 World Health Organisation (WHO) growth reference, were used to define stunting (HFAz < -2SD) and severe stunting (HFAz < -3SD). Multilevel logistic regression analyses that adjusted for cluster and survey weights were used to determine potential risk factors associated with stunting and severe stunting among children under-5 years in Nigeria.

Results: The prevalence of stunting and severe stunting were 29% [95% Confidence interval (Cl): 27.4, 30.8] and 16.4% [95%Cl: 15.1, 17.8], respectively for children aged 0-23 months, and 36.7% [95%Cl: 35.1, 38.3] and 21% [95%Cl: 19.7, 22.4], respectively for children aged 0-59 months. Multivariate analysis revealed that the most consistent significant risk factors for stunting and severe stunting among children aged 0-23 months and 0-59 months are: sex of child (male), mother's perceived birth size (small and average), household wealth index (poor and poorest households), duration of breastfeeding (more than 12 months), geopolitical zone (North East, North West, North Central) and children who were reported to having had diarrhoea in the 2 weeks prior to the survey [Adjusted odds ratio (AOR) for stunted children 0-23 months = 1.22 (95%Cl: 0.99, 1.49)];[AOR for stunted children 0-59 months = 1.31 (95%Cl: 1.16, 1.49)], [AOR for severely stunted children 0-23 months = 1.31 (95%Cl: 1.03, 1.67)]; [AOR for severely stunted children 0-59 months = 1.58 (95%Cl: 1.38, 1.82)].

Conclusions: In order to meet the post-2015 sustainable development goals, policy interventions to reduce stunting in Nigeria should focus on poverty alleviation as well as improving women's nutrition, child feeding practices and household sanitation.
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http://dx.doi.org/10.1186/s12887-016-0770-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5237247PMC
January 2017

Are stunted young Indonesian children more likely to be overweight, thin, or have high blood pressure in adolescence?

Int J Public Health 2017 Jan 4;62(1):153-162. Epub 2016 Oct 4.

Discipline of Child and Adolescent Health, The Children's Hospital at Westmead (University of Sydney Clinical School), Sydney, Australia.

Objectives: To determine whether stunted young children are at greater risk of (1) overweight/obesity or thinness, and (2) high blood pressure (HBP) in adolescence.

Methods: A secondary data analysis using the Indonesian Family Life Survey waves 1 (1993) to 4 (2007). We generated a 14-year follow-up cohort (1993-2007) and two 7-year cohorts (1993-2000 and 2000-2007) of children aged 2.0-4.9 years. Stunting (HAZ < -2), thinness (BMIZ < -2), and overweight/obesity (BMIZ > +1) were determined based upon the WHO Child Growth Standards. HBP (>90th percentile) was interpreted using the 4th Report on the Diagnosis of HBP in Children and Adolescents.

Results: 765, 1083, and 1589 children were included in the 14-year cohort, and the two 7-year cohort analyses, respectively. In the 7-year cohorts, early life stunting was inversely associated with overweight/obesity (prevalence ratio 0.32 and 0.38, respectively; P < 0.05), but no significant association was found with the 14-year cohort. There was no significant association between childhood stunting and thinness at adolescence or in the odds/likelihood of having high systolic or diastolic blood pressure.

Conclusions: We found no association between early life stunting and overweight/obesity, thinness and HBP in adolescence.
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http://dx.doi.org/10.1007/s00038-016-0905-xDOI Listing
January 2017

Stunting coexisting with overweight in 2·0-4·9-year-old Indonesian children: prevalence, trends and associated risk factors from repeated cross-sectional surveys.

Public Health Nutr 2016 10 28;19(15):2698-707. Epub 2016 Apr 28.

1Discipline of Paediatrics and Child Health,The Children's Hospital at Westmead (University of Sydney Clinical School),Locked Bag 4001,Westmead,NSW 2145,Australia.

Objective: The persistence of undernutrition, along with overweight and obesity, constitute the double burden of malnutrition. The present study aimed to: (i) describe the prevalence and trends of concurrent stunting and overweight in Indonesian children; (ii) identify potentially associated risk factors; and (iii) determine whether stunted children are at greater risk of overweight compared with those of healthy height.

Design: A secondary data analysis of children aged 2·0-4·9 years in four cross-sectional studies of the Indonesian Family Life Survey. Children's height and BMI Z-scores were calculated based on the WHO Child Growth Standards (2006). We defined 'concurrent stunting and overweight' as height-for-age Z-score +1. Multivariate generalised linear latent and mixed models were used to determine associated risk factors.

Setting: Thirteen out of twenty-seven provinces in Indonesia.

Subjects: Children (n 4101) from four waves of the Indonesian Family Life Survey (1993-2007).

Results: There were inconsistent trends in the prevalence of concurrent stunting and overweight from waves 1 to 4. Children were more likely to be stunted and overweight when they were in the youngest age group (2·0-2·9 years), were weaned after the age of 6 months, had short-statured mothers or lived in rural areas. Stunted children were significantly more likely to be overweight than healthy-height children (OR>1) but did not differ significantly different across each wave (OR=1·34-2·01).

Conclusions: Concurrent stunting and overweight occurs in Indonesian children aged 2·0-4·9 years. Current policies and programmes need to be tailored for the management of this phenomenon.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5039402PMC
http://dx.doi.org/10.1017/S1368980016000926DOI Listing
October 2016

Household air pollution and under-five mortality in India (1992-2006).

Environ Health 2016 Apr 26;15:54. Epub 2016 Apr 26.

School of Science and Health, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2571, Australia.

Background: Household air pollution (HAP) - predominantly from cooking fuel is a major public health hazard and one of the leading causes of respiratory illness and deaths among children under-five years in India. This study investigates the association between HAP from cooking fuel and under-five mortality using India's National Family and Health Survey (NFHS) datasets over the period 1992-2006 (total of 166,382 children), and the extent to which the association differed by environmental and behavioral factors affecting level of exposure.

Methods: The association between HAP and under-five mortality of three age-groups (neonatal age between 0-28 days, post-neonatal age between 1-11 months and children aged between 12-59 months) was examined using multi-level logistic regression models.

Results: HAP was associated with mortality among children aged under-five (OR = 1.30, 95%CI = 1.18-1.43, P < 0.001) and was more strongly associated in sub-group analyses of post-neonatal mortality (OR = 1.42, 95%CI = 1.19-1.71, P < 0.001) and child mortality (OR = 1.42, 95%CI = 1.05-1.91, P = 0.021) than neonatal mortality (OR = 1.23, 95%CI = 1.09-1.39, P = 0.001). The association was stronger for households in rural areas and for households without a separate kitchen using polluting fuel, and in women who had never breastfed for all age-groups.

Conclusion: Use of cooking fuel in the household is associated with increased risk of mortality in children aged under-five years. Factors relating to access to clean fuels, improvements in infrastructure and household design and behavioral factors are discussed, and can result in further declines in under-five mortality in India.
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http://dx.doi.org/10.1186/s12940-016-0138-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4845508PMC
April 2016

Household Air Pollution and Under-Five Mortality in Bangladesh (2004-2011).

Int J Environ Res Public Health 2015 Oct 15;12(10):12847-62. Epub 2015 Oct 15.

School of Science and Health, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571, Australia.

Household air pollution (HAP) is one of the leading causes of respiratory illness and deaths among children under five years in Bangladesh. This study investigates the association between HAP from cooking fuel and under-five mortality using Bangladesh Demographic and Health Survey (BDHS) datasets over the period 2004-2011 (n = 18,308 children), and the extent to which this association differed by environmental and behavioral factors affecting level of exposure. The association between HAP and neonatal (age between 0-28 days), infant (age between 0 and 11 months) and under-five (age between 0 and 59 months) mortality was examined using multilevel logistic regression models. HAP was not strongly associated with overall neonatal (OR = 1.49, 95% CI = 1.01-2.22, p = 0.043), infant (OR = 1.27, 95% CI = 0.91-1.77, p = 0.157) or under-five mortality (OR = 1.14, 95% CI = 0.83-1.55, p = 0.422) in the context of overall decreasing trends in under-five mortality. The association was stronger for households with an indoor kitchen using polluting fuels, and in women who had never breastfed. Reductions in exposure to pollution from cooking fuel, given it is a ubiquitous and modifiable risk factor, can result in further declines in under-five mortality with household design and behavioural interventions.
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http://dx.doi.org/10.3390/ijerph121012847DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4627003PMC
October 2015

Determinants of stunting and severe stunting among under-fives in Tanzania: evidence from the 2010 cross-sectional household survey.

BMC Pediatr 2015 Oct 21;15:165. Epub 2015 Oct 21.

School of Science and Health, Western Sydney University, Building 24.2.40, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2571, Australia.

Background: Stunting is one of the main public health problems in Tanzania. It is caused mainly by malnutrition among children aged less than 5 years. Identifying the determinants of stunting and severe stunting among such children would help public health planners to reshape and redesign new interventions to reduce this health hazard. This study aimed to identify factors associated with stunting and severe stunting among children aged less than five years in Tanzania.

Methods: The sample is made up of 7324 children aged 0-59 months, from the Tanzania Demographic and Health Surveys 2010. Analysis in this study was restricted to children who lived with the respondent (women aged 15-49 years). Stunting and severe stunting were examined against a set of individual-, household- and community-level factors using simple and multiple logistic regression analyses.

Results: The prevalence of stunting and severe stunting were 35.5% [95% Confidence interval (CI): 33.3-37.7] and 14.4% (95 % CI: 12.9-16.1) for children aged 0-23 months and 41.6% (95 % CI: 39.8-43.3) and 16.1% (95 % CI: 14.8-17.5) for children aged 0-59 months, respectively. Multivariable analyses showed that the most consistent significant risk factors for stunted and severely-stunted children aged 0-23 and 0-59 months were: mothers with no schooling, male children, babies perceived to be of small or average size at birth by their mothers and unsafe sources of drinking water [adjusted odds ratio (AOR) for stunted children aged 0-23 months = 1.37; 95% CI: (1.07, 1.75)]; [AOR for severely stunted children aged 0-23 months = 1.50; 95% CI: (1.05, 2.14)], [AOR for stunted children aged 0-59 months = 1.42; 95% CI: (1.13, 1.79)] and [AOR for severely stunted children aged 0-59 months = 1.26; 95% CI: (1.09, 1.46)].

Conclusions: Community-based interventions are needed to reduce the occurrence of stunting and severe stunting in Tanzania. These interventions should target mothers with low levels of education, male children, small- or average-size babies and households with unsafe drinking water.
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http://dx.doi.org/10.1186/s12887-015-0482-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4618754PMC
October 2015

Risk factors for under-5 mortality: evidence from Bangladesh Demographic and Health Survey, 2004-2011.

BMJ Open 2015 Aug 21;5(8):e006722. Epub 2015 Aug 21.

Sydney School of Public Health, University of Sydney, Newcastle, New South Wales, Australia.

Objective: The aim of this study was to identify factors associated with mortality in children under 5 years of age using a nationally representative sample of singleton births for the period of 2004-2011.

Design, Setting And Participants: Pooled 2004, 2007 and 2011 cross-sectional data sets of the Bangladesh Demographic and Health Surveys were analysed. The surveys used a stratified two-stage cluster sample of 16,722 singleton live-born infants of the most recent birth of a mother within a 3-year period.

Main Outcome Measures: Outcome measures were neonatal mortality (0-30 days), postneonatal mortality (1-11 months), infant mortality (0-11 months), child mortality (1-4 years) and under-5 mortality (0-4 years).

Results: Survival information for 16,722 singleton live-born infants and 522 deaths of children <5 years of age included: 310 neonatal deaths, 154 postneonatal deaths, 464 infant deaths, 58 child deaths and 522 under-5 deaths. Multiple variable analysis showed that, over a 7-year period, mortality reduced significantly by 48% for postneonatal deaths, 33% for infant deaths and 29% for under-5 deaths, but there was no significant reduction in neonatal deaths (adjusted OR (AOR) = 0.79, 95% CI 0.59 to 1.06) or child deaths (AOR = 1.00, 95% CI 0.51 to 1.94). The odds of neonatal, postneonatal, infant, child and under-5 deaths decreased significantly among mothers who used contraceptive and mothers who had other children aged 3 years or older. The risk of neonatal, postneonatal, infant, child and under-5 deaths was significantly higher in mothers who reported a previous death of a sibling.

Conclusions: Our study suggests that family planning is needed to further reduce the overall rate of under-5 deaths in Bangladesh. To reduce childhood mortality, public health interventions that focus on child spacing and contraceptive use by mothers may be most effective.
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http://dx.doi.org/10.1136/bmjopen-2014-006722DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4550704PMC
August 2015

Risk factors for postneonatal, infant, child and under-5 mortality in Nigeria: a pooled cross-sectional analysis.

BMJ Open 2015 Mar 27;5(3):e006779. Epub 2015 Mar 27.

School of Science and Health, University of Western Sydney, Campbelltown, New South Wales, Australia.

Objectives: To identify common factors associated with post-neonatal, infant, child and under-5 mortality in Nigeria.

Design, Setting And Participants: A cross-sectional data of three Nigeria Demographic and Health Surveys (NDHS) for the years 2003, 2008 and 2013 were used. A multistage, stratified, cluster random sampling method was used to gather information on 63,844 singleton live-born infants of the most recent birth of a mother within a 5-year period before each survey was examined using cox regression models.

Main Outcome Measures: Postneonatal mortality (death between 1 and 11 months), infant mortality (death between birth and 11 months), child mortality (death between 12 and 59 months) and under-5 mortality (death between birth and 59 months).

Results: Multivariable analyses indicated that children born to mothers with no formal education was significantly associated with mortality across all four age ranges (adjusted HR=1.30, 95% CI 1.01 to 1.66 for postneonatal; HR=1.38, 95% CI 1.11 to 1.84 for infant; HR=2.13, 95% CI 1.56 to 2.89 for child; HR=1.19, 95% CI 1.02 to 1.41 for under-5). Other significant factors included living in rural areas (HR=1.48, 95% CI 1.16 to 1.89 for postneonatal; HR=1.23, 95% CI 1.03 to 1.47 for infant; HR=1.52, 95% CI 1.16 to 1.99 for child; HR=1.29, 95% CI 1.11 to 1.50 for under-5), and poor households (HR=2.47, 95% CI 1.76 to 3.47 for postneonatal; HR=1.40, 95% CI 1.10 to 1.78 for infant; HR=1.72, 95% CI 1.19 to 2.49 for child; HR=1.43, 95% CI 1.17 to 1.76 for under-5).

Conclusions: This study found that no formal education, poor households and living in rural areas increased the risk of postneonatal, infant, child and under-5 mortality among Nigerian children. Community-based interventions for reducing under-5 deaths are needed and should target children born to mothers of low socioeconomic status.
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http://dx.doi.org/10.1136/bmjopen-2014-006779DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4386230PMC
March 2015

The effect of solid fuel use on childhood mortality in Nigeria: evidence from the 2013 cross-sectional household survey.

Environ Health 2014 Dec 16;13:113. Epub 2014 Dec 16.

School of Medicine, University of Western Sydney, Locked Bag 1797, Penrith, NSW 2571, Australia.

Background: In Nigeria, approximately 69% of households use solid fuels as their primary source of domestic energy for cooking. These fuels produce high levels of indoor air pollution. This study aimed to determine whether Nigerian children residing in households using solid fuels at <5 years of age were at higher risk of death.

Methods: The 2013 Nigeria Demographic and Health Survey data were analysed in Cox regression analyses to examine the effects of solid fuel use on deaths of children aged 0-28 days (neonatal), 1-11 months (post-neonatal), and 12-59 months (child).

Results: The results indicated that approximately 0.8% of neonatal deaths, 42.9% of post-neonatal deaths, and 36.3% of child deaths could be attributed to use of solid fuels. The multivariable analyses found that use of solid fuel was associated with post-neonatal mortality (hazard ratio [HR] =1.92, 95% confidence interval [CI]: 1.42-2.58) and child mortality (HR = 1.63, CI: 1.09-2.42), but was not associated with neonatal mortality (HR = 1.01, CI: 0.73-1.26). Living in rural areas and poor households were associated with an increased risk of death during the three mortality periods.

Conclusion: Living in a rural area and poor households were strongly associated with an increased risk of a child > 1 to < 60 months dying due to use of solid fuels. The health effects of household use of solid fuels are a major public health threat that requires increased research and policy development efforts. Research should focus on populations in rural areas and low socioeconomic households so that child survival in Nigeria can be improved.
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http://dx.doi.org/10.1186/1476-069X-13-113DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4290397PMC
December 2014

Determinants of stunting and severe stunting among under-fives: evidence from the 2011 Nepal Demographic and Health Survey.

BMC Pediatr 2014 Sep 27;14:239. Epub 2014 Sep 27.

Nutrition Promotion and Consultancy Service, Kathmandu, Nepal.

Background: Stunting remains a major public health concern in Nepal as it increases the risk of illness, irreversible body damage and mortality in children. Public health planners can reshape and redesign new interventions to reduce stunting and severe stunting among children aged less than 5 years in this country by examining their determinants. Hence, this study identifies factors associated with stunting and severe stunting among children aged less than five years in Nepal.

Methods: The sample is made up of 2380 children aged 0 to 59 months with complete anthropometric measurements from the 2011 Nepal Demographic and Health Survey (NDHS). Simple and multiple logistic regression analyses were used to examine stunting and severe stunting against a set of variables.

Results: The prevalences of stunting and severe stunting were 26.3% [95% confidence Interval (CI): 22.8, 30.1] and 10.2% (95%CI: 7.9, 13.1) for children aged 0-23 months, respectively, and 40.6 (95%CI: 37.3, 43.2) and 15.9% (95%CI: 13.9, 18.3) for those aged 0-59 months, respectively. After adjusting for potential confounding factors, multivariable analyses showed that the most consistent significant risk factors for stunted and severely stunted children aged 0-23 and 0-59 months were household wealth index (poorest household), perceived size of baby (small babies) and breastfeeding for more than 12 months (adjusted odds ratio (AOR) for stunted children aged 0-23 months = 2.60 [95% CI: (1.87, 4.02)]; AOR for severely stunted children aged 0-23 months = 2.87 [95% CI: (1.54, 5.34)]; AOR for stunted children aged 0-59 months = 3.54 [95% CI: (2.41, 5.19)] and AOR for severely stunted children aged 0-59 months = 4.15 [95% CI: (2.45, 6.93)].

Conclusions: This study suggests that poorest households and prolonged breastfeeding (more than 12 months) led to increased risk of stunting and severe stunting among Nepalese children. However, community-based education intervention are needed to reduce preventable deaths triggered by malnutrition in Nepal and should target children born to mothers of low socioeconomic status.
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http://dx.doi.org/10.1186/1471-2431-14-239DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4263111PMC
September 2014

Determinants of neonatal mortality in Nigeria: evidence from the 2008 demographic and health survey.

BMC Public Health 2014 May 29;14:521. Epub 2014 May 29.

School of Science and Health, University of Western Sydney, Locked Bag 1797, Penrith, New South Wales (NSW) 2571, Australia.

Background: Nigeria continues to have one of the highest rates of neonatal deaths in Africa. This study aimed to identify risk factors associated with neonatal death in Nigeria using the 2008 Nigeria Demographic and Health Survey (NDHS).

Methods: Neonatal deaths of all singleton live-born infants between 2003 and 2008 were extracted from the 2008 NDHS. The 2008 NDHS was a multi-stage cluster sample survey of 36,298 households. Of these households, survival information of 27,147 singleton live-borns was obtained, including 996 cases of neonatal mortality. The risk of death was adjusted for confounders relating to individual, household, and community level factors using Cox regression.

Results: Multivariable analyses indicated that a higher birth order of newborns with a short birth interval ≤ 2 years (hazard ratio [HR] = 2.19, confidence interval [CI]: 1.68-2.84) and newborns with a higher birth order with a longer birth interval > 2 years (HR = 1.36, CI: 1.05-1.78) were significantly associated with neonatal mortality. Other significant factors that affected neonatal deaths included neonates born to mothers younger than 20 years (HR = 4.07, CI: 2.83-5.86), neonates born to mothers residing in rural areas compared with urban residents (HR = 1.26, CI: 1.03-1.55), male neonates (HR = 1.30, CI: 1.12-1.53), mothers who perceived their neonate's body size to be smaller than the average size (HR = 2.10, CI: 1.77-2.50), and mothers who delivered their neonates by caesarean section (HR = 2.80, CI: 1.84-4.25).

Conclusions: Our study suggests that the Nigerian government needs to invest more in the healthcare system to ensure quality care for women and newborns. Community-based intervention is also required and should focus on child spacing, childbearing at a younger age, and poverty eradication programs, particularly in rural areas, to reduce avoidable neonatal deaths in Nigeria.
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http://dx.doi.org/10.1186/1471-2458-14-521DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4049428PMC
May 2014