FeedBurner makes it easy to receive content updates in My Yahoo!, Newsgator, Bloglines, and other news readers.
A message from this feed's publisher:This is one of the news feeds from Eldis. You can also choose to receive the content of this feed as an email message. Or we can supply you with HTML code to add the feed to your own website. Visit http://www.eldis.org/go/newsfeeds for more information, or contact us at email@example.com
Micronutrient insufficiencies are a serious public health problem among women of reproductive age in Low and Middle Income Countries including India, adversely affecting maternal health and economic productivity, and child growth and educational outcomes. Fruit and vegetables are important sources of micronutrients and consumption of these foods is lower than recommendations. Value chain analysis involves understanding how actors (farmers/ producers, wholesalers and vendors) make decisions about what produce they grow and sell. It can be employed to improve nutrition by identifying constraints to the supply and demand of healthful foods and developing interventions to address these constraints.
The University of Southampton undertook a study titled Identifying nutrition-sensitive interventions to improve maternal diet quality in rural Indian settings using value chain analysis supported by the Leveraging Agriculture for Nutrition in South Asia (LANSA) consortium awarded from the Call for Proposals under LANSA’s first Responsive Window opportunity. The study aims to develop an interdisciplinary framework linking value chain activities to nutrition in rural Maharashtra.
Recommendations for future action:
The findings of this research are qualitative and hypothesis generating. In order to prioritise interventions, quantitative survey data would be useful. Recommendations for future research and interventions is to reduce supply and demand constraints. Some
suggestions for future interventions are:
A gendered understanding of poverty is crucial for exploring its differing impacts and this analysis provides valuable insights in a number of key areas. This evidence is a synthesis from 122 research grants awarded by the Economic and Social Research Council (ESRC) and UK Department for International Development (DFID) Joint Fund for Poverty Alleviation Research since 2005.
The insights could have particular relevance as governments focus on working towards the Sustainable Development Goals (SDGs) that include commitments on gender equality across the board. Gender is one of four areas that the ESRC and DFID tasked four groups of researchers to look at, across the diverse projects funded through the Joint Fund. The resulting reports - children and young people; gender; with those on health; and research methods to follow - will be valuable pieces of research and rich sources of information which we all hope will be of interest to a broad range of audiences. They highlight the specific achievements and contributions of Joint Fund research - to knowledge about development issues, to methods and approaches to researching these, and to supporting social and economic impact.
The ESRA also point to spaces where more research would be valuable, issuing challenges both to researchers and funders to consider how they continue to drive, as well as respond to, evolving development agendas and changing global circumstances. A series of summaries to capture these findings and their implications for policymakers as well as for researchers also accompany the main reports, produced by the Impact Initiative.
A gendered understanding of poverty is crucial for exploring its differing impacts. Women, in particular, may be vulnerable to the effects of poverty and the causes of women’s poverty, and how poverty is experienced, may differ from men. Neither women nor men, however, are a homogenous group and how poverty is experienced depends on other intersecting issues such as age, class, ethnicity, disability etc. Issues which poverty alleviation research also needs to take into account in order to get a more nuanced picture of people’s lived experiences to help shape policy responses that are relevant and appropriate.
Since 2005, the ESRC-DFID Joint Fund for Poverty Alleviation Research has commissioned high quality social science research addressing the international development goal of reducing poverty amongst the poorest in the world. Evidence from this research has improved understandings of the gendered nature of poverty and how differing identities impact people’s lived experiences of poverty. In particular the research has provided valuable insights in a number of key areas:
The evidence report provides an assessment of 122 research grants awarded by the ESRC-DFID Joint Fund for Poverty Alleviation Research covering research in Central Asia, Latin America, the Middle East, South Asia, South East Asia and Sub-Saharan Africa.
The case for investing in nutrition is clear. Poor nutrition during the first 1,000 days - from pregnancy through a child’s second birthday - can cause life-long and irreversible damage, with consequences at the individual, community, and national level.
Programmes can become more nutrition-sensitive by:
Over the past two decades, many developing countries have made impressive progress in reducing undernutrition. In this paper, the authors explore potential explanations of this success by applying consistent statistical methods to multiple rounds of Demographic Health Surveys for Bangladesh, Nepal, Ethiopia, Odisha, Senegal, and Zambia.
The research finds that changes in household wealth, mother's education and access to antenatal care are the largest drivers of nutritional improvement, except for Zambia where large increases in bednet usage is the single largest factor. Other factors play a smaller role in explaining nutritional improvements with improvements in sanitation only appearing to be important in South Asia. Overall, the results point to the need for multidimensional nutritional strategies involving a broad range of nutrition-sensitive sectors.
asset accumulation and parental education are important predictor of nutritional improvement in most countries
improved sanitation is more strongly associated with height-for-age in South Asian countries
asset accumulation and parental education are important predictor of nutritional improvement in most countries
Reducing child undernutrition is gaining high priority on the international development agenda in the post-MDG agenda, both as a maker and marker of development. In this paper, the authors use data from 1970 to 2012 for 116 countries, finding that safe water access, sanitation, women’s education, gender equality, and the quantity and quality of food available in countries have been key drivers of past reductions in stunting. Income growth and governance played essential facilitating roles. Complementary to nutrition-specific and nutrition-sensitive programs and policies, accelerating reductions in undernutrition in the future will require increased investment in these priority areas.
The current Maternal and Child Health Nutrition (MCHN) statistics from India reflect poorly on the existing Government schemes. Experts recognize the conception of two year period (the first 1000 days) as a critical window of opportunity for influencing the poor MCHN status. A clear identification and critical assessment of government schemes/programmes which may impact the 1000 day period can help identify the strength, weakness, opportunity and threats in these interventions, which in turn can inform future offerings.
The objective of this study was to review the nutrition related Government interventions which directly affect the 1000 day period. A review of all Government programmes and policies in the area of MCHN was undertaken using multiple strategies namely internet search, direct communication with experts, library visits, analysing Government documents and reports. The results indicated that out of the 33 MCHN interventions, six conformed to the direct nutrition interventions which may impact the 1000 day period. Detailed Strength, Weakness, Opportunities, Threats (SWOT) analysis of these interventions has shown scope of improvement and areas of learning. The Indian Government has introduced a good leverage of interventions that impact the 1000 day period. However the nutrition component needs to be strengthened with interventions focussing on health care needs, immunisation, cash transfer etc. The recognition of the importance of nutrition was only in terms of provision for proper food with no focus on macro and micro nutrient content. This is an area which needs to be strengthened in the interventions.
This document requires a free login in order to access the full-text.
Undernutrition affects over 2 billion people; but most of the global policy focus has been on technical solutions rather than an understanding of nutrition politics. This paper reviews existing literature on nutrition politics and policy. The authors identify a number of recurring themes surrounding knowledge; politics, and capacities. While the literature on nutrition politics and policy is growing, the paper demonstrates how there are a number of gaps in understanding that might be addressed from wider development scholarship on politics and related issues such as power and the state, participation, and accountability.
The authors state that the gaps are many and deep, and highlight those of recent note, including:
In addition to targeting health and other areas related to undernutrition, a key priority is also the transformation of the agriculture and food sector. While patterns of crop and livestock production are widely expected to affect nutrition and the health of vulnerable groups, the evidence base for a positive impact, albeit growing, is still limited and sometimes inconclusive.
This article offers insights into assessing the effectiveness of post farm-gate agri-food value chains at improving the nutrition intake of vulnerable groups. It develops a conceptual framework integrating the value chain concepts with agriculture and nutrition, and identifies key outcomes and requirements for value chains to be successful at delivering substantive and sustained consumption of nutrient-dense foods by poor households. Other frameworks linking value chains with nutrition have been published, but this article provides the analytical lens to assess post-farm-gate value chains.
To achieve improvements in the intake of nutritious foods by the target populations food must be: safe to eat on a sustained basis; nutrient dense at the point of consumption; and consumed in adequate amounts on a sustained basis. This shifts the focus to the role of public actions and policy in terms of shaping the functioning of food value chains.
By assessing the limits of what business can and cannot contribute in a given market context, policy-makers and other relevant stakeholders will be more capable of creating an appropriate institutional environment that shapes how value chains operate for the benefit of vulnerable target groups, designing and implementing effective policies and strategies with respect to the role and use of market-based interventions.
The well-known pathways that link agriculture to child nutrition are food, quality of food, and care of feeding. Further, agricultural productivity growth contributes significantly to poverty reduction and reduction in child undernutrition. Care of children and feeding practices depend upon women’s knowledge, and hence women’s education and their freedom to act are closely related to child nutrition.
Spatial distribution of poverty in Bangladesh shows that poverty is concentrated in ecologically unfavourable areas. Recently, the issue of spatial distribution of undernutrition has emerged as a matter of concern as well, considering the growing evidence of the strong persistence of existing inequalities.Therefore, whether ecological differences have affected nutritional outcomes is becoming an important issue for research.
This paper aims to understand whether spatial and seasonal variations affect maternal and childhood undernutrition in Bangladesh. The study first tests the hypothesis whether agricultural and household incomes are same across different agro-ecological environments. It then carries out an in-depth analysis of the effect of unfavourable ecologies on maternal and child malnutrition.
In the results, panel data analysis showed that household income is not equal across agro-ecology; the fragility of the environment may thus affect the household’s ability to access food, which may have negative influence on the nutritional status of mothers and children. Coastal areas have less dependence on agriculture, particularly on cultivation which diminished over time. Per capita income has been increasing in coastal areas, led by remittance growing at 8 per cent per year against 6 per cent in other areas.
Regression analysis shows that a household in coastal zones earns 19 per cent lower than one in favourable zones. Although farm practices are lower in unfavourable areas, the deficiency is compensated by increased non-farm incomes. The results from the Food Security Nutrition Surveillance Projects (FSNSP) data found that overall the rate of stunting and wasting prevalence were 36 per cent and 11.7 per cent respectively. Among the mothers, nearly 28 per cent suffered from chronic energy deficiencies.
The study found that highly significant regional heterogeneity in undernutrition exists in Bangladesh; alarmingly high levels prevail in the Haor Basin and coastal belt areas. The study also found significantly higher rates of underweight and wasting prevailing in the monsoon season compared to the two harvest seasons (post-Aman and post-Aus) among children under five. Month of birth failed to show any significant association with the nutrition outcome of the children.
In order to determine the most effective strategies for accelerating reduction in undernutrition, it is important that the determinants of undernutrition are known. The findings of this study imply the importance of bringing geographical location and seasonal thinking back into the various current debates on hunger and nutrition.
It is now widely recognised that intake of sufficient dietary energy does not ensure adequate intake of protein and micronutrients necessary for leading an active and healthy life. Legumes, animal products, fruit and vegetables are important sources of minerals and micronutrients. Micronutrient deficiency causes impaired cognitive development, compromises immunity and incresses vulnerability to infectious diseases and, in severe cases, even causes mortality.
Recent studies show that the consumption of animal and fish products, which are dense in protein and micronutrients, has a higher correlation with nutritional status than does energy consumption. Thus, to improve the nutritional situation it is crucial that issues of dietry quality are addressed in addition to those of dietry quantity.
The rate of decline in undernutrition and malnutrition in Bangladesh has not been matching economic and agricultural progress. The persistence of undernutrition is considered a serious public health problem in Bangladesh. This paper aims to estimate the recent changes in diet diversity from the detailed food intake data estimated from the household income and expenditure surveys, and analyse the drivers of change, including the level of income and sources of income such as agriculture.
Background: Undernutrition is highly prevalent among infants in Uganda. Optimal infant feeding practices may improve nutritional status, health, and survival among children.
Objective: Our study evaluates the socioeconomic distribution of exclusive breastfeeding (EBF) and growth outcomes among infants included in a trial, which promoted EBF by peer counselors in Uganda.
Design: Twenty-four clusters comprising one to two communities in Uganda were randomized into intervention and control arms, including 765 mother-infant pairs. Intervention clusters received the promotion of EBF by peer counselors in addition to standard care. Breastfeeding and growth outcomes were compared according to wealth quintiles and intervention/control arms. Socioeconomic inequality in breastfeeding and growth outcomes were measured using the concentration index 12 and 24 weeks postpartum. We used the decomposition of the concentration index to identify factors contributing to growth inequality at 24 weeks.
Results: EBF was significantly concentrated among the poorest in the intervention group at 24 weeks postpartum, concentration index - 0.060. The control group showed a concentration of breastfeeding among the richest part of the population, although not statistically significant. Stunting, wasting, and underweight were similarly significantly concentrated among the poorest in the intervention group and the total population at 24 weeks, but showing non-significant concentrations for the control group.
Conclusion: This study shows that EBF can be successfully promoted among the poor. In addition, socioeconomic inequality in growth outcomes starts early in infancy, but the breastfeeding intervention was not strong enough to counteract this influence.
Background: Long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS) are the main malaria prevention interventions in Ethiopia. There is conflicting evidence that the combined application of both interventions is better than either LLINs or IRS used alone. This trial aims to investigate whether the combination of LLINs (PermaNet 2.0, Vestergaard Frandsen, Lausanne, Switzerland) with IRS using propoxur will enhance the protective benefits and cost-effectiveness of the interventions against malaria and its effect on mosquito behavior, as compared to each intervention alone.
Methods/Design: This 2 x 2 factorial cluster randomized controlled trial is being carried out in the Adami Tullu district in south-central Ethiopia for about 116 weeks from September 2014 to December 2016. The trial is based on four arms: LLINs + IRS, LLINs alone, IRS alone and control. Villages (or clusters) will be the unit of randomization. The sample size includes 44 clusters per arm, with each cluster comprised of approximately 35 households (about 175 people). Prior to intervention, all households in the LLINs + IRS and LLINs alone arms will be provided with LLINs free of charge. Households in the LLINs+IRS and IRS alone arms will be sprayed with carbamate propoxur once a year just before the main malaria transmission season throughout th e investigation. The primary outcome of this trial will be a malaria incidence based on the results of the rapid diagnostic tests in patients with a fever or history of fever attending health posts by passive case detection. C ommunity-based surveys will be conducted each year to assess anemia among children 5-59 months old. In addition, community-b ased malaria prevalence surveys will be conducted each year on a representative sample of households during the main transmission season. The cost-effectiveness of the interventions and entomological studies will be simultaneously conducted. Analysis will be based on an intention-to-treat principle.
Discussion: This trial aims to provide evidence on the combined use of LLINs and IRS for malaria prevention by answering the following research questions: Can the co mbined use of LLINs and IRS significantly reduce the incidence of malaria compared with the use of either LLINs or IRS alone? And is the reduced incidence justifiable compared to the added costs? Will the combined use of LLINs and IRS reduce vector density, infection, longevity and the entomological inoculation rate? These data are crucial in order to maximize the impact of vector control interventions on the morbidity and mortality of malaria
India, one of the world’s two population superpowers, is undergoing unprecedented demographic changes. Increasing longevity and falling fertility have resulted in a dramatic increase in the population of adults aged 60 and up, in both absolute and relative terms. This change presents wide-ranging and complex health, social, and economic challenges, both current and future, to which this diverse and heterogeneous country must rapidly adapt.
This paper first lays out the context, scope, and magnitude of India’s demographic changes. It then details the major challenges these shifts pose in the interconnected areas of health, especially the massive challenges of a growing burden of noncommunicable diseases; gender, particularly the needs and vulnerabilities of an increasingly female older adult population; and income security.
The paper also presents an overview of India’s recent and ongoing initiatives to adapt to population aging and provide support to older adults and their families. It concludes with policy recommendations that may serve as a productive next step forward, keeping in mind the need for urgent and timely action on the part of government, private companies, researchers, and general population.
Background: Malaria and malnutrition are the major causes of morbidity and mortality in under-five children in developing countries such as Ethiopia. Malnutrition is the associated cause for about half of the deaths that occur among under-five children in developing countries. However, the relationship between malnutrition and malaria is controversial still, and it has also not been well documented in Ethiopia. The aim of this study was to assess whether malnutrition is associated with malaria among under-five children.
Methods: A case–control study was conducted in Adami Tulu District of East Shewa Zone in Oromia Regional State, Ethiopia. Cases were all under-five children who are diagnosed with malaria at health posts and health centres. The diagnosis was made using either rapid diagnostic tests or microscopy. Controls were apparently healthy under-five children recruited from the community where cases resided. The selection of the controls was based on World Health Organization (WHO) cluster sampling method. A total of 428 children were included. Mothers/caretakers of under-five children were interviewed using pre-tested structured questionnaire prepared for this purpose. The nutritional status of the children was assessed using an anthropometric method and analyzed using WHO Anthro software. A multivariate logistic analysis model was used to determine predictors of malaria.
Results: Four hundred twenty eight under-five children comprising 107 cases and 321 controls were included in this study. Prevalence of wasting was higher among cases (17.8 %) than the controls (9.3 %). Similarly, the prevalence of stunting was 50.5 % and 45.2 % among cases and controls, respectively. Severe wasting [Adjusted Odds Ratio (AOR) =2.9, 95 % CI (1.14, 7.61)] and caretakers who had no education [AOR = 3, 95 % CI (1.27, 7.10)] were independently associated with malarial attack among under-five children.
Conclusion: Children who were severely wasted and had uneducated caretakers had higher odds of malarial attack. Therefore, special attention should be given for severely wasted children in the prevention and control of malaria.
Background. Pesticide exposure is an important public health concern in Ethiopia, but there is limited information on pesticide intoxications. Residents may have an increased risk of pesticide exposure through proximity of their homes to farms using pesticides. Also the pesticide exposure might be related to employment at these farms. This study investigated the prevalence of acute pesticide intoxications (API) by residence proximity to a nearby flower farm and assessed if intoxications were related to working in these farms or not.
Methods. A cross-sectional survey involving 516 persons was conducted. Participants were grouped according to their residence proximity from a large flower farm; living within 5 kilometers and 5–12 kilometers away, respectively. In a structured interview, participants were asked if they had health symptoms within 48 h of pesticide exposure in the past year. Those who had experienced this, and reported two or more typical pesticide intoxication symptoms, were considered as having had API. Chi-square and independent t-tests were used to compare categorical and continuous variables, respectively. Confounding variables were adjusted by using binomial regression model.
Results. The prevalence of API in the past year among the residents in the study area was 26 %, and it was higher in the population living close to the flower farm (42 %) compared to those living far away (11 %), prevalence ratio (PR) = 3.2, 95 % CI: 2.2-4.8, adjusted for age, gender & education. A subgroup living close to the farm & working there had significantly more API (56 %) than those living close & didn’t work there (16 %), adjusted PR = 3.0, 95 % CI: 1.8-4.9. Flower farm workers reported more API (56 %) than those not working in the flower farm (13 %,), adjusted PR = 4.0, 95 % CI: 2.9-5.6.
Conclusion. Our study indicates a 26 % prevalence of self-reported symptoms attributable to API. The residents living closer than 5 kilometers to the flower farm reported significantly higher prevalence of self-reported API than those living 5–12 kilometers away. This increased risk of API was associated with work at the flower farm.
Background: Ethiopia is one of the countries with the highest burden of undernutrition, with rates of stunting and underweight as high as 40% and 25%, respectively. National efforts are underway for an accelerated reduction of undernutrition by the year 2030. However, for this to occur, understanding the spatial variations in the distribution of undernutrition on a varying geographic scale, and its determinants will contribute a quite a bit to enhance planning and implementing nutrition intervention programmes.
Objectives: The aim of this thesis was to evaluate the large- and small-scale spatial variations in the distribution of undernutrition indicators, the underlying processes and the factors responsible for the observed spatial variations.
Methods: We used nationally available climate and undernutrition data to evaluate the macro-scale spatial pattern of undernutrition and its determinants. We applied a panel study design, and evaluated the effect of growing seasonal rainfall and temperature variability on the macro-scale spatial variations (Paper I). We conducted a repeated cross- sectional survey to assess the performance of the Household Food Insecurity Access Scale (HFIAS) developed internationally to measure household food insecurity. The results from this validation work were used to modify the HFIAS items for subsequent papers (Papers III and IV). We conducted a census on six randomly selected kebeles to evaluate the spatial patterns of undernutrition on a smaller scale (Paper III). For Paper IV, we conducted a cross-sectional survey on a representative sample, and employed a Bayesian geo-statistical model to help identify the risk factors for stunting, thereby accounting for the spatial structure (spatial dependency) of the data.
Results: In Paper I, we demonstrated spatial variations in the distribution of stunting across administrative zones in the country, which could be explained in part by rainfall. However, the models poorly explained the variation in stunting within an administrative zone during the study period. We indicated that a single model for all agro-ecologic zones may not be appropriate. In Paper II, we showed that the internal consistency of the HFIAS' tools, as measured by Cronbach's alpha, was adequate. We observed a lack of reproducibility in HFIAS score among rural households. Therefore, we modified the HFAIS tool, and used it for subsequent surveys in this thesis (Papers III and IV). In Paper III, spatial clustering on a smaller scale (within a kebele) was found for wasting and severe wasting. Spatial clustering on a higher scale (inter-kebele) was found for stunting and severe stunting. Children found within the identified cluster were 1.5 times more at risk of stunting, and nearly five times more at risk of wasting, than children residing outside this cluster. In Paper IV, we found a significant spatial heterogeneity in the distribution of stunting in the district. Using both the local Anselin Moran's I (LISA) and the scan statistics, we identified statistically significant clusters of high value (hotspots) and a most likely significant cluster for stunting in the eastern part of the district. We found that the risk of stunting was higher among boys, children whose mother or guardian had no education and children who lived in a food-insecure household. We showed that including a spatial component (spatial structure of the data) into the Bayesian model improved the model fit compared with the model without this spatial component.
Conclusion: We demonstrated that stunting and wasting exhibited a spatial heterogeneity, both on a large and small scale, rather than being distributed randomly. We demonstrated that there is a tendency for undernourished cases (stunting and wasting) to occur near each other than to occur homogeneously. We demonstrated a micro-level spatial variation in risk and vulnerability to undernutrition in a district with a high burden of undernutrition. Identifying such areas where a population at risk lives is central in assisting a geographical targeting of intervention. We recommend further study, possibly using a trial design or implementation research approach, to help evaluate the feasibility and benefits of geographically targeting nutritional interventions.
Young people account for 30% of the population in South Africa, with just under 15 million young people aged 10 – 24 years. Adolescence is considered a time of both risk and opportunity: When rapid physical and psychological changes may lead to a rise in risk behaviour, substance abuse, sexual and reproductive health problems, violence and mental illness.2 Adolescent health and behaviour are also key determinants of the adult burden of disease. It is therefore critical to invest in youth friendly services that promote physical and mental health, and enable young people to successfully navigate the challenges of adolescence and take on adult responsibilities.
Young people experience a range of barriers that limit their access to healthcare services including transport costs, clinic hours clashing with school timetables, negative attitudes from healthcare workers and a lack of privacy and confidentiality.
The rapid development of information and communication technology (ICTs) – particularly access to mobile phones – has the potential to address these challenges and improve young people’s access to health-related information and services, especially in poor, remote settings. The World Health Organisation has recognised how mobile health (m-health) programmes have the potential to bring services closer to adolescents by providing 24-hour access and confidential, anonymous and personalised interactions.
While there has been significant investment in m-health initiatives across Africa, little research has been done on how young people actually use mobile phones to seek healthcare – insight that is critical in understanding how the uptake of new ICTs might entrench and/or disrupt health inequalities. This research brief presents key findings from a study led by Durham Universityi to investigate the use of mobile phones amongst youth in Sub-Saharan Africa and considers the implications for policy and practice.
The dominant view within Western biomedicine is that children are vulnerable and in need of adult protection, while medicines are powerful, dangerous and should be controlled by experts, however, a growing literature suggests that children and adolescents (in both Western and developing-country contexts) often take active roles in health-seeking. Here, we consider young people’s health-seeking practices in Ghana: a country with a rapidly changing therapeutic landscape, characterised by the recent introduction of health insurance, mass advertising of medicines, and increased use of mobile phones. Qualitative and quantitative data are presented from eight field-sites in urban and rural Ghana, including 131 individual interviews, focus groups, plus a questionnaire survey of 1005 9-to-17-year-olds.
This paper shows that many young people take active responsibility for their own (and others’) healthcare. However, there is substantial variation in health-seeking practices and associated agency; these processes are shaped by (and also shape) resources available, including economic, social, cultural, psychological, informational and locational forms of capital. Dynamic interactions between resources and health-seeking agency operate within a wider, rapidly-changing therapeutic landscape, which has opened access to a greater range of healthcare possibilities. The paper concludes by considering implications for health and wellbeing, and suggest possible interventions for facilitating young people to seek healthcare safely and effectively.
Changes in Ghana’s therapeutic landscape, which mirror those taking place across the continent, are likely to increase young people’s health-seeking agency over coming years. Regulating rapidly expanding pharmaceutical markets and associated advertising is notoriously difficult, which means that children (and adults) have increasingly easy and cheap access to a range of restricted drugs, without necessarily knowing how to use them appropriately. The pragmatic question is how best to facilitate young people to seek healthcare safely and effectively.
Confidentiality and effective, non-judgmental communication are key features of adolescent-friendly services. Ensuring that existing formal health services in Ghana meet the needs of children and adolescents is an important starting point; this will involve investing resources in training and supporting staff to improve inter-generational communication skills and empathetic approaches.
With dramatic recent rises in schooling in Ghana (and elsewhere in Africa), schools offer an important forum for health education and services, and school-based health education should be extended beyond the usual health promotion messages to cover safe and appropriate use of medicines.
User-fees and health insurance also require careful reflection. Finding here indicate that health insurance, which reduces up-front costs of healthcare, might increase urban adolescents’ independent use of formal, accredited health services. However, many young people are not covered by insurance because their parents cannot afford the premiums. Removing user-fees for under-18s would be an important step to facilitating effective health-seeking and ability to access higher-quality services, in Ghana and elsewhere. However, as we have indicated, user-fees are not the only barrier to health-service use for young people, particularly those living in rural areas. Even with health insurance, for those without effective access to appropriate, affordable services (both formal and informal), good quality healthcare is still as out of reach as ever.
Since 2010, the NICK study has sought to help two project countries, Chile and Kenya, reduce urban malnutrition in young children by facilitating intersectoral actions to change the social determinants. In urban Kenya chronic stunting is an endemic problem jeopardizing children’s physical and mental development. In urban Chile child overweight and obesity is a serious public health problem associated with increased risk of morbidity and mortality from chronic diseases such as diabetes mellitus and coronary heart disease.
The 2010 and 2013 Lancet Series on Maternal and Child Nutrition identified the need for increased inter-sectoral action to address the complex causation of child malnutrition. The 2013 Series called for more studies to strengthen the evidence base for ‘nutrition sensitive’ programming to address the social determinants and find out what works and how programmes should be designed in specific country contexts. Now that more people worldwide are living in cities than rural areas, there have also been calls for more attention to be paid to the poorest and most vulnerable families living in urban informal settlements. The NICK study responds to these calls by addressing the question: Can child malnutrition amongst families living in poverty in informal settlements in the cities of Mombasa in Kenya, and Valparaíso in Chile, be reduced through broadening community and stakeholder participation to change the social determinants of nutritional status?
Findings from the situational analysis confirmed that the social determinants of child malnutrition in the study areas were a broad range of social, economic and environmental factors operating at local, municipal, provincial and central levels. They included education, income, working conditions, housing, neighbourhood and community conditions, the status of women and level of social inclusion. These determinants impacted child nutrition through influencing access to nutritious foods, child care practices and access to basic services.
Key lessons learnt: What works? What does not work?
The research team renamed this study the NICK Project :Nutritional Improvement for children in urban Chile and Kenya.
Teenage childbearing and attainment at school in South Africa are investigated using nationally-representative data from the National Income Dynamics Study. The analysis focuses on the outcomes by 2010 of a panel of 673 childless young women aged 15–18 in 2008. Girls who had their first birth by 2010 had 4.4 times the odds of leaving school and 2.2 times the odds of failing to matriculate, controlling for other factors. Girls from the highest-income households were unlikely, and girls who were behind at school relatively likely, to give birth. More than half the new mothers enrolled in school in 2010. They were most likely to enroll if they were rural residents who resided with their own mother and she had attended secondary school.
Poor educational attainment, teenage motherhood and childhood poverty are interrelated problems in South Africa: for middle-class families, avoiding early motherhood contributes to the intergenerational transmission of privilege. Dissuading girls in their mid-teens who are behind at school from becoming teenage mothers may require intervention at an earlier stage of their schooling.
Preliminary evidence from a 2009 global evidence review suggested that community-based child protection mechanisms are likely to be more effective and sustainable if they are linked with formal aspects of the child protection system. To test the value of nonformal-formal linkages, this action research uses a quasi-experimental design to test the effectiveness of a community owned and driven intervention that seeks to reduce teenage pregnancy.
In each of Moyamba and Bombali Districts, there were two clusters of three communities in different but comparable chiefdoms. One cluster was an intervention cluster, whereas the other was a comparison cluster. In the intervention clusters, community members from three villages worked collaboratively to develop an intervention that addressed a child protection concern of their choosing. In both intervention clusters, the communities elected to focus on teen pregnancy, an issue that had been documented as a key concern in previous ethnographic work. The intervention, which was developed by the community, included components on family planning, sexual and reproductive health education, and life skills and was implemented in partnership with NGOs and District Ministry of Health partners.
Successful integration of nutrition interventions into large-scale development programmes from nutrition-relevant sectors, such as agriculture, can address critical underlying determinants of undernutrition and enhance the coverage and effectiveness of on-going nutrition-specific activities. However, evidence on how this can be done is limited.
This study examines the feasibility of delivering maternal, infant, and young child nutrition behaviour change communication through an innovative agricultural extension programme serving nutritionally vulnerable groups in rural India. The existing agriculture programme involves participatory production of low-cost videos promoting best practices and broad dissemination through village-level women’s self-help groups. For the nutrition intervention, 10 videos promoting specific maternal, infant, and young child nutrition practices were produced and disseminated in 30 villages. A range of methods was used to collect data, including in-depth interviews with project staff, frontline health workers, and self-help group members and their families; structured observations of mediated video dissemination sessions; nutrition knowledge tests with project staff and self-help group members; and a social network questionnaire to assess diffusion of promoted nutrition messages.
The authors found the nutrition intervention to be well-received by rural communities and viewed as complementary to existing frontline health services. However, compared to agriculture, nutrition content required more time, creativity, and technical support to develop and deliver. Experimentation with promoted nutrition behaviours was high, but sharing of information from the videos with non-viewers was limited.
Key lessons learned include the benefits of and need for:
Understanding the experience of developing and delivering this intervention will benefit the design of new nutrition interventions which seek to leverage agriculture platforms.
Urbanisation can bring many benefits the rate of change but in many developing countries the rate of change has been so fast and so dramatic that many cities have been unable to cope. Rapid, unplanned urbanisation has led to widespread social inequity and stratification, the rapid growth of informal settlements and slums, environmental degradation, heavy migrant inflows, and breakdown of the social support systems and networks.
It is not surprising, therefore, that there is a strong and well established link between child malnutrition and various dimensions of disadvantage in the urban setting. Child undernutrition has become an endemic problem in many poor urban areas of developing countries, jeopardizing the physical and mental development of growing children.
At the same time, social conditions and globalisation create the emerging risk of child overweight and obesity due to consumption of inappropriate foods, promoted as a part of the processes of globalization of food production systems, and lack of physical activity linked to changes in occupational and leisure activities. Many cities in the developing world are therefore facing a double burden of child under-nutrition and obesity and municipal governments are uniquely positioned to play a leading role in addressing these problems.
The primary aim of this structured literature review is to synthesize what is known about the effectiveness of interventions to reduce child malnutrition through changing the social determinants in poor urban areas of developing countries. The review focuses on child malnutrition because studies have shown that the early childhood years are the most critical. The importance of nutrition intervention throughout the lifecycle is also acknowledged.
A secondary aim is to draw out the implications of the findings for the further development of a three year research study known as the NICK Project (Nutritional Improvement for children in urban Chile and Kenya). This project aims to help two cities, Mombasa and Valparaiso, reduce child malnutrition in children less than five years of age living in poor urban areas of these cities by intervening at the municipal level to broaden community and stakeholder participation and provide exemplars of successful small-scale interventions that can change the social determinants. If successful, the innovative approach used in this study could serve as a useful guide for action in the cities of other high burden countries.
Despite the emphasis given to poverty reduction in policy statements and a substantial increase in social spending, money-metric poverty has shown little improvement since South Africa's transition to democracy in 1994. Alternative approaches to measuring well-being and inequality may show a more positive trend.
This article uses the 2008 National Income Dynamics Study to assess the magnitude of inequalities in under-five child malnutrition ascribable to economic status. The article compares these results with those of Zere and McIntyre, who analysed similar data collected in 1993. In both cases, household income, proxied by per-capita household expenditure, was used as the indicator of socio-economic status. Children's heights and weights have increased since 1993 and being stunted or underweight has become less common. Furthermore, pro-rich inequalities in stunting and being underweight have significantly declined since the end of apartheid. This suggests that pro-poor improvements in child welfare have taken place. Policies that may have contributed to this include the Child Support Grant, introduced in 1998, and improvements in healthcare and the education of women.
On average the burden of disease and death is born primarily by poorer people within poorer countries.The high rates of child mortality in developing countries today constitute one of the harshest failures of development. It is estimated that about 10 million children die each year before their first birthday and that a fourth of these deaths occur in India.
The initial motivation of project disussed in this paper was to present and analyse evidence that challenges the conventional wisdom on the overwhelming importance of socio-economic status, introducing a systematic role for culture (identified here as religion). In India, Muslims have poorer socioeconomic status (SES) on average but they have persistently achieved substantially higher child survival rates than Hindus. This remarkable fact has escaped attention and analysis. An aspect of religion that is closely examined in this project is gender preference. This research also extends the analysis of religion differentials in health to look at religion differentials in education as this helps sort explanations in terms of investments in children vs healthy behaviours.
The author finds some evidence that the Muslim advantage in child survival may derive partly from the fact that they are less likely than Hindus to favour sons over daughters. The research shows that the Muslim advantage is greater for girl survival although they do have an advantage for boy survival. It is argued that this is related to their better maternal health - which is supported by the fact that most of the differential is apparent soon after birth. The author also argues that better maternal health is also related to lower son preference.
Research challenges, implicitly, the popular perception that the status of women in Muslim communities is lower than that of men, showing that it is even lower in Hindu communities. This research also undermines the argument that Muslims have “lower human capital” than Hindus because they have been discriminated against. It shows that they have stronger health capital and suggests that they may have stronger social capital, alongside their clearly weaker educational capital.
Lymphatic filariasis (LF) and leprosy are neglected tropical diseases (NTDs) representing a significant global burden of disease morbidity. Like most NTDs, LF and leprosy are most prevalent in poor, rural and marginalised populations. NTD prevalence is becoming known as a ‘proxy for poverty and disadvantage’. Although not commonly fatal, LF and leprosy both have devastating debilitating effects when left untreated. Both are treatable, yet millions of people around the world live with the consequences of permanent disability.
LF and leprosy are targeted for elimination by the World Health Organization (WHO). Global efforts to reduce the burden of disease have been guided by WHO targets for disease elimination. Roadmaps for eliminating LF and leprosy include strategies that identify guidelines for disease prevention, treatment, and morbidity management and disability prevention (MMDP).
A significant portion of disease burden associated with LF and leprosy are related to disability and deformity caused by disease. Therefore, to reach elimination targets and meet the needs of those affected by disease, strategies and programmes must have a strong focus on MMDP. Poor uptake of MMDP coupled with a lack of WASH consideration in MMDP strategy guidelines represents a significant barrier to improving the quality of life and health of infected individuals. Therefore, this paper aims to clearly identify the role of WASH for MMDP self-care, the WASH needs required for practising and optimising self-care, and the potential barriers to an individual’s access to WASH services.
Progress towards the Millennium Development Goals (MDGs) has been uneven. Inequalities in child health are large and effective interventions rarely reach the most in need. Little is known about how to reduce these inequalities. We describe and explain the equity impact of a women’s group intervention in India that strongly reduced the neonatal mortality rate (NMR) in a cluster-randomised trial. We conducted secondary analyses of the trial data, obtained through prospective surveillance of a population of 228, 186. The intervention effects were estimated separately, through random effects logistic regression, for the most and less socio-economically marginalised groups.
Progress towards the Millennium Development Goals (MDGs) has been uneven. Inequalities in child health are large and effective interventions rarely reach the most in need. Little is known about how to reduce these inequalities.
This paper describes and explains the equity impact of a women’s group intervention in India that strongly reduced the neonatal mortality rate (NMR) in a cluster-randomised trial. The authors conducted secondary analyses of the trial data, obtained through prospective surveillance of a population of 228 186. The intervention effects were estimated separately, through random effects logistic regression, for the most and less socio-economically marginalised groups.
Among the most marginalised, the NMR was 59% lower in intervention than in control clusters in years 2 and 3 (70%, year 3); among the less marginalised, the NMR was 36% lower (35%, year 3). The intervention effect was stronger among the most than among the less marginalised (P-value for difference = 0.028, years 2-3; P-value for difference = 0.009, year 3).
The stronger effect was concentrated in winter, particularly for early NMR. There was no effect on the use of health-care services in either group, and improvements in home care were comparable. Participatory community interventions can substantially reduce socio-economic inequalities in neonatal mortality and contribute to an equitable achievement of the unfinished MDG agenda.
This report synthesises insights on children and young people (CYP) from research funded by the Economic and Social Research Council (ESRC) and the UK Department for International Development (DFID) Joint Fund for Poverty Alleviation Research. It identifies the major contributions the scheme has made to knowledge on CYP in low- and middle-income countries and on effective policies for promoting CYP wellbeing. It situates learning from scheme-funded research within the wider field of CYP-oriented international development research and reflects on the ways in which findings relate to contemporary
development policy agendas for CYP. The report is based on a thorough review of all available documentation and outputs related to the 126 grants funded at the start of the review period and on conversations and interviews with current grant-holders.
The development literature in the recent past has brought out the stark differences in the social and economic status of Dalits and Adivasis as compared to other social groups in India. Most of these studies tended to focus on the correlates of group identity, material deprivation and poverty of these groups to their development deficit.
Dominant discussions in public health in India have often tended to sideline the questions of discrimination while examining the gap in health status among social groups mainly due to the over influence of more visible issues such as unbalanced resource allocation and spending, poor coverage of services, infrastructure lacuna, human resource shortage, affordability and issues of governance. Whilst not many, there, are evidences that discrimination and resulting deprivation have an impact on health of the people in the Indian context.
The paper examines whether the dalit castes are adequately represented in the health service system in rural India in the context of the already established caste based discrimination in service delivery. Drawing from official data, the paper shows an overall domination of non-dalits in healthcare services. The paper presents two scenarios to understand it further. Fist is the similarities in health disparities between Scheduled Castes (SCs) and non-SC/Scheduled Tribes (STs) of Bihar and Tamil Nadu, which have huge presence of non SC/STs in significant positions of healthcare delivery. Second is the case of Andhra Pradesh (undivided), which has less intergroup disparities and better distribution of health personnel from dalit castes at all levels of health services. These cases confirm the persistence of unfavourable environments for dalits with the domination of non-dalits in health services.
Mental health is a critically important issue in global health today, and yet does not receive due policy attention. Mental illness will likely affect one in four people within their lifetime and neuropsychiatric conditions now account for 13% of the global burden of disease - with 70% of that burden in low- and middle-income countries. Despite this, mental health has not yet achieved the policy influence that would be proportionate to its burden.
This report applies several theoretical approaches to analyse mental health as a policy issue and the particular challenges it faces. It also applies other supporting analytical approaches regarding the tractability of a policy issue and for assessing the effectiveness of global health networks.
The report focusses on mental health at a global level, but highlights the need for more detailed analysis at a more local level, given that policy traction is highly dependent on local context, actors and systems of decision-making.
In 2015 the world took a huge step forward by including mental health in the Sustainable Development Goals (SDGs), which set the global agenda for the next three decades. Now that they have been agreed, the world is looking to how the SDGs will be funded and how progress towards achieving them will be measured. Mental health is severely underfunded. Despite the huge burden it places on global health, it receives a fraction of the funding of other diseases.
Reporting of mental health spending by country governments and donors is inconsistent, and tracking of spending all but non-existent (as it is often
rolled into general health budgets).
This report provides an overview of who is currently funding mental health and who isn’t, but could be. It is a synthesis of research previously conducted in this field and analyses both existing and new funders. It highlights how little information there is on what donors are spending on mental health globally, what types of activities are funded and why funding mental health delivers a variety of benefits, and it suggests how to frame the issue to encourage more investment.
More than 700 million women in the world today were married before their 18th birthday and one in three of those women was married before age 15. Child marriage can trigger a cycle of disadvantage across every part of a girl’s life.
Maternal mortality is the second leading cause of death for adolescent girls aged 15–19 years old (after suicide). An estimated 70,000 adolescent girls die each year from complications during pregnancy or childbirth. Every year 2.5 million girls under 16 give birth.
Aside from child marriage and inadequate sexual and reproductive helath care, this report highlights further barriers to girls' equality, including gender-based violence, trafficking, economic exclusion when household resources are limited and boys are prioritised, education and learning gaps, and gender issues arising from conflict and disasters.
This report identifies the three specific Guarantees to Girls that governments must make - fair finance, equal treatment and accountability - that governments must make to reach excluded children.
The Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013–2020, endorsed by the World Health Organization, provides a roadmap and a menu of policy options for Member States and other stakeholders to take coordinated and coherent action to reduce mortality from noncommunicable diseases (NCDs) and exposure to risk factors.
To address the increasing number of requests from Member States for guidance on how to design fiscal policies on diet, WHO convened a technical meeting of global experts in fiscal policies on 5–6 May 2015 in Geneva. The main objectives of the meeting were to review evidence and existing guidance, discuss country case studies and provide considerations with regards to the scope, design and implementation of effective fiscal policies on diet. The meeting consisted of presentations and discussions during plenary and in working groups on the evidence, country experiences and technical aspects of policy design and implementation.
It was concluded that there is reasonable and increasing evidence that appropriately designed taxes on sugar-sweetened beverages would result in proportional reductions in consumption, especially if aimed at raising the retail price by 20% or more. There is similar strong evidence that subsidies for fresh fruits and vegetables that reduce prices by 10–30% are effective in increasing fruit and vegetable consumption. Greater effects on the net energy intake and weight may be accomplished by combining subsidies on fruit and vegetables and taxation of target foods and beverages. Vulnerable populations, including low-income consumers, are most price-responsive and, in terms of health, benefit most from changes in the relative prices of foods and beverages.
Consistent with the evidence on tobacco taxes, specific excise taxes – as opposed to sales or other taxes – based on a percentage of retail price, are likely to be most effective. In countries with strong tax administration, taxes that are calculated based on nutrient content can have greater impact. A proper situation analysis, good political advocacy, appropriate objective setting and evaluation, should be part of the multidisciplinary development and implementation of such policies.
There are evidence gaps that could be addressed, with more countries developing and implementing such fiscal policies. Lack of standards or criteria for determining exactly what to tax is a challenge experienced by countries and the development of a nutrient profile model for designing and implementing fiscal policies was recommended. In addition, there was a call for a manual on developing and implementing fiscal policies for diet.
It is recommended that:
The southern Indian city of Hyderabad has seen unprecedented growth and is an emerging megacity. Some processes in its rapid urbanisation and development have had serious repercussions and are proving to be a threat to the city and its environs. The provision of basic amenities like water supply for its growing population has been particularly affected in the newly developing areas beyond the city's municipal boundaries. Piped municipal water supply is often sporadic and inadequate, resulting in a widening demand-supply gap, particularly in the peri-urban areas of the city.
Informal water markets, particularly private tankers, play a crucial role in filling such gaps. However, most of these water trucks or tankers use groundwater as their major water source. They have a well-structured institutional nexus of illegal suppliers and operators. Moreover, tanker-supplied water has tradeoffs that tend to be ignored: energy costs associated with such an inefficient system of transporting bulk water; the health and social costs of the high number of road traffic accidents caused by these tankers; and the impact of their groundwater abstraction on other water users in peri-urban areas. Despite the critical nature of this issue, little is known or documented about this rapidly growing informal tanker market, particularly in peri-urban Hyderabad.
In this context, SaciWATERs has undertaken a two-year project: Understanding the Magnitude of the Tanker-Based Economy and its Implications on Water Resources: A Study of Private Water Tanker Market in Peri-Urban Hyderabad. The research project has been funded by Arghyam and the Bordeaux Urban Community.
In July 2016, the National Treasury of South Africa proposed an effective 20% tax on sugary soft drinks. The proposal derives from the National Department of Health strategy to reduce obesity. It is rooted in the scientific consensus that these kinds of drinks are a key factor behind rising obesity and the attendant ailments of diabetes, heart disease and some cancers. The Beverage Association of South Africa’s (BEVSA) response to the sugar tax proposal has been aggressively publicised. But its arguments rely on a misunderstanding of economic realities combined with repeated misrepresentations of the available data. In particular, because of the host of substitutes available for sugary drinks, both consumers and producers can adapt to the tax in ways that avoid economic costs while achieving significant health benefits.
This brief suggests in arguing that sugar consumption is not a significant problem in South Africa, BEVSA’s document misuses FAO data while ignoring actual studies of diet and nutrition.
Diarrhoea is among the main causes of morbidity and mortality in children within the developing world. According to the (2007) Intergovernmen al Panel on Climate Change (IPCC) report, there is an expected increase in the global annual average temperature by 2100, which could result in increased temperatures and rainfall in many areas of the globe, causing significant temperature variability in the future. It was reported that with a change in climatic parameters such as average temperatures and rainfall, the rate of certain health conditions i.e., thermal stress and infectious diseases increases. It is worth noting that children under five years old are susceptible to the problem of climate-sensitive diseases with estimates ranging from 10% to 20% of populations in areas with limited capacity to manage the health impact of climate change. Increasing evidence has emphasized the seasonal relationship between the peak of diarrhoea occurrence and climatic factors such as the rainy season and high temperatures in developing countries. The link existing between climate parameters and diarrhoeal disease can be expected to fluctuate with different causal agents such as rotavirus, norovirus, Giardia, Cryptosporidium and pathogenic Escherichia coli, Campylobacter and Salmonella.
This paper describes the relationship between temperature change and diarrhoea in under five-year-old children in the Cape Town Metropolitan Area (CTMA) of South Africa. The study used climatic and aggregated surveillance diarrhoea incidence data of two peak periods of seven months each over two consecutive years. A Poisson regression model and a lagged Poisson model with autocorrelation was performed to test the relationship between climatic parameters (minimum and maximum temperature) and incidence of diarrhoea.
The paper concludes that there was an association between an increase in minimum and maximum temperature, and the rate at which diarrhoea affected children under the age of five years old in the Cape Town Metropolitan Area. This finding may have implications for the effects of global warming and requires further investigation.
Climate change has been recognized as both one of the biggest threats and the biggest opportunities for global health in the 21st century. This trend review seeks to assess and characterize the amount and type of scientific literature on the link between climate change and human health.
The authors tracked the use of climate-related terms and their co-occurrence with health terms during the 25 years since the first Intergovernmental Panel on Climate Change (IPCC) report, from 1990 to 2014, in two scientific databases and in the IPCC reports. They investigated the trends in the number of publications about health and climate change through time, by nature of the health impact under study, and by geographic area. Then the authors compared the scientific production in the health field with that of other sectors on which climate change has an impact.
Results: The number of publications was extremely low in both databases from 1990 (325 and 1,004, respectively) until around 2006 (1,332 and 4,319, respectively), which has since then increased exponentially in recent years (6,079 and 17,395, respectively, in 2014). However, the number of climate change papers regarding health is still about half that of other sectors. Certain health impacts, particularly malnutrition and non-communicable diseases (NCDs), remain substantially understudied. Approximately two-thirds of all published studies were carried out in OECD countries (Organization for Economic Cooperation and Development), predominantly in Europe and North America.
There is a clear need for further research on the links between climate change and health. This pertains particularly to research in and by those countries in which health will be mostly affected and capacity to adapt is least. Specific undertreated topics such as NCDs, malnutrition, and mental health should gain the priority they deserve. Funding agencies are invited to take note of and establish calls for proposals accordingly. Raising the interest in this research area in young scientists remains a challenge and should lead to innovative courses for large audiences, such as Massive Open Online Courses.