A systematic review of unintended pregnancy in cross-cultural settings: Does it have adverse consequences for children?

Introduction: Although there has been a great deal of concern about the consequences of unintended pregnancies on child health, there has been little documented evidence across specific outcomes to inform programs and policies. This paper highlights the association between unintended pregnancy, and its health and developmental consequences to children.Methods: Published and grey evidence available adverse effects of unintended pregnancy on children were extracted electronically using search engines: PubMed, EMBASE and Google Scholar for the period January 1981 through January 2017. The PRISMA checklist was used and qualities of eligible studies were assessed for method validity and result interpretation. Effect-size odds ratioswere calculated from extracted data.Results: Of the 107 studies identified after removal of duplications, 29 studies with a quality score ranging from 3 to 6 (Mean = 5.65; SD±0.65) were included. Pattern of child rearing, development and health were found to differ for children classified to be breads of an unintended pregnancy. However, many of the available studies appear to have methodological limitations such as recall bias and brief period of follow-ups limiting causal inferences and to determine a temporal sequence. The findings were found to be inconsistent across studies.Conclusion: Studies provide evidence relating to adverse health outcomes for children of unintended births. The existing knowledge is limited by weak research methodologies and a paucity of studies addressing subsequent health and developmental effects beyond the early childhood period. There is a need for more multi-wave longitudinal studies to assess child health and developmental trajectories associated with unintended pregnancies. [Ethiop. J. Health Dev. 2017;31 (3):138-154]Keywords: Unplanned pregnancy, unwanted pregnancy, child development, child health consequenc

The short-term economic effects of COVID-19 on low-income households in rural Kenya:An analysis using weekly financial household data

International audienceThis research assesses how low-income households in rural Kenya coped with the immediate economic consequences of the COVID-19 pandemic. It uses granular financial data from weekly household interviews covering six weeks before the first case was detected in Kenya to five weeks after during which various containment measures were implemented. Based on household-level fixed-effects regressions, our results suggest that income from work decreased with almost one-third and income from gifts and remittances reduced by more than one-third after the start of the pandemic. Nevertheless, household expenditures on food remained at pre-COVID levels. We do not find evidence that households coped with reduced income through increased borrowing, selling assets or withdrawing savings. Instead, they gave out less gifts and remittances themselves, lent less money to others and postponed loan repayments. Moreover, they significantly reduced expenditures on schooling and transportation, in line with the school closures and travel restrictions. Thus, despite their affected livelihoods, households managed to keep food expenditures at par, but this came at the cost of reduced informal risk-sharing and social support between households

Height deficit in early adulthood following substantiated childhood maltreatment: a birth cohort study

Early life stress including childhood maltreatment has been associated with reduced head circumference and/or brain size, cognitive, and academic deficits in children and adolescents. However, little is known about the effect of childhood maltreatment on height, especially in early adulthood. This study was designed to examine the association between confirmed cases of multiple or subtypes of childhood maltreatment and stunted growth in young adulthood controlling for perinatal and familial confounding factors. A total of 2661 (48.4% female) young adults from the Mater Hospital-University Study of Pregnancy (MUSP) had data on standardised height-for-age score measurement as part of physical assessment at the 21-year follow-up. Prospectively substantiated cases of childhood maltreatment, 0–14 years of age, were linked to the MUSP dataset. Ethical approval was obtained from the Human Ethics Review Committee of The University of Queensland and the Mater Hospital. Multiple regression analyses were performed to determine the effects of childhood maltreatment on height in young adults. Childhood physical or emotional abuse and neglect were significantly associated with a deficit in height in young adulthood after controlling for perinatal and familial confounders. Multiple incidents of childhood maltreatment also were associated with a deficit in height

Gender-based differences in injecting drug use by young adults who experienced maltreatment in childhood: findings from an Australian birth cohort study

Background Childhood maltreatment has been associated with a range of adverse mental and psychosocial outcomes, but its association with subsequent injecting drug use (IDU) is less clear. This study investigates the associations between specific and multiple forms of substantiated childhood maltreatment and IDU reported at 21 years. Method The Mater-University of Queensland Study of Pregnancy is a prospective birth cohort study. It recruited pregnant women at their first antenatal clinic visit and collected data on their children at 21 years. Data from 3750 participants (1769 males and 1981 females) were analysed using agency substantiated childhood maltreatment from birth to 14 years of age and self-reports of ever IDU at 21 years. We used multivariable logistic regression analyses to control for possible confounders. Results The sample's mean age was 20.6 years. Some 4.1% (n\ua0=\ua072) of males and 4.6% (n\ua0=\ua091) of females had experienced substantiated childhood maltreatment. The prevalence of IDU was 6.6% (n\ua0=\ua0118) and 4.6% (n\ua0=\ua091) for males and females, respectively. In adjusted models, all forms of substantiated childhood maltreatment, with the exception of sexual abuse, were associated with IDU in females (adjusted odds ratios (AORs)\ua0=\ua02.69–3.02) but only emotional abuse (AOR\ua0=\ua02.51) was associated with IDU in males. Multiply occurring forms of childhood maltreatment were also associated with IDU in females (AORs\ua0=\ua02.36–3.41) but not in males. Conclusions Injecting drug use appears to be an adverse outcome of childhood maltreatment particularly in females. Additional research is needed to better understand why females appear to be more affected than males

Digital arterial pressure pulse wave analysis and cardiovascular events in the general population:the Prevention of Renal and Vascular End-stage Disease study

BACKGROUND: Arterial stiffness influences the contour of the digital pressure pulse wave. METHOD: Here, we investigated whether the digital pulse propagation index (DPPI), based on the digital pressure pulse wave, DPPI is associated with cardiovascular events, heart failure, and mortality in a large population-based cohort. Between 2001 and 2003, DPPI was measured with a PortaPres noninvasive hemodynamic monitoring device (FinaPres Medical Systems, Amsterdam, The Netherlands) in participants of the Prevention of Renal and Vascular End-stage Disease study, a community-based cohort. We assessed the main determinants of the DPPI and investigated associations of DPPI with cardiovascular events and mortality. RESULTS: The study included 5474 individuals. Mean age was 52.3 ± 11.8 years and 50.5% was male. Median baseline DPPI was 5.81 m/s (interquartile range 5.47-6.20). Higher age, mean arterial blood pressure, body height, heart rate, current smoking, and lower HDL cholesterol levels and waist circumference were independent determinants of the DPPI (r = 0.43). After adjustment for heart rate, highlogDPPI was associated with all-cause mortality [hazard ratio: 1.67, 95% confidence interval (1.55-1.81) per SD; P &lt; 0.001], cardiovascular mortality [hazard ratio 1.95 (1.72-2.22); P &lt; 0.001], and incident heart failure with reduced ejection fraction [hazard ratio 1.81 (1.60-2.06); P &lt; 0.001]. These associations remained independent upon further adjustment for confounders. Optimal cutoff values for DPPI ranged between 6.1 and 6.3 m/s for all endpoints. After multivariable adjustment, DPPI was no longer associated with coronary artery disease events or cerebrovascular events. CONCLUSION: The DPPI is associated with an increased risk of development of new onset heart failure with reduced ejection fraction and all-cause and cardiovascular mortality, but not with coronary artery events or cerebrovascular events.</p

Global, regional, and country-specific lifetime risks of stroke, 1990 and 2016

BACKGROUND The lifetime risk of stroke has been calculated in a limited number of selected populations. We sought to estimate the lifetime risk of stroke at the regional, country, and global level using data from a comprehensive study of the prevalence of major diseases. METHODS We used the Global Burden of Disease (GBD) Study 2016 estimates of stroke incidence and the competing risks of death from any cause other than stroke to calculate the cumulative lifetime risks of first stroke, ischemic stroke, or hemorrhagic stroke among adults 25 years of age or older. Estimates of the lifetime risks in the years 1990 and 2016 were compared. Countries were categorized into quintiles of the sociodemographic index (SDI) used in the GBD Study, and the risks were compared across quintiles. Comparisons were made with the use of point estimates and uncertainty intervals representing the 2.5th and 97.5th percentiles around the estimate. RESULTS The estimated global lifetime risk of stroke from the age of 25 years onward was 24.9% (95% uncertainty interval, 23.5 to 26.2); the risk among men was 24.7% (95% uncertainty interval, 23.3 to 26.0), and the risk among women was 25.1% (95% uncertainty interval, 23.7 to 26.5). The risk of ischemic stroke was 18.3%, and the risk of hemorrhagic stroke was 8.2%. In high-SDI, high-middle-SDI, and low- SDI countries, the estimated lifetime risk of stroke was 23.5%, 31.1% (highest risk), and 13.2% (lowest risk), respectively; the 95% uncertainty intervals did not overlap between these categories. The highest estimated lifetime risks of stroke according to GBD region were in East Asia (38.8%), Central Europe (31.7%), and Eastern Europe (31.6%), and the lowest risk was in eastern sub-Saharan Africa (11.8%). The mean global lifetime risk of stroke increased from 22.8% in 1990 to 24.9% in 2016, a relative increase of 8.9% (95% uncertainty interval, 6.2 to 11.5); the competing risk of death from any cause other than stroke was considered in this calculation. CONCLUSIONS In 2016, the global lifetime risk of stroke from the age of 25 years onward was approximately 25% among both men and women. There was geographic variation in the lifetime risk of stroke, with the highest risks in East Asia, Central Europe, and Eastern Europe