Factors associated with early growth in Egyptian infants: implications for addressing the dual burden of malnutrition

Optimal nutrition is critical to the attainment of healthy growth, human capital and sustainable development. In Egypt, infants and young children face overlapping forms of malnutrition, including micronutrient deficiencies, stunting and overweight. Yet, in this setting, little is known about the factors associated with growth during the first year of life. A rise in stunting in Lower Egypt from 2005 to 2008 prompted this implementation research study, which followed a longitudinal cohort of infants from birth to 1 year of age within the context of a USAID-funded maternal and child health integrated programme. We sought to determine if growth patterns and factors related to early growth differed in Lower and Upper Egypt, and examined the relationship between weight loss and subsequent stunting at 12 months of age. Growth patterns revealed that length-for-age z-score (LAZ) decreased and weight-for-length z-score (WLZ) increased from 6 to 12 months of age in both regions. One-quarter of infants were stunted and nearly one-third were overweight by 12 months of age in lower Egypt. Minimum dietary diversity was significantly associated with WLZ in Lower Egypt (β = 0.22, P < 0.05), but not in Upper Egypt. Diarrhoea, fever and programme exposure were not associated with any growth outcome. Weight loss during any period was associated with a twofold likelihood of stunting at 12 months in Lower Egypt, but not Upper Egypt. In countries, like Egypt, facing the nutrition transition, infant and young child nutrition programmes need to address both stunting and overweight through improving dietary quality and reducing reliance on energy-dense foods

Factors associated with early growth in Egyptian infants: implications for addressing the dual burden of malnutrition.

Optimal nutrition is critical to the attainment of healthy growth, human capital and sustainable development. In Egypt, infants and young children face overlapping forms of malnutrition, including micronutrient deficiencies, stunting and overweight. Yet, in this setting, little is known about the factors associated with growth during the first year of life. A rise in stunting in Lower Egypt from 2005 to 2008 prompted this implementation research study, which followed a longitudinal cohort of infants from birth to 1 year of age within the context of a USAID-funded maternal and child health integrated programme. We sought to determine if growth patterns and factors related to early growth differed in Lower and Upper Egypt, and examined the relationship between weight loss and subsequent stunting at 12 months of age. Growth patterns revealed that length-for-age z-score (LAZ) decreased and weight-for-length z-score (WLZ) increased from 6 to 12 months of age in both regions. One-quarter of infants were stunted and nearly one-third were overweight by 12 months of age in lower Egypt. Minimum dietary diversity was significantly associated with WLZ in Lower Egypt (β = 0.22, P \u3c 0.05), but not in Upper Egypt. Diarrhoea, fever and programme exposure were not associated with any growth outcome. Weight loss during any period was associated with a twofold likelihood of stunting at 12 months in Lower Egypt, but not Upper Egypt. In countries, like Egypt, facing the nutrition transition, infant and young child nutrition programmes need to address both stunting and overweight through improving dietary quality and reducing reliance on energy-dense foods

Effect of monitoring the onset of calving by a calving alarm thermometer on the prevalence of dystocia, stillbirth, retained fetal membranes and clinical metritis in a Hungarian dairy farm.

The objective of the present study was to assess the effectiveness of an intravaginal thermometer in the field prediction of the second stage of labor and to determine its impact on the health of dams and newborn calves. Holstein cows (n¼241) were randomly selected about 5 (mean±SD: 4.7±2.0) days before the expected date of calving and the thermometerwas inserted intothe vagina. Another 113 cattle served as controls. There was no false alarm during the experiment. The risk of dystocia (Score >1) was 1.9 times higher, the prevalence of stillbirth was 19.8 times higher, the risk of retained fetal membranes (RFM) was 2.8 times higher and the risk of clinical metritis was 10.5 times higher in the control group than in the experimental group. The prevalence of stillbirth was 7 times higher in cows with dystocia compared to cows with eutocia. The presence of dystocia and stillbirth increased the risk of RFM 4 and 5 times, respectively. The occurrence of RFM increased the risk of development of clinical metritis with a 22 times higher odds. The results indicate that the use of calving alert systems not only facilitates controlling the time of parturition and providing prompt and appropriate calving assistance but also decreases the number of dystocia cases and improves reproductive efficiency, postpartum health of the dam and newborn calf survival

Evaluation of a commercial intravaginal thermometer to predict calving in a Hungarian Holstein‐Friesian dairy farm

In this study, the utility of a commercial intravaginal thermometer was evaluated as an automated method for the prediction of calving in a total of 257 healthy pregnant Holstein–Friesian female cattle. The accuracy and the sensitivity of predicting calving within 48 hr before calving were also evaluated. The intravaginal temperature changes from 72 hr before and up to calving were significantly (p ≤ .001) affected by parity, season (summer vs. autumn), the time of day (8 a.m. or 8 p.m.) and the 6-hr time intervals (38.19°C: first interval 0 to 6 hr before calving vs. 38.78°C: twelfth interval 66 to 72 hr before calving), while the gender (p = .943), and the weight of the calf (p = .610), twinning (p = .300), gestation length (p = .186), foetal presentation (p = .123), dystocia (p = .197) and retention of foetal membranes (p = .253) did not affect it significantly. The sensitivity of the SMS of expecting calving within 48 hr and the positive predictive value were 62.4% and 75%, respectively, while the sensitivity and the positive predictive value for the SMS of expulsion reached 100%. It can be concluded that the investigated thermometer is not able to predict calving within 48 hr accurately; however, imminent calving can be accurately alerted

Counting every stillbirth and neonatal death through mortality audit to improve quality of care for every pregnant woman and her baby

BACKGROUND: While there is widespread acknowledgment of the need for improved quality and quantity of information on births and deaths, there has been less movement towards systematically capturing and reviewing the causes and avoidable factors linked to deaths, in order to affect change. This is particularly true for stillbirths and neonatal deaths which can fall between different health care providers and departments. Maternal and perinatal mortality audit applies to two of the five objectives in the Every Newborn Action Plan but data on successful approaches to overcome bottlenecks to scaling up audit are lacking. METHODS: We reviewed the current evidence for facility-based perinatal mortality audit with a focus on low- and middle-income countries and assessed the status of mortality audit policy and implementation. Based on challenges identified in the literature, key challenges to completing the audit cycle and affecting change were identified across the WHO health system building blocks, along with solutions, in order to inform the process of scaling up this strategy with attention to quality. RESULTS: Maternal death surveillance and review is moving rapidly with many countries enacting and implementing policies and with accountability beyond the single facility conducting the audits. While 51 priority countries report having a policy on maternal death notification in 2014, only 17 countries have a policy for reporting and reviewing stillbirths and neonatal deaths. The existing evidence demonstrates the potential for audit to improve birth outcomes, only if the audit cycle is completed. The primary challenges within the health system building blocks are in the area of leadership and health information. Examples of successful implementation exist from high income countries and select low- and middle-income countries provide valuable learning, especially on the need for leadership for effective audit systems and on the development and the use of clear guidelines and protocols in order to ensure that the audit cycle is completed. CONCLUSIONS: Health workers have the power to change health care routines in daily practice, but this must be accompanied by concrete inputs at every level of the health system. The system requires data systems including consistent cause of death classification and use of best practice guidelines to monitor performance, as well as leaders to champion the process, especially to ensure a no-blame environment, and to access change agents at other levels to address larger, systemic challenges

Improving the Accuracy for Analyzing Heart Diseases Prediction Based on the Ensemble Method

Heart disease is the deadliest disease and one of leading causes of death worldwide. Machine learning is playing an essential role in the medical side. In this paper, ensemble learning methods are used to enhance the performance of predicting heart disease. Two features of extraction methods: linear discriminant analysis (LDA) and principal component analysis (PCA), are used to select essential features from the dataset. The comparison between machine learning algorithms and ensemble learning methods is applied to selected features. The different methods are used to evaluate models: accuracy, recall, precision, F-measure, and ROC.The results show the bagging ensemble learning method with decision tree has achieved the best performance

Percent Distribution of Women in the Intervention Group at Endline by Participation in Program Activities.

<p>Percent Distribution of Women in the Intervention Group at Endline by Participation in Program Activities.</p

Relationship between impact and exposure: Percentage of Women in the Intervention Group with Desired Knowledge or Behavior at Endline, by the Intensity of their Exposure to SMART Activities.

<p>Relationship between impact and exposure: Percentage of Women in the Intervention Group with Desired Knowledge or Behavior at Endline, by the Intensity of their Exposure to SMART Activities.</p

Bivariate and multivariate analyses of changes in behavior: Percentage of women with desired behavior, by data collection round, study group, and region.

<p>Bivariate and multivariate analyses of changes in behavior: Percentage of women with desired behavior, by data collection round, study group, and region.</p