Households with a stunted child and obese mother: trends and child feeding practices in a middle-income country, 1992-2008.

Middle-income countries in the intermediate stages of the nutrition transition are facing a complex picture of nutrition-related diseases with child stunting and maternal obesity coexisting within single households (SCOB). A debate exists as to whether SCOB is a true phenomenon or a statistical artefact. In this study, we examine time trends and determinants of SCOB in Egypt and test the hypothesis that increased child sugary snack consumption, and reduced fruit/vegetable consumption (markers of poor dietary diversity) are associated with SCOB. Data on 25,065 mothers and their children from the Egyptian Demographic and Health Surveys from 1992, 1995, 2005 and 2008 are used to examine trends in child stunting, maternal obesity and child-mother household type [normal/non-obese, stunted/non-obese, normal/obese, stunted/obese (SCOB)]. The association of child sugary snack and fruit/vegetable consumption with household type is also examined using multinomial logistic regression adjusting for maternal age, maternal education, child age, breastfeeding, household wealth and urban/rural residence. The prevalence of SCOB increased between the periods 1992/95 and 2005/08 despite reductions in stunting levels. This increase paralleled a rise in maternal obesity. Child sugary snack consumption was associated with higher odds (51 %) of belonging to a SCOB household compared with normal/non-obese households, while fruit/vegetable consumption was associated with lower odds (24 %). The results suggest the existence of a link between the rise in maternal obesity and an increase in SCOB, and an association between child sugary snack consumption and SCOB. Addressing SCOB may require a household-rather than individual-based approach to nutrition

Addressing the double burden of malnutrition in Egypt: do conditional cash transfers have a role?

Many developing countries are undergoing rapid socio-economic changes that impact on health and its social distribution. These changes can occur so rapidly that there is a resulting co-existence of diseases of affluence and diseases of poverty. Priority setting for nutritional programs has focused on the alleviation of undernutrition in low income settings. However, evidence shows that in many Low-and-Middle Income Countries the prevalence of obesity among women is increasing and can coexist with childhood stunting. This dual burden of poor nutrition contributes to worsening health inequity between the poor and the rich. Global and national policy makers are looking for novel programs to replace social protection mechanisms deemed inefficient. Conditional Cash Transfer (CCT) programs have emerged as an increasingly popular poverty alleviation strategy with some positive results. However, there is evidence they may have a negative impact if the complexity of transition settings is not taken into account. In this paper, we review the nutritional situation in Egypt and compare two CCT programs (Mexico and Colombia) in an attempt to identify features that would address both child undernutrition and adult overnutrition. We conclude with suggestions for design of an Egyptian CCT program that would help maximise benefit to its beneficiaries

Is the social gradient of female obesity in lower income settings reversing and why? An investigation into the association between wealth, education and obesity

Female levels of obesity in low- and middle-income countries (LMICs) are rising. Obesity prevalence has been the greatest in high socio-economic status (SES) groups, but recent evidence suggests a changing pattern with the prevalence of obesity rising rapidly among lower SES groups and exceeding the former - a reversal of the social gradient of obesity. However, inconsistencies in the gradient by SES indicator have put the reversal into question. Using nationally representative surveys, the thesis: 1) examines the time variation in the SES-obesity association splitting SES into two components; and 2) tests the hypothesis that education protects against the obesogenic effects of improved material circumstances through cognitive skills and their influence on media exposure and dietary behaviour. Egypt (~40% female obesity prevalence) is investigated using Demographic and Health Surveys data. Changes in the SES-obesity association over the period 1992-2008 are examined including the separate and joint effects of education and material circumstances on obesity. Then, Egypt is compared with countries of different levels of economic development: Benin, Nigeria, India, Jordan, Peru, Colombia (DHS data) and China (Four-Provinces survey data). Finally, literacy, TV exposure and sweet snack use are investigated as mediators. All estimates are adjusted for age group, area of residence, and number of children using multivariate logistic regression. The findings showed variation over time and by country consistent with the reversal of the social gradient. Education significantly modified the association between material circumstances and obesity at middle levels of country income. There was evidence that literacy and TV exposure may mediate this inter-relationship but the study power limited inferences on dietary behaviour. The findings support the possibility that education drives the reversal of the social gradient of female obesity and that cognitive skills may be more important than material circumstances in preventing female obesity. Thus, investments in education could be viewed as preventive medicine

Are estimates of socioeconomic inequalities in chronic disease artefactually narrowed by self-reported measures of prevalence in low-income and middle-income countries? Findings from the WHO-SAGE survey

Background: The use of self-reported measures of chronic disease may substantially underestimate prevalence in low-income and middle-income country settings, especially in groups with lower socioeconomic status (SES). We sought to determine whether socioeconomic inequalities in the prevalence of non-communicable chronic diseases (NCDs) differ if estimated by using symptom-based or criterion-based measures compared with self-reported physician diagnoses. Methods: Using population-representative data sets of the WHO Study of Global Ageing and Adult Health (SAGE), 2007–2010 (n=42 464), we calculated wealth-related and education-related concentration indices of self-reported diagnoses and symptom-based measures of angina, hypertension, asthma/chronic lung disease, visual impairment and depression in three ‘low-income and lower middle-income countries’—China, Ghana and India—and three ‘upper-middle-income countries’—Mexico, Russia and South Africa. Results: SES gradients in NCD prevalence tended to be positive for self-reported diagnoses compared with symptom-based/criterion-based measures. In China, Ghana and India, SES gradients were positive for hypertension, angina, visual impairment and depression when using self-reported diagnoses, but were attenuated or became negative when using symptom-based/criterion-based measures. In Mexico, Russia and South Africa, this distinction was not observed consistently. For example, concentration index of self-reported versus symptom-based angina were: in China: 0.07 vs −0.11, Ghana: 0.04 vs −0.21, India: 0.02 vs −0.16, Mexico: 0.19 vs −0.22, Russia: −0.01 vs −0.02 and South Africa: 0.37 vs 0.02. Conclusions: Socioeconomic inequalities in NCD prevalence tend to be artefactually positive when using self-report compared with symptom-based or criterion-based diagnostic criteria, with greater bias occurring in low-income countries. Using standardised, symptom-based measures would provide more valid estimates of NCD inequalities

Education modifies the association of wealth with obesity in women in middle-income but not low-income countries: an interaction study using seven national datasets, 2005-2010.

Education and wealth may have different associations with female obesity but this has not been investigated in detail outside high-income countries. This study examines the separate and inter-related associations of education and household wealth in relation to obesity in women in a representative sample of low- and middle-income countries (LMICs)

Education is associated with lower levels of abdominal obesity in women with a non-agricultural occupation: an interaction study using China's four provinces survey

Background: The prevalence of obesity is increasing rapidly in low- and middle-income countries (LMICs) as their populations become exposed to obesogenic environments. The transition from an agrarian to an industrial and service-based economy results in important lifestyle changes. Yet different socioeconomic groups may experience and respond to these changes differently. Investigating the socioeconomic distribution of obesity in LMICs is key to understanding the causes of obesity but the field is limited by the scarcity of data and a uni-dimensional approach to socioeconomic status (SES). This study splits socioeconomic status into two dimensions to investigate how educated women may have lower levels of obesity in a context where labour market opportunities have shifted away from agriculture to other forms of employment. Methods: The Four Provinces Study in China 2008/09 is a household-based community survey of 4,314 people aged ≥60 years (2,465 women). It was used to investigate an interaction between education (none/any) and occupation (agricultural/non-agricultural) on high-risk central obesity defined as a waist circumference ≥80 cm. An interaction term between education and occupation was incorporated in a multivariate logistic regression model, and the estimates adjusted for age, parity, urban/rural residence and health behaviours (smoking, alcohol, meat and fruit & vegetable consumption). Complete case analyses were undertaken and results confirmed using multiple imputation to impute missing data. Results: An interaction between occupation and education was present (P = 0.02). In the group with no education, the odds of central obesity in the sedentary occupation group were more than double those of the agricultural occupation group even after taking age group and parity into account (OR; 95%CI: 2.21; 1.52, 3.21), while in the group with any education there was no evidence of such a relationship (OR; 95%CI: 1.25; 0.92, 1.70). Health behaviours appeared to account for some of the association. Conclusion: These findings suggest that education may have a protective role in women against the higher odds of obesity associated with occupational shifts in middle-income countries, and that investment in women’s education may present an important long term investment in obesity prevention. Further research could elucidate the mechanisms behind this association

A Study into the Role of International Collaborations in Higher Education to Enhance Research Capacity for Disaster Resilience

International collaborations in the context of Disaster Resilience (DR) is pivotal due to several reasons. It helps to propose ways to create more coherent international approaches on disaster risk reduction, climate change adaptation and resilience strengthening; it helps to enhance risk management capabilities by bridging the gap between science and legal/policy issues; it helps to address the issue of efficient management of trans-boundary crises. The need to optimise international cooperation in relation to resourcing research, capacity building to undertake research and facilitating its uptake is mentioned throughout the Sendai Framework for disaster risk reduction 2015-2030 (SFDRR). Given their different capacities, as well as the linkage between the level of support provided to them and the extent to which they will be able to implement the SFDRR, developing countries require an enhanced provision of means of implementation, including adequate, sustainable and timely resources, through international cooperation and global partnerships for development, and continued international support, so as to strengthen their efforts to reduce disaster risk. The purpose of this paper is to examine the level of engagement of Higher Education Institutions (HEIs) in developing countries in Asia in international collaborations to improve their Research and Innovation (R&I) capacities in DR. Based on a project entitled ASCENT (Advancing Skills Creation and Enhancement), the findings of the paper focuses on three Asian countries, i.e. Bangladesh, Sri Lanka and Thailand. Other than an extant literature review, the paper findings are drawn from a questionnaire survey carried out in eight HEIs from the said countries. There are already several regional initiatives that promote collaboration among HEIs towards building resilience. These networks should be supported and encouraged to grow. These global networks should collaborate with existing bodies to ensure that the role of higher education is understood and can be made use of. Findings of this paper supports the need for an enhanced international partnership to improve the science-policy interface in DR and to achieve the objectives of the SFDRR