Dietary Diversity Score during Pregnancy is Associated with Neonatal Low Apgar Score : A Hospital-Based Cross-Sectional Study

Background: Apgar score is an established index of neonatal well-being and development. Nutrition during pregnancy is an accepted risk factor for neonatal low Apgar score. Objective: To investigate the association between dietary diversity score and low Apgar score. Methods: This was a hospital based cross-sectional study. The study participants were 420 mothers who delivered and were attending the postnatal clinic at the Cape Coast Metropolitan Hospital. Mothers' dietary information during pregnancy was assessed with a food frequency questionnaire. In reference to the FAOs women's Dietary Diversity Score (DDS), the subjects were categorized into low, medium or high DDS. The primary outcome was Apgar score. Apgar scores <5 were classified as low. Results: The mean age (+/- standard deviation, SD) of subjects was 26.7 +/- 5.7 years with a range of 17 to 45 years. The prevalence of low Apgar score among the study population was 16.9%. Majority of the study participants had a low DDS in relation to low Apgar score whereas 7.5% had high DDS. After adjusting for potential confounding factors, the odds of low Apgar score in the low DDS group was three times higher than those who had high DDS (Adjusted odds ratio, AOR= 3.10, 95% confidence interval, CI=1.23-4.48). Conclusion: Dietary diversity score during pregnancy was associated with a low Apgar score in the study area. The results of this study reinforce the significance of adequate nutrition during pregnancy in the study area.Peer reviewe

The Conundrum of Low COVID-19 Mortality Burden in sub-Saharan Africa: Myth or Reality?

The burden of coronavirus disease (COVID-19) in sub-Saharan Africa (SSA) has been substantially lower compared to other regions of the world. Extensive morbidity and mortality were not observed among countries in SSA during the first wave of the COVID-19 pandemic. To explain this phenomenon, several hypotheses have been formulated, including the low median age of the population in most SSA countries, lack of long-term care facilities, cross-protection from other local coronaviruses, insufficient testing and reporting resulting in an undercounting of COVID-related deaths, genetic risk factors, or the benefit of early lockdowns that were extensive in many SSA countries. Early lockdowns in SSA have been some of the strictest and resulted in devastating economic and social consequences and increased mortality from other health-related problems including maternal deaths. We review the literature and rationale supporting the various hypotheses that have been put forward to account for relatively low hospitalization and death rates for COVID-19 in SSA. We conclude that the strongest evidence would support the demographic age structure with a very low median age as the primary factor in leading to the low mortality seen in the first wave of the pandemic. The impact of new variants of concern in SSA raises the risk of more severe waves. Nevertheless, furthering the understanding of the underlying explanations for the low morbidity and mortality seen across SSA countries may allow the adoption of unique strategies for limiting the spread of COVID-19 without the need for stringent lockdowns

Do dietary practices and household environmental quality mediate socioeconomic inequalities in child undernutrition risk in West Africa?

We investigated the relationship between socioeconomic status and child undernutrition in West Africa (WA), and further examined the mediating role of dietary practices (measured as Minimum Dietary Diversity [MDD], Minimum Meal Frequency [MMF], and Minimum acceptable diet [MAD]) and household environmental quality (HEQ) in the observed relationship. Thirteen countries were included in the study. We leveraged the most recent Demographic and Health Surveys datasets ranging from 2010 to 2019. Poisson regression model with robust standard errors was used to estimate prevalence ratios and their corresponding 95% CIs. Structural Equation Modelling was used to conduct the mediation analysis. West Africa. 132,448 under-five children born within five years preceding the survey were included. Overall, 32.5%, 8.2%, 20.1% and 71.7% of WA children were stunted, wasted, underweight and anaemic, respectively. Prevalence of undernutrition decreased with increasing maternal education and household wealth (Trend p-values < 0.001). Secondary or higher maternal education and residence in rich households were associated with statistically significant decrease in the prevalence of stunting, wasting, underweight and anaemia among children in WA. MAD was found to mediate the association of low maternal education and poor household wealth with childhood stunting and underweight by 35.9% to 44.5%. MDD, MMF and HEQ did not mediate the observed relationship. The study findings enables an evaluation and improvement of existing intervention strategies through a socioeconomic lens to help address the high burden of child undernutrition in WA and other developing regions

Secular trends in low birth weight and child undernutrition in West Africa : evidence from complex nationwide surveys, 1985–2019

Objective: We present prevalence estimates and secular trends of stunting, wasting, underweight, and anaemia among children under 5 years of age and low birth weight (LBW) over the period 1985–2019 in West Africa (WA). Design: Analysis of Demographic and Health Survey (DHS) and World Bank data. DerSimonian–Laird random effect model with the Knapp–Hartung adjustment to the standard error was used to derive overall prevalence estimates. We used fixed effect ordinary least square regression models with cluster robust standard error to conduct time trends analyses. Setting: West Africa. Participants: Children aged 0 to 59 months. Results: Three distinct periods (1986–1990, 1993–1996 and 1997–2000) of sharp increases in prevalence of all outcomes was observed. After the year 2000, prevalence of all outcomes except LBW started to decline with some fluctuations. LBW prevalence showed a steady increase after 2000. We observed a decline in prevalence of stunting (β = –0·20 %; 95 % CI –0·43 %, 0·03 %), log-wasting (β = –0·02 %; 95 % CI –0·02 %, –0·01 %), log-underweight (β = –0·02 %; 95 % CI –0·03 %, –0·01 %) anaemia (β = –0·44; 95 % CI –0·55 %, –0·34 %), and an increase in LBW (β = 0·06 %; 95 % CI –0·10 %, 0·22 %) in WA over the period. Pooled prevalence of stunting, wasting, underweight, anaemia and LBW in WA for the period 1985–2019 was 26·1 %, 16·4 %, 22·7 %, 76·2 % and 11·3 %, respectively. Conclusions: Child undernutrition prevalence varied greatly between countries and the year cohorts. We observed marginal reductions in prevalence of all outcomes except anaemia where the reductions were quite striking and LBW where an increase was noted. There is the need for more rigorous and sustained targeted interventions in WA

Household energy usage, indoor air pollution and health

It seems likely that households have used energy for cooking for as long as there have been households. Globally, until the industrial revolution, this would have been principally woodfuel, agricultural waste (e.g. straw), dried dung and charcoal, with some regions relying on coal and peat. Archaeological evidence suggests the use of oil lamps for lighting appears to also stretch towards the beginnings of households, with ceramic decorated lamps dating from a few thousand years BC (Cam, 2014). Today, although difficult to estimate because traditional biomass energy use (for cooking and heating) is not accurately captured in energy statistics, bioenergy sources currently supply around 10-13% (1365 to 1775 million tonnes of oil equivalent annually) of the world's primary energy making biomass the world's fourth largest energy source (Hemstock & Singh, 2015; International Energy Agency, 2017). Around 70% (955 to 1242 million tonnes of oil equivalent annually) of this bioenergy use is in developing countries. It is used in the form of traditional woodfuel (fuelwood and charcoal), agricultural residues and dung to provide domestic energy services, mostly for cooking, by burning on open fires in 41% (Bonjour et at., 2013) of households in the world. These energy sources, along with coal and peat in some areas, are often inefficiently used and can be environmentally detrimental. They are deleterious to health when used traditionally and in inefficient domestic appliances in poorly ventilated cooking areas. Gender is also an issue as women are usually customarily responsible for cooking, meaning that women and children are at greater risk of exposure to high levels of indoor air pollution. In some least developed countries and in lower income households of developed countries, biomass provides more than 90% of total energy consumption for the populations who live in rural areas (Hemstock & Singh, 2015). A common issue affecting biomass, solid fossil fuel, and oil use for domestic energy services is that the products of combustion (smoke) are harmful to health if inhaled in substantial amounts over long periods of time, often leading to a range of illnesses such as pneumonia and significant impacts on increasing rates of mortality (WHO 2018; cf. Poddar and Chakrabarti 2016). Tragically, indoor air pollution is a key causal factor child pneumonia - a leading cause of death in children under five in many least developed countries, accounting for the deaths of around half a million children under the age of 5 years annually (Mortimer, 2017). This is clearly contrary to SDG3 Good Health and Wellbeing (UN 2015). Issues surrounding indoor air pollution and health are also directly linked to SDG7: Affordable and Clean Energy, which is related to fuel and technology choices available for domestic energy services; which are in turn linked to SDGs 1, 2, 4-6 and 8-13

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015

SummaryBackground The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors—the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). Findings Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57·8% (95% CI 56·6–58·8) of global deaths and 41·2% (39·8–42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million [192·7 million to 231·1 million] global DALYs), smoking (148·6 million [134·2 million to 163·1 million]), high fasting plasma glucose (143·1 million [125·1 million to 163·5 million]), high BMI (120·1 million [83·8 million to 158·4 million]), childhood undernutrition (113·3 million [103·9 million to 123·4 million]), ambient particulate matter (103·1 million [90·8 million to 115·1 million]), high total cholesterol (88·7 million [74·6 million to 105·7 million]), household air pollution (85·6 million [66·7 million to 106·1 million]), alcohol use (85·0 million [77·2 million to 93·0 million]), and diets high in sodium (83·0 million [49·3 million to 127·5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. Interpretation Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. Funding Bill & Melinda Gates Foundation

Whether weather matters: Evidence of association between in utero meteorological exposures and foetal growth among Indigenous and non-Indigenous mothers in rural Uganda

Pregnancy and birth outcomes have been found to be sensitive to meteorological variation, yet few studies explore this relationship in sub-Saharan Africa where infant mortality rates are the highest in the world. We address this research gap by examining the association between meteorological factors and birth weight in a rural population in southwestern Uganda. Our study included hospital birth records (n = 3197) from 2012 to 2015, for which we extracted meteorological exposure data for the three trimesters preceding each birth. We used linear regression, controlling for key covariates, to estimate the timing, strength, and direction of meteorological effects on birth weight. Our results indicated that precipitation during the third trimester had a positive association with birth weight, with more frequent days of precipitation associated with higher birth weight: we observed a 3.1g (95% CI: 1.0–5.3g) increase in birth weight per additional day of exposure to rainfall over 5mm. Increases in average daily temperature during the third trimester were also associated with birth weight, with an increase of 41.8g (95% CI: 0.6–82.9g) per additional degree Celsius. When the sample was stratified by season of birth, only infants born between June and November experienced a significant associated between meteorological exposures and birth weight. The association of meteorological variation with foetal growth seemed to differ by ethnicity; effect sizes of meteorological were greater among an Indigenous subset of the population, in particular for variation in temperature. Effects in all populations in this study are higher than estimates of the African continental average, highlighting the heterogeneity in the vulnerability of infant health to meteorological variation in different contexts. Our results indicate that while there is an association between meteorological variation and birth weight, the magnitude of these associations may vary across ethnic groups with differential socioeconomic resources, with implications for interventions to reduce these gradients and offset the health impacts predicted under climate change