The Increase in Hemoglobin Concentration With Altitude Differs Between World Regions and Is Less in Children Than in Adults

To compensate for decreased oxygen partial pressure, high-altitude residents increase hemoglobin concentrations [Hb]. The elevation varies between world regions, posing problems in defining cutoff values for anemia or polycythemia. The currently used altitude adjustments (World Health Organization [WHO]), however, do not account for regional differences. Data from The Demographic and Health Survey (DHS) Program were analyzed from 32 countries harboring >4% of residents at altitudes above 1000 m. [Hb]-increase, (ΔHb/km altitude) was calculated by linear regression analysis. Tables show 95% reference intervals (RIs) for different altitude ranges, world regions, and age groups. The prevalence of anemia and polycythemia was calculated using regressions in comparison to WHO adjustments. The most pronounced Δ[Hb]/km was found in East Africans and South Americans while [Hb] increased least in South/South-East Asia. In African regions and Middle East, [Hb] was decreased in some altitude regions showing inconsistent changes in different age groups. Of note, in all regions, the Δ[Hb]/km was lower in children than in adults, and in the Middle East, it was even negative. Overall, the Δ[Hb]/km from our analysis differed from the region-independent adjustments currently suggested by the WHO resulting in a lower anemia prevalence at very high altitudes. The distinct patterns of Δ[Hb] with altitude in residents from different world regions imply that one single, region-independent correction factor for altitude is not be applicable for diagnosing abnormal [Hb]. Therefore, we provide regression coefficients and reference-tables that are specific for world regions and altitude ranges to improve diagnosing abnormal [Hb]

Estimates and trends of zero vegetable or fruit consumption among children aged 6-23 months in 64 countries.

Children require a diverse diet, that includes vegetables and fruits, to support growth and development and prevent non-communicable diseases. The WHO-UNICEF established a new infant and young child feeding (IYCF) indicator: zero vegetable or fruit (ZVF) consumption among children aged 6-23 months. We estimated the prevalence, trends, and factors associated with ZVF consumption using nationally representative, cross-sectional data on child health and nutrition in low-and-middle-income countries. We examined 125 Demographic and Health Surveys in 64 countries conducted between 2006-2020 with data on whether a child ate vegetables or fruits the previous day. Prevalence of ZVF consumption was calculated by country, region, and globally. Country trends were estimated and tested for statistical significance (p<0.05). Logistic regression analysis was used to examine the relationship between ZVF and child, mother, household, and survey cluster characteristics by world region and globally. Using a pooled estimate of the most recent survey available in each country, we estimate the global prevalence of ZVF consumption as 45.7%, with the highest prevalence in West and Central Africa (56.1%) and the lowest in Latin America and the Caribbean (34.5%). Recent trends in ZVF consumption varied by country (16 decreasing, eight increasing, 14 no change). Country trends in ZVF consumption represented diverse patterns of food consumption over time and may be affected by the timing of surveys. Children from wealthier households and children of mothers who are employed, more educated, and have access to media were less likely to consume ZVF. We find the prevalence of children aged 6-23 months who do not consume any vegetables or fruits is high and is associated with wealth and characteristics of the mother. Areas for future research include generating evidence from low-and-middle-income countries on effective interventions and translating strategies from other contexts to improve vegetable and fruit consumption among young children

The quality of maternal nutrition and infant feeding counselling during antenatal care in South Asia

Abstract Antenatal care (ANC) provides a platform to counsel pregnant women on maternal nutrition and to prepare the mother to breastfeed. Recent reviews suggest that gaps in the coverage and quality of counselling during pregnancy may partly explain why services do not consistently translate to improved behavioural outcomes in South Asia. This scoping literature review collates evidence on the coverage and quality of counselling on maternal nutrition and infant feeding during ANC in five South Asian countries and the effectiveness of approaches to improve the quality of counselling. Coverage data were extracted from the most recent national surveys, and a scoping review of peer‐reviewed and grey literature (1990–2019) was conducted. Only Afghanistan and Pakistan have survey data on the coverage of counselling on both maternal nutrition and breastfeeding, nine studies described the quality of counselling and three studies assessed the effectiveness of interventions to improve the quality of services. This limited body of evidence suggests that inequalities in access to services, gaps in capacity building opportunities for frontline workers and the short duration and frequency of counselling contracts constrain quality, while the format, duration, frequency and content of health worker training, together with supportive supervision, are probable approaches to improve quality. Greater attention is needed to integrate indicators into monitoring and supervision mechanisms, periodic surveys and programme evaluations to assess the status of and track progress in improving quality and to build accountability for quality counselling, while research is needed to understand how best to assess and strengthen quality in specific settings

Percentage of children age 36–59 months on-track for the physical, social-emotional, learning, and literacy-numeracy ECDI domains by country.

Percentage of children age 36–59 months on-track for the physical, social-emotional, learning, and literacy-numeracy ECDI domains by country.</p

Adjusted odds ratios for on-track literacy-numeracy development among children age 36–59 months across all countries.

AOR = adjusted odds ratio, LB = Lower bound of 95% confidence interval; UB = upper bound of 95% confidence interval. Models were adjusted for region. In Jordan child nutritional status was not included and in Senegal maternal height was not included. Blank cells indicate that no coefficients were produced in the model because of small sample sizes. + Malnourished refers to children who are not stunted, underweight, overweight, or wasted. (DOCX)</p

Conceptual framework of the relationship between anemia status and early childhood development.

Thicker arrow shows pathway that was not directly assessed as brain development data (dashed box) was not available in the datasets. Other arrows and boxes show the pathways and relationships examined in the analyses.</p

Variables used in analysis.

Notes: Maternal height was not collected in Senegal 2017. Child nutritional status was not included in Jordan 2017–18 due to data quality concerns. 1 Stunted, underweight, overweight, or wasted were categorized as follows: children under 5 in the household were categorized as underweight, or normal according to the weight-for-age Z-score, categorized as stunted or normal according to the height-for-age Z-score, and categorized as wasted, normal, or overweight according to the weight-for-height Z-score in comparison to the mean on the WHO Child Growth Standards scale. (DOCX)</p

Adjusted odds ratios for on-track learning development among children age 36–59 months across all countries.

AOR = adjusted odds ratio, LB = Lower bound of 95% confidence interval; UB = upper bound of 95% confidence interval. Models were adjusted for region. In Jordan child nutritional status was not included and in Senegal maternal height was not included. Blank cells indicate that no coefficients were produced in the model because of small sample sizes. + Malnourished refers to children who are not stunted, underweight, overweight, or wasted. (DOCX)</p

ECDI domains, items, and scoring.

Anemia is a significant public health problem in many low- and middle-income countries (LMICs), with young children being especially vulnerable. Iron deficiency is a leading cause of anemia and prior studies have shown associations between low iron status/iron deficiency anemia and poor child development outcomes. In LMICs, 43% of children under the age of five years are at risk of not meeting their developmental potential. However, few studies have examined associations between anemia status and early childhood development (ECD) in large population-based surveys. We examined the associations between severe or moderate anemia and ECD domains (literacy-numeracy, physical, social-emotional, and learning) and an overall ECD index among children age 36–59 months. Nine Demographic and Health Surveys (DHS) from phase VII of The DHS Program (DHS-7) that included the ECD module and hemoglobin testing in children under age five years were used. Bivariate and multivariate logistic regressions were run for each of the five outcomes. Multivariate models controlled for early learning/interaction variables, child, maternal, and paternal characteristics, and socio-economic and household characteristics. Results showed almost no significant associations between anemia and ECD domains or the overall ECD index except for social-emotional development in Benin (AOR = 1.00 p 0.05) and physical development in Maldives (AORs = 0.97 p 0.05). Attendance at an early childhood education program was also significantly associated with the outcomes in many of the countries. Our findings reinforce the importance of the Nurturing Care Framework which describes a multi-sectoral approach to promote ECD in LMICs.</div

Odds ratios (OR) and adjusted odds ratios (AORs) for the effect of anemia on on-track early childhood development domains and overall index among children age 36–59 months across all countries.

Odds ratios (OR) and adjusted odds ratios (AORs) for the effect of anemia on on-track early childhood development domains and overall index among children age 36–59 months across all countries.</p