Modelling under-nutrition in under-five children in Malawi

Despite numerous Government efforts to tackle the problem of child under-nutrition in Malawi, the levels of child under-nutrition remain high with stunting estimated at 47% and underweight at 12.7% . This thesis investigates whether the levels and patterns of stunting and underweight in Malawi have changed between the years 2000 and 2010 and if so how. It studies how feeding patterns and child immunisation affects child’s nutritional status in Malawi and analyses the different pathways through which household and community level socio-economic factors affect a child’s nutritional status in Malawi. The Malawi Demographic and Health Survey (MDHS) data sets of 2000, 2004 and 2010 are used in the study of levels and patterns of child under-nutrition in Malawi whilst the 2004 MDHS is used to investigate how feeding patterns and child immunisation affect a child’s nutritionals status in Malawi. The 2004 Malawi Integrated Household Survey data is merged with the 2004 Community level to analyse the pathways through which household and community level socio-economic factors affect child nutritional status in Malawi.Results of this study show that children from communities that have a daily market are less likely to be stunted compared to children from communities without a daily market. Children from communities that trace their descendants through their father have a lower likelihood of stunting compared to children from communities that trace their descendants through the mother due to being of relatively higher economic status. The levels of stunting and underweight have gone down significantly from 54.1% and 21.4% respectively in the year 2000 to 47.1% and 12.7% respectively in 2010. However, the percentage of children that are stunted but not affected with other under-nutrition problems has hardly changed, estimated at 37.2% in 2000 and 36.2% in 2010. Although generally female children are less likely to be stunted and less likely to be underweight, female children are more likely to be underweight as they get older. Contrary to what one would expect, children are more likely to be stunted during harvest time compared to the hunger season. Most of the children are fed food from the local grain, whilst in fact children aged between 7 to 36 months who consume food from animal sources are less likely to be undernourished. Children whose mothers are in possession of a child health card1 are less likely to be underweight. The Malawi Government should therefore intensify its efforts of encouraging mothers to attend under-five clinics, feed children that are undergoing weaning food from animal sources and should invest more in programmes that boost socio-economic status such as education and entrepreneurship skills

Increased mortality risk for motherless children aged less than 5 years:a systematic review and meta-analysis

Objective: To investigate, within so-called general populations, the relationship between maternal survival and mortality of children younger than five years.Methods: We conducted a systematic review of literature published between January 1990 and November 2016 that reported maternal vital status and the corresponding mortality of children younger than five years. Seven studies were included in a qualitative analysis and four in a random-effects meta-analysis. Summary estimates of the odds of dying by maternal survival were obtained and statistical heterogeneity estimated. Quality of the included studies and evidence was assessed using a Cochrane tool for assessing risk of bias and the Grading of Recommendations Assessment, Development and Evaluation criteria, respectively.Findings: Among children younger than five years, those whose mother had died were found to be 4.09 times (95% confidence interval, CI: 2.40–6.98) more likely to die than those with surviving mothers. Due to heterogeneity (I2: 83%), further pooled estimates were not possible. For children that were motherless as a result of maternal mortality, the increased odds of dying ranged from 1.40 (95% CI: 0.47–4.21) to 2.92 (95% CI: 1.21–7.04) among those aged between two and four years, 6.1 (95% CI: 2.27–16.77) to 33.78 (95% CI: 24.21–47.14) for those younger than one year and 4.39 (95% CI: 3.34–5.78) to 51.68 (95% CI: 20.26–131.80) for those younger than six months.Conclusion: The loss of a mother was associated with increased mortality among children, especially when maternal death occurred in the first year of the child’s life

Spatial distribution and predictors of lifetime experience of intimate partner violence among women in South Africa

In recent times, intimate partner has gained significant attention. However, there is limited evidence on the spatial distribution and predictors of intimate partner violence. Therefore, this study examined the spatial distribution and predictors of intimate partner violence in South Africa. The dataset for this study was obtained from a cross-sectional survey of the 2016 South Africa Demographic and Health Survey. We adopted both spatial and multilevel analyses to show the distribution and predictors of intimate partner violence among 2,410 women of reproductive age who had ever experienced intimate partner violence in their lifetime in South Africa. The spatial distribution of intimate partner violence in South Africa ranged from 0 to 100 percent. Western Cape, Free State, and Eastern Cape were predicted areas that showed a high proportion of intimate partner violence in South Africa. The likelihood of experiencing intimate partner violence among women in South Africa was high among those who were cohabiting [aOR = 1.41; 95%(CI = 1.10–1.81)] and women who were previously married [aOR = 2.09; 95%(CI = 1.30–3.36)], compared to women who were currently married. Women who lived in households with middle [aOR = 0.67; 95%(CI = 0.48–0.95)] and richest wealth index [aOR = 0.57; 95%(CI = 0.34–0.97)] were less likely to experience lifetime intimate partner violence compared to those of the poorest wealth index. The study concludes that there is a regional variation in the distribution of intimate partner violence in South Africa. A high prevalence of intimate partner violence was found among women who live in the Western Cape, Free State, and Eastern Cape. Furthermore, predictors such as women within the poorest wealth index, women who were cohabiting and those who were previously married should be considered in the development and implementation of interventions against intimate partner violence in South Africa

How important are community characteristics in influencing children's nutritional status? Evidence from Malawi population-based household and community surveys

Using the 2004 data from the Malawi Integrated Household Survey and the Malawi Community Survey, this study investigates the influence of community characteristics on stunting among children under five years of age in a rural context. Multilevel logistic regression modelling on 4284 children with stunting as the dependent variable shows that availability of daily markets and lineage defined in terms of patrilineal or matrilineal communities were significant community determinants of childhood stunting in Malawi. There were significant differences in socio-economic status between household heads from matrilineal and patrilineal communities. Implementation of strategies that empower communities and households economically such as supporting the establishment of community daily markets and promoting household income generating opportunities can effectively reduce the burden of childhood stunting in Malawi

Trends and protective factors of female genital mutilation in Burkina Faso: 1999 to 2010

BackgroundThe practice of Female Genital Mutilation (FGM) is common in several African countries and some parts of Asia. This practice is not only a violation of human rights, but also puts women at risk of adverse health outcomes. This paper analysed the trends in the prevalence of FGM in Burkina Faso and investigated factors that are associated with this practice following the enactment of an FGM law in 1996.MethodsThe study used the Burkina Faso Demographic and Health Survey (DHS) data sets from women aged 15 to 49 years undertaken in 1999, 2003 and 2010. Chi square tests were carried out to investigate whether there has been a change in the levels of FGM in Burkina Faso between 1999 and 2010 and multilevel logistic regression analysis were employed to identify factors that were significantly associated with undergoing FGM.ResultsThe levels of FGM in Burkina Faso declined significantly from 83.6% in 1999 to 76.1% in 2010. The percentage of women circumcised between the ages of 0 to 5 years increased from 34.2% in 1999 to 69% in 2010. Significantly more women in 2010 than in 1999 were of the opinion that FGM should stop (90.6% versus 75.1%, respectively). In 2010, the odds of getting circumcised were lowest amongst women that were born in the period 1990 to 1995 (immediately before the FGM law was enacted) compared to women born in the period 1960-1965 [OR 0.16 (0.13,0.20)]. There was significant variation of FGM across communities. Other factors that were significantly associated with being circumcised were education level, religion, ethnicity, urban residence and age at marriage.ConclusionsAlthough the prevalence of FGM has declined in Burkina Faso, the levels are still high. In order to tackle the practice of FGM in Burkina Faso, the government of Burkina Faso and its development partners need to encourage girls’ participation in education and target its sensitization campaigns against FGM towards Muslim women, women residing in rural areas and women of Mossi ethnic background