Predictors of complementary feeding practices in Afghanistan: Analysis of the 2015 Demographic and Health Survey.

Despite improvements over the past 20 years, high burdens of child mortality and undernutrition still coexist in Afghanistan. Global evidence indicates that complementary feeding (CF) practices predict child survival and nutritional status. Our study aims to describe CF practices in Afghanistan and to discern underlying predictors of CF by analysing data from Afghanistan's 2015 Demographic and Healthy Survey. Multilevel models were constructed comprising potential predictors at individual, household, and community levels and four CF indicators: timely introduction of solid, semi-solid, or soft foods (INTRO), minimum meal frequency (MMF), minimum dietary diversity (MDD), and minimum acceptable diet (MAD) among breastfed children. INTRO prevalence among children aged 6-8 months was 56%, whereas the prevalence of MMF, MDD, and MAD among children aged 6-23 months was 55%, 23%, and 18%, respectively. Of the seven food groups considered, four were consumed by 20% or fewer children: eggs (20%), legumes and nuts (18%), fruits and vegetables (15%), and flesh foods (14%). Increasing child age and more antenatal care visits were significantly and positively associated with greater odds of meeting all CF indicators. Lower household wealth and lower community-level access to health care services were associated with lower odds of MDD and MAD. Disparities in achieving recommended CF practices were observed by region. CF practices in Afghanistan are poor and significant socioeconomic inequities in CF are observed across the country. Our study calls for urgent policy and programme attention to improve complementary feeding practices as an intrinsic part of the national development agenda

Stagnating trends in complementary feeding practices in Bangladesh: An analysis of national surveys from 2004-2014.

Bangladesh has experienced steady socio-economic development. However, improvements in child growth have not kept pace. It is important to document complementary feeding (CF) practices-a key determinant of children's growth-and their trends over time. The study aims to examine trends in CF practices in children aged 6-23 months using data from Bangladesh Demographic and Health Surveys conducted in 2004, 2007, 2011, and 2014. Multilevel logistic regression models were applied to identify independent predictors of four CF practice indicators among children 6-23 months, namely, timely introduction of complementary foods, minimum meal frequency, minimum dietary diversity, and minimum acceptable diet. Introduction of complementary foods was achieved among 64-71% of children between 2004 and 2014. The proportion meeting minimum meal frequency increased from 2004 to 2007 (71-81%) and declined and held steady at 65% from 2011 to 2014. The proportion meeting minimum dietary diversity in 2011 and 2014 was low (25% and 28%), and so was minimum acceptable diet (19% and 20%). From 2007 to 2014, child dietary diversity decreased and the most decline was in the consumption of legumes and nuts (29% to 8%), vitamin A-rich fruits and vegetables (54% to 41%), and other fruits and vegetables (47% to 20%). Young child age (6-11 months), poor parental education, household poverty, and residence in the Chittagong and Sylhet independently predicted poorer feeding practices. Dietary diversity and overall diet in Bangladeshi children are strikingly poor. Stagnation or worsening of feeding practices in the past decade are concerning and call for decisive policy and programme action to address inappropriate child feeding practices

Trends and predictors of appropriate complementary feeding practices in Nepal: An analysis of national household survey data collected between 2001 and 2014.

There is evidence that suboptimal complementary feeding contributes to poor child growth. However, little is known about time trends and determinants of complementary feeding in Nepal, where the prevalence of child undernutrition remains unacceptably high. The objective of the study was to examine the trends and predictors of suboptimal complementary feeding in Nepali children aged 6-23 months using nationally representative data collected from 2001 to 2014. Data from the 2001, 2006, and 2011 Nepal Demographic and Health Surveys and the 2014 Multiple Indicator Cluster Survey were used to estimate the prevalence, trends and predictors of four WHO-UNICEF complementary feeding indicators: timely introduction of complementary foods (INTRO), minimum meal frequency (MMF), minimum dietary diversity (MDD), and minimum acceptable diet (MAD). We used multilevel logistic regression models to identify independent factors associated with these indicators at the individual, household and community levels. In 2014, the weighted proportion of children meeting INTRO, MMF, MDD, and MAD criteria were 72%, 82%, 36% and 35%, respectively, with modest average annual rate of increase ranging from 1% to 2%. Increasing child age, maternal education, antenatal visits, and community-level access to health care services independently predicted increasing odds of achieving MMF, MDD, and MAD. Practices also varied by ecological zone and sociocultural group. Complementary feeding practices in Nepal have improved slowly in the past 15 years. Inequities in the risk of inappropriate complementary feeding are evident, calling for programme design and implementation to address poor feeding and malnutrition among the most vulnerable Nepali children

Plasma proteome correlates of lipid and lipoprotein: biomarkers of metabolic diversity and inflammation in children of rural Nepal.

Proteins involved in lipoprotein metabolism can modulate cardiovascular health. While often measured to assess adult metabolic diseases, little is known about the proteomes of lipoproteins and their relation to metabolic dysregulation and underlying inflammation in undernourished child populations. The objective of this population study was to globally characterize plasma proteins systemically associated with HDL, LDL, and triglycerides in 500 Nepalese children. Abnormal lipid profiles characterized by elevated plasma triglycerides and low HDL-cholesterol (HDL-C) concentrations were common, especially in children with subclinical inflammation. Among 982 proteins analyzed, the relative abundance of 11, 12, and 52 plasma proteins was correlated with LDL-cholesterol (r = -0.43∼0.70), triglycerides (r = -0.39∼0.53), and HDL-C (r = -0.49∼0.79) concentrations, respectively. These proteins included apolipoproteins and numerous unexpected intracellular and extracellular matrix binding proteins, likely originating in hepatic and peripheral tissues. Relative abundance of two-thirds of the HDL proteome varied with inflammation, with acute phase reactants higher by 4∼40%, and proteins involved in HDL biosynthesis, cholesterol efflux, vitamin transport, angiogenesis, and tissue repair lower by 3∼20%. Untargeted plasma proteomics detects comprehensive sets of both known and novel lipoprotein-associated proteins likely reflecting systemic regulation of lipoprotein metabolism and vascular homeostasis. Inflammation-altered distributions of the HDL proteome may be predisposing undernourished populations to early chronic disease

An Assessment to Benchmark the Seismic Performance of a Code-Conforming Reinforced-Concrete Moment-Frame Building

This report describes a state-of-the-art performance-based earthquake engineering methodology that is used to assess the seismic performance of a four-story reinforced concrete (RC) office building that is generally representative of low-rise office buildings constructed in highly seismic regions of California. This “benchmark” building is considered to be located at a site in the Los Angeles basin, and it was designed with a ductile RC special moment-resisting frame as its seismic lateral system that was designed according to modern building codes and standards. The building’s performance is quantified in terms of structural behavior up to collapse, structural and nonstructural damage and associated repair costs, and the risk of fatalities and their associated economic costs. To account for different building configurations that may be designed in practice to meet requirements of building size and use, eight structural design alternatives are used in the performance assessments. Our performance assessments account for important sources of uncertainty in the ground motion hazard, the structural response, structural and nonstructural damage, repair costs, and life-safety risk. The ground motion hazard characterization employs a site-specific probabilistic seismic hazard analysis and the evaluation of controlling seismic sources (through disaggregation) at seven ground motion levels (encompassing return periods ranging from 7 to 2475 years). Innovative procedures for ground motion selection and scaling are used to develop acceleration time history suites corresponding to each of the seven ground motion levels. Structural modeling utilizes both “fiber” models and “plastic hinge” models. Structural modeling uncertainties are investigated through comparison of these two modeling approaches, and through variations in structural component modeling parameters (stiffness, deformation capacity, degradation, etc.). Structural and nonstructural damage (fragility) models are based on a combination of test data, observations from post-earthquake reconnaissance, and expert opinion. Structural damage and repair costs are modeled for the RC beams, columns, and slabcolumn connections. Damage and associated repair costs are considered for some nonstructural building components, including wallboard partitions, interior paint, exterior glazing, ceilings, sprinkler systems, and elevators. The risk of casualties and the associated economic costs are evaluated based on the risk of structural collapse, combined with recent models on earthquake fatalities in collapsed buildings and accepted economic modeling guidelines for the value of human life in loss and cost-benefit studies. The principal results of this work pertain to the building collapse risk, damage and repair cost, and life-safety risk. These are discussed successively as follows. When accounting for uncertainties in structural modeling and record-to-record variability (i.e., conditional on a specified ground shaking intensity), the structural collapse probabilities of the various designs range from 2% to 7% for earthquake ground motions that have a 2% probability of exceedance in 50 years (2475 years return period). When integrated with the ground motion hazard for the southern California site, the collapse probabilities result in mean annual frequencies of collapse in the range of [0.4 to 1.4]x10 -4 for the various benchmark building designs. In the development of these results, we made the following observations that are expected to be broadly applicable: (1) The ground motions selected for performance simulations must consider spectral shape (e.g., through use of the epsilon parameter) and should appropriately account for correlations between motions in both horizontal directions; (2) Lower-bound component models, which are commonly used in performance-based assessment procedures such as FEMA 356, can significantly bias collapse analysis results; it is more appropriate to use median component behavior, including all aspects of the component model (strength, stiffness, deformation capacity, cyclic deterioration, etc.); (3) Structural modeling uncertainties related to component deformation capacity and post-peak degrading stiffness can impact the variability of calculated collapse probabilities and mean annual rates to a similar degree as record-to-record variability of ground motions. Therefore, including the effects of such structural modeling uncertainties significantly increases the mean annual collapse rates. We found this increase to be roughly four to eight times relative to rates evaluated for the median structural model; (4) Nonlinear response analyses revealed at least six distinct collapse mechanisms, the most common of which was a story mechanism in the third story (differing from the multi-story mechanism predicted by nonlinear static pushover analysis); (5) Soil-foundation-structure interaction effects did not significantly affect the structural response, which was expected given the relatively flexible superstructure and stiff soils. The potential for financial loss is considerable. Overall, the calculated expected annual losses (EAL) are in the range of $52,000 to$97,000 for the various code-conforming benchmark building designs, or roughly 1% of the replacement cost of the building ($8.8M). These losses are dominated by the expected repair costs of the wallboard partitions (including interior paint) and by the structural members. Loss estimates are sensitive to details of the structural models, especially the initial stiffness of the structural elements. Losses are also found to be sensitive to structural modeling choices, such as ignoring the tensile strength of the concrete (40 EAL) or the contribution of the gravity frames to overall building stiffness and strength (15 change in EAL). Although there are a number of factors identified in the literature as likely to affect the risk of human injury during seismic events, the casualty modeling in this study focuses on those factors (building collapse, building occupancy, and spatial location of building occupants) that directly inform the building design process. The expected annual number of fatalities is calculated for the benchmark building, assuming that an earthquake can occur at any time of any day with equal probability and using fatality probabilities conditioned on structural collapse and based on empirical data. The expected annual number of fatalities for the code-conforming buildings ranges between 0.05*10 -2 and 0.21*10 -2 , and is equal to 2.30*10 -2 for a non-code conforming design. The expected loss of life during a seismic event is perhaps the decision variable that owners and policy makers will be most interested in mitigating. The fatality estimation carried out for the benchmark building provides a methodology for comparing this important value for various building designs, and enables informed decision making during the design process. The expected annual loss associated with fatalities caused by building earthquake damage is estimated by converting the expected annual number of fatalities into economic terms. Assuming the value of a human life is$3.5M, the fatality rate translates to an EAL due to fatalities of $3,500 to$5,600 for the code-conforming designs, and $79,800 for the non-code conforming design. Compared to the EAL due to repair costs of the code-conforming designs, which are on the order of$66,000, the monetary value associated with life loss is small, suggesting that the governing factor in this respect will be the maximum permissible life-safety risk deemed by the public (or its representative government) to be appropriate for buildings. Although the focus of this report is on one specific building, it can be used as a reference for other types of structures. This report is organized in such a way that the individual core chapters (4, 5, and 6) can be read independently. Chapter 1 provides background on the performance-based earthquake engineering (PBEE) approach. Chapter 2 presents the implementation of the PBEE methodology of the PEER framework, as applied to the benchmark building. Chapter 3 sets the stage for the choices of location and basic structural design. The subsequent core chapters focus on the hazard analysis (Chapter 4), the structural analysis (Chapter 5), and the damage and loss analyses (Chapter 6). Although the report is self-contained, readers interested in additional details can find them in the appendices

Infant Serum and Maternal Milk Vitamin B-12 Are Positively Correlated in Kenyan Infant-Mother Dyads at 1-6 Months Postpartum, Irrespective of Infant Feeding Practice.

BackgroundVitamin B-12 is an essential nutrient required for many functions including DNA synthesis, erythropoiesis, and brain development. If maternal milk vitamin B-12 concentrations are low, infants may face elevated risks of deficiency when exclusively breastfed.ObjectiveWe evaluated cross-sectional associations between infant serum vitamin B-12 concentrations and maternal milk vitamin B-12 concentrations at 1-6 mo postpartum among an unsupplemented population in rural western Kenya, and assessed biological demographic, and dietary characteristics associated with adequate infant serum vitamin B-12.MethodsWe modeled 1) infant serum vitamin B-12 using maternal milk vitamin B-12 concentration with linear regression; and 2) adequate (>220 pmol/L) infant serum vitamin B-12 using hypothesized biological, demographic, and dietary predictors with logistic regression. In both models, we used generalized estimating equations to account for correlated observations at the cluster-level.ResultsThe median (quartile 1, quartile 3) infant serum vitamin B-12 concentration was 276 pmol/L (193, 399 pmol/L) and approximately one-third of infants had serum vitamin B-12 ≤220 pmol/L, indicating that they were vitamin B-12 depleted or deficient. There was a positive correlation between maternal milk and infant serum vitamin B-12 (r = 0.36, P < 0.001) and in multivariable analyses, maternal milk vitamin B-12 concentration was significantly associated with infant serum vitamin B-12 adequacy (P-trend = 0.03).ConclusionsDespite a high prevalence (90%) of maternal milk vitamin B-12 concentrations below the level used to establish the Adequate Intake (<310 pmol/L), there was a low prevalence of infant vitamin B-12 deficiency. We found few factors that were associated with infant vitamin B-12 adequacy in this population, including infant feeding practices, although maternal vitamin B-12 status was not measured. The contribution of maternal milk to infant vitamin B-12 status remains important to quantify across populations, given that maternal milk vitamin B-12 concentration is modifiable with supplementation. This trial was registered at clinicaltrials.gov as NCT01704105

Snack food consumption among Bangladeshi children, supplementary data from a large RCT

Childhood obesity has been associated with consumption of energy-dense foods such as caloric beverages and fast foods. Many low- and middle-income countries like Bangladesh are now experiencing a rising problem of noncommunicable diseases along with the long-standing problem of stunting and undernutrition. WASH Benefits Bangladesh was a large community-based cluster randomized controlled trial conducted in rural Bangladesh. Study clusters were randomized into seven arms: single nutrition (N); water (W); sanitation (S); hygiene (H); combined water, sanitation, and hygiene (WSH); WSH and nutrition (N + WSH); and a double sized control (C). Nutrition intervention messages included four promotional components: maternal nutrition, breastfeeding, complementary feeding, and lipid-based nutrient supplements. The World Health Organization infant food frequency questionnaire (24-hr recall and 7-day recall) was administered at Year 1 and Year 2 of intervention. The likelihood of any snack food consumption was significantly lower (odds ratio 0.37: 95% confidence interval [0.28, 0.49]) in the nutrition intervention arms compared to the control arm in Year 2 follow-up. In addition, in the water intervention arm, fewer children (about 50% less) consumed soft drinks, but not the other sugar-sweetened beverages, compared with control in Year 2. There were no other differences between groups. Simple messages about balanced diet and feeding family foods were effective in lowering commercially produced snack food consumption of the young children in low-income rural communities of Bangladesh. Provision of safe water apparently encouraged mothers to reduce offering unhealthy beverages to the young children

Predictors and pathways of language and motor development in four prospective cohorts of young children in Ghana, Malawi, and Burkina Faso

BackgroundPrevious reviews have identified 44 risk factors for poor early child development (ECD) in low- and middle-income countries. Further understanding of their relative influence and pathways is needed to inform the design of interventions targeting ECD.MethodsWe conducted path analyses of factors associated with 18-month language and motor development in four prospective cohorts of children who participated in trials conducted as part of the International Lipid-Based Nutrient Supplements (iLiNS) Project in Ghana (n = 1,023), Malawi (n = 675 and 1,385), and Burkina Faso (n = 1,122). In two cohorts, women were enrolled during pregnancy. In two cohorts, infants were enrolled at 6 or 9 months. In multiple linear regression and structural equation models (SEM), we examined 22 out of 44 factors identified in previous reviews, plus 12 additional factors expected to be associated with ECD.ResultsOut of 42 indicators of the 34 factors examined, 6 were associated with 18-month language and/or motor development in 3 or 4 cohorts: child linear and ponderal growth, variety of play materials, activities with caregivers, dietary diversity, and child hemoglobin/iron status. Factors that were not associated with child development were indicators of maternal Hb/iron status, maternal illness and inflammation during pregnancy, maternal perceived stress and depression, exclusive breastfeeding during 6 months postpartum, and child diarrhea, fever, malaria, and acute respiratory infections. Associations between socioeconomic status and language development were consistently mediated to a greater extent by caregiving practices than by maternal or child biomedical conditions, while this pattern for motor development was not consistent across cohorts.ConclusionsKey elements of interventions to ensure quality ECD are likely to be promotion of caregiver activities with children, a variety of play materials, and a diverse diet, and prevention of faltering in linear and ponderal growth and improvement in child hemoglobin/iron status

Pharmacists in Pharmacovigilance: Can Increased Diagnostic Opportunity in Community Settings Translate to Better Vigilance?

The pharmacy profession has undergone substantial change over the last two to three decades. Whilst medicine supply still remains a central function, pharmacist’s roles and responsibilities have become more clinic and patient focused. In the community (primary care), pharmacists have become important providers of healthcare as Western healthcare policy advocates patient self-care. This has resulted in pharmacists taking on greater responsibility in managing minor illness and the delivery of public health interventions. These roles require pharmacists to more fully use their clinical skills, and often involve diagnosis and therapeutic management. Community pharmacists are now, more than ever before, in a position to identify, record and report medication safety incidents. However, current research suggests that diagnostic ability of community pharmacists is questionable and they infrequently report to local or national schemes. The aim of this paper is to highlight current practice and suggest ways in which community pharmacy can more fully contribute to patient safety