Double burden or double-counting of child malnutrition? The methodological and theoretical implications of stuntingoverweight in low and middle income countries

Background: There is increasing concern at research and policy levels about the double burden of child malnutrition (DBCM) – with stunting and overweight found across different groups of children. Despite some case studies suggesting that stunting and overweight can occur concurrently in children, here known as ‘stuntingoverweight’, and major drives to reduce all forms of malnutrition in LMICs, stuntingoverweight is continually overlooked. This research evidences the prevalence of stuntingoverweight across LMICs, exploring the theoretical and methodological implications of failing to acknowledge this form of malnutrition. Methods: Prevalence estimates of stuntingoverweight are constructed from 79 LMICs with nationally representative anthropometric survey data. Stunting and overweight estimates are amended to exclude stuntedoverweight children. These estimates are compared to those published in the JMEs - evidencing overestimation and double-counting of stuntedoverweight children. Results: Children can be concurrently stunted and overweight. Stuntedoverweight children are found in all LMICs, from 0.3% to 11.7% of under-fives and are included in both stunting and overweight rates. Analysed together, this leads to double-counting of stuntedoverweight children. This artificial inflation of stunting and overweight rates can give a false impression of a DBCM, obscuring the true diversity of malnutrition present. Over ten million children are stuntedoverweight in the World. Conclusions: Stuntingoverweight is a newly recognised, understudied phenomenon. Affected children are included in both stunting and overweight prevalence estimates, introducing unobserved heterogeneity to both individual- and population-level research and double-counting to population-level research. Overlooking stuntedoverweight children has great implications for methodology, theory, policies, programmes and the health of affected children

Under 10 mortality patterns, risk factors, and mechanisms in low resource settings of Eastern Uganda: an analysis of event history demographic and verbal social autopsy data

Background Globally, the under-10 years of age mortality has not been comprehensively studied. We applied the life-course perspective in the analysis and interpretation of the event history demographic and verbal autopsy data to examine when and why children die before their 10th birthday. Methods We analysed a decade (2005–2015) of event histories data on 22385 and 1815 verbal autopsies data collected by Iganga-Mayuge HDSS in eastern Uganda. We used the lifetable for mortality estimates and patterns, and Royston-Parmar survival analysis approach for mortality risk factors’ assessment. Results The under-10 and 5–9 years of age mortality probabilities were 129 (95% Confidence Interval [CI] = 123–370) per 1000 live births and 11 (95% CI = 7–26) per 1000 children aged 5–9 years, respectively. The top four causes of new-born mortality and stillbirth were antepartum maternal complications (31%), intrapartum-related causes including birth injury, asphyxia and obstructed labour (25%), Low Birth Weight (LBW) and prematurity (20%), and other unidentified perinatal mortality causes (18%). Malaria, protein deficiency including anaemia, diarrhoea or gastrointestinal, and acute respiratory infections were the major causes of mortality among those aged 0–9 years–contributing 88%, 88% and 46% of all causes of mortality for the post-neonatal, child and 5–9 years of age respectively. 33% of all causes of mortality among those aged 5–9 years was a share of Injuries (22%) and gastrointestinal (11%). Regarding the deterministic pattern, nearly 30% of the new-borns and sick children died without access to formal care. Access to the treatment for the top five morbidities was after 4 days of symptoms’ recognition. The childhood mortality risk factors were LBW, multiple births, having no partner, adolescence age, rural residence, low education level and belonging to a poor household, but their association was stronger among infants. Conclusions We have identified the vulnerable groups at risk of mortality as LBW children, multiple births, rural dwellers, those whose mother are of low socio-economic position, adolescents and unmarried. The differences in causes of mortalities between children aged 0–5 and 5–9 years were noted. These findings suggest for a strong life-course approach in the design and implementation of child health interventions that target pregnant women and children of all ages

Old-age mortality in Germany prior to and after reunification

Recent trends in German life expectancy show a considerable increase. Most of this increase has resulted from decreasing mortality at older ages. Patterns of oldest old mortality (ages 80+) differed significantly between men and women as well as between East and West Germany. While West German oldest old mortality decreased since the mid 1970s, comparable decreases in East Germany did not become evident until the late 1980s. Yet, the East German mortality decline accelerated after German reunification in 1990, particularly among East German females, attesting to the plasticity of human life expectancy and the importance of late life events. Medical care, individual economic resources and life-style factors are discussed as potential determinants of the decline in old age mortality in Germany

Communism, health and lifestyle: the paradox of mortality transition in Albania, 1950-1990

This study takes a systematic look at the incredible rise in the life expectancy of the population in Albania, one of the world's poorest countries. Through an analysis of archive documents and statistics, the author examines the social, economic and political factors behind this rise