Determinants of Stunting and Severe Stunting Among Under-Fives in Tanzania: Evidence from the 2010 Cross-Sectional Household Survey.

Stunting is one of the main public health problems in Tanzania. It is caused mainly by malnutrition among children aged less than 5 years. Identifying the determinants of stunting and severe stunting among such children would help public health planners to reshape and redesign new interventions to reduce this health hazard. This study aimed to identify factors associated with stunting and severe stunting among children aged less than five years in Tanzania. The sample is made up of 7324 children aged 0-59 months, from the Tanzania Demographic and Health Surveys 2010. Analysis in this study was restricted to children who lived with the respondent (women aged 15-49 years). Stunting and severe stunting were examined against a set of individual-, household- and community-level factors using simple and multiple logistic regression analyses. The prevalence of stunting and severe stunting were 35.5 % [95 % Confidence interval (CI): 33.3-37.7] and 14.4 % (95 % CI: 12.9-16.1) for children aged 0-23 months and 41.6 % (95 % CI: 39.8-43.3) and 16.1 % (95 % CI: 14.8-17.5) for children aged 0-59 months, respectively. Multivariable analyses showed that the most consistent significant risk factors for stunted and severely-stunted children aged 0-23 and 0-59 months were: mothers with no schooling, male children, babies perceived to be of small or average size at birth by their mothers and unsafe sources of drinking water [adjusted odds ratio (AOR) for stunted children aged 0-23 months = 1.37; 95 % CI: (1.07, 1.75)]; [AOR for severely stunted children aged 0-23 months = 1.50; 95 % CI: (1.05, 2.14)], [AOR for stunted children aged 0-59 months = 1.42; 95 % CI: (1.13, 1.79)] and [AOR for severely stunted children aged 0-59 months = 1.26; 95 % CI: (1.09, 1.46)]. Community-based interventions are needed to reduce the occurrence of stunting and severe stunting in Tanzania. These interventions should target mothers with low levels of education, male children, small- or average-size babies and households with unsafe drinking water

The effect of Hausman and Bootstrap applications to the Rasch measurement model in educational testing

University of Technology, Sydney. Faculty of Education.NO FULL TEXT AVAILABLE. Access is restricted indefinitely. The hardcopy may be available for consultation at the UTS Library.NO FULL TEXT AVAILABLE. Access is restricted indefinitely. ----- BACKGROUND: Since, the introduction of the Rasch (1960) measurement model to educational and psychological testing, several tests for determining model fit in Rasch have been proposed. The two most commonly used tests for evaluating goodness of fit for Rasch are the chi-square fit statistics (Linacre & Wright, 1994; Wright & Panchapakassen, 1969) and the conditional maximum likelihood method (Andersen, 1973a,b). Other model selections for Rasch are the Wald test, the Lagrange Multiplier test (Fischer & Molenaar, 1995) and the Hausman test (Hausman, 1978; Weesie, 1999). In this study, two statistical methods used are the bootstrap and Hausman test. These two methods were introduced to improve on the existing methods for estimating fit statistics in Rasch especially, when one is faced with poorly fitted items, missing items and items collected at different levels of hierarchy. This thesis is subdivided into three parts. First it sheds light upon the application of the fit statistics to multilevel Rasch model and items that are poorly fitted. Second, it examines five different statistical methods for imputing missing dichotomously-scored items and third, the thesis introduces the bootstrap application to the Rasch measurement model for the first time. OBJECTIVES: The main objectives of this study are fourfold: firstly, to determine whether the bootstrap method produces the same result as the parametric Rasch item difficulty estimates, secondly, to examine the Hausman test for poorly fitted items; thirdly, to assess whether the bootstrap imputation method is statistically better than other parametric imputation methods when estimating Infit and Outfit statistics using standard Rasch software; and, lastly the use of the Hausman specification test to determine the fit statistics for Rasch at two levels of hierarchy. HYPOTHESES: The main hypotheses of this thesis are that (a) The bootstrap replicate (B=lOOO) produces similar standard error values as the parametric method (N=200); (b) The bootstrap imputation method does reduces imputation bias; and (c) There are statistical differences between two level and three level item difficulty estimates. PARTICIPANTS: The participants in study 1 comprised 200 high school students (male= 120, female= 80) ranging in age from 15to19 years (mean= 16.Syears, SD= 1.8) in Nigeria. The sample comprised largely disadvantaged students from low socioeconomic backgrounds. The participants in study 2 comprised 2375 high school students in Indonesia (male = 1217, female= 1158) ranging in age from 14 to 16. Since, this study focused primarily on imputation methods, only data from participants who failed to complete 10 percent to 26 percent of responses were retained, yielding a sample of 644 respondents. Study 3 participants comprised 50 students (male=26, female = 24) ranging in age from 12.5 to 13 years (mean= 12.98 years, SD= 0.14) from the International Association for the Evaluation of Educational Achievement mathematics study for high school pupils in Australia. The sample of the population was drawn in two stages. Only year 9 students with completed information were used in the analysis. The sample used in this study consisted of three types of schools that is, 52% comprehensive; 26% selective academic and 22% selective vocational. STATISTICAL METHODS: The statistical methods used were the Bootstrap; Hausman test, imputation methods and multilevel modelling. These were calculated using the following statistical software: RUMM, WINSTEPS, STATA and the R-statistical package. RESULTS: In the first study, initial analysis using RUMM showed that the fit of the items to the Rasch model was poor and 1000 bootstrap replicates of the sample were generated. The main findings were that the simulation and bootstrap method for estimating the Hausman test for Rasch were statistically better than the parametric method. In the second study, five statistical methods: Person mean imputation substitution, item mean imputation substitution, regression imputation substitution, principle component imputation substitution (also called parametric imputation methods) and the bootstrap imputation method were examined for imputing missing items. Results showed that the mean values, the WINSTEPS Infit, Outfit and item difficulty for the bootstrap imputation method were similar to the estimates from original sample while, the parametric imputation methods estimates were inconsistent with the estimates of the original sample. Finally, the third study provided item difficulty estimates for two and three levels Rasch model for hierarchical generalised linear models using a 10 item data set from the second International Association for the Evaluation of Educational Achievement (IAEA) mathematics study for high school pupils in Australia and this sample was conducted in 1978. The findings from the data set suggested that the Hausman test shows a statistical difference in item difficulty estimates between two - and three-level Rasch model with random effect. CONCLUSION: The main purpose of this thesis is to examine the effect of the bootstrap and Hausman specification test for Rasch. The Hausman specification test may be superior to Andersen's likelihood ratio test statistics because the Hausman test procedure required both the estimation of the standard error and the test statistics while the bootstrap method is a resampling technique. The findings of the first study that supported the first hypothesis are in two parts. The first part suggested that larger bootstrap replicate (B=1000 or more) item difficulty estimate for Rasch is not sensitive to sample size while the second part of the first study concluded that there was no need to eliminate poorly fitted items as suggested previously in the literature, rather simulation or bootstrap methods may be considered as an alternative method for estimating the fit statistics for Rasch. The second study supported the hypothesis that the bootstrap imputation method was superior and the estimates produced by other parametric imputation methods were biased. Finally, the third study concluded that ignoring the multilevel nature of a data set will have an adverse consequence on how one will interpret item difficulty estimate in Rasch and this is in favour of the third hypothesis. The findings from this thesis will not only provide Rasch users with an alternative way of investigating research question by using the bootstrap method but also demonstrate how researcher can use the Hausman specification model to determine the fit statistics for an hierarchically structured data set and for poorly fitted items

Household environment associated with anaemia among children aged 6–59 months in Ethiopia: a multilevel analysis of Ethiopia demographic and health survey (2005–2016)

Abstract Background Anaemia continues to be a major public health challenge globally, including in Ethiopia. Previous studies have suggested that improved household environmental conditions may reduce anaemia prevalence; however, population-level evidence of this link is lacking in low-income countries. Therefore, this study aimed to examine the association between environmental factors and childhood anaemia in Ethiopia. Methods In this study, we conducted an analysis of the data from the Ethiopian Demographic and Health Survey (EDHS), a nationally representative population-based survey conducted in Ethiopia between 2005 and 2016. The study included a total of 21,918 children aged 6–59 months. Children were considered anemic if their hemoglobin (Hb) concentration was less than 11.0 g/dl. To examine the association between environmental factors and anemia, we used multilevel mixed-effect models. These models allowed us to control for various confounding factors including: child, maternal, household and community-level variables. The study findings have been reported as adjusted odds ratios (AORs) along with 95% confidence intervals (CIs) at a significance level of p < 0.05. Results The study found the overall prevalence of childhood anaemia to be 49.3% (95%CI: 48.7–49.9) between 2005 and 2016 in Ethiopia. The prevalence was 47.6% (95%CI: 46.1–49.1) in 2005, 42.8% (95%CI: 41.8–43.8) in 2011, and increased to 57.4% (95%CI: 56.3–58.4) in 2016. The pooled data showed that children from households practising open defecation were more likely to be anaemic (AOR: 1.19, 95% CI: 1.05–1.36). In our survey specify analysis, the odds of anaemia were higher among children from households practising open defecation (AOR: 1.33, 95% CI: 1.12–1.58) in the EDHS-2011 and EDHS-2016 (AOR: 1.49, 95% CI: 1.13–1.90). In contrast, neither household water sources nor the time to obtain water was associated with anaemia after controlling for potential confounders. The other variables significantly associated with childhood anaemia include: the child’s age (6–35 months), not fully vaccinated (AOR: 1.14, 95%CI: 1.05–1.24), children not dewormed in the last 6 months (AOR: 1.11, 95%CI: 1.01–1.24), children born to mothers not working (AOR: 1.10, 95%CI: 1.02–1.19), children from poor households (AOR: 1.18: 95%CI: 1.06–1.31), and rural residence (AOR: 1.23, 95%CI: 1.06–1.42). Conclusion In Ethiopia, about fifty percent of children suffer from childhood anemia, making it a serious public health issue. Open defecation is a major contributing factor to this scourge. To address this issue effectively, it is recommended to strengthen initiatives aimed at eliminating open defecation that involve various approaches, including sanitation infrastructure development, behavior change campaigns, and policy interventions. In addition, to reduce the burden of anemia in children, a multi-faceted approach is necessary, involving both prevention and treatment strategies

Factors Associated with Knowledge, Attitudes, and Prevention towards HIV/AIDS among Adults 15&ndash;49 Years in Mizoram, North East India: A Cross-Sectional Study

Despite a campaign of effective educational interventions targeting knowledge, attitudes, and prevention, Human Immunodeficiency-Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) continues to be a significant public health issue in India, with Mizoram reporting the highest HIV/AIDS cases in 2018&ndash;2019. In this study, we extracted Mizoram state from the National Family Health Survey Fourth Series (NFHS-4) 2015&ndash;2016 datasets and investigated factors associated with respondents&rsquo; knowledge, attitudes, and prevention towards HIV/AIDS. The sample included 3555 adults aged 15&ndash;49 years residing in Mizoram, North-east India. Respondents who reported having ever heard of HIV/AIDS was 98%. Multivariate analysis indicated that the probability of having inadequate knowledge of HIV/AIDS was higher among those with no schooling, who were illiterate, of non-Christian faiths, belonging to backward tribes or caste, from poor households, and those who lived in rural areas, not exposed to media. The odds of mother-to-child transmission (PMTCT) of HIV/AIDS transmission was high among females (AOR = 3.12, 95% CI 2.34&ndash;4.16), respondents aged 35&ndash;39 years (AOR = 1.74, 95% CI 1.05&ndash;2.87) and those belonging to other backward class. The HIV/AIDS knowledge of respondents was found to be encouraging as the majority (98%) were considered to have a good level of understanding of the condition. An educational intervention to reduce the number of adults 15&ndash;49 years infected with HIV/AIDS in Mizoram should target those from low socioeconomic groups, those from non-Christian religions, and those from other backward classes

Mapping of nutrition policies and programs in South Asia towards achieving the Global Nutrition targets

Abstract Background South Asia continues to host the triple burden of child malnutrition with high levels of child undernutrition, hidden hunger (micronutrient deficiencies) and childhood overweight/obesity. To combat malnutrition, the international community along with the National governments have launched initiatives to track the country’s progress towards achieving the Global Nutrition targets by 2025. This review captures the country-specific efforts of nutrition-specific and nutrition-sensitive sectoral programs and policies towards achieving these targets for eight South Asian countries. Methods A systematic internet search was undertaken to search relevant policies and programs from Government websites and twelve International Organisations working in the region. The authors developed a template to map the policies against the following criteria: (i) enabling supportive environment; (ii) Initiatives targeted at nutrition-specific interventions; and (iii) Initiatives targeted at nutrition-specific interventions that impact child malnutrition. A narrative descriptive approach was used to present findings. Results All eight countries had relevant policies and programs to address child malnutrition and macronutrient deficiencies with targets for significant reductions in stunting and improved breastfeeding. However, despite the outlined there are major challenges of implementation, monitoring, evaluation and quality that persist with increased dependency on international donors and organisations for funding and/or implementation of nutrition plans. Conclusion There is a need to contextualise efforts designated to donors and governments to improve the tracking of efforts that impact nutrition

Risk of neonatal and post-neonatal mortality by breastfeeding status and kitchen location.

<p>Risk of neonatal and post-neonatal mortality by breastfeeding status and kitchen location.</p

Risk of child and under-five mortality by breastfeeding status and kitchen location.

<p>Risk of child and under-five mortality by breastfeeding status and kitchen location.</p

Risk factors for postneonatal, infant, child and under-5 mortality in Nigeria: a pooled cross-sectional analysis

Objectives: To identify common factors associated with post-neonatal, infant, child and under-5 mortality in Nigeria. Design, setting and participants: A cross-sectional data of three Nigeria Demographic and Health Surveys (NDHS) for the years 2003, 2008 and 2013 were used. A multistage, stratified, cluster random sampling method was used to gather information on 63 844 singleton live-born infants of the most recent birth of a mother within a 5-year period before each survey was examined using cox regression models. Main outcome measures: Postneonatal mortality (death between 1 and 11 months), infant mortality (death between birth and 11 months), child mortality (death between 12 and 59 months) and under-5 mortality (death between birth and 59 months). Results: Multivariable analyses indicated that children born to mothers with no formal education was significantly associated with mortality across all four age ranges (adjusted HR=1.30, 95% CI 1.01 to 1.66 for postneonatal; HR=1.38, 95% CI 1.11 to 1.84 for infant; HR=2.13, 95% CI 1.56 to 2.89 for child; HR=1.19, 95% CI 1.02 to 1.41 for under-5). Other significant factors included living in rural areas (HR=1.48, 95% CI 1.16 to 1.89 for postneonatal; HR=1.23, 95% CI 1.03 to 1.47 for infant; HR=1.52, 95% CI 1.16 to 1.99 for child; HR=1.29, 95% CI 1.11 to 1.50 for under-5), and poor households (HR=2.47, 95% CI 1.76 to 3.47 for postneonatal; HR=1.40, 95% CI 1.10 to 1.78 for infant; HR=1.72, 95% CI 1.19 to 2.49 for child; HR=1.43, 95% CI 1.17 to 1.76 for under-5). Conclusions: This study found that no formal education, poor households and living in rural areas increased the risk of postneonatal, infant, child and under-5 mortality among Nigerian children. Community-based interventions for reducing under-5 deaths are needed and should target children born to mothers of low socioeconomic status

Determinants of neonatal mortality in Nigeria: evidence from the 2008 demographic and health survey

Background: Nigeria continues to have one of the highest rates of neonatal deaths in Africa. This study aimed to identify risk factors associated with neonatal death in Nigeria using the 2008 Nigeria Demographic and Health Survey (NDHS). Methods. Neonatal deaths of all singleton live-born infants between 2003 and 2008 were extracted from the 2008 NDHS. The 2008 NDHS was a multi-stage cluster sample survey of 36,298 households. Of these households, survival information of 27,147 singleton live-borns was obtained, including 996 cases of neonatal mortality. The risk of death was adjusted for confounders relating to individual, household, and community level factors using Cox regression. Results: Multivariable analyses indicated that a higher birth order of newborns with a short birth interval = 2 years (hazard ratio [HR] = 2.19, confidence interval [CI]: 1.68-2.84) and newborns with a higher birth order with a longer birth interval > 2 years (HR = 1.36, CI: 1.05-1.78) were significantly associated with neonatal mortality. Other significant factors that affected neonatal deaths included neonates born to mothers younger than 20 years (HR = 4.07, CI: 2.83-5.86), neonates born to mothers residing in rural areas compared with urban residents (HR = 1.26, CI: 1.03-1.55), male neonates (HR = 1.30, CI: 1.12-1.53), mothers who perceived their neonate's body size to be smaller than the average size (HR = 2.10, CI: 1.77-2.50), and mothers who delivered their neonates by caesarean section (HR = 2.80, CI: 1.84-4.25). Conclusions: Our study suggests that the Nigerian government needs to invest more in the healthcare system to ensure quality care for women and newborns. Community-based intervention is also required and should focus on child spacing, childbearing at a younger age, and poverty eradication programs, particularly in rural areas, to reduce avoidable neonatal deaths in Nigeria

HIV and its associated factors among people who inject drugs in Mizoram, Northeast India.

AimTo estimate the prevalence and associated factors with the human immune-deficiency virus (HIV) among people who inject drugs (PWID) in Mizoram, Northeast India.MethodsThe data source for the analysis was the 2019-2020 Mizoram State AIDS Control Society (MSACS) survey from 2695 PWID registered for the Targeted Intervention (TI) services. Logistic regression analysis was conducted to examine the factors associated with HIV among PWID after adjusting for sociodemographic characteristics, injection, and sexual behaviours.Results21.19% of the participants tested positive for HIV and the prevalence of HIV among male and female participants were 19.5% and 38.6%, respectively. Multiple logistic regression analysis revealed that female (AOR 1.74; 95% CI 1.26-2.41), 35 years or older (AOR 1.45; 95% CI 1.06-1.99), married (AOR 1.41; 95% CI1.08-1.83), divorced/separated/widowed (AOR 2.12; 95% CI 1.59-2.82) and sharing of needle/syringe (AOR 1.62; 95% CI 1.30-2.00) were all positively associated with HIV infection. We also found that concomitant alcohol use was reduced by 35% (AOR 0.65; 95% CI 0.51-0.82) among HIV positive PWID, and HIV infection was also reduced by 46% (AOR 0.54; 95% CI 0.44-0.67) among those PWID who use a condom with a regular partner.ConclusionThe findings of this study suggested that there is a high prevalence of HIV among PWID with 1 in 5 PWID reported to have HIV. HIV among PWID was significantly higher among those over 35 years of age, females and divorced/separated/widowed participants. Needle/syringe sharing behaviour is an important determinant of HIV infection. The high prevalence of HIV among PWID population is multifactorial. To reduce HIV among PWID in Mizoram, interventions should target those sharing needles/syringes, females, especially those over 35 years of age and unmarried participants