Can universal insecticide-treated net campaigns achieve equity in coverage and use? the case of northern Nigeria

<p>Abstract</p> <p>Background</p> <p>Insecticide-treated nets (ITNs) are effective tools for malaria prevention and can significantly reduce severe disease and mortality due to malaria, especially among children under five in endemic areas. However, ITN coverage and use remain low and inequitable among different socio-economic groups in sub-Saharan Africa, particularly in Nigeria. Several strategies have been proposed to increase coverage and use and reduce inequity in Nigeria, including free distribution campaigns recently conducted by the Nigerian federal government. Using data from the first post-campaign survey, the authors investigated the effect of the mass free distribution campaigns in achieving equity in household ownership and use of ITNs.</p> <p>Methods</p> <p>A post-campaign survey was undertaken in November 2009 in northern Nigeria to assess the effect of the campaigns in addressing equity across different socio-economic groups. The survey included 987 households randomly selected from 60 clusters in Kano state. Using logistic regression and the Lorenz concentration curve and index, the authors assessed equity in ITN coverage and use.</p> <p>Results</p> <p>ITN ownership coverage increased from 10% before the campaigns to 70%-a more than fivefold increase. The campaigns reduced the ownership coverage gap by 75%, effectively reaching parity among wealth quintiles (Concentration index 0.02, 95% CI (-0.02 ; 0.05) versus 0.21 95%CI (0.08 ; 0.34) before the campaigns). ITN use (individuals reporting having slept under an ITN the night before the survey visit) among individuals from households owning at least one ITN, was 53.1% with no statistically significant difference between the lowest, second, third and fourth wealth quintiles and the highest wealth quintile (lowest: odds ratio (OR) 0.87, 95% confidence interval (CI) (0.67 ; 1.13); second: OR 0.85, 95% CI (0.66 ; 1.24); third: OR 1.10 95% CI (0.86 ; 1.4) and fourth OR 0.91 95% CI (0.72 ; 1.15).</p> <p>Conclusion</p> <p>The campaign had a significant impact by increasing ITN coverage and reducing inequity in ownership and use. Free ITN distribution campaigns should be sustained to increase equitable coverage. These campaigns should be supplemented with other ITN distribution strategies to cover newborns and replace aging nets.</p

Learning to Eat Vegetables in Early Life: The Role of Timing, Age and Individual Eating Traits

Vegetable intake is generally low among children, who appear to be especially fussy during the pre-school years. Repeated exposure is known to enhance intake of a novel vegetable in early life but individual differences in response to familiarisation have emerged from recent studies. In order to understand the factors which predict different responses to repeated exposure, data from the same experiment conducted in three groups of children from three countries (n = 332) aged 4–38 m (18.9±9.9 m) were combined and modelled. During the intervention period each child was given between 5 and 10 exposures to a novel vegetable (artichoke puree) in one of three versions (basic, sweet or added energy). Intake of basic artichoke puree was measured both before and after the exposure period. Overall, younger children consumed more artichoke than older children. Four distinct patterns of eating behaviour during the exposure period were defined. Most children were “learners” (40%) who increased intake over time. 21% consumed more than 75% of what was offered each time and were labelled “plate-clearers”. 16% were considered “non-eaters” eating less than 10 g by the 5th exposure and the remainder were classified as “others” (23%) since their pattern was highly variable. Age was a significant predictor of eating pattern, with older pre-school children more likely to be non-eaters. Plate-clearers had higher enjoyment of food and lower satiety responsiveness than non-eaters who scored highest on food fussiness. Children in the added energy condition showed the smallest change in intake over time, compared to those in the basic or sweetened artichoke condition. Clearly whilst repeated exposure familiarises children with a novel food, alternative strategies that focus on encouraging initial tastes of the target food might be needed for the fussier and older pre-school children

The effects of repeated exposure and variety on vegetable intake in pre-school children

Children's vegetable consumption in the UK remains lower than national recommendations, presenting potential long-term health risks. It is known that repeated exposure promotes intake of novel vegetables and that offering children variety and choice can also encourage intake. The current study aimed to compare the impact of offering variety over simple repeated exposure as a strategy for increasing pre-school children's vegetable consumption. Children (N = 95) aged 24–55 months were recruited through participating nurseries and assigned to receive repeated exposure (RE) to a single vegetable snack or a mixed snack consisting of five different vegetables (variety: V). A minimum of 5 (maximum 6) exposures were given for both RE and V conditions. Pre and post-intervention intake measures of both the RE and V snacks were taken for each child. Follow up measures took place 1 month post-intervention (n = 40). Vegetable intake increased significantly from pre to post intervention for snacks congruent to the condition to which children were assigned. Magnitude of change was smaller for the variety condition. Follow up data revealed that snack intake remained significantly higher than baseline 1 month post-intervention (p < 0.001). In agreement with previous work this study confirmed that repeated exposure was effective in promoting children's vegetable intake but there was no additional benefit of variety in this context. It may be that for moderately familiar vegetables, serving them alone encourages intake and for this age group, avoids contamination fears or effects of neophobia

Eating and Drinking in Childhood

This chapter describes the development of eating and drinking in typically developing children up to the end of school age. Together with physiological and cognitive development, children’s eating behavior undergoes major evolutions. During the early period when eating is essential to sustain growth, children eat easily and at the onset of complementary feeding discover the foods of their future diet which are marked by distinct tastes, flavors, and textures from the milk they had received before. Then they undergo a period when they may become picky and/or neophobic, which may last until school age. For this reason, eating and drinking will first be described in infancy, before the onset of food neophobia (from birth to 2–3 years), during the preschool years (from 2–3 years to 6 years), and right after this period, in school-aged children (from 7 years until 11 years). The mysteries of (pre)adolescent eating and drinking will not be covered in this chapter. Then, within each section, the following aspects will be covered: sensory capacities, likes and dislikes, attitudes and thinking, and role of the environment, including the family environment