Impact of maternal common mental disorders on child educational outcomes at 7 and 9 years:a population-based cohort study in Ethiopia

OBJECTIVES: To examine the association between exposure to maternal common mental disorders (CMD) in preschool and early school age children and subsequent child educational outcomes.DESIGN: A population-based cohort study.SETTING: The study was undertaken in the Butajira health and demographic surveillance site (HDSS), a predominantly rural area of south central Ethiopia.PARTICIPANTS: Inclusion criteria are women aged between 15 and 49 years, able to speak Amharic, in the third trimester of pregnancy and resident of the HDSS. 1065 women were recruited between July 2005 and February 2006 and followed up. When the average age of children was 6.5 years old, the cohort was expanded to include an additional 1345 mothers and children who had been born in the 12 months preceding and following the recruitment of the original cohort, identified from the HDSS records. Data from a total of 2090 mother-child dyads were included in the current analysis.MEASURES: Maternal CMD was measured when the children were 6-7 (6/7) and 7-8 (7/8) years old using the Self-reporting Questionnaire, validated for the setting. Educational outcomes (dropout) of the children at aged 7/8 years (end of 2013/2014 academic year) were obtained from maternal report. At age 8/9 years (end of 2014/2015 academic year), educational outcomes (academic achievement, absenteeism and dropout) of the children were obtained from school records.RESULTS: After adjusting for potential confounders, exposure to maternal CMD at 7/8 years was associated significantly with school dropout (OR 1.07; 95% CI 1.00 to 1.13, P=0.043) and absenteeism (incidence rate ratio 1.01; 95% CI 1.00 to 1.02 P=0.026) at the end of 2014/2015 academic year. There was no association between maternal CMD and child academic achievement.CONCLUSION: Future studies are needed to evaluate whether interventions to improve maternal mental health can reduce child school absenteeism and dropout

Prevalence and predictors of undernutrition among infants aged six and twelve months in Butajira, Ethiopia: The P-MaMiE Birth Cohort

<p>Abstract</p> <p>Background</p> <p>Child undernutrition is a major public health problem in low income countries. Prospective studies of predictors of infant growth in rural low-income country settings are relatively scarce but vital to guide intervention efforts.</p> <p>Methods</p> <p>A population-based sample of 1065 women in the third trimester of pregnancy was recruited from the demographic surveillance site (DSS) in Butajira, south-central Ethiopia, and followed up until the infants were one year of age. After standardising infant weight and length using the 2006 WHO child growth standard, a cut-off of two standard deviations below the mean defined the prevalence of stunting (length-for-age <-2), underweight (weight-for-age <-2) and wasting (weight-for-length <-2).</p> <p>Results</p> <p>The prevalence of infant undernutrition was high at 6 months (21.7% underweight, 26.7% stunted and 16.7% wasted) and at 12 months of age (21.2% underweight, 48.1% stunted, and 8.4% wasted). Significant and consistent predictors of infant undernutrition in both logistic and linear multiple regression models were male gender, low birth weight, poor maternal nutritional status, poor household sanitary facilities and living in a rural residence. Compared to girls, boys had twice the odds of being underweight (OR = 2.00; 95%CI: 1.39, 2.86) at 6 months, and being stunted at 6 months (OR = 2.38, 95%CI: 1.69, 3.33) and at 12 months of age (OR = 2.08, 95%CI: 1.59, 2.89). Infant undernutrition at 6 and 12 months of age was not associated with infant feeding practices in the first two months of life.</p> <p>Conclusion</p> <p>There was a high prevalence of undernutrition in the first year of infancy in this rural Ethiopia population, with significant gender imbalance. Our prospective study highlighted the importance of prenatal maternal nutritional status and household sanitary facilities as potential targets for intervention.</p

Social research to understand farmer and agricultural stakeholder attitudes towards bovine tuberculosis vaccination of cattle

Background: This social research study employed a behavioural insights framework, Easy, Attractive, Social, Timely (‘EAST’), to identify cues that may influence farmer and stakeholder attitudes towards the deployment of Cattle BCG vaccine. Methods: The EAST framework was employed to develop policy scenarios consisting of several cues likely to affect vaccine uptake. These scenarios consisted of a government-led approach, an individual farmer-led approach, and a third approach, also farmer-led but organised collectively. The government approach was mandatory, while the farmer-led approaches were both voluntary. The scenarios were tested during farmer participatory workshops (n=8)and stakeholder interviews (n=35). Results: Overall, the EAST framework provided a useful approach for gathering behavioural insights around attitudes towards cattle vaccination. We found an overall receptiveness towards the idea of vaccinating cattle against bovine tuberculosis, particularly where clear, transparent messaging around the likely efficacy is mobilised, where clarity around potential implications for trading is provided, and where vaccine doses are provided free of charge and administered by veterinarians and veterinary technicians. In general, these factors were a pre-requisite to a mandatory (government-led) national approach, which was the preferred deployment mechanism among farmers and stakeholders. However, these conditions would also likely facilitate a voluntary vaccination programme. Limitations: Trust in those involved in delivering a vaccine programme and trust in the vaccine itself represent a crucial aspect of farmer and stakeholder attitudes towards cattle vaccination; however, this aspect was not covered by the EAST framework. Conclusion: EAST provided a novel framework for examining attitudes towards cattle vaccination with Cattle BCG, although we recommend incorporating a ‘trust’ component in future iterations

Exploring farmer attitudes towards the vaccination of badgers against bovine tuberculosis

This report investigates farmer attitudes towards the prospect of vaccinating badgers. It forms part of a larger social research project to examine farmers’ current and future willingness to vaccinate, or facilitate the vaccination of, cattle and badgers on their farms. Participatory workshops were carried out with farmers across England, within a range of bTB risk areas in which participants discussed four badger vaccination scenarios (Government-led approach to badger vaccination, Science-led approach to badger vaccination, Vaccinating in badger cull areas, Combined cattle and badger vaccination). All four scenarios were unpopular amongst farmers, though the science-led approach with a scientific trial was the least unappealing

Common perinatal mental disorders and post-infancy child development in rural Ethiopia:a population-based cohort study

Objective: To investigate whether maternal common mental disorders (CMD) in the postnatal period are prospectively associated with child development at 2.5 and 3.5 years in a rural low-income African setting. Methods: This study was nested within the C-MaMiE (Child outcomes in relation to Maternal Mental health in Ethiopia) population-based cohort in Butajira, Ethiopia, and conducted from 2005 to 2006. The sample comprised of 496 women who had recently given birth to living, singleton babies with recorded birth weight measurements, who were 15 to 44 years of age, and residing in six rural sub-districts. Postnatal CMD measurements were ascertained 2 months after delivery. Language, cognitive, and motor development were obtained from the child 2.5 and 3.5 years after birth using a locally adapted version of the Bayley Scales of Infant Development (3rd Ed). Maternal CMD symptoms were measured using a locally validated WHO Self-Reporting Questionnaire. A linear mixed-effects regression model was used to analyze the relationship between postnatal CMD and child development. Results: After adjusting for confounders, there was no evidence for an association between postnatal CMD and overall child development or the cognitive sub-domain in the preschool period. There was no evidence of effect modification by levels of social support, socioeconomic status, stunting, or sex of the child. Conclusions: Previous studies from predominantly urban and peri-urban settings in middle-income countries have established a relationship between maternal CMD and child development, which contrasts with the findings from this study. The risk and protective factors for child development may differ in areas characterized by high social adversity and food insecurity. More studies are needed to investigate maternal CMD’s impact on child development in low-resource and rural areas

Exploring farmer and stakeholder attitudes towards the vaccination of cattle against bovine tuberculosis

This report assesses farmer attitudes towards a cattle bTB vaccine, and the potential influence of different behavioural incentives to promote vaccine use. Three hypothetical policy scenarios relevant to England and Wales were developed to examine attitudes to cattle vaccination amongst farmers and industry stakeholders. Each scenario reflected a different model of delivery: mandatory (state-led), individual farmer-led, and collective (via local vaccination companies). Farmers and agricultural stakeholders were, in principle, generally supportive of cattle vaccination, and supported an effective, trade barrier-free vaccine

Maternal mental health in primary care in five low- and middle-income countries: a situational analysis.

BACKGROUND: The integration of maternal mental health into primary health care has been advocated to reduce the mental health treatment gap in low- and middle-income countries (LMICs). This study reports findings of a cross-country situation analysis on maternal mental health and services available in five LMICs, to inform the development of integrated maternal mental health services integrated into primary health care. METHODS: The situation analysis was conducted in five districts in Ethiopia, India, Nepal, South Africa and Uganda, as part of the Programme for Improving Mental Health Care (PRIME). The analysis reports secondary data on the prevalence and impact of priority maternal mental disorders (perinatal depression, alcohol use disorders during pregnancy and puerperal psychosis), existing policies, plans and services for maternal mental health, and other relevant contextual factors, such as explanatory models for mental illness. RESULTS: Limited data were available at the district level, although generalizable data from other sites was identified in most cases. Community and facility-based prevalences ranged widely across PRIME countries for perinatal depression (3-50 %) and alcohol consumption during pregnancy (5-51 %). Maternal mental health was included in mental health policies in South Africa, India and Ethiopia, and a mental health care plan was in the process of being implemented in South Africa. No district reported dedicated maternal mental health services, but referrals to specialised care in psychiatric units or general hospitals were possible. No information was available on coverage for maternal mental health care. Challenges to the provision of maternal mental health care included; limited evidence on feasible detection and treatment strategies for maternal mental disorders, lack of mental health specialists in the public health sector, lack of prescribing guidelines for pregnant and breastfeeding women, and stigmatising attitudes among primary health care staff and the community. CONCLUSIONS: It is difficult to anticipate demand for mental health care at district level in the five countries, given the lack of evidence on the prevalence and treatment coverage of women with maternal mental disorders. Limited evidence on effective psychosocial interventions was also noted, and must be addressed for mental health programmes, such as PRIME, to implement feasible and effective services

Development of a scalable mental healthcare plan for a rural district in Ethiopia

Background:Developing evidence for the implementation and scaling up of mental healthcare in low- and middle-income countries (LMIC) like Ethiopia is an urgent priority.AimsTo outline a mental healthcare plan (MHCP), as a scalable template for the implementation of mental healthcare in rural Ethiopia.Method:A mixed methods approach was used to develop the MHCP for the three levels of the district health system (community, health facility and healthcare organisation).Results:The community packages were community case detection, community reintegration and community inclusion. The facility packages included capacity building, decision support and staff well-being. Organisational packages were programme management, supervision and sustainability.Conclusions:The MHCP focused on improving demand and access at the community level, inclusive care at the facility level and sustainability at the organisation level. The MHCP represented an essential framework for the provision of integrated care and may be a useful template for similar LMIC

Chronic atmospheric reactive N deposition has breached the N sink capacity of a northern ombrotrophic peatbog increasing the gaseous and fluvial N losses

Peatlands play an important role in modulating the climate, mainly through sequestration of carbon dioxide into peat carbon, which depends on the availability of reactive nitrogen (Nr) to mosses. Atmospheric Nr deposition in the UK has been above the critical load for functional and structural changes to peatland mosses, thus threatening to accelerate their succession by vascular plants and increasing the possibility of Nr export to downstream ecosystems. The N balance of peatlands has received comparatively little attention, mainly due to the difficulty in measuring gaseous N losses as well as the Nr inputs due to biological nitrogen fixation (BNF). In this study we have estimated the mean annual N balance of an ombrotrophic bog (Migneint, North Wales) by measuring in situ N2 + N2O gaseous fluxes and also BNF in peat and mosses. Fluvial N export was monitored through a continuous record of DON flux, while atmospheric N deposition was modelled on a 5 × 5 km grid. The mean annual N mass balance was slightly positive (0.7 ± 4.1 kg N ha−1 y−1) and varied interannually indicating the fragile status of this bog ecosystem that has reached N saturation and is prone to becoming a net N source. Gaseous N losses were a major N output term accounting for 70% of the N inputs, mainly in the form of the inert N2 gas, thus providing partial mitigation to the adverse effects of chronic Nr enrichment. BNF was suppressed by 69%, compared to rates in pristine bogs, but was still active, contributing ~2% of the N inputs. The long-term peat N storage rate (8.4 ± 0.8 kg N ha−1 y−1) cannot be met by the measured N mass balance, showing that the bog catchment is losing more N than it can store due its saturated status