Undernutrition in Infants and Young Children in India: A Leadership Agenda for Action

In India, child undernutrition happens very early in life; 30 per cent of Indian infants younger than six months old are underweight and 58 per cent of children in the age group 18–23 months old are stunted; moreover, 56 per cent of severe wasting in India happens before children are two years old. Recognising the centrality of the first two years of life to respond to India's nutrition challenge, the Coalition for Sustainable Nutrition Security in India called on an Expert Task Force on Infant and Young Child Nutrition to identify the ten evidence?based, high impact, cost?effective interventions with the greatest potential to reduce rates of undernutrition in infants and young children (0–23 months old) in India. These ten Essential Interventions are the evidence base for a broad?base Leadership Agenda for Action to Reduce Undernutrition in Infants and Young Children in India

Successful Community Nutrition Programming:lessons from Kenya,Tanzania,and Uganda

Learning from success is the most effective and efficient way of learning.This report brings together the main findings of a series of assessments of successful community nutrition programming carried out in Kenya, Tanzania, and Uganda between 1999 and 2000. The overall aim of the assessments was to identify key lessons, or the main driving forces behind the successful processes and outcomes in these programs. Such elements of success fundamentally have to do with both what was done and how it was done. Experience with community-based nutrition programming, as documented in various syntheses and reviews during the 1990s, does show that malnutrition can be effectively addressed on a large scale, at reasonable cost, through appropriate programs and strategies, and backed up by sustained political support. In most cases, successful attempts to overcome malnutrition originate with participatory, community-based nutrition programs undertaken in parallel with supportive sectoral actions directed toward nutritionally at-risk groups. Such actions are often enabled and supported by policies aimed at improving access by the poor to adequate social services, improving women’s status and education, and\ud fostering equitable economic growth. Successful community-based programs are not islands of excellence existing in an imperfect world. Rather, part of their success has to do with contextual factors that provide an enabling or supportive environment. Some of these contextual factors are particularly influenced by policy, some less so. Contextual factors may include, for example, high literacy rates, women’s empowerment, community organizational capacity and structures, appropriate legislation. Nutrition program managers cannot normally influence contextual factors, at least in the short term.\ud In addition to favorable contextual factors, certain program factors contribute to successful programs, such as the design, implementation, and/or management of the program or project, which can, of course, be influenced by program managers. Both contextual and program factors, and the way they interact, need to be identified in order to understand the dynamics behind success. In 1998, under the Greater Horn of Africa Initiative (GHAI) supported by the United States Agency for International Development (USAID), nutrition coalitions were formed in Kenya, Tanzania, and Uganda. These nutrition coalitions, comprising individuals representing government, non-governmental organizations (NGOs), donors, academic institutions, and the private sector, seek to advance the nutrition agenda both in policy and programming through coordination and advocacy efforts. One of the first tasks of the nutrition coalitions, under the leadership of the Program for Applied Technologies in Health (PATH) in Kenya, the Tanzania Food and Nutrition Centre (TFNC) in Tanzania, and the African Medical Research Foundation (AMREF) in Uganda, was to prepare an inventory of community nutrition programs in their respective countries and identify of better practices in community nutrition programming. Country teams, supported by USAID/REDSO/ESA and LINKAGES/AED, then selected three successful programs in their respective countries based on preestablished "process" and "outcome" criteria. UNICEF has a long history of promoting and supporting community-based programs in Eastern and Southern Africa and has supported many reviews and evaluations. As part of its continued effort to strengthen community-based programs by learning from new success stories, UNICEF also identified for review a relatively large scale successful program in Tanzania\u

Prospective pilots of routine data captures by paediatricians in clinics and validation of the disability complexity scale

AIMS To pilot prospective data collection by paediatricians at the point of care across England using a defined terminology set; demonstrate feasibility of data collection and utility of data outputs; and confirm that counting the number of needs per child is valid for quantifying complexity. METHOD Paediatricians in 16 hospital and community settings collected and anonymized data. Participants completed a survey regarding the process. Data were analysed using R version 3.1.2

Quantifying multi-facted needs in a district disability clinic population: analysis of data captured at point of care and development of a disabilities terminology set and disabilities complexity scale.

AIMS To develop a Disabilities Terminology Set and quantify the multifaceted needs of disabled children and their families in a district disability clinic population. METHOD Data from structured electronic clinic letters of children attending paediatric disability clinics from June 2007 to May 2012 in Sunderland, north-east England collected at the point of clinical care were analysed to determine appropriate terms for consistent recording of each need and issue. Terms were collated to count the number of needs per child. RESULTS A Systemized nomenclature of Medicine – Clinical Terms subset of 296 terms was identified and published, and 8392 consultations for 1999 children were reviewed. The required number of clinic appointments correlated strongly with the number of needs identified. Children with intellectual disabilities in addition to cerebral palsy and epilepsy had more than double the number of conditions, technology dependencies, and family-reported issues than those without

Socio-economic factors associated with delivery assisted by traditional birth attendants in Iraq, 2000

<p>Abstract</p> <p>Background</p> <p>Traditional birth attendants (TBAs) are likely to deliver lower quality maternity care compared to professional health workers. It is important to characterize women who are assisted by TBAs in order to design interventions specific to such groups. We thus conducted a study to assess if socio-economic status and demographic factors are associated with having childbirth supervised by traditional birth attendants in Iraq.</p> <p>Methods</p> <p>Iraqi Multiple Indicator Cluster Survey (MICS) data for 2000 were used. We estimated frequencies and proportions of having been delivered by a traditional birth attendant and other social characteristics. Logistic regression analysis was used to assess the association between having been delivered by a TBA and wealth, area of residence (urban versus rural), parity, maternal education and age.</p> <p>Results</p> <p>Altogether 22,980 women participated in the survey, and of these women, 2873 had delivery information and whether they were assisted by traditional birth attendants (TBAs) or not during delivery. About 1 in 5 women (26.9%) had been assisted by TBAs. Compared to women of age 35 years or more, women of age 25–34 years were 22% (AOR = 1.22, 95%CI [1.08, 1.39]) more likely to be assisted by TBAs during delivery. Women who had no formal education were 42% (AOR = 1.42, 95%CI [1.22, 1.65]) more likely to be delivered by TBAs compared to those who had attained secondary or higher level of education. Women in the poorest wealth quintile were 2.52 (AOR = 2.52, 95%CI [2.14, 2.98]) more likely to be delivered by TBAs compared to those in the richest quintile. Compared to women who had 7 or more children, those who had 1 or 2 were 28% (AOR = 0.72, 95%CI [0.59, 0.87]) less likely to be delivered by TBAs.</p> <p>Conclusion</p> <p>Findings from this study indicate that having delivery supervised by traditional birth attendants was associated with young maternal age, low education, and being poor. Meanwhile women having 1 or 2 children were less likely to be delivered by TBAs. These factors should be considered in the design of interventions to reduce the rate of deliveries assisted by TBAs in favour of professional midwives, and consequently reduce maternal and neonatal mortality rates and other adverse events.</p

The role of leadership in HRH development in challenging public health settings

As part of the special feature on leadership and human resources (HR), Management Sciences for Health profiles three leaders who have made a significance difference in the HR situation in their countries. By taking a comprehensive approach and working in partnership with stakeholders, these leaders demonstrate that strengthening health workforce planning, management, and training can have a positive effect on the performance of the health sector

The burden of child maltreatment in the East Asia and Pacific region

This study estimated the health and economic burden of child maltreatment in the East Asia and Pacific region, addressing a significant gap in the current evidence base. Systematic reviews and meta-analyses were conducted to estimate the prevalence of child physical abuse, sexual abuse, emotional abuse, neglect, and witnessing parental violence. Population Attributable Fractions were calculated and Disability-Adjusted Life Years (DALYs) lost from physical and mental health outcomes and health risk behaviors attributable to child maltreatment were estimated using the most recent comparable Global Burden of Disease data. DALY losses were converted into monetary value by assuming that one DALY is equal to the sub-region’s per capita GDP. The estimated economic value of DALYs lost to violence against children as a percentage of GDP ranged from 1.24% to 3.46% across sub-regions defined by the World Health Organization. The estimated economic value of DALYs (in constant 2000 US$) lost to child maltreatment in the EAP region totaled US$151 billion, accounting for 1.88% of the region’s GDP. Updated to 2012 dollars, the estimated economic burden totaled US $194 billion. In sensitivity analysis, the aggregate costs as a percentage of GDP range from 1.36% to 2.52%. The economic burden of child maltreatment in the East Asia and Pacific region is substantial, indicating the importance of preventing and responding to child maltreatment in this region. More comprehensive research into the impact of multiple types of childhood adversity on a wider range of putative health outcomes is needed to guide policy and programs for child protection in the region, and globally