Trends in childhood mortality in Kenya: the urban advantage has seemingly been wiped out

Background: we describe trends in childhood mortality in Kenya, paying attention to the urban–rural and intra-urban differentials.Methods: we use data from the Kenya Demographic and Health Surveys (KDHS) collected between 1993 and 2008 and the Nairobi Urban Health and Demographic Surveillance System (NUHDSS) collected in two Nairobi slums between 2003 and 2010, to estimate infant mortality rate (IMR), child mortality rate (CMR) and under-five mortality rate (U5MR).Results: between 1993 and 2008, there was a downward trend in IMR, CMR and U5MR in both rural and urban areas. The decline was more rapid and statistically significant in rural areas but not in urban areas, hence the gap in urban–rural differentials narrowed over time. There was also a downward trend in childhood mortality in the slums between 2003 and 2010 from 83 to 57 for IMR, 33 to 24 for CMR, and 113 to 79 for U5MR, although the rates remained higher compared to those for rural and non-slum urban areas in Kenya.Conclusions: the narrowing gap between urban and rural areas may be attributed to the deplorable living conditions in urban slums. To reduce childhood mortality, extra emphasis is needed on the urban slums

Anthelmintic activity and cytotoxic effects of compounds isolated from the fruits of Ozoroa insignis del. (Anacardiaceae)

Ozoroa insignis Del. is an ethnobotanical plant widely used in traditional medicine for various ailments, including schistosomiasis, tapeworm, and hookworm infections. From the so far not investigated fruits of Ozoroa insignis, the anthelmintic principles could be isolated through bioassay-guided isolation using Caenorhabditis elegans and identified by NMR spectroscopic analysis and mass spectrometric studies. Isolated 6-[8(Z)-pentadecenyl] anacardic (1), 6-[10(Z)-heptadecenyl] anacardic acid (2), and 3-[7(Z)-pentadecenyl] phenol (3) were evaluated against the 5 parasitic organisms Schistosoma mansoni (adult and newly transformed schistosomula), Strongyloides ratti, Heligmosomoides polygyrus, Necator americanus, and Ancylostoma ceylanicum, which mainly infect humans and other mammals. Compounds 1-3 showed good activity against Schistosoma mansoni, with compound 1 showing the best activity against newly transformed schistosomula with 50% activity at 1microM. The isolated compounds were also evaluated for their cytotoxic properties against PC-3 (human prostate adenocarcinoma) and HT-29 (human colorectal adenocarcinoma) cell lines, whereby compounds 2 and 3 showed antiproliferative activity in both cancer cell lines, while compound 1 exhibited antiproliferative activity only on PC-3 cells. With an IC50 value of 43.2 microM, compound 3 was found to be the most active of the 3 investigated compounds

Influence of bunch maturation and chemical precursors on acrylamide formation in starchy banana chips

The present study investigated the effect of ripening stages and chemical precursors on acrylamide formation in deep-fried chips of five plantains and one cooking banana. The highest level of acrylamide was found in the cooking banana, followed by False Horn plantain and French plantain, respectively. French plantain hybrids exhibited a significantly lower (P 0.60) with acrylamide formation in fried chips. The higher level of TP was significantly related (P < 0.05) to the lower level of acrylamide (r = −0.62). The reduced levels of carotenoid isomers, except lutein, during fruit ripening were positively correlated (P < 0.05) with acrylamide formation, especially trans-BC (r = 0.72) and 9-cis-BC(r = 0.64)

How does cultivar, maturation, and pre-treatment affect nutritional, physicochemical, and pasting properties of plantain flours?

Open Access JournalThe effect of cultivar, ripening stage, and pre-treatment method were investigated on the nutritional, physicochemical, and pasting properties of plantain flours from two plantains and two plantain hybrids. There were significant variations (p < 0.05) in chemical composition and physical properties influenced by the interaction of cultivars, ripening stages, and pre-treatment methods. The highest levels of amylose, water-holding capacity (WHC), and oil-holding capacity (OHC) were observed in unripe flours and acid-treated flour recorded the highest content of resistant starch (RS). Flour after pre-blanching contained the highest level of total phenolic (TP), carotenoid contents, and browning index (BI) value. In contrast, acid-treated flours had the lowest BI value. As ripening progressed, peak viscosity and breakdown values increased but final viscosity, setback, and pasting temperature values were reduced. Untreated flour samples showed the highest peak viscosity. Higher breakdown values were found in acid-treated samples and higher setback values in pre-blanched samples

Consumer preferences and socioeconomic factors decided on plantain and plantain-based products in the central region of Cameroon and Oyo state, Nigeria

Open Access Journal; Published online: 22 Aug 2021Plantain is a key staple food in Central and West Africa, but there is limited understanding of its market in Africa. In addition, the cooking methods for enhancing the nutritional value, consumer preference, and willingness to pay for plantain and plantain-based products are not well understood. The knowledge gaps in the market and consumer dimension of the food chain need to be known to increase plantain utilization and guide breeding efforts. This research contributes by examining the cooking methods, consumer preference, and willingness to pay for plantain and plantain-based products in Cameroon and Nigeria. A household survey sample of 454 Cameroonian consumers in four divisions of Central Region and 418 Nigerian consumers in seven government areas of Oyo State in southwest Nigeria was the basis for the analysis. The results showed some levels of similarity and difference in the consumption and cooking of boiled, roasted, and fried plantain in both countries. The trend in consumption of all plantain-based products was constant in Cameroon but increased in Nigeria. The most important factor influencing Cameroonian consumers’ choice of plantain and its products was taste, while the nutrition trait influenced Nigerian consumers. Both Cameroonian and Nigerian consumers considered packaging, location of produce, and size and quantity as the least important factors. In addition, socioeconomic characteristics were significant determinants of consumers’ choices to consume plantain and its products. Gender significantly influenced (p < 0.05) taste, while nutrition was significantly driven (p < 0.05) by education and annual income. Household size played a significant role (p < 0.05) in consumers’ choices when the price was considered. These findings serve as a guideline to improve existing products to match the needs of consumers in each country and develop products for different consumer segments and potentially increase production

Global Burden of Sickle Cell Anaemia in Children under Five, 2010-2050: Modelling Based on Demographics, Excess Mortality, and Interventions

The global burden of sickle cell anaemia (SCA) is set to rise as a consequence of improved survival in high-prevalence low- and middle-income countries and population migration to higher-income countries. The host of quantitative evidence documenting these changes has not been assembled at the global level. The purpose of this study is to estimate trends in the future number of newborns with SCA and the number of lives that could be saved in under-five children with SCA by the implementation of different levels of health interventions.First, we calculated projected numbers of newborns with SCA for each 5-y interval between 2010 and 2050 by combining estimates of national SCA frequencies with projected demographic data. We then accounted for under-five mortality (U5m) projections and tested different levels of excess mortality for children with SCA, reflecting the benefits of implementing specific health interventions for under-five patients in 2015, to assess the number of lives that could be saved with appropriate health care services. The estimated number of newborns with SCA globally will increase from 305,800 (confidence interval [CI]: 238,400-398,800) in 2010 to 404,200 (CI: 242,500-657,600) in 2050. It is likely that Nigeria (2010: 91,000 newborns with SCA [CI: 77,900-106,100]; 2050: 140,800 [CI: 95,500-200,600]) and the Democratic Republic of the Congo (2010: 39,700 [CI: 32,600-48,800]; 2050: 44,700 [CI: 27,100-70,500]) will remain the countries most in need of policies for the prevention and management of SCA. We predict a decrease in the annual number of newborns with SCA in India (2010: 44,400 [CI: 33,700-59,100]; 2050: 33,900 [CI: 15,900-64,700]). The implementation of basic health interventions (e.g., prenatal diagnosis, penicillin prophylaxis, and vaccination) for SCA in 2015, leading to significant reductions in excess mortality among under-five children with SCA, could, by 2050, prolong the lives of 5,302,900 [CI: 3,174,800-6,699,100] newborns with SCA. Similarly, large-scale universal screening could save the lives of up to 9,806,000 (CI: 6,745,800-14,232,700) newborns with SCA globally, 85% (CI: 81%-88%) of whom will be born in sub-Saharan Africa. The study findings are limited by the uncertainty in the estimates and the assumptions around mortality reductions associated with interventions.Our quantitative approach confirms that the global burden of SCA is increasing, and highlights the need to develop specific national policies for appropriate public health planning, particularly in low- and middle-income countries. Further empirical collaborative epidemiological studies are vital to assess current and future health care needs, especially in Nigeria, the Democratic Republic of the Congo, and India

Rural-urban disparities in child nutrition in Bangladesh and Nepal

Background The persistence of rural-urban disparities in child nutrition outcomes in developing countries alongside rapid urbanisation and increasing incidence of child malnutrition in urban areas raises an important health policy question - whether fundamentally different nutrition policies and interventions are required in rural and urban areas. Addressing this question requires an enhanced understanding of the main drivers of rural-urban disparities in child nutrition outcomes especially for the vulnerable segments of the population. This study applies recently developed statistical methods to quantify the contribution of different socio-economic determinants to rural-urban differences in child nutrition outcomes in two South Asian countries – Bangladesh and Nepal. Methods Using DHS data sets for Bangladesh and Nepal, we apply quantile regression-based counterfactual decomposition methods to quantify the contribution of (1) the differences in levels of socio-economic determinants (covariate effects) and (2) the differences in the strength of association between socio-economic determinants and child nutrition outcomes (co-efficient effects) to the observed rural-urban disparities in child HAZ scores. The methodology employed in the study allows the covariate and coefficient effects to vary across entire distribution of child nutrition outcomes. This is particularly useful in providing specific insights into factors influencing rural-urban disparities at the lower tails of child HAZ score distributions. It also helps assess the importance of individual determinants and how they vary across the distribution of HAZ scores. Results There are no fundamental differences in the characteristics that determine child nutrition outcomes in urban and rural areas. Differences in the levels of a limited number of socio-economic characteristics – maternal education, spouse’s education and the wealth index (incorporating household asset ownership and access to drinking water and sanitation) contribute a major share of rural-urban disparities in the lowest quantiles of child nutrition outcomes. Differences in the strength of association between socio-economic characteristics and child nutrition outcomes account for less than a quarter of rural-urban disparities at the lower end of the HAZ score distribution. Conclusions Public health interventions aimed at overcoming rural-urban disparities in child nutrition outcomes need to focus principally on bridging gaps in socio-economic endowments of rural and urban households and improving the quality of rural infrastructure. Improving child nutrition outcomes in developing countries does not call for fundamentally different approaches to public health interventions in rural and urban areas

The development and validation of an urbanicity scale in a multi-country study

Background : Although urban residence is consistently identified as one of the primary correlates of non-communicable disease in low- and middle-income countries, it is not clear why or how urban settings predispose individuals and populations to non-communicable disease (NCD), or how this relationship could be modified to slow the spread of NCD. The urban&ndash;rural dichotomy used in most population health research lacks the nuance and specificity necessary to understand the complex relationship between urbanicity and NCD risk. Previous studies have developed and validated quantitative tools to measure urbanicity continuously along several dimensions but all have been isolated to a single country. The purposes of this study were 1) To assess the feasibility and validity of a multi-country urbanicity scale; 2) To report some of the considerations that arise in applying such a scale in different countries; and, 3) To assess how this scale compares with previously validated scales of urbanicity. Methods : Household and community-level data from the Young Lives longitudinal study of childhood poverty in 59 communities in Ethiopia, India and Peru collected in 2006/2007 were used. Household-level data include parents&rsquo; occupations and education level, household possessions and access to resources. Community-level data include population size, availability of health facilities and types of roads. Variables were selected for inclusion in the urbanicity scale based on inspection of the data and a review of literature on urbanicity and health. Seven domains were constructed within the scale: Population Size, Economic Activity, Built Environment, Communication, Education, Diversity and Health Services. Results : The scale ranged from 11 to 61 (mean 35) with significant between country differences in mean urbanicity; Ethiopia (30.7), India (33.2), Peru (39.4). Construct validity was supported by factor analysis and high corrected item-scale correlations suggest good internal consistency. High agreement was observed between this scale and a dichotomized version of the urbanicity scale (Kappa 0.76; Spearman&rsquo;s rank-correlation coefficient 0.84 (p&thinsp;&lt;&thinsp;0.0001). Linear regression of socioeconomic indicators on the urbanicity scale supported construct validity in all three countries (p&thinsp;&lt;&thinsp;0.05). Conclusions : This study demonstrates and validates a robust multidimensional, multi-country urbanicity scale. It is an important step on the path to creating a tool to assess complex processes like urbanization. This scale provides the means to understand which elements of urbanization have the greatest impact on health