Prevalence of Short Peer Reviews in 3 Leading General Medical Journals.

Importance: High-quality peer reviews are often thought to be essential to ensuring the integrity of the scientific publication process, but measuring peer review quality is challenging. Although imperfect, review word count could potentially serve as a simple, objective metric of review quality. Objective: To determine the prevalence of very short peer reviews and how often they inform editorial decisions on research articles in 3 leading general medical journals. Design, Setting, and Participants: This cross-sectional study compiled a data set of peer reviews from published, full-length original research articles from 3 general medical journals (The BMJ, PLOS Medicine, and BMC Medicine) between 2003 and 2022. Eligible articles were those with peer review data; all peer reviews used to make the first editorial decision (ie, accept vs revise and resubmit) were included. Main Outcomes and Measures: Prevalence of very short reviews was the primary outcome, which was defined as a review of fewer than 200 words. In secondary analyses, thresholds of fewer than 100 words and fewer than 300 words were used. Results were disaggregated by journal and year. The proportion of articles for which the first editorial decision was made based on a set of peer reviews in which very short reviews constituted 100%, 50% or more, 33% or more, and 20% or more of the reviews was calculated. Results: In this sample of 11 466 reviews (including 6086 in BMC Medicine, 3816 in The BMJ, and 1564 in PLOS Medicine) corresponding to 4038 published articles, the median (IQR) word count per review was 425 (253-575) words, and the mean (SD) word count was 520.0 (401.0) words. The overall prevalence of very short (<200 words) peer reviews was 1958 of 11 466 reviews (17.1%). Across the 3 journals, 843 of 4038 initial editorial decisions (20.9%) were based on review sets containing 50% or more very short reviews. The prevalence of very short reviews and share of editorial decisions based on review sets containing 50% or more very short reviews was highest for BMC Medicine (693 of 2585 editorial decisions [26.8%]) and lowest for The BMJ (76 of 1040 editorial decisions [7.3%]). Conclusion and Relevance: In this study of 3 leading general medical journals, one-fifth of initial editorial decisions for published articles were likely based at least partially on reviews of such short length that they were unlikely to be of high quality. Future research could determine whether monitoring peer review length improves the quality of peer reviews and which interventions, such as incentives and norm-based interventions, may elicit more detailed reviews.

Economic Growth and Childhood Malnutrition in Low- and Middle-Income Countries.

Importance: Economic growth may reduce childhood malnutrition through improvements of several contributing factors, but the empirical evidence is mixed. Identifying the most important factors that contribute to child malnutrition and their associations with economic growth can inform decision-making about targeted investments to improve children's health. Objective: To assess the associations between economic growth and malnutrition, contributing factors and malnutrition, and economic growth and contributing factors of malnutrition in low- and middle-income countries (LMICs). Design, Setting, and Participants: This cross-sectional study used data from 239 Demographic and Health Surveys from January 1, 1990, to December 31, 2021. Observations included 1 138 568 children aged 0 to 35 months with valid anthropometric measures and information on contributing factors of malnutrition from 58 LMICs. Data were analyzed from May 20, 2022, to February 16, 2023. Exposure: National per-capita gross domestic product (GDP) was used as a proxy for economic growth. Main Outcomes and Measures: Six measures of childhood malnutrition were constructed: stunting (height-for-age z score <-2), underweight (weight-for-age z score <-2), wasting (weight-for-height z score <-2), overweight (weight-for-height z score >2), obesity (weight-for-height z score >3), and dietary diversity failure (consumption of less than 5 of 8 different food groups in the past 24 hours). Eighteen contributing factors of malnutrition were constructed, of which 10 were underlying determinants (eg, access to improved sanitation) and 8 were immediate determinants (eg, breastfeeding initiation). Results: A total of 1 138 568 children (mean [SD] age, 17.14 [10.26] months; 579 589 [50.9%] boys and 558 979 [49.1%] girls) were included in the analysis. Of these, 27.3% (95% CI, 27.2%-27.4%) had stunting; 25.7% (95% CI, 25.6%-25.8%), underweight; 11.2% (95% CI, 11.1%-11.2%), wasting; 3.8% (95% CI, 3.7%-3.8%), overweight; 1.1% (95% CI, 1.1%-1.1%), obesity; and 79.8% (95% CI, 79.7%-79.9%), dietary diversity failure. Per-capita GDP was weakly associated with childhood malnutrition. The odds ratios associated with a 5% increase in per-capita GDP were 0.99 (95% CI, 0.99-1.00) for stunting, 1.01 (95% CI, 1.00-1.01) for wasting, 1.00 (95% CI, 1.00-1.00) for underweight, 0.98 (95% CI, 0.98-0.98) for overweight, 0.98 (95% CI, 0.97-0.98) for obesity, and 1.03 (95% CI, 1.01-1.04) for dietary diversity failure. Although strong associations were found between many contributing factors and most outcomes for malnutrition, associations identified between per-capita GDP and these contributing factors themselves were ambiguous. Conclusions and Relevance: In this multicountry cross-sectional study, economic growth was weakly associated with childhood malnutrition and several contributing factors. To reduce child malnutrition, economic growth may need to be accompanied by more targeted investments to improve contributing factors that are strongly associated with child malnutrition, such as maternal health and education.

Assessment of Undernutrition Among Children in 55 Low- and Middle-Income Countries Using Dietary and Anthropometric Measures.

Importance: Evidence on the suitability of anthropometric failure (ie, stunting, underweight, and wasting) as a stand-alone measure of child undernutrition can inform global and national nutrition and health agendas. Objective: To provide a comprehensive estimate of the prevalence of child undernutrition by evaluating both dietary and anthropometric measures simultaneously across 55 low- and middle-income countries. Design, Setting, and Participants: This was a cross-sectional study that used Demographic and Health Surveys program data from July 2009 to January 2019, to allocate children into dietary and anthropometric failure categories. Nationally representative household surveys were conducted in 55 low- and middle-income countries. Participants included children aged 6 to 23 months who were born singleton and had valid anthropometric measures as well as available 24-hour food intake recollection. Data analysis was conducted from August 23 to October 22, 2020. Exposures: Two factors were considered to allocate children into the respective categories. Dietary failure was based on the World Health Organization standards for minimum dietary diversity. Anthropometric failure was constructed using the World Health Organization child growth reference standard z score for stunted growth, muscle wasting, and less than average weight for age. Main Outcomes and Measures: Dietary and anthropometric failures were cross-tabulated, which yielded 4 potential outcomes: dietary failure only, anthropometric failure only, both failures, and neither failure. Total child populations for each category were extrapolated from United Nations population estimates. Results: Of the 162 589 children (median age [range], 14 months [6-23 months]; 83 467 boys [51.3%]; 78 894 Asian children [48.5%]) in our sample, 42.9% of children had dietary failure according to the standard World Health Organization definition without being identified as having anthropometric failures. In all, 34.7% had both failures, 42.9% had dietary failure only, 8.3% had anthropometric failure only, and 14.1% had neither failure. Dietary and anthropometric measures were discordant for 51.2% of children; these children had nutritional needs identified by only 1 of the 2 measures. Dietary failure doubled the proportion of children in need of dietary interventions compared with anthropometry alone (43%). A total of 45.3 million additional children who experienced undernutrition in these 55 countries were not captured through the evaluation of anthropometric failures only. These results were consistent across geographic regions. Conclusions and Relevance: The results of this cross-sectional study suggest that the current standard of measuring child undernutrition by estimating the prevalence of anthropometric failure should be complemented with dietary and food-based measures. Anthropometry alone may fail to identify many children who have insufficient dietary intake.