Impact of Drinking Water Source and Sanitation Facility on Malnutrition Prevalence in Children under Three: A Gender-Disaggregated Analysis Using PDHS 2017-18.

OBJECTIVES: The proposed research studied the determinants of male and female child malnutrition in Pakistan. More specifically, it observed the role of the sanitation facility and drinking water source as important determinants of malnutrition in a gender analysis. METHODS: Novel data of 1010 children under three years of age from PDHS 2017-18 were used. A CIAF (Cumulative Index for Anthropometric Failure) was established to assess malnourishment in the children. Discrete-choice logistic methodology was applied in this empirical research to study the likelihood of malnourishment in children. RESULTS: The logistic regression results depicted that factors such as a child belonging to a deprived area, the status of home wealth, and the education of the mother were common determinants of malnutrition in children. Factors such as a child having diarrhea (OR = 1.55, CI = 0.96-2.50) and the drinking water source (OR = 0.62, CI = 0.37-1.03) were separate prominent predictors of malnutrition in male children whereas the sanitation facility was the main determinant of malnutrition in female children (OR = 0.64, CI = 0.43-0.95). CONCLUSION: This study concludes that important links exist between the drinking water source and male child malnutrition and between sanitation facilities and female child malnutrition.

Key Challenges to Optimal Therapeutic Coverage and Maternal Utilization of CMAM Program in Rural Southern Pakistan: A Qualitative Exploratory Study.

Severe Acute Malnutrition (SAM) is a serious public health problem in many low- and middle-income countries (LMICs). Therapeutic programs are often considered the most effective solution to this problem. However, multiple social and structural factors challenge the social inclusion, sustainability, and effectiveness of such programs. In this article, we aim to explore how poor and remote households face structural inequities and social exclusion in accessing nutrition-specific programs in Pakistan. The study specifically highlights significant reasons for the low coverage of the Community Management of Acute Malnutrition (CMAM) program in one of the most marginalized districts of south Punjab. Qualitative data are collected using in-depth interviews and FGDs with mothers and health and nutrition officials. The study reveals that mothers' access to the program is restricted by multiple structural, logistical, social, and behavioral causes. At the district level, certain populations are served, while illiterate, and poor mothers with lower cultural capital from rural and remote areas are neglected. The lack of funding for nutrition causes the deprioritization of nutrition by the health bureaucracy. The subsequent work burden on Lady Health Workers (LHWs) and the lack of proper training of field staff impact the screening of SAM cases. Moreover, medical corruption in the distribution of therapeutic food, long distances, traveling or staying difficulties, the lack of social capital, and the stigmatization of mothers are other prominent difficulties. The study concludes that nutrition governance in Pakistan must address these critical challenges so that optimal therapeutic coverage can be achieved.

Distance to Healthcare Facility and Lady Health Workers' Visits Reduce Malnutrition in under Five Children: A Case Study of a Disadvantaged Rural District in Pakistan.

This study accesses the impact of lady health worker (LHWs) visits in the community and distance to a healthcare facility on the nutritional status of under-five children. Additionally, it explores the perceptions and attitudes of the community about the performance of LHWs. A self-administered instrument was applied to gather data on different parameters, such as children's height, age, weight, and socioeconomic status from 384 rural households in a marginalized district of Punjab province with the help of a purposive random sampling technique. The binary logistic regression model was employed for the computation of the probability of malnutrition. The prevalences of stunting, underweight children, and wasting in the district were 34.8%, 46.1%, and 15.5%, respectively. The logistic results illustrate that those households in which LHW visits occur regularly within 15 days (OR = 0.28 with 95% CI: 0.09-0.82) have a lower probability of malnutrition prevalence among their children. The distance to the health facility shows that the odds of malnutrition were higher from 3-4 Kilometers (Km) (OR = 2.61, 95% CI: 0.85-8.14), and odds were also higher for the ≥5 km category (OR = 2.88, 95% CI: 0.94-8.82). Children from richer families had lower chances of being malnourished (OR = 0.28, 95% CI: 0.07-1.14). Furthermore, the respondents show a positive attitude towards LHWs. They have given the first rank to their performance being beneficial to mothers and childcare, especially on checkups and safe deliveries, while they have shown negative responses and given lower ranks to their performance due to irregular visits (6th rank) and poor community awareness (7th rank). We conclude that LHWs' regular visits to targeted households and less distance to healthcare facilities reduce the malnutrition risk in under-five children.

The Relationship Between Job Burnout and Depressive Symptoms Among Chinese Firefighters: Colleagueship as a Moderator.

OBJECTIVES: This study aims to investigate the association between job burnout and depressive symptoms among Chinese firefighters, assuming colleagueship to play a moderating role in the aforementioned relationship. METHODS: This study is based on an online survey recruiting 1328 Chinese male firefighters from July 1 to August 31, 2021. Multiple linear regressions were used to examine the associations. RESULTS: This study revealed that all dimensions of job burnout were associated with worse depressive symptoms. Cynicism (ß = 0.30; 95% confidence interval [CI], 0.236, 0.356) had the strongest association with depressive symptoms, followed by emotional exhaustion and inefficacy. Moreover, firefighters with better affective colleagueship (ß = -0.10; 95% CI, -0.141, -0.061) and better obligatory colleagueship (ß = -0.07; 95% CI, -0.115, -0.034) were less likely to have depressive symptoms when confronted with job burnouts. CONCLUSIONS: This study suggests employers and practitioners should target their intervention efforts at both job burnout and colleagueship.

Rural mothers' beliefs and practices about diagnosis, treatment, and management of children health problems: A qualitative study in marginalized Southern Pakistan.

Introduction: Appropriate health-seeking beliefs and practices are indispensable for the survival and development of children. In this study, we explore childcare beliefs and practices of rural mothers and analyze the different ways childhood illness is diagnosed and managed in a marginalized rural community in Southern Pakistan. Methods: Using purposive sampling, in-depth interviews are conducted to obtain qualitative data from 20 illiterate and rural mothers in addition to 15 healthcare providers in the district Rajanpur of South Punjab. Results and discussion: The findings reveal that rural mothers' access to healthcare and therapeutic programs is impeded due to geographical isolation, structural inequalities, poverty, and illiteracy. Consequently, evil eyes, witchcraft, and spirits are recognized as potential threats to children's health and nutrition. Therefore, the treatment of childhood morbidity and malnutrition is mostly performed with folk, domestic, herbal, magico-religious remedies, and spiritual healing methods. The current study also highlights that many low-income and rural mothers tend to normalize childhood illness when they become unable to advocate for their children's health and nutrition. Besides improving low-income mothers' access to healthcare facilities, health education and risk communication at the field level through field health staff could be most effective for health promotion.

A Qualitative Exploration in Causes of Water Insecurity Experiences, and Gender and Nutritional Consequences in South-Punjab, Pakistan.

Although water insecurity has been discussed in general, its impacts on mothers' physical and mental health, and infants' and young children's feeding (IYCF), has largely been ignored. This study explores household water insecurity experiences and their association with optimal health and nutrition of women and children in the Rajanpur district of Punjab Province. Using focus group discussions (FGDs) and key informants (KIIs) interviews from an area with high maternal-child malnutrition prevalence, a qualitative study was conducted to describe local experiences of water acquirement and arrangement, and of the consequences of water insecurity. The findings highlight that rural Western marginalized populations of the Rajanpur district rely on brackish, canal, or flood surface water as the water supply is absent, which intensifies mothers' work burden and stress, and often makes them victims of violence, stigma, and sickness. Water fetching impacts women in unforeseen ways, impacting the psychosocial and physical health of mothers engaged in maternal breastfeeding. Water insecurity, originally rooted in regional disparities, compounds with gender inequities, which leads to maternal stress and child sickness. Justice in water resources is imperative and urgent in the deprived South of Punjab province for improving public health nutrition.