The socio-economic determinants of infant mortality in Nepal: analysis of Nepal Demographic Health Survey, 2011.

BACKGROUND: Infant mortality reflects not only the health of infants but societal well-being as a whole. This study explores distal socioeconomic and related proximate determinants of infant mortality and provides evidence for designing targeted interventions. METHODS: Survival information on 5391 live born infants (2006-2010) was examined from the nationally representative Nepal Demographic Health Survey 2011. Bivariate logistic regression and multivariate hierarchical logistic regression approaches were performed to analyze the distal-socioeconomic and related proximate determinants of infant mortality. RESULTS: Socio-economic distal determinants are important predictors for infant mortality. For example, in reference to infants of the richest class, the adjusted odds ratio of infant mortality was 1.66 (95% CI: 1.00-2.74) in middle class and 1.87 (95% CI: 1.14-3.08) in poorer class, respectively. Similarly, the populations of the Mountain ecological region had a higher odds ratio (aOR =1.39, 95% CI: 0.90-2.16) of experiencing infant mortality compared with the populations of the Terai plain region. Likewise, the population of Far-western development region had a higher adjusted odds ratio (aOR =1.62, 95% CI: 1.02-2.57) of experiencing infant mortality than the Western development region. Moreover, the association of proximate determinants with infant mortality was statistically significant. For example, in reference to size at birth, adjusted odds ratio of infant dying was higher for infants whose birth size, as reported by mothers, was very small (aOR = 3.41, 95% CI: 2.16-5.38) than whose birth size was average. Similarly, fourth or higher birth rank infants with a short preceding birth interval (less than or equal to 2 years) were at greater risk of dying (aOR =1.74, 95% CI: 1.16-2.62) compared to the second or third rank infants with longer birth intervals. A short birth interval of the second or the third rank infants also increased the odds of infant death (aOR = 2.03, 95% CI: 1.23-3.35). CONCLUSIONS: Socioeconomic distal and proximate determinants are associated with infant mortality in Nepal. Infant mortality was higher in the poor and middle classes than the wealthier classes. Population of Mountain ecological region and Far western development region had high risk of infant mortality. Similarly, infant dying was higher for infants whose birth size, as reported by mothers, was very small and who has higher birth rank and short preceding birth interval. This study uniquely addresses both broader socioeconomic distal and proximate determinants side by side at the individual, household and community levels. For this, both comprehensive, long-term, equity-based public health interventions and immediate infant care programs are recommended.

Nutritional habits among high-performance endurance athletes.

BACKGROUND AND OBJECTIVE: For athletes, the main purpose of nutrition is to ensure the compensation of increased energy consumption and the need for nutrients in the athlete's body, thereby enabling maximum adaptation to physical loads. The aim of this study was to determine the habits of highly trained endurance athletes depending on sports type, sex and age in order to improve the planning and management of the training of athletes using targeted measures. MATERIALS AND METHODS: In 2009-2012, the dietary habits of 146 endurance athletes were analyzed. The actual diet of Lithuania endurance athletes was investigated using a 24-h dietary survey method. Data on the athletes' actual diet were collected for the previous day. RESULTS: It was found that 80.8% of endurance athletes used lower-than-recommended amounts of carbohydrates in their diet, and more than 70% of athletes used higher-than-recommended levels of fat, saturated fatty acids, and cholesterol. The diet of female athletes was low in carbohydrates, dietary fiber, protein, omega-3 fatty acids, B vitamins, potassium, calcium, phosphorus, iron, manganese, and zinc. Athletes aged 14-18 years tended to consume quantities of protein that were either lower than recommended or excessive. CONCLUSIONS: The diet of highly trained endurance athletes does not fully meet their requirements and in this situation cannot ensure maximum adaptation to very intense and/or long-duration physical loads. The diet of highly trained endurance athletes must be optimized, adjusted and individualized. Particular attention should be focused on female athletes.

Determinants of maternal health service utilization in Ethiopia: analysis of the 2011 Ethiopian Demographic and Health Survey.

BACKGROUND: Antenatal Care (ANC), use of skilled delivery attendants and postnatal care (PNC) services are key maternal health services that can significantly reduce maternal mortality. Understanding the factors that affect service utilization helps to design appropriate strategies and policies towards improvement of service utilization and thereby reduce maternal mortality. The objective of this study was to identify factors that affect utilization of maternal health services in Ethiopia. METHODS: Data were drawn from the 2011 Ethiopia Demographic and Health Survey. The dependent variables were use of ANC, skilled delivery attendants and PNC services. The independent variables were categorized as socio-cultural, perceived needs and accessibility related factors. Data analysis was done using SPSS for windows version 20.0. Bivariate and multivariate logistic regression models were used in the analysis. RESULTS: Thirty four percent of women had ANC visits, 11.7% used skilled delivery attendants and 9.7% of women had a postnatal health checkup. Education of women, place of residence, ethnicity, parity, women's autonomy and household wealth had a significant association with the use of maternal health services. Women who completed higher education were more likely to use ANC (AOR = 3.8, 95% CI = 1.8-7.8), skilled delivery attendants (AOR = 3.4, 95% CI = 1.9-6.2) and PNC (AOR = 3.2, 95% CI = 2.0-5.2). Women from urban areas use ANC (AOR = 2.3, 95% CI = 1.9-2.9), skilled delivery attendants (AOR = 4.9, 95% CI = 3.8-6.3) and PNC services (AOR = 2.6, 95% CI = 2.0-3.4) more than women from rural areas. Women who have had ANC visits during the index pregnancy were more likely to subsequently use skilled delivery attendants (AOR = 1.3, 95% CI = 1.1-1.7) and PNC (AOR = 3.4, 95% CI = 2.8-4.1). Utilization of ANC, delivery and PNC services is more among more autonomous women than those whose spending is controlled by other people. CONCLUSION: Maternal health service utilization in Ethiopia is very low. Socio-demographic and accessibility related factors are major determinants of service utilization. There is a high inequality in service utilization among women with differences in education, household wealth, autonomy and residence. ANC is an important entry point for subsequent use of delivery and PNC services. Strategies that aim improving maternal health service utilization should target improvement of education, economic status and empowerment of women.

Assessment of nutrition and physical activity of 6th-7th grade schoolchildren in the city of Vilnius, Lithuania.

BACKGROUND: Evaluation of eating habits and physical activity is very important for health interventions. Our aim in this study was to assess the characteristics of eating and physical activity of 6-7th grade schoolchildren in the city of Vilnius, Lithuania, as well as the association between dietary habits and physical activity. METHODS: The study was conducted within the project "Education of healthy diets and physical activity in schools". The sample consisted of 1008 schoolchildren from 22 schools in the city of Vilnius, and was based on empirical methods, including a questionnaire poll and comparative analysis. Statistical software Stata v.12.1 (Stata corp LP) was used to analyze the data. RESULTS: Our study showed that less than half (37.1%) of study participants had physically active leisure time. Boys were significantly more physically active than girls. More than half (61.4%) of children ate breakfast every day. Girls were more likely to eat vegetables and sweets. Schoolchildren who ate vegetables and dairy products as well as those who got enough information about physical activity and spoke about it with their family members were more physically active. CONCLUSIONS: The results of the study confirmed that schoolchildren were not sufficiently physically active. It was found that low physical activity is related to dietary and other factors, such as lack of information about physical activity and its benefits.

Organic food consumption by athletes in Lithuania.

BACKGROUND: With environmental pollution increasing, interest in organic farming and organic foodstuffs has been growing all over the world. Data on organic food consumption by Lithuanian athletes is not yet available. This lack of data determined the aim of this study: to identify the particulars of organic foodstuff consumption among athletes. METHODS: In September-November 2012, we polled 158 of the best-performing athletes of the Olympic sports team through direct interviews. An approved questionnaire was used to identify the specifics of organic foodstuff consumption among athletes. RESULTS: The survey results showed that 97% of athletes consume organic foodstuffs, and 80% of athletes highlighted the positive impact of organic food on health. Nevertheless, a slim majority of athletes (51.7%) consume organic foodstuffs seldomly, 2-3 times per week. The range of organic foodstuffs consumed depends on the gender of athletes, and the consumption of some products depends on monthly incomes. CONCLUSIONS: Survey results confirm the need for the production and expansion of the variety of organic foodstuffs. In the course of the development of the organic food market, it should be beneficial for manufacturers to target high-performance athletes and physically active people.