Predictors for achieving adequate antenatal care visits during pregnancy: a cross-sectional study in rural Northwest Rwanda.

BACKGROUND: Inadequate antenatal care (ANC) in low-income countries has been identified as a risk factor for poor pregnancy outcome. While many countries, including Rwanda, have near universal ANC coverage, a significant proportion of pregnant women do not achieve the recommended regimen of four ANC visits. The present study aimed to explore the factors associated with achieving the recommendation, with an emphasis on the distance from household to health facilities. METHODS: A geo-referenced cross-sectional study was conducted in Rutsiro district, Western province of Rwanda with 360 randomly selected women. Multiple logistic regression analysis including adjusted odd ratio (aOR) were performed to identify factors associated with achieving the recommended four ANC visits. RESULTS: The majority (65.3%) of women had less than four ANC visits during pregnancy. We found a significant and negative association between distance from household to health facility and achieving the recommended four ANC visits. As the distance increased by 1 km, the odds of achieving the four ANC visits decreased by 19% (aOR = 0.81, P = 0.024). The odds of achieving the recommended four ANC visits were nearly two times higher among mothers with secondary education compared with mothers with primary education or less (aOR = 1.90, P = 0.038). In addition, mothers who responded that their household members always seek health care when necessary had 1.7 times higher odds of achieving four ANC visits compared with those who responded as unable to seek health care (aOR = 1.7, P = 0.041). Furthermore, mothers from poor households had 2.1 times lower odds of achieving four ANC visits than mothers from slightly better-off households (aOR = 2.1, P = 0.028). CONCLUSIONS: Findings from the present study suggest that, in Rutsiro district, travel distance to health facility, coupled with socio-economic constraints, including low education and poverty can make it difficult for pregnant women to achieve the recommended ANC regimen. Innovative strategies are needed to decrease distance by bringing ANC services closer to pregnant women and to enhance ANC seeking behaviour. Interventions should also focus on supporting women to attain at least secondary education level as well as to improve the household socioeconomic status of pregnant women, with a particular focus on women from poor households.

The impacts of the COVID-19 shock on sustainability and farmer livelihoods in Sri Lanka.

The COVID-19 pandemic and its handling in Sri Lanka has affected vegetable farmers in numerous ways and these impacts will constrain the country's move towards sustainable development. A field level study with vegetable farmers and key informants was carried out using exploratory research to understand, describe and analyze the impact of COVID-19 on the livelihoods of vegetable farmers and its relevance in achieving SDG 1. Data were supplemented by an extensive literature review. The analysis showed that the pandemic's impact on vegetable farmers in Sri Lanka is multidimensional and will increase vulnerability among vegetable farmers, for the long run. Adapting alternative inputs and marketing strategies, provision of immediate financial support, promoting innovative technology and service provision, and implementing intervention strategies tailored to farmer heterogeneity will improve farmer livelihoods and the prosperity of the sector.

Comparison of Nutritive Values of Tropical Pasture Species Grown in Different Environments, and Implications for Livestock Methane Production: A Meta-Analysis.

The demand for dairy products is ever increasing across the world. The livestock sector is a significant source of greenhouse gas (GHG) emissions globally. The availability of high-quality pasture is a key requirement to increase the productivity of dairy cows as well as manage enteric methane emissions. Warm-season perennial grasses are the dominant forages in tropical and subtropical regions, and thus exploring their nutritive characteristics is imperative in the effort to improve dairy productivity. Therefore, we have collated a database containing a total of 4750 records, with 1277 measurements of nutritive values representing 56 tropical pasture species and hybrid cultivars grown in 26 different locations in 16 countries; this was done in order to compare the nutritive values and GHG production across different forage species, climatic zones, and defoliation management regimes. Average edaphoclimatic (with minimum and maximum values) conditions for tropical pasture species growing environments were characterized as 22.5 °C temperature (range 17.5-29.30 °C), 1253.9 mm rainfall (range 104.5-3390.0 mm), 582.6 m elevation (range 15-2393 m), and a soil pH of 5.6 (range 4.6-7.0). The data revealed spatial variability in nutritive metrics across bioclimatic zones and between and within species. The ranges of these nutrients were as follows: neutral detergent fibre (NDF) 50.9-79.8%, acid detergent fibre (ADF) 24.7-57.4%, crude protein (CP) 2.1-21.1%, dry matter (DM) digestibility 30.2-70.1%, metabolisable energy (ME)3.4-9.7 MJ kg-1 DM, with methane (CH4) production at 132.9-133.3 g animal-1 day-1. The arid/dry zone recorded the highest DM yield, with decreased CP and high fibre components and minerals. Furthermore, the data revealed that climate, defoliation frequency and intensity, in addition to their interactions, have a significant effect on tropical pasture nutritive values and CH4 production. Overall, hybrid and newer tropical cultivars performed well across different climates, with small variations in herbage quality. The current study revealed important factors that affect pasture nutritive values and CH4 emissions, with the potential for improving tropical forage through the selection and management of pasture species.

Risk assessment approaches for evaluating cumulative exposures to multiple pesticide residues in agro-products using seasonal vegetable monitoring data from Hainan, China: a case study.

Risks from combined exposure to multiple chemicals in food have prompted a growing concern for their effect on human health. Risk management of chemical mixtures should be based on developing and harmonizing methodologies to scientifically evaluate their cumulative adverse effects. In this study, a simplified tiered approach of cumulative exposure assessment is described along with a case study of vegetables in China's Hainan province during 2012-2014. This case study could be a reference for the Chinese National Risk Assessment Programs for vegetable and fruit products. In the proposed assessment approach, Tier 1 acts as a screening tier to categorize and evaluate chemicals under a conservative scenario, and it prioritizes the pesticides of most concern. Tier 2 refines the grouping of substances from Tier 1 and normalizes the toxic potency of the chemicals to sum the exposure of chemical mixtures in a given assessment group. Tier 3 applies the refined exposure model and the input parameter distribution to create probabilistic models using Monte Carlo simulation. This approach will be helpful in the cumulative exposure assessment where data on pesticide residues are sufficient, but the individual dietary consumption is inadequate.

A Mixed-Methods Study of Factors Influencing Access to and Use of Micronutrient Powders in Rwanda.

The World Health Organization recommends point-of-use fortification with multiple micronutrients powder (MNP) for foods consumed by children aged 6-23 months in populations where anemia prevalence among children under 2 years or under 5 years of age is 20% or higher. In Rwanda, anemia affects 37% of children under 5 years. The MNP program was implemented to address anemia, but research on factors affecting the implementation of the MNP program is limited. We conducted a mixed-methods study to examine the factors influencing access to and use of MNP among mothers (N=379) in Rutsiro district, northwest Rwanda. Inductive content analysis was used for qualitative data. Logistic regression analysis was used to determine factors associated with the use of MNP. Qualitative results indicated that the unavailability of MNP supplies and distribution issues were major barriers to accessing MNP. Factors influencing the use of MNP included mothers' perceptions of side effects and health benefits of MNP, as well as inappropriate complementary feeding practices. Mothers of older children (aged 12-23 months) were more likely to use MNP than those of younger children (aged 6-11 months) (adjusted odds ratio [aOR]=3.63, P<.001). Mothers whose children participated in the supplementary food program were nearly 3 times more likely to use MNP than those whose children had never participated in the program (aOR=2.84, P=.001). Increasing household hunger score was significantly associated with lower odds of using MNP (aOR=0.80, P=.038). Mechanisms to monitor MNP supply and program implementation need to be strengthened to ensure mothers have access to the product. MNP program implementers should address gaps in complementary feeding practices and ensure mothers have access to adequate complementary foods.

Prevalence of thyroid dysfunction in postpartum women with suboptimal iodine and selenium and adequate iron status.

OBJECTIVE: Postpartum women experience thyroid dysfunction at twice the prevalence of the general population. Adequate biosynthesis of thyroid hormones depends on three trace elements: iodine, selenium and iron. This study aimed to investigate thyroid dysfunction within a cohort of women at six months postpartum in relation to iodine, selenium and iron status. DESIGN: This cross-sectional study was part of an observational longitudinal cohort Mother and Infant Nutrition Investigation; data obtained at six months postpartum are reported. SUBJECTS: Mother-infant pairs (n = 87) were recruited at three months postpartum and followed up at six months postpartum (n = 78). MEASUREMENTS: Thyroid hormones (free triiodothyronine, free thyroxine, thyroid-stimulating hormone) and thyroid peroxidase antibodies were measured. Urinary iodine concentration, breast milk iodine concentration, serum thyroglobulin, plasma selenium, serum ferritin and serum soluble transferrin receptors were determined. Nonparametric data were expressed as median (25th, 75th percentile). RESULTS: Thyroid dysfunction was found in 18% of women, and 4% of women had iron deficiency. Median urinary iodine concentration was 85 (43, 134) µg/L, median breast milk iodine concentration was 59 (39, 109) µg/L, and median serum thyroglobulin at 11.4 (8.6, 18.6) µg/L, indicating iodine deficiency. Median plasma selenium concentration was 105.8 (95.6, 115.3) µg/L. Women with marginally lower plasma selenium concentration were 1.12% times more likely to have abnormal TSH concentrations (p = .001). CONCLUSIONS: There was a high prevalence of thyroid dysfunction. Plasma selenium concentration was the only significant predictor of the likelihood that women had thyroid dysfunction within this cohort, who were iodine deficient and mostly had adequate iron status. Strategies are required to improve both iodine and selenium status to better support maternal thyroid function.

An empirical study of factors associated with height-for-age z-scores of children aged 6-23 months in northwest Rwanda: the role of care practices related to child feeding and health.

We aimed to identify the factors influencing child height-for-age z-scores (HAZ) as a measure of child nutritional status in Rwanda, and to examine the role of child feeding and health practices. We conducted a cross-sectional study involving 379 children (aged 6-23 months) and their mothers in northwest Rwanda. Data were collected using a pre-tested, structured questionnaire. An infant and young child feeding practices index (ICFI) and health practices index (HPI) were developed and categorised into tertiles, and linear regression analyses were performed to assess their association with child HAZ. Overall, mothers of non-stunted children exhibited better feeding and health practices than those of stunted children. ICFI was positively associated with child HAZ. We found an adjusted mean HAZ difference of 0·14 between children whose mothers were in high ICFI tertile compared with those in low tertile. Neither HPI nor any of its components were significantly associated with child HAZ. Other factors that were positively associated with child HAZ were infant birth weight (P < 0·001) and maternal height (P < 0·001). Child age, sex (male) (P < 0·05) and altitude (P < 0·05) were negatively associated with child HAZ. Diarrhoea (P < 0·05) and respiratory infections (P < 0·05) were negatively associated with HAZ in younger children aged 6-11 months. Policies to reduce stunting in this population must focus on both pre- and postnatal factors. Appropriate child feeding practices, particularly breast-feeding promotion and improvement in children's dietary diversity combined with measures to control infections should be given priority.

A qualitative analysis of infant and young child feeding practices in rural Rwanda.

OBJECTIVE: To explore and gain an in-depth understanding of the factors influencing child feeding practices among rural caregivers in Rwanda. DESIGN: In-depth semi-structured qualitative interviews were conducted. Purposive sampling was used to recruit participants. Interviews were audio-recorded, transcribed verbatim and coded. Data were analysed inductively using thematic analysis. SETTING: Rutsiro District, Western Province, Rwanda. PARTICIPANTS: Participants included twenty-four mothers (median age 32 years) with children 6-23 months old. RESULTS: We identified five key themes: (i) breast-feeding practices and role in food supply; (ii) family v. children's food preparations; (iii) food classification systems and their influence on child feeding decisions; (iv) child feeding during diarrhoeal episodes and (v) influence of poverty on child feeding practices and child care. CONCLUSIONS: Mothers' infant and young child feeding decisions are informed by information both from health workers and from traditional/own knowledge. Navigating through this information sometimes creates conflicts which results in less than optimal child feeding. A nutrition educational approach that is cognisant of maternal perceptions should be employed to improve child feeding practices. Efforts to improve child feeding practices must be complemented by programmes that enhance household economic opportunities and access to foods.

Setting Better-Informed Climate Targets for New Zealand: The Influence of Value and Modeling Choices.

Quantifying greenhouse gas (GHG) emissions and setting GHG emissions budgets for anthropogenic systems are influenced by several value and modeling choices. This study, for the first time, quantified the influence of choice of GHG accounting approach, GHG metric, time horizon, climate threshold, global emissions budget calculation method, and effort-sharing approach, taking New Zealand (NZ) as a case study. First, NZ's production- and consumption-based emissions were quantified using multiregional input-output analysis and applying different GHG metrics (global warming and temperature potentials) and time horizons (20 and 100 years). Second, global emissions budgets for 1.5 °C, 2 °C, and 1 W m-2 climate thresholds were estimated. Budget shares were then assigned to NZ using two effort-sharing approaches (grandfathering and economic value), and emissions were benchmarked against the assigned shares. Finally, the analysis was undertaken at the NZ sector level. The results showed that, for each GHG accounting approach, NZ's total emissions exceeded their budget shares, irrespective of the choices; the largest source of uncertainty was the choice of global emissions budget calculation method, followed by GHG metric, climate threshold, effort-sharing approach, and reference year for the grandfathering approach. The sector-level analysis showed that, while most sectors exceeded their budget shares, some performed within them. The ranking of uncertainty sources was quite different at the sector level, with the choice of effort-sharing approach providing the largest source of uncertainty. Overall, the study indicates the importance of handling value and modeling choices in a transparent way when quantifying GHG emissions and setting emissions budgets for anthropogenic systems.