What the percentage of births in facilities does not measure: readiness for emergency obstetric care and referral in Senegal.

Introduction: Increases in facility deliveries in sub-Saharan Africa have not yielded expected declines in maternal mortality, raising concerns about the quality of care provided in facilities. The readiness of facilities at different health system levels to provide both emergency obstetric and newborn care (EmONC) as well as referral is unknown. We describe this combined readiness by facility level and region in Senegal. Methods: For this cross-sectional study, we used data from nine Demographic and Health Surveys between 1992 and 2017 in Senegal to describe trends in location of births over time. We used data from the 2017 Service Provision Assessment to describe EmONC and emergency referral readiness across facility levels in the public system, where 94% of facility births occur. A national global positioning system facility census was used to map access from lower-level facilities to the nearest facility performing caesareans. Results: Births in facilities increased from 47% in 1992 to 80% in 2016, driven by births in lower-level health posts, where half of facility births now occur. Caesarean rates in rural areas more than doubled but only to 3.7%, indicating minor improvements in EmONC access. Only 9% of health posts had full readiness for basic EmONC, and 62% had adequate referral readiness (vehicle on-site or telephone and vehicle access elsewhere). Although public facilities accounted for three-quarters of all births in 2016, only 16% of such births occurred in facilities able to provide adequate combined readiness for EmONC and referral. Conclusions: Our findings imply that many lower-level public facilities-the most common place of birth in Senegal-are unable to treat or refer women with obstetric complications, especially in rural areas. In light of rising lower-level facility births in Senegal and elsewhere, improvements in EmONC and referral readiness are urgently needed to accelerate reductions in maternal and perinatal mortality.

When does family size matter? Sibship size, socioeconomic status and education in England.

There is still no clear understanding of the relationship between sibship size and child outcomes. Research from across disciplines, and across settings, reports conflicting results suggesting that the relationship is complex and ecologically dependent. Evolutionary models predict that parents will make reproductive decisions based on their ability to invest in each child, but that this is not necessarily equal across children. Here we use data from the Next Steps study linked to National Pupil Database to examine the relationship between sibship size and Key Stage 4 (GCSE) maths and English grades in England for children born in 1989/1990. We were interested to further examine if and how associations might differ at the ends of the socioeconomic spectrum and we also tested if direct measures of parental investment could mitigate any negative impact of larger families. Multilevel ordinary least squares regression models with a random effect for school show that sibship sizes are associated with school grades, as is socioeconomic status. Moreover, the association between sibship size and grades holds true across the socioeconomic spectrum. Birth order was only weakly associated with school results, and only significant in some models. Parental investment is important, however, and might offset the some of the negative impact of larger families, for both maths and English attainment.

Using sequence analysis to test if human life histories are coherent strategies.

Life history theory, a prominent ecological model in biology, is widely used in the human sciences to make predictions about human behaviour. However, its principal assumptions have not been empirically tested. We address this gap with three research questions: (1) do humans exhibit coherent life history strategies; (2) do individuals adopt strategies along a slow-fast continuum; and (3) are socioeconomic circumstances during childhood associated with the pace of the life history strategy that an individual adopts? Data from the Wisconsin Longitudinal Study is used to reconstruct the life histories of US women including information on puberty, fertility, menopause and death. We introduce a novel methodological approach to evolutionary anthropology, sequence analysis, to assess if human life histories are coherent strategies and how these strategies are patterned. In subsequent analyses we used multinomial logistic regressions to test whether childhood socioeconomic status predicts the life history patterns women follow. Results provide little evidence that humans follow coherent life-history strategies; Wisconsin women are clustered by the number of children they have but not by ages at life events. Socioeconomic status does not predict which cluster women fall into, suggesting that less well-off women do not have higher fertility, as predicted.

Cross-cultural evidence does not support universal acceleration of puberty in father-absent households.

Father absence in early life has been shown to be associated with accelerated reproductive development in girls. Evolutionary social scientists have proposed several adaptive hypotheses for this finding. Though there is variation in the detail of these hypotheses, they all assume that family environment in early life influences the development of life-history strategy, and, broadly, that early reproductive development is an adaptive response to father absence. Empirical evidence to support these hypotheses, however, has been derived from WEIRD (Western, Educated, Industrialized, Rich and Democratic) populations. Data from a much broader range of human societies are necessary in order to properly test adaptive hypotheses. Here, we review the empirical literature on father absence and puberty in both sexes, focusing on recent studies that have tested this association beyond the WEIRD world. We find that relationships between father absence and age at puberty are more varied in contexts beyond WEIRD societies, and when relationships beyond the father-daughter dyad are considered. This has implications for our understanding of how early-life environment is linked to life-history strategies, and for our understanding of pathways to adult health outcomes, given that early reproductive development may be linked to negative health outcomes in later life This article is part of the theme issue 'Developing differences: early-life effects and evolutionary medicine'.

Does community-based point of care HIV testing reduce late HIV diagnosis? A retrospective study in England and Wales.

The objective of this study was to investigate if patients diagnosed in community clinics have higher baseline CD4 cell counts than those diagnosed in Genitourinary medicine (GUM)/HIV clinics. We undertook a retrospective review of baseline CD4 cell counts for patients receiving a reactive HIV test in community-testing clinics. Eleven local HIV clinics were contacted to determine the baseline CD4 cell counts of these patients. Baseline CD4 cell counts of those diagnosed in the community were compared with mean local GUM/HIV clinic and median national baseline CD4 cell count for their year of diagnosis. Clients diagnosed in community settings had a mean baseline CD4 cell count of 481 cells/mm3 (SD 236 cells/mm3) and median baseline of 483 cells/mm3 (interquartile range 311-657 cells/mm3). This was significantly higher than those diagnosed in the GUM/HIV clinic local to the community-testing site (mean baseline CD4 397 cells/mm3, p = 0.014) and the national median for that year (336 cells/mm3, p < 0.001). HIV testing in community settings identifies patients at an earlier stage of infection than testing in clinical settings.

Do grandparents compete with or support their grandchildren? In Guatemala, paternal grandmothers may compete, and maternal grandmothers may cooperate.

Previous research has found that the presence of grandparents, particularly grandmothers, is often positively associated with child survival. Little research has explored the potential mechanisms driving these associations. We use data from rural Guatemala to test whether contact with and direct investment (advice and financial) from grandparents is associated with child health, proxied by height. Our results demonstrate the complexity of family relationships and their influence on child health, suggesting that both cooperative and competitive relationships exist within the family. The clearest evidence we find for grandparental influence is that having a living paternal grandmother tends to be negatively associated with child height. By contrast, contact with maternal kin appears broadly to be beneficial for child height, although these relationships are weaker. These patterns are mirrored in maternal body mass index, suggesting grandparental influence acts partly through maternal health. These findings support the hypotheses that, under conditions of limited resources, family relationships may be competitive within the family lineage which shares the same resource base, but cooperative when there are few costs to cooperation. Finally, financial assistance from maternal grandfathers is positively correlated with infant length but negatively with the height of older children, perhaps because the receipt of financial support is an indication of need. The provision of advice shows no associations with child height.

How does childhood socioeconomic hardship affect reproductive strategy? Pathways of development.

OBJECTIVES: In high-income populations, evidence suggests that socioeconomic disadvantage early in life is correlated with reproductive strategy. Children growing up in unfavorable rearing environments tend to experience earlier sexual maturity and first births. Earlier first births may be associated with higher fertility, but links between socioeconomic disadvantage and larger family size have rarely been tested. The pathways through which early disadvantage influences reproduction are unknown. We test whether physiological factors link childhood adversity to age at first birth and total children. METHODS: Using data from the Newcastle Thousand Families Study, a 1947 British birth cohort, we developed path models to identify possible physiological traits linking childhood socioeconomic status, and poor housing standards, to two reproductive outcomes: age at first birth and total children. We explored birth weight, weight gain after birth, childhood illnesses, body mass index at age 9, age at menarche, and adult height as possible mediators. RESULTS: We found direct, negative effects of socioeconomic status (SES) and housing on age at first birth, and of housing on fertility. Although we found links between childhood disadvantage and menarche and height, neither of these were significantly correlated with either reproductive outcome. Age at first birth completely mediates the relationship between childhood adversity and total fertility, which we believe has not been empirically demonstrated before. CONCLUSIONS: While there are some links between childhood adversity and child health, we find little evidence that physiological pathways, such as child health and growth, link early childhood adversity to reproductive outcomes in this relatively well-nourished population. Am. J. Hum. Biol. 28:356-363, 2016. © 2015 The Authors American Journal of Human Biology Published by Wiley Periodicals, Inc.

Childhood family disruption and adult height: is there a mediating role of puberty?

BACKGROUND AND OBJECTIVES: Childhood family background is known to be associated with child growth and development, including the onset of puberty, but less is known about the influence of childhood family disruption on outcomes in later life. Given the associations between early family disruption and childhood development, we predicted that there may be long-term health-relevant consequences of childhood disruption. METHODOLOGY: Using data from a large US interview sample (n = 16 207), we test if death or divorce of parents, at different childhood periods, was associated with adult stature, and whether age at puberty mediated this relationship, for men and women. RESULTS MEN: : parental death and divorce during early childhood was associated with shorter adult height, and later puberty. Later puberty was associated with shorter adult height. Path analyses demonstrated that the relationship between parental divorce and height was completely mediated by age at puberty; although parental death was only partially mediated by age at puberty. WOMEN: the father's death during early childhood was associated with earlier puberty, which was in turn associated with shorter adult stature. The relationship between paternal death and height is entirely mediated by age at puberty; no evidence of a direct relationship between childhood family disruption and adult height. CONCLUSIONS: Early childhood familial disruption is associated with shorter height for men, and is partially mediated by later puberty. For women, the relationship between father's death, and height was completely mediated by earlier puberty. These findings indicate that disruption during childhood can have long-reaching health repercussions, particularly for boys.

Father absence and reproduction-related outcomes in Malaysia, a transitional fertility population.

Father absence is consistently associated with children's reproductive outcomes in industrialized countries. It has been suggested that father absence acts as a cue to particular environmental conditions that influence life history strategies. Much less is known, however, about the effects of father absence on such outcomes in lower-income countries. Using data from the 1988 Malaysian Family Life Survey (n = 567), we tested the effect of father absence on daughters' age at menarche, first marriage, and first birth; parity progression rates; and desired completed family size in Malaysia, a country undergoing an economic and fertility transition. Father absence during later childhood (ages 8 to 15), although not during earlier childhood, was associated with earlier progressions to first marriage and first birth, after controlling for other confounders. Father absence does not affect age at menarche, desired family size, or progression from first to second birth. The patterns found in this transitional population partly mirror those in developed societies, where father absence accelerates reproductive events. There is, however, a notable contrast between the acceleration in menarche for father-absent girls consistently found in developed societies and the lack of any association in our findings. The mechanisms through which father absence affects reproduction may differ in different ecological contexts. In lower-income contexts, direct paternal investment or influence may be of more importance in determining reproductive behavior than whether fathers act as a cue to environmental conditions.

A not-so-grim tale: how childhood family structure influences reproductive and risk-taking outcomes in a historical U.S. Population.

Childhood family structure has been shown to play an important role in shaping a child's life course development, especially in industrialised societies. One hypothesis which could explain such findings is that parental investment is likely to be diluted in families without both natural parents. Most empirical studies have examined the influence of only one type of family disruption or composition (e.g. father absence) making it difficult to simultaneously compare the effects of different kinds of family structure on children's future outcomes. Here we use a large, rich data source (n=16,207) collected by Alfred Kinsey and colleagues in the United States from 1938 to 1963, to examine the effects of particular childhood family compositions and compare between them. The dataset further allows us to look at the effects of family structure on an array of traits relating to sexual maturity, reproduction, and risk-taking. Our results show that, for both sexes, living with a single mother or mother and stepfather during childhood was often associated with faster progression to life history events and greater propensity for risk-taking behaviours. However, living with a single father or father and stepmother was typically not significantly different to having both natural parents for these outcomes. Our results withstand adjustment for socioeconomic status, age, ethnicity, age at puberty (where applicable), and sibling configuration. While these results support the hypothesis that early family environment influences subsequent reproductive strategy, the different responses to the presence or absence of different parental figures in the household rearing environment suggests that particular family constructions exert independent influences on childhood outcomes. Our results suggest that father-absent households (i.e. single mothers or mothers and stepfathers) are most highly associated with subsequent fast life history progressions, compared with mother-absent households, and those with two natural parents.

Father absence predicts age at sexual maturity and reproductive timing in British men.

Despite the widespread assumption that paternal investment is substantial in our species, previous studies have shown mixed results in relation to the impact of fathers on both offspring survival and reproductive outcomes. Using data from a large representative sample of British men, we tested whether father absence is associated with the timing of reproduction-related events among boys, while controlling for various cues denoting early childhood adversity. We further tested whether the loss of the father at different childhood stages matters, so as to assess whether early life is the most important period or if effects can be seen during later childhood. The results show that father absence before age seven is associated with early reproduction, while father absence between ages 11 and 16 only is associated with delayed voice-breaking (a proxy for puberty), even after adjusting for other factors denoting childhood adversity. We conclude that fathers do exert an influence on male reproductive outcomes, independently of other childhood adversities and that these effects are sensitive to the timing of father absence.