RESUMO
BACKGROUND: Causes of infant linear growth faltering in low-income settings remain poorly understood. Identifying age-specific risk factors in observational studies might be influenced by statistical model selection. OBJECTIVES: To estimate associations of selected household factors and infant feeding behaviors within discrete age intervals with interval-specific changes in length-for-age z-scores (LAZs) or attained LAZ, using 5 statistical approaches. METHODS: Data from a birth cohort in Dhaka, Bangladesh (n = 1157) were analyzed. Multivariable-adjusted associations of infant feeding patterns or household factors with conditional LAZ (cLAZ) were estimated for 5 intervals in infancy. Two alternative approaches were used to estimate differences in interval changes in LAZ, and differences in end-interval attained LAZ and RRs of stunting (LAZ < -2) were estimated. RESULTS: LAZ was symmetrically distributed with mean ± SD = -0.95 ± 1.02 at birth and -1.00 ± 1.04 at 12 mo. Compared with exclusively breastfed infants, partial breastfeeding (difference in cLAZ: -0.11; 95% CI: -0.20, -0.02) or no breastfeeding (-0.30; 95% CI: -0.54, -0.07) were associated with slower growth from 0 to 3 mo. However, associations were not sustained beyond 6 mo. Modifiable household factors (smoking, water treatment, soap at handwashing station) were not associated with infant growth, attained size, or stunting. Alternative statistical approaches yielded mostly similar results as conditional growth models. CONCLUSIONS: The entire infant LAZ distribution was shifted down, indicating that length deficits were mostly caused by ubiquitous or community-level factors. Early-infant feeding practices explained minimal variation in early growth, and associations were not sustained to 12 mo of age. Statistical model choice did not substantially alter the conclusions. Modifications of household hygiene, smoking, or early infant feeding practices would be unlikely to improve infant linear growth in Bangladesh or other settings where growth faltering is widespread.
RESUMO
Refugees have health needs relating to unstable living situations and poor access to care. We examined the nature of health problems requiring gynaecological referrals for refugee women in Toronto. A retrospective cohort design was used to examine gynaecologic referrals of women at a refugee clinic between December, 2011 and June, 2016. The primary outcome measure was the indications for gynaecological referral. 125 out of 1040 women received a gynaecologic referral for 131 unique concerns. The most common referrals were for abnormal uterine bleeding and cervical dysplasia. Fibroids were prevalent amongst African patients, while referrals for LARCs/sterilization were absent from Middle Eastern patients. 26% of patients referred had a sexual violence history. Refugee women exhibit gynaecologic needs similar to the broader population. Needs vary by geographic origins. As global conflicts shift, so too will this population's needs. High rates of sexual violence history reflect the need for further understanding and intervention.