Birth outcomes in relation to neighborhood food access and individual food insecurity during pregnancy in the Environmental Influences on Child Health Outcomes (ECHO)-wide cohort study.

BACKGROUND: Limited access to healthy foods, resulting from residence in neighborhoods with low-food access or from household food insecurity, is a public health concern. Contributions of these measures during pregnancy to birth outcomes remain understudied. OBJECTIVES: We examined associations between neighborhood food access and individual food insecurity during pregnancy with birth outcomes. METHODS: We used data from 53 cohorts participating in the nationwide Environmental Influences on Child Health Outcomes-Wide Cohort Study. Participant inclusion required a geocoded residential address or response to a food insecurity question during pregnancy and information on birth outcomes. Exposures include low-income-low-food-access (LILA, where the nearest supermarket is >0.5 miles for urban or >10 miles for rural areas) or low-income-low-vehicle-access (LILV, where few households have a vehicle and >0.5 miles from the nearest supermarket) neighborhoods and individual food insecurity. Mixed-effects models estimated associations with birth outcomes, adjusting for socioeconomic and pregnancy characteristics. RESULTS: Among 22,206 pregnant participants (mean age 30.4 y) with neighborhood food access data, 24.1% resided in LILA neighborhoods and 13.6% in LILV neighborhoods. Of 1630 pregnant participants with individual-level food insecurity data (mean age 29.7 y), 8.0% experienced food insecurity. Residence in LILA (compared with non-LILA) neighborhoods was associated with lower birth weight [ß -44.3 g; 95% confidence interval (CI): -62.9, -25.6], lower birth weight-for-gestational-age z-score (-0.09 SD units; -0.12, -0.05), higher odds of small-for-gestational-age [odds ratio (OR) 1.15; 95% CI: 1.00, 1.33], and lower odds of large-for-gestational-age (0.85; 95% CI: 0.77, 0.94). Similar findings were observed for residence in LILV neighborhoods. No associations of individual food insecurity with birth outcomes were observed. CONCLUSIONS: Residence in LILA or LILV neighborhoods during pregnancy is associated with adverse birth outcomes. These findings highlight the need for future studies examining whether investing in neighborhood resources to improve food access during pregnancy would promote equitable birth outcomes.

Exclusive breastfeeding during the 40-day rest period and at six months in Lebanon: a cross-sectional study.

BACKGROUND: Exclusive breastfeeding is recommended for the first 6 months of life with well-established benefits to the mother and child. The traditional practice of the 40-day rest period helps establish and maintain exclusive breastfeeding. This study aims to estimate the prevalence and examine the factors associated with exclusive breastfeeding at 40 days and at 6 months in Lebanon. METHODS: A cross-sectional survey was conducted in 2011-2012 as part of the "Early Life Nutrition and Health in Lebanon" study. A nationally representative sample of 1005 children aged five years or younger and their mothers was drawn from households using a stratified cluster sampling design. Trained nutritionists interviewed eligible mothers about sociodemographic characteristics of the household and maternal and child characteristics including infant feeding practices. Anthropometric measurements of the mother and child were collected. Multinomial logistic regression analysis was conducted to examine the characteristics associated with exclusive breastfeeding. RESULTS: The prevalence of exclusive breastfeeding was 41.5% at 40 days and 12.3% at 6 months. Children in families with three or more children had higher odds of exclusive breastfeeding for 40 days (Adjusted Odds Ratio [AOR] 1.76, 95% Confidence Interval [CI] 1.19, 2.60). Children in families owning two or more cars had lower odds of exclusive breastfeeding for 40 days (AOR 0.45, 95% CI 0.24, 0.83) and at 6 months (AOR 0.32, 95% CI 0.14, 0.77). Similarly, children delivered via Caesarian section had lower odds of exclusive breastfeeding for 40 days (AOR 0.49, 95% CI 0.34, 0.71) and at 6 months (AOR 0.39, 95% CI 0.24, 0.65). The odds of exclusive breastfeeding for 6 months were lower among children of overweight (AOR 0.50, 95% CI 0.26, 0.95) or obese (AOR 0.56, 95% CI 0.32, 0.98) mothers. CONCLUSIONS: The association between higher socio-economic status, as reflected by car ownership, and C-section delivery with lower odds of exclusive breastfeeding persisted across the first 6 months in Lebanon. Future research should investigate the factors associated with exclusive breastfeeding in prospective cohort studies and help to better understand the cultural practice of the 40-day rest period in relation to breastfeeding.

Gender equity in planning, development and management of human resources for health: a scoping review.

BACKGROUND: Gender equity remains a challenge across various labor markets with the health market being no exception. Despite the increased influx of women into health professions, horizontal and vertical occupational gender inequities persist. MAIN BODY: The objective of this scoping review is to map the studies on gender equity in healthcare systems in terms of workforce planning, development, and management, as well as to identify the barriers and facilitators for integrating gender equity into healthcare systems. We reviewed the literature on the topic using nine electronic and two grey literature databases with the search strategy combining medical subheadings and keywords for each of the following four concepts of interest: "gender equity," "human resources for health," "healthcare setting," and "management processes." The scoping review included studies focusing on the examination of gender equity at the level of the health workforce. Out of 20,242 studies identified through the database search, the full text of 367 articles was assessed for eligibility and 110 were included in the qualitative analysis. The data of those studies was abstracted and analyzed into themes. Results do not only reveal a global dearth of studies focused on this important topic, but also the concentration of such studies in a few countries around the globe, mainly in North America and Europe. Four out of each five studies included in this review focused on physicians, followed by nurses (14%). In terms of design, an overwhelming majority of studies utilized quantitative designs (75%), followed by qualitative designs and database analyses. Studies were categorized into four pre-determined main themes: facilitators and barriers, workforce planning, HRH management, and HRH development. CONCLUSION: Future research is needed to better understand poorly covered sub-themes such as mentorship, professional development, and training, as well as recruitment and retention among others. It is also equally needed to fill in the gaps in professional groups, study type, methodology, and region. While the review unearthed a number of well-studied themes, significant aspects of the topic remain untapped especially in developing countries and at the level of health professionals other than physicians.