A systematic review on estimating population attributable fraction for risk factors for small-for-gestational-age births in 81 low- and middle-income countries.

Background: Small for gestational age (SGA) is a public health concern since it is associated with mortality in neonatal and post-neonatal period. Despite the large magnitude of the problem, little is known about the population-attributable risk (PAR) of various risk factors for SGA. This study estimated the relative contribution of risk factors for SGA, as a basis for identifying priority areas for developing and/or implementing interventions to reduce the incidence of SGA births and related mortality and morbidity. Methods: We conducted a literature review on 63 potential risk factors for SGA to quantify the risk relationship and estimate the prevalence of risk factors (RFs). We calculated the population-attributable fraction for each of the identified RF for 81 Countdown countries and calculated regional estimates. Twenty-five RFs were included in the final model while extended model included all the 25 RFs from the final model and two additional RFs. Results: In the final and extended models, the RFs included in each model have a total PAF equal to 63.97% and 69.66%, respectively of SGA across the 81 LMICs. In the extended model, maternal nutritional status has the greatest PAF (28.15%), followed by environmental and other exposures during pregnancy (15.82%), pregnancy history (11.01%), and general health issues or morbidity (10.34%). The RFs included in the final and extended model for Sub-Saharan African (SSA) region have a total PAF of 63.28% and 65.72% of SGA, respectively. In SSA, the top three RF categories in the extended model are nutrition (25.05%), environment and other exposure (13.01%), and general health issues or morbidity (10.72%), while in South-Asia's it was nutrition (30.56%), environment and other exposure (15.27%) and pregnancy history (11.68%). Conclusions: The various types of RFs that play a role in SGA births highlight the importance of a multifaceted approach to tackle SGA. Depending on the types of RFs, intervention should be strategically targeted at either individual or household and/or community or policy level. There is also a need to research the mechanisms by which some of the RFs might hinder fetal growth.

Population attributable fractions for risk factors for spontaneous preterm births in 81 low- and middle-income countries: A systematic analysis.

Background: Complications associated with preterm birth (PTB) are the largest contributor to under-five mortality globally. Success in reaching the Sustainable Development Goal target requires identifying potentially modifiable risk factors for PTB, estimating the relative importance of these risk factors, and identifying/implementing effective prevention strategies to address them. Methods: We conducted a literature review to define risk relationships and estimate prevalence for established risk factors for spontaneous PTB (sPTB). We then estimated population attributable fractions (PAF) for the sPTB risk factors identified in the review as statistically significant for the 81 low- and middle-income (LMIC) countries included in the Countdown 2030 initiative. We summed country-level findings to produce PAFs for each risk factor and regional estimates for sub-Saharan Africa and South Asia. Results: Forty-four potential sPTB risk factors were identified. and the final analysis included twenty-four risk factors with evidence of significant associations with sPTB. A second model with three additional risk factors with borderline insignificant associations was also run. Taken together, the twenty-four risk factors had a total PAF of 73% for all 81 countries and 77% and 72% of sPTB in sub-Saharan Africa and South Asia, respectively. For all countries, maternal undernutrition had the highest PAF (17.5%), followed by maternal infections (16.6%), environmental exposures (16%) and pregnancy history (8.7%). Conclusions: While multiple risk factors contribute to sPTB, no single risk factor addresses a predominant fraction, and 27% of spontaneous preterm births are not associated with risk factors that we identified. Despite the significant role of preterm birth in child survival, there are major data gaps in LMIC settings. Furthermore, there is a paucity of evidence for effective interventions to prevent preterm birth. Preventing sPTB requires understanding underlying mechanisms leading to sPTB in different populations, and the identification/implementation of effective interventions.

Consumption of animal source foods, especially fish, is associated with better nutritional status among women of reproductive age in rural Bangladesh.

In rural Bangladesh, intake of nutrient-rich foods, such as animal source foods (ASFs), is generally suboptimal. Diets low in nutrients and lacking in diversity put women of reproductive age (WRA) at risk of malnutrition as well as adverse birth outcomes. The objective of this study was to assess the relationship between maternal dietary diversity, consumption of specific food groups and markers of nutritional status, including underweight [body mass index (BMI) < 18.5 kg/m2 ], overweight (BMI ≥ 23 kg/m2 ) and anaemia (haemoglobin < 120 g/dl) among WRA in Bangladesh. This analysis used data from the third round of a longitudinal observational study, collected from February through May of 2017. Dietary data were collected with a questionnaire, and Women's Dietary Diversity Score (WDDS) was calculated. Associations between WDDS, food group consumption and markers of nutritional status were assessed with separate adjusted logistic regression models. Among WRA, the prevalence of underweight, overweight and anaemia was 13.38%, 40.94% and 39.99%, respectively. Women who consumed dark green leafy vegetables (DGLV) or eggs were less likely to be anaemic or underweight, respectively, and women who consumed ASFs, particularly fish, were less likely to be underweight compared with women who did not consume these foods. WDDS did not show any consistent relationship with WRA outcomes. Interventions that focus on promoting optimal nutritional status among WRA in Bangladesh should emphasise increasing consumption of specific nutrient-rich foods, including ASFs, DGLV and eggs, rather than solely focusing on improving diet diversity in general.

Sustained intake of animal-sourced foods is associated with less stunting in young children.

The value of animal-sourced foods (ASFs) in providing key nutrients, particularly for child growth and where diets are of low quality, is understood mainly from cross-sectional assessment of current consumption. Longitudinal panel data from Nepal, Bangladesh and Uganda were used here to assess associations among previous (lagged) and contemporaneous ASF intake with linear growth of children aged 6-24 months. Lagged ASF consumption was significantly correlated with a 10% decline in stunting in Nepali children who consumed any ASF in the previous year, while current intake was associated with a 9% decline in stunting in Uganda. Previous consumption of two or more ASFs showed a stronger association, ranging from a 10% decline in stunting in Bangladesh to a 16% decline in Nepal. This novel lagged analysis emphasizes the need for regular and appropriate levels of ASF intake by young children to support healthy growth in resource-constrained settings.

Household Engagement in Both Aquaculture and Horticulture Is Associated with Higher Diet Quality than Either Alone.

The consumption of high-quality diverse diets is crucial for optimal growth, health, and wellbeing. OBJECTIVE: This study assessed the diet quality of households by their type of engagement in homestead aquaculture and/or horticulture. Socio-demographic determinants of diet quality were also studied. METHOD: Diet quality was assessed using a nutrient adequacy ratio (NAR), based on the preceding 7 days' dietary recall at the household level. Adult male equivalent units (AMEs) were used for age- and sex-specific intra-household distribution of household intakes. Mean adequacy ratios (MAR) were computed as an overall measure of diet quality, using NAR. RESULTS: Better diet quality (mean ± SD) was associated with households engaged in both homestead aquaculture and horticulture (0.43 ± 0.23; p < 0.001) compared to only one type of agriculture (0.38 ± 0.20) or none (0.36 ± 0.20). Tukey's post-hoc test confirmed significant differences in diet quality between both and either engagement (0.05 ± 0.01, p < 0.001), both and no engagement (0.07 ± 0.01, p < 0.001), and either and no engagement households (0.02 ± 0.01, p < 0.001). Beyond farm production of nutrient-rich foods, generalized estimating equations showed that diet quality was influenced by the higher educational level and occupation of adult household members, higher daily per capita food expenditure, sex, family size and region. CONCLUSIONS: Projects that promote and support household engagement in both homestead aquaculture and horticulture have the potential to improve the diet quality of households.

Measuring Nutrition Governance: An Analysis of Commitment, Capability, and Collaboration in Nepal.

BACKGROUND: Global commitments to nutrition have supported calls for better evidence to support effective investments at national level. However, too little attention has so far been paid to the role of governance in achieving impacts. OBJECTIVE: This article explores the ways by which the commitment and capabilities of policy implementers affect collaborative efforts for achieving nutrition goals. METHODS: Over 1370 structured interviews were held with government and nongovernment officials over 3 years in 21 districts. Coded responses supported quantitative analysis of stakeholders' knowledge, attitudes, and practices regarding policy implementation. RESULTS: Stakeholder commitment was already high in 2013 when a new national policy was adopted, but capabilities were weak. Only one-third of interviewed respondents had any nutrition training. Rollout of training focusing on districts targeted for early implementation of multisector programming. This raised levels of nutrition training among interviewed respondents to 57% in 2015, which raised demand for technical information to support actions. Better understanding of the complexity of cross-sector work led to calls for higher budgets and more effective cross-sectoral collaboration. CONCLUSION: Nepal offers an example of effective efforts to improve nutrition governance across sectors at all levels of administration. The promotion of awareness, capacity, and new ways of working shows promise. Trainings, information sharing, and management support led to growing willingness among civil servants to engage across sectors. Structured surveys offer a viable way to track change across institutions and sectors.