Is child anemia associated with early childhood development? A cross-sectional analysis of nine Demographic and Health Surveys.

Anemia is a significant public health problem in many low- and middle-income countries (LMICs), with young children being especially vulnerable. Iron deficiency is a leading cause of anemia and prior studies have shown associations between low iron status/iron deficiency anemia and poor child development outcomes. In LMICs, 43% of children under the age of five years are at risk of not meeting their developmental potential. However, few studies have examined associations between anemia status and early childhood development (ECD) in large population-based surveys. We examined the associations between severe or moderate anemia and ECD domains (literacy-numeracy, physical, social-emotional, and learning) and an overall ECD index among children age 36-59 months. Nine Demographic and Health Surveys (DHS) from phase VII of The DHS Program (DHS-7) that included the ECD module and hemoglobin testing in children under age five years were used. Bivariate and multivariate logistic regressions were run for each of the five outcomes. Multivariate models controlled for early learning/interaction variables, child, maternal, and paternal characteristics, and socio-economic and household characteristics. Results showed almost no significant associations between anemia and ECD domains or the overall ECD index except for social-emotional development in Benin (AOR = 1.00 p < 0.05) and physical development in Maldives (AORs = 0.97 p < 0.05). Attendance at an early childhood education program was also significantly associated with the outcomes in many of the countries. Our findings reinforce the importance of the Nurturing Care Framework which describes a multi-sectoral approach to promote ECD in LMICs.

Estimating the prevalence of exclusive breastfeeding with data from household surveys: Measurement issues and options.

The importance of breastfeeding for infant and maternal health is well established. The World Health Organization recommends that all infants be exclusively breastfed until they reach 6 months of age. The standard indicator to measure adherence to this criterion is the percentage of children aged 0-5 months who are currently being exclusively breastfed. This paper proposes supplementary measures that are easily calculated with existing survey data. First, for an accurate assessment of the WHO recommendation, we estimate the percentage of infants who are being exclusively breastfed at the exact age of 6 months. Second, an adjustment is proposed for prelacteal feeding. These two modifications, separately and in combination, are applied to data from 31 low-and middle-income countries that have participated in the Demographic and Health Surveys Program since 2015. There is considerable variation in the effects across countries. The modifications use existing data to provide a more accurate estimate than the standard indicator of the achievement of the exclusive breastfeeding until 6 months recommendation.

Exclusive breastfeeding: aligning the indicator with the goal.

While the global objective is exclusive breastfeeding (EBF) for a full 6 months duration, the standard indicator is a "prevalence" indicator, that is, the percentage of all children under age 6 months who are exclusively breastfed at a point in time. That yields a higher percentage than a more direct indicator of duration and can be easily misunderstood, exaggerating the amount of EBF. A measurement of actual percentage of children exclusively breastfeeding for a full 6 months can be easily calculated from standard DHS and MICS data.

Deaths of clients in methadone treatment in Texas: 1994-2002.

This study analyzes causes of deaths of 766 patients who died while in methadone treatment in Texas between 1994 and 2002. Compared with deaths in the general population of Texas, deaths of clients in methadone treatment were 4.6 times more likely to be from a drug overdose, 3.4 times more likely to be from liver disease, 1.7 times more likely to be from a respiratory disease, 1.5 times more likely to be from a homicide and 1.4 times more likely to be from AIDS, but less likely to be from suicide, motor vehicle accidents, cardiovascular diseases or cancer. Of the clients, 20% died of liver disease, 18% of cardiovascular disease and 14% of drug overdose. An older cohort had been in treatment longer, had more take-homes, were on higher doses and tended to die of chronic diseases. A younger cohort tended to die from traumas, including drug overdose. Time in treatment was 43.3 months; mean daily dose was 77.3mg; number of days/month dosed in the clinic was 13.9. Given these rates, the scope of services should include on-site treatment for other medical conditions and staff should be educated about and counsel about the risk of death for new patients.