Socio-economic inequalities in the effect of public policies and the COVID-19 pandemic on exclusive breastfeeding in Chile.

OBJECTIVE: To assess the impact of the addition of 12 maternity leave (ML) weeks (2011), a pay for performance (P4P) exclusive breastfeeding (EBF) promotion strategy (2015), and the COVID-19 pandemic in EBF inequalities in Chile. STUDY DESIGN: Interrupted time-series analyses (ITSAs). METHODS: Aggregated national EBF data by municipality and month were collected from 2009 to 2020. We assess the impact of the three events in EBF inequalities using two procedures: 1. ITSA stratified by municipal SES quintiles (Q1-Q5); 2. Calculating the EBF slope index of inequality (SII). RESULTS: The EBF prevalence was higher in lower SES municipalities before and after the three time-events. No impact in EBF inequalities was observed after the extended ML. The P4P strategy increased EBF at six months in all SES quintiles (effect size between 4% and 5%), but in a higher level in poorer municipalities (SII: -0.36% and -1.05%). During COVID-19, wealthier municipalities showed a slightly higher EBF at six months prevalence (SII: 1.44%). CONCLUSION: The null impact of the extended ML in EBF inequalities could be explained by a low access to ML among affiliated to the public health system (20%). The P4P strategy includes multiple interventions that seemed effective in increasing EBF across all SES quintiles, but further in lower quintiles. The restrictions in healthcare access in poorer municipalities could explain EBF inequalities during COVID-19.

Trends in overweight among women differ by occupational class: results from 33 low- and middle-income countries in the period 1992-2009.

OBJECTIVE: There has been an increase in overweight among women in low- and middle-income countries but whether these trends differ for women in different occupations is unknown. We examined trends by occupational class among women from 33 low- and middle-income countries in four regions. DESIGN: Cross-national study with repeated cross-sectional demographic health surveys. SUBJECTS: Height and weight were assessed at least twice between 1992 and 2009 in 248,925 women aged 25-49 years. Interviews were conducted to assess occupational class, age, place of residence, educational level, household wealth index, parity, age at first birth and breastfeeding. We used logistic and linear regression analyses to assess the annual percent change in overweight (body mass index >25 kg m(-2)) by occupational class. RESULTS: The prevalence of overweight ranged from 2.2% in Nepal in 1992-1997 to 75% in Egypt in 2004-2009. In all the four regions, women working in agriculture had consistently lower prevalence of overweight, while women from professional, technical, managerial as well as clerical occupational classes had higher prevalence. Although the prevalence of overweight increased in all the occupational classes in most regions, women working in agriculture and production experienced the largest increase in overweight over the study period, while women in higher occupational classes experienced smaller increases. To illustrate, overweight increased annually by 0.5% in Latin America and the Caribbean and by 0.7% in Sub-Saharan Africa among women from professional, technical and managerial classes, as compared with 2.8% and 3.7%, respectively, among women in agriculture. CONCLUSION: The prevalence of overweight has increased in most low- and middle-income countries, but women working in agriculture and production have experienced larger increases than women in higher occupational classes.

Trends in overweight by educational level in 33 low- and middle-income countries: the role of parity, age at first birth and breastfeeding.

This study examined trends in overweight among women of reproductive age by educational level in 33 low- and middle-income countries, and estimated the contribution of parity, age at first birth and breastfeeding to these trends. We used repeated cross-sectional Demographic Health Surveys of 255,828 women aged 25-49 years interviewed between 1992 and 2009. We applied logistic regression to model overweight (>25 kg m(-2) ) as a function of education, reproductive variables and time period by country and region. The prevalence of overweight ranged from 3.4% in South and Southeast Asia to 73.7% in North Africa West/Central Asia during the study period. The association between education and overweight differed across regions. In North Africa West/Central Asia and Latin American, lower education was associated with higher overweight prevalence, while the inverse was true in South/Southeast Asia and Sub-Saharan Africa. In all regions, there was a consistent pattern of increasing overweight trends across all educational groups. Older age at first birth, longer breastfeeding and lower parity were associated with less overweight, for differences by educational level in overweight prevalence and trends.

Hemoglobin concentration is inversely associated with erythrocyte folate concentrations in Colombian school-age children, especially among children with low vitamin B12 status.

BACKGROUND: While the majority of cases of nutritional anemia in developing countries are caused by iron deficiency, other micronutrient deficiencies may also be involved. In Colombia, it was recently reported that 38% of school children were anemic; yet, the rate of iron deficiency was only 3.6%. OBJECTIVE: To determine if micronutrients other than iron were responsible for low hemoglobin concentrations in Colombian school children. METHODS: We examined hemoglobin concentrations in relation to plasma ferritin, vitamin A, vitamin B12, and erythrocyte folate levels in a representative sample of 2812 low- and middle-income children (5-12 years) from Bogotá, Colombia. RESULTS: In multivariate analysis, hemoglobin concentration was positively associated with child's age, mother's age, household's socioeconomic stratum, and family income. Low ferritin was related to 3.6 g/l lower hemoglobin concentration (95% confidence interval=-6.0, -1.3). Unexpectedly, we found an inverse trend in hemoglobin concentration by quartiles of erythrocyte folate; the adjusted hemoglobin concentration difference between the highest and lowest folate quartiles was -6.0 g/l (95% confidence interval=-7.2, -4.9; P for trend <0.0001). This difference was greatest among children with vitamin B12 concentration <148 pmol/l (-11.5 g/l), followed by children with vitamin B12 concentration 148-221 pmol/l (-7.7 g/l), and smallest in children with vitamin B12 concentration >221 pmol/l (-5.7 g/l); P for interaction=0.04. CONCLUSIONS: Hemoglobin concentration is inversely related to erythrocyte folate concentrations in a setting where folate fortification was adopted more than a decade ago. The impact of improving vitamin B12 status on this inverse relationship should be examined.