Sex differences in nutritional status of HIV-exposed children in Rwanda: a longitudinal study.

OBJECTIVE: To examine sex differences in nutritional status in relation to feeding practices over time in a cohort of HIV-exposed children participating in a complementary feeding programme in Rwanda. METHODS: We applied a longitudinal design with three measurements 2-3 months apart among infants participating in a complementary feeding programme who were 6-12 months old at baseline. Using early feeding practices and a composite infant and child feeding index (ICFI) as indicators of dietary patterns, we conducted a multivariate analysis using a cross-sectional time series to assess sex differences in nutritional status and to determine whether there was a link to discrepancies in dietary patterns. RESULTS: Among 222 boys and 258 girls, the mean (±SD) Z-score of stunting, wasting and underweight was -2.01 (±1.59), -0.15 (±1.46), -1.19 (±1.29) for boys; for girls they were -1.46 (±1.56), 0.22 (±1.29), -0.63 (±1.19); all sex differences in all three indicators were statistically significant (P < 0.001). However, there were only minor differences in early feeding practices and none in the ICFI by sex. CONCLUSIONS: HIV-exposed male children may be at higher risk of malnutrition in low-resource setting countries than their female counterparts. However, at least in a setting where complementary foods are being provided, explanations may lie outside the sphere of dietary patterns.

Influence of non-directional errors in anthropometric measurements and age estimation on anthropometric prevalence indicators.

Anthropometric prevalence indicators such as stunting, wasting, and underweight are widely-used population-level tools used to track trends in childhood nutrition. Threats to the validity of these data can lead to erroneous decision making and improper allocation of finite resources intended to support some of the world's most vulnerable populations. It has been demonstrated previously that aggregated prevalence rates for these indicators can be highly sensitive to biases in the presence of non-directional measurement errors, but the quantitative relationship between the contributing factors and the scale of this bias has not been fully described. In this work, a Monte Carlo simulation exercise was performed to generate high-statistics z-score distributions with a wide range of mean and standard deviation parameters relevant to the populations in low- and middle-income countries (LMIC). With the important assumption that the distribution's standard deviation should be close to 1.0 in the absence of non-directional measurement errors, the shift in prevalence rate due to this common challenge is calculated and explored. Assuming access to a given z-score distribution's mean and standard deviation values, this relationship can be used to evaluate the potential scale of prevalence bias for both historical and modern anthropometric indicator results. As a demonstration of the efficacy of this exercise, the bias scale for a set of 21 child anthropometry datasets collected in LMIC contexts is presented.

Farm forests, seasonal hunger, and biomass poverty: Evidence of induced intensification from panel data in the Ethiopian Highlands.

Seasonal hunger is the most common food insecurity experience for millions of small dryland farmers. This study tests the relationships between food insecurity, farm forests, and biomass poverty using a longitudinal dataset from the Amhara region of Ethiopia. These data form part of the Ethiopia Socioeconomic Survey, which collected panel data over three survey rounds from 530 households between 2011 and 2016. This dataset represents a collection of unique socioeconomic, wellbeing, and micro-land use measures, including farm forests. Hierarchical mixed effect regression models assessed the relationship between food insecurity and farm forests as well as the conditional effects of biomass poverty among the poorest farmers and women-headed households. Over a six-year study period, farmers reported increased stress from smaller land holdings, higher prices, and climate-related shocks. A clear trend towards spontaneous dispersed afforestation is observed by both researchers and satellite remote sensing. Model results indicate, dedicating approximately 10% of farm area to forest reduces months of food insecurity by half. The greatest reductions in food insecurity from farm forests are reported by ultra-poor and crop residue-burning households, suggesting that biomass poverty may be a major constraint to resilient food security on these farms. This research provides novel quantitative evidence of induced intensification and food security impacts of farm management preserving and building stores of biomass value as green assets. The results reported here have important implications for nature-based solutions as a major strategy to achieve sustainable development in some contexts.

Toward a more systematic understanding of water insecurity coping strategies: insights from 11 global sites.

INTRODUCTION: Water insecurity-the inability to access and benefit from affordable, reliable and safe water for basic needs-is a considerable global health threat. With the urgent need to target interventions to the most vulnerable, accurate and meaningful measurement is a priority. Households use diverse strategies to cope with water insecurity; however, these have not been systematically characterised nor measured. The Food Insecurity Coping Strategies Index has been insightful for targeting nutrition interventions to the most vulnerable. As a first step towards creating an analogous scale for water, this study characterises the largest empirical data set on water insecurity coping strategies and proposes guidance on measuring it using a novel toolkit. METHODS: Open-ended responses on water insecurity coping (n=2301) were collected across 11 sites in 10 low- and middle-income countries in the Household Water InSecurity Experiences (HWISE) Scale validation study. Responses were characterised and compared with behaviours identified in the literature to construct an instrument to systematically assess coping. RESULTS: We identified 19 distinct strategies that households used when experiencing water insecurity. These findings, paired with prior literature, were used to develop a Water Insecurity Coping Strategies Assessment Toolkit with guidance on its piloting to assess coping prevalence, frequency and severity. CONCLUSIONS: The widespread occurrence of water insecurity coping strategies underscores the importance of understanding their prevalence and severity. The Water Insecurity Coping Strategies Assessment Toolkit offers a comprehensive approach to evaluate these strategies and inform the design and monitoring of interventions targeting those most vulnerable to water insecurity.

Multivariate analysis of food consumption profiles in crisis settings.

Preventing malnutrition is one of the primary objectives of many humanitarian agencies, and household surveys are regularly employed to monitor food insecurity caused by political, economic, or environmental crises. Consumption frequencies for standard food groups are often collected to characterize the depth of food insecurity in a community and measure the impact of food assistance programs, producing a vector of bounded, correlated counts for each household. While aggregate indicators are typically used to summarize these results with a single statistic, they can be difficult to interpret and provide insufficient detail to judge the effectiveness of assistance programs. To address these limitations, we have developed a multivariate modeling framework for consumption frequency data. We introduce methods to update baseline models for the analysis of the smaller and more variable surveys typically collected in crisis settings, and we present an application of our approach to national consumption data collected in Yemen in 2014 and 2016 by the World Food Programme. The approach provides more nuanced and interpretable information about consumption changes in response to shocks and the effectiveness of humanitarian assistance.

Sexual risk behaviors among youth heads of household in Gikongoro, south province of Rwanda.

BACKGROUND: As a result of the 1994 genocide and AIDS, Rwanda has a crisis of orphans. In 2005, the Ministry of Local Governance and Social Affairs of Rwanda has reported one million vulnerable children. Many of these are not only orphans but also youth heads of households (YHH). The purpose of this study was to: (a) identify risk behaviors that expose YHH to HIV infection, (b) determine gender-specific high risk profiles and, (c) determine predictors of sexual onset. METHODS: A household survey was conducted among 692 YHH, aged 12-24, all beneficiaries of a World Vision basic needs program in Gikongoro, Rwanda, from January to March 2004. Participants were interviewed using a structured questionnaire. Data was collected on socio-demographic variables, HIV/AIDS prevention knowledge and sexual risk behaviors. Bivariate analyses of the study variables were performed to examine differences between males and females. A logistic regression analysis was conducted to analyze factors that were independently associated with the debut of having sex. RESULTS: Forty-one percent of respondents reported sexual onset before age 15. Males were more likely to start earlier than females (50.4% versus 26.7%) but females reported more sexual onset with an older partner. Fifty-eight percent of females had their first intercourse with a partner who was four or more years older than themselves. While sexual activity was low (1.75 mean lifetime sexual partner, 0.45 mean sexual partner last twelve months), sexual experience was related to less social connectedness and use of drugs. Having a close friend also appeared to be protective for sexual debut. The analysis also found that although YHH were aware of some prevention measures against HIV/AIDS, there was low (19.8%) knowledge of the "ABC" prevention program promoted by the government. In addition, despite 85% of respondents knowing someone who had died of AIDS, only 31% perceived themselves at risk of HIV infection, and there was very low (13.2%) condom use among the sexually experienced. CONCLUSIONS: Results suggest the urgent need of HIV prevention programs tailored to YHH that provide knowledge, enhance negotiations skills, and increase the perception of HIV infection risk among YHH in Rwanda.

Traditional and social media coverage and charitable giving following the 2010 earthquake in Haiti.

INTRODUCTION: Media reports on disasters may play a role in inspiring charitable giving to fund post-disaster recovery, but few analyses have attempted to explore the potential link between the intensity of media reporting and the amount of charitable donations made. The purposes of this study were to explore media coverage during the first four weeks of the 2010 earthquake in Haiti in order to assess changes in media-intensity, and to link this information to data on contributions for emergency assistance to determine the impact of media upon post-disaster charitable giving. METHODS: Data on newspaper and newswire coverage of the 2010 earthquake in Haiti were gathered from the NexisLexis database, and traffic on Twitter and select Facebook sites was gathered from social media analyzers. The aggregated measure of charitable giving was gathered from the Center for Philanthropy at Indiana University. The intensity of media reporting was compared with charitable giving over time for the first month following the event, using regression modeling. RESULTS: Post-disaster coverage in traditional media and Twitter was characterized by a rapid rise in the first few days following the event, followed by a gradual but consistent decline over the next four weeks. Select Facebook sites provided more sustained coverage. Both traditional and new media coverage were positively correlated with donations: every 10% increase in Twitter messages relative to the peak percentage was associated with an additional US $236,540 in contributions, while each additional ABC News story was associated with an additional US $963,800 in contributions. CONCLUSIONS: While traditional and new media coverage wanes quickly after disaster-causing events, new and social media platforms may allow stories, and potentially charitable giving, to thrive for longer periods of time.

Evaluation of a case management program for HIV clients in Rwanda.

Case management is a standard practice in the United States for the effective care of people living with HIV and AIDS (PLHA); however, application of this approach in developing countries has not been demonstrated. Although great advances have been made in Africa to increase PLHA's access to HIV services, care and support systems often remain fragmented. In September 2004, CARE International initiated a case management program in health facilities in Rwanda designed to enhance linkages between clinical and non-clinical services for PLHA. This paper presents findings from an evaluation of the program conducted in 2006 focusing on its implementation, specifically the responsibilities of case managers, community linkages, and integration within the health facility. Program outcomes of antiretroviral treatment adherence and quality of life among PLHA also were explored. Qualitative data were collected from case managers, clients, health care providers, and CARE staff. A survey was conducted among 75% of the 149 case managers. Results indicate the case management program strengthened linkages between health facility and community service providers for PLHA. However, most case managers (79%) reported inadequate resources to carry out their duties and high client loads, averaging 55 clients each. They also had limited referral networks. Nonetheless, case managers were highly regarded and appreciated by health professionals, who reported that the program helped to enhance patient-doctor relationships and ensure follow-up of patients' needs. Respondents further highlighted benefits of improved psychosocial well-being and better adherence to antiretroviral medications among clients. Issues remain in terms of case management efficacy in developing country environments, notably the availability and accessibility of needed ancillary services. Despite some limitations, data suggest case management is a viable strategy for providing comprehensive support to PLHA in Rwanda and its implementation elsewhere in Africa should be explored. Considerations in replicating this approach are discussed.

Interaction of G-protein beta3 subunit and nitric oxide synthase gene polymorphisms on carotid artery intima-media thickness in young adults: the Bogalusa Heart Study.

BACKGROUND: G-protein beta3 subunit (GNB3) gene C825T and endothelial nitric oxide (eNOS) gene G894T polymorphisms both influence arterial structure and function. However, information is scant regarding the interaction of these genes on arterial wall thickness. METHODS: This aspect was examined in 654 white and black subjects, aged 25-43 years (72.9% white, 39.3% male). Arterial wall thickness was assessed in terms of the average intima-media thickness (IMT) of common carotid, internal carotid, and carotid bulb segments by B-mode ultrasonography. RESULTS: Frequencies of T allele of the GNB3 C825T polymorphism (0.718 vs. 0.304, P < 0.0001) and G allele of the eNOS G894T polymorphism (0.868 vs. 0.661, P < 0.0001) were higher in blacks compared to whites. In a multivariate model including gender, age, mean arterial pressure, body mass index, triglycerides/HDL cholesterol ratio, insulin resistance index, smoking, and/or race, there was no significant genotypic effect on carotid IMT with respect to GNB3 C825T or eNOS G894T polymorphisms among whites, blacks, and total sample. However, the carriers of TT genotype of the GNB3 C825T and T allele of the eNOS G894T had a significantly lower carotid IMT among blacks (P = 0.003) and the total sample (P = 0.006). CONCLUSION: These results indicate that the genetic variations of the eNOS gene in combination with the GNB3 gene jointly influence carotid artery wall thickening process in young adults, especially in blacks.

A comparative evaluation of dietary indicators used in food consumption assessments of at-risk populations.

BACKGROUND: Easy-to-collect dietary indicators have been used increasingly for planning and evaluation of food security interventions. Various indicators have been employed, but rarely has a full set of indicators been compared using a common framework. OBJECTIVE: This paper evaluates the performance of five dietary indicators for the assessment of household energy consumption using a common framework and recent data from Mozambique. METHODS: Data were analyzed from a 2004 household survey, Current Vulnerability Analysis in Seven Provinces of Mozambique. Households (n = 4,358) were sampled from 42 rural districts using a two-stage design, and a quantitative 24-hour dietary recall was employed. Household energy intake ratios were calculated as the food energy consumed by household members divided by the sum of the members' recommended intakes. Five proxy indicators of household consumption in the previous day were developed: the number of meals, the number of food groups, the number of food items, a score based on a simple weighting of food groups consumed, and a predicted energy intake ratio based on weighting of food groups consumed with previously estimated regression coefficients. The performance of these indicators was assessed using correlations with energy intake, receiver operator characteristic analysis, efficiency of predictions, and prevalence estimate comparisons. RESULTS: Although the predicted energy intake ratio performed best on all these performance criteria, and the simple food-group-weighted score performed second best, differences among the indicators on many of the criteria were relatively small. CONCLUSIONS: New assessment systems could take full advantage of easy-to-collect information by using one of these best-scoring indicators, although established systems could continue to use some of the other indicators explored here, such as the food item count, without much loss in accuracy.

G-6A polymorphism of angiotensinogen gene modulates the effect of blood pressure on carotid intima-media thickness. The Bogalusa Heart Study.

BACKGROUND: The adverse association between blood pressure and carotid artery intima-media thickness (IMT), a surrogate measure of subclinical atherosclerosis, is well-known. However, whether the G-6A polymorphism of the angiotensinogen (AGT) gene, a candidate gene of hypertension and vascular remodeling, modulates this relationship is unknown. METHODS: In 662 white and black subjects aged 25 to 43 years (73.4% white, 39.7% male), common carotid IMT was measured by B-mode ultrasonography. RESULTS: The variant A-6 allele frequency was higher in blacks than in whites (0.850 v 0.448, P < .0001). In a bivariate analysis, there were no differences in mean arterial blood pressure and common carotid IMT between carriers and noncarriers of the G allele in whites, blacks, or the total sample, after adjusting for gender, age, and race. In a multivariable regression analysis that included the status of the G allele (carriers versus noncarriers) along with gender, age, mean arterial blood pressure, body mass index, LDL cholesterol, triglycerides:HDL cholesterol ratio, homeostasis model assessment of insulin resistance, smoking, and race (in the total sample), mean arterial blood pressure was significantly and adversely associated with common carotid IMT in whites, blacks, and the total sample. This adverse positive relationship between mean arterial blood pressure and common carotid IMT was noted among noncarriers but not carriers of the G allele (comparison of slopes, P = .02) in the total sample. Although the interaction was not significant (P = .2 and P = .05 in whites and blacks, respectively), a trend similar to that in the total sample was found in both races. CONCLUSIONS: In a recessive manner, the genetic variant (G-6A) of the AGT gene modulates the association between blood pressure and carotid IMT in young adults.

Health tracking for improved humanitarian performance.

Presently, there is no shortage of methods for collecting data on populations requiring assistance from humanitarian health interventions. However, utilizing a working group, the authors of this paper have looked at these methods through a critical lens and found that there is need for improvement upon existing systems of data collection and analysis. The authors concluded that efforts to standardize the methods of data collection are needed to achieve universal uniformity, and that more funding should be allocated to analyze the data collected.

Dialogue is destiny: managing the message in humanitarian action.

During humanitarian response efforts, the mass media serves as the primary informational intermediary informing donors, policy makers, and the non-affected public. A lack of professional standards within the current culture of journalism, the politics of media ownership, and media manipulation by governments has distorted reporting on humanitarian crises, with possible detrimental effects on response efforts. Humanitarian response organizations must assume a proactive, leading role in the management and sharing of information with each other as well as with donors, policy makers, and the public. This will require working with the media as partners, as well as exploring innovative methods of mass communication. A multi-stakeholder, cooperative communication initiative could help improve media involvement, and harness the media as a credible and knowledgeable communication tool for response efforts. A professional publication dedicated to the discipline of humanitarian relief also could optimize efforts, communicate the perspectives of beneficiaries, and manage the underutilized resource of the general public.

Conflict and HIV: A framework for risk assessment to prevent HIV in conflict-affected settings in Africa.

In sub-Saharan Africa, HIV/AIDS and violent conflict interact to shape population health and development in dramatic ways. HIV/AIDS can create conditions conducive to conflict. Conflict can affect the epidemiology of HIV/AIDS. Conflict is generally understood to accelerate HIV transmission, but this view is simplistic and disregards complex interrelationships between factors that can inhibit and accelerate the spread of HIV in conflict and post conflict settings, respectively. This paper provides a framework for understanding these factors and discusses their implications for policy formulation and program planning in conflict-affected settings.

Influence of nitric oxide synthase gene polymorphism (G894T) on carotid artery intima-media thickness in adults: the Bogalusa Heart Study.

Nitric oxide generated by the vascular endothelial nitric oxide synthase (eNOS) plays an important role in the regulation of vascular structure/function and blood pressure. However, information is scant regarding the influence of G894T polymorphism of the eNOS gene on arterial wall thickness in asymptomatic young adults. This aspect was examined for G894T polymorphism in 661 White and Black subjects, aged 25 to 43 years (73.2% White; 39.5% male). Arterial vascular changes were assessed by common carotid intima-media thickness (IMT) using B-mode ultrasonography. The variant T allele frequency of G894T was significantly higher in Whites compared with Blacks (0.339 vs. 0.102; P < .0001). In bivariate analysis, adjusted for gender, age, mean arterial blood pressure, and/or race, carotid IMT was marginally lower in carriers vs. non-carriers of T allele in Whites (P = .07), but significantly lower for the total number of subjects (P = .04). In multivariable regression analysis, adjusted for gender, age, mean arterial pressure, body mass index (BMI), low-density lipoprotein cholesterol, triglycerides/high-density lipoprotein cholesterol ratio, homeostasis model assessment of insulin resistance, smoking, and race (in the total sample), the variant allele was independently associated with lower carotid IMT in both the White subjects (P = .04), and total sample (P = .03). These results suggest that the allelic variation of G894T polymorphism of the eNOS gene beneficially influences vascular changes as measured by carotid IMT in asymptomatic young adults.

The effect of the health care supply environment on children's nutritional status in rural Nepal.

This article examines the effect of access to health infrastructure, personnel and services on children's nutritional status in rural Nepal. Data for the study come from the 1996 Nepal Living Standards Survey, which includes individual- and household-level information on children's nutritional status and its environmental and socioeconomic determinants, and community-level information on the availability of health care infrastructure, personnel and services. The study uses a structural modelling approach to assess the relative contributions of the health care supply environment on children's anthropometric status via the pathway of maternal and child health (MCH) service use. The findings suggest that improvements in the availability of outreach clinics and the structural quality of the closest public facility would be expected to have statistically significant and large effects on the use of MCH services, and that increases in MCH service use would have a statistically significant impact on weight-for-age, but not weight-for-height or height-for-age. The overall impact of the heath care supply environment on nutritional status is assessed through a series of policy simulations.