| 1. |
- Sysoev, Oleg, 1981-, et al.
(författare)
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PSICA : Decision trees for probabilistic subgroup identification with categorical treatments
- 2019
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Ingår i: Statistics in Medicine. - : Wiley. - 0277-6715 .- 1097-0258. ; 38:22, s. 4436-4452
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Tidskriftsartikel (refereegranskat)abstract
- Personalized medicine aims at identifying best treatments for a patient with given characteristics. It has been shown in the literature that these methods can lead to great improvements in medicine compared to traditional methods prescribing the same treatment to all patients. Subgroup identification is a branch of personalized medicine, which aims at finding subgroups of the patients with similar characteristics for which some of the investigated treatments have a better effect than the other treatments. A number of approaches based on decision trees have been proposed to identify such subgroups, but most of them focus on two-arm trials (control/treatment) while a few methods consider quantitative treatments (defined by the dose). However, no subgroup identification method exists that can predict the best treatments in a scenario with a categorical set of treatments. We propose a novel method for subgroup identification in categorical treatment scenarios. This method outputs a decision tree showing the probabilities of a given treatment being the best for a given group of patients as well as labels showing the possible best treatments. The method is implemented in an R package psica available on CRAN. In addition to a simulation study, we present an analysis of a community-based nutrition intervention trial that justifies the validity of our method.
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| 2. |
- Abdelmenan, Semira, et al.
(författare)
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Perception of affordable diet is associated with pre-school children's diet diversity in Addis Ababa, Ethiopia : the EAT Addis survey
- 2024
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Ingår i: BMC Nutrition. - : BioMed Central (BMC). - 2055-0928. ; 10
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Tidskriftsartikel (refereegranskat)abstract
- Background: Despite improvements in food access and nutrition security over the last few decades, malnutrition remains a major public health problem. One of the significant contributors to these problems is affordability of nutritious food. This study aimed to examine the association between perceived food affordability and pre-school children's diet diversity in Addis Ababa, Ethiopia.Methods: Cross-sectional data from 2017 to 18 were used for the analysis. A 24-hour dietary recall assessment was done to assess children's dietary diversity (DD). We used a modified operational definition of affordability indicator called perceived affordability of dietary diversity (afford-DD) to evaluate the impact of the food environment in terms of affordability at the household level. A sample (n 4,898) of children aged 6-59 months representative of households in Addis Ababa was randomly selected using a multistage sampling procedure including all districts in the city. Mixed-effects linear regression models were used to assess the association between children's DD and afford-DD.Results: The survey revealed that the mean (standard deviation [SD]) of children's DD was 3.9 [±1.4] while the mean [SD] of afford-DD was 4.6 [±2.1]. Overall, 59.8% of children met the minimum dietary diversity (≥ 4 food groups). White roots and tubers were the most commonly consumed food groups regardless of their affordability. Considerable variations were observed between households that reported the food item affordable and not affordable in consumption of Vitamin A rich vegetables and fruits, meat and fish, egg, and dairy. The children's DD was positively associated with afford-DD after adjusting for maternal education, household wealth status and other relevant confounding. Higher maternal education modified the association between affordability and children's diet diversity.Conclusions: This study suggests higher perceived food affordability was associated with better diet diversity in children. A higher level of maternal education had the potential to mitigate affordability challenges in meeting the children's dietary diversity needs. Our study emphasizes the need for inclusive food programs and nutrition interventions addressing social differences, intensifying efforts to make nutrient-rich diets affordable for the less privileged, and highlights the potential benefits of targeting maternal education in addressing child dietary diversity.
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| 3. |
- Abdelmenan, Semira, et al.
(författare)
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The Social Stratification of Availability, Affordability, and Consumption of Food in Families with Preschoolers in Addis Ababa : The EAT Addis Study in Ethiopia
- 2020
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Ingår i: Nutrients. - : MDPI AG. - 2072-6643. ; 12:10
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to understand the quality of diet being consumed among families in Addis Ababa, and to what extent social stratification and perceptions of availability and affordability affect healthy food consumption. Data were collected from 5467 households in a face-to-face interview with mothers/caretakers and analyzed using mixed effect logistic regression models. All family food groups, except fish were perceived to be available by more than 90% of the participants. The food groups cereals/nuts/seeds, other vegetables, and legumes were considered highly affordable (80%) and were the most consumed (>75%). Households with the least educated mothers and those in the lowest wealth quintile had the lowest perception of affordability and also consumption. Consumption of foods rich in micronutrients and animal sources were significantly higher among households with higher perceived affordability, the highest wealth quintile, and with mothers who had better education. Households in Addis Ababa were generally seen to have a monotonous diet, despite the high perceived availability of different food groups within the food environment. There is a considerable difference in consumption of nutrient-rich foods across social strata, hence the cities food policies need to account for social differences in order to improve the nutritional status of the community.
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| 4. |
- Ahmed, Sultan, et al.
(författare)
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Arsenic Exposure Affects Plasma Insulin-Like Growth Factor 1 (IGF-1) in Children in Rural Bangladesh
- 2013
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 8:11, s. e81530-
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Tidskriftsartikel (refereegranskat)abstract
- Background: Exposure to inorganic arsenic (As) through drinking water during pregnancy is associated with lower birth size and child growth. The aim of the study was to assess the effects of As exposure on child growth parameters to evaluate causal associations. Methodology/Findings: Children born in a longitudinal mother-child cohort in rural Bangladesh were studied at 4.5 years (n=640) as well as at birth (n=134). Exposure to arsenic was assessed by concurrent and prenatal (maternal) urinary concentrations of arsenic metabolites (U-As). Associations with plasma concentrations of insulin-like growth factor 1 (IGF-1), calcium (Ca), vitamin D (Vit-D), bone-specific alkaline phosphatase (B-ALP), intact parathyroid hormone (iPTH), and phosphate (PO4) were evaluated by linear regression analysis, adjusted for socioeconomic factor, parity and child sex. Child U-As (per 10 mu g/L) was significantly inversely associated with concurrent plasma IGF-1 (beta=-0.27; 95% confidence interval: -0.50, -0.0042) at 4.5 years. The effect was more obvious in girls (beta=-0.29; -0.59, 0.021) than in boys, and particularly in girls with adequate height (beta=-0.491; -0.97, -0.02) or weight (beta=-0.47; 0.97, 0.01). Maternal U-As was inversely associated with child IGF-1 at birth (r=-0.254, P=0.003), but not at 4.5 years. There was a tendency of positive association between U-As and plasma PO4 in stunted boys (beta=0.27; 0.089, 0.46). When stratified by % monomethylarsonic acid (MMA, arsenic metabolite) (median split at 9.7%), a much stronger inverse association between U-As and IGF-1 in the girls (beta=-0.41; -0.77, -0.03) was obtained above the median split. Conclusion: The results suggest that As-related growth impairment in children is mediated, at least partly, through suppressed IGF-1 levels.
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| 5. |
- Akhtar, Evana, et al.
(författare)
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A longitudinal study of rural Bangladeshi children with long-term arsenic and cadmium exposures and biomarkers of cardiometabolic diseases
- 2021
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Ingår i: Environmental Pollution. - : Elsevier. - 0269-7491 .- 1873-6424. ; 271
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Tidskriftsartikel (refereegranskat)abstract
- There is growing interest in understanding the contribution of environmental toxicant exposure in early life to development of cardiometabolic diseases (CMD) in adulthood. We aimed to assess associations of early life exposure to arsenic and cadmium with biomarkers of CMD in children in rural Bangladesh. From a longitudinal mother-child cohort in Matlab, Bangladesh, we followed up 540 pairs. Exposure to arsenic (U–As) and cadmium (U–Cd) was assessed by concentrations in urine from mothers at gestational week 8 (GW8) and children at ages 4.5 and 9 years. Blood pressure and anthropometric indices were measured at 4.5 and 9 years. Metabolic markers (lipids, glucose, hemoglobin A1c, adipokines, estimated glomerular filtration rate (eGFR) were determined in plasma/blood of 9 years old children. In linear regression models, adjusted for child sex, age, height-for-age z score (HAZ), BMI-for-age z score (BAZ), socioeconomic status (SES) and maternal education, each doubling of maternal and early childhood U–Cd was associated with 0.73 and 0.82 mmHg increase in systolic blood pressure (SBP) respectively. Both early and concurrent childhood U–Cd was associated with diastolic (D)BP (β = 0.80 at 4.5 years; β = 0.75 at 9 years). Each doubling of U–Cd at 9 years was associated with decrements of 4.98 mg/dL of total cholesterol (TC), 1.75 mg/dL high-density lipoprotein (HDL), 3.85 mg/dL low-density lipoprotein (LDL), 0.43 mg/dL glucose and 4.29 units eGFR. Each doubling of maternal U–Cd was associated with a decrement of 1.23 mg/dL HDL. Both maternal and childhood U–As were associated with decrement in TC and HDL. Multiple comparisons were checked with family-wise error rate Bonferroni-type-approach. The negative associations of arsenic and cadmium with biomarkers of CMD in preadolescent children indicated influence of both metal(loid)s on fat and carbohydrate metabolism, while cadmium additionally influenced kidney function and BP. Thus, fewer outcomes were associated with U–As compared to U–Cd at preadolescence.
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| 6. |
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| 7. |
- Berhane, Hanna Y, et al.
(författare)
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Mixed blessings: : A qualitative exploration of mothers' experience of child care and feeding in the rapidly urbanizing city of Addis Ababa, Ethiopia
- 2018
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 13:11
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Tidskriftsartikel (refereegranskat)abstract
- Many studies have drawn attention to the vital role mothers have in safeguarding the health and nutritional wellbeing of their children. However, little is known about mothers' experiences and the challenges they face in fulfilling this role in rapidly urbanizing cities in Africa. This study aims to explore child care and feeding practices of mothers with children under five years of age in Addis Ababa, Ethiopia. This qualitative study was conducted using a semi-structured interview guide. A total of thirty-six interviews were conducted with purposively selected participants. All interviews were audio recorded, transcribed verbatim and translated for analysis. We used a thematic analysis approach, which was guided by a resilience framework. The findings are presented as three major themes. 1) 'Mixed blessings-balancing motherhood's expectations'. While mothers identified positively with the social recognition and sense of fulfillment of being a 'good mother', they were ambivalent/torn about earning the necessary income from outside work and fulfilling their duties at home. 2) 'Instabilities due to rampant urban sprawl'. While women expressed a keen desire to balance work and motherhood, the disintegrating social capital, due to large in-migration, market fluctuations and abrupt/forced resettlements to new housing units had left mothers without support for childcare, stressed and exhausted. 3) 'Anchored by faith: a source of resilience to cope with adversities'. In the face of the multiple adversities, mothers cited their strong faith as their most reliable foundation for their resilience. In summary, the societal and environmental changes accompanying the rapid urbanization in low income settings makes combining child care and working outside the home very challenging for mothers. As a result they suffer from fatigue and feelings of isolation. Efforts to improve child feeding and care in urban low-income settings need to consider context appropriate strategies that support mothers with small children.
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| 8. |
- Berhane, Hanna Y., et al.
(författare)
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Social Stratification, Diet Diversity and Malnutrition among Preschoolers : A Survey of Addis Ababa, Ethiopia
- 2020
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Ingår i: Nutrients. - : MDPI AG. - 2072-6643. ; 12:3
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Tidskriftsartikel (refereegranskat)abstract
- In Sub-Saharan Africa, being overweight in childhood is rapidly rising while stunting is still remaining at unacceptable levels. A key contributor to this double burden of malnutrition is dietary changes associated with nutrition transition. Although the importance of socio-economic drivers is known, there is limited knowledge about their stratification and relative importance to diet and to different forms of malnutrition. The aim of this study was to assess diet diversity and malnutrition in preschoolers and evaluate the relative importance of socioeconomic resources. Households with children under five (5467) were enrolled using a multi-stage sampling procedure. Standardized tools and procedures were used to collect data on diet, anthropometry and socio-economic factors. Multivariable analysis with cluster adjustment was performed. The prevalence of stunting was 19.6% (18.5-20.6), wasting 3.2% (2.8-3.7), and overweight/obesity 11.4% (10.6-12.2). Stunting, overweight, wasting and limited diet diversity was present in all social strata. Low maternal education was associated with an increased risk of stunting (Adjusted odds ratio (AOR): 1.8; 1.4-2.2), limited diet diversity (AOR: 0.33; 0.26-0.42) and reduced odds of being overweight (AOR: 0.61; 0.44-0.84). Preschoolers in Addis Ababa have limited quality diets and suffer from both under- and over-nutrition. Maternal education was an important explanatory factor for stunting and being overweight. Interventions that promote diet quality for the undernourished whilst also addressing the burgeoning problem of being overweight are needed.
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| 9. |
- Berhane, Hanna Yemane, 1989-
(författare)
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Social Stratification of Children's Diet and Nutrition: Understanding Women's Situation in Addis Ababa
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Childhood undernutrition is the cause of nearly half of all deaths in under-five children. In sub-Saharan African countries, this problem is further complicated by the rising prevalence of overweight. Mothers play a key role in child care and nutrition, however, in cities that are undergoing rapid social and economic changes, little is known about their lived experiences and challenges. Moreover, little is known about the influence of the neighbourhood food environment and family socio-economic conditions of food acquisition and intake in sub-Saharan Africa. Therefore, the study aims to understand the nexus between mothers’ child care and feeding experiences, neighbourhood food environment, diet diversity, and family socioeconomic status. Methods: A mixed qualitative and quantitative study design was used. The qualitative component involved thirty-six in-depth interviews with mothers who had children under the age of five years. A thematic analysis approach was used to analyse verbatim transcripts. For the quantitative component, two rounds of cross-sectional household surveys were conducted. The sample was drawn from all districts of Addis Ababa; a total of 5467 households with mother-child pairs. Data were analysed using a generalised estimating equation (GEE) and mixed-effect logistic regression model. Results: Urban mothers are under pressure to ensure their child gets adequate care and food; the changes in their environment owing to the reconstruction of city and migration further limit their ability to do so. Mothers expressed that their decision of what to feed their children is influenced by children’s preferences, perceived safety of the food, familiarity with the food, and affordability.Children receiving the recommended minimum diet diversity totaled 59.9% (58.5–61.3). Having an adequately diverse diet was associated with having an educated mother, and being from the wealthier and more food-secure households. Animal source and vitamin-A-rich food groups are the least affordable and consumed food groups in the study settings. Families with uneducated mothers, in the lowest wealth group and those who perceived food groups to be unaffordable, consumed a less diverse diet.The prevalence of stunting was 19.6% (18.5–20.6) and that of over-weight/obesity was 11.4% (10.6–12.2). Maternal education level was associated with both forms of malnutrition; children with uneducated mothers were more likely to be stunted (AOR: 1.8; 1.4–2.2) and less likely to be overweight/obese (AOR: 0.61; 0.44–0.84), while being from the highest wealth household and from a severely food insecure household were associated with a higher likelihood of obesity and stunting, respectively. Conclusion: Child nutritional outcomes and diet quality vary by the socioeconomic status of the family; particularly that of mothers. Therefore, efforts to improve diet and nutritional outcomes of children need to consider mechanisms to strongly support mothers.
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| 10. |
- Berhane, Hanna Y, et al.
(författare)
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What Influences Urban Mothers' Decisions on What to Feed Their Children Aged Under Five-The Case of Addis Ababa, Ethiopia
- 2018
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Ingår i: Nutrients. - : MDPI AG. - 2072-6643. ; 10:9
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Tidskriftsartikel (refereegranskat)abstract
- Mothers carry the prime responsibility for childcare and feeding in low-income countries. Understanding their experiences in providing food for their children is paramount to informing efforts to improve the nutritional status of children. Such information is lacking in Sub-Saharan Africa. To understand what influences urban mothers' food acquisition and their motivations for selecting food for their children, 36 in-depth interviews were carried out with mothers having children under five years of age. Interviews were conducted in the local language, audio-recorded, transcribed, and translated into English. Data were analyzed using thematic analysis which led to the identification of four major themes: mothers give-in to a child-driven diet; quick-fix versus the privilege of planning; keen awareness on food safety, nutrition, and diet diversity; and social, familial, and cultural influences. The findings indicate that child feeding practices are influenced by interlinked social and environmental factors. Hence, nutrition education campaigns should focus on targeting not only families but also their children. Attention should also be given to food safety regulations, as well as to the much-needed support of mothers who are struggling to ensure their children's survival in low-income countries.
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