| 1. |
- Daoud, Adel, 1981, et al.
(författare)
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IMF fairness: Calibrating the policies of the International Monetary Fund based on distributive justice
- 2022
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Ingår i: World Development. - : Elsevier BV. - 0305-750X .- 1873-5991. ; 157
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Tidskriftsartikel (refereegranskat)abstract
- The International Monetary Fund (IMF) provides financial assistance to its member countries in economic difficulties but at the same time requires these countries to reform public policies. In several contexts, these reforms have been at odds with population health and material living standards. While researchers have empirically analyzed the consequences of IMF reforms on health, no analysis has yet identified under what conditions tradeoffs between consequences for populations and economic outcomes would be fair and acceptable. Our article analyzes and identifies five principles to govern such tradeoffs and thus define IMF fairness. The article first reviews existing policy-evaluation studies, which on balance show that IMF policies, in their pursuit of macroeconomic improvement, frequently produce adverse effects on children's health and material living standards. Secondly, the article discusses four theories from distributive ethics—maximization, egalitarianism, prioritarianism, and sufficientarianism—to identify which is most compatible with the IMF's core mission of improving macroeconomic conditions, while at the same time balancing the consequences for population outcomes. Using a distributive justice analysis of IMF policies, we argue that sufficientarianism constitutes the most compatible theory. Thirdly, the article formalizes IMF fairness in the language of causal inference. It also supplies a framework for empirically measuring the extent to which IMF policies fulfill the criteria of IMF fairness, using observational data.
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| 2. |
- Karlsson, Omar, et al.
(författare)
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Changing speed of reduction in under-5 mortality rates over the 20th century
- 2020
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Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 1470-2738 .- 0143-005X. ; 75:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Declines from high levels of under-5 mortality rate (U5MR) first occurred in Western Europe. Knowledge and technologies gained from early mortality reductions could accelerate the U5MR decline for countries that followed. We explored whether average annual reduction (AAR) in U5MR increased between countries over time in the 20th century.Methods We used U5MR time series from the Human Mortality Database and United Nations for 110 countries experiencing a decline from 100 to 50 under-5 deaths per 1000 live births during the 20th century.Results Between 1907 and 1938, the AAR was 2.61 (95% CI 2.09, 3.13) deaths per 1000 live births per year on average and increased by 0.06 (95% CI 0.02, 0.10) deaths for each year that passed before the decline started. Countries going through the decline in 1938–1968 and 1968–1999 showed an AAR of 3.96 and 3.67 (95% CI 3.37, 4.54 and 3.26, 4.07), respectively, with no increase in AAR.Conclusions Acceleration in U5MR reduction was apparent in today’s high-income countries, indicating that greater similarities and capacity may have facilitated the adaptation of mortality reducing knowledge and technologies. Greater emphasis on simple and individual-level interventions or more difficult circumstances may also explain the lack of acceleration in mortality reduction after 1950.
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| 3. |
- Karlsson, Omar, et al.
(författare)
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Child wasting before and after age two years: A cross-sectional study of 94 countries
- 2022
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Ingår i: EClinicalMedicine. - : Elsevier BV. - 2589-5370. ; 46
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundWasting reflects infections and poor nutrition and affects almost 50 million children at any given time. Wasting comes with immediate risk of mortality and increased risks for long-term negative consequences for development. Children under two are particularly sensitive to undernutrition and infections. We estimated the age patterning in wasting prevalence.MethodsWe calculated wasting prevalence and used Poisson regression models to estimate prevalence ratios comparing prevalence in children under and over two years using data from Demographic and Health Surveys and Multiple Indicator Cluster Surveys from 94 mostly low- and middle-income countries, including 804,172 children under five, born to a nationally representative sample of women 15–49 years old. Wasting prevalence was defined as the percentage of children with weight-for-height below –2 z-score from the median of the WHO 2006 growth standard.FindingsWasting prevalence for children under two was 14% (95% CI: 13, 14) while it was 9% (95% CI: 9, 9) for children 2–4 years old—leading to a prevalence ratio of 0·66 (95% CI: 0·64, 0·67) in our pooled sample. Prevalence ratios were less than one, indicating lower prevalence in children over two, in 87 countries and statistically significantly lower than one at a 5% level (non-adjusted) in 68 countries. Wasting prevalence was generally lower in children under two for males and females and the wealthiest and poorest households.InterpretationSince wasting prevalence was observed to be greater among children 0–2 years, and adverse exposure to undernutrition and infections are particularly harmful and interventions are more effective during the 1000 days from conception until age two, nutrition interventions should ensure coverage of children under two through programmatic measures to increase detection and enrollment in wasting programs.
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| 4. |
- Karlsson, Omar, et al.
(författare)
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Consumption of Vitamin-A-Rich Foods and Vitamin A Supplementation for Children under Two Years Old in 51 Low- and Middle-Income Countries
- 2021
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Ingår i: Nutrients. - : MDPI AG. - 2072-6643. ; 14:1
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Tidskriftsartikel (refereegranskat)abstract
- Vitamin A supplementation for children 6-59 months old is an important intervention that boosts immune function, especially where children do not consume enough vitamin-A-rich foods. However, the low coverage of vitamin A supplementation is a persistent problem in low- and middle-income countries. We first estimated the percentage of children 6-23 months old receiving the minimum dietary diversity, vitamin-A-rich foods, and vitamin A supplementation, and second, the difference in the percentage receiving vitamin A supplementation between children 6-23 months old and children 24-59 months old using nationally representative cross-sectional household surveys, namely, the Demographic and Health Surveys, conducted from 2010 to 2019 in 51 low- and middle-income countries. Overall, 22% (95% CI: 22, 23) of children received the minimum dietary diversity, 55% (95% CI: 54, 55) received vitamin-A-rich foods, 59% (95% CI: 58, 59) received vitamin A supplementation, and 78% (95% CI: 78, 79) received either vitamin-A-rich foods or supplementation. A wide variation across countries was observed; for example, the percentage of children that received either vitamin-A-rich foods or supplementation ranged from 53% (95% CI: 49, 57) in Guinea to 96% (95% CI: 95, 97) in Burundi. The coverage of vitamin A supplementation should be improved, especially for children 6-23 months old, in most countries, particularly where the consumption of vitamin-A-rich foods is inadequate.
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| 5. |
- Karlsson, Omar, et al.
(författare)
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Estimating heritability of height without zygosity information for twins under five years in low- and middle-income countries : An application of normal finite mixture distribution models
- 2022
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Ingår i: SSM - Population Health. - : Elsevier BV. - 2352-8273. ; 17
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Tidskriftsartikel (refereegranskat)abstract
- Twin studies are widely used to estimate heritability of traits and typically rely on knowing the zygosity of twin pairs in order to determine variation attributable to genetics. Most twin studies are conducted in high resource settings. Large scale household survey data, such as the Demographic and Health Surveys, collect various biomarkers for children under five years old in low- and middle-income countries. These data include twins but no information on zygosity. We applied mixture models to obtain heritability estimates without knowing zygosity of twins, using 249 Demographic and Health Surveys from 79 low- and middle-income countries (14,524 twin pairs). We focused on height of children, adjusted for age and sex, but also provided estimates for other biomarkers available in the data. We estimated that the heritability of height in our sample was 46%.
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| 6. |
- Karlsson, Omar, et al.
(författare)
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Maternal height-standardized prevalence of stunting in 67 low- and- middle-income countries
- 2022
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Ingår i: Journal of Epidemiology. - 0917-5040. ; 32:7, s. 337-337
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Prevalence of stunting is frequently used as a marker of population-level child undernutrition. Parental height varies widely in low- and middle-income countries (LMIC) and is also a major determinant of stunting. While stunting is a useful measure of child health, with multiple causal components, removing the component attributable to parental height may in some cases be helpful to identify shortcoming in current environments.Methods: We estimated maternal height-standardized prevalence of stunting (SPS) in 67 LMIC and parental height-SPS in 20 LMICs and compared with crude prevalence of stunting (CPS) using data on 575,767 children under-five from 67 Demographic and Health Surveys (DHS). We supplemented the DHS with population-level measures of other child health outcomes from the World Health Organization's (WHO) Global Health Observatory and the United Nations' Inter-Agency Group for Child Mortality Estimation. Prevalence of stunting was defined as percentage of children with height-for-age falling below -2 z-scores from the 2006 WHO growth standard.Findings: The average CPS across countries was 27.8% (95% CI: 27.5 to 28.1) and the average SPS was 23.3% (95% CI: 23.0 to 23.6). The rank of countries according to SPS differed substantially from the rank according to CPS. Guatemala, Bangladesh, and Nepal had the biggest improvement in ranking according to SPS compared to CPS, while Gambia, Mali, and Senegal had the biggest decline in ranking. Guatemala had the largest difference between CPS and SPS with a CPS of 45.2 (95% CI: 43.7 to 46.9) and SPS of 14.1 (95% CI: 12.6 to 15.8). Senegal had the largest increase in the prevalence after standardizing maternal height, with a CPS of 28.8% (95% CI: 25.8 to 30.2) and SPS of 31.6% (95% CI: 29.5 to 33.8). SPS correlates better than CPS with other population-level measures of child health.Conclusions: Our study suggests that CPS is sensitive to adjustment for maternal height. Maternal height, while a strong predictor of child stunting, is not amenable to policy interventions. We showed the plausibility of SPS in capturing current exposures to undernutrition and infections in children.
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| 7. |
- Karlsson, Omar, et al.
(författare)
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Patterns in child stunting by age : A cross-sectional study of 94 low- and middle-income countries
- 2023
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Ingår i: Maternal and Child Nutrition. - 1740-8709. ; 19:4
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Tidskriftsartikel (refereegranskat)abstract
- Child stunting prevalence is primarily used as an indicator of impeded physical growth due to undernutrition and infections, which also increases the risk of mortality, morbidity and cognitive problems, particularly when occurring during the 1000 days from conception to age 2 years. This paper estimated the relationship between stunting prevalence and age for children 0-59 months old in 94 low- and middle-income countries. The overall stunting prevalence was 32%. We found higher stunting prevalence among older children until around 28 months of age-presumably from longer exposure times and accumulation of adverse exposures to undernutrition and infections. In most countries, the stunting prevalence was lower for older children after around 28 months-presumably mostly due to further adverse exposures being less detrimental for older children, and catch-up growth. The age for which stunting prevalence was the highest was fairly consistent across countries. Stunting prevalence and gradient of the rise in stunting prevalence by age varied across world regions, countries, living standards and sex. Poorer countries and households had a higher prevalence at all ages and a sharper positive age gradient before age 2. Boys had higher stunting prevalence but had peak stunting prevalence at lower ages than girls. Stunting prevalence was similar for boys and girls after around age 45 months. These results suggest that programmes to prevent undernutrition and infections should focus on younger children to optimise impact in reducing stunting prevalence. Importantly, however, since some catch-up growth may be achieved after age 2, screening around this time can be beneficial.
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| 8. |
- Karlsson, Omar, et al.
(författare)
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Prevalence of Children Aged 6 to 23 Months Who Did Not Consume Animal Milk, Formula, or Solid or Semisolid Food During the Last 24 Hours Across Low- and Middle-Income Countries
- 2024
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Ingår i: JAMA Network Open. - 2574-3805. ; 7:2
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Tidskriftsartikel (refereegranskat)abstract
- IMPORTANCE: The introduction of solid or semisolid foods alongside breast milk plays a vital role in meeting nutritional requirements during early childhood, which is crucial for child growth and development. Understanding the prevalence of zero-food children (defined for research purposes as children aged 6 to 23 months who did not consume animal milk, formula, or solid or semisolid food during the last 24 hours) is essential for targeted interventions to improve feeding practices.OBJECTIVE: To estimate the percentage of zero-food children in 92 low- and middle-income countries.DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study analyzed nationally representative cross-sectional household data of children aged 6 to 23 months from the Demographic and Health Surveys and the Multiple Indicator Cluster Surveys conducted between May 20, 2010, and January 27, 2022. Data were obtained from 92 low- and middle-income countries. Standardized procedures were followed to ensure data comparability and reliability. Both percentage and number of zero-food children were estimated.MAIN OUTCOMES AND MEASURES: The outcome studied was defined as a binary variable indicating children aged 6 to 23 months who had not been fed any animal milk, formula, or solid or semisolid foods during the 24 hours before each survey, as reported by the mother or caretaker.RESULTS: A sample of 276 379 children aged 6 to 23 months (mean age, 14.2 months [95% CI, 14.15-14.26 months]) in 92 low- and middle-income countries was obtained, of whom 51.4% (95% CI, 51.1%-51.8%) were boys. The estimated percentage of zero-food children was 10.4% (95% CI, 10.1%-10.7%) in the pooled sample, ranging from 0.1% (95% CI, 0%-0.6%) in Costa Rica to 21.8% (95% CI, 19.3%-24.4%) in Guinea. The prevalence of zero-food children was particularly high in West and Central Africa, where the overall prevalence was 10.5% (95% CI, 10.1%-11.0%), and in India, where the prevalence was 19.3% (95% CI, 18.9%-19.8%). India accounted for almost half of zero-food children in this study.CONCLUSIONS AND RELEVANCE: In this cross-sectional study of 276 379 children aged 6 to 23 months, substantial disparities in the estimates of food consumption across 92 low- and middle-income countries were found. The prevalence of zero-food children underscores the need for targeted interventions to improve infant and young child feeding practices and ensure optimal nutrition during this critical period of development. The issue is particularly urgent in West and Central Africa and India.
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| 9. |
- Karlsson, Omar, et al.
(författare)
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Refrigerator ownership and child health and nutrition in low- and middle-income countries
- 2023
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Ingår i: Global Food Security. - 2211-9124. ; 37
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Tidskriftsartikel (refereegranskat)abstract
- Undernutrition and diarrhea cause stunted growth and poor child health. Refrigerators allow consumption of perishable foods and reduce food contaminations causing diarrhea. This study used 188 Demographic and Health Surveys from 66 low- and middle-income countries with adjusted regressions and coarsened exact matching, comparing children within the same neighborhoods and narrow groups of household wealth, as well as other important variables, simultaneously. Children in households with a refrigerator had 0.08 (95% confidence interval: 0.03, 0.13) to 0.12 (95% confidence interval: 0.01, 0.23) greater height-for-age z-score. Results for diarrhea and complementary feeding of perishable foods were less robust, which may relate to shortcomings in these measures, although point estimates indicated beneficial effects, particularly at low socioeconomic status.
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| 10. |
- Karlsson, Omar, et al.
(författare)
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Trends in underweight, stunting, and wasting prevalence and inequality among children under three in Indian states, 1993-2016
- 2021
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Ingår i: Scientific Reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 11
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Tidskriftsartikel (refereegranskat)abstract
- Child undernutrition remains high in India with far-reaching consequences for child health and development. Anthropometry reflects undernutrition. We examined the state-level trends in underweight, stunting, and wasting prevalence and inequality by living standards using four rounds of the National Family Health Surveys in 26 states in India, conducted in 1992-1993, 1998-1999, 2005-2006, and 2015-2016. The average annual reduction (AAR) for underweight ranged from 0.04 percentage points (pp) (95% CI - 0.12, 0.20) in Haryana to 1.05 pp (95% CI 0.88, 1.22) in West Bengal for underweight; 0.35 pp (95% CI 0.11, 0.59) in Manipur to 1.47 (95% CI 1.19, 1.75) in Himachal Pradesh for stunting; and - 0.65 pp (95% CI - 0.77, - 0.52) in Haryana to 0.36 pp (95% CI 0.22, 0.51) in Bihar & Jharkhand for wasting. We find that change in the pp difference between children with the poorest and richest household living standards varied by states: statistically significant decline (increase) was observed in 5 (3) states for underweight, 5 (4) states for stunting, and 2 (1) states for wasting. Prevalence of poor anthropometric outcomes as well as disparities by states and living standards remain a problem in India.
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| 11. |
- Naito, R., et al.
(författare)
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Impact of social isolation on mortality and morbidity in 20 high-income, middle-income and low-income countries in five continents
- 2021
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Ingår i: Bmj Global Health. - : BMJ. - 2059-7908. ; 6:3
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Tidskriftsartikel (refereegranskat)abstract
- Objective To examine the association between social isolation and mortality and incident diseases in middle-aged adults in urban and rural communities from high-income, middle-income and low-income countries. Design Population-based prospective observational study. Setting Urban and rural communities in 20 high income, middle income and low income. Participants 119 894 community-dwelling middle-aged adults. Main outcome measures Associations of social isolation with mortality, cardiovascular death, non-cardiovascular death and incident diseases. Results Social isolation was more common in middle-income and high-income countries compared with low-income countries, in urban areas than rural areas, in older individuals and among women, those with less education and the unemployed. It was more frequent among smokers and those with a poorer diet. Social isolation was associated with greater risk of mortality (HR of 1.26, 95% CI: 1.17 to 1.36), incident stroke (HR: 1.23, 95% CI: 1.07 to 1.40), cardiovascular disease (HR: 1.15, 95% CI: 1.05 to 1.25) and pneumonia (HR: 1.22, 95% CI: 1.09 to 1.37), but not cancer. The associations between social isolation and mortality were observed in populations in high-income, middle-income and low-income countries (HR (95% CI): 1.69 (1.32 to 2.17), 1.27 (1.15 to 1.40) and 1.47 (1.25 to 1.73), respectively, interaction p=0.02). The HR associated with social isolation was greater in men than women and in younger than older individuals. Mediation analyses for the association between social isolation and mortality showed that unhealthy behaviours and comorbidities may account for about one-fifth of the association. Conclusion Social isolation is associated with increased risk of mortality in countries at different economic levels. The increasing share of older people in populations in many countries argues for targeted strategies to mitigate its adverse effects.
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| 12. |
- Subramanian, S. V., et al.
(författare)
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Geo-mapping of COVID-19 Risk Correlates Across Districts and Parliamentary Constituencies in India
- 2020
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Ingår i: Harvard Data Science Review. - 2644-2353.
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Tidskriftsartikel (refereegranskat)abstract
- In the current stage of the COVID-19 pandemic, as countries open up after an extended period of lockdown, it is important to assure the population that their health is not being sacrificed. In this article, we develop a geomapping approach to identify high-risk areas by considering four nonclinical risk correlates for COVID-19. These are population density, percentage of the population that is exposed to crowding in a household, percentage of the population without access to handwashing facilities, and percentage of the population over 65 years of age. We provide an empirical proof-of-concept demonstration for this approach for India at two critical geographic units: districts and parliamentary constituencies, collectively responsible for policy administration and governance. Our findings suggest that the geographies of the four nonclinical risk correlates are largely independent of one another (i.e., at most, there is a small correlation between measures). We avoid applying differential weights to the four measures or combining these measures into a single index, as there is an intrinsic rationale for viewing them separately since they represent mostly independent dimensions of risks that require different responses. Our primary objective was to leverage currently available data to provide decision makers detailed information and geovisualization, identifying areas with potentially differential susceptibilities to COVID-19. The information provided here can be used as a means for further ground verification and, when appropriate, for impact planning and intervention, as well as providing a rationale for eventual efficacy assessment of different nonpharmaceutical interventions. While this exercise is primarily descriptive at this stage, the estimates generated are new, rigorous, and have high relevance for timely policy discussions. We use data from the Demographic and Health Surveys, which have extensive geographic coverage and high level of standardizations, making our highly accessible approach easy to extend to other low- and middle-income countries. We share this conceptualization of geomapping, and all the data and codes used for this exercise, to encourage wider applications and advancements.
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| 13. |
- Subramanian, S.V., et al.
(författare)
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Should India adopt a country-specific growth reference to measure undernutrition among its children?
- 2023
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Ingår i: The Lancet Regional Health - Southeast Asia. - : Elsevier BV. - 2772-3682. ; 9
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- The 2006 World Health Organization (WHO) growth standard—based on the Multi Growth Reference Study (MGRS)—is a universal standard for healthy height and weight of young children. The share of children that deviate substantially from this growth standard (i.e., fall below −2 standard deviations) defines three important indicators: stunting (low height-for-age), wasting (low weight-for-height), and underweight (low weight-for-age). These three indicators are most often used to assess prevalence of different forms of undernutrition in a population. The prevalence of stunting, wasting, and underweight based on the MGRS are used to set international (e.g., Sustainable Development Goals) and national (e.g., POSHAN Abhiyaan in India) targets and guide substantial allocation of resources for reducing child undernutrition.
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| 14. |
- Teufel, Felix, et al.
(författare)
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Analysis of Attained Height and Diabetes Among 554,122 Adults Across 25 Low- and Middle-Income Countries
- 2020
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Ingår i: Diabetes Care. - : American Diabetes Association. - 1935-5548 .- 0149-5992. ; 43:10, s. 2403-2410
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The prevalence of type 2 diabetes is rising rapidly in low-income and middle-income countries (LMICs), but the factors driving this rapid increase are not well understood. Adult height, in particular shorter height, has been suggested to contribute to the pathophysiology and epidemiology of diabetes and may inform how adverse environmental conditions in early life affect diabetes risk. We therefore systematically analyzed the association of adult height and diabetes across LMICs, where such conditions are prominent.RESEARCH DESIGN AND METHODS: We pooled individual-level data from nationally representative surveys in LMICs that included anthropometric measurements and diabetes biomarkers. We calculated odds ratios (ORs) for the relationship between attained adult height and diabetes using multilevel mixed-effects logistic regression models. We estimated ORs for the pooled sample, major world regions, and individual countries, in addition to stratifying all analyses by sex. We examined heterogeneity by individual-level characteristics.RESULTS: Our sample included 554,122 individuals across 25 population-based surveys. Average height was 161.7 cm (95% CI 161.2-162.3), and the crude prevalence of diabetes was 7.5% (95% CI 6.9-8.2). We found no relationship between adult height and diabetes across LMICs globally or in most world regions. When stratifying our sample by country and sex, we found an inverse association between adult height and diabetes in 5% of analyses (2 out of 50). Results were robust to alternative model specifications.CONCLUSIONS: Adult height is not associated with diabetes across LMICs. Environmental factors in early life reflected in attained adult height likely differ from those predisposing individuals for diabetes.
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| 15. |
- Thoma, Berenike, et al.
(författare)
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Children's education and parental old-age health : Evidence from a population-based, nationally representative study in India
- 2021
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Ingår i: Population Studies. - : Informa UK Limited. - 1477-4747 .- 0032-4728. ; 75:1, s. 51-66
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Tidskriftsartikel (refereegranskat)abstract
- Previous research has documented intergenerational transmission of human capital from children to parents. Less is known, however, about heterogeneity in this 'upward transmission' in low-resource settings. We examine whether co-resident adult children's education is associated with improved health among older parents in India, using nationally representative data from the 2014 Indian National Sample Survey. Parents of children with tertiary education had a lower probability of reporting poor health than parents of children with less than primary education. The benefits of children's education persisted after controlling for economic factors, suggesting that non-pecuniary pathways-such as health knowledge or skills-may play an important role. The association was more pronounced among economically dependent parents and those living in the North and West regions. Taken together, our results point to a strong positive association between children's education and parental health, the role of non-pecuniary pathways, and the importance of subnational heterogeneity in India.
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