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- Mishra, A, et al.
(författare)
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Diminishing benefits of urban living for children and adolescents' growth and development
- 2023
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Ingår i: Nature. - : Springer Science and Business Media LLC. - 1476-4687 .- 0028-0836. ; 615:7954, s. 874-883
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Tidskriftsartikel (refereegranskat)abstract
- Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1–6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5–19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was <1.1 kg m–2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified.
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- Karlsson, Omar, et al.
(författare)
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The relationship of household assets and amenities with child health outcomes: an exploratory cross-sectional study in India 2015–2016
- 2020
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Ingår i: SSM - Population Health. - : Elsevier BV. - 2352-8273. ; 10
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Tidskriftsartikel (refereegranskat)abstract
- Healthy development of children in India is far from ensured. Proximate determinants of poor child health outcomes are infectious diseases and undernutrition, which are linked to socioeconomic status. In low- and middle-income countries, researchers rely on wealth indices, constructed from information on households’ asset ownership and amenities, to study socioeconomic disparities in child health. Some of these wealth index items can, however, directly affect the proximate determinants of child health. This paper explores the independent association of each item used to construct the Demographic and Health Surveys’ wealth index with diverse child health outcomes. This cross-sectional study used nationally representative sample of 245,866 children, age 0–59 months, from the Indian National Family Health Surveys conducted in 2015–16. The study used conditional Poisson regression models as well as a range of sensitivity specifications. After controlling for socioeconomic status, health care use, maternal factors, community-level factors, and all wealth index items, the following wealth index items were the most consistently associated with child health; type of toilet facilities, water source, refrigerator, pressure cooker, type of cooking fuel, having a bank account, land usable for agriculture, floor material, roof material, mobile phone, and motorcycle/scooter. The association with type of toilet facilities and water source was particularly strong for mortality, showing a 16-35% and 14-26% lower mortality, respectively. Most items used to construct the Demographic and Health Surveys’ wealth index only indicate household socioeconomic status, while a few items may affect child health directly, and can be useful targets for policy intervention.
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- Karlsson, Omar, et al.
(författare)
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Weakening association of parental education: analysis of child health outcomes in 43 low- and middle-income countries
- 2018
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Ingår i: International Journal of Epidemiology. - : Oxford University Press (OUP). - 0300-5771 .- 1464-3685. ; 48:1, s. 83-97
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundParental education has been suggested to be an effective instrument for improving child health in low- and middle-income countries. Both education and child health have improved, however, as well as related factors. These changes may have implications for the observed association.MethodsWe used Demographic and Health Surveys conducted in 43 countries at two points in time, between 1991 and 2016, to test if the association of parental education with child health has changed over time. We explored how changes relate to commonly cited confounders and pathways, including fertility, household living standards, health care use, urbanicity and geographical clustering. We used linear probability models, Gelbach decomposition, and assessed a range of sensitivity specifications.ResultsThe point estimate for an additional year of maternal education has attenuated by 0.27% points (56%) for under-5 mortality, 0.34% points (15%) for child stunting, 0.42% points (30%) for child underweight and 0.09% points (24%) for child wasting. The point estimate for paternal education has attenuated by 0.20% points (53%) for under-5 mortality, 0.15% points (8%) for child stunting, 0.28% points (24%) for underweight and 0.06% points (19%) for wasting. Changes in confounding and mediation by fertility, household living standards and urban-rural differences explain to a large extent the attenuations. Geospatial clustering increasingly drives the association of parental education with child health.ConclusionsThe role of parental education in child health has attenuated considerably over time in low-resource settings. Decision makers should take into account this weakening association when designing policies aimed at improving child health.
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- Li, Zhihui, et al.
(författare)
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Distribution of under-5 deaths in the neonatal, postneonatal, and childhood periods : a multicountry analysis in 64 low- and middle-income countries
- 2021
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Ingår i: International Journal for Equity in Health. - : Springer Science and Business Media LLC. - 1475-9276. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: As under-5 mortality rates declined all over the world, the relative distribution of under-5 deaths during different periods of life changed. To provide information for policymakers to plan for multi-layer health strategies targeting child health, it is essential to quantify the distribution of under-5 deaths by age groups.METHODS: Using 245 Demographic and Health Surveys from 64 low- and middle-income countries conducted between 1986 and 2018, we compiled a database of 2,437,718 children under-5 years old with 173,493 deaths. We examined the share of deaths that occurred in the neonatal (< 1 month), postneonatal (1 month to 1 year old), and childhood (1 to 5 years old) periods to the total number of under-5 deaths at both aggregate- and country-level. We estimated the annual change in share of deaths to track the changes over time. We also assessed the association between share of deaths and Gross Domestic Product (GDP) per capita.RESULTS: Neonatal deaths accounted for 53.1% (95% confidence interval [CI]: 52.7, 53.4) of the total under-5 deaths. The neonatal share of deaths was lower in low-income countries at 44.0% (43.5, 44.5), and higher in lower-middle-income and upper-middle income countries at 57.2% (56.8, 57.6) and 54.7% (53.8, 55.5) respectively. There was substantial heterogeneity in share of deaths across countries; for example, the share of neonatal to total under-5 deaths ranged from 20.9% (14.1, 27.6) in Eswatini to 82.8% (73.0, 92.6) in Dominican Republic. The shares of deaths in all three periods were significantly associated with GDP per capita, but in different directions-as GDP per capita increased by 10%, the neonatal share of deaths would significantly increase by 0.78 percentage points [PPs] (0.43, 1.13), and the postneonatal and childhood shares of deaths would significantly decrease by 0.29 PPs (0.04, 0.54) and 0.49 PPs (0.24, 0.74) respectively.CONCLUSIONS: Along with the countries' economic development, an increasing proportion of under-5 deaths occurs in the neonatal period, suggesting a need for multi-layer health strategies with potentially heavier investment in newborn health.
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