Operational implications of using 2006 World Health Organization growth standards in nutrition programmes: secondary data analysis

Operational implications of using 2006 World Health Organization growth standards in nutrition programmes: secondary data analysis . Seal A , Kerac M . ( 2007 ) British Medical Journal , 334 , 733 – 735 . doi: 10.1136/bmj.39101.664109.AE     

Prevalence and factors affecting underweight,overweight and obesity using Asian and World Health Organization cutoffs among adults in Nepal: Analysis of the Demographic and Health Survey 2016

ObjectiveThere is a little published data on prevalence and determinants of underweight, overweight and obesity among adults in Nepal. This study analysed the cross-sectional Nepal Demographic and Health Survey (NDHS) 2016 to obtain these using the World Health Organization (WHO) and Asian-specific cutoffs of body mass index (BMI).MethodsThe 2016 NDHS used a multistage cluster-sampling design to obtain data on major health indicators in Nepal. The BMI cutoffs for underweight was <18.5 kg/m². The BMI cutoffs for overweight/obesity as per the Asian and WHO classifications were ≥23, and ≥25 kg/m², respectively. After reporting the prevalence according to sex and background characteristics, multilevel logistic regression was conducted to estimate odds ratios.SubjectsThis analysis included 12,652 adults (5283 males and 7369 females) with a median age of 40 years (interquartile range [IQR]: 28–54).ResultsThe overall median BMI was 21.5 kg/m² (IQR:19.3–24.3). The overall prevalence of underweight was 16.7% (15.1% among males and 17.1% among females). The Asian-specific BMI cutoffs found the prevalence of overweight and obesity as 26.4% (27.4% among males and 25.6% among females) and 11.0% (7.7% among males and 13.3% among females), respectively. The WHO-recommended BMI cutoffs found 18.2% people overweight (16.7% among males and 19.3% among females) and 4.3% (2.5% among males and 5.6% among females) people obese. The prevalence and odds of extreme body weight categories (i.e., underweight, overweight and obesity) varied according to age, sex, education level, household wealth status, place, ecological zone and provinces of residence as per both recommended cutoffs. Overall, higher education level and wealth status were positively associated with overweight/obesity and inversely associated with underweight as per both cutoffs.ConclusionA large proportion Nepalese adults have either underweight, overweight or obesity, and could be at a greater risk of mortality and morbidity due to these extreme body weight categories. It is essential to address the factors or characteristics that are associated with the higher prevalence and likelihood of these extreme body weight categories to reduce the overall burden of underweight and overweight/obesity in Nepal.     

Demographic and predictive correlates of smokeless tobacco use in elementary school children

BACKGROUND. To assess the basic demographics and predictive correlates of smokeless tobacco use in school-age children, a stratified random sample of 559 rural and urban first, third, fifth, and seventh graders in western North Carolina was surveyed regarding experimentation with smokeless tobacco. METHODS. Two versions of a survey were developed: a shorter version administered orally to first graders and a longer version provided to others. Reported percentages across demographic variables were broken down in a 4 x 2 x 2 analysis of variance; correlations were used to assess the relationships among potentially predictive variables. RESULTS. Results indicated that 36 percent of male rural first graders had tried smokeless tobacco, increasing to 70 percent by the seventh grade. Overall, rural males were more likely to have tried or be regularly using smokeless tobacco than were urban males or females. Other questions correlating with smokeless tobacco use indicated that it is predicted by three general concerns: a) perceived flavor, b) self-concept and presentation to peers, and c) family influence. DISCUSSION. Educational interventions must begin at the kindergarten or first grade levels. Programs for adolescents must provide for alternative ways of receiving perceived social image benefits of smokeless tobacco use. Familial support must be considered in all programming.     

The Association of Childhood Pneumonia with Household Air Pollution in Nepal: Evidence from Nepal Demographic Health Surveys

Introduction

Childhood pneumonia is a major cause of mortality worldwide while household air pollution (HAP) is a major contributor to childhood pneumonia in low and middle-income countries. This paper presents the prevalence trend of childhood pneumonia in Nepal and assesses its association with household air pollution.

Methods

The study analysed data from the 2006, 2011 and 2016 Nepal Demographic Health Surveys (NDHS). It calculated the prevalence of childhood pneumonia and the factors that cause household air pollution. The association of childhood pneumonia and HAP was assessed using univariate and multi-variate analysis. The population attributable fraction (PAF) of indoor pollution for causing pneumonia was calculated using 2016 NDHS data to assess the burden of pneumonia attributable to HAP factors.

Results

The prevalence of childhood pneumonia decreased in Nepal between 2006 and 2016 and was higher among households using polluting cooking fuels. There was a higher risk of childhood pneumonia among children who lived in households with no separate kitchens in 2011 [Adjusted risk ratio (ARR) 1.40, 95% CI 1.01–1.97] and in 2016 (ARR 1.93, 95% CI 1.14–3.28). In 2016, the risk of children contracting pneumonia in households using polluting fuels was double (ARR 1.98, 95% CI 1.01–3.92) that of children from households using clean fuels. Based on the 2016 data, the PAF for pneumonia was calculated as 30.9% for not having a separate kitchen room and 39.8% for using polluting cooking fuel.

Discussion for Practice

Although the occurrence of childhood pneumonia in Nepal has decreased, the level of its association with HAP remained high.

     

Low Compliance with Iron-Folate Supplementation Among Postpartum Mothers of Nepal: An Analysis of Nepal Demographic and Health Survey 2011

One in five maternal deaths are directly attributable to anaemia in the world. The World Health Organization recommends iron supplementation from the second trimester of pregnancy to 45 days after delivery. The aim of this study was to determine the compliance rate of iron-folate consumption and the factors associated with iron-folate consumption among post-natal mothers in Nepal. This study utilised the data of Nepal Demographic and Health Survey (NDHS) 2011. The NDHS 2011 is a cross sectional and nationally representative survey. Of the 4,148 respondents, only 20.7 % consumed iron throughout the post-natal period for 45 days. Mothers who had higher and secondary education [adjusted Odd ratio (aOR) 3.101; 95 % CI (2.268–4.240)]; had attended four or more antenatal care visits [aOR 9.406; 95 % CI (5.552–15.938)]; lived in Far-western development region [aOR 1.822; 95 % CI (1.387–2.395)]; delivered in health facility [aOR 1.335; 95 % CI (1.057–1.687)]; and attended postnatal care [aOR 2.348; 95 % CI (1.859–2.965)] were more likely to take iron for 45 days of postpartum. Intervention to increase the compliance with the postpartum iron-folate supplementation are required to avoid adverse pregnancy outcomes associated with poor iron status with especial focus on the mothers who delivered at homes and did not attend post-natal check up.     

Prevalence and socio-economic correlates of smoking among lone mothers in Australia

OBJECTIVE: To report smoking prevalence among Australian lone mothers by age and socio-economic group and to examine the extent to which the difference in smoking prevalence between lone mothers and other women is due to socio-economic factors. METHODS: This was a secondary analysis of data from the 1995 National Health Survey (NHS), which was conducted by the Australian Bureau of Statistics (ABS). Information was collected from 53,800 respondents using face-to-face interviews. This analysis was limited to single mothers (n=1,184) who had at least one dependent child aged under 15. The outcome measure was smoking status, distinguishing regular smokers from occasional smokers, ex-smokers and never-smokers. RESULTS: The overall smoking prevalence among lone mothers was 46.3% (Cl 43.5%-49.1%). Lone mothers who were younger, less educated, received government pension/benefits, occupied rental housing or who lived in more disadvantaged areas were more likely to smoke than others. A strong 'lone mother effect' remained after controlling for socio-economic variables. The odds of smoking for lone mothers were 2.4 times greater than for married mothers (95% Cl 2.0-2.9) and twice as large as those for women living alone (95% CI 1.62.4). CONCLUSION: As the prevalence for this population group is considerably higher than the prevalence for other women within each age category, programs to assist lone mothers to quit smoking are a priority for the long-term health of these women and their children. Furthermore, we discuss how policies and interventions that enhance the material conditions and social circumstances of lone mothers can bring about a decline in their smoking prevalence.     

Neighbourhood socioeconomic context and self reported health and smoking: a secondary analysis of data on seven cities

OBJECTIVE: Many studies have shown that poor health status and harmful health behaviour occur more frequently in deprived neighbourhoods. Most studies show modest associations between area level socioeconomic factors, the neighbourhood context, and health outcomes. However, estimates for the contextual effects vary. It is unclear if this variation is attributable to differences in methodology. This study examines whether contextual neighbourhood differences in health outcomes really vary between cities or that differences in methodology may account for these differences. DESIGN: Secondary analysis of data from health interview surveys in seven large Dutch cities in the 1990s comprising 23 269 residents of 484 neighbourhoods, using multilevel logistic models. SETTING: General population aged 16 and over. MAIN OUTCOME MEASURES: Self reported health, smoking of cigarettes. MAIN RESULTS: The socioeconomic context of neighbourhoods is associated with health outcomes in all large Dutch cities. The strength of the association varies between cities, but variation is much smaller in the age group 25-64. Furthermore, neighbourhood differences vary in size between native and other residents. Contextual neighbourhood differences are about two times larger for self reported health than for the smoking of cigarettes, but for native Dutch people they are of similar size. CONCLUSIONS: A comparatively large improvement in health may be gained in deprived neighbourhoods, because of the poorer health status to which the context of these neighbourhoods also contributes. Health promoting interventions should be aimed at the residents and at the context of deprived neighbourhoods, taking differences between ethnic groups and age groups into account.     

Prevalence of cigarette smoking among secondary school students--Budapest, Hungary, 1995 and 1999

The average per capita cigarette consumption in Hungary is among the highest in the world (World Health Organization [WHO], unpublished data, 1997) (1). In 1999, the Metropolitan Institute of State Public Health and Public Health Officer Service, Budapest, Hungary, collaborating with CDC, conducted a survey of cigarette smoking among secondary school students aged 14-18 years in Budapest (1999 population of Budapest: approximately 2 million), similar to a survey conducted in 1995 (2). This report summarizes the survey findings, which indicate that current smoking among secondary school students in Budapest increased from 36% in 1995 to 46% in 1999.     

Income and smoking behavior in Germany--a secondary analysis of data from the 1995 microcensus

We investigated to what extent two major parameters of the economic situation, namely the household income and the type of the major source of income, are related to smoking behaviour. Study variables are current cigarette smoking and ex-smoking. Databasis is the Public Use File of the "Microcensus 1995", which is a representative survey for Germany, conducted under the auspices of the German Federal Statistical Bureau. Included in the analysis were 185,822 persons aged 18 years and older. 30.9% of males and 18.2% of females are current smokers. 39% of males and 31.2% of females, who had been smokers at any time, stopped smoking. For persons aged 18 to 64 years, we observed strong income-related differences in the smoking prevalence. The higher the income the lower was the rate of smokers. Higher rates for ex-smokers were observed for persons older than 30 years, who had a high household income. For study subjects with a primary income based on unemployment or social welfare payments, we found for both sexes a remarkably higher smoking prevalence. Due to the fact that the underlying causes for the higher prevalence of smoking in the poorer segments of the population are not very well understood, it is rather difficult to establish a comprehensive prevention strategy for this high-risk population group.     

Trends and correlates of single motherhood in Kenya: Results from the Demographic and Health Survey

Single motherhood exposes women to poorer socioeconomic and health outcomes, which may also negatively impact child outcomes. The Demographic and Health Surveys of 1989, 1993, 1998, 2003, and 2009 were used to investigate trends over time and factors associated with single motherhood in Kenya. Urban residence, older age, and poorer economic status were associated with single motherhood over time. Women with more than one child, and those with children under 15 years living at home were less likely to be single mothers. As women become single mothers at different stages, targeted and supportive strategies are required to mitigate associated risks.     

Prevalence and correlates of depressive symptoms in secondary school children in Dhaka city,Bangladesh

ABSTRACT

Objectives: Depression is a leading contributor to the global burden of disease, and often starts at a young age. Depression in young people can increase the risk of unhealthy lifestyle behaviour and can lead to substantial disability, social problems, poor health, and suicide. Other research has examined depressive symptoms among adult populations in Bangladesh, but little is known about other age groups. The aim of this study was to assess the prevalence and socio-demographic correlates of depressive symptoms among secondary school children of Dhaka city, Bangladesh.

Design: A self-completed questionnaire was administered to 898 students from eight secondary schools of Dhaka, the capital City of Bangladesh. Of the respondents, 755 (372 males, 383 females; average age 14.26 years; SD 1.15) completed the 10-item Center for Epidemiological Studies Depression Scale (CESD-10). A score of 10 or more was used to indicate depressive symptoms. Parents completed a separate questionnaire to provide individual and household/family-level data. Generalized Estimating Equations (GEE) was used to assess sociodemographic and lifestyle factors associated with adolescent depressive symptoms.

Results: Among the responding adolescents, 25% reported depressive symptoms with prevalence more common among females than males (30% vs. 19%). Factors significantly associated with symptoms of depression included being female, aged 15–16 years, self-perception of non-normal weight, feeling unsafe at school, sleep disturbance, low life satisfaction, high intake of sugary drinks, and regularly skipping breakfast.

Conclusion: Depressive symptoms are prevalent among secondary school children in urban Bangladesh. Interventions for adolescents with depressive symptoms could focus on lifestyle practices such as weight management, personal safety, sleep hygiene and healthy eating.     

Perceived smoking norms,socioenvironmental factors,personal attitudes and adolescent smoking in China: a mediation analysis with longitudinal data

PurposeTo gather information on inter-relationships among risk factors affecting adolescent smoking for tobacco control in China, the world’s largest tobacco producer and consumer.MethodLongitudinal data were collected six months apart in 2003 from 813 students in grades 7, 8, 10, and 11 from two schools in Beijing, China. Linear regression was used to assess both the direct effect from predictor variables (smoking among influential others, pro-tobacco media, and attitudes toward smoking) on cigarette use and the indirect effect mediated through the perceived smoking norms (percentage of smokers among peers).ResultsAmong the 803 subjects (mean age of 15.5 years, SD = 1.7; 52.1% female), 18.3% of males and 1.7% of females smoked in the past 30 days. Smoking among influential others (best friends, father, mother, male teachers, female teachers, and adults in general) and perceived positive psychological and social rewards from smoking at baseline were associated with number of cigarettes smoked at follow-up, whereas exposure to pro-tobacco media was not significantly associated with smoking. The mediated effect was greater for adult smoking (70% to 90%) than for best friend smoking (11% to 16%).ConclusionSmoking among influential others and attitudes toward smoking influence adolescent smoking both directly and indirectly. The finding of the indirect effect mediated through perceived smoking norms expands our knowledge on smoking etiology. Effective adolescent smoking intervention programs in China need to include a component targeting adult smoking to reduce perceived smoking norms.     

Trends in smoking among the adult population in Brazilian capitals: a data analysis of telephone surveys from 2006 to 2009

The objective of this study was to analyze the trend of tobacco use and smoking cessation, and the intensity of cigarettes per day from 2006 to 2009 in the Brazilian state capitals. Data were analyzed for 18-year-old individuals or older who were interviewed by the Telephone-based Surveillance of Risk and Protective Factors for Chronic Diseases (VIGITEL), which was performed in the Brazilian State capitals and the Federal District in 2006, 2007, 2008, and 2009. For each year and large areas, age-adjusted prevalence and prevalence according to age groups (18 to 29, 30 to 59 and 60 and older) stratified by sex were calculated. Smoking cessation index was assessed and, for current smokers, the proportion of those who reported smoking 20 or more cigarettes a day was estimated according to gender and age group (18 to 39 and 40 and over). The results show a slight tendency to the reduction of tobacco use among men and stability for women, except for residents from the North and Northeast Regions. In general, the greatest prevalence among men is in younger groups; while amongst women, it is in the intermediary age group (30 to 59 years old). Smoking cessation seems to be slightly higher among men; there is a strong reverse relation between tobacco use and schooling. The proportion of 20 or more cigarettes per day is higher among older people and varies in Brazilian Regions. Results point out the need to prioritize strategies for tobacco control that can reach young individuals and women at low-education level.     

Prevalence and correlates of smoking among urban adult men in Bangladesh: slum versus non-slum comparison

Background  

Smoking is one of the leading causes of premature death particularly in developing countries. The prevalence of smoking is high among the general male population in Bangladesh. Unfortunately smoking information including correlates of smoking in the cities especially in the urban slums is very scarce, although urbanization is rapid in Bangladesh and slums are growing quickly in its major cities. Therefore this study reported prevalences of cigarette and bidi smoking and their correlates separately by urban slums and non-slums in Bangladesh.