Building capacity for birth defects surveillance in Africa: Implementation of an intermediate birth defects surveillance workshop

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Each year around the world, it is estimated that 300,000 neonates are born with a neural tube defect. Many countries, however, are still lacking comprehensive birth defects surveillance registries. Comprehensive birth defects surveillance systems can help countries understand the magnitude and distribution of the problem. These systems can also provide information about biological, contextual, social and environmental determinants of birth defects. This information in turn can be used to identify effective and implementable solutions, and to evaluate prevention and management strategies to improve quality performance. This paper summarizes the development and implementation of an online pre-course training and in-person surveillance workshop conducted between 2014 December and 2015 March for representatives from six African countries. Feedback given by participants provided valuable lessons learned that can be applied to subsequent trainings and workshops.

Assessing and Applying Evidence-Based Interventions at the Community Level in India as a Model Policy to Reduce Neonatal Mortality Rates in Nigeria

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The percentage of deaths in Nigeria that occur in the first month of life make up 28% of all deaths under five years, yet most of these deaths can be prevented by simple interventions, such as exclusive breastfeeding. This paper aims to address the challenges of reducing neonatal mortality in Nigeria by examining the efficacy of home-based, newborn care interventions and policies that have been implemented successfully in India. A comparison of similarities and differences between India and Nigeria was done using qualitative and quantitative data of various health indicators. The analysis included identifying policy-related factors contributing to India’s newborn survival rates. A literature search of randomized controlled trials of community health worker interventions shown to reduce neonatal mortality was also conducted. While it appears that Nigeria spends more money than India on health per capita and as percent GDP, it still lags behind India in its neonatal, infant, and under five mortality rates. Both countries have comparably low numbers of healthcare providers. In contrast to Nigeria, India’s community health workers receive training on how to deliver postnatal care in the home setting. Three randomized controlled trials of home-based, newborn care strategies revealed that community health workers trained to provide a preventive package of interventions during multiple postnatal visits in rural India, Bangladesh, and Pakistan reduced neonatal mortality percentages by 54%, 34%, and 15-20%, respectively. To address the urgency of neonatal mortality, countries with weak health systems need to invest in evidence-based, newborn care interventions that utilize available human resources. The current available evidence of models of postnatal care provision demonstrates that home-based care and health education provided by community health workers can effectively reduce neonatal mortality rates.

Nutritional Status of 9th Grade Students in Amman, Jordan

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Jordan, like many countries around the world, is experiencing a nutrition transition. While Jordan has primarily dealt with malnutrition issues in the past, an influx of foods high in sodium, carbohydrates, and fat has steered the country towards realizing the impacts of overnutrition on its population. A cross-sectional study design was used to evaluate 488 ninth-grade students from six public schools in Amman, Jordan. To assess students’ dietary habits, a twenty-eight item validated questionnaire was administered. A one-way analysis of variance showed that red meat, fish, manakeesh pastries, mortadella, candy and desserts and energy drinks were significantly associated with BMI categories. A crude, unadjusted linear regression model showed that candy and desserts were significantly associated with BMI (RR=1.40, 95%CI -2.52, -0.28, p=0.014). In an adjusted linear regression model, candy and desserts remained significantly associated with BMI (adjusted RR=-1.49, 95% CI: -2.64, -0.33, p=0.012). Results from this study indicate that Jordan seems to be undergoing a nutrition transition in school-aged children where undernutrition and overnutrition are taking place simultaneously. Food aid and policy efforts should focus on the impact of diet on Jordanians, and in particular on school-aged children, to lessen the burden of chronic diseases on this future generation.

The Relationship between Exclusive Breastfeeding Duration and Growth in San Pablo, Ecuador

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This study sought to determine (1) the relationship between Exclusive Breastfeeding (EBF) duration and future height; (2) the prevalence of EBF in San Pablo, Ecuador (3) the risk factors for stunting in an impoverished setting. This study surveyed the mothers of 148 first graders in primary schools in San Pablo, Ecuador, and then measured the height of the children. The study revealed that 8.1% of women performed EBF for 12 months. Stunting did not correlate to the duration of EBF (p=0.9484). Stunted children and non-stunted children did not differ in many potential confounders; however, the number of children in the family was higher for stunted children than non-stunted children (p=0.0139). This study suggests that EBF duration has no effect on future stunting. The number of children in the family increased the risk of stunting. Unlike previous research, which showed underfeeding in South America, this study revealed an Ecuadorian community that values prolonged EBF culturally.

A Student’s Observations on the State of Maternal Care in India

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As the second most populous country in the world, India struggles to provide universal healthcare with an infrastructure that has not kept pace with its economic growth and expanding population. With limited resources, physicians are spread thin and standards of health are low. As a result, the wealthy opt for private healthcare and receive world-class medical attention while the majority subsists on the most minimal treatments. These limitations, in combination with a traditional male-dominated culture, leave women with little freedom of choice when it comes to treatment of their bodies. This gender inequality in healthcare is amplified by a lack of education of family planning strategies. After spending a month shadowing physicians in both private and public hospitals in India, I saw first hand the shortcomings of the Indian health system, particularly in relation to women’s health. Despite the obvious need to repair public healthcare, overpopulation and government corruption prevent improvements in the healthcare infrastructure.

Child Iron Supplementation in Regions with High Rates of Anemia: An Assessment of Risk to Iron-Replete Children and Recommendations for Future Study

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Iron deficiency anemia affects nearly 1.6 billion people worldwide and can result in delayed cognitive and motor development, impaired growth, and reduced immune function. Therefore, the WHO recommends universal iron supplementation for children in regions where prevalence of anemia exceeds 40%. However there are hypothesized risks associated with excess iron, so iron-replete children may be adversely affected by additional exposure through supplementation. The objectives of this paper are to determine, through a systematic review of existing literature, if iron supplementation increases the risk of adverse health outcomes in iron-replete children under the age of 5. PubMed and CENTRAL were searched to identify appropriate studies that fit the following inclusion criteria: children under the age of five, analysis or stratified sub-analysis of iron-replete children, a supplementation intervention only, and randomized controlled trials (RCTs) or prospective observational studies. Backward and forward searches were also conducted. Nine randomized controlled trials and one prospective clinical study were included. The Cochrane Risk of Bias Tool was used to assess selection, performance, detection, and reporting bias in each RCT. The evidence suggests that iron supplementation does not adversely affect mental and motor skill development, height, head circumference, or arm circumference. Results regarding the impact on weight gain are mixed and require further study. Some evidence suggests that the rate of diarrhea is higher in supplemented children, but other morbidities are unaffected. None of the studies investigated the impact of supplementation on risk or severity of malaria. From this review there is insufficient evidence to recommend against universal iron supplementation in areas with a high prevalence of iron deficiency. The literature would benefit from more trials on this topic, particularly whether supplementation of iron-replete children inhibits weight gain or increases the risk of contracting malaria. External validity would be strengthened with studies of larger sample sizes.

The Relationship between Exclusive Breastfeeding Duration and Growth in San Pablo, Ecuador

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This study sought to determine (1) the relationship between Exclusive Breastfeeding (EBF) duration and future height; (2) the prevalence of EBF in San Pablo, Ecuador (3) the risk factors for stunting in an impoverished setting. This study surveyed the mothers of 148 first graders in primary schools in San Pablo, Ecuador, and then measured the height of the children. The study revealed that 8.1% of women performed EBF for 12 months. Stunting did not correlate to the duration of EBF (p=0.9484). Stunted children and non-stunted children did not differ in many potential confounders; however, the number of children in the family was higher for stunted children than non-stunted children (p=0.0139). This study suggests that EBF duration has no effect on future stunting. The number of children in the family increased the risk of stunting. Unlike previous research, which showed underfeeding in South America, this study revealed an Ecuadorian community that values prolonged EBF culturally.

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