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Evidence suggests that autistic adults have higher odds of developing several co-occurring conditions, but less is known about disparities by race and ethnicity in this population. Using 2008-2012 Medicaid Analytic eXtract (MAX) data, we (i) identify the prevalence of co-occurring conditions among the population of autistic adult Medicaid beneficiaries compared to a matched sample of those without an autism spectrum disorder (ASD) diagnosis, (ii) conduct logistic regression to estimate odds ratios for these health conditions predicted by an autism diagnosis, and (iii) estimate odds of having these health conditions as predicted by racial/ethnic group among the autistic population only. Overall, autistic adults did not have higher prevalence of some major health conditions (cardiovascular conditions, stroke, cancer, cardiovascular disease), but they did have higher odds of others (nutrition conditions, epilepsy, disorders of the central nervous system). Analysis by racial/ethnic group, however, shows that Black, Hispanic, and Asian autistic beneficiaries had higher odds of diabetes, hospitalized cardiovascular diseases, and hypertension, among other conditions. Policymakers should be aware that racial disparities found in the general population persist in the autistic population and should work to implement systems and programs to improve screening and preventive care for minority autistic populations. LAY SUMMARY: Autistic adults may have several co-occurring physical and mental health conditions, which could differ by racial/ethnic group. We find that, compared to the general Medicaid population, autistic adult Medicaid beneficiaries have elevated odds of some health conditions, like epilepsy and nutrition conditions, as well as some psychiatric conditions, such as anxiety and attention disorders. We also find that many of the same health disparities by racial/ethnic group in the general population persist among the autistic adult Medicaid population. For example, Black, Hispanic, and Asian Medicaid autistic beneficiaries have higher odds of diabetes, and Black and Hispanic autistic beneficiaries have higher odds of obesity and nutrition conditions than white autistic beneficiaries.

Micronutrient powder (MNP) can reduce iron deficiency in young children, which has been well established in efficacy trials. However, the cost of different delivery platforms has not been determined. We calculated the cost and cost‐efficiency of distributed MNP through community‐based mechanisms and in health facilities in a primarily rural district in Uganda. An endline survey (n = 1072) identified reach and adherence. During the 9‐month pilot, 37,458 (community platform) and 12,390 (facility platform) packets of MNP were distributed. Each packet consisted of 30 MNP sachets. In 2016, total costs were $277,082 (community platform, $0.24/sachet) and $221,568 (facility platform, $0.59/sachet). The cost per child reached was lower in the community platform ($53.24) than the facility platform ($65.97). The cost per child adhering to a protocol was $58.08 (community platform) and $72.69 (facility platform). The estimated cost of scaling up the community platform pilot to the district level over 3 years to cover approximately 17,890 children was $1.23 million (scale‐up integrated into a partner agency program) to $1.62 million (government scale‐up scenario). Unlike previous estimates, these included opportunity costs. Community‐based MNP delivery costs were greater, yet more cost‐efficient per child reached and adhering to protocol than facility‐based delivery. However, total costs for untargeted MNP delivery under program settings are potentially prohibitive., This study estimates costs based on programmatic elements using two delivery platforms in a single rural site in Uganda: (1) delivery by community health workers (community‐based platform) and (2) delivery using facility‐based health providers (facility‐based platform). We calculated the cost of micronutrient powders (MNP) provision from start‐up to the “last mile”— the final leg in product and service delivery when MNP reaches beneficiaries. We compared costs and cost‐efficiency across delivery platforms using several indicators of outcomes and estimated the costs of scaling up, extending the pilot program, and integrating MNP delivery activities into existing infant and young child feeding programs.

BACKGROUND AND OBJECTIVES Autistic children and children with attention-deficit/hyperactivity disorder (ADHD) may have more frequent visits to the emergency department (ED). We aim to identify the primary reasons for ED visits among autistic children and children with ADHD, compared to a random sample of visits. METHODS Using 2008 to 2017 Nationwide Emergency Department Sample data, we assessed the most frequent primary diagnoses for ED visits among children (ages 3–12 and 13–18 years, separately) (1) with an autism diagnosis, (2) with ADHD, and (3) a random sample (1 000 000 visits). We regressed primary reasons for visits on autism or ADHD diagnosis, controlling for individual characteristics, to assess the odds of presenting for these reasons. RESULTS Although the 10 most frequent diagnoses among the random sample were physical health conditions, autistic children and children with ADHD often presented for psychiatric conditions. Older children with autism and with ADHD more frequently presented for mood disorders (10%–15% of visits; odds ratios [ORs] = 5.2–8.5) and intentional self-harm (ORs = 3.2–5.0). Younger children with ADHD more commonly presented with mood disorders (6.6% of visits; OR = 18.3) and younger autistic children more often presented with attention-deficit, conduct, and disruptive behavior disorders (9.7% of visits; OR = 9.7). CONCLUSIONS Autistic children and children with ADHD have higher odds of presenting to the ED for psychiatric conditions than a random sample, including for self-harm. Clinicians should treat these populations sensitively, recognize and assess the risk for self-harm, and facilitate continuing psychiatric care.

Micronutrient powders (MNP) have the potential to increase micronutrient intake, yet documentation of implementation lessons remains a gap. This paper presents results of a pilot in Uganda comparing community‐ and facility‐based delivery of MNP and documenting experiences of caregivers and distributors. The pilot's mixed method evaluation included a cross‐sectional endline survey, monthly household visits, and midline and endline interviews. Primary outcomes were ever‐covered (received ≥1 MNP packet), repeat‐coverage (received ≥2 MNP packets), and adherence (consumed no more than 1 MNP sachet per day, consumed MNP with food, and consumed MNP 3+ days in past week). An adjusted Wald chi‐square test compared differences in programme outcomes between arms, and logit regression identified predictors to adherence. Key informant interviews were coded thematically. Most programme outcomes in the endline survey were statistically significantly higher in the community arm, although in both arms, adherence was lower than other outcomes (adherence 31.4% in facility vs. 58.3% in community arm). Counselling, receipt of communication materials, perceived positive effects, MNP knowledge, and child liking MNP were consistent predictors of adherence in both arms. Qualitative findings corroborated survey results, revealing that social encouragement and advocacy facilitated use and that forgetting to give MNP was a barrier. Facility arm caregivers also cited distance, time, and transportation cost as barriers. Distributors had positive experiences with training and supervision but experienced increased workloads in both arms. MNP programme design is context‐specific but could benefit from strengthened community sensitization, continued and more effective counselling for caregivers, and increased support for distributors.

Recent research has demonstrated some growth recovery among children stunted in infancy. Less is known about key age ranges for such growth recovery, and what factors are correlates with this growth. This study characterized child growth up to age 1 year, and from ages 1 to 5 and 5 to 8 years controlling for initial height-for-age z-score (HAZ), and identified key distal household and community factors associated with these growth measures using longitudinal data on 7266 children in the Young Lives (YL) study in Ethiopia, India, Peru and Vietnam. HAZ at about age 1 year and age in months predicted much of the variation in HAZ at age 5 years, but 40–71% was not predicted. Similarly, HAZ at age 5 years and age in months did not predict 26–47% of variation in HAZ at 8 years. Multiple regression analysis suggests that parental schooling, consumption, and mothers' height are key correlates of HAZ at about age 1 and also are associated with unpredicted change in HAZ from ages 1 to 5 and 5 to 8 years, given initial HAZ. These results underline the importance of a child's starting point in infancy in determining his or her growth, point to key distal household and community factors that may determine early growth in early life and subsequent growth recovery and growth failure, and indicate that these factors vary some by country, urban/rural designation, and child sex.