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We analysed population data from the 2015–16 National Family Health Survey to disentangle the intricate underlying effects of reproductive behaviours and fertility preferences on child growth. We expected birth interval length to be more strongly associated with stunting than sibsize and these effects to be moderated by whether the child was wanted or unintended (mistimed/unwanted). Regression analyses showed strong and equal effects of short birth interval and sibsize on stunting, when adjusted for potential confounders and unobserved between-mother heterogeneity. There were no statistical associations between stunting and mistiming/unwantedness of index children, suggesting the absence of discrimination against such children. We conclude that while fertility preferences have no effect, reproductive behaviours exert significant influence on child growth. Sibsize has been falling for many years in India but birth interval lengths have remained largely unchanged. The results underscore the need for strengthening uptake of reversible contraceptives to enable longer birth intervals. [ABSTRACT FROM AUTHOR]

This study was conducted to evaluate whether cooled floor pads combined with chilled drinking water could alleviate negative impacts of heat stress on lactating sows. Thirty sows (Landrace × Yorkshire, Parity = 1 to 6) were housed in individual farrowing stalls in two rooms with temperatures being controlled at 29.4°C (0700–1900 hours) and 23.9°C (1900–0700 hours). Sows in one room (Cool), but not in the other room (Control) were provided cooled floor pads (21–22°C) and chilled drinking water (13–15°C). Behavior of sows (15 sows/treatment) was video recorded during farrowing, and days 1, 3, 7, 14, and 21 after farrowing. Videos were viewed continuously to register the birth time of each piglet, from which total farrowing duration and birth intervals were calculated. The number of drinking bouts and the duration of each drinking bout were registered for each sow through viewing videos continuously for 2 h (1530–1730 hours) each video-recording day. Postures (lying laterally, lying ventrally, sitting, and standing) were recorded by scanning video recordings at 5-min intervals for 24 h each video-recording day, and time budget for each posture was calculated. Rectal temperature and respiration rate were measured for all sows the day before and after farrowing, and then once weekly. Sow and litter performance was recorded. Data were analyzed using the Glimmix procedure of SAS. The cooling treatment did not affect sow behavior or litter performance. Sows in the Cool room had lower rectal temperature (P = 0.03) and lower respiration rate (P < 0.001), consumed more feed (P = 0.03), tended to have reduced weight loss (P = 0.07), and backfat loss (P = 0.07) during lactation than sows in the Control room. As lactation progressed, sows increased drinking frequency (P < 0.001) and time spent lying ventrally (P < 0.0001), standing (P < 0.001), and sitting (P < 0.0001), and decreased time spent lying laterally (P < 0.0001) in both Cool and Control rooms. While cooled floor pads combined with chilled drinking water did not affect sow behavior, they did alleviate heat stress partially, as indicated by decreased rectal temperature, respiration rate, weight, and backfat loss, and increased feed intake in lactating sows. [ABSTRACT FROM AUTHOR]

"A Space Expedition for early elementary and preschool" is a course and a set of activities based on active-inquiry learning. Through the one-day course teachers of young learners are encouraged to create settings for the children to become, and remain, curious and inquisitive. The activities are created with a larger theme project in mind; they can be used in any order, depending on the interests of the learners. The children's role in choosing the topics is essential throughout the course, as the intention is to allow the children to pursue their interests, and hence lead the project forwards. The teachers are encouraged to reflect on personal experiences and ideas together with the children to ensure a feeling of ethos and purpose, and help the children contemplate on their own educational values. All activities and resources used in this course are created by Andøya Space Education. • Allow young learners to realise the excitement of space exploration. • Our children are the space explorers of the future so let us give them the tools. • Most children work best when they can visualize and play their way to knowledge. • Learning with the children eases the pressure on teachers having all the answers. [ABSTRACT FROM AUTHOR]

Background/Context: Educators have considered how Minecraft supports language and literacy practices in the game and in the spaces and circumstances immediately surrounding gameplay. However, it is still necessary to develop additional conceptualizations of how children and youth's online and offline worlds and experiences are blurred by and through the games. In this study, I take up this call and examine how the boundaries of the digital were blurred by one child as he wrote in response to a standardized writing prompt within his urban fourth-grade classroom. Purpose/Objective/Research Question/Focus of Study: Through snapshots of Jairo's writing, I illuminate how he muddled the lines between his physical play experiences and those he had in the virtual world of Minecraft. In doing so, I argue that he carried over his personal interest as a fan of Minecraft into the writing curriculum through creative language play. As Jairo "borrowed" his physical play experiences in the virtual world of Minecraft to complete an assigned writing task, he exemplified how children blur playworlds of physical and digital play in the elementary ELA classroom. Research design: Drawing on data generated in an 18-week case study, I examine how one child, Jairo, playfully incorporated his lived experiences in the virtual world of Minecraft into mandated writing tasks. Conclusions/Recommendations: My examination of his writing is meant to challenge writing scholars, scholars of play, and those engaged in rethinking media's relation to literacy. I encourage a rethinking of what it means for adults to maintain clear lines of what is digital play and what is not. I suggest adults might have too heavy a hand in bringing play into classrooms. Children already have experiences with play--both physical and digital. We must cultivate a space for children to build on what was previously familiar to them by offering scaffolds to bridge these experiences between what we, as adults, understand as binaries. Children do not necessarily see distinctions between "reality" and play worlds, or between digital and physical play. For children, play worlds and digital worlds are perhaps simply worlds; it is we as adults who harbor a desire for clear boundaries. [ABSTRACT FROM AUTHOR]

Background: Men's involvement in pre-pregnancy care is important to ensure a positive pregnancy outcome. The objective of this study is to determine the level of knowledge of pre-pregnancy care among men and the factors associated with poor knowledge. Methods: This work is a cross-sectional study conducted at the outpatient clinics of Hospital Universiti Sains Malaysia involving 235 married men. A self-administered questionnaire was used and it consisted of four sections: socio-demographic data, reproductive characteristics of couples, clinical characteristics and knowledge of pre-pregnancy care. Results: More than half of the men (51.9%) had poor knowledge of pre-pregnancy care, mostly on high-risk pregnancy, consequences of poor birth spacing and effect of maternal anaemia on a baby. The mean (SD) knowledge was 11.86 (3.85). Poor knowledge of pre-pregnancy care was significantly associated with age (adjusted odds ratio [AOR] = 0.96; 95% CI: 0.94, 0.99, P = 0.002) and education level (AOR = 2.61; 95% CI: 1.49, 4.57; P = 0.001). Conclusion: The men in our study had poor knowledge of pre-pregnancy care. Further health promotion and education are needed to be focused on men to increase their knowledge and share the responsibilities in maternal health. [ABSTRACT FROM AUTHOR]

Mr. Malthus confesses that his proposal to exclude them would not remove the evil, and both he and Mr. Godwin have declared that the true remedy can alone be found in preventives. I The right of couples "to determine freely and responsibly the number and spacing of their children", long taken for granted in most of the world, was formally declared at the 1968 International Conference on Human Rights. [Extracted from the article]

Do firstborn children have a height advantage? Empirical findings have found mostly that, yes, second or higher-order children often lag behind firstborns in height outcomes, especially in developing countries. However, empirical investigations of birth-order effects on child height overlook the potential impact that birth spacing can have. We provide an explanation for the negative birth-order effect on stunting outcomes for young Indian children and show it is driven by short preceding-birth spacing. We find that firstborn children are taller than children of higher birth order: The height-for-age gap for third (or higher)-order children is twice the gap for children second in birth order. However, this pattern is observed when spacing between later-born children and their immediate elder siblings is fewer than 3 y. Interestingly, the firstborn height advantage disappears when later-born children are born at least 3 y after their elder siblings. Thus, our findings indicate that spacing length between children explains differences in height, over birth order. Although India's family planning policy has resulted in a substantial reduction in total fertility, its achievement in spacing subsequent births has been less impressive. In showing that spacing can alleviate or aggravate birth-order effects on attained height, our study fills an evidence gap: Reducing fertility alone may not be sufficient in overcoming negative birth-order effects. To reduce the detrimental effects of birth order on child stunting, policy responses--and therefore research priorities--require a stronger focus on increasing the time period between births. [ABSTRACT FROM AUTHOR]

Background: Humans life histories have been described as "slow", patterned by slow growth, delayed maturity, and long life span. While it is known that human life history diverged from that of a recent common chimpanzee-human ancestor some ~4–8 mya, it is unclear how selection pressures led to these distinct traits. To provide insight, we compare wild chimpanzees and human subsistence societies in order to identify the age-specific vital rates that best explain fitness variation, selection pressures and species divergence. Methods: We employ Life Table Response Experiments to quantify vital rate contributions to population growth rate differences. Although widespread in ecology, these methods have not been applied to human populations or to inform differences between humans and chimpanzees. We also estimate correlations between vital rate elasticities and life history traits to investigate differences in selection pressures and test several predictions based on life history theory. Results: Chimpanzees' earlier maturity and higher adult mortality drive species differences in population growth, whereas infant mortality and fertility variation explain differences between human populations. Human fitness is decoupled from longevity by postreproductive survival, while chimpanzees forfeit higher potential lifetime fertility due to adult mortality attrition. Infant survival is often lower among humans, but lost fitness is recouped via short birth spacing and high peak fertility, thereby reducing selection on infant survival. Lastly, longevity and delayed maturity reduce selection on child survival, but among humans, recruitment selection is unexpectedly highest in longer-lived populations, which are also faster-growing due to high fertility. Conclusion: Humans differ from chimpanzees more because of delayed maturity and lower adult mortality than from differences in juvenile mortality or fertility. In both species, high child mortality reflects bet-hedging costs of quality/quantity tradeoffs borne by offspring, with high and variable child mortality likely regulating human population growth over evolutionary history. Positive correlations between survival and fertility among human subsistence populations leads to selection pressures in human subsistence societies that differ from those in modern populations undergoing demographic transition. [ABSTRACT FROM AUTHOR]

A popular method for simultaneously modeling of correlated count response with excess zeros and time to event is by means of the joint models. In these models, the likelihood‐based methods (such as expectation‐maximization algorithm and Newton‐Raphson) are used for estimating the parameters, but in the presence of contaminations, these methods are unstable. To overcome this challenge, we extend the M‐estimator methods and propose a robust estimator approach to obtain a robust estimation of the regression parameters in the joint model. Our proposed algorithm has two steps (Expectation and Solution). In the expectation step, the likelihood function is expected by conditioning on the observed data and in the solution step, the parameters are computed, with solving robust estimating equations. Therefore, this algorithm achieves robustness by applying robust estimating equations and weighted likelihood in the S‐step. Simulation studies under various situations of contaminations show that the robust algorithm gives us consistent estimates with a smaller bias than likelihood‐based methods. The application section uses data on factors affecting fertility and birth spacing. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization recommended a minimum of 33 months between consecutive live births to reduce the incidence of adverse pregnancy outcomes. Poorly spaced pregnancies are associated with poor maternal and child health outcomes such as low birth weight, stillbirth, uterine rupture, neonatal mortality, maternal mortality, child malnutrition, and maternal hemorrhage. However, there was limited evidence on the duration of birth interval and its predictors among reproductive-age women in Ethiopia. Therefore, this study aimed to investigate the duration of birth interval and its predictors among reproductive-age women in Ethiopia. Methods: A secondary data analysis was conducted based on the 2016 Ethiopian Demographic and Health Survey data. A total weighted sample of 11022 reproductive-age women who gave birth within five years preceding the survey was included for analysis. To identify the predictors, the Gompertz gamma shared frailty model was fitted. The theta value, Akakie Information Criteria (AIC), Bayesian Information Criteria (BIC), and deviance was used for model selection. Variables with a p-value of less than 0.2 in the bi-variable analysis were considered for the multivariable analysis. In the multivariable Gompertz gamma shared frailty analysis, the Adjusted Hazard Ratio (AHR) with a 95% Confidence Interval (CI) was reported to show the strength and statistical significance of the association. Results: The median inter-birth interval in Ethiopia was 38 months (95% CI: 37.58, 38.42). Being living in Addis Ababa (AHR = 0.15, 95% CI: 0.03, 0.70), being rural resident (AHR = 1.13, 95% CI: 1.01, 1.23), being Muslim religious follower (AHR = 6.53, 95% CI: 2.35, 18.18), having three birth (AHR = 0.51, 95% CI: 0.10, 0.83), having four birth (AHR = 0.30, 95% CI: 0.09, 0.74), five and above births (AHR = 0.10, 95% CI: 0.02, 0.41), and using contraceptive (AHR = 2.35, 95% CI: 1.16, 4.77) were found significant predictors of duration of birth interval. Conclusion: The length of the inter-birth interval was consistent with the World Health Organization recommendation. Therefore, health care interventions that enhance modern contraceptive utilization among women in rural areas and Muslim religious followers would be helpful to optimize birth interval. [ABSTRACT FROM AUTHOR]

In female mammals, reproduction, and in particular lactation, is the energetically most exigent life-history phase. Reproduction is strongly controlled by body reserves and food availability, so females with better body condition or food supply are believed to have higher reproductive output. Additionally, the growth and mortality of young mammals depends on their postnatal development. Therefore, the degree of precociality affects energetic demands for both mothers and young. To study the reproductive performance of the precocial European hare (Lepus europaeus), we analysed relationships between six predictor variables describing maternal and environmental effects and nine response variables relating to reproduction from 217 captive females. We compared the data with those of precocial and altricial mammal species from an extensive literature search. For hares, we found: (1) Heavier females had heavier litters at birth. (2) In summer and spring, total litter mass was larger than in winter. (3) At the end of lactation, the litters of multiparous females were heavier than those of primiparous females. (4) Both older females and females giving birth for the first time had relatively high leveret mortality during lactation. Comparing our results with the literature for other mammals revealed that the body condition (i.e., body mass) of females before birth is predictive of reproductive parameters in both precocial and altricial species. In the precocial hare, female body condition is no longer predictive of reproductive parameters at the end of lactation, whereas in altricial species, female body condition remains predictive of reproduction (litter mass at the end of lactation, offspring mortality) until the end of lactation. We conclude that these effects are caused by precocial offspring feeding on solid food soon after birth and, thus, being less dependent on the mother's body condition during lactation than altricial offspring. In line with this, precociality might have evolved as a way of buffering offspring against maternal effects. [ABSTRACT FROM AUTHOR]

Objective: Investigate factors associated with symptoms of postpartum depression in mothers from families in social vulnerability.Methods: Information was used from the baseline of a randomized trial to assess a child development program that enrolled 3,242 children < 12 months of age from beneficiary families of the Bolsa Família Program residing in 30 municipalities (counties) in six states of Brazil. The Edinburgh Postnatal Depression Scale (EPDS) was applied to the mothers, and depression was defined as score ≥10. Information on the mother (schooling, age, parity, marital status, skin color, smoking, number of prenatal appointments, and planning of the pregnancy), family (paternal schooling, household crowding, support from the child's father and the family during the pregnancy, and number of children under 7 years living in the household), and infant (sex, gestational age, birthweight, Apgar score, and child's age at the time of the interview) was collected. Prevalence rates for depressive symptoms were calculated with crude and adjusted odds ratios (OR) and 95% confidence intervals (95%CI), using hierarchical logistic regression, in a multilevel model.Results: The analysis included 3,174 mothers with information on EPDS. The interviews were conducted on average 7.9 months (standard deviation= 2.9) after childbirth. Overall prevalence of depressive symptoms was 26.5% (25.0-28.1%). In the adjusted analysis, higher parity was associated with higher odds of postpartum depression (p <0.001). Women with ≥3 previous deliveries showed an odds 84% higher of presenting depressive symptoms (OR= 1.84; 1.43-2.35) than primiparae. Higher maternal and paternal schooling, presence of husband or partner, and having received support from the child's father and the family during the pregnancy were protective factors against postpartum depression.Conclusion: The study showed high prevalence of postpartum depressive symptoms. Promotion of parental education, alongside with the promotion of support to the woman during pregnancy by the child's father and by the family, as well as family planning leading to birth spacing are measures that may help to prevent postpartum depressive symptoms. [ABSTRACT FROM AUTHOR]

In developing countries including Ethiopia stunting remained a major public health burden. It is associated with adverse health consequences, thus, investigating predictors of childhood stunting is crucial to design appropriate strategies to intervene the problem stunting. The study uses data from the Ethiopian Demographic and Health Survey (EDHS) conducted from January 18 to June 27, 2016 in Ethiopia. A total of 8117 children aged 6–59 months were included in the study with a stratified two stage cluster sampling technique. A Bayesian multilevel logistic regression was fitted using Win BUGS version 1.4.3 software to identify predictors of stunting among children age 6–59 months. Adjusted odds ratio (AOR) with 95% credible intervals was used to ascertain the strength and direction of association. In this study, increasing child's age (AOR = 1.022; 95% CrI 1.018–1.026), being a male child (AOR = 1.16; 95%CrI 1.05–1.29), a twin (AOR = 2.55; 95% CrI 1.78–3.56), having fever (AOR = 1.23; 95%CrI 1.02–1.46), having no formal education (AOR = 1.99; 95%CrI 1.28–2.96) and primary education (AOR = 83; 95%CrI 1.19–2.73), birth interval less than 24 months (AOR = 1.40; 95% CrI 1.20–1.61), increasing maternal BMI (AOR = 0.95; 95% CrI 0.93–0.97), and poorest household wealth status (AOR = 1.78; 95% CrI 1.35–2.30) were predictors of childhood stunting at individual level. Similarly, region and type of toilet facility were predictors of childhood stunting at community level. The current study revealed that both individual and community level factors were predictors of childhood stunting in Ethiopia. Thus, more emphasize should be given by the concerned bodies to intervene the problem stunting by improving maternal education, promotion of girl education, improving the economic status of households, promotion of context-specific child feeding practices, improving maternal nutrition education and counseling, and improving sanitation and hygiene practices. [ABSTRACT FROM AUTHOR]

Background: In sub-Saharan African countries, neonatal mortality rates remain unacceptably high. Ethiopia is one of the countries in Sub-Saharan Africa with the highest death rates of newborn children. Therefore, this study aimed to identify the risk factors associated with neonatal mortality in Ethiopia at the individual and community level. Methods: The 2016 Ethiopian Demographic and Health Survey data was accessed and used for the analysis. A total of 2449 newborn children were included in the analysis. The multilevel logistic regression model was used to identify the significant factor of neonatal mortality. Adjusted odds ratio with a 95% confidence interval and p-value < 0.05 in the multilevel model was reported. Results: A total of 2449 newborn children were included in this study. Multiple birth type (AOR = 3.18; 95% CI 2.78, 3.63), birth order of ≥ 5 (AOR = 2.15; 95% CI 1.75, 2.64), pre-term birth (AOR = 5.97; 95% CI 4.96, 7.20), no antenatal care (ANC) visit during pregnancy (AOR = 2.33; 95% CI 2.09, 2.61), not received TT injection during pregnancy (AOR = 2.28; 95% CI 1.92, 2.71), delivered at home (AOR = 1.99; 95% CI 1.48, 2.69), less than 24 months of preceding birth interval (AOR = 1.51; 95% CI 1.35,1.68), smaller birth size (AOR = 1.58; 95% CI 1.46, 1.71), never breastfeeding (AOR = 2.43; 95% CI 2.17, 2.72), poor wealth index (AOR = 1.29; 95% CI 1.17,1.41), non-educated mothers (AOR = 1.58; 95% CI 1.46, 1.71), non-educated fathers (AOR = 1.32; 95% CI 1.12, 1.54), rural residence (AOR = 2.71; 95% CI 2.23, 3.29), unprotected water source (AOR = 1.35; 95% CI 1.16, 1.58), and have no latrine facility (AOR = 1.78; 95% CI 1.50, 2.12) were associated with a higher risk of neonatal mortality. Neonates living in Amhara, Oromia, Somali, Harari, and Dire Dawa had a higher risk of neonatal mortality compared to Tigray. Moreover, the random effects result showed that about 85.57% of the variation in neonatal mortality was explained by individual- and community-level factors. Conclusions: The findings suggest that attention be paid to education-based programs for mothers that would highlight the benefits of delivery care services, such as ANC visits, TT injections, and facility births. Meanwhile, public health initiatives should focus on expanding access to quality sanitation facilities, especially for latrines and drinking water that could improve neonatal health at the community-level as a whole. [ABSTRACT FROM AUTHOR]

Objective: This study examines trends and puts forward projections of under-5 mortality (U5M) in Bangladesh and identifies the effects of maternal high-risk fertility behaviours and use of healthcare services. Methods: Data from seven waves of the Bangladesh Demographic and Health Survey (1994–2014) were analyzed for trends and projections of U5M and a Chi-square (χ2) test was used to identify if there was any association with maternal high-risk fertility behaviours and use of healthcare services. A multivariate logistic regression model was used to determine the effects of fertility behaviors and healthcare usage on the occurrence of U5M adjusting with confounders. Results: U5M declined from 82.5 to 41.0 per 1000 livebirths during 1994–2014 and is projected to further reduce to 17.6 per 1000 livebirths by 2030. The study identified a noticeable regional variation in U5M with maternal high-risk fertility behaviours including age at birth <18 years (aOR: 1.84, 95% CI: 1.23–2.76) and birth interval <24 months (aOR: 1.56, 95% CI: 1.02–2.37) found to be significant determinants. There was a 39–53% decline in this rate of mortality among women that had used antenatal care services at least four times (aOR, 0.51, 95% CI: 0.27–0.97), delivery care (aOR, 0.47, 95% CI: 0.24–0.95), and had received postnatal care (aOR, 0.61, 95% CI: 0.41–0.91) in their last birth. Cesarean section was found to be associated with a 51% reduction in U5M (aOR, 0.49, 95% CI: 0.29–0.82) compared to its non-use. Conclusion: The Sustainable Development Goals require a U5M rate of 25 per 1000 livebirths to be achieved by 2030. This study suggests that with the current trend of reduction, Bangladesh will achieve this target before the deadline. This study also found that maternal high-risk fertility behaviours and non-use of maternal healthcare services are very prevalent in some regions of Bangladesh and have increased the occurrence of U5M in those areas. This suggests therefore, that policies and programmes designed to reduce the pregnancy rates of women that are at risk and to encourage an increase in the use of maternal healthcare services are needed. [ABSTRACT FROM AUTHOR]

Background: Closely spaced birth increases the risk of adverse maternal and child health outcomes. In Ethiopia, the prevalence of short birth spacing was highly variable across studies. Besides, contraceptive use, educational status, and duration of breastfeeding were frequently mentioned factors affecting short birth spacing. Therefore, this meta-analysis aimed to estimate the pooled prevalence of short birth spacing and its association with contraceptive use, educational status, and duration of breastfeeding among reproductive-age women in Ethiopia. Methods: International databases: Google Scholar, PubMed, CINAHL, Cochrane library, HINARI, and Global Health were searched systematically to identify articles reporting the prevalence of short birth spacing and its association with contraceptive use, educational status, and duration of breastfeeding among reproductive-age women in Ethiopia. The data were analyzed by STATA/SE version-14 statistical software. The random-effect model was used to estimate the pooled prevalence of short birth spacing and the log odds ratio was used to determine the association. Moreover, egger's test and I-squared statistics were used to assess publication bias and heterogeneity respectively. Results: After reviewing 511 research articles, a total of nine articles with 5,682 study participants were included in this meta-analysis. The pooled prevalence of short birth spacing in Ethiopia was 46.9% [95% CI: (34.7, 59.1)]. Significant heterogeneity was observed between studies (I2 = 98.4, p <0.001). Not using contraceptives [OR = 3.87, 95% CI: (2.29, 6.53)] and duration of breastfeeding < 24 months [OR = 16.9, 95%CI: (2.69, 106.47)] had a significant association with short birth spacing. Conclusions: Although a minimum inter-pregnancy interval of two years was recommended by the World Health Organization (WHO), significant numbers of women still practiced short birth spacing in Ethiopia. Duration of breastfeeding and non-use of contraceptives were factors significantly associated with short birth spacing. So, efforts should be made to improve breastfeeding practice and contraceptive utilization among women in Ethiopia. [ABSTRACT FROM AUTHOR]

Background: Severe acute malnutrition (SAM) is the most extreme and visible form of undernutrition plagued by chronic poverty, household food insecurity, lack of education. One of the indigenous and marginalized community of Nepal, Satar/Santhal has often been neglected and is devoid of good education and are economically deprived. This predisposes under 5 children of Satar into malnutrition. The study aims to assess determinants of SAM among children under 5 years of age in Satar community of Jhapa district, Nepal. Material & methods: A community based matched case control study was carried from September 2019 to February 2020 among under five children of Satar community residing in Jhapa district. Multistage random sampling technique was used to select 50 cases and 100 controls in the ratio of 1:2. Information was collected through personal interview with the parents and anthropometric measurement of the children was measured. Bivariate and multivariate conditional logistic regression analysis was used to explore the determinants of severe acute malnutrition. Results: A total of 664 children between the age group of 6–59 months were screened for SAM. The prevalence of SAM was found 7.53%. Factors like, low economic status, birth interval less than 2 years, frequency of breast feeding <8 times/day and household food insecurity were found to be significant determinants of SAM. Multivariate logistic regression documented low economic status (AOR: 11.14, 95% CI 1.42 to 87.46); and frequency of breast feeding <8 times/day (AOR: 2.09, 95% CI 1.00 to 4.37) as determinants of SAM. Conclusion: Low economic status and frequency of breast feeding less than 8times/day were major determinants of SAM among children under 5yrs of age. Ending malnutrition will require greater efforts and integrated approaches to eradicate extreme poverty. Multi-sector approaches have been conducting for SAM in Nepal but there are no specific approaches for marginalized community. [ABSTRACT FROM AUTHOR]

Objective: To examine fertility intentions among abortion patients and the potential of abortion for avoiding short birth intervals.Study Design: We used national data from a sample of more than 8000 individuals obtaining abortions in the United States in 2014. We created a measure of fertility intentions based on prior births and responses to an item asking about future childbearing expectations. We identify respondents who reported having a birth in the last 12 months as at risk of a short birth interval. We used simple logistic regression to assess for differences in these measures according to key demographic variables.Results: Most commonly, 39% of patients intended to have (more) children, with similar proportions wanting to delay a first birth (20%) or postpone a second or higher order birth (19%). Some 31% of abortion patients had completed childbearing; they had one or more prior births and did not want to have any more children. Similar proportions of respondents were not sure if they wanted to have children (16%) or did not want to have any children (15%). Among abortion patients who had children, 14% had had a birth in the prior year. We estimate that as many as 77,800 short birth intervals were averted in 2014 because individuals had access to abortion.Conclusions: These findings support the view that abortion allows individuals to plan and space their births according to their reproductive life plans and intentions.Implications: Access to abortion may help thousands of individuals in the United States avoid short birth intervals, potentially leading to improvements in maternal and child health. [ABSTRACT FROM AUTHOR]

Uterotonics are widely used in the pig industry but their effects have not been investigated critically. The objective was to evaluate the effects of oxytocin and carbetocin on farrowing duration, birth interval, farrowing assistance, stillbirth rate, and piglet viability traits by performing a systematic review and a meta-analysis. The search for studies was performed during January 2020 using the PubMed, ISI Web of Science, Science Direct, and Scopus databases. The literature search was conducted using the key words: oxytocin, pig, farrowing, stillbirth, piglet, dose, and carbetocin. Studies which evaluated the effects of oxytocin or carbetocin on farrowing duration, birth interval, stillbirth rate, and farrowing assistance were included in the review. Of 1215 articles, 23 (1.9%) were selected for fulfilling the criteria for inclusion in the present study. A high variety of doses was observed among studies. Oxytocin increased (30%; P < 0.05) the stillborn proportion in the litters compared to control sows. Both oxytocin and carbetocin increased the need of farrowing assistance by 137% (P < 0.01) and 40% (P < 0.05), respectively, compared to control. The use of oxytocin reduced the farrowing duration by 18% and the birth interval by 17%, while carbetocin reduced the same responses by 27 and 23%, respectively (P < 0.01). When used judiciously, uterotonics are a valuable tool to shorten farrowing duration of hyperprolific sows. However, the treatment is not exempt of deleterious effects for piglets and sows. Therefore, the criteria to use these drugs should be based on individual cases and not as part of hormonal protocols for all parturient sows. • Farrowing duration is decreased by oxytocin and carbetocin. • Birth interval is decreased by oxytocin and carbetocin. • Oxytocin increases the stillborn amount. • Oxytocin and carbetocin increases the need of farrowing assistance. • There is no dose standardization in the use of oxytocin or carbetocin. [ABSTRACT FROM AUTHOR]

A duration of parturition beyond 300 min negatively impacts the health of the sow and the survival of piglets during parturition. Hence, oxytocin is widely used to speed up the parturition. However, oxytocin's negative side effects raise the need of finding alternative treatments such as those already implemented in human medicine. The aim of this study was to evaluate the efficacy of Prostaglandin E2 (PGE2) applied intravaginally (PGE2-V) (1.0 mg) or intramuscularly (PGE2-M) (2.5 mg) to improve the parturition process after expulsion of the fourth piglet compared to a placebo (P–V), which was sterile intravaginal gel or intramuscular oxytocin application (OXY-M) (20 iu) in free farrowing systems.In total, 201 eutocic sows were examined after stratification by parity and random allocation into groups: 54 (P–V), 48 (OXY-M), 50 (PGE2-V), 49 (PGE2-M). Farrowing duration (time between first piglet and last piglet), piglet interval and placenta expulsion duration (time between first and last placenta) were recorded, and each piglet was scored for meconium staining and vitality. Furthermore, stillborn piglets were categorized into ante-partum and intra-partum deaths.Under the present conditions, neither administration of PGE2 nor oxytocin revealed a significant effect on the farrowing process or the vitality of the piglets when compared to untreated sows. Nonetheless, significant differences could be detected between PGE-2 and oxytocin treatments. The duration of farrowing was significantly shorter in oxytocin-treated sows (156 min) compared to sows treated intramuscularly with PGE2 (238 min). Furthermore, the placenta expulsion duration in the OXY-M group (130 min) significantly differed from PGE2-V (198 min) and PGE2-M group (218 min). Although these accelerations of parturition might be considered as a beneficial effect, routine treatment with uterotonic agents after birth of the fourth piglet in free farrowing eutocic sows cannot be recommended, because an overall benefit when compared to untreated sows was not approved. • First study that evaluated efficacy of PGE2 on the birth process in eutocic sows. • Routine treatment with uterotonic agents in free farrowing system not recommended. • Application of an intravaginal uterotonic agent in free farrowing systems is feasible. [ABSTRACT FROM AUTHOR]

• Interval from pregnancy loss to next IVF did not affect chances of conception • Shorter cycle interval post-biochemical or spontaneous vs. medical or surgical loss • Miscarriage type and number embryos transferred affected chance of next pregnancy • Pregnancy chance lower after medical or surgical vs. biochemical or spontaneous loss • Higher chance of live birth with shorter interval to first cycle post-miscarriage Is the interval length between an early pregnancy loss and the following treatment cycle a predictor for achieving clinical pregnancy among IVF patients? This retrospective cohort study of 257 women who reinitiated treatment after first-trimester IVF pregnancy loss was conducted at a tertiary, university-affiliated medical centre between 1 January 2014 to 1 January 2018. Women aged 18–40 years, with normal uterine cavity, who experienced first-trimester pregnancy loss at less than 14 weeks after IVF, were included. Miscarriages were classified as spontaneous, biochemical, medical or surgical. Among 257 women, interval to subsequent IVF treatment was not associated with achieving pregnancy. Patients after biochemical pregnancy (72.7 ± 56.4, median 60 days) or spontaneous miscarriage (97.7 ± 93.1, median 66 days) had shorter intervals to next cycle, compared with medical (111.9 ± 103.2, median 65 days) or surgical (123.4 ± 111.1, median 84 days) (Kaplan–Meier, P = 0.03) miscarriages. Logistic regression analysis showed that the chance of subsequent pregnancy was affected by the number of embryos transferred (P = 0.009) and the type of miscarriage. Medical (P = 0.005) and surgical (P = 0.017) miscarriages were related to lower likelihood of pregnancy compared with biochemical pregnancy (reference group). When pregnancy was achieved in the first post-miscarriage cycle, the chance of live birth increased with shorter intervals (median 57.5 days), whereas second miscarriage was related to longer intervals (median 82.5 days) between miscarriage and subsequent IVF cycle (P = 0.03). On the basis of this cohort, IVF should not be postponed after pregnancy loss, as shorter intervals were associated with greater likelihood of live birth. [ABSTRACT FROM AUTHOR]

Background: Both short and long birth intervals are associated with many risk factors and about 29% of births are short birth intervals in Ethiopia. The purpose of this study is to model the birth intervals of adult women aged 15-49 years using accelerated failure time and shared frailty models in order to analyze the birth intervals of Ethiopian women.Methods: The data was obtained from the 2016 Ethiopian Demographic and Health Survey (EDHS). Accelerated failure time with different baseline and shared frailty models are used for the analysis to identify important demographic and socio-economic factors affecting the length of birth intervals and correlates of the birth intervals respectively.Results: The data consists of 9147 women, of which about 7842 (85.5%) are closed interval and the rest of 1323(14.5%) are open interval. Accelerated failure time (AFT) result revealed that women education level, husbands education level, age at first birth, marital status, religion and family wealth index are significant factors affecting birth interval of women in Ethiopia.Conclusion: Women with closely spaced births tend to have larger family sizes when compared with women with longer inter-birth interval. Longer successive birth interval tends to reduce the total fertility rate of women. Furthermore, improvements in socio-economic status and level of education of women associate with reduced fertility, improved maternal and child wellbeing, and longer birth interval. [ABSTRACT FROM AUTHOR]

Background: Worldwide, preterm birth accounts for 1 million deaths of infants each year and 60% of these deaths occur in developing countries. In addition to the significant health consequences on the infant, preterm birth can lead to economic costs. There was a lack of study in western Ethiopia, and most of those studies conducted in other parts of a country were based on card review with a cross-sectional study design. The risk factors of preterm birth may vary from region to region within the same country due to variation in socioeconomic status and health care service coverage. Therefore, this study aimed to identify determinants of preterm birth in western Ethiopia. Methods: An institutional-based case-control study was conducted from February 15 to April 15, 2020, in western Ethiopia. The eligible 188 cases and 377 controls were randomly selected for this study. Cases were women who gave birth after 28 weeks and before 37 completed weeks of gestation, and controls were women who gave birth at and after 37 weeks of gestation from the first day of the last normal menstrual period. Data were collected by a structured interviewer-administered questionnaire. The collected data were entered into Epi info version 7 and exported to SPSS version 21 for analysis. Multivariable logistic regression was used to identify determinants of preterm birth at P-value <0.05. Results: From a total of 565 eligible participants, 516 (172 cases and 344 controls) participated in this study with a response rate of 91.3%. The result of the multivariable analysis shows that mothers who developed pregnancy-induced hypertension (AOR = 3.13, 95% CI; 1.78, 5.50), only one time ANC visits (AOR = 5.99, 95% CI; 2.65, 13.53), experienced premature rupture of membrane (AOR = 3.57, 95% CI; 1.79, 7.13), birth interval less than two years (AOR = 2.96, 95% CI; 1.76, 4.98), developed anemia during the current pregnancy (AOR = 4.20, 95% CI; 2.13, 8.28) and didn't get dietary supplementation during the current pregnancy (AOR = 2.43, 95% CI; 1.51, 3.91) had statistically significant association with experiencing preterm birth. Conclusion: Antenatal care service providers should focus on mothers with pregnancy-induced hypertension, premature rupture of membrane, and anemia during pregnancy, and refer to the senior experts for early management to reduce the risk of preterm delivery. Antenatal care services such as counseling the mother on the benefit of dietary supplementation during pregnancy, antenatal care follow up, and lengthening birth interval should be integrated into the existing health extension packages. New and inclusive strategies such as the establishment of comprehensive mobile clinic services should also be designed to reduce the burden of preterm birth among women living in the rural community. Lastly, we recommend future researchers to conduct longitudinal and community-based studies supplemented with qualitative methods. [ABSTRACT FROM AUTHOR]

Background. Prenatal testicular torsion (PTT) is exceedingly rare in intrauterine development, often diagnosed at the time of birth and very rarely diagnosed in utero during routine gestational ultrasound. As a result, incidence is unknown, and there exists no consensus regarding the pathophysiology of this phenomenon nor universally recognized algorithms and guidelines regarding its diagnosis and management. Case Presentation. We present the case of an antenatally diagnosed torsion and our subsequent management which included ipsilateral orchiectomy and prophylactic contralateral orchiopexy via a scrotal approach. Conclusion. While controversy regarding surgical intervention in patients with unilateral PTT exists due to poor salvage rates—estimated to be less than 1%—the risk of anorchia is higher in affected patients due to limitations in the accuracy of detecting bilateral testicular involvement. Risk of misdiagnosis of bilaterality may lead to lasting sequelae such as infertility and devastating psychological consequences for affected patients, supporting the need for surgical exploration, as was performed in our case. [ABSTRACT FROM AUTHOR]

Background: Pelvic organ prolapse (POP) is one of the main contributors to reproductive health problems that affect women's quality of life. Previous studies have reported the risk factors and prevalence of POP. The aim of this study is to examine the association between POP and short birth intervals in a rural area of Nepal. Methods: A cross-sectional study was conducted in Panchapuri municipality, located in Surkhet District of Karnali Province in Nepal. A questionnaire was used to collect information on POP, birth intervals, and other known confounding factors, such as age and parity. Multiple logistic regression analysis was used to examine the association between minimum birth intervals and POP. Results: The study recruited 131 women. The prevalence of POP was 29.8%. The mean (SD) of maternal age was 32.3 (0.7) years. The median parity was 2, with a range of 2–6 children. More than half (64.9%) of the women reported a minimum birth interval of less than 2 years. Maternal age at birth, minimum birth interval, parity, and latest birth interval were significantly associated with POP in univariate analyses. After adjusting for the potential confounding factors such as age and occupation, the minimum birth interval was significantly associated with POP [AOR = 3.08, 95% CI 1.04–9.19]. Conclusion: The prevalence of POP was high in this rural area of Nepal. Age, parity, occupation, and minimum birth interval were significantly associated with POP. [ABSTRACT FROM AUTHOR]

Background: Family planning (FP) can lengthen birth intervals and potentially reduce the risk of foetal death, low birthweight, prematurity, and being small for gestational age. Effective FP is most easily achieved through access to and acceptability of modern contraceptive methods (MCMs). This study aimed to identify mechanisms of acceptability and the contexts in which they are triggered and to generate theories to improve the selection and implementation of effective interventions by studying an intervention integrating FP with childhood immunisation services.Methods: Qualitative interpretative synthesis of findings from realist evaluations of FP interventions in five African countries was guided by an analytical framework. Empirical mechanisms of acceptability were identified from semi-structured interviews and focus group discussions with key stakeholders (N = 253). The context in which these mechanisms were triggered was also defined. Empirical mechanisms of acceptability were matched to constructs of a theoretical framework of acceptability. Context-acceptability theories (CATs) were developed, which summarised constructs of acceptability triggered for specific actors in specified contexts. Examples of interventions that may be used to trigger acceptability for these actors were described.Results: Seven CATs were developed for contexts with strong beliefs in religious values and with powerful religious leaders, a traditional desire for large families, stigmatisation of MCM use, male partners who are non-accepting of FP, and rumours or experiences of MCM side effects. Acceptability mechanisms included alignment with values and beliefs without requiring compromise, actors' certainty about their ability to avoid harm and make the intervention work, and understanding the intervention and how it works. Additionally, acceptability by one group of actors was found to alter the context, triggering acceptability mechanisms amongst others.Conclusions: This study demonstrated the value of embedding realist approaches within implementation research. CATs are transferable theories that answer the question: given the context, what construct of acceptability does an intervention need to trigger, or more simply, what intervention do we need to apply here to achieve our outcomes? CATs facilitate transfer of interventions across geographies within defined contexts. [ABSTRACT FROM AUTHOR]

Background: Familial chylomicronemia is an extremely rare disease. Lipoprotein lipase deficiency, lipoprotein defect or lipoprotein receptor defect are the main genetic causes of familial chylomicronemia.Case Presentation: We report a rare case of hypertriglyceridemia which was diagnosed at 24 days after birth. A newborn south east Asian baby born for G3P2A1 mother was presented with hematuria at 24 days at the hospital. The patient's family history is significant for pink blood in an elder sibling who died within a few months of birth without a proper diagnosis. Physical examination was not significant for any findings. Urinalysis revealed numerous RBC in the urine. Blood draw to perform renal function test revealed a characteristic pink blood. Baby's blood was normal and red in color at the time of birth. During the present visit, although most of the blood test were not able to be carried out by the regular laboratory instruments, the patient's lipid profile was alarmingly high with triglyceride levels over 4000 mg/dL. Due to a very high triglyceride level in a neonate and a significant familial history, a genetic cause of hypertriglyceridemia is suspected. Upon diagnosis, baby was discontinued of breast feeding completely and was given a special diet devoid of triglyceride and containing medium chain fatty acid diet and was also started with fenofibrate. After a month and a half, follow up tests were conducted which showed the triglyceride level was reduced to 1300 and a reversal of the blood color from pink to red. Since the imported diet was extremely expensive for the family, the patient was put on skimmed milk with medium-chain triglyceride (MCT) oil. With 6 weeks of treatment, baby's condition has improved and is thriving well.Conclusions: Our case reports an extremely rare and fatal condition and illustrated the significance of timely diagnosis and intervention for saving the life of the baby. [ABSTRACT FROM AUTHOR]

Background: Approximately 200 million women and girls were reported to have undergone female genital mutilation worldwide in 2015.UNICEF's data based on household survey estimates 15% of women from 15–49 years have undergone FGM from year 2004–2015. Despite this, reliable data on trend of prevalence of female genital mutilation and its associated birth outcomes have not been documented in Tanzania. This study aimed at determining the trends of female genital mutilation and associated maternal and neonatal adverse outcomes in northern Tanzania. Methods: A cross-sectional study was conducted using maternally-linked data from Kilimanjaro Christian Medical birth registry involving 30,286 women who gave birth to singletons from 2004–2014. The prevalence of female genital mutilation was computed as proportion of women with female genital mutilation yearly over 10 years. Odds ratios with 95% confidence intervals for adverse birth outcomes associated with female genital mutilation were estimated using multivariable logistic regression model. Results: Over the 10-year period, the prevalence of female genital mutilation averaged 15.4%. Female genital mutilation decreased from 23.6% in 2005 to 10.6% in 2014. Female genital mutilation was associated with increased odds for caesarean section (aOR1.26; 95% CI: 1.18–1.34), post-partum haemorrhage (aOR 1.31; 95% CI: 1.10–1.57) and long hospital stay (aOR 1.21; 95% CI: 1.14–1.29). Female genital mutilation also increased women's likelihood of delivering an infant with low Apgar score at 5th minute (aOR 1.60; 95% CI: 1.37–1.89).FGM type III and IV had increased odds of caesarean section, episiotomy and prolonged duration of hospital stay as compared to FGM type I and II, although the association was statistically insignificant. Conclusion: Female genital mutilation prevalence has declined over the study period. Our study has demonstrated that postpartum haemorrhage, delivery by caesarean section, long maternal hospital stays and low APGAR score are associated with FGM. Initiatives to mitigate FGM practice should be strengthened further to reduce/eliminate this practice. Moreover, surgical interventions to improve severe form FGM are welcomed to improve the aforementioned aspects of obstetric outcome in this locality. [ABSTRACT FROM AUTHOR]

Rapid population growth of reintroduced lions ( Panthera leo) poses several ecological and management challenges in small (<1000 km2), fenced wildlife reserves. Changes in the natural social-ecological conditions of reintroduced lions can lead to a breakdown of natural predator--prey relationships and this is undesirable from both a biodiversity conservation and wildlife management perspective. Here,we present lion population vital rates across 16 small, fenced reserves in South Africa to test whether varying social ecological conditions, associated with lion population structures, can drive changes in vital rates. Study reserves were categorized (A--D) according to the number of resident prides and male coalitions. Lion population structure within a reserve affected lion vital rates differentially, and lion population growth was highest in reserves that contained a single resident pride. The presence of more than one pride in a reserve resulted in a younger age at first birth and marginally longer birth intervals. The presence of extra-pride adult males reduced cub survival, lioness age at first birth and birth intervals. These results can inform lion management decisions and, in particular, how lion population structure affects management outcomes. Our results also inform appropriate management protocols for lions depending on the specific social and ecological context of an individual reserve. [ABSTRACT FROM AUTHOR]

The objective of the study was to find the socioeconomic and proximate determinants of mortality in children under five years of age in Peru. To this end, the study focuses on the theoretical approach of Mosley and Chen (1984) and on the econometric methodology of the Cox proportional hazards semi-parametric and non-parametric Kaplan and Meier models. Regarding socioeconomic determinants, the results show that the mother's years of education, the economic status of the home, and the mother's health coverage significantly reduce the risk of death for children under the age of five. Likewise, the mother's years of education have a significant interactive effect with the socioeconomic level of the home and access to health service coverage which influence child survival. As for the proximal determinants, the age of the mother, the intervals between births, the order of birth of the children, and health facilities predict the risk of death for children under five years of age. [ABSTRACT FROM AUTHOR]

The feasibility of delayed cord clamping (DCC) in preterm infants with placental insufficiency (PI) is questionable. We aimed to study the effect of DCC on stem cell transfusion, hematological parameters, and clinical outcomes in preterm infants born to mothers with PI. Preterm infants, < 34 weeks' gestation, born to mothers with PI were randomized based on the timing of umbilical cord clamping into delayed clamping for 60 s (DCC group) or immediate cord clamping (ICC group) groups at time of birth. CD34 percentage as a marker of stem cell transfusion, early and late-onset anemia, hypothermia, hypotension, polycythemia, hyperbilirubinemia, duration of oxygen therapy, bronchopulmonary dysplasia, intra-ventricular hemorrhage, necrotizing enterocolitis, sepsis, mortality, and length of hospital stay were compared between studied groups. We found that peripheral blood CD34 percentage was significantly higher in DCC compared with that in the ICC group (median (IQR) of 0.5 (0.40–0.7) versus 0.35 (0.20–0.5), p = 0.004). Infants in the DCC group had significantly lower episodes of anemia of prematurity at 2 months, red blood cell transfusion, and shorter duration of oxygen therapy compared with those in the ICC group. Conclusion: In conclusion, DCC compared with ICC increased stem cell transfusion and decreased early- and late-onset anemia in preterm infants with placental insufficiency. Trial registration: NCT03731546 www.clinicaltrials.gov What is Known: • Delayed cord clamping has been recommended by the American Academy of Pediatrics as a standard of care practice during delivery of preterm infants. • The feasibility of DCC in preterm infants with placental insufficiency (PI) is uncertain. What is New: • This randomized controlled trial demonstrated that DCC in the delivery room care of preterm infants born to mothers with placental insufficiency increased stem cell transfusion and decreased early- and late-onset anemia. [ABSTRACT FROM AUTHOR]

Background: Stillbirth is one of the adverse outcomes of pregnancy, and it is among the major public health problems in developing countries including Ethiopia. Stillbirth has wide-reaching consequences for parents, care providers, community and society at large. Purpose: To assess the determinant of stillbirth among deliveries attended in Bale zone hospitals Southeast Ethiopia. Methods: An institution-based unmatched case–control study was conducted. Cases were deliveries whose birth outcome was stillbirth and controls were deliveries with live birth. A pretested and structured checklist was used to collect data from a sample of 402 (134 cases and 268 controls). Systematic random sampling was used to recruit samples from a list of charts in the delivery registration book. Data were entered into EpiData version 4.2 and exported to SPSS version 20 for analysis. Crude and adjusted odds ratio with 95%CI was calculated and P-value < 0.05 was used to declare statistical significance. Results: A total of 402 charts of mothers (134 cases and 268 controls) were included in the analysis. Preceding birth interval < 24 months (AOR: 2.991; 95%CI: 1.351– 6.621), antenatal visit started at third trimester (AOR: 2.739; 95%CI: 1.048– 7.158), referred from other health facility (AOR: 3.215; 95%CI: 1.430– 7.229), labor length ≥ 24 h (AOR: 3.169; 95%CI: 1.241– 8.091), presence of meconium stained amniotic fluid (AOR: 2.670; 95%CI: 1.082– 6.592) and giving birth to a baby < 2500 g (AOR: 3.155; 95%CI: 1.235– 8.07) were determinants of stillbirth. Conclusion: Preceding birth interval of < 24 months, antenatal visit started at third trimester, referred from other health facility, presence of meconium stained amniotic fluid, labor length ≤ 24 h and giving birth to a baby < 2500 g were found the determinants of stillbirth. Intrapartum care, early identification of labor complications and referral system are required. [ABSTRACT FROM AUTHOR]

Objective: The Reducing Enteropathy, Undernutrition, and Contamination in the Environment (REDUCE) program focuses on identifying exposure pathways to faecal pathogens for young children in the Democratic Republic of the Congo (DRC) and on developing scalable interventions to reduce faecal contamination from these pathways.Methods: A prospective cohort study of 690 participants was conducted to investigate the association between hand, food, and environmental faecal contamination and diarrhoeal disease prevalence among young children in Walungu Territory, South Kivu, DRC. A total of 1923 hand rinse, soil, food, object, surface, stored water and water source samples were collected during unannounced spot checks after baseline enrolment and analysed for Escherichia coli. Caregiver reports of diarrhoea were obtained from children < 5 years at a 6-month follow-up.Results: E.coli was detected in 73% of child and caregiver hand-rinse samples, 69% of soil samples from child play spaces, 54% of child food samples, 38% of objects and surfaces children were observed putting in their mouths, 74% of stored water samples, and 40% of source water samples. Children < 5 years with E. coli on their hands had significantly higher odds of diarrhoea at the 6-month follow-up (odds ratio: 2.03 (95% confidence interval: 1.05, 3.92)).Conclusion: The cohort study findings from the REDUCE program have shown that child hand contamination is associated with diarrhoeal disease in rural DRC, and that there is high faecal contamination in child plays spaces and food. These findings provide evidence demonstrating the urgent need to provide clean play spaces for young children and interventions targeting hand hygiene to reduce paediatric exposure to faecal pathogens. [ABSTRACT FROM AUTHOR]

Prevalence of Stunting among under-five children is very high in many developing countries of the World. As step towards reducing the prevalence, there is need to identify the important determinants and the Trend of Stunting in the specific context. This paper examined the general trend and determinants of stunting among children 0-59 months in Nigeria. The anthropometric indices Height for age z-score was used to determine a child's nutritional status as whether a child is stunted and the impacts of some socioeconomic, Demographic, Community level, Environmental and maternal factors on this are determined. Results from this study shows that Child's sex, mother's birth interval, Mother's and their partner's educational status, Locality, geopolitical zones of the mother's, Wealth index, parents source of drinking water among others contributed positively to Stunting among children 0-59 months in Nigeria (p < 0.05). The general results showed that Stunting among less than five years children in Nigeria has significantly improves over time between 1990 and 2003 (p < 0.05). Although following a sinusoidal pattern. Five waves of national data from the Nigerian Demographic and Health Surveys for 1990, 1999, 2003, 2008 and 2013 were employed in the study. [ABSTRACT FROM AUTHOR]

This article aims to discuss the importance of the sociopolitical participation of children and teenager in spaces for the construction of public policies as a strategy for strengthening democracy in modern societies. The article is the result of a bibliographic and documentary review. The reflections made are based on the perspective that naturalizing approaches to childhood and adolescence are contributory to the non-realization of the right to sociopolitical participation of the child-adolescent population. In contrast to naturalizing approaches, the sociohistorical perspective, together with the processes of empowerment and transgressive education, are identified as potentialities for the legitimate inclusion of children and teenargers in decision-making spaces (councils, public hearings, assemblies, etc.), since they seek to awaken individual and collective consciences for the construction of strategies to confront the oppressive practices of adult-centeredness, sexism, racism and capitalism. [ABSTRACT FROM AUTHOR]

Women experiencing homelessness have higher rates of unintended pregnancy than stably housed women and may benefit from reproductive interconception care. How reproductive interconception care differs between women who did and did not experience perinatal homelessness is not known. We estimated prevalence ratios of reproductive interconception behaviors among US women experiencing homelessness during the perinatal period.We used data from the 2016-2019 Pregnancy Risk Assessment Monitoring System to calculate the prevalence of 5 reproductive interconception care outcomes: attending a maternal postpartum checkup, participating in a conversation with a health care provider about birth intervals, receiving family planning counseling, obtaining a prescription for short-acting contraception, and having a long-acting reversible contraceptive inserted. We used complex survey weights, stratified by perinatal homelessness, and converted adjusted logistic regression odds ratios between housing status and outcome variables to adjusted prevalence ratios (aPRs) and 95% CIs.Among participants, approximately 2.4% (weighted percentage; unweighted 2953 of 100 706) experienced homelessness sometime in the 12 months before their children were born; the majority were non-Hispanic (83.2%) and White (69.4%), were not married (82.2%), and had public health insurance (56.8%). Perinatal homelessness was significantly associated with a lower prevalence of attending a postpartum maternal visit (aPR = 0.90; 95% CI, 0.87-0.94) and a higher prevalence of having a conversation about birth intervals with their health care providers (aPR = 1.13; 95% CI, 1.03-1.21).Findings suggest that improving attendance at postpartum visits and evaluating birth interval conversations may strengthen interconception care practices while contextualizing social determinants such as housing stability. Improving uptake of postpartum visits may reduce unintended pregnancy, short birth intervals, and adverse birth outcomes in future pregnancies among women experiencing homelessness. [ABSTRACT FROM AUTHOR]

Eutherian mammals have characteristic lengths of gestation that are key for reproductive success, but relatively little is known about the processes that determine the timing of parturition, the process of birth, and how they are coordinated with fetal developmental programs. This issue remains one of biology's great unsolved mysteries and has significant clinical relevance because preterm birth is the leading cause of infant and under 5 year old child mortality worldwide. Here, we consider the evolutionary influences and potential signaling mechanisms that maintain or end pregnancy in eutherian mammals and use this knowledge to formulate general theoretical evolutionary models. These models can be tested through evolutionary species comparisons, studies of experimental manipulation of gestation period and birth timing, and human clinical studies. Understanding how gestation time and parturition are determined will shed light on this fundamental biological process and improve human health through the development of therapies to prevent preterm birth. [ABSTRACT FROM AUTHOR]

Background: Appropriate complementary feeding has the potential to prevent 6 percent of all under five deaths particularly in developing countries. However, infant and young child feeding practices in Ethiopia are suboptimal. Data on complementary feeding practices in Horro district are also lacking. Therefore, this study aimed to determine magnitude and determinants of appropriate complementary feeding practice among mothers of children age 6–23 months in Horro district, Western Ethiopia. Methods: Community based cross sectional study was conducted from February to March 2016 in six kebeles of Horro district, Western Ethiopia. A total of 325 mothers of children age 6–23 months were included in the study. Data were collected using pre-tested interviewer administered structured questionnaire; entered into EPI-INFO version 3.5.4 and analyzed using SPSS version 20. Odds ratio was calculated with 95% CI to identify determinants of appropriate complementary feeding practice. P-values less than 0.05 were considered as statistically significant. Results: The magnitude of appropriate complementary feeding practice in the study area was 9.91%. Lower age of child (6-11months) [AOR: 0.195, 95% CI: (0.045–0.846)], having no formal education [AOR = 0.115:95% CI: (0.002, 0.290)] and giving birth for the first time [AOR = 0.271:95% CI: (0.011, 0.463)] were factors negatively associated with appropriate complementary feeding practice. Conclusion: Only one tenth of mothers practiced appropriate complementary feeding. This strongly calls for sustained nutrition education targeting uneducated mothers, mothers who gave birth for the first time and those with very young children to improve the practice. [ABSTRACT FROM AUTHOR]

This paper examines recent changes in the life trajectories of Indian women. We use data from four major national population surveys that span the years 1998–2016. We look at several cohorts of women across the states and regions. We compare decisions related to education, marriage, childbearing and participation in the labor force. Though there is considerable diversity across states and regions, as well as religious groups, we find some consistent patterns that emerge everywhere. First, educational attainment and the age at marriage have been steadily increasing. Women who do not complete secondary school are more likely to marry early. Second, caste and religion (rather than education) play a significant role in decisions after marriage, such as the timing of births, the use of contraception and labor force participation. Third, women from disadvantaged communities continue to have very different life trajectories than other social groups. They are more likely to use contraception and participate in the labor force. Lower levels of schooling also appear to exacerbate the disadvantages of social identity. The pace of these changes varies sharply across states as well as regions of the country. [ABSTRACT FROM AUTHOR]

The Earned Income Tax Credit (EITC) is one of the largest anti-poverty programs in the United States, providing over $67 billion to more than 27 million families for the tax year 2016, an average of $2,455. By subsidizing the earnings of low-income workers, the EITC reduces poverty both directly through the credit itself and indirectly through labor supply incentives. The two primary determinants of the amount a tax unit receives are earned income and number of children. Many studies define eligibility based on the presence of children in a household and separate analyses by marital status, a reflection of the fundamentally different incentives the EITC poses for single- and dual-earner households. However, as the EITC theoretically encourages fertility and generally discourages marriage, endogenous responses along these two dimensions could bias estimates which rely on them for identification and sample selection. In this paper, I revisit the classic question of the EITC's labor market effects while exploiting a source of arguably exogenous variation in EITC receipt that does not rely on these potentially endogenous characteristics: birth timing around the end of the calendar year. Using the Survey of Income and Program Participation, my results show positive earnings and employment effects for unmarried women in the 12 months following their first/only child's birth, including for those with a high school degree or less (low-ed). Overall, the results are usually small and insignificant for married women, with the exception of negative (and sometimes significant) effects on earnings for low-ed married women. Using a difference-in-discontinuities approach, I separate the income effect of the credit itself from the information effect, which, I argue, occurs when women receive the EITC for the first time. I show that, while the income effect is negative across all groups of women, the information effects are positive for unmarried women and negative for married women, again consistent with theory and the body of evidence on the EITC. [ABSTRACT FROM AUTHOR]

Background: Contraceptive use is the best and most cost-effective strategy to reduce feto-maternal adverse effects of short birth intervals. More than two-thirds of women in developing countries who do not want to conceive are not using contraception methods. Although there were various primary studies in different parts of the country, there is no nationally representative evidence on postpartum modern contraception utilization and its determinants in Ethiopia. Objective: This review was aimed to determine the best available pieces of evidence to pool the magnitude of postpartum modern contraception utilization and find out its determinants. Methods: Published studies were extensively searched by using electronic databases and unpublished studies were identified from the digital library. All observational studies conducted on the magnitude of postpartum modern contraception utilization and its determinants in Ethiopia were included. Data were extracted on the Microsoft Excel spreadsheet and analyzed using STATA 14.1 version. A random-effects model was used to estimate the pooled magnitude of postpartum modern contraception utilization with a 95% confidence interval (CI). Inverse variance (I2) was used to identify the presence of heterogeneity and forest plot was used to estimate the pooled magnitude of postpartum contraception utilization. The presence of publication bias was assessed by funnel plots and Egger's statistical tests. Sub-group analysis was computed to minimize underlying heterogeneity. Findings: In this review, 19 primary studies were included. The pooled magnitude of postpartum modern contraception utilization in Ethiopia was 45.79% (95%CI 36.45%, 55.13%). The review found that having more than four Antenatal care visits(ANC), having postnatal care visit (PNC), having a formal education, history of family planning use, history of counseling on family planning, and having greater than four alive children as significant determinants of postpartum modern contraception utilization. Conclusion: The magnitude of postpartum modern contraception utilization in Ethiopia was low. ANC visit, PNC visit, maternal educational status, history of previous family planning use, counseling on family planning, and number of alive children were found to be significant determinants of postpartum modern contraception utilization. Therefore, strengthening focused ANC and PNC services to encourage women in utilizing modern contraception during the postnatal period is needed. [ABSTRACT FROM AUTHOR]

Introduction. Anemia is highly dominant among pregnant women due to the need for iron for women themselves and their fetuses. Nearly half a billion globally and around one-third in Ethiopia of pregnant women were affected by anemia which has both health and economic impact. Therefore, this study aimed to identify the determinants of anemia among pregnant women attending antenatal care at public hospitals in the West Shewa zone, Oromia regional state, Central Ethiopia, 2019. Methods. An unmatched case-control study was conducted at public hospitals in the West Shewa zone, Ethiopia, from February to April 2019. A consecutive sampling was used to select study participants. Data were collected by a structured questionnaire, and the collected data were entered into Epi Info version 7 and SPSS version 23 for analyses. Descriptive statistics such as tables, graphs, and proportions were used to present the data. Binary and multiple logistic regression analyses were computed to identify the determinants of anemia. Adjusted odds ratio (AOR) with 95% confidence interval (CI) and p value <0.05 were used to determine the presence of an association. Result. A total of 426 women (142 cases and 284 controls) participated in this study with a 95.3% response rate. Family size >5 (AOR = 2.95, 95% CI: 1.34–6.50), peptic ulcer diseases (PUD) (AOR = 2.85, 95% CI: 1.14–7.13), having the previous history of abortion (AOR = 2.84, 95% CI: 1.08–7.47), birth interval <2 years (AOR = 2.61, 95% CI: 1.20–5.70), antepartum hemorrhage (APH) (AOR = 6.05, 95% CI: 1.95–18.81), and not using latrine (AOR = 3.45, 95% CI: 1.30–9.24) were the identified determinants of anemia. Conclusions. Family size, PUD, abortion, birth interval, APH, and unable to use latrine were the determinants of anemia among pregnant women. Therefore, the intervention on anemia prevention should consider the promotion of family planning methods and counseling on latrine utilization. [ABSTRACT FROM AUTHOR]

Background: Short birth interval is a universal public health problem resulting in adverse fetal, neonatal, child and maternal outcomes. In Ethiopia, more than 50% of the overall inter birth spacing is short. However, prior scientific evidence on its determinants is limited and even then findings are inconsistent. Methods: A community -based unmatched case-control study was employed on 218 cases and 436 controls. Cases were ever married reproductive age women whose last delivery has been in the past five years with birth interval of less than 3 years between the latest two successive live births whereas those women with birth interval of 3–5 years were taken as controls. A multistage sampling technique was employed on 30% of the kebeles in Dessie city administration. A pre-tested interviewer based questionnaire was used to collect data by 16 trained diploma nurses and 8 health extension workers supervised by 4 BSc nurses. The collected data were cleaned, coded and double entered into Epi-data version 4.2 and exported to SPSS version 22. Binary logistic regression model was considered and those variables with P<0.25 in the bivariable analysis were entered in to final model after which statistical significance was declared at P< 0.05 using adjusted odds ratio at 95% CI. Result: In this study, contraceptive use (AOR = 11.2, 95% CI: 5.95–21.15), optimal breast feeding for at least 2 years (AOR = 0.098, 95% CI:0.047–0.208), age at first birth <25 years (AOR = 0.36, 95% CI: 0.282–0.761), having male preceding child (AOR = 0.46, 95% CI: 0.166–0.793) and knowing the duration of optimum birth interval correctly (AOR = 0.45, 95% CI: 0.245–0.811) were significant determinants of short birth interval. Conclusion: Contraceptive use, duration of breast feeding, age at first birth, preceding child sex and correct understanding of the duration of birth interval were significant determinants of short birth interval. Fortunately, all these significant factors are likely modifiable. Thus, the existing efforts of optimizing birth interval should be enhanced through proper designation and implementation of different strategies on safe breastfeeding practice, modern contraceptive use and maternal awareness about the health merits of optimum birth interval. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this prospective birth cohort study was to evaluate the effect of the programme for prevention (PP) of early childhood caries and the resulting need for orthodontic treatment in 8-year-old German children. Material and methods: Children who had been enrolled in a caries-risk-related recall system with continuous dental care starting at the time of birth (prevention group, PG) were compared with children of the same birth cohort whose parents decided not to participate in the programme (control group, CG). All children (n = 289) participating in the last PP evaluation at the age of 5 years were invited again and examined by blinded clinicians. Dental caries was scored using the WHO diagnostic criteria expanded to d1-level without radiography. Impressions were taken of children with premature tooth loss to analyse space conditions. Results: Two hundred twenty-seven children (mean age 8.4 ± 0.6 years; 46.7% female) were examined. Children in the PG (n = 127) showed significantly lower caries prevalence and experience (3.1%, 0.4 ± 1.0 d3–4mft) than children in the CG (37.3%, 3.9 ± 3.5 d3–4mft). Orthodontic analysis found a higher prevalence of premature tooth extraction, followed by a greater extent of space loss in the CG (41.0%; 3.3 ± 4.4 mm) vs. PG (7.9%; 0.4 ± 1.9 mm) and an increase in early orthodontic treatment need (KIG P3, IOTN 5). Conclusions: The PP was an effective approach for preventing caries-related premature tooth loss in children and conserving relevant arch length. Clinical relevance: Children who received continuous dental care starting at the time of birth showed better oral health with less premature loss of deciduous teeth and lower need for orthodontic treatment at the age of 8 years. Trial registration: German Clinical Trials Register DRKS00003438, https://drks-neu.uniklinik-freiburg.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00003438 [ABSTRACT FROM AUTHOR]

Objective: We aimed to evaluate the rates of short interpregnancy interval pregnancies and deliveries among women who receive immediate postpartum LARC.Study Design: We conducted a retrospective cohort study of all women who delivered at Montefiore Medical Center between January 2015 and June 2016 (N = 9561). In this cohort, we identified all repeat deliveries and pregnancies within 18 months of the initial delivery. Using logistic regression models, we compared rates of short interpregnancy interval delivery and pregnancy among recipients of an immediate postpartum IUD, immediate postpartum implant, and no immediate postpartum LARC, adjusting for covariates including patient age, mode of delivery, socioeconomic status, and race.Results: In our cohort, 12.9% of patients received immediate postpartum LARC. The rates of short interpregnancy interval delivery were 3.3% (N = 259/7833) among patients who did not receive immediate postpartum LARC, 1% (N = 6/595) among immediate postpartum IUD recipients, and 0.4% (N = 2/562) among immediate postpartum implant recipients. The rates of short interpregnancy interval pregnancy were 13.8% (N = 1082/7833) among patients who did not receive immediate postpartum LARC, 7.4% (N = 44/595) among immediate postpartum IUD recipients, and 5.2% (N = 29/562) among immediate postpartum implant recipients. Both recipients of immediate postpartum IUDs and immediate postpartum implants had lower rates of short interpregnancy interval delivery and pregnancy compared to patients who did not receive immediate postpartum LARC.Conclusions: This study confirms that women who received immediate postpartum IUDs and implants have lower rates of short interpregnancy interval pregnancies.Implications: Making immediate postpartum LARC widely available is a promising public health approach to help women achieve a longer interpregnancy interval. [ABSTRACT FROM AUTHOR]

Teachers and caregivers organize children's everyday life in early childhood settings to support children's well-being, learning and development. Teachers' organizational decisions (e.g. daily schedule, arrangement of furnishings, activities, behavioural expectations) are influenced by a set of ideas, norms and values which they may or may not be conscious of at the time. The purpose of this study is to gain a deeper understanding of how democratic, caring and disciplinary values are communicated and negotiated between adults and children (from birth to five) in crèche and preschool settings, with particular attention to whether these values are animated in isolation (e.g. separately from one another) or in a more unified fashion. The conceptual framework for this study is based on previous theories and research on democracy education, communicative action, educational content and children's democratic formation, caring values and disciplinary values. The researchers analysed video recordings of interactions between children and teachers during lunch, circle time and free activities. The findings reveal the nature and extent to which teachers expect children to follow and participate in the social order that adults have established for them, as well as ways in which empathic practitioners create space for children to influence changes in the social order. [ABSTRACT FROM AUTHOR]

Persistently high levels of unintended fertility, combined with evidence that over- and underachieved fertility are typical and not exceptional, have prompted researchers to question the utility of fertility desires writ large. In this study, we elaborate this paradox: widespread unintendedness and meaningful, highly predictive fertility desires can and do coexist. Using data from Malawi, we demonstrate the predictive validity of numeric fertility timing desires over both four-month and one-year periods. We find that fertility timing desires are highly predictive of pregnancy and that they follow a gradient wherein the likelihood of pregnancy decreases in correspondence with desired time to next birth. This finding holds despite the simultaneous observation of high levels of unintended pregnancy in our sample. Discordance between desires and behaviors reflects constraints to achieving one's fertility and the fluidity of desires but not their irrelevance. Fertility desires remain an essential—if sometimes blunt—tool in the demographers' toolkit. [ABSTRACT FROM AUTHOR]

Selenium (Se) is an essential trace element for animals and exists in nature in both inorganic and organic forms. Although organic Se is more bioavailable than inorganic Se, there are inconsistent reports on the effect of organic Se on the reproductive performance of sows. This study was conducted to investigate the effect of maternal organic Se (2-hydroxy-4-methylselenobutanoic [ HMSeBA ]) supplementation on reproductive performance and antioxidant capacity of sows, and the long-term effect on the growth performance and antioxidant capacity of their offspring with or without lipopolysaccharide (LPS) challenge. The experimental design used in this study was a completely randomized design; 45 Landrace × Yorkshire sows were randomly allocated to receive one of the following three diets during gestation: control diet (Control, basal diet, n = 15), sodium selenite (Na2SeO3)-supplemented diet (Na2SeO3, basal diet + 0.3 mg Se/kg Na2SeO3, n = 15), and HMSeBA-supplemented diet (HMSeBA, basal diet + 0.3 mg Se/kg HMSeBA, n = 15). On day 21 of age, male offspring from each group were injected with LPS or saline (n = 6). As compared with the control group, maternal HMSeBA supplementation increased the number of total born piglets, while decreased birth weight (P < 0.05). In the first week of lactation, maternal HMSeBA supplementation increased litter weight gain compared with the Na2SeO3 group (P < 0.05) and increased the average daily gain of piglets compared with the control group and Na2SeO3 group (P < 0.05). Meanwhile, maternal HMSeBA supplementation decreased piglet birth interval as compared with the control group and Na2SeO3 group (P < 0.05). Besides, plasma glutathione peroxidase (GSH-Px) activity was higher in the HMSeBA group on farrowing 0 min and 90 min, while malondialdehyde (MDA) concentration was lower on farrowing 0, 90, and 135 min than those in the control group (P < 0.05). In addition, maternal HMSeBA supplementation increased the concentration of selenoprotein P (SELENOP) in colostrum compared with the control group (P < 0.05). Further study revealed that the LPS-challenged HMSeBA group had higher GSH-Px and total antioxidant capacity and lower MDA in weaning piglets compared with the LPS-challenged control group (P < 0.05). Taken together, maternal HMSeBA supplementation increased the number of total born piglets, shortened the duration of farrowing, improved the antioxidant capacities of sows and their offspring, and improved the growth performance of suckling pigs at the first week of lactation. Thus, HMSeBA supplementation during gestation has the potentiality to produce more kilogram of meat. [ABSTRACT FROM AUTHOR]