Béatrice Nikiéma

Providing information on pregnancy complications during antenatal visits: unmet educational needs in sub-Saharan Africa

INTRODUCTION Lack of information on the warning signs of complications during pregnancy, parturition and postpartum hampers womens ability to partake fully in safe motherhood initiatives. We assessed the extent to which women in 19 countries of sub-Saharan Africa recall receiving information about pregnancy complications during antenatal care for the most recent pregnancy, and examined the impact of advice receipt on the likelihood of institutional delivery. METHODS A cross-sectional, cross-country analysis was performed on data from the most recent Demographic and Health Surveys (DHS) of 19 countries of sub-Saharan Africa. Multilevel logistic regressions were used to predict the probability of receiving information and delivering in a health centre, by clinical risk factors (age, parity, previous pregnancy termination), social factors (area of residence, education), and the frequency of service utilization (number of visits). RESULTS The percentage of women recalling information about potential complications of pregnancy during antenatal care varied widely, ranging from 6% in Rwanda to 72% in Malawi, and in 15 of the 19 countries, less than 50% of women reported receiving information. Institutional delivery ranged from 29% (Ethiopia) to 92% (Congo Brazzaville). Teenagers (OR = 0.84), uneducated (OR = 0.65) and rural women (OR = 0.70) were less likely to have been advised, compared with women aged 20-34 years, women with secondary education and urban women, respectively. Likelihood of recalling information increased with the number of antenatal visits. Advice reception interacts with the number of antenatal visits to increase the likelihood of institutional delivery. CONCLUSION There is a high level of unmet need for information on pregnancy complications in sub-Saharan Africa, particularly among those who face significant barriers to accessing care if complications occur. Educational interventions are critical to safe motherhood initiatives; health providers must fully use the educational opportunity in antenatal care.

Sustained active transportation is associated with a favorable body mass index trajectory across the early school years: findings from the Quebec Longitudinal Study of Child Development birth cohort

OBJECTIVE To determine the extent to which active transportation (AT) to and from school is associated with changes in body mass index (BMI) from kindergarten (6-year-olds) through grade 2 (8-year-olds). METHODS The sample included 1170 children (50.4% of baseline participants) who were part of the Quebec Longitudinal Study of Child Development (QLSCD), a birth cohort established in 1998 in Quebec, Canada. Data were collected by trained interviewers using structured interviews and measuring height and weight in the home with the person most knowledgeable about the childs health. Relative weight was operationalized as age- and sex-adjusted BMI Z-scores. RESULTS Growth curve analyses showed that using AT to and from school both when in kindergarten and in grade 1 was predictive of a lower BMI Z-score (coeff=-0.18, SE=0.09, p=0.05) in grade 1. Using AT to and from school in kindergarten, grade 1, and grade 2 was predictive of a lower BMI Z-score (coeff=-0.30, SE=0.098, p=0.003) in grade 2. No other covariates were predictive of relative weight across time, although having an overweight or obese mother was associated with a BMI Z-score of 0.39 (SE=0.07, p<0.001) across all time points. CONCLUSION Sustained AT is associated with more healthful trajectories of BMI across the early school years.

Duration of Poverty and Child Health in the Quebec Longitudinal Study of Child Development: Longitudinal Analysis of a Birth Cohort

OBJECTIVES. The objective of this study was to examine the relationship between duration of poverty and the health of preschool children in the Quebec Longitudinal Study of Child Development birth cohort. METHODS. Data from the Quebec Longitudinal Study of Child Development for 1950 children who were followed annually up to age 3 years were analyzed. Poverty was defined as having an income below the low-income cutoff from Statistics Canada. Five health indicators were examined: asthma attacks, infections, growth delay, a cumulative health-problems index, and maternal perception of the childs health. The association between duration of poverty and child health was explored with logistic regression modeling controlling for child and mother characteristics, including the mothers level of education, social support, and physical violence. RESULTS. In this birth cohort, 13.7% (268) 3-year-old children from the Quebec Longitudinal Study of Child Development experienced intermittent poverty since birth (1–2 episodes), and another 14.4% (280) experienced chronic poverty (3–4 episodes). Children from families with chronic poverty had more frequent asthma attacks and had a higher cumulative health-problems index score, whereas children with intermittent poverty were more often perceived to be in less than very good health by their mothers. These associations remained statistically significant when controlling for child and mother characteristics. No association was observed between duration of poverty and infections or growth delay. CONCLUSIONS. Chronic poverty affects a large number of children and has negative consequences for preschool childrens health, although universal health care is available. The effects of chronic poverty may vary according to different health indicators and the age of the child.

Understanding the determinants of active transportation to school among children: Evidence of environmental injustice from the Quebec longitudinal study of child development

PURPOSE To examine the combined influence of poverty and dangerousness of the neighborhood on active transportation (AT) to school among a cohort of children followed throughout the early school years. METHODS Growth curve modeling was used to identify determinants of AT to school among 710 children participating in the Quebec Longitudinal Study of Child Development from 2003 through 2006. Parent-reported dangerousness and pedestrian-vehicle collision data were merged with travel mode and health data. RESULTS At age 6 years, insufficient household income, having an older sibling, and living in a neighborhood that is not excellent for raising children, or characterized with high decay were predictive of greater likelihood of using AT and remained unchanged as children progressed from kindergarten through grade 2. CONCLUSION A public health concern is children experiencing environmental injustice. Since AT is most likely to be adopted by those living in poverty and because it is also associated with unsafe environments, some children are experiencing environmental injustice in relation to AT. Interventions may be implemented to reduce environmental injustice through improvements in road safety.

Poverty and Chronic Illness in Early Childhood: A Comparison Between the United Kingdom and Quebec

OBJECTIVES: Our goal was to examine the association between poverty, in the first and fourth years of life and cumulatively in the first and fourth years of life, and the health of children in the fourth year of life in the UK Millennium Cohort Study and in the Quebec Longitudinal Study of Child Development (QLSCD). METHODS: Data from the UK Millennium Cohort Study of 14 556 children and from the QLSCD of 1950 children were analyzed. Comparable measures of poverty were households in receipt of the safety-net benefit: income support in the United Kingdom and social welfare in Quebec. Three parent-reported health indicators were examined: asthma attack, long-standing illness, and limiting long-standing illness by the fourth year of life. Associations were explored with logistic regression modeling controlling for child characteristics and maternal education. RESULTS: Poverty only in the first year of life significantly increased the risk of asthma attacks and limiting long-standing illness in the fourth year of life among UK children; trends were in the expected direction in the QLSCD but did not reach statistical significance. Poverty in the fourth year of life only significantly increased the risk of all 3 outcomes for UK children but not for Quebec children. For children experiencing poverty in both the first and fourth years of life, the risks for all 3 outcomes also increased in the United Kingdom, whereas only the risk of limiting long-standing illness increased in Quebec. Adjustment for confounding had little effect on the increased risks associated with poverty. CONCLUSIONS: These findings suggest that experience of poverty at various times in early childhood increases the risk of asthma attacks and chronic illness in the fourth year of life; however, they also indicate that poverty at different stages of the early childhood life course may have different effects on chronic illness in different country settings.

The influence of poverty and social support on the perceived health of children born to minority migrant mothers.

Objective. Poverty and low social support are common among minority migrant families. Little is known about their impact on the health of children of minority migrants to Canada. This study examined the associations between maternal perception of childs health and migration status, and examined the specific role of poverty and low social support in these associations. Design. Data from the first two rounds of the Quebec Longitudinal Study of Child Development (QLSCD) were analysed. The sample included 1990 children at 17 months of age, classified according to their mothers migration status: children of minority migrant mothers (n=165) and Canadian-born mothers (n=1825). Maternal perception of childs health status and social support were measured at 17 months, household income was measured at 5 and 17 months. Multivariable logistic regressions were performed; interactions of migration status with poverty and social support were tested. Results. Poverty and low social support were more common among minority migrant mothers than among Canadian-born mothers. Children of minority migrant mothers who were ‘never poor’ and reported high levels of social support were perceived in better health (OR 0.42; 95% confidence interval (CI): 0.19–0.91) than children of Canadian-born mothers (reference group). In contrast, children of minority migrant mothers who were ‘always poor’ and reported low social support were perceived in worse health (OR 6.32; 95% CI: 1.69–23.71) compared to the reference group. Conclusion. In Quebec, economic hardship and lack of social support are common realities among minority migrants with young children. Combined exposure to poverty and low social support is most detrimental to the perceived health of children of minority migrants.

Poverty's latent effect on adiposity during childhood: evidence from a Québec birth cohort

Background Childhood poverty heightens the risk of obesity in adulthood, but the age at which this risk appears is unclear. We analysed the association between poverty trajectories with body mass index (BMI) Z-scores or the risk of being overweight or obese across four ages (6 years, 8 years, 10 years and 12 years) in childhood. Methods Data were from the 1998–2010 ‘Quebec Longitudinal Study of Child Development’ cohort (n=698). Poverty was defined using Statistics Canadas thresholds, and trajectories were characterised with a Latent Class Growth Analysis. Multivariable linear and logistic regression models adjusted for sex, whether the mother was an immigrant, maternal education and birth weight. Results Four income trajectories were identified: a reference group (stable non-poor), and 3 higher exposure categories (increasing likelihood of poverty, decreasing likelihood of poverty or stable poor). Compared with children from stable non-poor households, children from stable poor households had BMI Z-scores that were 0.39 and 0.43 larger than children from stable non-poor households at age 10 years and 12 years, respectively (p<0.05). Compared with children from stable non-poor households, children from stable poor households were 2.22, 2.34, and 3.04 times more likely to be overweight or obese at age 8 years, 10 years and 12 years, respectively (p<0.05). Conclusion A latency period for the detrimental effects of child poverty on the risk of overweight or obesity was detected. Whether the effects continue to widen with increasing duration of exposure to poverty as the children age should be investigated.

Duration of lack of money for basic needs and growth delay in the Quebec Longitudinal Study of Child Development birth cohort

Objective: To examine the relationship between duration of lack of money for basic needs and growth delay in a birth cohort. Methodology: Mothers of children (n = 1929) from the Quebec Longitudinal Study of Child Development (QLSCD) participating when the children were ages 2½ and 4 years were interviewed at home and data were extracted from birth records. Children’s height at 4 years old was transformed into an age- and sex-adjusted z-score. A z-score under the 10th percentile of the Centers for Disease Control and Prevention population growth curve was equated with growth delay. Lack of money for basic needs (paying for rent, electricity and/or heating, clothing, medications or other needs) when the children were ages 2½ and 4 years was reported by the mother. Results: Only 2.5% of children experienced two episodes of lack of money for basic needs. Logistic regression analyses showed that, after adjusting for confounding variables, the probability of growth delay at 4 years among children whose families experienced two episodes of lack of money was higher than for their peers who had not lacked money (OR 3.43; 95% CI 1.54 to 7.66). Experiencing lack of money only at 2½ years showed higher but not significant odds of growth delay at 4 years (OR 1.51; 95% CI 0.84 to 2.72), whereas the likelihood of growth delay was similar for children who experienced lack of money only at 4 years and for their counterparts who never lacked money (OR 0.74; 95% CI 0.26 to 2.11). Conclusion: In an industrialised country toddlers whose families experienced persistent lack of money for basic needs are more likely to have growth delay even after controlling for neonatal conditions and their mothers’ characteristics.

Comparison of three lifecourse models of poverty in predicting cardiovascular disease risk in youth

OBJECTIVE Childhood poverty heightens the risk of adulthood cardiovascular disease (CVD), but the underlying pathways are poorly understood. Three lifecourse models have been proposed but have never been tested among youth. We assessed the longitudinal association of childhood poverty with CVD risk factors in 10-year-old youth according to the timing, accumulation, and mobility models. METHODS The Québec Longitudinal Study of Child Development birth cohort was established in 1998 (n = 2120). Poverty was defined as annual income below the low-income thresholds defined by Statistics Canada. Multiple imputation was used for missing data. Multivariable linear regression models adjusted for gender, pubertal stage, parental education, maternal age, whether the household was a single parent household, whether the child was overweight or obese, the childs physical activity in the past week, and family history. RESULTS Approximately 40% experienced poverty at least once, 16% throughout childhood, and 25% intermittently. Poverty was associated with significantly elevated triglycerides and insulin according to the timing and accumulation models, although the timing model was superior for predicting insulin and the accumulation model was superior for predicting triglycerides. CONCLUSIONS Early and prolonged exposure to poverty significantly increases CVD risk among 10-year-old youth.

Measuring women's perceived ability to overcome barriers to healthcare seeking in Burkina Faso

BackgroundIn sub-Saharan Africa, women must overcome numerous barriers when they need modern healthcare. Respect of gender norms within the household and the community may still influence womens ability to obtain care. A lack of gender-sensitive instruments for measuring womens ability to overcome barriers compromises attempts to adequately quantify the burden and risk of exclusion they face when seeking modern healthcare. The aim of this study was to create and validate a synthetic measure of womens access to healthcare from a publicly available and possibly internationally comparable population-based survey.MethodSeven questionnaire items from the Burkina Faso 2003 DHS were combined to create the index. Cronbachs alpha coefficient was used to test the reliability of the index. Exploratory factor analyses (EFA) and confirmatory factor analyses (CFA) were applied to evaluate the factorial structure and construct validity of the index while taking into account the hierarchical structure of the data.ResultsThe index has a Cronbachs alpha of 0.75, suggesting adequate reliability. In EFA, three correlated factors fitted the data best. In CFA, the construct of perceived ability to overcome barriers to healthcare seeking emerged as a second-order latent variable with three domains: socioeconomic barriers, geographical barriers and psychosocial barriers. Model fit indices support the indexs global validity for women of reproductive age in Burkina Faso. Evidence for construct validity comes from the finding that womens index scores increase with household living standard.ConclusionThe DHS items can be combined into a reliable and valid, gender-sensitive index quantifying reproductive-age womens perceived ability to overcome barriers to healthcare seeking in Burkina Faso. The index complies conceptually with the sector-cross-cutting capability approach and enables measuring directly the perceived access to healthcare. Therefore it can help to improve the design and evaluation of interventions that aim to facilitate healthcare seeking in this country. Further analyses may examine how far the index applies to similar contexts.