Helga Bjørnøy Urke

Trends in stunting and overweight in Peruvian pre-schoolers from 1991 to 2011: findings from the Demographic and Health Surveys

Objective To examine trends in stunting and overweight in Peruvian children, using 2006 WHO Multicentre Growth Reference Study criteria. Design Trend analyses using nationally representative cross-sectional surveys from Demographic and Health Surveys (1991–2011). We performed logistic regression analyses of stunting and overweight trends in sociodemographic groups (sex, age, urban–rural residence, region, maternal education and household wealth), adjusted for sampling design effects (strata, clusters and sampling weights). Setting Peru. Subjects Children aged 0–59 months surveyed in 1991–92 (n 7999), 1996 (n 14 877), 2000 (n 11 754), 2007–08 (n 8232) and 2011 (n 8186). Results Child stunting declined (F(1, 5149) = 174·8, P ≤ 0·00) and child overweight was stable in the period 1991–2011 (F(1, 5147) = 0·4, P ≤ 0·54). Over the study period, levels of stunting were highest in rural compared with urban areas, the Andean and Amazon regions compared with the Coast, among children of low-educated mothers and among children living in households in the poorest wealth quintile. The trend in overweight rose among males in coastal areas (F(1, 2250) = 4·779, P ≤ 0·029) and among males in the richest wealth quintile (F(1, 1730) = 5·458, P ≤ 0·020). Conclusions The 2011 levels of stunting and overweight were eight times and three and a half times higher, respectively, than the expected levels from the 2006 WHO growth standards. The trend over the study period in stunting declined in most sociodemographic subgroups. The trend in overweight was stable in most sociodemographic subgroups.

Influence of childcare practices on nutritional status of Ghanaian children: a regression analysis of the Ghana Demographic and Health Surveys

Objectives Guided by the UNICEF framework for childcare, this study examined the association of childcare practices (CCP) with infant and young childrens growth (height-for-age Z-scores, HAZ), and investigated whether care practices are more important to growth in some sociodemographic subgroups of children. Design Cross-sectional survey. Setting Urban and rural Ghana. Participants The study sample comprised 1187 dyads of mothers aged 15–49 years and their youngest child (aged 6–36 months). Results The results showed that CCP was a significant predictor of HAZ, after controlling for covariates/confounders at child, maternal and household levels. Children with higher CCP scores had higher HAZ. A 1-unit increase in the CCP score was associated with a 0.17-unit increase in HAZ. Childs and mothers age, number of children under 5 years, place of residence, maternal weight and wealth index were also significantly associated with HAZ. Statistical interaction analyses revealed no subgroup differences in the CCP/HAZ relationship. Conclusions This study found a significant, positive association between CCP and child growth, after accounting for other important determinants of child growth at maternal and household levels. This calls for research into the effects on growth of various CCP components, with longitudinal cohort study designs that can disentangle causal relationships.

Validity of a Single Item Food Security Questionnaire in Arctic Canada

OBJECTIVES: Assess sensitivity and specificity of each of the 18 US Department of Agriculture (USDA) Household Food Security Scale Module (HFSSM) questionnaire items to determine whether a rapid assessment of child and adult food insecurity is feasible in an Inuit population. METHODS: Food insecurity prevalence was assessed by the 18-item USDA HFSSM in a randomized sample of Inuit households participating in the Inuit Health Survey and the Nunavut Inuit Child Health Survey. Questions were evaluated for sensitivity, specificity, predictive value (+/−), and total percent accuracy for adult and child food insecurity (yes/no). Child food security items were evaluated for both surveys. RESULTS: For children, the question “In the last 12 months, were there times when it was not possible to feed the children a healthy meal because there was not enough money?” had the best performance in both samples with a sensitivity and specificity of 92.3% and 97.3%, respectively, for the Inuit Health Survey, and 88.5% and 95.4% for the Nunavut Inuit Child Health Survey. For adults, the question “In the last 12 months, were there times when the food for you and your family just did not last and there was no money to buy more?” demonstrated a sensitivity of 93.0% and a specificity of 93.4%. CONCLUSIONS: Rapid assessment of child and adult food insecurity is feasible and may be a useful tool for health care and social service providers. However, as prevalence and severity of food insecurity change over time, rapid assessment techniques should not replace periodic screening by using the full USDA HFSSM questionnaire.

Household food security and adequacy of child diet in the food insecure region north in Ghana

Background and objectives Adequate diet is of crucial importance for healthy child development. In food insecure areas of the world, the provision of adequate child diet is threatened in the many households that sometimes experience having no food at all to eat (household food insecurity). In the context of food insecure northern Ghana, this study investigated the relationship between level of household food security and achievement of recommended child diet as measured by WHO Infant and Young Child Feeding Indicators. Methods Using data from households and 6–23 month old children in the 2012 Feed the Future baseline survey (n = 871), descriptive analyses assessed the prevalence of minimum meal frequency; minimum dietary diversity, and minimum acceptable diet. Logistic regression analysis was used to examine the association of minimum acceptable diet with household food security, while accounting for the effects of child sex and age, maternal -age, -dietary diversity, -literacy and -education, household size, region, and urban-rural setting. Household food security was assessed with the Household Hunger Scale developed by USAID’s Food and Nutrition Technical Assistance Project. Results Forty-nine percent of children received minimum recommended meal frequency, 31% received minimum dietary diversity, and 17% of the children received minimum acceptable diet. Sixty-four percent of the children lived in food secure households, and they were significantly more likely than children in food insecure households to receive recommended minimum acceptable diet [O.R = 0.53; 95% CI: 0.35, 0.82]. However, in 80% of food secure households, children did not receive a minimal acceptable diet by WHO standards. Conclusions Children living in food secure households were more likely than others to receive a minimum acceptable diet. Yet living in a food secure household was no guarantee of child dietary adequacy, since eight of 10 children in food secure households received less than a minimum acceptable diet. The results call for research into factors besides household food security in the search for determinants of child diet adequacy. In this study at least, household food security was a very weak marker of child diet adequacy. This finding is of significance to public health practice, since it calls into question any assumption that having enough food in a household necessarily results in adequately fed children.

Reliability of demographic and socioeconomic variables in predicting early initiation of breastfeeding: a replication analysis using the Kenya Demographic and Health Survey data

Objectives Examine the reliability of sociodemographic variables in predicting initiation of breastfeeding within an hour of birth (EarlyBF), using data from 1998, 2003 and 2008–2009. Study design A replication analysis using the Kenya Demographic and Health Survey (KDHS) data collected in 1998, 2003 and 2008–2009. The candidate predictor variables were childs gender, home or health facility place of birth, vaginal or caesarean mode of birth, urban or rural setting, province of residence, Wealth Index and maternal education, occupation, literacy and media exposure. Setting Kenya. Participants 6375 dyads of mothers aged 15–49 and their children aged 0–23 months (2125 dyads in each of the survey years). Results Mode of birth and province were statistically significant predictors of EarlyBF in 1998, 2003 and 2008–2009. Children delivered through caesarean section were non-EarlyBF in 1998 (OR 2.63, 95% CI 1.72 to 4.04), 2003 (OR 3.36, 95% CI 1.83 to 6.16) and 2008 (OR 3.51, 95% CI 2.17 to 5.69). The same was true of those living in the Western province in 1998 (OR 2.67, 95% CI 1.61 to 4.43), 2003 (OR 4.92, 95% CI 3.01 to 8.04) and 2008 (OR 6.07, 95% CI 3.54 to 10.39). Conclusions The 1998 KDHS data do not provide the basis for reliable prediction of EarlyBF, with reliability conceptualised as replicability of findings using highly similar data sets from 2003 and 2008–2009. Most of the demographic and socioeconomic variables were unreliable predictors of EarlyBF. We speculate that activities in parts or all of Kenya changed the analysis context in the period between 1998 and 2008–2009, and these changes were of a sufficient magnitude to affect the relationships under investigation. The degree to which this is a general problem in child health research is not known, calling for further research to investigate this methodological issue with other health end points and other data.

Child diet and healthy growth in the context of rural poverty in the Peruvian Andes: What influences primary caregivers’ opportunities and choices?

This study explored opportunities and choices related to child feeding among women living in a remote and low-income district in the Andean highlands. Data were collected through in-depth interviews with mothers (N = 7) with reputations for providing good child care, and who participated in an NGO-run social and health programme. The aim of this study was to learn about women’s positive experience with child feeding, in the context of living in low-income communities. Such knowledge could be of substantial practical value to health promotion practitioners, in illuminating existing local circumstances and practices that produce good child nutrition. The women who were most knowledgeable about child health and diet were better educated and had relatively higher social positions in the community. Regarding contextual factors related to child feeding, numerous references were made to the extensive use of own crops and food stuffs, seen to provide a better diet than that available in cities where people buy their food. In discussing food and meal preparation habits, there were clear references to child welfare and health as motivating factors in the choices that were made. The NGO programme was not mentioned by the interviewer, to avoid prompting, yet the respondents referred to it explicitly, and attributed improved health-related knowledge and skills to the NGO education interventions (e.g. education about nutritious meal preparation, child care skills, and sanitation practices). It is concluded that the women were concerned about providing a good diet to their children, they were aware of the impact of feeding practices on child health, and that education about health and diet helped them to improved feeding practices.

High school physical education What contributes to the experience of flow

This study seeks to identify factors that promote positive experiences in high school physical education (PE). The study combines elements of Self-determination Theory (SDT) with the theory of flow. Special attention is given to gender differences. The study sample consisted of 167 Norwegian senior high school students (78 females and 89 males) who completed a questionnaire after having participated in a PE class. The majority of the students reported having flow experiences, although this was more true for boys than for girls. Those who had experienced flow also tended to be those who had experienced the fulfilment of basic psychological needs and were characterized by a high level of autonomous motivation. In boys, the need for competence was a stronger predictor of flow than other factors, while for girls the need for relatedness was the stronger predictor of flow. Although a high percentage of the participants in this study reported an experience of flow, a significant minority of the students (more girls than boys) did not report an experience of flow. The findings confirm previous research on the relationship between the different constructs of SDT and the experience of flow, indicating that this relationship also applies in PE. The experience of flow in PE might result in positive PE experiences that can have significant health benefits for the individual student and our society.

Specific Resistance Resources in the Salutogenic Model of Health

This chapter discusses conceptual and concrete differences between generalised and specific resistance resources in the salutogenic model of health. This is important to health promotion research and practice, because the means by which these different types of resources are strengthened are dissimilar. It is important to distinguish between the two types of resistance resources, to ensure that health promotion pays balanced attention to both types. Generalised resistance resources arise from the cultural, social and environmental conditions of living and early childhood rearing and socialisation experiences, in addition to idiosyncratic factors and chance. Specific resistance resources, on the other hand, are optimised by societal action in which health promotion has a contributing role, for example the provision of supportive social and physical environments. Specific resistance resources actually have as much or more relevance to health promotion practice as do generalized resistance resources. By drawing attention to the special nature of specific resistance resources, one also draws attention to what should be a core aim of health promotion: to ensure that availability of the right specific resistance resource at the right time is not all too often a matter of ‘chance or luck’, as Antonovsky worried.

Changes in Optimal Childcare Practices in Kenya: Insights from the 2003, 2008-9 and 2014 Demographic and Health Surveys

Objective(s) Using nationally representative surveys conducted in Kenya, this study examined optimal health promoting childcare practices in 2003, 2008–9 and 2014. This was undertaken in the context of continuous child health promotion activities conducted by government and non-government organizations throughout Kenya. It was the aim of such activities to increase the prevalence of health promoting childcare practices; to what extent have there been changes in optimal childcare practices in Kenya during the 11-year period under study? Methods Cross-sectional data were obtained from the Kenya Demographic and Health Surveys conducted in 2003, 2008–9 and 2014. Women 15–49 years old with children 0–59 months were interviewed about a range of childcare practices. Logistic regression analysis was used to examine changes in, and correlates of, optimal childcare practices using the 2003, 2008–9 and 2014 data. Samples of 5949, 6079 and 20964 women interviewed in 2003, 2008–9 and 2014 respectively were used in the analysis. Results Between 2003 and 2014, there were increases in all health facility-based childcare practices with major increases observed in seeking medical treatment for diarrhoea and complete child vaccination. Mixed results were observed in home-based care where increases were noted in the use of insecticide treated bed nets, sanitary stool disposal and use of oral rehydration solutions, while decreases were observed in the prevalence of urging more fluid/food during diarrhoea and consumption of a minimum acceptable diet. Logit models showed that area of residence (region), household wealth, maternal education, parity, mothers age, child’s age and pregnancy history were significant determinants of optimal childcare practices across the three surveys. Conclusions The study observed variation in the uptake of the recommended optimal childcare practices in Kenya. National, regional and local child health promotion activities, coupled with changes in society and in living conditions between 2003 and 2014, could have influenced uptake of certain recommended childcare practices in Kenya. Decreases in the prevalence of children who were offered same/more fluid/food when they had diarrhea and children who consumed the minimum acceptable diet is alarming and perhaps a red flag to stakeholders who may have focused more on health facility-based care at the expense of home-based care. Concerted efforts are needed to address the consistent inequities in the uptake of the recommended childcare practices. Such efforts should be cognizant of the underlying factors that affect childcare in Kenya, herein defined as region, household wealth, maternal education, parity, mothers age, child’s age and pregnancy history.

The Influence of Maternal and Household Resources, and Parental Psychosocial Child Stimulation on Early Childhood Development: A Cross-Sectional Study of Children 36–59 Months in Honduras

Optimal early childhood development (ECD) is currently jeopardized for more than 250 million children under five in low- and middle-income countries. The Sustainable Development Goals has called for a renewed emphasis on children’s wellbeing, encompassing a holistic approach that ensures nurturing care to facilitate optimal child development. In vulnerable contexts, the extent of a family’s available resources can influence a child’s potential of reaching its optimal development. Few studies have examined these relationships in low- and middle-income countries using nationally representative samples. The present paper explored the relationships between maternal and paternal psychosocial stimulation of the child as well as maternal and household resources and ECD among 2729 children 36–59 months old in Honduras. Data from the Demographic and Health Surveys conducted in 2011–2012 was used. Adjusted logistic regression analyses showed that maternal psychosocial stimulation was positively and significantly associated with ECD in the full, rural, and lowest wealth quintile samples. These findings underscore the importance of maternal engagement in facilitating ECD but also highlight the role of context when designing tailored interventions to improve ECD.