Olukunmi O Balogun

Alcohol Consumption and Psychological Distress in Adolescents: A Multi-Country Study

PURPOSE To examine the association between alcohol use and psychological distress among adolescents in a range of developing countries. METHODS Secondary data analysis of the Global School-Based Student Health Survey was conducted using nationally representative data from 12 developing countries: Botswana, Grenada, Indonesia, Kenya, Myanmar, the Philippines, Saint Lucia, Saint Vincent and the Grenadines, the Seychelles, Thailand, Trinidad and Tobago, and Uganda. The surveys were conducted between 2003 and 2008 and involved 32,001 adolescents primarily aged 13-15 years. We used multivariate logistic regression analysis to determine the association between alcohol use and psychological distress. RESULTS The prevalence of past 30-day alcohol use and lifetime drunkenness varied widely across countries, as did the occurrence of psychological distress (anxiety-induced sleeplessness and/or depression). The risk of psychological distress was significantly higher among adolescents when using alcohol in all countries except Myanmar. In nine of the 12 countries, past 30-day alcohol use was associated with psychological distress, while students who had been drunk at least once in their lifetime had an increased risk of experiencing psychological distress in 11 of the study countries. CONCLUSIONS The high prevalence of alcohol use among adolescents and the strength of the association with psychological distress present a major public health challenge in developing countries. The urgent need to reduce adolescent alcohol use necessitates the implementation of context- and culture-specific strategies that reduce the physical availability of alcohol.

Factors influencing breastfeeding exclusivity during the first 6 months of life in developing countries: a quantitative and qualitative systematic review.

Breastfeeding is the most advantageous feeding option for infants, and epidemiological studies provide evidence for its promotion. The objective of this review was to comprehensively delineate the barriers and facilitators of exclusive breastfeeding of infants aged 0-6 months old by mothers in developing countries. A search of CINAHL, MEDLINE and PsycINFO was carried out to retrieve studies from January 2001 to January 2014. Using our inclusion criteria, we selected studies that described barriers and facilitators of exclusive breastfeeding. Qualitative and quantitative studies were considered. Twenty-five studies involving 11 025 participants from 19 countries were included. Barriers and facilitators of exclusive/full breastfeeding were identified, analysed tabulated and summarised in this review. Maternal employment was the most frequently cited barrier to exclusive breastfeeding. Maternal perceptions of insufficient breast milk supply was pervasive among studies while medical barriers related to illness of mothers and/or infants as well as breast problems, rather than health care providers. Socio-cultural factors such as maternal and significant others beliefs about infant nutrition also often constitute strong barriers to exclusive breastfeeding. Despite these barriers, mothers in developing countries often possess certain personal characteristics and develop strategic plans to enhance their success at breastfeeding. Health care providers should be informed about the determinants of exclusive breastfeeding and provide practical anticipatory guidance targeted at overcoming these barriers. In so doing, health care providers in developing countries can contribute to improving maternal and child health outcomes.

Effects of nutrition interventions during pregnancy on low birth weight: an overview of systematic reviews

Introduction Low birth weight (LBW, birth weight less than 2500 g) is associated with infant mortality and childhood morbidity. Poor maternal nutritional status is one of several contributing factors to LBW. We systematically reviewed the evidence for nutrition-specific (addressing the immediate determinants of nutrition) and nutrition-sensitive (addressing the underlying cause of undernutrition) interventions to reduce the risk of LBW and/or its components: preterm birth (PTB) and small-for-gestational age (SGA). Methods We conducted a comprehensive literature search in MEDLINE, EMBASE, CINAHL and the Cochrane Database of Systematic Reviews (September 2015). Systematic reviews of randomised controlled trials focusing on nutritional interventions before and during pregnancy to reduce LBW and its components were eligible for inclusion into the overview review. We assessed the methodological quality of the included reviews using A Measurement Tool to Assess Reviews (AMSTAR), PROSPERO: CRD42015024814. Results We included 23 systematic reviews which comprised 34 comparisons. Sixteen reviews were of high methodological quality, six of moderate and only one review of low quality. Six interventions were associated with a decreased risk of LBW: oral supplementation with (1) vitamin A, (2) low-dose calcium, (3) zinc, (4) multiple micronutrients (MMN), nutritional education and provision of preventive antimalarials. MMN and balanced protein/energy supplementation had a positive effect on SGA, while high protein supplementation increased the risk of SGA. High-dose calcium, zinc or long-chain n-3 fatty acid supplementation and nutritional education decreased the risk of PTB. Conclusion Improving women’s nutritional status positively affected LBW, SGA and PTB. Based on current evidence, especially MMN supplementation and preventive antimalarial drugs during pregnancy may be considered for policy and practice. However, for most interventions evidence was derived from a small number of trials and/or participants. There is a need to further explore the evidence of nutrition-specific and nutrition-sensitive interventions in order to reach the WHO’s goal of a 30% reduction in the global rate of LBW by 2025.

Diagnostic Accuracy of Ultrasound Scanning for Prenatal Microcephaly in the context of Zika Virus Infection: A Systematic Review and Meta-analysis

To assess the accuracy of ultrasound measurements of fetal biometric parameters for prenatal diagnosis of microcephaly in the context of Zika virus (ZIKV) infection, we searched bibliographic databases for studies published until March 3rd, 2016. We extracted the numbers of true positives, false positives, true negatives, and false negatives and performed a meta-analysis to estimate group sensitivity and specificity. Predictive values for ZIKV-infected pregnancies were extrapolated from those obtained for pregnancies unrelated to ZIKV. Of 111 eligible full texts, nine studies met our inclusion criteria. Pooled estimates from two studies showed that at 3, 4 and 5 standard deviations (SDs) <mean, sensitivities were 84%, 68% and 58% for head circumference (HC); 76%, 58% and 58% for occipitofrontal diameter (OFD); and 94%, 85% and 59% for biparietal diameter (BPD). Specificities at 3, 4 and 5 SDs below the mean were 70%, 91% and 97% for HC; 84%, 97% and 97% for OFD; and 16%, 46% and 80% for BPD. No study including ZIKV-infected pregnant women was identified. OFD and HC were more consistent in specificity and sensitivity at lower thresholds compared to higher thresholds. Therefore, prenatal ultrasound appears more accurate in detecting the absence of microcephaly than its presence.

Accuracy of ultrasound scanning relative to reference tests for prenatal diagnosis of microcephaly in the context of Zika virus infection: a systematic review of diagnostic test accuracy

Objective: To assess the accuracy of ultrasound measurements of fetal biometric parameters for prenatal diagnosis of microcephaly in the context of Zika virus (ZIKV) infection. Methods: We searched MEDLINE, EMBASE, CINAHL, CDTA and other bibliographic databases for studies published until 3rd March 2016. We extracted the numbers of true positives, false positives, true negatives and false negatives and performed meta-analysis to estimate group sensitivity and specificity, where possible. Predictive values for ZIKVinfected pregnancies were extrapolated from those obtained for pregnancies unrelated to ZIKV. Results: Out of 111 eligible full texts, nine studies met our inclusion criteria. Pooled estimates from two studies showed that at 3, 4 and 5 standard deviations (SDs) < mean, sensitivities were 84%, 68% and 58% for head circumference (HC); 76%, 58% and 58% for occipito-frontal diameter (OFD); and 94%, 85% and 59% for biparietal diameter (BPD). Specificities at 3, 4 and 5 SDs below the mean were 70%, 91% and 97% for HC; 84%, 97% and 97% for OFD; and 16%, 46% and 80% for BPD. No study including ZIKV-infected pregnant women was identified. Extrapolated positive predictive values for ZIKV-infected pregnancies at 3, 4 and 5 SD < mean were 2.6%, 6.7% and 15.6% for HC; 4.3%, 15.6% and 15.6% for OFD; and 1.0%, 1.4% and 2.8% for BPD, respectively. Negative predictive values at 3, 4 and 5 SDs < mean were over 99% for HC, OFD, and BPD. Five out of seven studies with descriptive data reported high rates of false positives when ultrasound is applied for prenatal diagnosis of microcephaly. Conclusion: Prenatal ultrasound appears more accurate in detecting the absence of microcephaly than its presence.