Early childhood development project in Uganda as a strategy for reducing children's poor growth indicators: an explanatory study

This study shall explore the activities of the Uganda nutrition and early childhood development project using explanatory program effects, qualitative research methods to determine the role/interplay of project factors and community dynamics in relation to poor growth and social indicators in Ugandan children. This project aimed to improve the quality of life for children age less than 6 years by improving their nutrition, health, cognitive and psychosocial development. The key concern remains how successful and sustainable are the outcomes? Data shall be collected using interviews, focus groups and document reviews. Data analysis shall employ the thematic networks analytical tool, which is aided by the ATLAS.ti software. The key hypotheses and recommendations from the analysis shall then be tested in a suitable community location and period in line with the research questions.     

Poverty, health infrastructure and the nutrition of Peruvian children

This paper offers empirical evidence on the impact of the expansion in health infrastructure of the 1990s upon child nutrition in Peru, as measured by the height for age z-score. Using a pooled sample of three rounds of the Peruvian DHS, I have controlled for biases in the allocation of public investments by using a district fixed effects model. The econometric analysis shows a positive effect of the expansion of the last decade in urban areas, but not in rural areas. Furthermore, the effect for urban children is highly non-linear and has a pro-poor bias, in the sense that the estimated effect is larger for children of less educated mothers. These findings support the idea that reducing distance and waiting time barriers is necessary to improve child health and nutrition in developing countries, but that we need more explicitly inclusive policies to improve the health of the rural poor, especially indigenous groups, that are caught in this type of poverty trap.     

Child health,its dynamic interaction with nutrition and health memory – Evidence from Senegal

Child malnutrition is pervasive in developing countries and anthropometric measures such as weight-for-height and height-for-age have proven reliable indicators of short term malnutrition and stunting. Rather than studying these indicators separately, we look at their interaction and carve out child health dynamics. Considering height-for-age a child's health stock and weight-for-lagged height a proxy for nutritional inputs, we develop a child health production function that features self-productivity of past health stocks and contemporaneous nutritional inputs. We test the model on a Senegalese panel of 271 children between 0 and 5 years employing dynamic panel methods to control for endogeneity in the production function. In line with previous evidence, we find that children can partially catch-up from malnutrition spells. Yet, child health stocks also deplete quickly and need constant updating in the form of nutrition. This demonstrates the importance of health memory and that malnutrition cannot be fought with snapshot interventions. Consequently, sustainable nutrition interventions have to be long term and yield higher returns the earlier they reach children.     

Perceived Impact of Dental Pain on the Quality of Life of Preschool Children and Their Families

The aim of the present study was to evaluate the perceived impact of dental caries and dental pain on oral health-related quality of life (OHRQoL) among preschool children and their families. A cross-sectional study was conduct with 843 preschool children in Campina Grande, Brazil. Parents/caregivers answered a questionnaire on socio-demographic information, their child’s general/oral health and history of dental pain. The Brazilian version of the Early Childhood Oral Health Impact Scale was administered to determine the perceived impact of caries and dental pain on OHRQoL. The children underwent an oral examination. Logistic regression for complex sample was used to determine associations between the dependent and independent variables (OR: Odds ratio, α = 5%). The independents variables that had a p-value <0.20 in the bivariate analysis were selected for the multivariate model. The prevalence of dental caries and dental pain was 66.3% and 9.4%, respectively. Order of birth of the child, being the middle child (OR: 10.107, 95%CI: 2.008-50.869) and youngest child (OR: 3.276, 95%CI: 1.048-10.284) and dental pain (OR: 84.477, 95%CI: 33.076-215.759) were significant predictors of the perceived impact on OHRQOL for children. Poor perception of oral health was significant predictor of the perceived impact on OHRQOL for family (OR=7.397, 95%CI: 2.190-24.987). Dental caries was not associated with a perceived impact on the ORHQoL of either the children or their families. However, order of child birth and dental pain were indicators of impact of OHRQoL on preschool children and poor perception of oral health was indicators of impact on families.     

Heterogeneity in predictive power of early childhood nutritional indicators for mid-childhood outcomes: Evidence from Vietnam

We utilize longitudinal data on nearly 1800 children in Vietnam to study the predictive power of alternative measures of early childhood undernutrition for outcomes at age eight years: weight-for-age (WAZ8), height-for-age (HAZ8), and education (reading, math and receptive vocabulary). We apply two-stage procedures to derive unpredicted weight gain and height growth in the first year of life. Our estimates show that a standard deviation (SD) increase in birth weight is associated with an increase of 0.14 (standard error [SE]: 0.03) in WAZ8 and 0.12 (SE: 0.02) in HAZ8. These are significantly lower than the corresponding figures for a SD increase in unpredicted weight gain: 0.51 (SE: 0.02) and 0.33 (SE: 0.02).The heterogeneity of the predictive power of early childhood nutrition indicators for mid-childhood outcomes reflects both life-cycle considerations (prenatal versus postnatal) and the choice of anthropometric measure (height versus weight). Even though all the nutritional indicators that involve postnatal nutritional status are important predictors for all the mid-childhood outcomes, there are some important differences between the indicators on weight and height. The magnitude of associations with the outcomes is one aspect of the heterogeneity. More importantly there is a component of height-for-age z-score (at age 12 months) that adds predictive power for all the mid-childhood outcomes beyond that of birth weight and weight gain in the first year of life.     

Environmental influences during development and their later consequences for health and disease: implications for the interpretation of empirical studies

Early experience has a particularly great effect on most organisms. Normal development may be disrupted by early environmental influences; individuals that survive have to cope with the damaging consequences. Additionally, the responses required to cope with environmental challenges in early life may have long-term effects on the adult organism. A further set of processes, those of developmental plasticity, may induce a phenotype that is adapted to the adult environment predicted by the conditions of early life. A mismatch between prediction and subsequent reality can cause severe health problems in those human societies where economic circumstances and nutrition are rapidly improving. Understanding the underlying mechanisms of plasticity is, therefore, clinically important. However, to conduct research in this area, developmental plasticity must be disentangled from disruption and the adverse long-term effects of coping. The paper reviews these concepts and explores ways in which such distinctions may be made in practice.     

Factors influencing innate immunity and vaccine responses in infancy

Despite significant progress in reducing the burden of mortality in children under the age of five, reducing mortality in newborns remains a major challenge. Infection plays a significant role in infant deaths and interventions such as early vaccination or antenatal immunization could make a significant contribution to prevention of such deaths. In the last few years, we have gained new insights into immune ontogeny and are now beginning to understand the impact of vaccines, nutrition and environmental factors on ‘training′ of the immune response in early life. This review article sets out to explain why vaccine responses can be heterogeneous between populations and individuals by providing examples chosen to illustrate the impact of host, pathogen and environmental factors on shaping the immune ‘interactome′ in young children.     

The role of nutrition on epigenetic modifications and their implications on health

Nutrition plays a key role in many aspects of health and dietary imbalances are major determinants of chronic diseases including cardiovascular disease, obesity, diabetes and cancer. Adequate nutrition is particularly essential during critical periods in early life (both pre- and postnatal). In this regard, there is extensive epidemiologic and experimental data showing that early sub-optimal nutrition can have health consequences several decades later.     

Analysis of the effects of early nutritional environment on inbreeding depression in Drosophila melanogaster

The impact of nutritional deficiencies early in life in determining life-history variation in organisms is well recognized. The negative effects of inbreeding on fitness are also well known. Contrary to studies on vertebrates, studies on invertebrates are not consistent with the observation that inbreeding compromises resistance to parasites and pathogens. In this study, we investigated the effect of early nutrition on the magnitude of inbreeding depression in development time, adult body size and adult resistance to the bacterium Serratia marcescens in Drosophila melanogaster. We found that early nutritional environment had no effect on the magnitude of inbreeding depression in development time or adult body size but may have played a small role in adult resistance to the bacterial infection. Estimates of heritabilities for development time under the poor nutritional environment were larger than those measured under the standard nutritional conditions.     

Early education and health outcomes of a 2001 U.S. Birth Cohort

This paper looks at health outcomes, health behaviors, and health screening with respect to participation in Early Childhood Care and Education. With information on health status at multiple periods in time, we are able to look at whether healthier children select into early childhood education (as measured by center-based preschool care and Head Start), as well as whether early childhood education has immediate and near-term effects on a range of health status measures. There is some evidence that child obesity is ameliorated by participation in center-based preschool or Head Start and this finding is supported by clear evidence of improved nutrition and increased levels of health screening. Effects on other health outcomes such as asthma, ear infections, and respiratory problems may be partially masked by unobserved heterogeneity.     

The effects of prenatal exposure to Ramadan on stature during childhood and adolescence: Evidence from the Indonesian Family Life Survey

Many pregnant Muslim women fast during the Muslim holy month of Ramadan. A number of studies have reported negative life outcomes in adulthood for children who were prenatally exposed to Ramadan. However, other studies document minimal to no impact on neonatal indicators. Using data from the Indonesian Family Life Survey consisting of 45,246 observations of 21,723 children born to 9771 mothers, we contribute to the current discussion on prenatal exposure to Ramadan by examining the effects on stature (height-for-age Z-scores, weight-for-age Z-scores, and body-mass-index-for-age Z-scores: HAZ, WAZ, and BAZ, respectively) from early childhood to late adolescence (0–19 years of age). We introduce an objective mother’s religiosity indicator to improve the intention-to-treat estimations. Children were classified into three groups based on their mother’s religion-religiosity: religious Muslims, less-religious Muslims, and non-Muslims. Using cluster-robust mother fixed-effects, we found negative effects on stature for children born to religious Muslim mothers. The effects were age-dependent and timing-sensitive. For example, children born to religious Muslim mothers were shorter in late adolescence (15–19 years of age) compared to their unexposed siblings if they were prenatally exposed in the first trimester of pregnancy (HAZ difference = −0.105 SD; p-val. <0.05). Interestingly, we found positive effects on stature for exposed less-religious Muslim children that peak in early adolescence (10–14 years of age) and negative effects on stature for exposed non-Muslim children that occur only in early childhood (0–4 years of age). We nuance our discussion of health and socioeconomic factors to explain these surprising results.     

Parental nonemployment in childhood and children’s health later in life

While the effects of joblessness on the health of the non-employed are well-documented, its long-term spillover consequences on the health of their relatives, especially children, remain poorly understood. This research explores the long-term associations of parental nonemployment spells experienced during early, mid and late childhood on children’s mental and physical health. The analysis exploits data drawn from the British Household Panel Survey (BHPS) and the UK Household Longitudinal Study (UKHLS), linking detailed parental socioeconomic information with their children between the years 1993 and 2013. This paper employs a Correlated Random Effects (CRE) probit model that allows accounting for unobserved heterogeneity as well as a non-linear Generalized Estimating Equations (GEE) random effects estimator accounting in addition for the dependency structure of the data. Results indicate that experiencing parental nonemployment during early and late childhood has a negative association on the children’s likelihood of suffering from long-standing illnesses later in life, while experiencing parental nonemployment during middle childhood negatively affects the young adult’s mental health. Moreover, experiencing parental nonemployment during late childhood increases the probability of both reporting poor or fair self-assessed health and the likelihood of consuming prescribed medicines in early adulthood. However, there seems to be a considerable effect heterogeneity by family socioeconomic status, parents’ gender, and frequencies of parental nonemployment spells. Current adulthood circumstances, such as level of educational attainment, job situation and household demographics, are used to explore the potential mechanisms affecting results. These findings may help policymakers shape appropriate responses to mitigate the psychological and physical burden derived from parental nonemployment, especially among already disadvantaged households.     

Socio-economic determinants of health and physical fitness in southern Ethiopia

The dependence of health and physical fitness on the socio-economic factors of rural families in southern Ethiopia is investigated, with particular emphasis on the role of inequality. This paper contributes to our knowledge of the effect of inequality on health in several ways: it compares the results of objective and subjective health measures, it distinguishes between wealth inequality and nutrition inequality, and it evaluates the impact of nutrition inequality both at the village level and at the household level. The subjective health measures are the number of days respondents were ill during the last month, their ability to walk distances, their ability to carry heavy loads, and their ability to work in the field. The objective health measure is having Body Mass Index (BMI) lower than 18.5. Males are healthier than females. Height has a positive and significant effect on health and fitness and the same is true for per-capita wealth measured at the village level. Availability of satisfactory health facilities has a negative effect on morbidity. Per-capita wealth inequality is positively associated with morbidity and with a low BMI. Within-household nutrition inequality has a complex effect on health and physical fitness: the effect is negative, but only for household members whose nutritional status is above the household mean. The results indicate a clear positive effect of economic well-being on health and physical fitness. The role of inequality is less clear, and certainly deserves further analyses at both the theoretical and empirical levels.     

Entangled lives: Implications of the developmental origins of health and disease hypothesis for bioarchaeology and the life course

Epidemiological research since the 1980s has highlighted the consequences of early life adversity, particularly during gestation and early infancy, for adult health (the “Barker hypothesis”). The fast‐evolving field of molecular epigenetics is providing explanatory mechanisms concerning phenotypic plasticity in response to developmental stressors and the accumulation of disease risk throughout life. In addition, there is now evidence for the heritability of poor health across generations via epigenetic modifications. This research has the potential to invoke a paradigmatic shift in how we interpret factors such as growth insults and immune response in past skeletal remains. It demonstrates that health cannot be understood in terms of immediate environmental circumstances alone. Furthermore, it requires both a theoretical and practical re‐evaluation of disease biographies and the life course more generally. Individual life courses can no longer be regarded as discrete, bounded, life histories, with clearly defined beginning and end points. If socioeconomic circumstances can have intergenerational effects, including disease susceptibility and growth stunting, then individual biographies should be viewed as nested or “embedded” within the lives of others. This commingling of life courses may prove problematic to unravel; nevertheless, this review aims to consider the potential consequences for bioarchaeological interpretations. These include a greater consideration of: the temporal power of human skeletons and a life course approach to past health; infant health and the implications for maternal well‐being; and the impact of non‐proximate stressors (e.g., early life and ancestral environments) on the presence of health indicators. Am J Phys Anthropol 158:530–540, 2015. © 2015 Wiley Periodicals, Inc.     

A proposal for a Composite Index of Environmental Performance (CIEP) for countries

The need to determine the environmental impact caused by economic and human activities has induced a constant search for robust and effective tools that provide useful information for the design of public policies aiming to improve citizens’ quality of life. This paper develops a Composite Index of Environmental Performance (CIEP) from the Driving Force–Pressure–State–Exposure–Effect–Action (DPSEEA) methodology proposed by the World Health Organization (WHO). The CIEP allows us to determine the negative impacts that the driving forces have on the environment and the supposed pressure effect on the natural state of the available resources, which cause harmful effects on human health. In addition, we observe that actions and socio-environmental policies reduce the environmental impact and the mortality rate, while increasing the life expectancy. In relation to the selected indicators, it is realized that richer countries tend to have a better environmental quality and the population growth and density are factors that increase the driving force, which reduces the environmental quality of the countries.     

The early life environment and the epigenome

Several lines of evidence point to the early origin of adult onset disease. A key question is: what are the mechanisms that mediate the effects of the early environment on our health? Another important question is: what is the impact of the environment during adulthood and how reversible are the effects of early life later in life? The genome is programmed by the epigenome, which is comprised of chromatin, a covalent modification of DNA by methylation and noncoding RNAs. The epigenome is sculpted during gestation, resulting in the diversity of gene expression programs in the distinct cell types of the organism. Recent data suggest that epigenetic programming of gene expression profiles is sensitive to the early-life environment and that both the chemical and social environment early in life could affect the manner by which the genome is programmed by the epigenome. We propose that epigenetic alterations early in life can have a life-long lasting impact on gene expression and thus on the phenotype, including susceptibility to disease. We will discuss data from animal models as well as recent data from human studies supporting the hypothesis that early life social-adversity leaves its marks on our epigenome and affects stress responsivity, health, and mental health later in life.     

Size at birth, postnatal growth and risk of obesity

Epidemiological studies over the last 15 years have shown that size at birth, early postnatal catch-up growth and excess childhood weight gain are associated with an increased risk of adult cardiovascular disease and type 2 diabetes. At the same time, rising rates of obesity and overweight in children, even at pre-school ages, have shifted efforts towards the identification of very early factors that predict risk of subsequent obesity, which may allow early targeted interventions. Overall, higher birth weight is positively associated with subsequent greater body mass index in childhood and later life; however, the relationship is complex. Higher birth weight is associated with greater subsequent lean mass, rather than fat mass. In contrast, lower birth weight is associated with a subsequent higher ratio of fat mass to lean mass, and greater central fat and insulin resistance. This paradoxical effect of lower birth weight is at least partly explained by the observation that infants who have been growth restrained in utero tend to gain weight more rapidly, or 'catch up', during the early postnatal period, which leads to increased central fat deposition. There is still debate as to whether there are critical early periods for obesity: does excess weight gain during infancy, childhood or even very early neonatal life have a greater impact on long-term fat deposition and insulin resistance? Early identification of childhood obesity risk will be aided by identification of maternal and fetal genes that regulate fetal nutrition and growth, and postnatal genes that regulate appetite, energy expenditure and the partitioning of energy intake into fat or lean tissue growth.     

自由基、营养、天然抗氧化剂与衰老

影响衰老的因素很多,其中主要有遗传基因、饮食营养、生活方式、运动多少、心理状态、医疗条件及环境因素等。其中饮食营养是非常重要的因素,而且是可以控制的因素。研究证明,营养不良和营养过剩都会影响健康和寿命,而健康和延长寿命最有效的方法是限食(限能)。最近,美国和英国的权威杂志《Science》和《Nature》发表研究文章表明,节食,以及一些自由基清除剂,如小分子多酚类物质白藜芦醇,可以启动长寿基因SIRI1,抑制肿瘤基因p53,阻断细胞凋亡,延缓衰老和延长寿命。早在1955年,Dr. Harman发表的“衰老的自由基理论”就提出,体内产生过多自由基是引起衰老的重要因素,保持体内自由基和抗氧化剂的平衡可以延缓衰老。我们的实验还证明,天然抗氧化剂茶多酚可延长果蝇的寿命,使果蝇匀浆中的超氧化物歧化酶(superoxide dismutase,SOD)活性增加,脂质过氧化水平降低,改善高脂引起的果蝇寿命缩短、SOD活性降低以及脂质过氧化水平的升高。作者最近的实验还证明,茶多酚可以防止氧化应激引起的线虫寿命的缩短,还可以预防和治疗6-OHDA引起的大鼠帕金森氏综合症,山楂黄酮可以预防和治疗蒙古沙鼠缺血引起的中风,大豆异黄酮和尼古丁可以预防和治疗转基因线虫和小鼠老年痴呆症。饮食营养和天然抗氧化剂研究的进展将对人类健康和延缓衰老,提供新的线索并做出重大贡献。     

Impact of social class on body fatness among rural pre-school Bengalee Hindu children of Arambagh, West Bengal, India

Body composition is a useful marker for assessing the adiposity of an individual. The amount of body fat (BF) differs with age, sex, environmental conditions and genotype, and is a good indicator of the health and nutritional status of a community. As the subcutaneous fat serves as a reservoir for energy during nutritional deprivation, lower BF in comparison with other studies indicates a lower energy intake by those children, who are affected by their lower socio-economic status. The objective of the present study was to evaluate the impact of socio-economic class, after allowing for sex and age, on body fatness among rural pre-school children of Bengalee Hindu ethnicity of Arambagh, West Bengal, India. The present study was undertaken at 20 Integrated Child Development Services (ICDS) scheme centers in Bali Gram Panchayat, Arambagh, Hooghly District of West Bengal, India. A total of 1012 boys and girls (aged 2-6 years) living in these areas were studied. The children were classified into two groups based on their social class: Schedule Castes (SC) and Non-Schedule Castes (NSC). In general, SC comprise socio-economically and educationally deprived individuals. Three-way analysis of variance was used to assess the effect of ethnicity on mid-upper arm circumference (MUAC) and sum of skinfolds (SS), allowing for age and sex. There was an increasing age trend in both these variables in both sexes in the two groups. All three factors had a significant effect on MUAC, whereas only age and social class had a significant impact on SS. In the case of MUAC, only one second order interaction (sex-age) was significant. In conclusion, we found that after controlling for age and sex, children belonging to the SC group had lower body fatness. These results implied that they were under more nutritional stress. There was also some evidence that at the early ages, girls belonging to the SC group probably received inadequate nutrition and as a result had lower body fat.