Higher Birth Order Research Articles

Perinatal and Demographic Risk Factors Associated with Autism Spectrum Disorder: A National Survey of Potential Predictors and Severity.

INTRODUCTION: This study investigates autism spectrum disorders (ASD) in Greece, focusing on estimating prevalence and identifying regional disparities in children aged 4 to 7 years. MATERIALS AND METHODS: Utilizing a quantitative, descriptive, and exploratory methodology, the research employed a structured questionnaire to gather extensive maternal and child health data. RESULTS: The sample consisted of 517 mothers of children diagnosed with ASD from all over Greece, contributing to a nuanced understanding of ASD predictors. This study aims to elucidate the role of prenatal factors in the likelihood of an ASD diagnosis and their impact on the subsequent functionality of children with ASD. The study identified significant predictors of lower functionality in children with ASD, including higher maternal age, delayed ASD diagnosis, lower family income, and higher birth order. Prenatal health issues, such as vaginal bleeding and infections, also influenced functional outcomes. Notably, a family history of neurological or psychiatric conditions appeared protective. DISCUSSION: The regression model demonstrated robust predictive power, underscoring the complexity of genetic, environmental, and socioeconomic factors in ASD development. The findings advocate for early diagnosis and intervention, systematic screening, and addressing socioeconomic disparities to improve functional outcomes. The results support evidence-based service development and policy adjustments to enhance early identification, intervention, and rehabilitation for children with ASD. CONCLUSIONS: Establishing standardized case-recording procedures and an ASD register at national and regional levels is recommended for systematic monitoring and resource evaluation.

Perceived Spousal Concordance on Desired Family Size and Birth Intendedness Among Second and Higher-Order Births in Pakistan

Perceived Spousal Concordance on Desired Family Size and Birth Intendedness Among Second and Higher-Order Births in Pakistan

Monochorionic Triamniotic Triplet Pregnancy: A Case Report

Triplet pregnancies are rare, and monozygotic triplet pregnancies are even rarer. Triplet pregnancies present increased risk in every aspect of the prenatal course. The rate of triplet and higher order births, in the United States, was 78.9 per 100 000 and that rate has decreased from a peak, in 1998. Sonography plays a vital role in the diagnosis and management of all multifetal pregnancies. To further illustrate the importance of sonography, a case of spontaneous monochorionic triamniotic (MCTA) triplets is presented. This set of triplets were delivered at 32 weeks gestation without significant adverse neonatal outcome.

Prevalence and Factors Associated with Protein Energy Malnutrition among Pre School Children in Rural Areas

Children, particularly those in rural areas, are among the most vulnerable to malnutrition, a silent emergency recognized by organizations such as the United Nations Children's Fund (UNICEF). This study delves into the complexities of undernutrition, specifically Protein Energy Malnutrition (PEM), among pre-school children aged 3-6 years in rural regions. The research aims to estimate the prevalence of PEM, identify associated factors, and analyze various feeding practices contributing to malnutrition. Data collection was conducted through survey methods, encompassing 3-6-year-old children, revealing alarming statistics. Findings from 20 article papers underscored that 27.96% of pre-school children were underweight, with 6.71% severely underweight. Notably, 42.78% of children lacking energy-dense foods, as per Recommended Dietary Allowance (RDA), experienced malnutrition. Additionally, more than one-third of children suffered from underweight due to PEM. The study highlights the elevated risk of malnutrition among children with low birth weights, shorter interpregnancy intervals, higher birth orders, and inadequate breastfeeding and immunization practices. These insights underscore the urgent need for targeted interventions to address the multifaceted challenges contributing to PEM among rural pre-school children.

Changes in First and Second Births to U.S. Teenagers From 2000 to 2022.

This study examines trends in the numbers, percentages, and rates of first and second and higher-order births to teenagers younger than age 20 and for those ages 15-17 and 18-19 by race and Hispanic origin. Data for this analysis are from the National Vital Statistics System birth data files from 2000 and 2022. Analyses are limited to births to females younger than age 20. Changes in the numbers, percentages, and rates of total, first, and second and higher-order teen births from 2000 to 2022 were calculated for all teenagers and for non-Hispanic American Indian and Alaska Native, non-Hispanic Black, non-Hispanic White, and Hispanic teenagers. The number of first teen births declined 67% and the number of second and higher-order teen births declined 79%, while the population of female teenagers increased 7% from 2000 to 2022. The declines were greater for younger teenagers compared with older teenagers. First and second and higher-order teen birth rates declined 69% and 80%, respectively. Similar declines were found for each race and Hispanic-origin group. In 2000 and 2022, first and second and higher-order birth rates were lowest among White teenagers. First birth rates were highest among Hispanic teenagers in 2000 and for Hispanic and non-Hispanic American Indian and Alaska Native teenagers in 2022. In 2000, second and higher-order birth rates were highest for non-Hispanic Black and Hispanic teenagers; second and higher-order birth rates were more similar by race and Hispanic-origin group in 2022.

Fertility Decline in Iceland, 2013-2022: Trends and Structures

Iceland is one of the Western countries that have experienced an unexpected fertility decrease in the 2010s. In this study, the aggregate Icelandic fertility decline is dissected to explore which fertility components are the main drivers behind the decline since 2010 in order to better understand whether the development is associated with compositional changes or linked to changes such as increased propensities of childlessness and decreased propensities to have another child. As such, it contributes empirical evidence to ongoing theorisation within current fertility debates. Official administrative register data are analysed by means of event-history analysis. Findings are presented as parity-specific birth risks and in the form of Kaplan-Meier estimates of synthetic period-based cohorts of women and men progressing to parity one over calendar years. In terms of results, we find that the fertility decline was concentrated around first births, and the decline can principally be attributed to women under the age of thirty. Propensities to remain childless have increased slightly since 2013, while there were no declines in the intensities to have a second and a third child. Hence, the development in Iceland appears to be driven by clear postponement of parenthood but not altered childbearing behaviour in terms of propensities to have a second and a third child. Results do not necessary contradict theories under the umbrella of the gender-relations framework, but they highlight the importance of exploring other factors impacting the transition to parenthood, such as perceived global and welfare uncertainties. Socioeconomic differentials in first-birth fertility and factors affecting postponement and ultimate childlessness should be explored further, as well as short-term developments in higher-order birth intensities during adverse circumstances, such as the 2008 economic crisis and the Covid-19 pandemic, during which periods the third-birth intensities increased.

Children’s sex composition and transition to higher-order birth among Turkish migrants in Europe and their non-migrant counterparts in Turkey: does having a son matter?

ABSTRACT A growing literature examines parental sex preferences for their children among migrant communities in Western countries and investigates whether migrants’ preferences align with those of the native population. Changes in preference may indicate cultural and structural assimilation into the destination country. We adopted a dissimilation from origins conceptual perspective and compared migrants’ behavior to that of their non-migrant peers in the origin country. We used the unique 2000 Families dataset, which includes multi-generational data on both early labor migrants to Europe and non-migrants from the same regions of origin in Turkey. The study provides the first examination of parental sex preferences for their children and fertility among Turkish migrants and their descendants in Europe and their non-migrant counterparts in Turkey. The findings show ongoing son preference among first-generation migrants and their children, thus supporting the theory of cultural persistence.

The effect of dietary diversity on anemia levels among children 6-23 months in sub-Saharan Africa: A multilevel ordinal logistic regression model.

Anemia is the most common hematologic disorder of children worldwide. Since dietary diversity is a main requirement of children is to get all the essential nutrients, it can thus use as one of the basic indicator when assessing the child's anemia. Although dietary diversity plays a major role in anemia among children in sub-Saharan Africa, there is little evidence of an association between the dietary diversity and anemia level to identified potential strategies for prevention of anemia level in sub-Saharan Africa. To examine the association between dietary diversity and anemia levels among children aged 6-23 months in sub-Saharan Africa. The most recent Demographic and Health Surveys from 32 countries in SSA were considered for this study, which used pooled data from those surveys. In this study, a total weighted sample of 52,180 children aged 6-23 months was included. The diversity of the diet given to children was assessed using the minimum dietary diversity (MDD), which considers only four of the seven food groups. A multilevel ordinal logistic regression model was applied due to the DHS data's hierarchical structure and the ordinal nature of anemia. With a p-value of 0.08, the Brant test found that the proportional odds assumption was satisfied. In addition, model comparisons were done using deviance. In the bi-variable analysis, variables having a p-value ≤0.2 were taken into account for multivariable analysis. The Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) was presented for potential determinants of levels of anemia in the multivariable multilevel proportional odds model. The overall prevalence of minimum dietary diversity and anemia among children aged 6-23 months were 43% [95% CI: 42.6%, 43.4%] and 72.0% [95% CI: 70.9%, 72.9%] respectively. Of which, 26.2% had mild anemia, 43.4% had moderate anemia, and 2.4% had severe anemia. MDD, being female child, being 18-23 months age, born from mothers aged ≥25, taking drugs for the intestinal parasite, higher level of maternal education, number of ANC visits, middle and richer household wealth status, distance of health facility and being born in Central and Southern Africa were significantly associated with the lower odds of levels of anemia. Contrarily, being 9-11- and 12-17-months age, size of child, having fever and diarrhea in the last two weeks, higher birth order, stunting, wasting, and underweight and being in West Africa were significantly associated with higher odds of levels of anemia. Anemia was a significant public health issue among children aged 6-23 months in sub-Saharan Africa. Minimum dietary diversity intake is associated with reduced anemia in children aged 6 to 23 months in sub-Saharan Africa. Children should be fed a variety of foods to improve their anemia status. Reducing anemia in children aged 6-23 months can be achieved by raising mother education levels, treating febrile illnesses, and improve the family's financial situation. Finally, iron fortification or vitamin supplementation could help to better reduce the risk of anemia and raise children's hemoglobin levels in order to treat anemia.

Determinants of normal haemoglobin concentration among under-five children in Sub-Saharan Africa: a Positive deviance inquiry using cross-sectional study design

BackgroundLow haemoglobin level in children is linked with short-term and long-term consequences including developmental delay. Globally, over half of the children under the age of five years had low haemoglobin...

Role of Women's Empowerment in Improving the Nutritional Status of Children Under Five Years of Age: An Insight From the National Family Health Survey-5.

Background Childhood malnutrition remains a global concern, especially in low- and middle-income countries, and is known to create an intergenerational cycle of illness and poverty. Women's empowerment has gained global recognition as a potential catalyst for improving child nutrition. The objective of this research was to investigate the association between women's empowerment factors and the nutritional status of children under five years of age. Methods The study used data from the National Family Health Survey-5, conducted in India between 2019 and 2021 by the International Institute of Population Sciences, Mumbai. A weighted sample of 29,491 mother-child pairs was analyzed. The odds ratio for women's empowerment and sociodemographic factors associated with the nutritional status of children under five years of age was calculated using Pearson's chi-square test and multiple logistic regression. Results The study foundthat the sex of the child (OR = 1.066, 95% CI: 1.017 to 1.117; p-value: 0.008), birth order (OR = 0.824, 95% CI: 0.780 to 0.871; p-value < 0.001), education of the mother (OR = 1.356, 95% CI: 1.255 to 1.464; p-value < 0.001), education of the father (OR = 1.227, 95% CI: 1.140 to 1.320; p-value < 0.001), having a bank or savings account that she uses (OR = 1.151, 95% CI: 1.084 to 1.221; p-value < 0.001), having a mobile phone that she uses (OR = 1.184, 95% CI: 1.125 to 1.246; p-value < 0.001), and wealth index (OR = 1.597, 95% CI: 1.514 to 1.684; p-value < 0.001) were significant predictors of undernutrition in children under the age of five (U5). Conclusion Women's empowerment factors play a significant role in improving childhood nutrition. In the study, male sex, higher birth order, lower parental education, poor wealth index, maternal lack ofaccess to a bank or a savings account, and lack of mobile phone ownership were found to besignificant predictors of undernutrition in children U5. The findings underscore the importance of family planning, financial inclusion, access to mobile phones, and higher education for women as important factors that can help improve the nutritional status of children under five years of age. Policymakers can utilize these insights to make targeted strategies for women's empowerment, thus improving the nutritional status of children. However, being a secondary data analysis, our research is constrained by the variables available in the dataset. Further research is required to better comprehend the complex relationship between women empowerment and child nutrition.

Spatial patterns and determinants of low utilization of delivery care service and postnatal check-up within 2 months following birth in Ethiopia: Bivariate analysis.

Home delivery is a nonclinical childbirth practice that takes place in one's home with or without traditional birth attendants and postnatal care is the care given to the mother and her newborn baby; according to world health organization (WHO), the postnatal phase, begins one hour after birth and lasts six weeks (42 days). This paper aimed to study the spatial pattern and determinant factors of low utilization of delivery care (DC) services and postnatal check-up (PNC) after live births in Ethiopia. This study used the 2016 Ethiopian Demographic and Health Survey data as a source. A total weighted samples of 11023 women-children pairs were included. The bivariate binary logistic regression analyses with spatial effect were modeled using SAS version 9.4 and ArcGIS version 10.8 was used for mapping. The spatial distribution of low utilization of delivery care service and postnatal check-up were significantly clustered in Ethiopia (Moran's I statistic 0.378, P-value < 0.001 and 0.177, P-value < 0.001 respectively). Among 11023 children-women pair, the prevalence of home delivery and no postnatal check-up within two months following birth were 72.6% and 91.4% respectively. The Liben, Borena, Guji, Bale, Dolo and Zone 2 were predicted to have high prevalence of home delivery and part of Afder, Shabelle, Korahe, Dolo and Zone 2 were high risk areas of no postnatal checkup. Lack of occupation, region, large family size, higher birth order, low utilization of antenatal care visit, unable to access mass media, big problem of health facility distance and the spatial variable were found to be jointly significant predictors of low utilization of DC and PNC in Ethiopia. Whereas older age, being reside in rural area and low wealth status affects delivery care service utilization. We suggest health providers, policy makers and stakeholders consider those variables with priority given to Liben, Borena, Guji, Bale, Dolo, Zone 2, Afder, Shabelle and Korahe, where home delivery and no PNC were predicted relatively high. We also recommend researchers to conduct further studies using latest survey data set.

Iatrogenic and demographic determinants of the national plural birth increase

ObjectiveTo study the contribution of ovulation induction and ovarian stimulation, in vitro fertilization (IVF) and unassisted conception to the increase in national plural births in the U.S., a significant contributor to adverse maternal and infant health outcomes. DesignNational and IVF-assisted plural birth data were derived from the Centers for Disease Control and Prevention’s National Vital Statistics System (1967-2021, after introduction of Clomiphene Citrate in the U.S.) and the National Assisted Reproductive Technology Surveillance System (1997-2021), respectively. Main Outcome MeasuresIn addition to IVF-assisted plural births, the contributions of unassisted conception to plural births among women aged <35 and ≥35 years were estimated using plural birth rates from 1949-1966, and a Bayesian logistic model with race and age as independent variables. The contribution of ovulation induction and ovarian stimulation was estimated as the difference between national plural births and IVF-assisted and unassisted counterparts. ResultsFrom 1967-2021, the national twin birth rate increased 1.7-fold to a 2014 high (33.9/1000 live births), then declined to 31.2/1000 live births; the triplet and higher-order birth rate increased 6.7-fold to a 1998 high (1.9/1000 live births), then declined to 0.8/1000 live births. In 2021, the contribution of unassisted conception among women <35 to the national plural births was 56.1%, followed by ovulation induction and ovarian stimulation (19.5%), unassisted conception among women ≥35 (16.8%) and IVF (7.6%). During 2009-2021, the contribution of ovulation induction and ovarian stimulation has remained stable, the contribution of unassisted conception among women <35 and women ≥35 has increased, and the contribution of IVF has decreased. ConclusionOvulation induction and ovarian stimulation are leading iatrogenic contributors to plural births. They are, therefore, targets for intervention to reduce the adverse maternal and infant health outcomes associated with plural births. Maternal age ≥35 is a significant contributor to the national plural birth increase.

In-house environmental factors and childhood acute respiratory infections in under-five children: a hospital-based matched case-control study in Bangladesh

BackgroundAcute respiratory infection (ARI) is one of the leading causes of morbidity and mortality among children under five globally, particularly in regions like South Asia and sub-Saharan Africa. Bangladesh has made substantial progress in reducing child mortality, yet pneumonia remains a significant contributor to under-five deaths. This study aimed to investigate the association between in-house environmental factors and childhood ARI, considering factors such as household crowding, smoking, and sanitation facilities.MethodsThis case-control study was conducted at a tertiary-level children’s hospital in Dhaka, Bangladesh, from March to September 2019. The study included children aged 6–59 months. Cases were children with ARI symptoms, while controls were children without such symptoms. Rigorous matching by age and gender was employed to ensure comparability. Data were collected through structured questionnaires, and bivariate and conditional logistic regression analyses were performed.ResultsSeveral household environmental factors were significantly associated with childhood ARIs. Children from overcrowded households (AOR = 2.66, 95% CI = 1.52–4.71; p < 0.001), those using unclean cooking fuels (OR = 2.41, 95% CI: 1.56, 3.73; p = < 0.001), those exposed to in-house smoking (AOR = 1.74, 95% CI = 1.01, 3.05; p = 0.04) and those with unimproved sanitation facilities faced higher odds (AOR = 4.35, 95% CI = 2.14–9.26) of ARIs. Additionally, preterm birth and higher birth order were associated with an increased risk of ARI. In contrast, exclusive breastfeeding was a protective factor.ConclusionIn-house environmental factors, including sanitation, crowding and in-house smoking, significantly influence childhood ARIs. Additionally, birth order and preterm birth play a crucial role. Promoting exclusive breastfeeding is associated with a lower ARI risk among under-five children in Bangladesh. These findings can guide interventions to reduce ARIs in low-income regions, particularly in South Asia.

The effects of reproductive variables on child mortality in Ethiopia: evidence from demographic and health surveys from 2000 to 2016

BackgroundChild mortality is a crucial indicator reflecting a country's health and socioeconomic status. Despite significant global improvements in reducing early childhood deaths, Southern Asia and sub-Saharan Africa still bear the highest burden of newborn mortality. Ethiopia is one of five countries that account for half of new-born deaths worldwide.MethodsThis study examined the relationship between specific reproductive factors and under-five mortality in Ethiopia. A discrete-time survival model was applied to analyze data collected from four Ethiopian Demographic and Health Surveys (EDHS) conducted between 2000 and 2016. The study focused on investigating the individual and combined effects of three factors: preceding birth interval, maternal age at childbirth, and birth order, on child mortality.ResultsThe study found that lengthening the preceding birth interval to 18–23, 24–35, 36–47, or 48+ months reduced the risk of under-five deaths by 30%, 46%, 56%, and 60% respectively, compared to very short birth intervals (less than 18 months). Giving birth between the ages 20–34 and 35+ reduced the risk by 34% and 8% respectively, compared to giving birth below the age of 20. The risk of under-five death was higher for a 7th-born child by 17% compared to a 2nd or 3rd-born child. The combined effect analysis showed that higher birth order at a young maternal age increased the risk. In comparison, lower birth order in older maternal age groups was associated with higher risk. Lastly, very short birth intervals posed a greater risk for children with higher birth orders.ConclusionNot only does one reproductive health variable negatively affect child survival, but their combination has the strongest effect. It is therefore recommended that policies in Ethiopia should address short birth intervals, young age of childbearing, and order of birth through an integrated strategy.

A Pregnancy and Childhood Epigenetics Consortium (PACE) meta-analysis highlights potential relationships between birth order and neonatal blood DNA methylation

Higher birth order is associated with altered risk of many disease states. Changes in placentation and exposures to in utero growth factors with successive pregnancies may impact later life disease risk via persistent DNA methylation alterations. We investigated birth order with Illumina DNA methylation array data in each of 16 birth cohorts (8164 newborns) with European, African, and Latino ancestries from the Pregnancy and Childhood Epigenetics Consortium. Meta-analyzed data demonstrated systematic DNA methylation variation in 341 CpGs (FDR adjusted P < 0.05) and 1107 regions. Forty CpGs were located within known quantitative trait loci for gene expression traits in blood, and trait enrichment analysis suggested a strong association with immune-related, transcriptional control, and blood pressure regulation phenotypes. Decreasing fertility rates worldwide with the concomitant increased proportion of first-born children highlights a potential reflection of birth order-related epigenomic states on changing disease incidence trends.

QuickStats: Rate of Triplet and Higher-Order Multiple Births,*,† by Age of Mother - National Vital Statistics System, United States, 1998 and 2022.

QuickStats: Rate of Triplet and Higher-Order Multiple Births,*,† by Age of Mother - National Vital Statistics System, United States, 1998 and 2022.

Mother–child dyads of overnutrition and undernutrition in sub-Saharan Africa

Background Malnutrition remains one of the major public health concerns globally. To achieve the Sustainable Development Goal 2 which seeks to ensure that hunger and malnutrition are reduced by 2030, it is imperative to ascertain the factors influencing their occurrence. This study examined the prevalence and factors associated with mother–child dyads of overnutrition and undernutrition in sub-Saharan Africa.MethodsDemographic and Health Survey data from 25 sub-Saharan African countries were used for the study. The sample was made up of 125,280 mother–child dyads. Descriptive analysis was performed to determine the prevalence of overweight or obese mother (OWOBM) with a stunted child (OWOBM-SC), OWOBM with an underweight child (OWOBM-UC), OWOBM with a wasted child (OWOBM-WC), and OWOBM with any form of child’s undernutrition indicators (OWOBM-SUWC). Multilevel regression models were developed to examine the factors associated with these indicators. The results were presented using an adjusted odds ratio (AOR) with their respective 95% confidence interval (CI).ResultsHigher likelihood of OWOBM-SUWC was found among women aged 45–49 [AOR 2.20, 95% CI 1.70, 2.85], those with primary [AOR 1.32, 95% CI 1.21, 1.44] or secondary education [AOR 1.21, 95% CI 1.09, 1.35], and divorced women [AOR 1.32, 95% CI 1.02, 1.73]. However, lower odds of OWOBM-SUWC were observed among women who were working [AOR 0.82, 95% CI 0.76, 0.89] and those breastfeeding [AOR 0.75, 95% CI 0.70, 0.82]. The odds of OWOBM-SUWC was lower among females compared to male children [AOR 0.85, 95% CI 0.80, 0.90]. Compared to children aged <1 year, children of all other age groups were more likely to have OWOBM-SUWC. Other child characteristics significantly associated with OWOBM-SUWC were low birth weight [AOR 1.50, 95% CI 1.32, 1.71], having diarrhea [AOR 1.13, 95% CI 1.04, 1.24], and higher birth order [AOR 1.37, 95% CI 1.13, 1.66]. Children whose mothers used unimproved toilet facilities [AOR 0.90, 95% CI 0.83, 0.98], those who lived in rural areas [AOR 0.79, 95% CI 0.71, 0.87], and children from the Central [AOR 0.55, 95% CI 0.46, 0.65], Eastern [AOR 0.44, 95% CI 0.38, 0.52] and Western [AOR 0.76, 95% CI 0.65, 0.89] sub-Saharan Africa were less likely to have OWOBM-SUWC.ConclusionCombination of child, maternal, and contextual factors could explain mother–child dyads of overnutrition and undernutrition in sub-Saharan Africa. Addressing this situation requires multidimensional policies and interventions that empower women through education and economic engagement. The observed sub-regional differences in policies and commitments related to addressing malnutrition suggest the need for comprehensive and coordinated efforts to implement and strengthen multisectoral comprehensive nutrition plans across sub-Saharan Africa. Sharing best practices and lessons learned can help improve the effectiveness and comprehensiveness of nutrition interventions and contribute to reducing the prevalence of malnutrition.

Determinants of severe acute malnutrition among under-five children in Ethiopia: analysis using data from the 2016 Ethiopia Demographic and Health Survey.

Malnutrition is a silent killer that is under-reported, under-addressed, and, as a result, emphasized. This study aimed to identify the determinants of severe acute malnutrition (SAM) among under-five children in Ethiopia. Cross-sectional data from the 2016 Ethiopian Demographic and Health Survey (EDHS) were used. A total of 6,170 under-five children were included in the current analysis. The data were cleaned and analyzed using STATA 14. An adjusted odds ratio (AOR) and their 95% confidence intervals (CIs) were calculated to determine the association between factors and outcomes. A p-value of less than 0.05 was considered significant in multivariable logistic regression. A multivariable logistic regression revealed that under-five children with the age of children in months 6-11 (AOR = 1.52, 95% CI: 1.25, 1.86), 12-23 (AOR = 1.98, 95% CI: 1.65, 2.37), and 24-59 months (AOR = 1.71, 95% CI: 1.40, 2.08), birth order between fourth and fifth (AOR = 1.24, 95% CI: 1.01, 1.54), having fever (AOR = 1.31, 95% CI: 1.09, 1.58), anemic children (AOR = 1.21, 95% CI: 1.07, 1.36), age of mothers in years 25-34 (AOR = 0.60, 95% CI: 0.51, 0.72) and 35-49 (AOR = 0.49, 95% CI: 0.39, 0.63), antenatal care (ANC) visits (AOR = 0.83, 95% CI: 0.71, 0.92), rural residence (AOR = 2.98, 95% CI: 2.54, 3.49), and solid fuels users (AOR = 2.46, 95% CI: 1.86, 3.26) were significant predictors. Older age of children, those with higher birth order, those having fever, anemic children, those living in rural areas, and solid fuel users were more likely to suffer from SAM, while older mothers and those having ANC visits had reduced SAM as significant predictors.

Unveiling the spatial pattern and determinants of child anaemia in India: National family health survey-5 chronicles (NFHS-5)

Background/Aim: Childhood anaemia continues to persist as a prominent nutritional disease and a public health challenge in India despite several initiatives by the Government of India. This study aimed to identify predictors and regional disparities for targeted interventions. Methods: This study utilised data from a nationally representative cross-sectional survey from the fifth round of the National Family Health Survey (NFHS-5), encompassing 177,695 children aged 6-59 months across 707 districts and 36 states and union territories of India. It employed multivariate logistic regression and spatial analysis at district levels to examine socio-demographic predictors and spatial patterns of childhood anaemia in the country. Result: Multivariate logistic results revealed, women aged 15-19 were 2.43 times more likely to have an anaemic child compared to those aged 35-49 and uneducated mothers had a 29 % higher likelihood of having an anaemic child. There was positive spatial autocorrelation (Moran's I value = 0.579) at the district level in India, with 108 identified hotspots in regions including Jammu and Kashmir, Ladakh, Gujarat, Maharashtra, Telangana, Uttar Pradesh, Rajasthan, Jharkhand, Chhattisgarh and Bihar. The spatial error model (SEM) indicated that mother's anaemia (0.53) and maternal education (0.23) were key predictors of child anaemia in India. Conclusion: The study findings provide valuable understanding regarding the socio-demographic predictors associated with childhood anaemia such as adolescent motherhood, low education, lack of media exposure, higher birth order and rural residence. Also, the spatial study provides the spatial heterogeneity of childhood anaemia at the district level and advocates more attention toward hotspot regions in the country.

Prevalence and associations of keratokonus among children, adults and elderly in the population‐based ural eye studies

Aims/Purpose: To estimate prevalence and associations of keratoconus in populations in Russia with an age from childhood to seniority.Methods: The study population consisted of the cohorts of three population‐based studies performed in urban and rural areas within the same geographical region in Bashkortostan/Russia: The Ural Children Eye Study (UCES; age: 6–18 years; n = 4890), Ural Eye and Medical Study (UEMS; age: 40+ years; n = 5314) and Ural Very Old Study (UVOS; age: 85+ years; n = 651). Based upon Scheimflug imaging, keratoconus was defined by a keratometric reading of ≥48 D in any eye.Results: The mean maximal and minimal corneal refractive power increased from the UCES (43.58 ± 1.50 dioptres (D) and 42.70 ± 1.42D, respectively) to the UEMS (44.26 ± 1.70 D and 43.61 ± 1.76D, resp.) and to the UVOS (45.1 ± 1.72D and 43.98 ± 1.68D, resp.). Correspondingly, keratoconus prevalence increased from the UCES (42/4890; 0.086%; 95% CI: 0.060, 0.112) to the UEMS (112/5314; 2.11%; 95% CI: 1.72, 2.49) and to the UVOS (42/651; 6.45%; 95% CI: 4.56, 8.34). In the UCES, higher keratoconus prevalence was associated (multivariable analysis) with higher birth order (OR: 2.34; 95% CI: 1.32, 4.15; p = 0.004), lower birthweight (OR: 0.99; 95% CI: 0.99, 0.99; p &lt; 0.001), and shorter axial length (OR: 0.15;9 5% CI: 0.08, 0.30; p &lt; 0.001). In the UEMS, keratoconus prevalence correlated with shorter axial length (OR: 0.15; 95% CI: 0.10, 0.23; p &lt; 0.001), larger corneal volume (OR: 1.17; 95% CI: 1.09, 1.25; p = 0.001), thicker lens (OR: 2.27; 95% CI:1.06, 5.28; p = 0.04), cortical cataract degree (OR: 1.02; 95% CI:1.01, 1.04; p = 0.01), and higher stage of age‐related macular degeneration (OR: 1.65; 95% CI: 1.09, 2.51; p = 0.02). In the UVOS, keratoconus prevalence correlated with lower educational level (OR: 0.84; 95% CI:0.71, 0.99; p = 0 0.04) and lower dynamometric hand grip force (OR: 0.92; 95% CI: 0.88, 0.97; p = 0.003).Conclusions: In this study on multiethnic groups from Russia, keratokonus prevalence increased from the paediatric group (0.09%) to the adult group (2.11%) and seniority group (6.45%), correlated mostly with biometric ocular parameters, and was in all age groups statistically independent of most systemic parameters.