Poor Child Health Outcomes Research Articles

Association between maternal perinatal stress and depression and infant DNA methylation in the first year of life

Maternal stress and depression during pregnancy and the first year of the infant’s life affect a large percentage of mothers. Maternal stress and depression have been associated with adverse fetal and childhood outcomes as well as differential child DNA methylation (DNAm). However, the biological mechanisms connecting maternal stress and depression to poor health outcomes in children are still largely unknown. Here we aim to determine whether prenatal stress and depression are associated with differences in cord blood mononuclear cell DNAm (CBMC-DNAm) in newborns (n = 119) and whether postnatal stress and depression are associated with differences in peripheral blood mononuclear cell DNAm (PBMC-DNAm) in children of 12 months of age (n = 113) from the Canadian Healthy Infant Longitudinal Development (CHILD) cohort. Stress was measured using the 10-item Perceived Stress Scale (PSS) and depression was measured using the 20-item Center for Epidemiologic Studies Depression Questionnaire (CESD). Both stress and depression were measured longitudinally at 18 weeks and 36 weeks of pregnancy and six months and 12 months postpartum. We conducted epigenome-wide association studies (EWAS) using robust linear regression followed by a sensitivity analysis in which we bias-adjusted for inflation and unmeasured confounding using the bacon and cate methods. To quantify the cumulative effect of maternal stress and depression, we created composite prenatal and postnatal adversity scores. We identified a significant association between prenatal stress and differential CBMC-DNAm at 8 CpG sites and between prenatal depression and differential CBMC-DNAm at 2 CpG sites. Additionally, we identified a significant association between postnatal stress and differential PBMC-DNAm at 8 CpG sites and between postnatal depression and differential PBMC-DNAm at 11 CpG sites. Using our composite scores, we further identified 2 CpG sites significantly associated with prenatal adversity and 7 CpG sites significantly associated with postnatal adversity. Several of the associated genes, including PLAGL1, HYMAI, BRD2, and ERC2 have been implicated in adverse fetal outcomes and neuropsychiatric disorders. These data further support the finding that differential DNAm may play a role in the relationship between maternal mental health and child health.

Child health and psychosocial wellness in the context of maternal role overload and depression

AbstractObjectiveThe objective of this study was to examine the variability of child health and psychosocial outcomes in the context of maternal role overload and maternal depression.BackgroundRole overload, characterized as time‐based role stress, is commonly linked to depression in mothers. However, it remains uncertain whether maternal role overload poses a risk for negative child health and wellness. Although maternal depression is a known risk factor for poor child health and psychosocial outcomes, the outcomes themselves often reveal variability.MethodThis study aimed to investigate the heterogeneity of child health and psychosocial outcomes using latent profile analyses. Multinomial logistic regression analyses were conducted to examine differences in profile membership based on the child's experiences of maternal role overload and depression. Data were from 1,172 mother–child dyads from the Family Matters study.ResultsThe analyses unveiled four distinct profiles (i.e., moderate health/psychosocial wellness, poor health/moderate psychosocial wellness, struggling health/poor psychosocial wellness, thriving health/psychosocial wellness), each associated with varying levels of health and psychosocial wellness. Both maternal role overload and depression were found to heighten the risk of poor health and psychosocial wellness in children.ConclusionChildren with struggling and poor health and psychosocial outcomes had higher odds of maternal depression and maternal role overload than children in the thriving profile. These findings suggest that maternal role overload is a potential risk to child health and psychosocial outcomes.ImplicationsThese findings emphasize the importance of continuous depression screening in mothers and the implementation of solution‐focused interventions targeting maternal role overload.

Simultaneously implementing pathways for improving asthma, pneumonia, and bronchiolitis care for hospitalized children: Protocol for a hybrid effectiveness-implementation, cluster-randomized trial.

Asthma, pneumonia, and bronchiolitis are the top causes of childhood hospitalization in the United States, leading to over 350,000 hospitalizations and ≈$2 billion in costs annually. The majority of these hospitalizations occur in general/community hospitals. Poor guideline adoption by clinicians contributes to poor health outcomes for children hospitalized with these illnesses, including longer recovery time/hospital stay, higher rates of intensive care unit transfer, and increased risk of hospital readmission. A prior single-center study at a children's hospital tested a multicondition clinical pathway intervention (simultaneous implementation of multiple pathways for multiple pediatric conditions) and demonstrated improved clinician guideline adherence and patient health outcomes. This intervention has not yet been studied in community hospitals, which face unique implementation barriers. To study the implementation and effectiveness of a multicondition pathway intervention for children hospitalized with asthma, pneumonia, or bronchiolitis in community hospitals. We will conduct a pragmatic, hybrid effectiveness-implementation, cluster-randomized trial in community hospitals around the United States (1:1 randomization to intervention vs. wait-list control). Our primary outcome will be the adoption of 2-3 evidence-based practices for each condition over a sustained period of 2 years. Secondary outcomes include hospital length of stay, ICU transfer, and readmission. This hybrid trial will lead to a comprehensive understanding of how to pragmatically and sustainably implement a multicondition pathway intervention in community hospitals and an assessment of its effects. Enrollment began in July 2022 and is projected to be completed in September 2024. Primary analysis completion is anticipated in March 2025, with reporting of results following.

The downstream effects of COVID-19 on adolescent girls in the Peruvian Amazon: qualitative findings on how the pandemic affected education and reproductive health

Due to COVID-19, schools were closed to mitigate disease spread. Past studies have shown that disruptions in education have unintended consequences for adolescents, including increasing their risk of school dropout,...

Food insecurity in children with heart disease.

This review discusses the epidemiology of food insecurity (FI) and its consequences in children with congenital heart disease. We aimed to highlight current interventions to screen and address food insecurity in the context of pediatric cardiology and to offer strategies for providers to engage in this meaningful work. Food insecurity is consistently associated with poor health outcomes in children. In the United States, 17.3% of households with children experience FI. Nonwhite and single-parent families are disproportionately affected. Interestingly, because of a low-quality diet, FI is associated with childhood obesity, putting affected children at increased risk for cardiovascular morbidity and mortality over time. Children with congenital heart disease are susceptible to poor outcomes due to unique altered metabolic demands, increased risk for growth impairment, frequent need for specialized feeding regimens, and additional morbidity associated with heart surgery in underweight children. Today, the burden of screening for FI is most commonly placed on general pediatricians. Considering the importance of nutrition to cardiovascular health and general wellbeing, and the ease with which screening can be performed, pediatric cardiologists and other subspecialists should take a more active role in FI screening.

Evaluating Health Literacy in Families of Injured Children: A Prospective Observational Cohort Study at a Level One Pediatric Trauma Center

BackgroundLow health literacy (HL) has been associated with poor health outcomes in children. Optimal recovery after pediatric injury requires caregiver participation in complicated rehabilitative and medical aftercare. We aimed to quantify HL among guardians of injured children and identify factors associated with low HL of guardians. MethodsA prospective observational cohort study was conducted to evaluate the HL using the Newest Vital Sign™ of guardians of injured children (≤18 years) admitted to a level 1 pediatric trauma center. Patient and guardian characteristics were compared across levels of HL using univariate statistics. We conducted multivariable logistic regression to identify factors independently-associated with low HL. ResultsA sample of 95 guardian-child dyads were enrolled. The majority of guardians had low HL (n = 52, 55%), followed by moderate HL (n = 36, 38%) and high HL (n = 7, 7%). Many families received public benefits (n = 47, 49%) and 12 guardians (13%) had both housing and employment insecurity. Guardians with low HL were significantly more likely to have insecure housing and not have completed any college. ConclusionThe majority of injured children had a primary guardian with low HL. Pediatric trauma centers should consider screening for low HL to ensure that families have adequate post-discharge support. Level of EvidenceLevel 3.

Challenges to the delivery and utilisation of child healthcare services: a qualitative study of the experiences of nurses and caregivers in a rural district in Ghana

BackgroundSub-Saharan Africa has one of the poorest child health outcomes in the world. Children born in this region face significant health challenges that jeopardise their proper growth and development. Even though the utilisation of child healthcare services safeguards the health of children, the challenges encountered by nurses in the delivery of services, and caregivers in the utilisation of these services, especially in rural areas, have contributed to poor child health outcomes in this region.AimThis study explored the experiences of nurses and caregivers in respect of the nursing human resource challenges to the delivery and utilisation of child healthcare services in a rural district in Ghana.MethodsIndividual qualitative interviews were conducted with ten nurses, who rendered child healthcare services; nine caregivers, who regularly utilised the available child healthcare services; and seven caregivers, who were not regular users of these services. These participants were purposively selected for the study. Data were collected using individual semi-structured interview guides and analysed qualitatively using content analysis. Themes and sub-themes were generated during the data analysis. The Ghana Health Service Research Ethics Review Committee and the Nelson Mandela University’s Research Ethics Committee approved the study protocol prior to data collection.ResultsThree main themes emerged from the data analysis. Theme One focused on the shortage of nurses, which affected the quality and availability of child healthcare services. Theme Two focused on inexperienced nurses, who struggled to cope with the demands related to the delivery of child healthcare services. Theme Three focused on the undesirable attitude displayed by nurses, which discouraged caregivers from utilising child healthcare services.ConclusionNurses contribute significantly to the delivery of child healthcare services; hence, the inadequacies amongst nurses, in terms of staff numbers and nursing expertise, affect the quality and availability of child healthcare services. Also, caregivers’ perceptions of the quality of child healthcare services are based on the treatment they receive at the hands of nurses and other healthcare workers. In this respect, the bad attitude of nurses may disincentivise caregivers in terms of their utilisation of these services, as and when needed. There is an urgent need to comprehensively address these challenges to improve child healthcare outcomes in rural areas in Ghana. Relevant authorities should decentralise training workshops for nurses in rural areas to update their skills. Additionally, health facilities should institute proper orientation and mentoring systems to assist newly recruited nurses to acquire the requisite competences for the delivery of quality family-centred care child healthcare services.

Characterizing Family Planning Utilization in Adult Women and Adolescents in Pohnpei, Federerated States of Micronesia

IntroductionIncreasing family planning xutilization in low-income countries to improve health outcomes of women and children is a global priority. The Federated States of Micronesia (FSM) has poor maternal child health outcomes; therefore, this study aimed to examine family planning utilization in Pohnpei State, FSM.MethodsThis cross-sectional study sought to characterize family planning utilization in adult women of reproductive age and high school age adolescents in Pohnpei using representative survey data collected in 2019 (N = 570 and N = 1726, respectively). Chi-square tests were used to determine significant factors associated with family planning utilization.ResultsAmong adult women of reproductive age (18–49 years old) not trying to get pregnant, 31.6% reported using contraception during last intercourse. Contraceptive use was significantly lower among younger women (18–24 years old) (21.7%, p = 0.021), unmarried women (18.6%, p < 0.001), those without health insurance (28.7%, p = 0.030), those who have never had a pap smear (20.5%, p < 0.001), and those who have never been pregnant (14.5%, p < 0.002). Among adolescents who reported being sexually active, 28.5% reported using any contraception at last intercourse and 22.6% reported using a condom at last intercourse. Condom use among sexually active adolescents was lowest among 12th graders (13.5%, p < 0.001) and girls (16.8%, p = 0.004).ConclusionsOur findings suggest that young, unmarried, never pregnant women face an unmet need for family planning. Additionally, women with lower access to and use of healthcare services have lower use of family planning.

Prevalence and determinants of minimum dietary diversity for women of reproductive age in Uganda

BackgroundGlobally, over a billion women of reproductive age (WRA) suffer from some kind of undernutrition micronutrient deficiencies, and/or anemia as a result of inadequate dietary diversity. This leads to poor maternal and child health outcomes, however, there is limited research on population level research on minimum dietary diversity for women (MDD-W). This study assessed the prevalence and predictors of MDD-W among WRA in Uganda.MethodsThis study was a secondary analysis of data from the lot quality assurance sampling (LQAS) survey conducted across 55 Ugandan districts between May and September 2022. Women of various ages were interviewed across 5 study subgroups that this study used to construct its study population (WRA). Descriptive analyses, tests for outcome differences, and multilevel mixed-effects logistic regression were conducted at a 5% statistical significance level using STATA version 17. The results were reported using Adjusted Odds Ratios (aOR) as the measure of the outcome.ResultsThe study analyzed responses from 29,802 WRA with a mean age of 27.8 (± 6.8) years. Only 8.8% (95% CI 8.5–9.3) achieved the MDD-W, the least proportion was observed in the South-Central region (3.13%). In the adjusted analysis, WRA who were older than 25 years (aOR 1.1, 95% CI 1.1–1.3, p < 0.001), had secondary education (aOR = 1.4, 95% CI 1.1–1.7, p = 0.003) or above (aOR = 1.7, 95% CI 1.3–2.2, p < 0.001), and used modern contraceptives (aOR = 1.1, 95% CI 1.0-1.3, p = 0.01) were more likely to achieve the MDD-W. Conversely, WRA who travelled longer distances to the nearest household water source (aOR = 0.8, 95% CI 0.7–0.9, p = 0.002) and those residing in larger households (aOR = 0.9, 95% CI 0.8-1.0, p = 0.019) were less likely to achieve the MDD-W.ConclusionA low proportion of WRA met the MDD-W. Age, education level, household sizes and use of modern contraception were predictors of MDD-W among WRA in Uganda. MDD-W-related program efforts in Uganda should strengthen multisectoral collaboration with prioritization of younger women, education, household sizes and access to safe water sources.

Malnourished children? Child health disparities and its causes in Eastern India

The disparity in child health outcomes across Indian districts, particularly in Eastern India, is alarming. Approximately half of the districts in this region exhibit very poor child health outcomes, evidenced by alarmingly high neonatal, infant, and under‐five mortality rates. This study analyses the existing levels and patterns of child health outcomes across 112 districts of Eastern India, a region known for its low levels of child health status. To do this, we have constructed a composite child health index (CHI) using nationally representative data from the National Family Health Survey (NFHS‐5). Using Principal Component Analysis, the study uses the CHI values to categorize the districts into high, moderate, and low‐performing districts. The results show a significant variation in CHI outcomes across the districts, with striking regional disparities. Notably, all high‐performing districts were located only in the state of Odisha. In contrast, a substantial proportion of the low‐performing districts were in the state of Bihar, suggesting systemic healthcare deficiencies. Using discriminant function analysis, we obtain the critical determinants of CHI to be sanitation facilities, mother's education, marriage before 18 years, and low body mass index of the mother. Our findings confirm that improvements in these areas are crucial for enhancing child health outcomes and ending intergenerational transmission of poor health outcomes. The implications of this study extend beyond eastern India, offering valuable insights into similar challenges in global low‐ and middle‐income regions.

The Diversity in Tobacco Use Among Women of Reproductive Age (15-49 Years) in Pakistan: A Secondary Analysis of a Multiple Indicator Cluster Survey 2016-2018.

Tobacco use in women of reproductive age group (15-9 years) may contribute to poor maternal and child health outcomes. We estimated the prevalence of smokeless tobacco (ST), cigarette, and waterpipe use among these women in Pakistan and explored associations with socio-economic differences and birth weights after recent childbirths (past 2 years). We used the Multiple Indicator Cluster Surveys datasets from three provinces in Pakistan. Prevalence was generated for current use of tobacco among women with recent childbirth (WWRC) and without recent childbirth (WWoRC). We further compared socio-economic status and birth weights between tobacco users and non-users. The prevalence of current ST use was 1.4% and 2.5%, and waterpipe smoking was 1.2% and 1.8%, in WWRC and WWoRC, respectively. ST use varied across Pakistan's provinces by 13 percentage points in WWRC and WWoRC while waterpipe smoking by 10 and 15 percentage points, respectively. The odds of using any form of tobacco were significantly lower with higher levels of education or wealth index. Compared to children born to mothers who did not use tobacco, the birth weight of children born to mothers who smoked waterpipe was on average 0.83 kg (95% CI -1.6 to -0.1) lower whereas it was 0.33 kg (95% CI -0.9 to 0.3) higher for ST users. Tobacco use among women of reproductive age in Pakistan varied significantly based on province and tobacco type. Waterpipe smoking was associated with a reduction in birth weight. Raising awareness of the harms of tobacco use among women of reproductive age and targeting interventions in high-burden regions of Pakistan should be prioritized. The prevalence of current smokeless tobacco use and waterpipe smoking varied significantly in Pakistan (~13 and ~15 percentage points, respectively) among women of reproductive age, and there seems to be little change in tobacco use behavior around pregnancy and early motherhood. The study highlights a need to better understand the prevalence of tobacco use in Pakistan, and further contextual research is warranted to understand the reasons for such high tobacco use in certain areas. This information highlights the need for improving current tobacco control interventions and policies, including measures that could help reduce its use and prevent its uptake. Furthermore, compared to children born to mothers who did not use any form of tobacco, we found a statistically significant difference (830 g) in birth weight for babies born to mothers who at the time of the interview smoked waterpipe and a non-statistically significant difference of about 330 g for children born to mothers who at the time of the interview used smokeless tobacco. In addition to our findings, some literature suggests the association of waterpipe smoking with low birth weight. A possible explanation could be the exposure to smoke that contains toxicants from the tobacco product itself in addition to the burning of charcoal, which is required when using waterpipe. Waterpipe smoking also results in high exposures to carbon monoxide and polycyclic aromatic hydrocarbons, which are known to be carcinogenic and teratogenic. In terms of smokeless tobacco use, further research is warranted to understand its impact on birth outcomes through longitudinal studies accounting for diverse products, its constituents and the amount of consumption.

Screening for Food Insecurity in a Pediatric Diabetes Program: Provider and Parent/Guardian Perspectives.

Food insecurity (FI) is associated with poor health outcomes in children, and studies have shown higher FI among children with diabetes mellitus. This study assessed provider (N = 22, 35.5% response rate) and parent/guardian (N = 207, 14.6% response rate) perspectives toward FI screening in a pediatric diabetes program. Among 22 providers, most "rarely" (54.5%) or "never" (27.3%) screened for FI although all felt that screening was at least "slightly important." Barriers included lack of time (63.6%), not remembering to screen (59.1%), lack of knowledge about how to address positive screens (45.5%), and being unsure how to screen (40.9%). Among 186 parent/guardians, only 24.1% had been asked about FI at a pediatric medical appointment, but only 8.6% disliked the idea of being asked by a medical provider at endocrinology visits. To be effective and sustainable, FI screening must fit within the visit flow, and providers need education on how to address positive screens.

Public health policy and political contestation in Indonesia.

Public health issues should be a focal concern for public leaders. A critical moment for articulating intended policies is during elections. At this time, candidates present significant ideas and proposals derived from the evaluation and reflection on the previous administration's governance. This approach ensures that the proposed programmes are grounded in evidence. In 2024, Indonesia conducted general elections, amid significant public health challenges such as the persistently high prevalence of stunting and poor maternal and child health outcomes. The Prabowo-Gibran, who then won the election, focused their campaign on providing free food and milk. This campaign appears to be unsupported by a comprehensive improvement plan, leading to the impression that public health issues are merely used to enhance electoral appeal.

High-risk fertility behaviors and associated factors among married reproductive-age women in sub-Saharan Africa: A multilevel mixed-effect analysis of nationally representative data from 35 countries.

Although high-risk fertility behaviors are linked with poor maternal and child health outcomes, their prevalence remains higher in resource-limited countries and varies significantly by context. Evidence on the recent estimates of these fertility risks at the sub-Saharan Africa level is limited. Therefore, this study aimed to examine the pooled prevalence of high-risk fertility behaviors and associated factors among married women in this region. Data from DHS of 35 sub-Saharan African countries were used and a weighted sample of 243,657 married reproductive-age women were included in the analysis. A multilevel binary logistic regression models were fitted and the final model was selected based on the log-likelihood and deviance values. A p-value less than 0.05 and an adjusted odds ratio with a corresponding 95% confidence interval were used to identify the factors associated with high-risk fertility behaviors. The pooled prevalence of high-risk fertility behaviors among women in sub-Saharan Africa was 77.7% [95% CI = 77.6%-77.9], where 43.1% [95% CI: 42.9%-43.3%], and 31.4% [95% CI = 31.2%-31.6%] had a single risk and combination of two or three fertility risks, respectively. The highest level of single-risk fertility pattern was observed in Burundi (53.4%) and Chad had the highest prevalence of both at least one (89.9%) and multiple (53.6%) fertility risks. Early and polygamous marriages, low maternal and husband education, poor wealth index, unmet need for contraception, couple's fertility discordance, rural residence, high community-level early marriage practice, and low community-level women empowerment were associated with risky fertility behaviors. More than three-quarters of married women in SSA were engaged in high-risk fertility behaviors, with significant variations across the included countries. Therefore, addressing the modifiable risk factors like improving access to need-based contraceptive methods and empowering couples through education for a better understanding of their reproductive health with particular attention to rural settings are important in reducing these fertility risks. The results also suggest the need to strengthen the policies regulating the prohibition of early and polygamous marriages.

Positive and adverse childhood experiences and mental health outcomes of children

ObjectiveResearchers and policymakers have identified adverse childhood experiences (ACEs) like abuse, neglect, and household dysfunction as a contributing factor to poor mental health outcomes for children. Positive childhood experiences (PCEs) like open family communication styles, having the ability to live and play in a safe, stable, and protective environment, having constructive opportunities for social engagement, and receiving mentorship from adults have been found to improve the mental health of children. PurposeThis paper explores the role of ACEs and PCEs on the mental health outcomes of children. MethodA sample of 22,628 children ages 6–17 from the National Survey of Children's Health (2017–2020) was used to explore the relationship between PCEs and ACEs and the mental health of children. Logistic regression analysis is used to model the effect of PCEs and ACEs on the odds of child mental health diagnoses. ResultsFindings indicate that with each additional ACE, there was a significant increase in the odds of reporting a MH condition (OR = 1.25, 95 % CI 1.09–1.43). Conversely, with each additional PCE, there is a significant decrease in the odds or reporting a MH condition (OR = 0.76, 95 % CI 0.68–0.84). There was also evidence that PCEs moderate the relationship between ACEs and reports of mental health conditions. When counts of ACEs are low, PCEs provide a protective effect on reports of mental health. But when the count of ACEs are high, children with higher numbers of PCEs have similar reports of mental health conditions. SummaryThis study provides information about the moderating effect of PCEs on the relationship between ACEs and child mental health diagnosis with the goal of informing policies and interventions focused on ameliorating the growing crisis of children's negative mental health and well-being. What is known?Adverse childhood events (ACEs) like abuse, neglect and household dysfunction are known to negatively impact the mental health and well-being of children. Positive childhood experiences (PCEs), on the other hand, can positively influence the mental health and well-being of children. What does this article add?This study examines the association between adverse and positive childhood experiences to understand how they impact the mental health outcomes of children ages 6–17. Findings indicate that when ACEs are lower, the impact of PCEs are positive, but when ACEs are higher, PCEs do not make much difference in reports of mental health problems.

Household food insecurity and child health outcomes: a rapid review of mechanisms and associations

BackgroundHousehold food insecurity (HHFI) has detrimental impact on child health outcomes. The primary aim of this work was to describe the mechanisms, defined as statistically quantified processes or systems, that explain the association between HHFI and poor child health outcomes. The secondary aim was to identify which child health outcomes were significantly associated with HHFI. MethodsIn this rapid review, we included real-world evidence studies in children and adolescents aged 3–24 years, from high-income countries. We searched peer-reviewed literature through the databases Medline, Embase, Web of Science and The Cochrane Library on March 10, 2022, with a 15-year time restriction. Key search terms included “food insecurity”, “food poverty”, “statistics”, “structural equation model*”, “regression”, “conceptual model*”, and “theoretical model*”. We identified additional studies by searching citations and references. Papers were selected using pre-defined criteria and non-English Language studies were excluded. We extracted summary data of published studies using the Cochrane data extraction template as a guide. We included a broad range of health outcomes to identify what aspects of health are affected by HHFI, including metabolic risk factors (eg, BMI), conditions (eg, depression), biological processes (eg, sleep) and parent–child interactions (eg, feeding styles). We performed a narrative synthesis, as heterogeneity precluded statistical synthesis. We used the Quality in Prognosis Studies tool to assess the mechanism studies. FindingsWe included 70 systematic reviews (six mechanism and 64 association reviews) from the UK, Canada, USA, Australia, and Ireland (including 18 887 mechanism studies and 986 759 association studies). Low-to-moderate bias was detected in mechanism studies, and there was variability in HHFI measures. Maternal depression and parenting stress during childhood played a mechanistic role between HHFI and adolescent depression (b=0·008, 95% CI 0·002–0·016) and anxiety (b=0·012, 0·002–0·026). Maternal stress mediated the association between HHFI and child overweight (odds ratio [OR] 1·79, 0·82–3·92, p<0·01), via restrictive feeding styles (OR 1·81, 1·15–2·85, p=0·010) that had negative impact on diet (p<0·01). Ethnicity, income, employment, and education moderated the relationship between HHFI and child health outcomes (p<0·001). InterpretationTwo key mechanistic pathways between HHFI and child health outcomes were diet and mental health of both child and parent, which appeared interrelated. Interventions targeting HHFI in children, should consider these pathways alongside sociodemographic factors. A strength of this review was that it was the first literature summary explaining the mechanisms between HHFI and child health, using evidence from high-income countries. A limitation was that HHFI measures were inconsistent between studies and countries, disallowing study comparisons. FundingUniversity of Sheffield.

Social protection as a nutrition-sensitive instrument to address malnutrition in sub-Saharan Africa: Examining the utility of the UNICEF conceptual model of care for maternal and child nutrition

AbstractChild nutrition, health and development are closely tied to maternal nutrition, health and well-being. The underlying drivers of poor maternal and child nutritional outcomes in sub-Saharan Africa are structural in nature. These risks include social, economic, and environmental factors that together compound vulnerability to poor outcomes. Poverty, as a driver of poor maternal and child health outcomes, is an important determinant that is both a cause and a consequence of malnutrition. The United Nations’ Children’s Fund (UNICEF)’s conceptual model for determinants of maternal and child nutrition outcomes released in 2020, is the agency’s latest iteration of child nutrition frameworks. The model identifies the underlying causes of malnutrition as extending beyond food and diets, to include household level dynamics, maternal factors, and the external environment. The manuscript discusses UNICEF’s conceptual model and its applicability in sub-Saharan Africa. It also considers the evidence on interventions aimed at addressing maternal and child nutrition in the region and the location of social protection among these policy tools, with a special focus on the extent to which these resonate with the conceptual model. It concludes by considering the conditions required for social protection instruments to work in the region and similar settings in the Global South. In this way, the manuscript provides a critical reflection about the role of social protection as a nutrition-sensitive instrument in sub-Saharan Africa, in the context of maternal and child nutrition outcomes.

Ruggedness and child health outcomes: Evidence from Burundi, Cameroon, Ethiopia and Nigeria

AbstractThis paper examines the effect of terrain ruggedness on child stunting in Burundi, Cameroon, Ethiopia and Nigeria. Using a cross‐section analysis with data from the Demographic and Health Surveys (DHS) and a measure that captures variation in the terrains of the countries, we find that the more difficult it is to traverse the terrain in Burundi, Cameroon and Nigeria, the higher the likelihood of child stunting. However, this association is not consistent for Ethiopia until we account for the Oromia region, which has the capital city Addis Ababa. These results remain robust with the inclusion of socio‐economic factors related to child health (e.g. maternal health, maternal education and household income), demographic factors (e.g. gender of child), other geographical factors (e.g. rainfall patterns and malaria prevalence) and survey and region effects. The results suggest that there are complementary factors to geography that may contribute to poor child health outcomes, such as the quality of infrastructure and the ability to access healthcare services. Given that child health is a key development outcome, understanding such spatial variations associated with child health inequalities can assist in designing effective intervention programmes and allocating resources where they are most needed.

An exploration of outdoor play and wellbeing in Northern Irish primary schools

ABSTRACT The increasingly poor physical and mental health outcomes for children in Northern Ireland are, in part, attributed to a sedentary, indoor lifestyle and a concern that children are not availing of outdoor play opportunities. For some children, the school playground is the only accessible outdoor space available to them and is therefore a critical site in terms of promoting wellbeing. This paper reports the findings of an exploratory study which investigated school staff’s attitudes and children’s views, perspectives and experiences of play in school playgrounds in Northern Ireland. The findings illustrate that the school playground shapes the way in which children access outdoor play through its physical, policy and social setup; and that the design, structure, management and provision of the school playground all play a role in shaping children’s play behaviours and enjoyment of play. Findings also indicate that children are not being consulted about their play space, and schools lack policies and training opportunities for staff regarding outdoor play. Based on the findings and applying concepts associated with the Affordance Framework [Gibson, J. J. (1979). The ecological approach to visual perception. Lawrence Erlbaum Associates], the transformative potential of restructuring primary school playgrounds in Northern Ireland is highlighted and implications for future research, policy and practice are outlined.

Early Life Adversity alters Maternal-Fetal-Placental Biology and may Propagate Population Health Disparities

Research findings dating back decades indicate that prenatal maternal psychological distress can predict poor child health outcomes, with potentially lasting effects. These results have been extensively replicated and have encouraged longitudinal cohort studies to begin before birth; many clinical interventions to promote maternal health in pregnancy are underway. Studies of prenatal maternal distress emphasize in utero effects, likely arising from multiple biological changes. Alternatively, developmental and life history models suggest that prenatal distress likely has pre-pregnancy developmental origins. Studies linking pre-pregnancy adversity to prenatal maternal distress and maternal-fetal-placental biology are underway, but are typically limited in scope. The ECHO-UPSIDE cohort is well-positioned to contribute novel data to this area; it is a prospective pregnancy cohort study of a socio-economically and racially/ethnically diverse sample at elevated psychosocial risk but normal medical risk status (Rochester, NY; n=326). Clinical, socio-demographic, health data and extensive biological samples were collected at each trimester and placentae were collected at birth. Women who experienced higher adversity in early childhood (using Adverse Childhood Experiences [ACE] scale) reported wide-spread differences in prenatal health, with moderate effect sizes (Cohen’s d>.5) for depressive and anxiety symptoms, stress, body mass index (BMI), sleep disturbance, and diet. Higher ACE scores predicted altered (flatter) diurnal cortisol pattern throughout pregnancy (p<.01). There was also limited but significant impact on maternal immune activation from specific immune markers and measures of placenta structure and function. The studies demonstrate potential pathways through which pre-pregnancy adversity may propagate persisting health disparities.