Individual- and Community-Level Risk Factors Associated with Childhood Diarrhea in Ethiopia: A Multilevel Analysis of 2016 Ethiopia Demographic and Health Survey

Fenta, Setegn Muche; Nigussie, Teshager Zerihun

doi:10.1155/2021/8883618

Cited by 7 publications

(8 citation statements)

References 30 publications

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“…Failure of the mammary gland to produce sufficient milk represents a medical condition leading to negative health outcomes for both mothers and children. These health effects are important in high resource settings and high-income countries, but they are profound with devastating consequences in low resource settings and low- and middle-income countries with unpredictable access to clean water and high-quality infant formula ( 69 , 70 ). Therefore, low milk production is a medical condition that has disproportional effects in vulnerable populations, making it an important contributor to global and domestic health disparities.…”

Section: Discussionmentioning

confidence: 99%

Fatty Acid Transfer from Blood to Milk Is Disrupted in Mothers with Low Milk Production, Obesity, and Inflammation

Walker

Harvatine

Ross

et al. 2022

The Journal of Nutrition

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Background Obesity is associated with chronic inflammation and is a risk factor for insufficient milk production. Inflammation-mediated suppression of lipoprotein lipase could inhibit mammary uptake of long-chain fatty acids (LCFAs, >16C). Objectives In an ancillary case control analysis, we investigated whether women with low milk production despite regular breast emptying have elevated inflammation and disrupted transfer of LCFAs from plasma into milk. Methods Data and specimens from a low milk supply study and an exclusively breastfeeding control group were analyzed, with milk production measured by 24-hour test-weighing at 2–10 weeks postpartum. Low milk supply groups were defined as very low (VL, <300 mL/d; n = 23) or moderate (MOD, ≥300 mL/d; n = 20) milk production, and compared to controls (≥699 mL/d; n = 18). Serum and milk fatty acids (weight% of total) were measured by gas chromatography, serum and milk TNF-α by ELISA, and serum high-sensitivity C-reactive protein (hsCRP) by clinical analyzer. Group differences were assessed by linear regression models, Chi-square exact tests, and Kruskal Wallis nonparametric tests. Results VL cases, as compared to MOD and controls, had higher prevalence of elevated serum hsCRP (>5 mg/L, 57%, 15%, 22%, respectively, p = 0.004), detectable milk TNF-α (67%, 32%, 33%, respectively, p = 0.04), and obesity (78%, 40%, 22%, respectively, p = 0.003). VL cases had lower LCFAs in milk (Mean[±SD], 60[±3%]) compared to MOD (65[±4%]) and controls (66[±5%]; (p < 0.001). Milk and serum LCFAs were strongly correlated in controls (r = 0.82, p < 0.001), but not in MOD (r = 0.25, p = 0.30) or VL (r = 0.20, p = 0.41) groups (pint < 0.001). Conclusions Mothers with very low milk production have significantly higher obesity and inflammatory biomarkers, lower LFCAs in milk, and disrupted association between plasma and milk LCFAs. These data support the hypothesis that inflammation disrupts normal mammary gland fatty acid uptake. Further research should address impacts of inflammation and obesity on mammary fatty acid uptake for milk production.

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Section: Discussionmentioning

confidence: 99%

Fatty Acid Transfer from Blood to Milk Is Disrupted in Mothers with Low Milk Production, Obesity, and Inflammation

Walker

Harvatine

Ross

et al. 2022

The Journal of Nutrition

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“…At first, we thought this was surprising, since other studies noted this effect in children aged 5 years and younger-although the age ranges in the study do differ [20,[36][37][38][39].However, there are several possible reasons for this finding. Many non-climatic risk factors are associated with diarrhea [40,41] among children aged 5 years and younger. Therefore, it is unlikely that temperature on its own would be found to be associated with diarrhea among these children.…”

Section: Discussionmentioning

confidence: 99%

Exploring the Association between Ambient Temperature and Daily Hospital Admissions for Diarrhea in Mopani District, Limpopo Province, South Africa

et al. 2023

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Diarrhea contributes significantly to global morbidity and mortality. There is evidence that diarrhea prevalence is associated with ambient temperature. This study aimed to determine if there was an association between ambient temperature and diarrhea at a rural site in South Africa. Daily diarrheal hospital admissions (2007 to 2016) at two large district hospitals in Mopani district, Limpopo province were compared to average daily temperature and apparent temperature (Tapp, ‘real-feel’ temperature that combined temperature, relative humidity, and wind speed). Linear regression and threshold regression, age-stratified to participants ≤5 years and >5 years old, considered changes in daily admissions by unit °C increase in Tapp. Daily ranges in ambient temperature and Tapp were 2–42 °C and −5–34 °C, respectively. For every 1 °C increase in average daily temperature, there was a 6% increase in hospital admissions for diarrhea for individuals of all ages (95% CI: 0.04–0.08; p < 0.001) and a 4% increase in admissions for individuals older than 5 years (95% CI: 0.02–0.05; p < 0.001). A positive linear relationship between average daily Tapp and all daily diarrheal admissions for children ≤5 years old was not statistically significant (95% CI: −0.00–0.03; p = 0.107). Diarrhea is common in children ≤5 years old, however, is more likely triggered by factors other than temperature/Tapp, while it is likely associated with increased temperature in individuals >5 years old. We are limited by lack of data on confounders and effect modifiers, thus, our findings are exploratory. To fully quantify how temperature affects hospital admission counts for diarrhea, future studies should include socio-economic–demographic factors as well as WASH-related data such as personal hygiene practices and access to clean water.

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“… 3 3 Moreover, food insecurity and malnutrition, associated with diarrhea, 3 4 , 3 5 are highly correlated with poverty. 3 6 , 3 7 …”

Section: Discussionmentioning

confidence: 99%

Risk factors for acute diarrhoea in children between 0 and 23 months of age in a peri-urban district of Pakistan: a matched case–control study

Sadiq

Mir

Jiwani

et al. 2022

International Health

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Background Diarrhoea is a leading cause of preventable childhood morbidity and mortality worldwide. Unfortunately, Pakistan has the third-highest burden of diarrhoea-related deaths in children <5 y of age. Therefore we aimed to evaluate factors associated with diarrhoea among Pakistani children. Methods A retrospective 1:2 matched case–control study nested in a baseline cross-sectional survey was conducted from October to December 2018 in Taluka Kotri, a two-thirds urban locality in the Jamshoro district. Children between the ages of 0 and 23 months with a history of diarrhoea in the 2 weeks preceding the survey were labelled as cases. Age-matched controls were children without symptoms of diarrhoea. Univariate and multivariable conditional logistic regression was performed to identify diarrhoea-related factors. Results A total of 1558 cases were matched with 3116 controls. Factors significantly associated with lower odds of diarrhoea in the multivariate analysis included increasing maternal age (odds ratio [OR] 0.78 [95% confidence interval {CI} 0.67 to 0.90]), breastfeeding (OR 0.77 [95% CI 0.66 to 0.90]), higher paternal education (OR 0.79 [95% CI 0.65 to 0.97]) and belonging to the rich (OR 0.66 [95% CI 0.54 to 0.80]) and richest quintiles (OR 0.54 [95% CI 0.44 to 0.66]). Conclusions This study identifies risk factors associated with diarrhoea in children <23 months of age, including younger maternal age, higher paternal education, not breastfeeding and poverty, which has implications for developing preventive programs and strategies that target populations with a higher risk of diarrhoea.

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Individual- and Community-Level Risk Factors Associated with Childhood Diarrhea in Ethiopia: A Multilevel Analysis of 2016 Ethiopia Demographic and Health Survey

Cited by 7 publications

References 30 publications

Fatty Acid Transfer from Blood to Milk Is Disrupted in Mothers with Low Milk Production, Obesity, and Inflammation

Fatty Acid Transfer from Blood to Milk Is Disrupted in Mothers with Low Milk Production, Obesity, and Inflammation

Exploring the Association between Ambient Temperature and Daily Hospital Admissions for Diarrhea in Mopani District, Limpopo Province, South Africa

Risk factors for acute diarrhoea in children between 0 and 23 months of age in a peri-urban district of Pakistan: a matched case–control study

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