The challenge of reducing neonatal mortality in middle-income countries: findings from three Brazilian birth cohorts in 1982, 1993, and 2004

ObjectivesAntenatal care (ANC) is an essential part of primary healthcare and its provision has expanded worldwide. There is limited evidence of large-scale cross-country studies on the impact of ANC offered to pregnant women on child health outcomes. We investigate the association of ANC in low-income and middle-income countries with short- and long-term mortality and nutritional child outcomes.SettingWe used nationally representative health and welfare data from 193 Demographic and Health Surveys conducted between 1990 and 2013 from 69 low-income and middle-income countries for women of reproductive age (15–49 years), their children and their respective household.ParticipantsThe analytical sample consisted of 752 635 observations for neonatal mortality, 574 675 observations for infant mortality, 400 426 observations for low birth weight, 501 484 observations for stunting and 512 424 observations for underweight.Main outcomes and measuresOutcome variables are neonatal and infant mortality, low birth weight, stunting and underweight.ResultsAt least one ANC visit was associated with a 1.04% points reduced probability of neonatal mortality and a 1.07% points lower probability of infant mortality. Having at least four ANC visits and having at least once seen a skilled provider reduced the probability by an additional 0.56% and 0.42% points, respectively. At least one ANC visit is associated with a 3.82% points reduced probability of giving birth to a low birth weight baby and a 4.11 and 3.26% points reduced stunting and underweight probability. Having at least four ANC visits and at least once seen a skilled provider reduced the probability by an additional 2.83%, 1.41% and 1.90% points, respectively.ConclusionsThe currently existing and accessed ANC services in low-income and middle-income countries are directly associated with improved birth outcomes and longer-term reductions of child mortality and malnourishment.

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Patterns of growth in childhood in relation to adult schooling attainment and IQ in 6 birth cohorts in low and middle-income countries: evidence from COHORTS

10.1101/2020.06.16.20133074 ◽

2020 ◽

Author(s):

Natalia E Poveda ◽

Fernando P Hartwig ◽

Cesar G Victora ◽

Linda S Adair ◽

Fernando C Barros ◽

...

Keyword(s):

Human Capital ◽

Early Childhood ◽

Early Life ◽

Linear Growth ◽

Relative Weight ◽

Childhood And Adolescence ◽

Birth Cohorts ◽

Middle Income ◽

Middle Income Countries ◽

School Attainment

SummaryBackgroundGrowth faltering has been associated with poor intellectual performance. The relative strengths of associations between growth in early and in later childhood remain underexplored. We examined the association between growth in childhood and adolescence and adult human capital in five low- or middle-income countries (LMICs).MethodsWe analyzed data from six prospective birth cohorts of five LMICs (Brazil, Guatemala, India, the Philippines, and South Africa). We assessed the associations of measures of height and relative weight at four ages (birth, at around age 2 years, mid-childhood (MC), adulthood), with two dimension of adult human capital (schooling attainment and IQ).FindingsIn site- and sex-pooled analyses, size at birth and linear growth from birth to around 2 years of age were positively associated with schooling attainment and adult IQ. Linear growth from age 2 years to MC and from MC to adulthood was not associated with higher school attainment or IQ. Change in relative weight in early childhood was not associated with either outcome. Relative weight in MC and in adulthood were inversely associated with schooling attainment but were not associated with adult IQ.InterpretationLinear growth in the first 1,000 days is a predictor of schooling attainment and IQ in adulthood in LMICs. Linear growth in later periods was not associated with either of these outcomes. Changes in relative weight had inconsistent association with schooling and IQ in adulthood.FundingBill and Melinda Gates Foundation (OPP1164115)Research in contextEvidence before this studyEarly life growth faltering has been associated with poor cognitive and intellectual performance in childhood and poorer schooling outcomes in children and adults. There is a paucity of data about how growth in specific age intervals over the course of childhood and adolescence relates to attained schooling and adult cognitive performance.We conducted a literature search using the terms (growth [Title/Abstract]) AND ((school [Title/Abstract] OR schooling [Title/Abstract]) AND (intelligence [Title/Abstract] OR IQ [Title/Abstract]) OR (human capital [Title/Abstract]) in Pubmed. The search yielded 536 publications from 1965 to 2020. We screened titles and selected 31 publications that included linear growth and our outcomes of interest, namely school attainment and intelligence quotient (IQ). Additionally, we checked reference lists of selected articles and identified eleven papers that were not displayed in the initial electronic query. We therefore reviewed 42 abstracts and identified 24 unique studies conducted in low and middle-income countries (LMICs). Fourteen of them investigated the association of birth size and/or early-life size with schooling or IQ, or with both outcomes during childhood. Three studies investigated the association between linear growth in early childhood and schooling and intelligence in adults, one studied the association between early-life undernutrition and IQ in early adulthood and another six publications investigated the association between growth and school attainment in adults. Economists have also studied the relationship between stunting or linear growth and schooling in LMICs, but to our knowledge not the relative importance of growth during specific age intervals.Added value of this studyThis is an analysis of the associations between child and adolescent growth and two dimensions of human capital (schooling attainment and IQ) in adulthood in six birth cohorts from five LMICs. The evidence of long-term associations of linear growth with adult IQ is scarce and the few published studies have analyzed data from a single country. In the present study, we found that size at birth and linear growth from birth to around 2 years of age were positively associated with both schooling and IQ in adulthood. Linear growth between early and mid-childhood (MC)was not associated with higher school attainment or IQ in adjusted models. Linear growth from MC to adulthood was not associated with IQ in men or women, and was inversely associated with schooling attainment in women only. Change in relative weight in early childhood was positively associated with schooling attainment only in minimally adjusted models. Relative weight measures in MC and adulthood were inversely associated with schooling attainment. Change in relative weight between MC and adulthood was not associated with adult IQ.Implications of all the available evidenceWe confirmed in multiple cohorts that birth size and linear growth from birth to age 2 years are predictors of schooling attainment and adult IQ. Linear growth in early life was the strongest predictor of these two human capital dimensions in adulthood among individuals in LMICs. We did not find evidence that supports the notion that linear growth in adolescence contributes to a better cognitive performance in adulthood. Thus, our results inform the more effective timing of nutritional and other interventions to improve linear growth and human capital in the long-term.

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Early-life exposure to ambient fine particulate air pollution and infant mortality: pooled evidence from 43 low- and middle-income countries

International Journal of Epidemiology ◽

10.1093/ije/dyz090 ◽

2019 ◽

Vol 48 (4) ◽

pp. 1125-1141 ◽

Cited By ~ 9

Author(s):

Nihit Goyal ◽

Mahesh Karra ◽

David Canning

Keyword(s):

Air Pollution ◽

Infant Mortality ◽

Neonatal Mortality ◽

Early Life ◽

Middle Income ◽

Middle Income Countries ◽

Particulate Air Pollution ◽

Fine Particulate ◽

Early Life Exposure ◽

Low And Middle Income

Abstract Background Many low- and middle-income countries are experiencing high and increasing exposure to ambient fine particulate air pollution (PM2.5). The effect of PM2.5 on infant and child mortality is usually modelled using concentration response curves extrapolated from studies conducted in settings with low ambient air pollution, which may not capture its full effect. Methods We pool data on more than half a million births from 69 nationally representative Demographic and Health Surveys that were conducted in 43 low- and middle-income countries between 1998 and 2014, and we calculate early-life exposure (exposure in utero and post partum) to ambient PM2.5 using high-resolution calibrated satellite data matched to the child’s place of residence. We estimate the association between the log of early-life PM2.5 exposure, both overall and separated by type, and the odds of neonatal and infant mortality, adjusting for child-level, parent-level and household-level characteristics. Results We find little evidence that early-life exposure to overall PM2.5 is associated with higher odds of mortality relative to low exposure to PM2.5. However, about half of PM2.5 is naturally occurring dust and sea-salt whereas half is from other sources, comprising mainly carbon-based compounds, which are mostly due to human activity. We find a very strong association between exposure to carbonaceous PM2.5 and infant mortality, particularly neonatal mortality, i.e. mortality in the first 28 days after birth. We estimate that, at the mean level of exposure in the sample to carbonaceous PM2.5—10.9 µg/m3—the odds of neonatal mortality are over 50% higher than in the absence of pollution. Conclusion Our results suggest that the current World Health Organization guideline of limiting the overall ambient PM2.5 level to less than 10 µg/m³ should be augmented with a lower limit for harmful carbonaceous PM2.5.

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