The Elders [to 28 November 2015]
http://theelders.org/news-media

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Guest blog Mai Abu Moghli 26 November 2015
Palestine Refugees in Syria: A Recurring Tragedy
Refugees for over six decades, Palestinians in Syria face a precarious legal status given the civil war and renewed displacement. Mai Abu Moghli – a PhD candidate at the Institute of Education, University of London explains how some are falling through the cracks of the international protection regime and calls for a solution based on human rights and international law.

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Guest blog Arifa Nasim 23 November 2015
How young people can combat violence against women
Violence against women is sometimes justified by abusers and perpetrators as a matter of ‘honour’. In this guest blog to mark the International Day for the Elimination of Violence Against Women, 18 year-old youth activist Arifa Nasim from London explains how she uses education to challenge prejudice within communities and encourages women of all ages and backgrounds to empower themselves.

Gavi [to 28 November 2015]
http://www.gavialliance.org/library/news/press-releases/

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Organisation of Islamic Cooperation approves Gavi membership to key health committee
Vaccine Alliance support already helping to immunise millions of children in OIC member states.
Geneva, 26 November 2015 – Gavi, the Vaccine Alliance has been officially invited to become a member of the Organisation for Islamic Cooperation’s (OIC) Steering Committee on Health.

The invitation, which recognises Gavi’s support for childhood immunisation in OIC member states, meant the Vaccine Alliance was able to participate in the 10th Steering Committee on Health (SCH) in Istanbul last week. The SCH, set up at the first Islamic Conference of Health Ministers (ICHM) in 2007, tracks implementation of a framework for action through progress and evaluation reports.

From 2000 to 30 September 2015, Gavi provided more than US$ 4 billion to support immunisation in 33 OIC member states – equivalent to 49% of Gavi disbursements. This has helped developing countries immunise more than 210 million children, saving over four million lives.

Ambassador Mohammed Naeem Khan, Assistant Secretary-General of Science and Technology at the Organisation of Islamic Cooperation (OIC), said: “We welcome Gavi as a member of SCH and highly appreciate its active support to OIC member states and look forward to further strengthening of the partnership between OIC and Gavi.”…

Global Fund [to 28 November 2015]
http://www.theglobalfund.org/en/news/

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The Link Between HIV and Violence Against Women
in Voices on 24 November 2015

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Accelerating the Elimination of Malaria in Southern Africa
By Dr. Richard Kamwi, Elimination 8 Ambassador and former Minister of Health of Namibia, and Mark Dybul, Executive Director of the Global Fund
in Voices on 23 November 2015

Start Network [to 28 November 2015]
http://www.start-network.org/news-blog/#.U9U_O7FR98E
[Consortium of British Humanitarian Agencies]

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Spotlight on the Start Fund: Peer field review of the Malawi & Mozambique flood response
November 23, 2015
Posted by Helen James in Blog.
In January 2015, the Start Fund responded to flooding in Malawi and Mozambique. The floods had caused mass displacement and destroyed the vast majority of agricultural livelihoods, affecting more than 1 million people.

The Learning and Evaluation Committee conducted its normal peer-review of the response, and a number of key questions arose. With their approval, the Monitoring and Evaluation team at Action Against Hunger decided to launch a learning exercise from July 11-18 using the 1% learning budget.

A bespoke methodology was developed for the Start Fund’s first ever peer field review. The pilot was successful and led to a number of key findings, detailed in this case study…

CHS International Alliance [to 28 November 2015]
http://chsalliance.org/news-events/news

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25/11/2015
The CHS is now available in Urdu
The Core Humanitarian Standard (CHS) is now available in Urdu. The Standard was translated into Urdu by Community World Service Asia (CWSA).

Global Humanitarian Assistance (GHA) [to 28 November 2015]
http://www.globalhumanitarianassistance.org/

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Ebola virus disease in Liberia
Report Synopsis
Date: 2015/11/23
On 20 November 2015 we responded to a funding alert for a new case of the Ebola virus disease in Liberia. The day before, less than three months after Liberia was last declared free of Ebola, it was confirmed that a 10-year-old boy had tested positive for the virus.

According to the UN Office for the Coordination of Humanitarian Affairs (OCHA)’s Financial Tracking Service (FTS), donors have committed/contributed US$236.9 million of humanitarian assistance to Liberia since the start of 2015. At least US$227.7 million of this is for the Ebola response. However, there are currently no financial contributions or pledges in response to this new outbreak of the disease.

Read our full analysis of the current funding situation.

The Sphere Project [to 28 November 2015]
http://www.sphereproject.org/news/

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Launching the global survey “Growing the Sphere network”
26 November 2015 | Sphere Project
The purpose of this survey is to help Sphere become a stronger, more robust and inclusive network whose mission it is to convene and support individuals, communities, organisations and like-minded standards-setting bodies who apply, promote and encourage voluntary adherence to humanitarian standards and principles….
The survey is available in English, Arabic, French and Spanish. You can take this survey online until 11 December 2015…

Center for Global Development [to 28 November 2015]
http://www.cgdev.org/page/press-center

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Changes in Funding Patterns by Latin American Banking Systems: How Large? How Risky? – Working Paper 420
11/20/15
Liliana Rojas-Suarez and José María Serena
This paper investigates the shifts in Latin American banks’ funding patterns in the post-global financial crisis period. To this end, we introduce a new measure of exposure of local banking systems to international debt markets that we term: International Debt Issuances by Locally Supervised Institutions. In contrast to well-known BIS measures, our new metric includes all entities that fall under the supervisory purview of the local authority.

ODI [to 28 November 2015]
http://www.odi.org/media

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Financing climate technology transfer
Briefing papers | November 2015 | Sam Barnard and Smita Nakhooda
We discuss the opportunities to encourage and finance technology transfer in developing countries, informed by the experience of the Global Environment Facility (GEF).

World Economic Forum  [to 28 November 2015]
https://agenda.weforum.org/news/

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City Planning Needed as 6 out of 10 Global Consumers Expect Driverless Revolution
Report News 24 Nov 2015
:: Nearly 60% of consumers in cities around the world are willing to travel in self-driving vehicles, according to a new World Economic Forum survey; acceptance highest in emerging markets such as China, India and UAE; around 50% in US and UK; lowest in Japan and Germany
:: City planners and governments need to prepare for introduction of self-driving cars; smart mobility cities such as Gothenburg and Singapore are already doing so
:: Find the full results of the survey here
New York, USA 24 November 2015 – The age of autonomous vehicles is fast approaching, and city leaders need to take steps to prepare as the disruptive technology becomes a reality, according to new survey results by the World Economic Forum released today…

Gordon and Betty Moore Foundation [to 28 November 2015]
https://www.moore.org/newsroom/press-releases

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Janet Corrigan, Ph.D., M.B.A., joins Gordon and Betty Moore Foundation
November 23, 2015
Palo Alto, Calif. – Today, the Gordon and Betty Moore Foundation announced the appointment of Janet Corrigan, Ph.D., M.B.A., as the new chief program officer for patient care. Dr. Corrigan will lead the team responsible for distributing more than $40 million a year to improve the experience and outcomes of patient care…

American Journal of Preventive Medicine
December 2015 Volume 49, Issue 6, p811-988, e89-e134
http://www.ajpmonline.org/current

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A Systematic Review of the Impact of Juvenile Curfew Laws on Public Health and Justice Outcomes
Elyse R. Grossman, Nancy A. Miller
p945–951
Published online: October 8 2015
Preview
Automobile crashes cause more than 800,000 youth injuries and deaths each year. Other youth suffer the consequences from being either a perpetrator or victim of a crime. One type of law that has an effect on youth behavior is juvenile curfew laws. These laws restrict the times that youth may occupy public places or streets. We systematically reviewed studies evaluating the effectiveness of these laws to address the question: Can juvenile curfew laws be used to improve youth public health and juvenile justice outcomes?

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 28 November 2015)

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Research article
Population level usage of health services, and HIV testing and care, prior to decentralization of antiretroviral therapy in Agago District in rural Northern Uganda
G. Abongomera, S. Kiwuwa-Muyingo, P. Revill, L. Chiwaula, T. Mabugu, A. Phillips, E. Katabira, V. Musiime, C. Gilks, A. Chan, J. Hakim, R. Colebunders, C. Kityo, D. Gibb, J. Seeley, D. Ford, for the Lablite Project Team
BMC Health Services Research 2015, 15:527 (28 November 2015)

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Research article
Survey of patient perceptions towards short-term mobile medical aid for those living in a medically underserved area of Swaziland
Yi-Hao Weng, Hung-Yi Chiou, Chi-Cheng Tu, Say-Tsung Liao, Patience Bhembe, Chun-Yuh Yang, Ya-Wen Chiu
BMC Health Services Research 2015, 15:524 (27 November 2015)

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 28 November 2015)

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Research article
Health care workers in Pearl River Delta Area of China are not vaccinated adequately against hepatitis B: a retrospective cohort study
Yu-Bao Zheng, Yu-Rong Gu, Min Zhang, Ke Wang, Zhan-lian Huang, Chao-Shuang Lin, Zhi-Liang Gao BMC Infectious Diseases 2015, 15:542 (22 November 2015)
Abstract
Backgrounds
Health-care workers’ (HCWs) exposure to bodily fluids puts them at risk of hepatitis B virus HBV infection. This study investigated HBV vaccination practices and outcomes in HCWs and assessed postvaccination seroprotection across HCWs in different departments.
Methods
A survey of HCWs in a Chinese public general hospital was carried out with a retrospective cohort of 1420 hospital HCWs (458 males and 962 females). HBV vaccination status (10-μg/dose used) was investigated in the cohort from vaccination records from the period of 1988 to 2008. Blood samples were collected and tested for hepatitis B surface antigen (HBsAg) and HBV antibodies (anti-HBs).
Results
The overall vaccination (complete course) and HBsAg carrier rates among HCWs were 40.42 % (574/1420) and 6.13 % (87/1420), respectively. Vaccination rates differed by department, with HCWs in internal medicine (39.5 %) and emergency (42.0 %) departments having particularly low rates. The natural infection rate was 7.53 % (107/1420) among HCWs. HCWs in the department of infectious diseases (vaccination rate, 57.8 %) had the highest rate of antibody produced by natural infection (88.2 %).
Conclusion
The vaccination rate was a disappointingly low among HCWs in Pearl River Delta Area of China. HCWs working in infectious diseases departments and technicians were at particularly likely to have been infected with HBV. A concerted effort is needed to bring vaccination rates up among Chinese HCWs in Pearl River Delta Area of southern China.

BMC Pregnancy and Childbirth
http://www.biomedcentral.com/bmcpregnancychildbirth/content
(Accessed 28 November 2015)

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Research article
Direct observation of respectful maternity care in five countries: a cross-sectional study of health facilities in East and Southern Africa
Heather Rosen, Pamela Lynam, Catherine Carr, Veronica Reis, Jim Ricca, Eva Bazant, Linda Bartlett, on behalf of the Quality of Maternal and Newborn Care Study Group of the Maternal and Child Health Integrated Program
BMC Pregnancy and Childbirth 2015, 15:306 (23 November 2015)
Abstract
Background
Poor quality of care at health facilities is a barrier to pregnant women and their families accessing skilled care. Increasing evidence from low resource countries suggests care women receive during labor and childbirth is sometimes rude, disrespectful, abusive, and not responsive to their needs. However, little is known about how frequently women experience these behaviors. This study is one of the first to report prevalence of respectful maternity care and disrespectful and abusive behavior at facilities in multiple low resource countries.
Methods
Structured, standardized clinical observation checklists were used to directly observe quality of care at facilities in five countries: Ethiopia, Kenya, Madagascar, Rwanda, and the United Republic of Tanzania. Respectful care was represented by 10 items describing actions the provider should take to ensure the client was informed and able to make choices about her care, and that her dignity and privacy were respected. For each country, percentage of women receiving these practices and delivery room privacy conditions were calculated. Clinical observers’ open-ended comments were also analyzed to identify examples of disrespect and abuse.
Results
A total of 2164 labor and delivery observations were conducted at hospitals and health centers. Encouragingly, women overall were treated with dignity and in a supportive manner by providers, but many women experienced poor interactions with providers and were not well-informed about their care. Both physical and verbal abuse of women were observed during the study. The most frequently mentioned form of disrespect and abuse in the open-ended comments was abandonment and neglect.
Conclusions
Efforts to increase use of facility-based maternity care in low income countries are unlikely to achieve desired gains if there is no improvement in quality of care provided, especially elements of respectful care. This analysis identified insufficient communication and information sharing by providers as well as delays in care and abandonment of laboring women as deficiencies in respectful care. Failure to adopt a patient-centered approach and a lack of health system resources are contributing structural factors. Further research is needed to understand these barriers and develop effective interventions to promote respectful care in this context.

BMC Public Health
http://www.biomedcentral.com/bmcpublichealth/content
(Accessed 28 November 2015)

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Research article
Provider costs for prevention and treatment of cardiovascular and related conditions in low- and middle-income countries: a systematic review
Elizabeth Brouwer, David Watkins, Zachary Olson, Jane Goett, Rachel Nugent, Carol Levin
BMC Public Health 2015, 15:1183 (26 November 2015)

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Research article
Systematic review of structural interventions for intimate partner violence in low- and middle-income countries: organizing evidence for prevention
Christine Bourey, Whitney Williams, Erin Bernstein, Rob Stephenson BMC Public Health 2015, 15:1165 (23 November 2015)

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Research article
Health literacy and refugees’ experiences of the health examination for asylum seekers – a Swedish cross-sectional study
Josefin Wångdahl, Per Lytsy, Lena Mårtensson, Ragnar Westerling
BMC Public Health 2015, 15:1162 (23 November 2015)

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Research article
A systematic review of studies evaluating Australian indigenous community development projects: the extent of community participation, their methodological quality and their outcomes
Mieke Snijder, Anthony Shakeshaft, Annemarie Wagemakers, Anne Stephens, Bianca Calabria BMC Public Health 2015, 15:1154 (21 November 2015)

Globalization and Health
http://www.globalizationandhealth.com/
[Accessed 28 November 2015]

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Research
Conceptual and institutional gaps: understanding how the WHO can become a more effective cross-sectoral collaborator
Gopinathan U, Watts N, Hougendobler D, Lefebvre A, Cheung A, Hoffman SJ and Røttingen JA Globalization and Health 2015, 11:46 (24 November 2015)
Abstract
Background
Two themes consistently emerge from the broad range of academics, policymakers and opinion leaders who have proposed changes to the World Health Organization (WHO): that reform efforts are too slow, and that they do too little to strengthen WHO’s capacity to facilitate cross-sectoral collaboration. This study seeks to identify possible explanations for the challenges WHO faces in addressing the broader determinants of health, and the potential opportunities for working across sectors.
Methods
This qualitative study used a mixed methods approach of semi-structured interviews and document review. Five interviewees were selected by stratified purposive sampling within a sampling frame of approximately 45 potential interviewees, and a targeted document review was conducted. All interviewees were senior WHO staff at the department director level or above. Thematic analysis was used to analyze data from interview transcripts, field notes, and the document review, and data coded during the analysis was analyzed against three central research questions. First, how does WHO conceptualize its mandate in global health? Second, what are the barriers and enablers to enhancing cross-sectoral collaboration between WHO and other intergovernmental organizations? Third, how do the dominant conceptual frames and the identified barriers and enablers to cross-sectoral collaboration interact?
Results
Analysis of the interviews and documents revealed three main themes: 1) WHO’s role must evolve to meet the global challenges and societal changes of the 21st century; 2) WHO’s cross-sectoral engagement is hampered internally by a dominant biomedical view of health, and the prevailing institutions and incentives that entrench this view; and 3) WHO’s cross-sectoral engagement is hampered externally by siloed areas of focus for each intergovernmental organization, and the lack of adequate conceptual frameworks and institutional mechanisms to facilitate engagement across siloes.
Conclusion
There are a number of external and internal pressures on WHO which have created an organizational culture and operational structure that focuses on a narrow, technical approach to global health, prioritizing disease-based, siloed interventions over more complex approaches that span sectors. The broader approach to promoting human health and wellbeing, which is conceptualized in WHO’s constitution, requires cultural and institutional changes for it to be fully implemented.

Health Economics, Policy and Law
Volume 11 – Issue 01 – January 2016
http://journals.cambridge.org/action/displayIssue?jid=HEP&tab=currentissue

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Special Section
Making fair choices on the path to universal health coverage: a précis
Alex Voorhoevea1 c1, Trygve Ottersena2 and Ole F. Norheima2
a1 Philosophy, Logic, and Scientific Method, London School of Economics, UK
a2 Department of Global Public Health and Primary Care, University of Bergen, Norway
Abstract
We outline key conclusions of the World Health Organisation’s report ‘Making Fair Choices on the Path to Universal Health Coverage (UHC)’. The Report argues that three principles should inform choices on the path to UHC: I. Coverage should be based on need, with extra weight given to the needs of the worse off; II. One aim should be to generate the greatest total improvement in health; III. Contributions should be based on ability to pay and not need. We describe how these principles determine which trade-offs are (un)acceptable. We also discuss which institutions contribute to fair and accountable choices.

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 11, Issue 11, 2015
http://www.tandfonline.com/toc/khvi20/current

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Vaccination of healthcare workers: A review
pages 2522-2537
DOI:10.1080/21645515.2015.1082014
Skerdi Haviari, Thomas Bénet, Mitra Saadatian-Elahi, Philippe André, Pierre Loulergue & Philippe Vanhems
Abstract
Vaccine-preventable diseases are a significant cause of morbidity and mortality. As new vaccines are proving to be effective and as the incidence of some infections decreases, vaccination practices are changing. Healthcare workers (HCWs) are particularly exposed to and play a role in nosocomial transmission, which makes them an important target group for vaccination. Most vaccine-preventable diseases still carry a significant risk of resurgence and have caused outbreaks in recent years. While many professional societies favor vaccination of HCWs as well as the general population, recommendations differ from country to country. In turn, vaccination coverage varies widely for each microorganism and for each country, making hospitals and clinics vulnerable to outbreaks. Vaccine mandates and non-mandatory strategies are the subject of ongoing research and controversies. Optimal approaches to increase coverage and turn the healthcare workforce into an efficient barrier against infectious diseases are still being debated.

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Immunization of pregnant women: Future of early infant protection
pages 2549-2555
DOI:10.1080/21645515.2015.1070984
Azure N Faucette, Michael D Pawlitz, Bo Pei, Fayi Yao & Kang Chen
Abstract
Children in early infancy do not mount effective antibody responses to many vaccines against commons infectious pathogens, which results in a window of increased susceptibility or severity infections. In addition, vaccine-preventable infections are among the leading causes of morbidity in pregnant women. Immunization during pregnancy can generate maternal immune protection as well as elicit the production and transfer of antibodies cross the placenta and via breastfeeding to provide early infant protection. Several successful vaccines are now recommended to all pregnant women worldwide. However, significant gaps exist in our understanding of the efficacy and safety of other vaccines and in women with conditions associated with increased susceptible to high-risk pregnancies. Public acceptance of maternal immunization remained to be improved. Broader success of maternal immunization will rely on the integration of advances in basic science in vaccine design and evaluation and carefully planned clinical trials that are inclusive to pregnant women.

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Vaccinations in prisons: A shot in the arm for community health
pages 2615-2626
Open access
DOI:10.1080/21645515.2015.1051269
Víctor-Guillermo Sequera, Salomé Valencia, Alberto L García-Basteiro, Andrés Marco & José M Bayas
Abstract
From the first day of imprisonment, prisoners are exposed to and expose other prisoners to various communicable diseases, many of which are vaccine-preventable. The risk of acquiring these diseases during the prison sentence exceeds that of the general population. This excess risk may be explained by various causes; some due to the structural and logistical problems of prisons and others to habitual or acquired behaviors during imprisonment. Prison is, for many inmates, an opportunity to access health care, and is therefore an ideal opportunity to update adult vaccination schedules. The traditional idea that prisons are intended to ensure public safety should be complemented by the contribution they can make in improving community health, providing a more comprehensive vision of safety that includes public health.

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Vaccine-preventable diseases in humanitarian emergencies among refugee and internally-displaced populations
pages 2627-2636
DOI:10.1080/21645515.2015.1096457
Eugene Lam, Amanda McCarthy & Muireann Brennan
Abstract
Humanitarian emergencies may result in breakdown of regular health services including routine vaccination programs. Displaced populations including refugees and internally displaced persons are particularly susceptible to outbreaks of communicable diseases such as vaccine-preventable diseases (VPDs). Common VPDs encountered in humanitarian emergencies include measles, polio, and depending on geographical location, meningococcal meningitis, yellow fever, hepatitis A, and cholera. We conducted a review of 50 published articles from 2000 to 2015 concerning VPDs in humanitarian emergencies. This article provides an update on the available literature regarding vaccinations among this highly vulnerable population and describes the unique challenges of VPDs during humanitarian emergencies. Humanitarian emergencies place affected populations at risk for elevated morbidity and mortality from VPDs due to creation or exacerbation of factors associated with disease transmission such as mass population movements, overcrowding, malnutrition, and poor water and sanitation conditions. Vaccination is one of the most basic and critical health interventions for protecting vulnerable populations during emergencies. Growing insecurity, as seen in the increasing number of targeted attacks on health workers in recent years, as well as destruction of cold chain and infrastructure for transportation of supplies, are creating new challenges in provision of life saving vaccines in conflict settings. Population displacement can also threaten global VPD eradication and elimination efforts. While highly effective vaccines and guidelines to combat VPDs are available, the trend of increasing number of humanitarian emergencies globally poses new and emerging challenges in providing vaccination among displaced populations.

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Research Paper
Immunizing nomadic children and livestock – Experience in North East Zone of Somalia
pages 2637-2639
DOI:10.1080/21645515.2015.1038682
Raoul Kamadjeua*, Abraham Mulugetab, Dhananjoy Guptac, Abdirisak Abshir Hirsid, Asalif Belaynehb, Marianne Clark-Hattinghc, Clement Adamsc, Payenda Abedc, Brenda Kyeyunec, Tajudin Ahmedb, Mohamed Salihe, Cyprien Biaoue & Brigitte Tourea
Abstract
Nomads and pastoralists represent around 30% of the population of North East zone of Somalia (Puntland) and have very limited access to basic health including immunization. During the 2013–2014 polio outbreak in Somalia, an increase number of polio cases notified health services among these underserved communities highlighted the urgent need to devise innovative strategies to reach them. Harnessing the high demand for veterinary services among pastoralist communities, the Ministry of Health and the Ministry of Livestock, with support from UNICEF, WHO and FAO launched an integrated human and animal vaccination campaign on 19 October 2014. Over 30 days, 20 social mobilizers conducted shelter to shelter social mobilization and interpersonal communication for nomadic/pastoralist hamlets, 20 human vaccination teams, accompanied by local community elders, traveled with animal vaccination teams to administer polio and measles vaccination to pastoralist communities in the 5 regions of Puntland. 26,393 children (0 to 10 years) received Oral Polio Vaccine (OPV) out of which 34% for the first time ever; 23,099 were vaccinated against measles. and 12,556 Vitamin A. Despite various operational challenges and a significantly higher operational cost of $6.2 per child reached with OPV, the integrated human and animal vaccination campaign was effective in reaching the unvaccinated children from nomadic and pastoralist communities of Somalia.

JAMA
November 24, 2015, Vol 314, No. 20
http://jama.jamanetwork.com/issue.aspx

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Viewpoint | November 24, 2015
Forced Migration – The Human Face of a Health Crisis
Lawrence O. Gostin, JD1; Anna E. Roberts, LLB, MIPH1
Extract
This Viewpoint discusses ways in which countries can help safeguard the rights and health of refugees, asylum-seekers, and forced migrants.
Addressing a joint session of Congress, Pope Francis said that migrants “travel for a better life.…Is that not what we want for our own children?”1 With that plea, the pontiff placed a human face on the modern migration crisis, with nearly 60 million refugees, asylum-seekers, and internally displaced persons (IDPs) fleeing predominantly from war-torn Syria, Afghanistan, and Somalia2; children comprise half the group. The global response is wholly incommensurate with the need: the European Union agreed to distribute only 120 000 asylum-seekers, and the United States will increase its annual refugee cap from 70 000 to 100 000 by 2017—neither of which will substantially affect the humanitarian crisis.

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Original Investigation | November 24, 2015
Prevalence of Body Mass Index Lower Than 16 Among Women in Low- and Middle-Income Countries
Fahad Razak, MD, MSc1,2,3; Daniel J. Corsi, PhD3,4; Arthur S. Slutsky, MD, MASc1,2; Anura Kurpad, MD, PhD5; Lisa Berkman, PhD3; Andreas Laupacis, MD, MSc1,2; S. V. Subramanian, PhD3
Abstract
Importance
Body mass index (BMI) lower than 16 is the most severe category of adult undernutrition and is associated with substantial morbidity, increased mortality, and poor maternal-fetal outcomes such as low-birth-weight newborns. Little is known about the prevalence and distribution of BMI lower than 16 in low- and middle-income countries (LMIC).
Objective
To determine the prevalence and distribution of BMI lower than 16 and its change in prevalence over time in women in LMIC.
Design, Settings, and Participants
Cross-sectional data analysis composed of nationally representative surveys from 1993 through 2012 from the Demographic and Health Surveys Program. Women aged 20 through 49 years from 60 LMIC (N = 500 761) and a subset of 40 countries with repeated surveys (N = 604 144) were examined.
Exposures
Wealth was measured using a validated asset index, age was categorized in deciles, education by highest completed level (none, primary, secondary, or greater), and place of residence as urban vs rural.
Main Outcomes and Measures
The primary outcome was BMI lower than 16. Analyses assessed the prevalence of BMI lower than 16, its association with sociodemographic factors, and change in prevalence. Logistic regression models were used to calculate odds ratios (ORs), adjusting for survey design and age structure.
Results
Among countries examined, the pooled, weighted, and age-standardized prevalence of BMI lower than 16 was 1.8% (95% CI, 1.7% to 1.8%) with the highest prevalence in India (6.2% [95% CI, 5.9% to 6.5%]), followed by Bangladesh (3.9% [95% CI, 3.4% to 4.3%]), Madagascar (3.4% [95% CI, 2.8% to 4.0%], Timor-Leste (2.9% [95% CI, 2.4% to 3.2%]), Senegal (2.5% [95% CI, 1.9% to 3.2%]), and Sierra Leone (2.2% [95% CI, 1.3% to 3.0%]); and 6 countries had prevalences lower than 0.1% (Albania, Bolivia, Egypt, Peru, Swaziland, and Turkey). The prevalence of BMI lower than 16 in women with a secondary or higher education level was 0.51% (95% CI, 0.47% to 0.55%), and in mutually adjusted models, a less than primary education level was associated with an OR of 1.4 (95% CI, 1.2 to 1.6). The prevalence of BMI lower than 16 was 0.43% (95% CI, 0.37% to 0.48%) in the highest wealth quintile with an OR of 3.0 (95% CI, 2.4 to 3.7) in the lowest wealth quintile. Among the 24 of 39 countries with repeated surveys, there was no decrease in prevalence. In Bangladesh and India, rates were declining with an average absolute change annually of −0.52% (95% CI, −0.58% to −0.46%) in Bangladesh and −0.11% (95% CI, −0.12% to −0.10%) in India.
Conclusions and Relevance
Among women in 60 LMIC, the prevalence of BMI lower than 16 was 1.8%, and was associated with poverty and low education levels. Prevalence of BMI lower than 16 did not decrease over time in most countries studied.