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To describe trends of childhood stunting among under-5s in Uganda and to assess the impact of maternal education, wealth and residence on stunting.
Design
Serial and pooled cross-sectional analyses of data from Uganda Demographic and Health Surveys (UDHS) of 1995, 2001, 2006 and 2011. Prevalence of stunting and mean height-for-age Z-score were computed by maternal education, wealth index, region and other sociodemographic characteristics. Multivariable logistic and linear regression models were fitted to survey-specific and pooled data to estimate independent associations between covariates and stunting or Z-score. Sampling weights were applied in all analyses.
Setting
Uganda.
Subjects
Children aged <5 years.
Results
Weighted sample size was 14 747 children. Stunting prevalence decreased from 44·8% in 1995 to 33·2% in 2011. UDHS reported stunting as 38% in 1995, underestimating the decline because of transitioning from National Center for Health Statistics/Centers for Disease Control and Prevention standards to WHO standards. Nevertheless, one in three Ugandan children was still stunted by 2011. South Western, Mid Western, Kampala and East Central regions had highest odds of stunting. Being born in a poor or middle-income household, of a teen mother, without secondary education were associated with stunting. Other persistent stunting predictors included small birth size, male gender and age 2–3 years.
Conclusions
Sustained decrease in stunting suggests that child nutrition interventions have been successful; however, current prevalence does not meet Millennium Development Goals. Stunting remains a public health concern and must be addressed. Customizing established measures such as female education and wealth creation while targeting the most vulnerable groups may further reduce childhood stunting.
If gender is neglected in the design and implementation of mainstream social welfare models, unequal social and economic outcomes for men and women tend to be reproduced. This paper contributes to debates about how social protection can contribute to promoting gender equality by considering the gendered redistributive and transformative effects of three types of social security instruments in South Africa: social assistance, unemployment insurance and public employment programmes. All the instruments have some pro-poor and gendered design innovations. The Child Support Grant has had better outcomes than the other instruments, but redistributive and transformative gender effects across the social security spectrum are disappointing. Limited social transformation is largely due to implementation inefficiencies and unresponsive institutions. To serve both economically redistributive and socially transformative ends, gender-sensitive synergies between social security instruments and with other multisectoral interventions could be strengthened, such as access to social services (especially quality child care) and access to basic services (such as water, electricity, transport and internet services).
This article provides new evidence on the relationship between benefit conditionality and mental health. Using data on Temporary Assistance for Needy Families policies (TANF) – the main form of poverty relief in the United States – it explores whether the mental health of low-educated single mothers varies according to the stringency of conditionality requirements attached to receipt of benefit. Specifically, the article combines state-level data on sanctioning practices, work requirements and welfare-to-work spending with health data from the Behavioral Risk Factor Surveillance System and evaluates the impact of conditionality on mental health over a fifteen-year period (2000 to 2015). It finds that states that have harsher sanctions, stricter job search requirements and higher expenditure on welfare-to-work policies, have worse mental health among low-educated single mothers. There is also evidence that between-wave increases in the stringency of conditionality requirements are associated with deteriorations in mental health among the recipient population. It is suggested that these findings may reflect an overall effect of ‘intensive conditionality’, rather than of the individual variables per se. The article ends by considering the wider implications for policy and research.
Models of household decision-making commonly focus on nuclear family members as primary decision-makers. If extended families shape the objectives and constraints of households, then neglecting the role of this network may lead to an incomplete understanding of health-seeking behaviour. Understanding the decision-making processes behind care-seeking may improve behaviour change interventions, better intervention targeting and support health-related development goals. This paper uses data from a cluster randomised trial of a participatory learning and action cycle (PLA) through women’s groups, to assess the role of extended family networks as a determinant of gains in health knowledge and health practice. We estimate three models along a continuum of health-seeking behaviour: one that explores access to PLA groups as a conduit of knowledge, another measuring whether women’s health knowledge improves after exposure to the PLA groups and a third exploring the determinants of their ability to act on knowledge gained. We find that, in this context, a larger network of family is not associated with women’s likelihood of attending groups or acquiring new knowledge, but a larger network of husband’s family is negatively associated with the ability to act on that knowledge during pregnancy and the postpartum period.
The aim of this study was to establish the association of maternal, family, and contextual correlates of anthropometric typologies at the household level in Colombia using 2005 Demographic Health Survey (DHS/ENDS) data.
Methods.
Household-level information from mothers 18–49 years old and their children <5 years old was included. Stunting and overweight were assessed for each child. Mothers were classified according to their body mass index. Four anthropometric typologies at the household level were constructed: normal, underweight, overweight, and dual burden. Four three-level [households (n = 8598) nested within municipalities (n = 226), nested within states (n = 32)] hierarchical polytomous logistic models were developed. Household log-odds of belonging to one of the four anthropometric categories, holding ‘normal’ as the reference group, were obtained.
Results.
This study found that anthropometric typologies were associated with maternal and family characteristics of maternal age, parity, maternal education, and wealth index. Higher municipal living conditions index was associated with a lower likelihood of underweight typology and a higher likelihood of overweight typology. Higher population density was associated with a lower likelihood of overweight typology.
Conclusion.
Distal and proximal determinants of the various anthropometric typologies at the household level should be taken into account when framing policies and designing interventions to reduce malnutrition in Colombia.
In this essay, we discuss the under-representation of women in leadership positions in global health (GH) and the importance of mentorship to advance women's standing in the field. We then describe the mentorship model of GROW, Global Research for Women. We describe the theoretical origins of the model and an adapted theory of change explaining how the GROW model for mentorship advances women's careers in GH. We present testimonials from a range of mentees who participated in a pilot of the GROW model since 2015. These mentees describe the capability-enhancing benefits of their mentorship experience with GROW. Thus, preliminary findings suggest that the GROW mentorship model is a promising strategy to build women's leadership in GH. We discuss supplemental strategies under consideration and next steps to assess the impact of GROW, providing the evidence to inform best practices for curricula elsewhere to build women's leadership in GH.
The paper distils results from a review of relevant literature and two gender analyses to highlight reasons for gender imbalances in senior roles in global health and ways to address them. Organizations, leadership, violence and discrimination, research and human resource management are all gendered. Supplementary materials from gender analyses in two African health organizations demonstrate how processes such as hiring, deployment and promotion, and interpersonal relations, are not ‘gender-neutral’ and that gendering processes shape privilege, status and opportunity in these health organizations. Organizational gender analysis, naming stereotypes, substantive equality principles, special measures and enabling conditions to dismantle gendered disadvantage can catalyze changes to improve women's ability to play senior global health roles in gendered organizations. Political strategies and synergies with autonomous feminist movements can increase women's full and effective participation and equal opportunities. The paper also presents organizational development actions to bring about more gender egalitarian global health organizations.
This article examines the development of the EU's gender equality framework of ‘hard’ and ‘soft’ law, including the incomplete gender mainstreaming of the European Employment Strategy. It highlights contradictions, rooted in political tensions between the social democratic principles which underpin the European Social Model, and the promotion of neo-liberal economic policies. It assesses the UK's role in shaping this European framework, and the framework's impact on the UK's employment policy. It concludes that Brexit will harm the pursuit of gender equality in the UK due to decoupling from the EU's equality framework and policy pathway. An additional risk is greater insularity in UK policy making through reduced exposure to the Open Method of Coordination. Brexit may, however, help progress gender equality in the rest of the EU if the outcome is greater unity focussed on an inclusive employment policy without the UK dragging its heels in favour of deregulated flexibility.
Historically, women have been less likely to be supported through higher degree training programmes, and they continue to hold more junior positions in science. This paper reviews the current gender research and gender capacity-building efforts led by the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR). Created more than 40 years ago as the only United Nations-based Special Programme dedicated to research and research capacity building on infectious diseases, TDR has a longstanding track record both in supporting research into gender-specific questions and in research capacity strengthening among women scientists. We provide an overview of these approaches, then describe a recent pilot programme on Women in Science, designed to understand and remedy the gender gaps in health research. The programme focused on Africa, but it is hoped that the replication of such schemes in TDR and other international funding agencies will lead to more attention being given to women in infectious diseases research in other continents.
This article may not be reprinted or reused in any way in order to promote any commercial products or services.
Gender equality is considered paramount to the success of the Sustainable Development Goals and incorporated into global health programming and delivery, but there is great gender disparity within global health leadership and an absence of women at the highest levels of decision making. This perspective piece outlines the current gaps and challenges, highlighting the lack of data and unanswered questions regarding possible solutions, as well as the activity of Women in Global Health and efforts to directly address the inequity and lack of female leaders. We conclude with an agenda and tangible next steps of action for promoting women's leadership in health as a means to promote the global goals of achieving gender equality and catalyzing change.
Gender equity is imperative to the attainment of healthy lives and wellbeing of all, and promoting gender equity in leadership in the health sector is an important part of this endeavour. This empirical research examines gender and leadership in the health sector, pooling learning from three complementary data sources: literature review, quantitative analysis of gender and leadership positions in global health organisations and qualitative life histories with health workers in Cambodia, Kenya and Zimbabwe. The findings highlight gender biases in leadership in global health, with women underrepresented. Gender roles, relations, norms and expectations shape progression and leadership at multiple levels. Increasing women's leadership within global health is an opportunity to further health system resilience and system responsiveness. We conclude with an agenda and tangible next steps of action for promoting women's leadership in health as a means to promote the global goals of achieving gender equity.
The SiS (Sex in Science) Programme on the WGC (Wellcome Genome Campus) was established in 2011. Key participants include the Wellcome Trust Sanger Institute, EMB-EBI (EMBL-European Bioinformatics Institute), Open Targets and Elixir. The key objectives are to catalyse cultural change, develop partnerships, communicate activities and champion our women in science work at a national and international level (http://www.sanger.ac.uk/about/sex-science). In this paper, we highlight some of the many initiatives that have taken place since 2013, to address gender inequality at the highest levels; the challenges we have faced and how we have overcome these, and the future direction of travel.
Antimicrobial resistance (AMR) is a global public health threat. Emergence of AMR occurs naturally, but can also be selected for by antimicrobial exposure in clinical and veterinary medicine. Despite growing worldwide attention to AMR, there are substantial limitations in our understanding of the burden, distribution and determinants of AMR at the population level. We highlight the importance of population-based approaches to assess the association between antimicrobial use and AMR in humans and animals. Such approaches are needed to improve our understanding of the development and spread of AMR in order to inform strategies for the prevention, detection and management of AMR, and to support the sustainable use of antimicrobials in healthcare.
Attracting and retaining women in health research is crucial as it will maximize creativity and innovation as well as increase gender competency and expertise in the field. To help address the gender gap in the research for health field in Cameroon, some women research scientists formed the Higher Institute for Growth in HEalth Research for Women (HIGHER Women) consortium to support and encourage the growth of women research scientists through a training institute with a Mentor–Protégé Program (MPP). The consortium set up a MPP aiming at providing professional guidance to facilitate protégés' growth and emergence in health research. The consortium has conducted two workshops aiming at increasing the early-career women's skills needed to launch their career and focusing on proposal writing with the aim of producing a fundable project. Since 2015, the consortium has brought together approximately 100 women comprising of 80 protégés. The most significant outcome is in the protégés' feedback from their annual evaluations. The protégés are now more likely to submit abstracts and attend international conferences. Some grants have been obtained as a result of the working relationship with mentors. The HIGHER women consortium works to develop a pipeline of women leaders in health research by fostering growth and leadership culture through their MPP.
Girls at early stages of adolescence are vulnerable to violence victimization in humanitarian contexts, but few studies examine factors that affect girls’ hope in these settings. We assessed attitudes toward traditional gender norms as an effect modifier of the relationship between violence exposure and future orientation in displaced girls.
Methods.
Secondary analysis, using multivariable regression of cross-sectional data from girls ages 10–14 in South Kivu, Democratic Republic of the Congo. Key variables of interest were attitudes toward intimate partner violence (IPV), Children's Hope Scale (CHS) score, and exposure to physical, emotional, and sexual violence within the last 12 months. Additional covariates included age, educational status, and territory.
Results.
The interaction of exposure to violence and attitudes toward IPV magnified the association between violence exposure and lower CHS score for physical violence (β = −0.09, p = 0.040) and unwanted sexual touching (β = −0.20, p = 0.003) among girls age 10–14, when adjusting for other covariates. The interaction of exposure to violence and attitudes toward IPV magnified the association between violence exposure and lower CHS score for forced sex (β = −0.22, p = 0.016) among girls age 13–14, when adjusting for covariates. Findings for emotional violence, any form of sexual violence, and coerced sex trended toward lower CHS scores for girls who reported higher acceptance of IPV, but did not reach significance.
Conclusions.
Findings support the utility of gender norms-transformative programming in increasing resilience of girls who have experienced sexual violence in humanitarian contexts.
National efforts to reduce low birth weight (LBW) and child malnutrition and mortality prioritise economic growth. However, this may be ineffective, while rising gross domestic product (GDP) also imposes health costs, such as obesity and non-communicable disease. There is a need to identify other potential routes for improving child health. We investigated associations of the Gender Inequality Index (GII), a national marker of women's disadvantages in reproductive health, empowerment and labour market participation, with the prevalence of LBW, child malnutrition (stunting and wasting) and mortality under 5 years in 96 countries, adjusting for national GDP. The GII displaced GDP as a predictor of LBW, explaining 36% of the variance. Independent of GDP, the GII explained 10% of the variance in wasting and stunting and 41% of the variance in child mortality. Simulations indicated that reducing GII could lead to major reductions in LBW, child malnutrition and mortality in low- and middle-income countries. Independent of national wealth, reducing women's disempowerment relative to men may reduce LBW and promote child nutritional status and survival. Longitudinal studies are now needed to evaluate the impact of efforts to reduce societal gender inequality.