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Summary Background India's 2011 census revealed a growing imbalance between the numbers of girls and boys at ages 0–6 years, which we hypothesise is due to increased prenatal sex determination followed by selective abortion of female foetuses. Methods We examined sex ratios by birth order among 0.25 million births in three rounds of the nationally-representative National Family Health Survey covering the period from 1990 to 2005. We estimated totals of selective female abortion by examining the birth cohorts of children aged 0–6 years in the 1991, 2001 and 2011 censuses. Findings The conditional sex ratio for second order births when the firstborn was a girl fell from 906 per 1000 boys in 1990 (99%CI 798–1013) to 836 in 2005 (99%CI 733–939); an annual decline of 0.5% (p for trend=0·001). Declines were much greater in mothers with 10 or more years of education than in illiterate mothers, and in wealthier households compared to poorer households. In contrast, no significant declines were noted in the sex ratio for second order births if the firstborn was a male, or for firstborns. Between the 2001 and 2011 censuses, more than twice the number of Indian districts (local administrative areas) showed declines in the child sex ratio as districts showing no change or increases. After adjusting for excess mortality rates in girls, the estimated number of selective female abortions rose from 0 to 2.0 million in the 1980s, 1.2 to 4.1 million in the 1990s, and 3.1 to 6.0 in the 2000s. Each 1% decline in child sex ratio at ages 0–6 years implied 1.2 to 3.6 million more selective female abortions. Selective female abortions totalled about 4.2 to 12.1 million from 1980–2010, with a greater rate of increase in the 1990s than in the 2000s. Interpretation Selective abortion of female foetuses, especially for pregnancies following a firstborn girl, has increased substantially in India. Most of India's population now live in states where selective female abortion is common. Funding US National Institutes of Health, Canadian Institute of Health Research, International Development Research Centre, Li Ka Shing Knowledge Institute.

SummaryBackground-Malaria, a non-fatal disease if detected promptly and treated properly, still causes many deaths in malaria-endemic countries with limited healthcare facilities. National malaria mortality rates are, however, particularly difficult to assess reliably in such countries, as any fevers reliably diagnosed as malaria are likely therefore to be cured. Hence, most malaria deaths are from undiagnosed malaria, which may be misattributed in retrospective enquiries to other febrile causes of death, or vice-versa.

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Results do not support the hypothesis of association observed in previous studies after appropriate controlling for confounding variables. Negative peri-natal outcomes are better explained by determinants other than periodontal health. This study adds to the growing body of literature on the relationship between periodontal diseases and systemic health.

BackgroundFinancial incentives are widely used strategies to alleviate poverty, foster development, and improve health. Cash transfer programs, microcredit, user fee removal policies and voucher schemes that provide direct or indirect monetary incentives to households have been used for decades in Latin America, Sub-Saharan Africa, and more recently in Southeast Asia. Until now, no systematic review of the impact of financial incentives on coverage and uptake of health interventions targeting children under 5 years of age has been conducted. The objective of this review is to provide estimates on the effect of six types of financial incentive programs: (i) Unconditional cash transfers (CT), (ii) Conditional cash transfers (CCT), (iii) Microcredit (MC), (iv) Conditional Microcredit (CMC), (v) Voucher schemes (VS) and (vi) User fee removal (UFR) on the uptake and coverage of health interventions targeting children under the age of five years.MethodsWe conducted systematic searches of a series of databases until September 1st, 2012, to identify relevant studies reporting on the impact of financial incentives on coverage of health interventions and behaviors targeting children under 5 years of age. The quality of the studies was assessed using the CHERG criteria. Meta-analyses were undertaken to estimate the effect when multiple studies meeting our inclusion criteria were available.ResultsOur searches resulted in 1671 titles identified 25 studies reporting on the impact of financial incentive programs on 5 groups of coverage indicators: breastfeeding practices (breastfeeding incidence, proportion of children receiving colostrum and early initiation of breastfeeding, exclusive breastfeeding for six months and duration of breastfeeding); vaccination (coverage of full immunization, partial immunization and specific antigens); health care use (seeking healthcare when child was ill, visits to health facilities for preventive reasons, visits to health facilities for any reason, visits for health check-up including growth control); management of diarrhoeal disease (ORS use during diarrhea episode, continued feeding during diarrhea, healthcare during diarrhea episode) and other preventive health interventions (iron supplementation, vitamin A, zinc supplementation, preventive deworming). The quality of evidence on the effect of financial incentives on breastfeeding practices was low but seems to indicate a potential positive impact on receiving colostrum, early initiation of breastfeeding, exclusive breastfeeding and mean duration of exclusive breastfeeding. There is no effect of financial incentives on immunization coverage although there was moderate quality evidence of conditional cash transfers leading to a small but non-significant increase in coverage of age-appropriate immunization. There was low quality evidence of impact of CCT on healthcare use by children under age 5 (Risk difference: 0.14 [95%CI: 0.03; 0.26]) as well as low quality evidence of an effect of user fee removal on use of curative health services (RD=0....

The term "stunting" has become pervasive in international nutrition and child health research, program, and policy circles. Although originally intended as a population-level statistical indicator of children's social and economic deprivation, the conventional anthropometric definition of stunting (height-for-age z scores <-2 SD) is now widely used to define chronic malnutrition. Epidemiologists often portray it as a disease, making inferences about the causes of growth faltering based on comparisons between stunted (i.e., undernourished) and nonstunted children. Stunting is commonly used to monitor public health and nutrition program effectiveness alongside calls for the "elimination of stunting." However, there is no biological basis for the -2 SD cutoff to define stunting, making it a poor individual-level classifier of malnutrition or disease. In fact, in many low- and middle-income countries, children above and below the threshold are similarly affected by growth-limiting exposures. We argue that the common use of stunting as an indicator of child linear growth has contributed to unsubstantiated assumptions about the biological mechanisms underlying linear growth impairment in low- and middle-income countries and has led to a systematic underestimation of the burden of linear growth deficits among children in low-resource settings. Moreover, because nutrition-specific short-term public health interventions may result in relatively minor changes in child height, the use of stunting prevalence to monitor health or nutrition program effectiveness may be inappropriate. A more nuanced approach to the application and interpretation of stunting as an indicator in child growth research and public health programming is warranted.