Background: Globally, malnutrition accounts for at least half of all childhood deaths. Managing malnutrition in the community settings involves identifying malnutrition using a universally validated screening tool and implementing appropriate interventions according to the degree of malnutrition. The aim of this study was to estimate prevalence and associated factors that result in malnutrition among children under-five years of age in Thatta and Sujawal districts in Sindh province, Pakistan. Methods: A cross-sectional survey was conducted between May and August 2014. A total of 3964 children underfive years were enrolled in the study. The WHO growth standards height-for-age Z-scores (HAZ), weight-for-height Z-scores (WHZ) and weight-for-age Z-scores (WAZ) were used to measure stunting, wasting and underweight. A structured questionnaire was used to collect data on socioeconomic conditions, family size, maternal education, parity and child morbidity. Multivariable logistic regression was used to determine the risk factors for malnutrition. Results: The prevalence of stunting, wasting and underweight were 48.2% (95% CI: 47.1-50.3), 16.2% (95% CI: 15.5-17. 9), and 39.5% (95% CI: 38.4-41.5), respectively. Stunting was slightly higher (51%) in boys than in girls (45%) (p < 0.001). The proportion of wasting (p = 0.039) and underweight (p = 0.206) was not significantly different between boys and girls. Fifty percent children in the poorest households were stunted as compared to 42% in the wealthiest households. Children in the poorest households were two times more likely to be wasted (20.6%) than children in the wealthiest households (10.3%) (OR 2.33, CI 1.69-3.21, p < 0.001). A similar relationship was observed between household wealth and underweight in children (43.8% in poorest and 28.8% in wealthiest households (OR 2.18, CI 1.72-2.77, p < 0.001). Household wealth was significantly associated with stunting, wasting and underweight. Diarrhea was associated with underweight. Factors such as mother's education, parity and family size were not associated with malnutrition in our study area. Conclusions: The findings of our study revealed that malnutrition was widespread among the children underfive years of age. The food/nutrient based interventions together with improved hygiene practices and household wealth should be targeted to improve malnutrition situation in the study area and in the country.

ObjectiveTo assess the effect of high-dose vitamin D in patients with painful diabetic neuropathy.MethodsA single intramuscular dose of 600 000 IU vitamin D was administered, and the effects on metabolic parameters and neuropathic pain assessed over 20 weeks.Results143 participants with predominantly type 2 diabetes, aged 52.31±11.48 years, with a Douleur Neuropathique 4 (DN4) score (3.0±1.8), total McGill pain score (21.2±14.9), and Short Form McGill Pain Questionnaire (SFMPQ) score (2.1±0.9), were enrolled. The baseline 25-hydroxyvitamin D (25(OH)D) level was 31.7±23.3 ng/mL and 58 (40.5%) patients showed evidence of vitamin D deficiency (25(OH)D<20 ng/mL). Intramuscular administration of vitamin D resulted in a significant increase in 25(OH)D (46.2±10.2 ng/mL, p<0.0001) and a reduction in positive symptoms on the DN4 (p<0.0001), total pain score (p<0.0001), and SFMPQ (p<0.0001).ConclusionsTreatment with a single intramuscular dose of 600 000 IU of vitamin D in patients with painful diabetic neuropathy is associated with a significant decrease in the symptoms of painful diabetic neuropathy.Trial registration numberBIDE-12/2014.

Culture-independent diagnostics have revealed a larger burden of Shigella among children in low-resource settings than previously recognized. We further characterized the epidemiology of Shigella in the first two years of life in a multisite birth cohort. We tested 41,405 diarrheal and monthly non-diarrheal stools from 1,715 children for Shigella by quantitative PCR. To assess risk factors, clinical factors related to age and culture positivity, and associations with inflammatory biomarkers, we used log-binomial regression with generalized estimating equations. The prevalence of Shigella varied from 4.9%-17.8% in non-diarrheal stools across sites, and the incidence of Shigella -attributable diarrhea was 31.8 cases (95% CI: 29.6, 34.2) per 100 child-years. The sensitivity of culture compared to qPCR was 6.6% and increased to 27.8% in Shigella -attributable dysentery. Shigella diarrhea episodes were more likely to be severe and less likely to be culture positive in younger children. Older age (RR: 1.75, 95% CI: 1.70, 1.81 per 6-month increase in age), unimproved sanitation (RR: 1.15, 95% CI: 1.03, 1.29), low maternal education (<10 years, RR: 1.14, 95% CI: 1.03, 1.26), initiating complementary foods before 3 months (RR: 1.10, 95% CI: 1.01, 1.20), and malnutrition (RR: 0.91, 95% CI: 0.88, 0.95 per unit increase in weight-for-age z-score) were risk factors for Shigella . There was a linear dose-response between Shigella quantity and myeloperoxidase concentrations. The burden of Shigella varied widely across sites, but uniformly increased through the second year of life and was associated with intestinal inflammation. Culture missed most clinically relevant cases of severe diarrhea and dysentery.

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BackgroundThe United Nation’s Sustainable Development Goals encompass lifelong learning from birth to youth to adulthood (Goal 4) and economic opportunities for young people (Goal 8). The targets include improving access to quality early childhood care and education (ECCE) as well as learning and training opportunities for adolescents and youth. Cross-generational models for young children and youth may offer opportunities to address the interconnections between goals and targets for the next generation. We investigated whether an ECCE programme for young children (3.5–6.5 years) delivered by female youth (18–24 years) in rural Pakistan would be effective on children’s school readiness.MethodsIn partnership with the National Commission for Human Development in Pakistan, we implemented the ‘Youth Leaders for Early Childhood Assuring Children are Prepared for School’ (LEAPS) programme to train female youth to deliver ECCE. The effectiveness of the LEAPS programme on children’s school readiness was evaluated in a cluster-randomised controlled trial. We randomly allocated five clusters (villages) to receive the intervention (n = 170 children) and five clusters to control (n = 170 children). Children’s school readiness was assessed after nine months of intervention exposure using the International Development and Early Learning Assessment tool. Analyses was by intention-to-treat. The trial is registered with ClinicalTrials.gov, number NCT02645162.FindingsAt endline, the intervention group had significantly higher school readiness scores (n = 166, mean percentage score 59.4, 95% CI 52.7 to 66.2) compared with the control group (n = 168, mean percentage score 45.5, 95% CI 38.8 to 52.3). The effect size (Cohen’s d) was 0.3.ConclusionTrained female youth delivered an ECCE programme that was effective in benefitting young children’s school readiness. The cross-generational model is a promising approach to support early child development; however, further evaluation of the model is needed to assess the specific benefits to youth including their skills and economic development.