ObjectiveTo determine the impact of intimate partner violence against women on children’s growth and nutritional status in low- and middle-income countries.MethodsWe pooled records from 42 demographic and health surveys in 29 countries. Data on maternal lifetime exposure to physical or sexual violence by an intimate partner, socioeconomic and demographic characteristics were collected. We used logistic regression models to determine the association between intimate partner violence and child stunting and wasting.FindingsPrior exposure to intimate partner violence was reported by 69 652 (34.1%) of the 204 159 ever-married women included in our analysis. After adjusting for a range of characteristics, stunting in children was found to be positively associated with maternal lifetime exposure to only physical (adjusted odds ratio, aOR: 1.11; 95% confidence interval, CI: 1.09–1.14) or sexual intimate partner violence (aOR: 1.09; 95% CI: 1.05–1.13) and to both forms of such violence (aOR: 1.10; 95% CI: 1.05–1.14). The associations between stunting and intimate partner violence were stronger in urban areas than in rural ones, for mothers who had low levels of education than for women with higher levels of education, and in middle-income countries than in low-income countries. We also found a small negative association between wasting and intimate partner violence (aOR: 0.94; 95%CI: 0.90–0.98).ConclusionIntimate partner violence against women remains common in low- and middle-income countries and is highly detrimental to women and to the growth of the affected women’s children. Policy and programme efforts are needed to reduce the prevalence and impact of such violence.
ObjectiveDespite multiple published studies regarding the association between formaldehyde exposure and childhood asthma, a consistent association has not been identified. Here we report the results of a systematic review of published literature in order to provide a more comprehensive picture of this relationship.Data sourcesAfter a comprehensive literature search, we identified seven peer-reviewed studies providing quantitative results regarding the association between formaldehyde exposure and asthma in children. Studies were heterogeneous with respect to the definition of asthma (e.g., self-report, physician diagnosis). Most of the studies were cross-sectional.Data extractionFor each study, an odds ratio (OR) and 95% confidence interval (CI) for asthma were either abstracted from published results or calculated based on the data provided. Characteristics regarding the study design and population were also abstracted.Data synthesisWe used fixed- and random-effects models to calculate pooled ORs and 95% CIs; measures of heterogeneity were also calculated. A fixed-effects model produced an OR of 1.03 (95% CI, 1.02–1.04), and random effects model produced an OR of 1.17 (95% CI, 1.01–1.36), both reflecting an increase of 10 μg/m3 of formaldehyde. Both the Q and I2 statistics indicated a moderate amount of heterogeneity.ConclusionsResults indicate a significant positive association between formaldehyde exposure and childhood asthma. Given the largely cross-sectional nature of the studies underlying this meta-analysis, further well-designed prospective epidemiologic studies are needed.
Formaldehyde exposure and asthma in children: a systematic review Exposição ao formol e asma em crianças: uma revisão sistemáticaResumo Apesar de múltiplos estudos publicados sobre a associação entre exposição ao formol e asma infantil, uma relação consistente ainda não foi identificada. Nós relacionamos os resultados de revisão de estudos publicados a fim de fornecer uma imagem mais compreensível desta relação. Após pesquisa, foram identificados sete estudos que proviam resultados quantitativos sobre a associação entre a exposição ao formol e a asma infantil. Estudos foram heterogêneos em relação à definição de asma. Para cada estudo, uma razão de chances (RC) e 95% de intervalo de confiança (IC) para asma foram abstraídos de resultados publicados ou calculados baseados nos dados fornecidos. Foram usados modelos de efeitos fixos e aleatórios para calcular RC agrupados e IC de 95%; medidas de heterogeneidade também foram calculadas. Um modelo de efeitos fixos produziu um a RC de 1.03 (IC de 95%, 1.02-1.04), e o modelo de efeitos aleatórios produziu uma RC de 1.17 (IC de 95%, 1.01-1.36), ambos refletindo um aumento de 10 μg/m3 de exposição ao formol. As estatís-ticas de Q and I2 indicaram uma quantidade moderada de heterogeneidade. Resultados indicam uma associação positiva entre exposição ao formol e asma infantil. Devido à natureza de cruzamento de dados destes estudos por baixo desta meta-análise, um estudo de prospectiva epidemiológica mais aprofundada é necessário. Palavras-chave Asma, Crianças, Epidemiologia, Formol Abstract Despite multiple published studies regarding the association between formaldehyde exposure and childhood asthma, a consistent association has not been identified. Here we report the results of a systematic review of published literature in order to provide a more comprehensive picture of this relationship. After a literature search, we identified seven studies providing quantitative results regarding the association between formaldehyde exposure and asthma in children. Studies were heterogeneous with respect to the definition of asthma. For each study, an odds ratio (OR) and 95% confidence interval (CI) for asthma were abstracted from published results or calculated based on the data provided. We used fixed-and random-effects models to calculate pooled ORs and 95% CIs; measures of heterogeneity were also calculated. A fixed-effects model produced an OR of 1.03 (95% CI, 1.02-1.04), and random effects model produced an OR of 1.17 (95% CI, 1.01-1.36), both reflecting an increase of 10 μg/m3 of formaldehyde. Both the Q and I2 statistics indicated a moderate amount of heterogeneity. Results indicate a positive association between formaldehyde exposure and childhood asthma. Given the largely cross-sectional nature of the studies underlying this meta-analysis, further well-designed prospective epidemiologic studies are needed.
IntroductionLow-income and middle-income countries (LMICs) are crucial in the global response to antimicrobial resistance (AMR), but diverse health systems, healthcare practices and cultural conceptions of medicine can complicate global education and awareness-raising campaigns. Social research can help understand LMIC contexts but remains under-represented in AMR research.ObjectiveTo (1) Describe antibiotic-related knowledge, attitudes and practices of the general population in two LMICs. (2) Assess the role of antibiotic-related knowledge and attitudes on antibiotic access from different types of healthcare providers.DesignObservational study: cross-sectional rural health behaviour survey, representative of the population level.SettingGeneral rural population in Chiang Rai (Thailand) and Salavan (Lao PDR), surveyed between November 2017 and May 2018.Participants2141 adult members (≥18 years) of the general rural population, representing 712 000 villagers.Outcome measuresAntibiotic-related knowledge, attitudes and practices across sites and healthcare access channels.FindingsVillagers were aware of antibiotics (Chiang Rai: 95.7%; Salavan: 86.4%; p<0.001) and drug resistance (Chiang Rai: 74.8%; Salavan: 62.5%; p<0.001), but the usage of technical concepts for antibiotics was dwarfed by local expressions like ‘anti-inflammatory medicine’ in Chiang Rai (87.6%; 95% CI 84.9% to 90.0%) and ‘ampi’ in Salavan (75.6%; 95% CI 71.4% to 79.4%). Multivariate linear regression suggested that attitudes against over-the-counter antibiotics were linked to 0.12 additional antibiotic use episodes from public healthcare providers in Chiang Rai (95% CI 0.01 to 0.23) and 0.53 in Salavan (95% CI 0.16 to 0.90).ConclusionsLocally specific conceptions and counterintuitive practices around antimicrobials can complicate AMR communication efforts and entail unforeseen consequences. Overcoming ‘knowledge deficits’ alone will therefore be insufficient for global AMR behaviour change. We call for an expansion of behavioural AMR strategies towards ‘AMR-sensitive interventions’ that address context-specific upstream drivers of antimicrobial use (eg, unemployment insurance) and complement education and awareness campaigns.Trial registration numberClinicaltrials.gov identifier NCT03241316.
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