IntroductionZika virus infection during pregnancy causes serious birth defects and might be associated with neurodevelopmental abnormalities in children. Early identification of and intervention for neurodevelopmental problems can improve cognitive, social, and behavioral functioning.MethodsPregnancies with laboratory evidence of confirmed or possible Zika virus infection and infants resulting from these pregnancies are included in the U.S. Zika Pregnancy and Infant Registry (USZPIR) and followed through active surveillance methods. This report includes data on children aged ≥1 year born in U.S. territories and freely associated states. Receipt of reported follow-up care was assessed, and data were reviewed to identify Zika-associated birth defects and neurodevelopmental abnormalities possibly associated with congenital Zika virus infection.ResultsAmong 1,450 children of mothers with laboratory evidence of confirmed or possible Zika virus infection during pregnancy and with reported follow-up care, 76% had developmental screening or evaluation, 60% had postnatal neuroimaging, 48% had automated auditory brainstem response-based hearing screen or evaluation, and 36% had an ophthalmologic evaluation. Among evaluated children, 6% had at least one Zika-associated birth defect identified, 9% had at least one neurodevelopmental abnormality possibly associated with congenital Zika virus infection identified, and 1% had both.ConclusionOne in seven evaluated children had a Zika-associated birth defect, a neurodevelopmental abnormality possibly associated with congenital Zika virus infection, or both reported to the USZPIR. Given that most children did not have evidence of all recommended evaluations, additional anomalies might not have been identified. Careful monitoring and evaluation of children born to mothers with evidence of Zika virus infection during pregnancy is essential for ensuring early detection of possible disabilities and early referral to intervention services.

Formative research was conducted in the Republic of the Marshall Islands to help develop a diabetes prevention intervention. Methods included in-depth interviews, semistructured interviews, and direct observation of household behaviors in urban and remote settings. Foods were classified into two main conceptual spheres: foods from the islands/Marshallese foods and imported/American foods. Diabetes (nanimij in tonal) is a highly salient illness and is believed to be caused by foods high in fat and sugar, consumption of imported/American foods, family background, and the atomic bomb testing. Physical activity and eating a traditional diet were viewed as important for preventing diabetes. The traditional belief system links a large body with health, and a thin body with illness; however, perceptions are changing with increased acculturation and education about the health risks of obesity. These findings were used to develop a diabetes prevention home visit intervention currently being implemented and evaluated in Marshallese households.This article presents formative research on the prevention of non-insulin-dependent diabetes mellitus (NIDDM) in the Republic of the Marshall Islands. NIDDM is a major cause of debilitating morbidity and mortality in industrialized countries and increasingly in nonindustrialized countries. As the onset of diabetes in the nonindustrialized world is linked with lifestyle changes associated with the globalization of the world economy and acculturative Western influence, effective primary prevention strategies are desperately needed.1,2 Unfortunately, interventions aimed at the primary prevention

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Many low-and middle-income countries are faced with a double burden of malnutrition characterized by a stagnating burden of undernutrition and an increasing prevalence of overweight and obesity often observed both at population and household levels. We used data from the 2017 National Integrated Child Health and Nutrition Survey in the Republic of the Marshall Islands to explore the prevalence of overweight mother-stunted child pairs (mother-child double burden, MCDB). We used bivariate analysis, multivariate logistic regression, and multinomial logistic regression analysis to explore associations between child-, maternal-, and household-level variables and both stunting and MCDB and other types of maternal-child pairs. Our results indicate that nearly three out of four mothers were overweight or obese and one in four households is home to an overweight mother with a stunted child. The risk of child stunting and of MCDB were largely associated with maternal characteristics of lower maternal height, maternal age at birth, years of education, and marital status and household economic status as measured by wealth index and number of household members. These findings support the growing body of evidence showing that the coexistence of high maternal overweight and child stunting (MCDB) has linked root causes to early life undernutrition that are exacerbated by the nutrition transition. KEYWORDS children, double burden of malnutrition, maternal obesity, Pacific, Republic of the Marshall Islands, stunting 1 | BACKGROUND Many low-and middle-income countries are faced with a double burden of malnutrition characterized by a stagnating burden of undernutrition and an increasing burden of overweight and obesity (Gillespie & Haddad, 2001). This phenomenon can occur at the population level, within communities and households, and even in the same person. Globally, the double burden of malnutrition is largely attributed to the nutrition transition in which populations shift from consumption of traditional nutrient-dense and low-fat diets to a "Western" diet consisting of high-energy, nutrient-poor foods (Ghattas, 2014; Popkin, 2002; Ziaullah, 2014). These processed convenience and snack foods are increasingly available and affordable in low-and middle-income countries as a result of economic growth and urbanization (Food and Agriculture Organization [FAO], 2006; Hoffman, 2001).

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