IMPORTANCE Evidence on the suitability of anthropometric failure (ie, stunting, underweight, and wasting) as a stand-alone measure of child undernutrition can inform global and national nutrition and health agendas. OBJECTIVE To provide a comprehensive estimate of the prevalence of child undernutrition by evaluating both dietary and anthropometric measures simultaneously across 55 low-and middleincome countries. DESIGN, SETTING, AND PARTICIPANTS This was a cross-sectional study that used Demographic and Health Surveys program data from July 2009 to January 2019, to allocate children into dietary and anthropometric failure categories. Nationally representative household surveys were conducted in 55 low-and middle-income countries. Participants included children aged 6 to 23 months who were born singleton and had valid anthropometric measures as well as available 24-hour food intake recollection. Data analysis was conducted from August 23 to October 22, 2020. EXPOSURES Two factors were considered to allocate children into the respective categories. Dietary failure was based on the World Health Organization standards for minimum dietary diversity. Anthropometric failure was constructed using the World Health Organization child growth reference standard z score for stunted growth, muscle wasting, and less than average weight for age. MAIN OUTCOMES AND MEASURES Dietary and anthropometric failures were cross-tabulated, which yielded 4 potential outcomes: dietary failure only, anthropometric failure only, both failures, and neither failure. Total child populations for each category were extrapolated from United Nations population estimates. RESULTS Of the 162 589 children (median age [range], 14 months [6-23 months]; 83 467 boys [51.3%]; 78 894 Asian children [48.5%]) in our sample, 42.9% of children had dietary failure according to the standard World Health Organization definition without being identified as having anthropometric failures. In all, 34.7% had both failures, 42.9% had dietary failure only, 8.3% had anthropometric failure only, and 14.1% had neither failure. Dietary and anthropometric measures were discordant for 51.2% of children; these children had nutritional needs identified by only 1 of the 2 measures. Dietary failure doubled the proportion of children in need of dietary interventions compared with anthropometry alone (43%). A total of 45.3 million additional children who experienced undernutrition in these 55 countries were not captured through the evaluation of anthropometric failures only. These results were consistent across geographic regions. CONCLUSIONS AND RELEVANCE The results of this cross-sectional study suggest that the current standard of measuring child undernutrition by estimating the prevalence of anthropometric failure (continued) Key Points Question Is anthropometric failure an adequate stand-alone measure to estimate global child undernutrition, and how do estimates change when dietary measures are also taken into account? Findings In this cross-sectional study of 162 589 children (...
Background: High-quality peer reviews are often thought to be essential to ensuring the integrity of the scientific publication process but measuring peer review quality is challenging. Although imperfect, review word count could serve as a simple, objective metric of review quality. We aimed to examine the prevalence of very short reviews and how often they inform editorial decisions on research articles in leading general medical journals. Methods: We compiled a data set of peer reviews from published full-length original research articles in The BMJ, BMC Medicine, and PLOS Medicine for the years 2003 to 2022. In our primary analyses, we used a threshold of <200 words to calculate the prevalence of very short reviews. In secondary analyses, we also used thresholds of <100 and <300 words. In addition to disaggregating results by journal and year, we plotted the proportion of articles for which the first editorial decision was made based on a set of peer reviews in which very short reviews constituted 100%, >=50%, >=33%, or >=20% of the reviews. Results: In this sample of 11,466 reviews corresponding to 4,038 published articles, the median review word count was 425 (Interquartile Range=253-675), and the mean was 520 (Standard Deviation=401). The overall prevalence of very short (<200 words) reviews was 17.1% [95% CI: 16.4%-17.8%]. Across the three journals, 20.9% [95% CI: 19.6%-22.2%] of initial editorial decisions were based on review sets containing ≥50% very short reviews. The prevalence of very short reviews and share of editorial decisions based on review sets containing >=50% very short reviews was highest for BMC Medicine at 26.8% [95% CI: 25.1%-28.5%] and lowest for The BMJ at 7.3% [95% CI: 5.7%-8.9%]. Conclusions: A substantial proportion of initial editorial decisions for published articles in these three leading general medical journals was based on peer reviews of such short length that they were unlikely to be of high quality. Future research should determine whether monitoring peer review length is a useful approach to improving the quality of the peer review process and which interventions, such as incentives and norm-based interventions, are most effective in soliciting more detailed reviews.
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