Chronic undernutrition and adolescent school performance in central Ethiopia

Chronic undernutrition among adolescents in developing countries has been identified as a major public health issue. Previous research has found associations between chronic undernutrition and academic performance outcomes in adolescents. There is need for localized research focusing on nutritional status and its association with educational outcomes among adolescents in different areas of Ethiopia. The purpose of this study was to examine whether chronic undernutrition (stunting) in adolescents in Ethiopia was correlated with various school performance outcomes. This study was a school-based cross-sectional study conducted in North Shewa zone, Ethiopia. Data were collected through a structured questionnaire. The researchers conducted multivariable linear regression analyses to investigate the relationship between stunting and four school performance outcomes, which included grade 8 Ministry exam score, all-subjects average score, English score, and Math score. The prevalence of stunting in this sample was 11%. After adjusting for all other variables in the model, stunting was positively associated with the grade eight Ministry exam score (β = -4.96; 95% [CI - 7.68, -2.25]; p < 0.001). In the multivariate analyses, sex (being female) was significantly associated with the grade eight Ministry exam score (β = -2.08; 95% CI [- 3.81, -0.35]; p = 0.019 ), the all-subjects average score (β = -3.97; 95% CI [-5.51, - 2.43]; p < 0.001), English score (β = -3.72; 95% CI [-5.60, -1.84]; p < 0 .001), and Math score (β = -4.87; 95% CI [-7.02, -2.72]; p < 0.001). Residence (living in a rural area) was significantly associated with all-subjects average score (β = -3.93; 95% CI [- 5.81, -2.06]; p < 0.001), English score (β = -2.65; 95% CI [-4.94, -0.35]; p = 0.024), and Math score (β = -3.86; 95% CI [-6.50, -1.22]; p = 0.004). Maternal education (grade 1-8) was significantly associated with English score (β = 5.46; 95% CI [1.31, 9.62]; p = 0.010) and Math score (β = 4.78; 95% CI [0.03, 9.53]; p = 0.049). These findings indicate that further research focusing on adolescent chronic undernutrition and educational outcomes as well as why chronic undernutrition is associated with certain performance outcomes and not others is needed before definitive conclusions can be made. Positive changes in child growth later in a child’s life may have important implications for cognition

Chronic undernutrition and adolescent school performance in central Ethiopia

Chronic undernutrition among adolescents in developing countries has been identified as a major public health issue. Previous research has found associations between chronic undernutrition and academic performance outcomes in adolescents. There isneed for localized research focusing on nutritional status and its association with educational outcomes among adolescents in different areas of Ethiopia. The purpose of this study was to examine whether chronic undernutrition (stunting) in adolescents inEthiopia was correlated with various school performance outcomes. This study was a school-based cross-sectional study conducted in North Shewa zone, Ethiopia. Data were collected through a structured questionnaire. The researchers conductedmultivariable linear regression analyses to investigate the relationship between stunting and four school performance outcomes, which included grade 8 Ministry exam score, all-subjects average score, English score, and Math score. The prevalence of stunting in this sample was 11%. After adjusting for all other variables in the model, stunting was positively associated with the grade eight Ministry exam score (β = -4.96; 95% [CI -7.68, -2.25]; p < 0.001). In the multivariate analyses, sex (being female) was significantly associated with the grade eight Ministry exam score (β = -2.08; 95% CI [-3.81, -0.35]; p = 0.019 ), the all-subjects average score (β = -3.97; 95% CI [-5.51, -2.43]; p < 0.001), English score (β = -3.72; 95% CI [-5.60, -1.84]; p < 0 .001), and Math score (β = -4.87; 95% CI [-7.02, -2.72]; p < 0.001). Residence (living in a rural area) was significantly associated with all-subjects average score (β = -3.93; 95% CI [- 5.81, -2.06]; p < 0.001), English score (β = -2.65; 95% CI [-4.94, -0.35]; p = 0.024), and Math score (β = -3.86; 95% CI [-6.50, -1.22]; p = 0.004). Maternal education (grade 1-8) was significantly associated with English score (β = 5.46; 95% CI [1.31, 9.62]; p = 0.010) and Math score (β = 4.78; 95% CI [0.03, 9.53]; p = 0.049). These findings indicate that further research focusing on adolescent chronic undernutrition and educational outcomes as well as why chronic undernutrition is associated with certain performance outcomes and not others is needed before definitive conclusions can be made. Positive changes in child growth later in a child’s life may have important implications for cognition

Situations Predisposing Primary Care Patients To Use Antibiotics Without a Prescription in the United States

BACKGROUND: Patients\u27 situations can impact their intentions to use antibiotics without medical guidance (non-prescription use) in the future. This survey determines the prevalence of intended (future) use of non-prescription antibiotics for 13 predefined situations and identifies the sociodemographic characteristics associated with intended use for these types of situations. METHODS: Patient surveys (N = 564) were conducted from January 2020 to June 2021 in the waiting rooms of 6 safety-net primary care clinics and 2 emergency departments in a private healthcare system. We used principal component analysis to identify 3 situational summary factors: barriers to a doctor visit, accessibility of non-prescription antibiotics, and previous symptom relief with antibiotics. Multivariate linear regression identified the sociodemographic predictors associated with each summary factor. RESULTS: The most common situations triggering patients to use non-prescription antibiotics were a perceived high cost of doctor visits (29.8%), having leftover prescription antibiotics (50.4%), and experiencing symptom relief with prior use of antibiotics (47.5%). Multivariate regression results revealed that younger patients ( CONCLUSIONS: Future stewardship interventions should consider the types of situations that drive patients\u27 decisions to use antibiotics without a prescription. Interventions aimed at reducing barriers to health care (eg, high costs and long waits associated with doctor appointments) and educating individuals on medically appropriate, nonantibiotic treatment options may reduce antibiotic use and antimicrobial resistance

Lack of Knowledge of Antibiotic Risks Contributes to Primary Care Patients\u27 Expectations of Antibiotics for Common Symptoms

Patient expectations of receiving antibiotics for common symptoms can trigger unnecessary use. We conducted a survey (n = 564) between January 2020 to June 2021 in public and private primary care clinics in Texas to study the prevalence and predictors of patients\u27 antibiotic expectations for common symptoms/illnesses. We surveyed Black patients (33%) and Hispanic/Latine patients (47%), and over 93% expected to receive an antibiotic for at least 1 of the 5 pre-defined symptoms/illnesses. Public clinic patients were nearly twice as likely to expect antibiotics for sore throat, diarrhea, and cold/flu than private clinic patients. Lack of knowledge of potential risks of antibiotic use was associated with increased antibiotic expectations for diarrhea (odds ratio [OR] = 1.6; 95% CI, 1.1-2.4) and cold/flu symptoms (OR = 2.9; 95% CI, 2.0-4.4). Lower education and inadequate health literacy were predictors of antibiotic expectations for diarrhea. Future antibiotic stewardship interventions should tailor patient education materials to include information on antibiotic risks and guidance on appropriate antibiotic indications

Heterogeneity in enterotoxigenic Escherichia coli and shigella infections in children under 5 years of age from 11 African countries: a subnational approach quantifying risk, mortality, morbidity, and stunting.

BACKGROUND: Diarrhoea, a global cause of child mortality and morbidity, is linked to adverse consequences including childhood stunting and death from other diseases. Few studies explore how diarrhoeal mortality varies subnationally, especially by cause, which is important for targeting investments. Even fewer examine indirect effects of diarrhoeal morbidity on child mortality. We estimated the subnational distribution of mortality, morbidity, and childhood stunting attributable to enterotoxigenic Escherichia coli (ETEC) and shigella infection in children younger than 5 years from 11 eastern and central African countries. These pathogens are leading causes of diarrhoea in young children and have been linked to increased childhood stunting. METHODS: We combined proxy indicators of morbidity and mortality risk from the most recent Demographic and Health Surveys with published relative risks to estimate the potential distribution of diarrhoeal disease risk. To estimate subnational burden, we used country-specific or WHO region-specific morbidity and mortality estimates and distributed them subnationally by three indices that integrate relevant individual characteristics (ie, underweight, probability of receiving oral rehydration treatment of diarrhoea, and receiving vitamin A supplementation) and household characteristics (ie, type of drinking water and sanitation facilities). FINDINGS: Characterising ETEC and shigella subnational estimates of indirect morbidity (infection-attributable stunting) and indirect mortality (stunting-related deaths from other infectious diseases) identified high-risk areas that could be missed by traditional metrics. Burundi and Democratic Republic of the Congo had the highest ETEC-associated and shigella-associated mortality and stunting rates. Mozambique, Democratic Republic of the Congo, and Zimbabwe had the greatest subnational heterogeneity in most ETEC and shigella mortality measures. Inclusion of indirect ETEC and shigella mortality in burden estimates resulted in a 20-30% increase in total ETEC and shigella mortality rates in some subnational areas. INTERPRETATION: Understanding the indirect mortality and morbidity of diarrhoeal pathogens on a subnational level will strengthen disease control strategies and could have important implications for the relative impact and cost-effectiveness of new enteric vaccines. Because our methods rely on publicly available data, they could be employed for national planning. FUNDING: Bill & Melinda Gates Foundation

Chronic undernutrition and adolescent school performance in central Ethiopia

Chronic undernutrition among adolescents in developing countries has been identified as a major public health issue. Previous research has found associations between chronic undernutrition and academic performance outcomes in adolescents. There is need for localized research focusing on nutritional status and its association with educational outcomes among adolescents in different areas of Ethiopia. The purpose of this study was to examine whether chronic undernutrition (stunting) in adolescents in Ethiopia was correlated with various school performance outcomes. This study was a school-based cross-sectional study conducted in North Shewa zone, Ethiopia. Data were collected through a structured questionnaire. The researchers conducted multivariable linear regression analyses to investigate the relationship between stunting and four school performance outcomes, which included grade 8 Ministry exam score, all-subjects average score, English score, and Math score. The prevalence of stunting in this sample was 11%. After adjusting for all other variables in the model, stunting was positively associated with the grade eight Ministry exam score (β = -4.96; 95% [CI -7.68, -2.25]; p &lt; 0.001). In the multivariate analyses, sex (being female) was significantly associated with the grade eight Ministry exam score (β = -2.08; 95% CI [-3.81, -0.35]; p = 0.019 ), the all-subjects average score (β = -3.97; 95% CI [-5.51, -2.43]; p &lt; 0.001), English score (β = -3.72; 95% CI [-5.60, -1.84]; p &lt; 0 .001), and Math score (β = -4.87; 95% CI [-7.02, -2.72]; p &lt; 0.001). Residence (living in a rural area) was significantly associated with all-subjects average score (β = -3.93; 95% CI [-5.81, -2.06]; p &lt; 0.001), English score (β = -2.65; 95% CI [-4.94, -0.35]; p = 0.024), and Math score (β = -3.86; 95% CI [-6.50, -1.22]; p = 0.004). Maternal education (grade 1-8) was significantly associated with English score (β = 5.46; 95% CI [1.31, 9.62]; p = 0.010) and Math score (β = 4.78; 95% CI [0.03, 9.53]; p = 0.049). These findings indicate that further research focusing on adolescent chronic undernutrition and educational outcomes as well as why chronic undernutrition is associated with certain performance outcomes and not others is needed before definitive conclusions can be made. Positive changes in child growth later in a child’s life may have important implications for cognition. Key words: Adolescent health, Central Ethiopia, undernutrition, stunting, academic performance</jats:p

Acculturation and Subjective Norms Impact Non-Prescription Antibiotic Use among Hispanic Patients in the United States

Using antibiotics without medical guidance (non-prescription antibiotic use) may contribute to antimicrobial resistance. Hispanic individuals are a growing demographic group in the United States (US) with a high prevalence of non-prescription antibiotic use. We investigated the effects of acculturation and subjective norms on Hispanic individuals’ intentions to use antibiotics without a prescription from the following sources: (1) markets in the United States (not legal), (2) other countries (abroad), (3) leftovers from previous prescriptions, and (4) friends/relatives. We surveyed self-identified Hispanic outpatients in eight clinics from January 2020 to June 2021 using the previously validated Short Acculturation Scale for Hispanics (SASH). Of the 263 patients surveyed, 47% reported previous non-prescription use, and 54% expressed intention to use non-prescription antibiotics if feeling sick. Individuals with lower acculturation (Spanish-speaking preferences) expressed greater intentions to use antibiotics from abroad and from any source. Individuals with more friends/relatives who obtain antibiotics abroad were over 2.5 times more likely to intend to use non-prescription antibiotics from friends/relatives (p = 0.034). Other predictors of intention to use non-prescription antibiotics included high costs of doctor visits and perceived language barriers in the clinic. Antibiotic stewardship interventions in Hispanic communities in the United States should consider the sociocultural and healthcare barriers influencing non-prescription use and promote language-concordant healthcare