Child undernutrition in affluent societies: what are we talking about?

In this paper we set out to explore the prevalence of child undernutrition found in community studies in affluent societies, but a preliminary literature review revealed that, in the absence of a gold standard method of diagnosis, the prevalence largely depends on the measure, threshold and the growth reference used, as well as age. We thus go on to explore describe the common clinical ‘syndromes’ of child undernutrition: wasting, stunting and failure to thrive (weight faltering) and how we have used data from two population-based cohort studies, this paper to explore how much these different ‘syndromes’ overlap and the extent to which they reflect true undernutrition. This analysis revealed that when more than one definition is applied to the same children, a majority are below the lower threshold for only one measure. However, those with both weight faltering and low BMI in infancy, go on in later childhood to show growth and body composition patterns suggestive of previous undernutrition. In older children there is even less overlap and most children with either wasting or low fat seem to be simply growing at one extreme of the normal range. We conclude that in affluent societies the diagnosis of undernutrition is only robust when it relies on a combination of both, that is decline in weight or BMI centile and wasting

The New Age of Hybridity and Clash of Norms: China, BRICS and Challenges of Global Governance in a Post-liberal International Order

This article sketches an analytical framework to account for new patterns of global governance. We characterize the emergent post-liberal international order as a new age of hybridity, which signifies that no overriding set of paradigms dominate global governance. Instead we have a complex web of competing norms, which creates new opportunities as well as major elements of instability, uncertainty and anxiety. In the age of hybridity, non-Western great powers (led by China) play an increasingly counter-hegemonic role in shaping new style multilateralism – ontologically fragmented, normatively inconsistent, and institutionally incoherent. We argue that democracy paradox constitutes the fundamental issue at stake in this new age of hybridity. On the one hand, global power transitions seem to enable ‘democratization of globalization’ by opening more space to the hitherto excluded non-Western states to make their voices heard. On the other hand, emerging pluralism in global governance is accompanied by the regression of liberal democracy and spread of illiberalism that enfeeble ‘globalization of democratization.

Global Shifts and the Limits of the EU’s Transformative Power in the European Periphery: Comparative Perspectives from Hungary and Turkey

This article highlights the weakening of the EU’s transformative capacity in the broader European periphery in a rapidly shifting global order, with reference to Hungary and Turkey. Although Hungary is an ‘insider’ and Turkey a relative ‘outsider’, their recent experiences display strikingly similar patterns, raising important concerns about the EU’s leverage. Under the influence of strong nationalist-populist leaders backed by powerful majorities, both countries have been moving in an increasingly illiberal direction, away from well-established EU norms. The article proposes an analytical framework based on a combination of push and pull factors that are driven by changing global political economy dynamics, which explains the EU’s declining appeal in its periphery, not only in reference to the internal dynamics of European integration and its multiple crises, but also the appeal of illiberal versions of strategic capitalism employed by rising powers, which serve as reference points for the elites of several states in diverse geographic settings

The dynamics of emerging middle-power influence in regional and global governance: the paradoxical case of Turkey

This article attempts to understand the properties, potentials and limits of middle-power activism in a changing global order. Extensive debate on the rise of emerging powers notwithstanding, the potential contributions of emerging middle powers in regional and global governance, and the imminent challenges they face in their struggle for an upgraded status in the hierarchy of world politics, is an understudied issue. This study aims to fill this gap by offering a broad conceptual framework for middle-power activism and testing it with reference to the Turkish case. In this context, the authors aim to address the following questions: What kind of roles can emerging middle powers play in a post-hegemonic international system? What are the dynamics, properties and limitations of emerging middle-power activism in regional and global governance? Based on an extensive study of the Turkish case, the authors’ central thesis is that emerging middle powers can make important contributions to regional and global governance. Their ultimate impact, however, is not inevitable, but depends on a complementary set of conditions, which are outlined in this study

Economic liberalization and the antecedents of top management teams: evidence from Turkish 'big' business

There has been an increased interest in the last two decades in top management teams (TMTs) of business firms. Much of the research, however, has been US-based and concerned primarily with TMT effects on organizational outcomes. The present study aims to expand this literature by examining the antecedents of top team composition in the context of macro-level economic change in a late-industrializing country. The post-1980 trade and market reforms in Turkey provided the empirical setting. Drawing upon the literatures on TMT and chief executive characteristics together with punctuated equilibrium models of change and institutional theory, the article develops the argument that which firm-level factors affect which attributes of TMT formations varies across the early and late stages of economic liberalization. Results of the empirical investigation of 71 of the largest industrial firms in Turkey broadly supported the hypotheses derived from this premise. In the early stages of economic liberalization the average age and average organizational tenure of TMTs were related to the export orientation of firms, whereas in later stages, firm performance became a major predictor of these team attributes. Educational background characteristics of teams appeared to be under stronger institutional pressures, altering in different ways in the face of macro-level change

Prevalence and Determinants of Obesity among Primary School Children in Dar es Salaam, Tanzania.

Childhood obesity has increased dramatically and has become a public health concern worldwide. Childhood obesity is likely to persist through adulthood and may lead to early onset of NCDs. However, there is paucity of data on obesity among primary school children in Tanzania. This study assessed the prevalence and determinants of obesity among primary school children in Dar es Salaam. A cross sectional study was conducted among school age children in randomly selected schools in Dar es Salaam. Anthropometric and blood pressure measurements were taken using standard procedures. Body Mass Index (BMI) was calculated as weight in kilograms divided by the square of height in meters (kg/m2). Child obesity was defined as BMI at or above 95th percentile for age and sex. Socio-demographic characteristics of children were determined using a structured questionnaire. Logistic regression was used to determine association between independent variables with obesity among primary school children in Dar es Salaam. A total of 446 children were included in the analysis. The mean age of the participants was 11.1±2.0 years and 53.1% were girls. The mean BMI, SBP and DBP were 16.6±4.0 kg/m2, 103.9±10.3mmHg and 65.6±8.2mmHg respectively. The overall prevalence of child obesity was 5.2% and was higher among girls (6.3%) compared to boys (3.8%). Obese children had significantly higher mean values for age (p=0.042), systolic and diastolic blood pressures (all p<0.001). Most obese children were from households with fewer children (p=0.019) and residing in urban areas (p=0.002). Controlling for other variables, age above 10 years (AOR=3.3, 95% CI=1.5-7.2), female sex (AOR=2.6, 95% CI=1.4-4.9), urban residence (AOR=2.5, 95% CI=1.2-5.3) and having money to spend at school (AOR=2.6, 95% CI=1.4-4.8) were significantly associated with child obesity. The prevalence of childhood obesity in this population was found to be low. However, children from urban schools and girls were proportionately more obese compared to their counterparts. Primary preventive measures for childhood obesity should start early in childhood and address socioeconomic factors of parents contributing to childhood obesity

Use of the new World Health Organization child growth standards to describe longitudinal growth of breastfed rural Bangladeshi infants and young children.

BACKGROUND: Although the National Center for Health Statistics (NCHS) reference has been widely used, in 2006 the World Health Organization (WHO) released new standards for assessing growth of infants and children worldwide. OBJECTIVE: To assess and compare the growth of breastfed rural Bangladeshi infants and young children based on the new WHO child growth standards and the NCHS reference. METHODS: We followed 1343 children in the Maternal and Infant Nutrition Intervention in Matlab (MINIMat) study from birth to 24 months of age. Weights and lengths of the children were measured monthly during infancy and quarterly in the second year of life. Anthropometric indices were calculated using both WHO standards and the NCHS reference. The growth pattern and estimates of undernutrition based on the WHO standards and the NCHS reference were compared. RESULTS: The mean birthweight was 2697 +/- 401 g, with 30% weighing <2500 g. The growth pattern of the MINIMat children more closely tracked the WHO standards than it did the NCHS reference. The rates of stunting based on the WHO standards were higher than the rates based on the NCHS reference throughout the first 24 months. The rates of underweight and wasting based on the WHO standards were significantly different from those based on the NCHS reference. CONCLUSIONS: This comparison confirms that use of the NCHS reference misidentifies undernutrition and the timing of growth faltering in infants and young children, which was a key rationale for constructing the new WHO standards. The new WHO child growth standards provide a benchmark for assessing the growth of breastfed infants and children

Algorithms for converting estimates of child malnutrition based on the NCHS reference into estimates based on the WHO Child Growth Standards

<p>Abstract</p> <p>Background</p> <p>The child growth standards released by the World Health Organization (WHO) in 2006 have several technical advantages over the previous 1977 National Center for Health Statistics (NCHS)/WHO reference and are recommended for international comparisons and secular trend analysis of child malnutrition. To obtain comparable data over time, earlier surveys should be reanalyzed using the WHO standards; however, reanalysis is impossible for older surveys since the raw data are not available. This paper provides algorithms for converting estimates of child malnutrition based on the NCHS reference into estimates based on the WHO standards.</p> <p>Methods</p> <p>Sixty-eight surveys from the WHO Global Database on Child Growth and Malnutrition were analyzed using the WHO standards to derive estimates of underweight, stunting, wasting and overweight. The prevalences based on the NCHS reference were taken directly from the database. National/regional estimates with a minimum sample size of 400 children were used to develop the algorithms. For each indicator, a simple linear regression model was fitted, using the logit of WHO and NCHS estimates as, respectively, dependent and independent variables. The resulting algorithms were validated using a different set of surveys, on the basis of which the point estimate and 95% confidence interval (CI) of the predicted WHO prevalence were compared to the observed prevalence.</p> <p>Results</p> <p>In total, 271 data points were used to develop the algorithms. The correlation coefficients (R²) were all greater than 0.90, indicating that most of the variability of the dependent variable is explained by the fitted model. The average difference between the predicted WHO estimate and the observed value was <0.5% for stunting, wasting and overweight. For underweight, the mean difference was 0.8%. The proportion of the 95% CI of the predicted estimate containing the observed prevalence was above 90% for all four indicators. The algorithms performed equally well for surveys without the entire age coverage 0 to 60 months.</p> <p>Conclusion</p> <p>To obtain comparable data concerning child malnutrition, individual survey data should be analyzed using the WHO standards. When the raw data are not available, the algorithms presented here provide a highly accurate tool for converting existing NCHS estimates into WHO estimates.</p