United Nations Children's Fund Canada

Thailand is now faced with a double burden of malnutrition. Using nationally representative data from the 2015-2016 Multiple Indicator Cluster Survey, we utilized multinomial logistic regression models to examine factors associated with stunting only, wasting only, overweight only, concurrent stunting and overweight, and concurrent stunting and wasting among children 0-59 months of age (n = 11,068). The prevalences of <5 stunting only (height-for-age Z score < -2 SD) and wasting only (WHZ < -2 SD) were 8.5% and 4.7%, respectively. The prevalence of <5 overweight only (WHZ > +2 SD) was 7.8%. Children 12-23 months (risk ratio [RR], 95% confidence interval [CI]: 1.47 [1.18, 1.83]; p < .01) and 24-35 months (RR, 95% CI: 1.56 [1.26, 1.94]; p < .001) were at increased risk for stunting only, compared with children 48-59 months. The strongest risk factor for stunting only was low birth weight (RR, 95% CI: 3.42 [2.86, 4.10]; p < .001). Children 0-5 months were at highest risk for wasting only, compared with children 48-59 months (RR, 95% CI: 2.91 [2.16, 3.92]; p < .001). Children 48-59 months and male children were more likely to be overweight only. Higher household wealth and smaller household size were also significant predictors of overweight only. A small proportion of children were concurrently stunted and overweight (1.3%) and concurrently stunted and wasted (0.6%). A multipronged approach focused on adequate prenatal care, improving breastfeeding and complementary feeding practices, and mitigating the growing burden of overweight is needed to address the double burden of malnutrition in Thailand.

Little is known about factors influencing children's dietary intake in Mongolia, a country undergoing rapid nutrition transition. Using nationally representative data from the 2017 Mongolia National Nutrition Survey, we assessed the nutritional status of children aged <2 years and examined household, maternal, and child factors associated with feeding practices among children aged 6-23 months (n = 938). Multivariable logistic regression models were used to identify predictors of minimum meal frequency (MMF), minimum dietary diversity (MDD), and minimum acceptable diet (MAD). The prevalence of child stunting (length/height-for-age Z-score < -2 SD) was 6.3%, and the prevalence of overweight (weight-for-height Z-score > +2 SD) was 16.8%. The prevalence of anaemia and iron deficiency was 39.0% and 32.2%, respectively, and 73.5% and 85.5% of children had inadequate vitamin A and vitamin D status, respectively. Of children aged 6-23 months, 92.1% (n = 864) had MMF, 49.6% (n = 465) had MDD, and 43.8% (n = 411) achieved MAD. Increased household wealth was positively associated with all three indicators, whereas severe food insecurity was not associated with MMF, MDD, or MAD. Older child age (odds ratio, 95% CI: 1.09 [1.06, 1.12]; p < .001) and maternal dietary diversity (odds ratio, 95% CI: 2.36 [1.67, 3.34]; p < .001) were positively associated with child MDD. Nutrition-specific and nutrition-sensitive efforts are needed to improve the dietary quality of infants and young children in Mongolia and reduce the high burdens of child micronutrient deficiency and overweight in the country.

Background: Age influences pregnancy and childbirth. Pregnant women aged less than 20 years old or pregnant adolescents are not physically and mentally ready to cope with pregnancy or childbirth. The husband's support highly determines the health status of the mother. This research aimed to determine the relationship between husband support and the behavior of pregnant adolescents to face pregnancy during the COVID-19 pandemic in the Gombong District, Kebumen Regency. Methods: This study used a cross-sectional approach. The population was all pregnant women aged less than 20 years in the Gombong District, Kebumen Regency. It used a saturated sampling technique involving 256 people. Data were analyzed using univariate and bivariate analysis to answer the percentage and the Chi-Square test to answer the research hypothesis. Results: The study showed that 130 (50.8%) husbands did not support the mothers, and 126 (49.2%) husbands supported the mothers. The result also showed that 116 (45.3%) of the pregnant women showed positive behavior, while140 (54.7%) pregnant women showed negative behavior. The chi-square test found a p-value of 0.005, which proved a significant relationship between the husband's support and the behavior of pregnant adolescents to overcome pregnancy during the covid-19 pandemic. Conclusion: Pregnant teenagers with husband support will prepare for pregnancy and childbirth programs more maturely to ensure the safety of both mother and fetus.

This paper outlines each aspect of coordination as it relates to the responses made by various organizations in the disaster-affected areas. It is a synthesis of the presentations and discussions pertaining to coordination during the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO), in Phuket, Thailand, 04-06 May 2005. Coordination is defined, and two important questions are answered: (1) What coordination was done well?; and (2) What coordination could have been done better?

BACKGROUND: A significant number of girls are married as children, which negatively impacts their health, education, and development. Given the sheer numbers of girls at risk of child marriage globally, the challenge to eliminate the practice is daunting. Programs to prevent child marriage are typically small-scale and overlook the costs and scalability of the intervention. IMPLEMENTATION: This study tested and costed different approaches to preventing child marriage in rural Burkina Faso and Tanzania. The approaches tested were community dialogue, provision of school supplies, provision of a livestock asset, a model including all components, and a control arm. A quasi-experimental design was employed with surveys undertaken at baseline and after 2 years of intervention. We examined the prevalence of child marriage and school attendance controlling for background characteristics and stratified by age group. Programmatic costs were collected prospectively. RESULTS: Among those in the community dialogue arm in Burkina Faso, girls aged 15 to 17 years had two-thirds less risk (risk ratio [RR]=0.33; 95% confidence interval [CI]=0.19, 0.60) of being married and girls aged 12 to 14 years had a greater chance of being in school (RR=1.18; 95% CI=1.07,1.29) compared to the control site. In Tanzania, girls aged 12 to 14 years residing in the multicomponent arm had two-thirds less risk of being married (RR=0.33; 95% CI=0.11, 0.99), and girls 15 to 17 in the conditional asset location had half the risk (RR=0.52; 95% CI=0.30, 0.91). All the interventions tested in Tanzania were associated with increased risk of girls 12 to 14 years old being in school, and the educational promotion arm was also associated with a 30% increased risk of girls aged 15 to 17 years attending school (RR=1.3; 95% CI=1.01, 1.67). Costs per beneficiary ranged from US$9 to US$117. CONCLUSION: The study demonstrates that minimal, low-cost approaches can be effective in delaying child marriage and increasing school attendance. However, community dialogues need to be designed to ensure sufficient quality and intensity of messaging. Program managers should pay attention to the cost, quality, and coverage of interventions, especially considering that child marriage persists in the most hard-to-reach rural areas of many countries.

Abstract Introduction Health service use among the general public can decline during infectious disease outbreaks and has been predicted among low and middle-income countries during the COVID-19 pandemic. In March 2020, the government of the Democratic Republic of the Congo (DRC) implemented public health measures across Kinshasa, including strict lockdown measures in the Gombe health zone, to mitigate impact of the pandemic. Methods Using data from the Health Management Information System (January 2018 - December 2020), we evaluated the impact of the pandemic on the use of essential health services (total visits, maternal health, vaccinations, visits for common infectious diseases, and diagnosis of non-communicable diseases) using interrupted time series with mixed effects segmented Poisson regression models during the first wave of the pandemic. Analyses were stratified by age, sex, health facility, and neighbourhood. Results Health service use dropped rapidly following the start of the pandemic and ranged from 16% for hypertension diagnoses to 39% for diabetes diagnoses. However, reductions were highly concentrated in Gombe (81% decline in total visits) relative to health zones without lockdown. When the lockdown was lifted, total visits, visits for infectious diseases, and diagnoses for non-communicable diseases increased approximately two-fold. Hospitals were more affected than health centres. Overall, the use of maternal health services and vaccinations was not significantly affected. Conclusion The COVID-19 pandemic resulted in important reductions in health service utilisation in Kinshasa, particularly Gombe. Lifting of lockdown led to a rebound in the level of health service use but it remained lower than pre-pandemic levels. Summary Box What is already known about this subject Substantial declines in the use of health services among the general public have been well-documented during previous outbreaks of infectious diseases. Modelled studies predicted substantial increases in morbidity and mortality in many low- and middle-income countries (LMICs) mainly due to expected declines in the use of health services among the general public. Only a small number of studies have so far evaluated the impact of the COVID-19 pandemic on the use of health services in LMICs and none have also evaluated both the implementation and lifting of lockdown measures. What are the new findings This study found that overall use of health services declined in Kinshasa but was most pronounced in the Gombe health zone which was subject to strict lockdown measures. Some health services were more affected than others, most notably visits and tests for malaria and visits for new diagnoses of non-communicable diseases. Maternal and child health services were relatively unaffected. When the lockdown measures were lifted, health service utilization rebounded but remained at levels lower than those observed pre-pandemic. What do the new findings imply The COVID-19 pandemic has likely had important effects on the use of health services among the general public throughout LMICs. However, evidence from Kinshasa suggests the effects may not be as widespread as previously assumed. The impact of strict social distancing measures needs on COVID-19 outcomes needs to be weighed off against the potential population-level health effects of these policies in various international contexts.

With fluoride-rich groundwater causing a climatic-dependent fluorosis in Mayo-Tsanaga River Basin, the overall objective of this study was to reduce fluoride concentrations in drinking water to acceptable levels thereby improving the resilience of the population to this climate change induced pathology. The specific objectives were to: (1) assess water chemistry in the study area to re-affirm the undesirable fluoride levels; (2) assess the impact of seasons on the concentrations of fluoride; (3) construct and evaluate the performance of a household bone char-based adsorption defluoridation filter. A combination of hydrogeochemical and engineering analyses demonstrated that the groundwater is predominantly Ca+Mg-HCO3 type, which contains as much as 6.73 mg/l of undesirable concentrations of geogenic fluoride. These concentrations increased with elevated pH, electrical conductivity and in the dry season, and were reduced to less than 0.2 mg/l when the groundwater was subjected to filtration through 300 g of 0.2-0.8 mm faction of charred cow bones in a home-based defluoridation filter. The bone char in the filter can effectively reduce fluoride concentration to less than 0.7 mg/l, which is the local threshold limit, without negative impact on the organoleptic (taste, color and odor) characteristics of drinking water. Compared with the commercially activated carbon, the bone char has an additional capacity of adsorbing fluoride at a rate of 4 mg/liter in 30 minutes, which indicates that with a defined saturation time, the bone char filter can protect the population against climate change-induced fluoride enrichment in drinking water.Keywords: Groundwater. geogenic fluoride. climate dependent fluorosis. bone char defluoridation. water chemistry

This paper provides an assessment and analysis of the increasing rates of mortality among the children of low-income African-American families in the United States and the intensifying problem of improper health care that seems to have given rise to it. The paper first documents the nature and determinants of the problem and then addresses the issue of policy prescriptions for eradicating the dilemma. The primary problem underlying the health-care access of low-income African-Americans is that there is neither a system of universal entitlement that ties their health care in with the rest of the population nor an explicit and comprehensive strategy for care outside the dominant private system.

The double burden of material deprivation and the psychological consequences of violent conflict has long-lasting effects on children’s wellbeing. Assessing child needs is therefore crucial to inform policies and move from humanitarian assistance towards reconstruction and development. We provide an analysis of the situation of children in east Mosul, Iraq, using unique data from a rapid humanitarian assessment administered on the ground immediately following the city’s liberation from ISIL in 2017. We develop a counting measure of multidimensional deprivation using nine dimensions. This measure shows the similarities and dissimilarities in the incidence of each deprivation across children with different displacement statuses: Internally Displaced Person (IDP), IDP returnee, host, and stayee. IDP and returnee children are the two most deprived groups in multiple dimensions, and food security remains a pressing issue for IDP children in particular. We explore with econometric analysis the relationship between deprivation and vulnerability on the one hand and humanitarian aid on the other. While immediate assistance is correlated with fewer deprivations, many deprived children were still missed by assistance. Aid efforts during any humanitarian emergency should consider children’s distinct deprivations in a deliberate and targeted manner rather than treating them simply as members of vulnerable households.

Since its adoption twenty-five years ago, the Convention on the Rights of the Child (CRC) has guided many actors and institutions around the world in relation to children. Yet, what influence has it had upon legislation, policies and programs, and what progress has occurred for children? An important measure of its impact is the status of the General Measures of the Implementation of the CRC, which the UN Committee on the Rights of the Child has identified as a foundational requirement of the framework of action. Focusing on law reform, budgeting, monitoring, and independent human rights institutions, this paper describes the state ofthese general measures with examples in different countries around the world to confirm the CRC's significance in governance and public policy. It is submitted that the CRC has been influential in public policy and that there is much more room for progress guided by the CRC. The paper concludes with recommendations for CRC states parties.

&lt;p&gt;Since its adoption twenty-five years ago, the Convention on the Rights of the Child (CRC) has guided many actors and institutions around the world in relation to children. Yet, what influence has it had upon legislation, policies and programs, and what progress has occurred for children? An important measure of its impact is the status of the General Measures of the Implementation of the CRC, which the UN Committee on the Rights of the Child has identified as a foundational requirement of the framework of action. Focusing on law reform, budgeting, monitoring, and independent human rights institutions, this paper describes the state ofthese general measures with examples in different countries around the world to confirm the CRC's significance in governance and public policy. It is submitted that the CRC has been influential in public policy and that there is much more room for progress guided by the CRC. The paper concludes with recommendations for CRC states parties.&lt;/p&gt;

The article reveals issues of social order that are relevant for modern Ukraine. It is emphasized that social ordering contributes to the development of social services. It is designed to improve the quality of such services in the community, create conditions for the activation of the public sector, and promote the effective and joint use of budget funds. The purpose of the article is to analyze the international experience of procurement of social services; description of the features of the modern process of introducing the purchase of social services by local authorities from non-state providers in different countries of the world. Based on the study of the provisions of regulatory and legal sources, the analysis of modern scientific sources of foreign researchers on the research topic, a generalization is made that social services form a general system of protection and inclusion of the European Community. The development of social order has become an effective tool of the market of social services, part of the neoliberal agenda of the countries of Western and Central Eastern Europe, one of the components of the change of the general system of public administration. It was noted that developed countries in the field of social protection followed a common trend of delegating their own powers to provide social services to non-state providers. At the same time, European countries paid attention to their own socio-cultural prerequisites and traditions. In particular, it was important for Germany to apply the principle of subsidiarity, to give greater initiative and authority to local communities to solve their own problems. For Great Britain, the competitive system of selecting a provider of social services in market conditions became a decisive factor. For the countries of Central and Eastern Europe, the acquired experience of other countries in combining both of these factors worked. The development of the individual dimension of social order took place in the Scandinavian countries, Germany, France, the Netherlands and other countries.

The role of education in diminishing child exploitation and child maltreatment should not be underestimated. If children and youth understand that they have rights and can speak up when they feel unsafe or at risk of harm, they are more likely to seek assistance from parents, caregivers, extended family or community members, helping professionals, teachers, social workers and others in time to protect themselves and prevent serious episodes of exploitation, abuse or neglect.

&lt;p&gt;Since its adoption twenty-five years ago, the Convention on the Rights of the Child (CRC) has guided many actors and institutions around the world in relation to children. Yet, what influence has it had upon legislation, policies and programs, and what progress has occurred for children? An important measure of its impact is the status of the General Measures of the Implementation of the CRC, which the UN Committee on the Rights of the Child has identified as a foundational requirement of the framework of action. Focusing on law reform, budgeting, monitoring, and independent human rights institutions, this paper describes the state ofthese general measures with examples in different countries around the world to confirm the CRC's significance in governance and public policy. It is submitted that the CRC has been influential in public policy and that there is much more room for progress guided by the CRC. The paper concludes with recommendations for CRC states parties.&lt;/p&gt;