Markers of Environmental Enteric Dysfunction are Associated with Poor Growth and Developmental Outcomes among Young Children in Lusaka, Zambia.

Objective: To examine cross-sectional relationships between biomarkers of environmental enteric dysfunction (EED), an acquired subclinical condition of the small intestine, and anthropometric and developmental outcomes among children in Lusaka, Zambia.

Study Design: Serum samples were collected from 240 children aged 27 to 35 months enrolled in a cluster-randomized trial assessing the effects of growth charts and small-quantity lipid-based nutrient supplements on linear growth. Samples were analyzed using the 11-plex Micronutrient and EED Assessment Tool, which incorporates 2 biomarkers of EED, namely intestinal fatty acid-binding protein (I-FABP), a marker of epithelial damage, and soluble CD14 (sCD14), a marker of microbial translocation.

Predictors of Stunting and Pathway Analysis for Linear Growth among Children Aged Two to Three Years after a Trial of Small-Quantity Lipid-Based Nutrient Supplements and Home-Installed Growth Charts in Three Districts in Zambia.

Background: Globally, 148 million children aged <5 y are stunted, with risk factors varying by context. Our "Impact of Growth Charts and Nutritional Supplements on Child Growth in Zambia" (ZamCharts) trial observed persistently high rates of stunting in all treatment groups after 18-mo of intervention with monthly distributions of small-quantity lipid-based nutrient supplements (SQ-LNS) and/or installation of a wall-mounted growth chart in children's homes.

Objectives: We sought to identify determinants of stunting and height-for-age z-score in children aged 27-36 mo who participated in the ZamCharts endline survey (n = 1911).

Feasibility and acceptability of the Problem Management for Moms programme for improving maternal mental health in Zambia: an open-label trial.

Background: Psychological distress is common among mothers in low-income and middle-income countries, limiting their capacity to care for themselves and their children. This study aimed to test the feasibility and acceptability of an adapted psychosocial intervention for distressed mothers in low-resource settings.

Methods: In this open-label trial, we enrolled women living in Lusaka, Zambia, with high mental distress (>7 score on the 20-item Self-Reporting Questionnaire [SRQ-20]) and children younger than 2 years, who had previously enrolled in the ZamCharts early childhood nutrition trial.

Perceptions of roles of community healthcare workers in early childhood in Limpopo, South Africa.

Background:  As part of the Reengineering Primary Health Care initiative, the South African National Department of Health (NDoH) has committed to expanding access to home-based care provided by community health workers. The NDOH also prioritised Community Health Workers (CHWs) in their agenda to improve child development outcomes in South Africa. However, there is limited research on CHWs' experiences and knowledge of early childhood development.

Motivation, Cues to Action, and Barriers to COVID-19 Vaccine Uptake: A Qualitative Application of the Health Belief Model among Women in Rural Zambia.

Vaccine hesitancy has played a major role in slowing the global COVID-19 response. Using cross-sectional, primarily qualitative data collected in four rural districts in Zambia, we aimed to explore community perceptions of COVID-19 disease and vaccines, including perceived motivators, cues to action, benefits, and barriers to vaccine uptake as guided by the Health Belief Model. In-depth interviews (IDIs) were conducted in late 2021 with women of reproductive age who were enrolled in an early childhood development study.

The impact of home-installed growth charts and small-quantity lipid-based nutrient supplements (SQ-LNS) on child growth in Zambia: a four-arm parallel open-label cluster randomised controlled trial.

Background: Childhood stunting remains common in many low-income settings and is associated with increased morbidity and mortality, as well as impaired child development.

Methods: The main objective of the study was to assess whether home-installed growth charts as well as small-quantity lipid-based nutrient supplements (SQ-LNS) can reduce growth faltering among infants. All caregivers of infants between 2 and 10 months of age at baseline, and at least 6 months old at the beginning of the interventions, in 282 randomly selected enumeration areas in Choma, Mansa and Lusaka districts in Zambia were invited to participate in the study.

Neonatal Physical Growth Predicts Electroencephalography Power in Rural South African Children.

Anthropometric measures at birth, indexing prenatal growth, are associated with later cognitive development. Children in low- and middle-income countries (LMIC) are at elevated risk for impaired prenatal and early postnatal growth and enduring cognitive deficits. However, the associations of neonatal physical growth with neural activity are not well-characterized in LMIC contexts, given the dearth of early childhood neuroimaging research in these settings.

The development and diversity of religious cognition and behavior: Protocol for Wave 1 data collection with children and parents by the Developing Belief Network.

The Developing Belief Network is a consortium of researchers studying human development in diverse social-cultural settings, with a focus on the interplay between general cognitive development and culturally specific processes of socialization and cultural transmission in early and middle childhood. The current manuscript describes the study protocol for the network's first wave of data collection, which aims to explore the development and diversity of religious cognition and behavior. This work is guided by three key research questions: (1) How do children represent and reason about religious and supernatural agents? (2) How do children represent and reason about religion as an aspect of social identity? (3) How are religious and supernatural beliefs transmitted within and between generations? The protocol is designed to address these questions via a set of nine tasks for children between the ages of 4 and 10 years, a comprehensive survey completed by their parents/caregivers, and a task designed to elicit conversations between children and caregivers.

Determinants of private-sector antibiotic consumption in India: findings from a quasi-experimental fixed-effects regression analysis using cross-sectional time-series data, 2011-2019.

The consumption of antibiotics varies between and within countries. However, our understanding of the key drivers of antibiotic consumption is largely limited to observational studies. Using Indian data that showed substantial differences between states and changes over years, we conducted a quasi-experimental fixed-effects regression study to examine the determinants of private-sector antibiotic consumption.

Feasibility of caregiver-administered anthropometric measurements of children under age 5: evidence from Zambia.

Background: Accurate measurement of children's anthropometry is of central importance for the assessment of nutritional status as well as for the evaluation of nutrition-specific interventions. Social distancing requirements during the recent Covid-19 pandemic made administration of standard assessor-led measurement protocols infeasible in many settings, creating demand for alternative assessment modalities.

Objective: To assess the feasibility and reliability of caregiver-administered anthropometric assessments of children under age 5.

Testing the feasibility, acceptability, and exploring trends on efficacy of the problem management plus for moms: Protocol of a pilot randomized control trial.

Mental health disorders are one of the most common causes that limit the ability of mothers to care for themselves and for their children. Recent data suggest high rates of distress among women in charge of young children in Zambia. Nevertheless, Zambia's public healthcare offers very limited treatment for common mental health distress.

Perceptions of HIV and Mental Illness as "Western" or "Traditional" Illnesses: A Cross-Sectional Study from Limpopo Province, South Africa.

Although Western biomedical treatment has dramatically increased across sub-Saharan African health systems, traditional medicine as a form of healing and beliefs in supernatural powers as explanations for disease remain prevalent. Research in this region has identified HIV in particular as a disease located within both the traditional African and Western medical paradigms, whilst mental illness is ascribed to primarily supernatural causes. Within this context, this study sought to understand and explore the perceptions of HIV and mental illness among a population of rural women in Limpopo, South Africa.

Consumption of systemic antibiotics in India in 2019.

Background: Inappropriate use of antibiotics is a significant driver of antibiotic resistance in India. Largely unrestricted over-the-counter sales of most antibiotics, manufacturing and marketing of many fixed-dose combinations (FDC) and overlap in regulatory powers between national and state-level agencies complicate antibiotics availability, sales, and consumption in the country.

Methods: We analyzed cross-sectional data from PharmaTrac, a nationally representative private-sector drug sales dataset gathered from a panel of 9000 stockists across India.

Willingness to pay brand premiums for generic medicines in Kenya: A bidding game experiment.

Background: Recent growth in the market share of higher priced branded generic medicines in low- and middle-income countries (LMICs) has raised concerns around affordability and access. We examined consumer willingness to pay (WTP) for branded versus unbranded generic non-communicable disease (NCD) medicines in Kenya.

Methods: We randomly assigned NCD patients to receive a hypothetical offer for either a Novartis Access-branded medicine or for an unbranded generic equivalent.

COVID-19 Knowledge and Prevention Behaviors in Rural Zambia: A Qualitative Application of the Information-Motivation-Behavioral Skills Model.

In early 2020, the Zambian Ministry of Health instituted prevention guidelines to limit spread of COVID-19. We assessed community knowledge, motivations, behavioral skills, and perceived community adherence to prevention behaviors (i.e.

A Qualitative Assessment of Community Acceptability and Use of a Locally Developed Children's Book to Increase Shared Reading and Parent-Child Interactions in Rural Zambia.

Introduction: Early reading interventions hold promise for increasing language and literacy development in young children and improving caregiver-child interactions. To engage rural caregivers and young children in home reading, Zambian child psychologists and education specialists developed a culturally representative, local language children's book targeted at pre-grade 1 children.

Objectives: We qualitatively assessed community acceptability and use of the book distributed to households with young children in two provinces of Zambia.

Evaluation of a community health worker home visit intervention to improve child development in South Africa: A cluster-randomized controlled trial.

Background: Effective integration of home visit interventions focused on early childhood development into existing service platforms is important for expanding access in low- and middle-income countries (LMICs). We designed and evaluated a home visit intervention integrated into community health worker (CHW) operations in South Africa.

Methods And Findings: We conducted a cluster-randomized controlled trial in Limpopo Province, South Africa.

A cost description of the setup costs of community-owned maternity waiting homes in rural Zambia.

Maternity waiting homes (MWHs) are one strategy to improve access to skilled obstetric care in low resource settings such as Zambia. The Maternity Homes Access in Zambia project built 10 MWHs at rural health centers in Zambia for women awaiting delivery and postnatal care (PNC) visits. The objective of this paper is to summarize the costs associated with setup of 10 MWHs, including infrastructure, furnishing, stakeholder engagement, and activities to build the capacity of local communities to govern MWHs.

Childhood adversity and educational attainment: Evidence from Zambia on the role of personality.

Introduction: We examine whether personality traits mediate the association between childhood adversity and educational attainment using longitudinal data from a cohort in Zambia.

Methods: We fit a structural equation model using data on three forms of childhood adversity-household poverty, stunting as a measure of chronic malnutrition, and death of a parent-and data on the "Big Five" personality traits and educational attainment assessed at 15 years of age.

Results: We find that childhood poverty and death of a parent are associated with lower openness to experience.

Trends in maternal mental health during the COVID-19 pandemic-evidence from Zambia.

The COVID-19 pandemic has increased social and emotional stressors globally, increasing mental health concerns and the risk of psychiatric illness worldwide. To date, relatively little is known about the impact of the pandemic on vulnerable groups such as women and children in low-resourced settings who generally have limited access to mental health care. We explore two rounds of data collected as part of an ongoing trial of early childhood development to assess mental health distress among mothers of children under 5-years-old living in two rural areas of Zambia during the COVID-19 pandemic.

Lessons from a Year of COVID-19 in Zambia: Reported Attendance and Mask Wearing at Large Gatherings in Rural Communities.

Zambia instituted prevention behavior guidelines for social gatherings before the first case of COVID-19 was confirmed on March 18, 2020. Guidelines included nonpharmaceutical interventions (NPIs) including mask wearing, social distancing, and reducing sizes of gatherings. Within a larger cluster randomized trial of community-based parenting groups in four rural districts (three in Southern Province, one in Eastern Province), we collected 5,711 questionnaires from intervention participants between August 2020 and September 2021, during which the country saw two COVID-19 waves.

Antibiotic consumption in India: geographical variations and temporal changes between 2011 and 2019.

Objectives: To describe and compare private sector systemic (J01) antibiotic consumption across Indian states from 2011 to 2019.

Methods: We used the nationally representative PharmaTrac dataset to describe the consumption rates in DDD across national, state and state-group [high focus (HF) and non-high focus (nHF)] levels. We used median and IQRs to describe and compare across states and state groups, and relative change and compound annual growth rate (CAGR) to examine temporal changes.

Digital Health Technologies Applied by the Pharmaceutical Industry to Improve Access to Noncommunicable Disease Care in Low- and Middle-Income Countries.

Background: There is limited research on how digital health technologies (DHTs) are used to promote access to care for patients with noncommunicable diseases (NCDs), particularly in low- and middle-income countries (LMICs). We describe the use of DHTs in pharmaceutical industry-led access programs aimed at improving access to NCD care in LMICs.

Methods: The Access Observatory is the largest publicly available repository containing detailed information about pharmaceutical industry-led access programs targeting NCDs.