Matteo Santangelo Ravà

Caregiver parenting practices, dietary diversity knowledge, and association with early childhood development outcomes among children aged 18-29 months in Zanzibar, Tanzania: a cross-sectional survey

With Allyson L. Russell, Elizabeth Hentschel, Isabel Fulcher, Matteo Santangelo Ravà, Gulam Abdulkarim, Omar Abdalla, Samira Said, Halima Khamis, Bethany Hedt-Gauthier & Kim Wilson

Many children in low- and middle-income countries fail to reach their cognitive potential, with experiences before age 3 critical in shaping long-term development. Zanzibar’s Jamii ni Afya program is the first national, digitally enabled community health volunteer (CHV) program promoting early childhood development (ECD). Using program baseline data, we explored home environment, caregivers’ parenting, health and nutrition knowledge and practices, and ECD outcomes in Zanzibar. We conducted a national household survey among 499 children aged 18-29 months using two-stage cluster sampling in February 2019. The primary outcome was child development score measured using the Caregiver Reported Early Developmental Index (CREDI). CREDI scores were positively associated with greater frequency of caregivers’ engagement (β = 0.036, p = 0.002, 95%CI = [0.014, 0.058]), and dietary diversity knowledge (β = 0.564, p < 0.001, 95%CI = [0.281, 0.846]).

Our findings demonstrate a positive association between both the frequency of caregiver child interactions and knowledge of adequate dietary diversity, and ECD outcomes. This aligns with global evidence that promoting early stimulation, play and learning opportunities, and dietary diversity can improve developmental outcomes. Further study is needed to establish causal relationships and assess the impact of ECD programming in Zanzibar.

The Forgotten Agenda of Wasting in Southeast Asia: Burden, Determinants and Overlap with Stunting: A Review of Nationally Representative Cross-Sectional Demographic and Health Surveys in Six Countries

with: Mueni Mutunga,1,* Severine Frison,2 Matteo Santangelo Ravà,3 and Paluku Bahwere4

Childhood wasting is among the most prevalent forms of undernutrition globally. The Southeast Asia region is home to many wasted children, but wasting is not recognized as a public health problem and its epidemiology is yet to be fully examined. This analysis aimed to determine the burden of wasting, its predictors, and the level of wasting and stunting concurrence. Datasets from Demographic and Health Surveys and Multiple Indicator Cluster Surveys in six countries in the region were analyzed. The pooled weighted prevalence for wasting and concurrent wasting and stunting among children 0–59 months in the six countries was 8.9%, 95% CI (8.0–9.9) and 1.6%, 95% CI (1.5–1.8), respectively. This prevalence is approximately 12-fold higher than the 0.7% prevalence of high-income countries; and translated into an absolute number of 1,088,747 children affected by wasting and 272,563 concurrent wasting and stunting. Wasting prevalence was 50 percent higher in the 0–23-month age group. Predictors for wasting included source of drinking water, wealth index, urban residence, child’s age and history of illness and mother’s body mass index. In conclusion, our analysis showed that wasting is a serious public health problem in the region that should be addressed urgently using both preventive and curative approaches.

Beyond high-income countries: Low numeracy is associated with older adult age around the world

With Wändi Bruine de Bruin, PhD Aulona Ulqinaku, PhD Jimena Llopis, MSc Matteo Santangelo Ravà, MSc

Background: Numeracy, or the ability to understand and use numbers, has been associated with obtaining better health and financial outcomes. Studies in high-income countries suggest that low numeracy is associated with older age -- perhaps especially among individuals with lower education. Here, we examined whether findings generalize to the rest of the world. Methods: Gallup surveyed >150,000 participants for the 2019 Lloyd’s Register Foundation World Risk Poll, from 21 low-income, 34 lower-middle income, 42 upper-middle income, and 43 high-income countries. Low numeracy was operationalized as failing to correctly answer “Is 10% bigger than 1 out of 10, smaller than 1 out of 10, or the same as 1 out of 10?” Results: Regressions controlling for participants’ education, income, and other characteristics found that, worldwide, low numeracy was associated with older age, lower education, and their interaction. Findings held in each country-income category, although low numeracy was more common in low-income countries than in high-income countries. Limitations: Age differences may reflect cohort effects and lifespan-developmental changes. Discussion: Low numeracy is more common among people who are older and less educated. We discuss the need for education and interventions outside of the classroom.