Person: Finlay, Jocelyn
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Finlay
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Jocelyn
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Finlay, Jocelyn
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Publication Global Burden of Double Malnutrition: Has Anyone Seen It?(Public Library of Science, 2011) Corsi, Daniel; Finlay, Jocelyn; Subramanian, SankaranBackground. Low- to middle-income countries (LMICs) are believed to be characterized by the coexistence of underweight and overweight. It has also been posited that such coexistence is appearing among the low socioeconomic status (SES) groups. Methods. We conducted a cross-sectional analysis of nationally representative samples of 451321 women aged 20–49 years drawn from 57 Demographic and Health Surveys conducted between 1994 and 2008. Body Mass Index (BMI in \(kg/m^2\)), was used to define underweight and overweight following conventional cut-points. Covariates included age, household wealth, education, and residence. We estimated multinomial multilevel models to assess the extent to which underweight \((BMI<18.5 kg/m^2)\) and overweight \((BMI≥25.0 kg/m^2)\) correlate at the country-level, and at the neighborhood-level within each country. Results. In age-adjusted models, there was a strong negative correlation between likelihood of being underweight and overweight at country- (r = −0.79, p<0.001), and at the neighborhood-level within countries (r = −0.51, P<0.001). Negative correlations ranging from −0.11 to −0.90 were observed in 46 of the 57 countries at the neighborhood-level and 29/57 were statistically significant \((p\leq 0.05)\). Similar negative correlations were observed in analyses restricted to low SES groups. Finally, the negative correlations across countries, and within-countries, appeared to be stable over time in a sub-set of 36 countries. Conclusion. The explicitly negative correlations between prevalence of underweight and overweight at the country-level and at neighborhood-level suggest that the hypothesized coexistence of underweight and overweight has not yet occurred in a substantial manner in a majority of LMICs.Publication Consequences of maternal mortality on infant and child survival: a 25-year longitudinal analysis in Butajira Ethiopia (1987-2011)(BioMed Central, 2015) Moucheraud, Corrina; Worku, Alemayehu; Molla, Mitike; Finlay, Jocelyn; Leaning, Jennifer; Yamin, AliciaBackground: Maternal mortality remains the leading cause of death and disability for reproductive-age women in resource-poor countries. The impact of a mother’s death on child outcomes is likely severe but has not been well quantified. This analysis examines survival outcomes for children whose mothers die during or shortly after childbirth in Butajira, Ethiopia. Methods: This study uses data from the Butajira Health and Demographic Surveillance System (HDSS) site. Child outcomes were assessed using statistical tests to compare survival trajectories and age-specific mortality rates for children who did and did not experience a maternal death. The analyses leveraged the advantages of a large, long-term longitudinal dataset with a high frequency of data collection; but used a strict date-based method to code maternal deaths (as occurring within 42 or 365 days of childbirth), which may be subject to misclassification or recall bias. Results: Between 1987 and 2011, there were 18189 live births to 5119 mothers; and 73 mothers of 78 children died within the first year of their child’s life, with 45% of these (n=30) classified as maternal deaths due to women dying within 42 days of childbirth. Among the maternal deaths, 81% of these infants also died. Children who experienced a maternal death within 42 days of their birth faced 46 times greater risk of dying within one month when compared to babies whose mothers survived (95% confidence interval 25.84-81.92; or adjusted ratio, 57.24 with confidence interval 25.31-129.49). Conclusions: When a woman in this study population experienced a maternal death, her infant was much more likely to die than to survive—and the survival trajectory of these children is far worse than those of mothers who do not die postpartum. This highlights the importance of investigating how clinical care and socio-economic support programs can better address the needs of orphans, both throughout the intra- and post-partum periods as well as over the life course.Publication Association between economic growth and early childhood nutrition – Authors' reply(Elsevier BV, 2015) Vollmer, Sebastian; Harttgen, Kenneth; Subramanyam, Malavika A; Finlay, Jocelyn; Klasen, Stephan; Subramanian, SankaranAnna Bershteyn and colleagues provide a useful comparison of estimates of the association between economic growth and early childhood undernutrition in our study1 with those of previous studies. Their comparative exercise supports our key conclusion that the contribution of economic growth to the reduction in early childhood undernutrition in low-income and middle-income countries is very small. We had already reported both absolute and relative changes in our study (tables 2 and 3) underlining that absolute changes are much smaller than relative ones.Publication Association between economic growth and early childhood undernutrition: evidence from 121 Demographic and Health Surveys from 36 low-income and middle-income countries(Elsevier BV, 2014) Vollmer, Sebastian; Harttgen, Kenneth; Subramanyam, Malavika A; Finlay, Jocelyn; Klasen, Stephan; Subramanian, SankaranBACKGROUND: Economic growth is widely regarded as a necessary, and often sufficient, condition for the improvement of population health. We aimed to assess whether macroeconomic growth was associated with reductions in early childhood undernutrition in low-income and middle-income countries. METHODS: We analysed data from 121 Demographic and Health Surveys from 36 countries done between Jan 1, 1990, and Dec 31, 2011. The sample consisted of nationally representative cross-sectional surveys of children aged 0-35 months, and the outcome variables were stunting, underweight, and wasting. The main independent variable was per-head gross domestic product (GDP) in constant prices and adjusted for purchasing power parity. We used logistic regression models to estimate the association between changes in per-head GDP and changes in child undernutrition outcomes. Models were adjusted for country fixed effects, survey-year fixed effects, clustering, and demographic and socioeconomic covariates for the child, mother, and household. FINDINGS: Sample sizes were 462,854 for stunting, 485,152 for underweight, and 459,538 for wasting. Overall, 35·6% (95% CI 35·4-35·9) of young children were stunted (ranging from 8·7% [7·6-9·7] in Jordan to 51·1% [49·1-53·1] in Niger), 22·7% (22·5-22·9) were underweight (ranging from 1·8% [1·3-2·3] in Jordan to 41·7% [41·1-42·3] in India), and 12·8% (12·6-12·9) were wasted (ranging from 1·2% [0·6-1·8] in Peru to 28·8% [27·5-30·0] in Burkina Faso). At the country level, no association was seen between average changes in the prevalence of child undernutrition outcomes and average growth of per-head GDP. In models adjusted only for country and survey-year fixed effects, a 5% increase in per-head GDP was associated with an odds ratio (OR) of 0·993 (95% CI 0·989-0·995) for stunting, 0·986 (0·982-0·990) for underweight, and 0·984 (0·981-0·986) for wasting. ORs after adjustment for the full set of covariates were 0·996 (0·993-1·000) for stunting, 0·989 (0·985-0·992) for underweight, and 0·983 (0·979-0·986) for wasting. These findings were consistent across various subsamples and for alternative variable specifications. Notably, no association was seen between per-head GDP and undernutrition in young children from the poorest household wealth quintile. ORs for the poorest wealth quintile were 0·997 (0·990-1·004) for stunting, 0·999 (0·991-1·008) for underweight, and 0·991 (0·978-1·004) for wasting. INTERPRETATION: A quantitatively very small to null association was seen between increases in per-head GDP and reductions in early childhood undernutrition, emphasising the need for direct health investments to improve the nutritional status of children in low-income and middle-income countries.Publication Height of Nations: A Socioeconomic Analysis of Cohort Differences and Patterns among Women in 54 Low- to Middle-Income Countries(Public Library of Science (PLoS), 2011) Subramanian, Sankaran; Özaltin, Emre; Finlay, JocelynBACKGROUND: Adult height is a useful biological measure of long term population health and well being. We examined the cohort differences and socioeconomic patterning in adult height in low- to middle-income countries. METHODS/FINDINGS: We analyzed cross-sectional, representative samples of 364,538 women aged 25-49 years drawn from 54 Demographic and Health Surveys (DHS) conducted between 1994 and 2008. Linear multilevel regression models included year of birth, household wealth, education, and area of residence, and accounted for clustering by primary sampling units and countries. Attained height was measured using an adjustable measuring board. A yearly change in birth cohorts starting with those born in 1945 was associated with a 0.0138 cm (95% CI 0.0107, 0.0169) increase in height. Increases in heights in more recent birth year cohorts were largely concentrated in women from the richer wealth quintiles. 35 of the 54 countries experienced a decline (14) or stagnation (21) in height. The decline in heights was largely concentrated among the poorest wealth quintiles. There was a strong positive association between height and household wealth; those in two richest quintiles of household wealth were 1.988 cm (95% CI 1.886, 2.090) and 1.018 cm (95% CI 0.916, 1.120) taller, compared to those in the poorest wealth quintile. The strength of the association between wealth and height was positive (0.05 to 1.16) in 96% (52/54) countries. CONCLUSIONS: Socioeconomic inequalities in height remain persistent. Height has stagnated or declined over the last decades in low- to middle-income countries, particularly in Africa, suggesting worsening nutritional and environmental circumstances during childhood.Publication The Cost of Low Fertility in Europe(Springer Science + Business Media, 2009) Bloom, David; Canning, David; Fink, Gunther; Finlay, JocelynWe analyze the effect of fertility on income per capita with a particular focus on the experience of Europe. For European countries with below-replacement fertility, the cost of continued low fertility will only be observed in the long run. We show that in the short run, a fall in the fertility rate will lower the youth dependency ratio and increase the working-age share, thus raising income per capita. In the long run, however, the burden of old-age dependency dominates the youth dependency decline, and continued low fertility will lead to small working-age shares in the absence of large migration inflows. We show that the currently very high working-age shares generated by the recent declines in fertility and migration inflows are not sustainable, and that significant drops in the relative size of the working-age population should be expected. Without substantial adjustments in labor force participation or migration policies, the potential negative repercussions on the European economy are large.Publication The association of maternal age with infant mortality, child anthropometric failure, diarrhoea and anaemia for first births: Evidence from 55 low- and middle-income countries(BMJ, 2011) Finlay, Jocelyn; Ozaltin, E.; Canning, DavidObjective: To examine the association between maternal age at first birth and infant mortality, stunting, underweight, wasting, diarrhoea and anaemia in children in low- and middle income countries. Design: Cross-sectional analysis of nationally representative household samples. A modified Poisson regression model is used to estimate unadjusted and adjusted RR ratios. Setting: Low- and middle-income countries. Population: First births to women aged 12-35 where this birth occurred 12-60 months prior to interview. The sample for analysing infant mortality is comprised of 176 583 children in 55 low- and middle-income countries across 118 Demographic and Health Surveys conducted between 1990 and 2008. Main outcome measures: Infant mortality in children under 12 months and stunting, underweight, wasting, diarrhoea and anaemia in children under 5 years. Results: The investigation reveals two salient findings. First, in the sample of women who had their first birth between the ages of 12 and 35, the risk of poor child health outcome is lowest for women who have their first birth between the ages of 27 and 29. Second, the results indicate that both biological and social mechanisms play a role in explaining why children of young mothers have poorer outcomes. Conclusions: The first-born children of adolescent mothers are the most vulnerable to infant mortality and poor child health outcomes. Additionally, first time mothers up to the age of 27 have a higher risk of having a child who has stunting, diarrhoea and moderate or severe anaemia. Maternal and child health programs should take account of this increased risk even for mothers in their early 20s. Increasing the age at first birth in developing countries may have large benefits in terms of child health.