Search results for: middle income group

Authors: Elisabeth Mamani-Mategula

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Background: Anaemia has significant consequences on both the mother and child's health as it results in maternal haemorrhage, low childbirth weight, premature delivery, poor organ development, and infections at birth and hence the need for treatment. In low-middle income countries, anaemic pregnant women are recommended to take 30 mg to 60 mg of elemental iron daily throughout pregnancy which are often poorly tolerated and adhered to. A potential alternative to oral iron is intravenous (IV) iron which allows the saturation of the body’s iron stores quickly. Currently, a randomised controlled trial on the Effect of intravenous iron on Anaemia in Malawian Pregnant women (REVAMP) is underway. Since this is new in Africa and Malawi is the second country to implement it, its acceptability to both the providers and end-users is not known. Suppose the use of IV iron during pregnancy would be acceptable in Malawi, it could change how we treat and manage pregnant women with anaemia and be scaled up throughout Malawi to improve maternal and child health. Objectives: To identify the barriers and facilitators of implementing IV iron in the Malawian healthcare system and identify ‘touchpoints’ and co-develop strategies to support and inform the implementation of the trial Methodology: A qualitative study was conducted with policymakers, government partners, and health managers through in-depth interviews to identify barriers and facilitators relating to the implementation of IV iron in the health system of Malawi. From the interviews, touchpoints were identified that formed the basis of the discussion in further discussing the barriers and suggested solutions in the co-design workshops with the community members and the health workers, respectively. We purposively recruited 20 health workers (10 male, 10 Female). 20 community members (10 male, 10 female) were recruited randomly. Data was collected through group discussions and interactive sessions and was recorded through audios, flip charts, and sticky notes. We familiarized ourselves with the data and identified themes. Results: Two co-design workshops were conducted with different community members and different health worker carders. Identified individual factors included lack of knowledge about anaemia, lack of male involvement, the attitude of health workers and patient non-compliance with appointments. Community factors included myths and misconceptions about IV iron, including associating the use of IV iron with vampirism and covid 19 vaccination. Health system factors identified were a shortage of staff and equipment, unfamiliarity with IV iron and its cost. Discussion: The use of IV iron, as suggested by the community members and health workers, demands civic education through bringing awareness to end-users and training to providers. Through these co-design workshops, community sensitization and awareness, briefing and training of health workers and creation of educational materials were done.

Keywords: acceptability, IV iron, barriers, facilitators, co-design

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Authors: Andrey Boyko

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Nowadays, there is no consensus about the influence of urethral plate (UP) width on the surgical outcomes after distal hypospadias repair. The purpose of the research was to study the association between UP width and surgical outcomes after distal hypospadias repair in children. Materials and methods: The study included 138 patients with distal hypospadias. The mean age at the time of surgery was 4.6 years (6 months – 16 years). We measured UP width at the “midpoint within the glans” and used the HOSE scale to assess postoperative outcomes. The patients were divided into 2 groups: group 1 – the patients (107) with UP < 8mm, group 2 – patients (31) with UP > 8mm. All boys underwent TIP repair. Preincision means UP width after incision means UP width, and the UP ratio was analyzed. Statistical data were obtained using Statistica 10. Results: The findings were preincision mean UP width - 5.4 mm and 9.4 mm; after incision mean UP width - 13mm and 17.5 mm; UP ratio - 0.41 and 0.53 in group 1 and group 2, respectively. Most postoperative complications (fistula, meatal stenosis, and stricture) happened in patients with UP width < 8 mm versus ≥ 8 mm (7/107 versus 2/31, respectively). HOSE results were 15.77 (group 1), 15.65 (group 2). The follow up lasted up to 12 months. Statistical analysis proved the absence of correlation between UP width and postoperative complications. Conclusions: In conclusion, it should be noted that the success of surgical repair mostly depended on the surgical technique.

Keywords: children, distal hypospadias, tip repair, urethral plate width

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Authors: Hsin-Yu Lin, Ching-Hsia Hung

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Obstructive sleep apnea (OSA) is characterized by a complete or partial obstruction of the upper airway during sleep. The vulnerable sites of upper airway collapses are consequences of sleep state-dependent reductions in tone in specific pharyngeal dilators. Clinical examinations reveal multilevel collapses of the upper airway among the patients with OSA. Therefore, an anatomically-based oropharyngeal rehabilitation should comprise a multilevel approach, including retropalatal, retroglossal, hypopharyngeal, temporomandibular, and facial levels, all of which involve different muscle groups and contribute to multifunctional interaction and coordination, such as swallowing, breathing, and phonation. The purpose of the study was to exam the effects of this rehabilitation program with a multilevel approach. In this study, fifteen subjects with newly diagnosed moderate or severe OSA (Apnea-Hypopnea-Index≥15) were randomized into an intervention group and control group. The intervention group (N=8) underwent a 12-week-intervention of a hospital-based rehabilitation program, while the control group (N=7) was kept on the waiting list. The 12-week-intervention comprised an anatomically based multilevel approach. The primary outcome was Polysomnography (PSG) data, and the secondary outcome was oropharyngeal and respiratory muscle function. In the intervention group, Apnea-Hypopnea-Index significantly improved (46.96±19.45 versus 32.78±10.78 events/h, p=0.017) compared with control group (35.77±17.49 versus 42.96±17.32 events/h, p=0.043). While the control group remained no change, the intervention group demonstrated other PSG outcomes significantly improvement, including arousal index (46.04±18.9 versus 32.98±8.35/h, p=0.035), mean SpO2 (92.88±2.1 versus 94.13±1.46%, p=0.039). Besides, the intervention group demonstrated significant improvement in oropharyngeal and respiratory muscle function compared to the control group. This anatomically-based oropharyngeal rehabilitation with a multilevel approach can be proven as a non-invasive therapy for patients with OSA.

Keywords: obstructive sleep apnea, upper airway, oropharyngeal rehabilitation, multilevel approach

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Authors: Hye-Sung Park, Eun-Ji Lee, Chan-Jung Lee, Won-Sik Kong

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This study was conducted to research king oyster mushroom (Pleurotus eryngii) mycelia with reinforced functionalities. 0 to 4% of saccharide components, such as glucose (glu), lactose (lac), mannitol (man), xylose (xyl), and fructose (fru) and 0 to 0.04% of amino acid components, such as aspartic acid (asp). Cysteine (cys), threonine (thr), glutamine (gln), and serine (ser) were added to liquid media, and antioxidant activities, nitrite scavenging activities, and total polyphenol contents of the cultured mycelia were measured. In the saccharide-added group, 4 strains except ASI 2887 had high antioxidant activities when 1% of xyl was added and especially, the antioxidant activity of ASI 2839 was 73.9%, which was the highest value. In the amino acid-added group, the antioxidant activity of ASI 2839 was 66.3% that was the highest value when 0.2% of ser was added. But all the 5 strains had lower antioxidant activities than the saccharide-added group overall. In the saccharide-added group, 4 strains except ASI 2887 had higher nitrite scavenging activities than other group when 1% of xyl was added and especially, the nitrite scavenging activity of ASI 2824 was 57.8% that was the highest value. It was revealed that the saccharide-added group and the amino acid-added group had a similar efficiency of nitrite scavenging activity. Although the same component-added group did not show a certain increase or decrease in total polyphenol contents, ASI 2839 with the highest antioxidant activity had 6.8mg/g, which was the highest content when 1% of xyl was added. In conclusion, this study demonstrated that when 1% of xyl was added, functionalities of Pleurotus eryngii mycelia, including antioxidant activities, nitrite scavenging activities, and total polyphenol contents improved.

Keywords: king oyster mushroom, saccharide, amino acid, mycelia

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Authors: Maaza Saeed, Caina Li

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The current 2-wave longitudinal study attempts to illuminate the well-established association between parental warm support and academic achievement through the mediating role of self-control while taking into account the moderating role of teacher emotional support. The present research has assessed 2569 Chinese students (aged 10-18 years, M = 13.27, SD = 0.67). They were recruited from the three public middle schools in Xi’an, a middle-sized city in the central part of China. Meditation analysis revealed that self-control mediated the relationship between parental warm support and academic achievement. Additionally, it was found the direct effect of parental warm support was not significant after controlling for the age and gender. Furthermore, moderation analysis revealed high parental warm support and higher teacher emotional support was related to increased self-control compared to lower teacher emotion support. The findings highlighted the importance of parental warm support, teacher emotional support, and self-control on academic achievement.

Keywords: self control, academic achievement, teacher emotional support/conflict, adolescent

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Authors: Ahmed Shaik

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Estimates are very critical in accounting and Financial Reporting cannot be complete without these estimates. There is a long list of accounting estimates that are required to be made to compute Net Income and to determine the value of assets and liabilities. To name a few, valuation of inventory, depreciation, valuation of goodwill, provision for bad debts and estimated warranties, etc. require the use of different valuation models and forecasts. Different business entities under the same industry may use different approaches to measure the value of financial items being reported in Income Statement and Balance Sheet. The disclosure notes do not provide enough details of the approach used by a business entity to arrive at the value of a financial item. Lack of details in the disclosure notes makes it difficult to compare the financial performance of one business entity with the other in the same industry. This paper is an attempt to identify the lack of enough information about accounting estimates in disclosure notes, the impact of the absence of details of accounting estimates on the comparability of financial data and financial analysis. An attempt is made to suggest the detailed disclosure while taking care of the cost and benefit of making such disclosure.

Keywords: accounting estimates, disclosure notes, financial reporting, transparency

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Authors: Esther M. Folarin, Evans Osabuohien, Ademola Onabote

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Agriculture constitutes an important part of development and poverty mitigation in lower-middle-income countries, like Nigeria. The level of agricultural productivity in the Nigerian economy in line with the level of demand necessary to meet the desired expectation of the Nigerian populace is threatening to meeting the standard of the United Nations (UN) Sustainable Development Goals (SDGs); This includes the SDG-2 (achieve food security through agricultural productivity). The overall objective of the study is to reveal the performance of the interaction variable in the model among other factors that help in the achievement of greater Nigerian agricultural productivity. The study makes use of Wave 4 (2018/2019) of the Living Standard Measurement Studies, Integrated Survey on Agriculture (LSMS-ISA). Qualitative analysis of the information was also used to provide complimentary answers to the quantitative analysis done in the study. The study employed human capital theory and Grossman’s theory of health Demand in explaining the relationships that exist between the variables within the model of the study. The study engages the Instrumental Variable Regression technique in achieving the broad objectives among other techniques for the other specific objectives. The estimation results show that there exists a positive relationship between female healthcare and the level of female agricultural productivity in Nigeria. In conclusion, the study emphasises the need for more provision and empowerment for greater female access to healthcare and educational attainment levels that aids higher female agricultural productivity and consequently an improvement in the total agricultural productivity of the Nigerian economy.

Keywords: agricultural productivity, education, female, healthcare, investment

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Authors: Ying Jia Teoh

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The Canning Basin is located between the Kimberley and Pilbara Precambrian cratonic blocks. It is a large but relatively poorly explored Paleozoic basin in remote Western Australia. During the early Ordovician period, the Australian continent was located near the equator. Middle Ordovician age Nita and Goldwyer Formations in Canning Basin are therefore warm water carbonates. The Nita Formation carbonates are a regressive sequence which conformably overlies the Goldwyer Formation. It contains numerous progradational cycles of limestone, vuggy dolomitized carbonate beds and shale deposited in subtidal to supratidal environments. The Goldwyer Formation contains transgressive shale sequences and regressive carbonates deposited in shallow subtidal conditions. The shales contain oil-prone Gloeocapsormorpha prisca-bearing source rocks. Llanvirnian relative sea-level fluctuations were reconstructed by using Fischer plots methodology for three key wells (wells McLarty 1, Looma 1 and Robert 1) in Broome Platform and compared with INPEFA data. The Goldwyer lower shale (interval Or1000P) shows increasing relative sea-level and this matches with a transgressive systems tract. Goldwyer middle carbonate (interval Or2000) shows relative sea-level drop and this matches with a regressive systems tract. Goldwyer upper shale (interval Or2000P) shows relative sea-level drop and this matches with a transgressive systems tract. Nita Formation Leo Member (interval Or3000) shows a relative sea level drop and this matches with a regressive systems tract. The Nita Formation Cudalgarra Member (intervals Or3000P and Or4000) with transgressive systems tract then this is followed by a regressive systems tract. This pattern matches with the relative sea-level curves in wells McLarty 1 and Robert 1. The correlation is weak for parts of well Looma 1. This is probably influenced by the fact that the thickness of this section is quite small. As a conclusion, Fischer plots for the Llanvirnian Goldwyer and Nita Formations show good agreement with the third order global sea level cycles of Haq and others. Fischer plots are generally correlated well with trend and cyclicity determined by INPEFA curves and as a method of cross-checking INPEFA data and sea-level change.

Keywords: canning basin, Fischer plots, Llanvirnian, middle Ordovician, sea-level fluctuations, stratigraphy

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Authors: Annika Freudenberger, Sin Sokhong

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In just a few years, the Face-to-Face Victory Gardens Project (F2F) in Cambodia has developed a high-impact project that has provided immediate and tangible benefits to local families. This has been accomplished with a relatively hands-off approach that relies on households’ own motivation and personal investments of time and resources -which is both unique and impressive in the landscape of NGO and government initiatives in the area. Households have been growing food both for their own consumption and to sell or exchange. Not all targeted beneficiaries are equally motivated and maximizing their involvement, but there is a clear subset of households -particularly those who serve as facilitators- whose circumstances have been transformed as a result of F2F. A number of household factors and contextual economic factors affect families’ income generation opportunities. All the households we spoke with became involved with F2F with the goal of selling some proportion of their produce (i.e., not exclusively for their own consumption). For some, this income is marginal and supplemental to their core household income; for others, it is substantial and transformative. Some engage directly with customers/buyers in their immediate community, while others sell in larger nearby markets, and others link up with intermediary vendors. All struggle, to a certain extent, to compete in a local economy flooded with cheap produce imported from large-scale growers in neighboring provinces, Thailand, and Vietnam, although households who grow and sell herbs and greens popular in Khmer cuisine have found a stronger local market. Some are content with the scale of their garden, the income they make, and the current level of effort required to maintain it; others would like to expand but are faced with land constraints and water management challenges. Households making a substantial income from selling their products have achieved success in different ways, making it difficult to pinpoint a clear “model” for replication. Within our small sample size of interviewees, it seems as though the families with a clear passion for their gardens and high motivation to work hard to bring their products to market have succeeded in doing so. Khmer greens and herbs have been the most successful; they are not high-value crops, but they are fairly easy to grow, and there is a constant demand. These crops are also not imported as much, so prices are more stable than those of crops such as long beans. Although we talked to a limited number of individuals, it also appears as though successful families either restricted their crops to those that would grow well in drought or flood conditions (depending on which they are affected by most); or benefit already from water management infrastructure such as water tanks which helps them diversify their crops and helps them build their resilience.

Keywords: food security, Victory Gardens, nutrition, Cambodia

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Authors: Nneka M. Chidieber-Mark, Roseline D. Ejike

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Non-Timber Forest Products (NTFPs) have been described as all biological materials, other than timber extracted from natural and managed forests for human subsistence and economic activities. This study focused on the production, utilization and marketing of Non-Timber Forest Products (NTFPs) in Ikwuano Local Government Area of Abia State, Nigeria. A multistage sampling technique was adopted in the selection of respondents for the study. Data were from primary sources only. Data collected were analysed using descriptive statistical tools as well as Net Income Analysis. Results show that a vast number of plant based and animal based NTFPs exist in the study area. They are harvested and used for multiple purposes. NTFPs are a source of income for the indigenes that depend on it for their livelihood. Unsustainable production and harvesting as well as poor marketing information was among the constraints impeding the growth and development of NTFPs sub-sector in the study area.

Keywords: non-timber forest products, production, utilization, marketing

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Authors: Shavindrie Cooray

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It is vital that students are supported in having balanced conversations about topics that might be controversial. This process is crucial to the development of critical thinking skills. This can be difficult to attain in e-learning environments, with some research finding students report a perceived loss in the quality of knowledge exchange and performance. This research investigated if Systems Theory could be applied to structure the discussion, improve information sharing, and reduce conflicts when students are working in online environments. This research involved 160 participants across four categories of student groups at a college in the Northeastern US. Each group was provided with a shared problem, and each group was expected to make a proposal for a solution. Two groups worked face-to-face; the first face to face group engaged with the problem and each other with no intervention from a facilitator; a second face to face group worked on the problem using Systems tools to facilitate problem structuring, group discussion, and decision-making. There were two types of virtual teams. The first virtual group also used Systems tools to facilitate problem structuring and group discussion. However, all interactions were conducted in a synchronous virtual environment. The second type of virtual team also met in real time but worked with no intervention. Findings from the study demonstrated that the teams (both virtual and face-to-face) using Systems tools shared more information with each other than the other teams; additionally, these teams reported an increased level of disagreement amongst their members, but also expressed more confidence and satisfaction with the experience and resulting decision compared to the other groups.

Keywords: e-learning, virtual teams, systems approach, conflicts

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Authors: Eda Yakit Ak, Ergül Aslan

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The study was conducted using the quasi-experimental design to determine the influence of the nursing support program prepared according to the Health Belief Model on reproductive health behaviors of orthopedically disabled women in the physical therapy and rehabilitation clinic at a university hospital between August 2019-October, 2020. The research sample included 50 women (35 in the control group and 15 in the experimental group with orthopedic disability). A 3-week nursing support program was applied to the experimental group of women. To collect the data, Introductory Information Form and Scale for Determining the Protective Attitudes of Married Women towards Reproductive Health (SDPAMW) were applied. The evaluation was made with a follow-up form for four months. In the first evaluation, the total SDPAMW scores were 119.93±20.59 for the experimental group and 122.20±16.71 for the control group. In the final evaluation, the total SDPAMW scores were 144.27±11.95 for the experimental group and 118.00±16.43 for the control group. The difference between the groups regarding the first and final evaluations for the total SDPAMW scores was statistically significant (p<0.01). In the experimental group, between the first and final evaluations regarding the sub-dimensions of SDPAMW, an increase was found in the behavior of seeing the doctor on reproductive health issues, protection from reproductive organ and breast cancer, general health behaviors to protect reproductive health, and protection from genital tract infections (p<0.05). Consequently, the nursing support program based on the Health Belief Model applied to orthopedically disabled women positively affected reproductive health behaviors.

Keywords: orthopedically disabled, woman, reproductive health, nursing support program, health belief model

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Authors: Elhadi Nasr, Ibrahim Ramadan

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Biostratigraphical analyses of well sections from the Maragh Low in the Eastern Sirt Basin has allowed high resolution correlations to be undertaken. Full integration of this data with available palaeoenvironmental, lithological, gravity, seismic, aeromagnetic, igneous, radiometric and wireline log information and a geochemical analysis of source rock quality and distribution has led to a more detailed understanding of the geological and the structural history of this area. Pre Sirt Unconformity two superimposed rifting cycles have been identified. The oldest is represented by the Amal Group of sediments and is of Late Carboniferous, Kasimovian / Gzelian to Middle Triassic, Anisian age. Unconformably overlying is a younger rift cycle which is represented the Sarir Group of sediments and is of Early Cretaceous, late Neocomian to Aptian in age. Overlying the Sirt Unconformity is the marine Late Cretaceous section. An assessment of pyrolysis results and a palynofacies analysis has allowed hydrocarbon source facies and quality to be determined. There are a number of hydrocarbon source rock horizons in the Maragh Low, these are sometimes vertically stacked and they are of fair to excellent quality. The oldest identified source rock is the Triassic Shale, this unit is unconformably overlain by sandstones belonging to the Sarir Group and conformably overlies a Triassic Siltstone unit. Palynological dating of the Triassic Shale unit indicates a Middle Triassic, Anisian age. The Triassic Shale is interpreted to have been deposited in a lacustrine palaeoenvironment. This particularly is evidenced by the dark, fine grained, organic rich nature of the sediment and is supported by palynofacies analysis and by the recovery of fish fossils. Geochemical analysis of the Triassic Shale indicates total organic carbon varying between 1.37 and 3.53. S2 pyrolysate yields vary between 2.15 mg/g and 6.61 mg/g and hydrogen indices vary between 156.91 and 278.91. The source quality of the Triassic Shale varies from being of fair to very good / rich. Linked to thermal maturity it is now a very good source for light oil and gas. It was once a very good to rich oil source. The Early Barremian Shale was also deposited in a lacustrine palaeoenvironment. Recovered palynomorphs indicate an Early Cretaceous, late Neocomian to early Barremian age. The Early Barremian Shale is conformably underlain and overlain by sandstone units belonging to the Sarir Group of sediments which are also of Early Cretaceous age. Geochemical analysis of the Early Barremian Shale indicates that it is a good oil source and was originally very good. Total organic carbon varies between 3.59% and 7%. S2 varies between 6.30 mg/g and 10.39 mg/g and the hydrogen indices vary between 148.4 and 175.5. A Late Barremian Shale unit of this age has also been identified in the central Maragh Low. Geochemical analyses indicate that total organic carbon varies between 1.05 and 2.38%, S2 pyrolysate between 1.6 and 5.34 mg/g and the hydrogen index between 152.4 and 224.4. It is a good oil source rock which is now mature. In addition to the non marine hydrocarbon source rocks pre Sirt Unconformity, three formations in the overlying Late Cretaceous section also provide hydrocarbon quality source rocks. Interbedded shales within the Rachmat Formation of Late Cretaceous, early Campanian age have total organic carbon ranging between, 0.7 and 1.47%, S2 pyrolysate varying between 1.37 and 4.00 mg/g and hydrogen indices varying between 195.7 and 272.1. The indication is that this unit would provide a fair gas source to a good oil source. Geochemical analyses of the overlying Tagrifet Limestone indicate that total organic carbon varies between 0.26% and 1.01%. S2 pyrolysate varies between 1.21 and 2.16 mg/g and hydrogen indices vary between 195.7 and 465.4. For the overlying Sirt Shale Formation of Late Cretaceous, late Campanian age, total organic carbon varies between 1.04% and 1.51%, S2 pyrolysate varies between 4.65 mg/g and 6.99 mg/g and the hydrogen indices vary between 151 and 462.9. The study has proven that both the Sirt Shale Formation and the Tagrifet Limestone are good to very good and rich sources for oil in the Maragh Low. High resolution biostratigraphical interpretations have been integrated and calibrated with thermal maturity determinations (Vitrinite Reflectance (%Ro), Spore Colour Index (SCI) and Tmax (ºC) and the determined present day geothermal gradient of 25ºC / Km for the Maragh Low. Interpretation of generated basin modelling profiles allows a detailed prediction of timing of maturation development of these source horizons and leads to a determination of amounts of missing section at major unconformities. From the results the top of the oil window (0.72% Ro) is picked as high as 10,700’ and the base of the oil window (1.35% Ro) assuming a linear trend and by projection is picked as low as 18,000’ in the Maragh Low. For the Triassic Shale the early phase of oil generation was in the Late Palaeocene / Early to Middle Eocene and the main phase of oil generation was in the Middle to Late Eocene. The Early Barremian Shale reached the main phase of oil generation in the Early Oligocene with late generation being reached in the Middle Miocene. For the Rakb Group section (Rachmat Formation, Tagrifet Limestone and Sirt Shale Formation) the early phase of oil generation started in the Late Eocene with the main phase of generation being between the Early Oligocene and the Early Miocene. From studying maturity profiles and from regional considerations it can be predicted that up to 500’ of sediment may have been deposited and eroded by the Sirt Unconformity in the central Maragh Low while up to 2000’ of sediment may have been deposited and then eroded to the south of the trough.

Keywords: Geochemical analysis of the source rocks from wells in Eastern Sirt Basin.

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Authors: Eudjen Cinc

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Work with a human voice, especially with a child s voice and cultivating the sound of the choir, presents an area of crucial importance for a conductor. We use the term conductor because it needs to be understood that regardless of whether we have in front of us an amateur or a professional choir, whether they are singers with a wealth of experience or children who are still developing and educating their inner ear so that in the future they could contribute to the development of choir music, the person who stands in front of the group and works with them, needs to have the characteristics of a conductor. Voice formation is a long-term process, without which there is no success in both solo and collective music performance.

Keywords: music group, conductor, collective, performance

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Authors: C. Gallottini, W. Di Mari, A. Amaddeo, K. Barbaro, A. Dolci, G. Dolci, L. Gallottini, G. Barraco, S. Eramo

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A group of 10 dogs (group A) with Periodontal Disease in the third stage, were subjected to regenerative therapy of periodontal tissues, by use of nano hydroxy apatite (NHA). These animals induced by general anesthesia, where treated by ultrasonic scaling, root planning, and at the end by a mucogingival flap in which it was applied NHA. The flap was closed and sutured with simple steps. Another group of 10 dogs (group B), control group, was treated only by scaling and root planning. No patient was subjected to antibiotic therapy. After three months, a check was made by inspection of the oral cavity, radiography and bone biopsy at the alveolar level. Group A showed a total restitutio ad integrum of the periodontal structures, and in group B still mild gingivitis in 70% of cases and 30% of the state remains unchanged. Numerous experimental studies both in animals and humans have documented that the grafts of porous hydroxyapatite are rapidly invaded by fibrovascular tissue which is subsequently converted into mature lamellar bone tissue by activating osteoblast. Since we acted on the removal of necrotic cementum and rehabilitating the root tissue by polishing without intervention in the ligament but only on anatomical functional interface of cement-blasts, we can connect the positive evolution of the clinical-only component of the cement that could represent this perspective, the only reason that Periodontal Disease become a Cement Disease, while all other clinical elements as nothing more than a clinical pathological accompanying.

Keywords: nanoidroxiaphatite, parodontal disease, cement disease, regenerative therapy

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Authors: Shantosa Yudha Siswanto, Julianto Arief Ismail, Rachmat Harryanto

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The research was conducted with the aim to know the effect of slope steepness on organic carbon and soil erodibility as erosion factor. This research was conducted from September to December 2011 in the Raharja and Cinanjung Village, Tanjungsari, Sumedang District, West Java, Indonesia. The study was carried out using physiographic free survey method, which is a survey based on land physiographic appearance. Soil sampling was carried out into transect on the similarity slope without calculating the point of observation range. Soil sampling was carried onto three classes of slope as follows: 8–15%, 15–25% and 25–40%. Each was consisted of three slope position i.e. top slope, middle slope and down slope and four samples of soil were taken from each of them, hence it resulted in 36 points of observation. The results of this study indicate that gradient of slope have some significant contribution in every sample. Middle slope with gradient 26-40% has the highest potential erosion occurrence. It has organic C content (0.84%) and the highest erodibility value (0.1092).

Keywords: slope steepness, erosion, erodibility, erosion factor

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Authors: Fall Abdourahmane, Lazrak Meryem, El Hsaini Houda, El Ammari Laila, Gamih Hasnae, Yahyane Abdelhakim, Benjouad Abdelaziz, Aguenaou Hassan, El Kari Khalid

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Introduction: The double burden of malnutrition (DBM), characterized by the coexistence of undernutrition and overnutrition, is a significant health challenge, particularly in low- and middle-income countries. In Morocco, 61.3% of women of reproductive age (WRA) are overweight or obese, including 30.4% who were obese, while 34.4% were anaemic, and 49.7% have iron deficiency anaemia. Objective: This study aims to determine the prevalence of DBM at the individual level among Moroccan WRA, defined by the coexistence of iron deficiency anaemia and overweight/obesity. Methods: a cross-sectional national survey was conducted among a representative sample of 2090 Moroccan WRA. Data collected included socio-economic parameters, anthropometric measurements, and blood samples. Haemoglobin levels were measured photometrically using Hemocue, while ferritin and CRP were assessed through immunoturbudimetry. Results: The prevalence of overweight/obesity, iron deficiency, anaemia and iron deficiency anaemia among WRA in Morocco were 60.2%, 30.6%, 34.4% and 50.0% respectively. The coexistence of overweight/obesity with anaemia and iron deficiency was observed in 19.2% and 16.3% of women, respectively. Among overweight/obese women, 32.5% were anaemic, 28.4% were iron deficient, and 47.6% had iron deficiency anaemia. the prevalence of DBM was higher in urban areas compared to rural settings. Conclusion: The coexistence of undernutrition and overnutrition among WRA highlights the urgent need for integrated public health interventions addressing both anaemia and obesity simultaneously. Tailored strategies should consider the specific socio-economic and geographical contexts to effectively combat this dual burden.

Keywords: the double burden of malnutrition, iron deficiency anaemia, overweight, obesity

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Authors: Larry E. Udu, Joseph N. Edeh

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Unarguably, the land is an indispensable factor of production and has been instrumental to numerous conflicts between crop farmers and herders in Nigeria. The conflicts pose a grave challenge to life and property, food security and ultimately to sustainable socio-economic development of the nation. The paper examines the causes of the Fulani herders/farmers conflicts, particularly in the Middle Belt; numerity of occurrences and extent of damage and their socio-economic implications. Content Analytical Approach was adopted as methodology wherein data was extensively drawn from the secondary source. Findings reveal that major causes of the conflict are attributable to violation of tradition and laws, trespass and cultural factors. Consequently, the numerity of attacks and level of fatality coupled with displacement of farmers, destruction of private and public facilities impacted negatively on farmers output with their attendant socio-economic implications on sustainable livelihood of the people and the nation at large. For instance, Mercy Corps (a Global Humanitarian Organization) in its research, 2013-2016 asserts that a loss of $14billion within 3 years was incurred and if the conflict were resolved, the average affected household could see increase income by at least 64 percent and potentially 210 percent or higher and that states affected by the conflicts lost an average of 47 percent taxes/IGR. The paper therefore recommends strict adherence to grazing laws; platform for dialogue bothering on compromises where necessary and encouragement of cattle farmers to build ranches for their cattle according to international standards.

Keywords: conflict, farmers, herders, Nigeria, socio-economic implications

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Authors: Ilja Käch, Abdul R. Jandali, Nadja Zechmann-Müller

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Introduction: We discuss the treatment of two young male patients suffering from scaphoid non-union after a traumatic scaphoid fracture. The currently propagated techniques for treating a scaphoid non-union in children are either the operative reconstruction of the scaphoid or the conservative treatment with splinting in a scaphoid cast. Cases: In the first case, we operated on a 13 years old male patient with a posttraumatic scaphoid non-union in the middle third with a humpback deformity. We resected the middle third of the scaphoid and grafted the defect with an iliac crest bone, and the DISI-Deformity was reduced. Fixation was performed with K-Wires and immobilisation in a scaphoid cast. In the second case a 13 years old male patient also with a posttraumatic scaphoid non-union in the middle third and humpback deformity, DISI-deformity, was treated conservatively. Immobilisation in a scaphoid cast for four months was performed. Results: Operative: One year postoperatively the patient achieved a painless free arc of motion. Flexion/Extension 70/0/60°, Radial-/Ulnarduction 30/0/30° and Pro-/Supination 90/0/90°. The computer tomogram showed complete consolidation and bony fusion of the iliac crest bone. Conservative: Six to eight months after conservative treatment the patient demonstrated painless motion and AROM Flexion/Extension 80/0/80°, Radial-/Ulnarduction and Pro-/Supination in maximum range. Complete consolidation in the computer tomogram with persistent humpback- and DISI deformity. Conclusion: In the literature, both techniques are described, either the operative scaphoid reconstruction or the conservative treatment with splinting. In our cases, both the operative and conservative treatments showed comparable good results. However, the humpback- and DISI deformity can only be addressed with a surgical approach.

Keywords: scaphoid, non-union, trauma, operative vs. non operative

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Authors: Dr., Suchita Daokar

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Background: Successful orthodontic treatment has always relied on anchorage. The stability of the implants depends on bone quantity, mini-implant design, and placement conditions. Out of the various methods of gaining stability, Platelet concentrations are gaining popularity for various reasons. PRF is a minimally invasive method, and there are various studies that has shown its role in enhancing the stability of general implants. However, there is no literature found regarding the effect of PRF in enhancing the stability of the orthodontic implant. Therefore, this study aimed to evaluate and assess the efficacy of PRF on the stability of the orthodontic implant. Methods: The study comprised of 9 subjects aged above 18 years of age. The split mouth technique was used; Group A (where implants were coated before insertion) and group B (implant were normally inserted). The stability of the implant was measured using resonance frequency analysis at insertion (T0), 24 hours (T1), 2 weeks (T2), at 4 weeks (T3), at 6 weeks (T4), and 8 weeks (T5) after insertion. Result: Statistically significant findings were found when group A was compared to group B using ANOVA test (p<0.05). The stability of the implant of group A at each time interval was greater than group B. The implant stability was high at T0 and reduces at T2, and increasing through T3 to T5. The stability was highest at T5. Conclusion: A chairside, minimally invasive procedure ofPRF coating on implants have shown promising results in improving the stability of orthodontic implants and providing scope for future studies.

Keywords: Orthodontic implants, stablity, resonance Frequency Analysis, pre

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Authors: Asmaa Hamdy, Israa Nassar, Tarek Aly

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Introduction: Femoral fractures are the most common presentation in the Emergency Department (ED), and they can present as isolated injuries or as part of a polytrauma situation. To provide optimum pain management care to these patients, practitioners must be well prepared and current with utilizing modern evidence-based knowledge and practices. Management of pain associated with fracture femur in the emergency department has a critical role in the satisfaction of patients and preventing further complications. This study aimed to evaluate the analgesic efficacy of ultrasound-guided femoral nerve block compared with intravenous fentanyl in fractures of the femur in patients presented to the Emergency Department. Patients and Methods: Fifty patients with femur fractures were divided into two groups: Group A: In this group (twenty-five patients) were given intravenous fentanyl 2 micro-grams/kg and re-assessed for pain by Visual Analogue Score (VAS). Group B: In this group (twenty-five patients) underwent ultrasonography-guided femoral nerve block and were re-assessed for pain by VAS. Results: VAS score on the movement of the fractured limb between group A and group B at a 10-minute post-intervention period shows P= 0.043, and hence the difference is significant. VAS score on the movement of the fractured limb between group A and group B during a 10-minute post-intervention period showed a significant difference. Seventeen patients in group A had major PID with a percentage of 63% VS 10 patients in group B with a percentage of 37%. conclusion: both femoral nerve block and intravenous fentanyl are effective in relieving pain in patients with femur fractures. But femoral nerve block provides better and more intense analgesia and major pain intensity difference in less time. Moreover, the use of FNB had fewer side effects and more Hemodynamics stability compared to opioids.

Keywords: femur fracture, nerve block, fentanyl, ultrasound guided

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Authors: Behnam Hasanzadeh, Asieh Abbassi Daloii, Ailin Ebrahimi

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The present study aims to investigate the effect of six weeks of progressive aerobic training and aqueous extract of Crataegus monogyna on VEGF variations and plasma angiopoetin-1/2 (ANG- 1/2) in male Wistar rats. Materials and methods: A number of 30 male Wistar rats, 4-6 months old, were randomly divided into four groups: control Crataegus monogyna (N=8), training Crataegus monogyna (N=8), control saline (N=6), and training saline (N=8). The aerobic training program included running on the treadmill at the speed of 34 meters per minute for 60 minutes per day. The training was conducted for six weeks, five days a week. Following each training session, both experimental and control subjects of Crataegus monogyna groups were orally fed with 0.5 mg Crataegus monogyna extract per gram of body weight. The normal saline group was given the same amount of normal saline solution (NS). Eventually, 72 hours after the last training session, blood samples were taken from inferior verna cava. Results: the results showed that progressive endurance training caused insignificant reductions in plasma VEGF concentration in the training group, Crataegus monogyna group and training-Crataegus monogyna group comparing the control group. Plasma ANG-1 concentration reduced in the training, Crataegus monogyna and training-Crataegus monogyna groups while plasma ANG-2 concentration significantly increased in the Crataegus monogyna group (P=0.022) comparing with the control group. The results showed that the ratio of plasma ANG-2 to ANG-1 significantly increased in the Crataegus monogyna group (P=0.028) comparing with the control group. Conclusion: the findings suggest that combination of aerobic training and Crataegus monogyna extract has no synergistic effect on anti-angiogenesis indicators and Crataegus monogyna extract had a stronger effect on anti-angiogenesis indicators.

Keywords: angiopoetin-1/2, VEGF, Crataegus monogyna extract, aerobic training

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Authors: A. Fogliata, L. Martiniello, A. Ambretti

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Introduction: The significance of balance and stability in physical education among adolescents is well-established. This study aims to assess the efficacy of Centering (CENT), which employs intra-abdominal pressure (IAP) in line with the Synchrony Method, in optimizing balance and reducing perceived stress. Materials and Methods: A 6-week intervention was conducted on a sample of adolescents, divided into a control group and an experimental group that incorporated CENT into their physical education program. The Stork Balance Test and the Perceived Stress Scale (PSS) were used to measure changes. Results: Findings revealed a significant enhancement in the balance of both the dominant and non-dominant limbs in the experimental group compared to the control group. Moreover, the PSS test indicated a reduction in perceived stress within the experimental group. Conclusion: Integrating the centering technique into physical education programs can lead to substantial improvements in adolescents' balance and stability, in addition to a reduction in perceived stress levels. These findings suggest the need for further research on broader populations to solidify these pivotal outcomes.

Keywords: adolescents, physical education, balance, centering, intra-abdominal pressure

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Authors: Ranj Tofik

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This article aims to demonstrate a link and/or correlation between the rise of China and the US-Iranian conflict, from a US point of view. To demonstrate this link, the article relies on the content analysis method by analyzing American reports and official data. This article concludes that this correlation indicates that the more China rises and the greater the Chinese threat to America, the more changes will occur in the US-Iranian conflict and the US actions regarding this conflict will increase – in the form of imposing sanctions and using means of pressure on Iran, or trying to reach an agreement and settlement with Iran. This article, via noting and observing that correlation, also claims that before 2012, Iran was a regional threat to US interests in the Middle East. However, after 2012 when the rise of China became one of the major threats to America, Iran, because of its rapprochement with China, became also part of the Chinese threat, which is a threat to America's global standing. In addition, observing this correlation indicates the possibility that the rise of China and its threat to the USA has become one of the main drivers in the US-Iranian conflict. Consequently, it can be said that Iran has become a vital issue in the US-China rivalry, as it has become an appropriate gateway for China to enter the Middle East and undermine US hegemony there.

Keywords: China-Iran relations, China's rise, JCPOA, US-Chinese competition, US-Iranian conflict

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Authors: Meha Singla, Shankhadeep Chaudhuri, Yadunandan Batchu

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Rental Housing is a more cost effective and flexible housing solution for the low income families than home-ownership. While India is undergoing a new industrial metamorphosis with multiple government initiatives that emphasise on the growth of manufacturing sector through policy frameworks and corridor development proposals, there is going to be a huge influx of low-income working population to the upcoming urban centres. As per stats, about 70 per cent of the housing demand at these centres fall into the affordable segment. And in the midst of this rapid urbanisation and huge immigration of young population, there is a lack of proper rental housing framework in the country. A large number of immigrants will be unable to support home-ownership thereby leading to proliferation of slums in urban centres. As a result, there is a dire need for immediate articulation of a comprehensive rental housing policy and affordable housing initiatives. In this paper, CommonFloor attempts to analyse successful rental housing case studies of the world followed by establishing a correlation between the gap in urban rental housing stock and the per capita income statistics to devise rental housing affordability specific to major Indian cities (Delhi, Mumbai, Bangalore, Chennai). Further, with the corroboration of market price trends, it will try to locate feasible micro-markets for immediate rental housing action. Final research findings will provide key data points thereby helping to design the approach for efficient utilisation of unsold residential inventory in the country in order to compensate the rental housing deficiency. This data set is believed to express viable model(s) of the rental housing approach for the government and private participants.

Keywords: housing prices, migration of population, real estate, rental housing, rental markets, residential property market, urbanisation

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Authors: Rewadee Watakakosol, Arunya Tuicomepee, Panrapee Suttiwan, Sakkaphat T. Ngamake

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Health problems caused by alcohol consumption not only have short-term effects at the time of drinking but also leave long-lasting health conditions. Teenagers who start drinking in their middle-high or high school years or before entering college have higher likelihood to increase their alcohol use and abuse, and they were found to be less healthy compared with their non-drinking peers when entering adulthood. This study aimed to examine factors that predict intention and readiness to reduce and quit alcohol consumption among Thai teenagers. Participants were 826 high-school and vocational school students, most of whom were females (64.4%) with the average age of 16.4 (SD = 0.9) and the average age of first drinking at 13.7 (SD = 2.2). Instruments included the scales that developed based on the Theory of Planned Behaviour theoretical framework. They were the Attitude toward Alcohol Reduction and Cessation Scale, Normative Group and Influence Scale, Perceived Behavioral Control toward Alcohol Reduction and Cessation Scale, Behavioral Intent toward Alcohol Reduction and Cessation Scale, and Readiness to Reduce and Quit Alcohol Consumption Scale. Findings revealed that readiness to reduce / quit alcohol was the most powerful predictive factor (β=. 53, p < .01), followed by attitude of easiness in alcohol reduction and cessation (β=.46, p < .01), perceived behavioral control toward alcohol reduction and cessation (β =.41, p < .01), normative group and influence (β=.15, p < .01), and attitude of being accepted from alcohol reduction and cessation (β = -.12, p < .01), respectively. Attitude of improved health after alcohol reduction and cessation did not show statistically significantly predictive power. All factors significantly predict teenagers’ alcohol reduction and cessation behavior and accounted for 59 percent of total variance of alcohol consumption reduction and cessation.

Keywords: alcohol consumption reduction and cessation, intention, readiness to change, Thai teenagers

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Authors: Maja Martinovic, Valentina Zarkovic, Hrvoje Maljak

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Europe is one of the most popular tourist destinations in the world, in which tourism occupies a significant place among the most relevant economic activities, and this applies to the Republic of Croatia as well. Based on this study, the authors intended to encourage and support the creation of an effective tourism policy in Croatia that would be based on the profiling of certain target groups. Another objective was to compare the results obtained from the customer analysis with the market analysis of the tourism industry in Croatia. The objective is to adapt the current tourist offer according to the identified needs and expectations of a particular tourist group in order to increase the attractiveness of Croatia as a tourist destination and motivate greater attendance of the targeted tourist groups. The current research was oriented towards the Russian market as the target group. Therefore, the authors wanted to encourage a discussion on how to attract more Russian guests. Consequently, the intention of the research was a detailed analysis of Russian tourists, in order to gain a better understanding of their travelling motives and tendencies. Furthermore, attention was paid to the expectations of Russian customers and to compare them with the Croatian tourist offer, and to determine whether there is a possibility for an overlap. The method used to obtain the information required was a survey conducted among Russian citizens about their travelling habits. The research was carried out on the basis of 166 participants of different age, gender, profession and income group. The sampling and distribution of the survey took place between May and July 2016. The results provided from the research indicate that Croatian tourism has certain unrealized potential considering the popularization of Croatia as a tourist destination, and there is a capacity for increasing the revenues within the group of Russian tourists. Such a conclusion is based on the fact that the Croatian tourist offer and the preferences of the Russian guests are compatible, i.e. they overlap in many aspects. The results demonstrate that beautiful nature, cultural and historical heritage as well as the sun and sea, play a leading role in attracting more Russian tourists. It is precisely these elements that form the three pillars of the Croatian tourist offer. On the other hand, the profiling revealed that the most desirable destinations for the Russian guests are Italy and Spain, both of which provide the same main tourist attractions as Croatia. Therefore, the focus of the strategic ideas given in the paper shifted to other tourism segments, such as type of accommodation, sales channels, travel motives, additional offer and seasonality etc., in order to gain advantage in the Russian market, the Mediterranean region and tourism in general. The purpose of the research is to serve as a foundation for analysing the attractiveness of the other tourist destinations in the Russian market, as well as to be a general basis for a more detailed profiling of the various specific target groups of the Russian and other tourist groups.

Keywords: Croatia, Russian market, target groups, tourism, tourist destination

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Authors: Sadam Elayah, Yang Li, Bing Shi

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Background: The impact of relaxing incisions on maxillofacial growth during palatoplasty remains a topic of debate, and further research is needed to understand its effects fully. Thus, the current study is the first long-term study that aimed to assess the maxillofacial growth of patients with isolated cleft palate following the Sommerlad-Furlow modified (S.F) technique and to estimate the impact of relaxing incisions on maxillofacial growth following S.F technique in patients with isolated cleft palate. Methods: A total of 85 participants, 55 patients with non-syndromic isolated soft and hard cleft palate underwent primary palatoplasty with our technique (30 patients received the Sommerlad-Furlow modified technique without relaxing incision (S.F+RI group), and 25 received Sommerlad-Furlow modified technique without relaxing (S.F-RI group) with no significant difference found between them regarding the cleft type, cleft width, and age at repair. While the other 30 were normal participants with skeletal class I pattern (C group). The control group was matched with the study group in number, age, and sex. All the study variables were measured using stable landmarks, including 12 linear and 10 angular variants. Results: The mean ages at collection of cephalograms were 6.03±0.80 in the S.F+RI group, 5.96±0.76 in the S.F-RI group, and 5.91±0.87 in the C group. Regarding cranial base, the results showed no statistically significant differences between the three groups in S-N and S-N-Ba. The S.F+R.I group had a significantly shorter S-Ba than the S.F-R.I & C groups (P= 0.01). However, there was no statistically significant difference between the S.F-R.I & C groups (P=0.80). Regarding the skeletal maxilla, there was no significant difference between the S.F+R.I and S.F-R.I groups in all linear measurements (N-ANS, S- PM & SN-PP ) except Co-A, the S.F+R.I group had significantly shorter Co-A than the S.F-R.I & C groups (P= <0.01). While the angular measurement, S.F+R.I group had significantly less SNA angle than the S.F-R.I & C groups (P= <0.01). Regarding mandibular bone, there were no statistically significant differences in all linear and angular mandibular measurements between the S.F+R.I and S.F-R.I groups. Regarding intermaxillary relation, the S.F+R.I group had significant differences in Co-Gn - Co-A and ANB compared to the S.F-R.I & C groups (P= <0.01). There was no statistically significant difference in PP-MP among the three groups. Conclusion: As a preliminary report, the Sommerlad-Furlow modified technique without relaxing incisions was found to have good maxillary positioning in the face and a satisfactory intermaxillary relationship compared to the Sommerlad-Furlow modified technique with relaxing incisions.

Keywords: relaxing incisions, cleft palate, palatoplasty, maxillofacial growth

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Authors: Sandhya Rijal, Saroj Adhikari, Ramesh R. Pant

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Non-Timber Forest Products (NTFPs) have attracted substantial interest in the recent years with the increasing recognition that these can provide essential community needs for improved and diversified rural livelihood and support the objectives of biodiversity conservation. Nevertheless, various challenges are witnessed in their sustainable harvest and management. Assuming that sustainable management with community stewardship can offer one of the solutions to existing challenges, the study assesses the linkages between NTFPs and rural livelihood in Lamabagar village of Dolakha, Nepal. The major objective was to document the status of NTFPs and their contributions in households of Lamabagar. For status documentation, vegetation sampling was done using systematic random sampling technique. 30 plots of 10 m × 10 m were laid down in six parallel transect lines at horizontal distance of 160 m in two different community forests. A structured questionnaire survey was conducted in 76 households (excluding non-response rate) using stratified random sampling technique for contribution analysis. Likewise, key informant interview and focus group discussions were also conducted for data triangulations. 36 different NTFPs were recorded from the vegetation sample in two community forests of which 50% were used for medicinal purposes. The other uses include fodder, religious value, and edible fruits and vegetables. Species like Juniperus indica, Daphne bholua Aconitum spicatum, and Lyonia ovalifolia were frequently used for trade as a source of income, which was sold in local market. The protected species like Taxus wallichiana and Neopicrorhiza scrophulariiflora were also recorded in the area for which the trade is prohibited. The protection of these species urgently needs community stewardship. More than half of the surveyed households (55%) were depending on NTFPs for their daily uses, other than economic purpose whereas 45% of them sold those products in the market directly or in the form of local handmade products as a source of livelihood. NTFPs were the major source of primary health curing agents especially for the poor and unemployed people in the study area. Hence, the NTFPs contributed to livelihood under three different categories: subsistence, supplement income and emergency support, depending upon the economic status of the households. Although the status of forest improved after handover to the user group, the availability of valuable medicinal herbs like Rhododendron anthopogon, Swertia nervosa, Neopicrorhiza scrophulariiflora, and Aconitum spicatum were declining. Inadequacy of technology, lack of easy transport access, and absence of good market facility were the major limitations for external trade of NTFPs in the study site. It was observed that people were interested towards conservation only if they could get some returns: economic in terms of rural settlements. Thus, the study concludes that NTFPs could contribute rural livelihood and support conservation objectives only if local communities are provided with the easy access of technology, market and capital.

Keywords: contribution, medicinal, subsistence, sustainable harvest

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Authors: Susan Thurstans, Natalie Sessions, Carmel Dolan, Kate Sadler, Bernardette Cichon, Shelia Isanaka, Dominique Roberfroid, Heather Stobagh, Patrick Webb, Tanya Khara

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For many years, wasting and stunting have been viewed as separate conditions without clear evidence supporting this distinction. In 2014, the Emergency Nutrition Network (ENN) examined the relationship between wasting and stunting and published a report highlighting the evidence for linkages between the two forms of undernutrition. This systematic review aimed to update the evidence generated since this 2014 report to better understand the implications for improving child nutrition, health and survival. Following PRISMA guidelines, this review was conducted using search terms to describe the relationship between wasting and stunting. Studies related to children under five from low- and middle-income countries that assessed both ponderal growth/wasting and linear growth/stunting, as well as the association between the two, were included. Risk of bias was assessed in all included studies using SIGN checklists. 45 studies met the inclusion criteria- 39 peer reviewed studies, 1 manual chapter, 3 pre-print publications and 2 published reports. The review found that there is a strong association between the two conditions whereby episodes of wasting contribute to stunting and, to a lesser extent, stunting leads to wasting. Possible interconnected physiological processes and common risk factors drive an accumulation of vulnerabilities. Peak incidence of both wasting and stunting was found to be between birth and three months. A significant proportion of children experience concurrent wasting and stunting- Country level data suggests that up to 8% of children under 5 may be both wasted and stunted at the same time, global estimates translate to around 16 million children. Children with concurrent wasting and stunting have an elevated risk of mortality when compared to children with one deficit alone. These children should therefore be considered a high-risk group in the targeting of treatment. Wasting, stunting and concurrent wasting and stunting appear to be more prevalent in boys than girls and it appears that concurrent wasting and stunting peaks between 12- 30 months of age with younger children being the most affected. Seasonal patterns in prevalence of both wasting and stunting are seen in longitudinal and cross sectional data and in particular season of birth has been shown to have an impact on a child’s subsequent experience of wasting and stunting. Evidence suggests that the use of mid-upper-arm circumference combined with weight-for-age Z-score might effectively identify children most at risk of near-term mortality, including those concurrently wasted and stunted. Wasting and stunting frequently occur in the same child, either simultaneously or at different moments through their life course. Evidence suggests there is a process of accumulation of nutritional deficits and therefore risk over the life course of a child demonstrates the need for a more integrated approach to prevention and treatment strategies to interrupt this process. To achieve this, undernutrition policies, programmes, financing and research must become more unified.

Keywords: Concurrent wasting and stunting, Review, Risk factors, Undernutrition

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