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Ekström, Eva-Charlotte
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Publications (10 of 79) Show all publications
Nozawa, Y., Hawlader, M. D., Ferdous, F., Raqib, R., Tofail, F., Ekström, E.-C. & Wagatsuma, Y. (2019). Effects of intrauterine growth restriction and postnatal nutrition on pediatric asthma in Bangladesh.. Journal of Developmental Origins of Health and Disease, 1-9
Open this publication in new window or tab >>Effects of intrauterine growth restriction and postnatal nutrition on pediatric asthma in Bangladesh.
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2019 (English)In: Journal of Developmental Origins of Health and Disease, ISSN 2040-1744, E-ISSN 2040-1752, p. 1-9Article in journal (Refereed) Epub ahead of print
Abstract [en]

Numerous studies have investigated the risk of developing asthma due to early-life experiences and environmental exposures. However, the influence of intrauterine growth restriction and postnatal undernutrition on childhood wheezing/asthma remains unclear. Thus, we examined the effects of both small for gestational age (SGA) and postnatal stunted growth on ever asthma among children in the rural areas in Bangladesh.Multiple follow-up studies were conducted in a cohort of randomized clinical trial of nutrition interventions during pregnancy (the MINIMat trial). Overall, 1208 and 1697 children were followed-up for asthma at 4.5 and 10 years, respectively. Anthropometric measurements were obtained at various intervals from birth to 10 years of age. Ever asthma was identified using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire.Results showed that SGA was significantly associated with increased risk of ever asthma at 4.5 and 10 years after adjusting for sex, body mass index, socioeconomic status, family history of asthma, gestational age at birth, mother's parity, mother's age at birth and intervention trial arm [odds ratio (OR)=1.97 (95% confidence interval (CI): 1.34-2.90) and 1.86 (95% CI: 1.18-2.72)]. For the postnatal effect of undernutrition, stunting at 1 and 2 years was significantly associated with ever asthma at 4.5 and 10 years [1 year: OR=1.77 (95% CI: 1.22-2.57) and OR=1.72 (95% CI: 1.16-2.56), 2 years: OR=1.49 (95% CI: 1.06-2.10) and OR=1.41 (95% CI: 1.02-1.96)].In conclusion, SGA and undernutrition during infancy has an influence on childhood asthma among children in Bangladesh, indicating the need for nutritional interventions early in life.

Keywords
Bangladesh, asthma, intrauterine growth restriction, small for gestational age, stunting
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-389946 (URN)10.1017/S2040174419000096 (DOI)30841946 (PubMedID)
Available from: 2019-08-01 Created: 2019-08-01 Last updated: 2019-08-01
Ziaei, S., Naved, R. T., Rahman, A., Raqib, R. & Ekström, E.-C. (2019). Maternal Experience of Domestic Violence, Associations with Children's Lipid Biomarkers at 10 Years: Findings from MINIMat Study in Rural Bangladesh. Nutrients, 11(4), Article ID 910.
Open this publication in new window or tab >>Maternal Experience of Domestic Violence, Associations with Children's Lipid Biomarkers at 10 Years: Findings from MINIMat Study in Rural Bangladesh
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2019 (English)In: Nutrients, ISSN 2072-6643, E-ISSN 2072-6643, Vol. 11, no 4, article id 910Article in journal (Refereed) Published
Abstract [en]

The consequences of maternal experience of Domestic Violence (DV) on their children's cardio-metabolic risk factors are unclear. We aimed to assess if maternal exposure to any or a specific form of DV (i.e., physical, sexual, emotional and controlling behaviors) before and after childbirth was associated with their children's lipid biomarkers at the age of 10 years. A current observational sub-study of a larger MINIMat trial included a cohort of 1167 mothers and their children. The conflict tactic scale was used to record women's experience of lifetime DV before and after childbirth at week 30 of pregnancy and at a 10-year follow up, respectively. Five ml of fasting blood sample was collected from the children to evaluate their lipid profile. Children of women who experienced any DV before childbirth had lower Apo A ((adj) -0.04; 95% CI: -0.08, -0.01). Women who experienced physical DV both before and after childbirth had children with higher triglycerides ((adj) 0.07; 95% CI: 0.01, 0.14). Children whose mother experienced sexual DV before birth had lower Apo A ((adj) -0.05; 95% CI: -0.08, -0.01) and High Density Lipoprotein (HDL) ((adj) -0.05; 95% CI: -0.10, -0.01) as well as higher Low Density Lipoprotein (LDL) ((adj) 0.17; 95% CI: 0.05, 0.29) and LDL/HDL ( 0.24; 95% CI: 0.11, 0.38). However, levels of LDL ((adj) -0.17; 95% CI: -0.28, -0.06), LDL/HDL ((adj) -0.12; 95% CI: -0.25, -0.00) and cholesterol ((adj) -0.13; 95% CI: -0.25, -0.02) were lower among the children of mothers who experienced controlling behavior after childbirth. Results from the current study suggest that maternal experience of physical or sexual DV might negatively affect their children's lipid profile at the age of 10 years.

Place, publisher, year, edition, pages
MDPI, 2019
Keywords
domestic violence, children, lipid biomarkers, Bangladesh
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-387224 (URN)10.3390/nu11040910 (DOI)000467749800203 ()31018615 (PubMedID)
Funder
Swedish Research Council, 521-2011-3124
Available from: 2019-06-25 Created: 2019-06-25 Last updated: 2019-06-25Bibliographically approved
Sysoev, O., Bartoszek, K., Ekström, E.-C. & Ekholm Selling, K. (2019). PSICA: Decision trees for probabilistic subgroup identification with categorical treatments. Statistics in Medicine, 38(22), 4436-4452
Open this publication in new window or tab >>PSICA: Decision trees for probabilistic subgroup identification with categorical treatments
2019 (English)In: Statistics in Medicine, ISSN 0277-6715, E-ISSN 1097-0258, Vol. 38, no 22, p. 4436-4452Article in journal (Refereed) Published
Abstract [en]

Personalized medicine aims at identifying best treatments for a patient with given characteristics. It has been shown in the literature that these methods can lead to great improvements in medicine compared to traditional methods prescribing the same treatment to all patients. Subgroup identification is a branch of personalized medicine, which aims at finding subgroups of the patients with similar characteristics for which some of the investigated treatments have a better effect than the other treatments. A number of approaches based on decision trees have been proposed to identify such subgroups, but most of them focus on two-arm trials (control/treatment) while a few methods consider quantitative treatments (defined by the dose). However, no subgroup identification method exists that can predict the best treatments in a scenario with a categorical set of treatments. We propose a novel method for subgroup identification in categorical treatment scenarios. This method outputs a decision tree showing the probabilities of a given treatment being the best for a given group of patients as well as labels showing the possible best treatments. The method is implemented in an R package psica available on CRAN. In addition to a simulation study, we present an analysis of a community-based nutrition intervention trial that justifies the validity of our method.

Keywords
bootstrap, decision trees, personalized medicine, random forest, subgroup discovery
National Category
Probability Theory and Statistics
Identifiers
urn:nbn:se:uu:diva-395435 (URN)10.1002/sim.8308 (DOI)000484974200020 ()31246349 (PubMedID)
Funder
Swedish Research Council, 2014-2161
Available from: 2019-10-30 Created: 2019-10-30 Last updated: 2019-10-30Bibliographically approved
Svefors, P., Sysoev, O., Ekström, E.-C., Persson, L.-Å., Arifeen, S. E., Naved, R. T., . . . Ekholm Selling, K. (2019). Relative importance of prenatal and postnatal determinants of stunting: data mining approaches to the MINIMat cohort, Bangladesh.. BMJ Open, 9(8), Article ID e025154.
Open this publication in new window or tab >>Relative importance of prenatal and postnatal determinants of stunting: data mining approaches to the MINIMat cohort, Bangladesh.
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2019 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 8, article id e025154Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: WHO has set a goal to reduce the prevalence of stunted child growth by 40% by the year 2025. To reach this goal, it is imperative to establish the relative importance of risk factors for stunting to deliver appropriate interventions. Currently, most interventions take place in late infancy and early childhood. This study aimed to identify the most critical prenatal and postnatal determinants of linear growth 0-24 months and the risk factors for stunting at 2 years, and to identify subgroups with different growth trajectories and levels of stunting at 2 years.

METHODS: Conditional inference tree-based methods were applied to the extensive Maternal and Infant Nutrition Interventions in Matlab trial database with 309 variables of 2723 children, their parents and living conditions, including socioeconomic, nutritional and other biological characteristics of the parents; maternal exposure to violence; household food security; breast and complementary feeding; and measurements of morbidity of the mothers during pregnancy and repeatedly of their children up to 24 months of age. Child anthropometry was measured monthly from birth to 12 months, thereafter quarterly to 24 months.

RESULTS: Birth length and weight were the most critical factors for linear growth 0-24 months and stunting at 2 years, followed by maternal anthropometry and parental education. Conditions after birth, such as feeding practices and morbidity, were less strongly associated with linear growth trajectories and stunting at 2 years.

CONCLUSION: The results of this study emphasise the benefit of interventions before conception and during pregnancy to reach a substantial reduction in stunting.

Keywords
epidemiology, nutrition, paediatrics, public health
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-397529 (URN)10.1136/bmjopen-2018-025154 (DOI)31383692 (PubMedID)
Available from: 2019-11-21 Created: 2019-11-21 Last updated: 2019-11-21
Islam, M. R., Trenholm, J. E., Rahman, A., Pervin, J., Ekström, E.-C. & Rahman, S. M. (2019). Sociocultural Influences on Dietary Practices and Physical Activity Behaviors of Rural Adolescents-A Qualitative Exploration.. Nutrients, 11(12), Article ID E2916.
Open this publication in new window or tab >>Sociocultural Influences on Dietary Practices and Physical Activity Behaviors of Rural Adolescents-A Qualitative Exploration.
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2019 (English)In: Nutrients, ISSN 2072-6643, E-ISSN 2072-6643, Vol. 11, no 12, article id E2916Article in journal (Refereed) Published
Abstract [en]

In the aftermath of nutrition transition and ever-increasing sedentarism, adolescents globally are exposed to negative health consequences. Diverse sociocultural influences play a critical role in their adoption of unhealthy dietary practices and suboptimal physical activity behaviors. Context-specific understandings of how these sociocultural influences shape adolescents' dietary and physical activity patterns in a rural, resource-limited setting remained elusive. Aiming to address the gap, this qualitative study explored adolescents' and mothers' perception of broader sociocultural aspects that sculpt the food choices, eating habits and physical activity behaviors of adolescents in Matlab, Bangladesh. Six digitally-recorded focus group discussions were transcribed verbatim, translated into English and analyzed thematically. Marked taste-driven dietary preference of adolescents and its prioritization within family by the mothers, popularity of street foods, better understanding of the importance of food hygiene and safety contrasting with narrow perception of balance and diversity in diet, peer influence along with deficient school and community food environment, internalization and rigidity of gender norms were found to be exerting major influence. The findings highlighted key targets for community-based nutrition interventions and endorsed thorough consideration of socio-cultural factors in formulating strategies to promote healthful eating and physical activity behaviors among the adolescents.

Keywords
Bangladesh, adolescent, dietary practices, physical activity
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-398679 (URN)10.3390/nu11122916 (DOI)31810284 (PubMedID)
Available from: 2019-12-09 Created: 2019-12-09 Last updated: 2019-12-09
Tadesse, E., Worku, A., Berhane, Y. & Ekström, E.-C. (2018). An integrated community-based outpatient therapeutic feeding programme for severe acute malnutrition in rural Southern Ethiopia: Recovery, fatality, and nutritional status after discharge.. Maternal and Child Nutrition, 14(2), Article ID 12519.
Open this publication in new window or tab >>An integrated community-based outpatient therapeutic feeding programme for severe acute malnutrition in rural Southern Ethiopia: Recovery, fatality, and nutritional status after discharge.
2018 (English)In: Maternal and Child Nutrition, ISSN 1740-8695, E-ISSN 1740-8709, Vol. 14, no 2, article id 12519Article in journal (Refereed) Published
Abstract [en]

A scaled up and integrated outpatient therapeutic feeding programme (OTP) brings the treatment of severely malnourished children closer to the community. This study assessed recovery from severe acute malnutrition (SAM), fatality, and acute malnutrition up to 14 weeks after admission to a programme integrated in the primary health care system. In this cohort study, 1,048 children admitted to 94 OTPs in Southern Ethiopia were followed for 14 weeks. Independent anthropometric measurements and information on treatment outcome were collected at four home visits. Only 32.7% (248/759) of children with SAM on admission fulfilled the programme recovery criteria at the time of discharge (i.e., gained 15% in weight, or oedema, if present at admission, was resolved at discharge). Of all children admitted to the programme for whom nutritional assessment was done 14 weeks later, 34.6% (321/928) were severely malnourished, and 37.5% (348/928) were moderately malnourished; thus, 72.1% were acutely malnourished. Of the children, 27/982 (2.7%) had died by 14 weeks, of whom all but one had SAM on admission. Children with severe oedema on admission had the highest fatality rate (12.0%, 9/75). The median length of admission to the programme was 6.6 weeks (interquartile range: 5.3, 8.4 weeks). Despite children participating for the recommended duration of the programme, many children with SAM were discharged still acutely malnourished and without reaching programme criteria for recovery. For better outcome of OTP, constraints in service provision by the health system as well as challenges of service utilization by the beneficiaries should be identified and addressed.

Keywords
Ethiopia, integrated outpatient therapeutic programme, outcome, recovery, severe acute child malnutrition
National Category
Nutrition and Dietetics Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-331991 (URN)10.1111/mcn.12519 (DOI)000428452800006 ()29024381 (PubMedID)
Funder
Sida - Swedish International Development Cooperation Agency, SWE-2010-179
Available from: 2017-10-20 Created: 2017-10-20 Last updated: 2019-01-25Bibliographically approved
Arifeen, S. E., Ekström, E.-C., Frongillo, E. A., Hamadani, J., Khan, A. I., Naved, R. T., . . . Persson, L.-Å. (2018). Cohort Profile: The Maternal and Infant Nutrition Interventions in Matlab (MINIMat) Cohort in Bangladesh. International Journal of Epidemiology, 47(6), 1737-1738e
Open this publication in new window or tab >>Cohort Profile: The Maternal and Infant Nutrition Interventions in Matlab (MINIMat) Cohort in Bangladesh
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2018 (English)In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 47, no 6, p. 1737-1738eArticle in journal (Refereed) Published
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-364628 (URN)10.1093/ije/dyy102 (DOI)000456664500005 ()29868907 (PubMedID)
Available from: 2018-10-30 Created: 2018-10-30 Last updated: 2019-03-18Bibliographically approved
Berhane, H. Y., Ekström, E.-C., Jirström, M., Berhane, Y., Turner, C., Alsanius, B. W. & Trenholm, J. E. (2018). Mixed blessings:: A qualitative exploration of mothers' experience of child care and feeding in the rapidly urbanizing city of Addis Ababa, Ethiopia. PLoS ONE, 13(11), Article ID e0207685.
Open this publication in new window or tab >>Mixed blessings:: A qualitative exploration of mothers' experience of child care and feeding in the rapidly urbanizing city of Addis Ababa, Ethiopia
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2018 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 11, article id e0207685Article in journal (Refereed) Published
Abstract [en]

Many studies have drawn attention to the vital role mothers have in safeguarding the health and nutritional wellbeing of their children. However, little is known about mothers' experiences and the challenges they face in fulfilling this role in rapidly urbanizing cities in Africa. This study aims to explore child care and feeding practices of mothers with children under five years of age in Addis Ababa, Ethiopia. This qualitative study was conducted using a semi-structured interview guide. A total of thirty-six interviews were conducted with purposively selected participants. All interviews were audio recorded, transcribed verbatim and translated for analysis. We used a thematic analysis approach, which was guided by a resilience framework. The findings are presented as three major themes. 1) 'Mixed blessings-balancing motherhood's expectations'. While mothers identified positively with the social recognition and sense of fulfillment of being a 'good mother', they were ambivalent/torn about earning the necessary income from outside work and fulfilling their duties at home. 2) 'Instabilities due to rampant urban sprawl'. While women expressed a keen desire to balance work and motherhood, the disintegrating social capital, due to large in-migration, market fluctuations and abrupt/forced resettlements to new housing units had left mothers without support for childcare, stressed and exhausted. 3) 'Anchored by faith: a source of resilience to cope with adversities'. In the face of the multiple adversities, mothers cited their strong faith as their most reliable foundation for their resilience. In summary, the societal and environmental changes accompanying the rapid urbanization in low income settings makes combining child care and working outside the home very challenging for mothers. As a result they suffer from fatigue and feelings of isolation. Efforts to improve child feeding and care in urban low-income settings need to consider context appropriate strategies that support mothers with small children.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-369725 (URN)10.1371/journal.pone.0207685 (DOI)000450775300036 ()30458024 (PubMedID)
Funder
Swedish Research Council Formas
Available from: 2018-12-17 Created: 2018-12-17 Last updated: 2019-02-07Bibliographically approved
Berhane, H. Y., Ekström, E.-C., Jirström, M., Berhane, Y., Turner, C., Alsanius, B. W. & Trenholm, J. E. (2018). What Influences Urban Mothers' Decisions on What to Feed Their Children Aged Under Five-The Case of Addis Ababa, Ethiopia. Nutrients, 10(9), Article ID 1142.
Open this publication in new window or tab >>What Influences Urban Mothers' Decisions on What to Feed Their Children Aged Under Five-The Case of Addis Ababa, Ethiopia
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2018 (English)In: Nutrients, ISSN 2072-6643, E-ISSN 2072-6643, Vol. 10, no 9, article id 1142Article in journal (Refereed) Published
Abstract [en]

Mothers carry the prime responsibility for childcare and feeding in low-income countries. Understanding their experiences in providing food for their children is paramount to informing efforts to improve the nutritional status of children. Such information is lacking in Sub-Saharan Africa. To understand what influences urban mothers' food acquisition and their motivations for selecting food for their children, 36 in-depth interviews were carried out with mothers having children under five years of age. Interviews were conducted in the local language, audio-recorded, transcribed, and translated into English. Data were analyzed using thematic analysis which led to the identification of four major themes: mothers give-in to a child-driven diet; quick-fix versus the privilege of planning; keen awareness on food safety, nutrition, and diet diversity; and social, familial, and cultural influences. The findings indicate that child feeding practices are influenced by interlinked social and environmental factors. Hence, nutrition education campaigns should focus on targeting not only families but also their children. Attention should also be given to food safety regulations, as well as to the much-needed support of mothers who are struggling to ensure their children's survival in low-income countries.

Keywords
Ethiopia, child feeding/nutrition, qualitative methods, urban mothers
National Category
Public Health, Global Health, Social Medicine and Epidemiology Nutrition and Dietetics
Identifiers
urn:nbn:se:uu:diva-364627 (URN)10.3390/nu10091142 (DOI)000448659900015 ()30135354 (PubMedID)
Available from: 2018-10-30 Created: 2018-10-30 Last updated: 2019-01-21Bibliographically approved
Frith, A., Ziaei, S., Frongillo, E., Khan, A., Ekström, E.-C. & Naved, R. (2017). Breastfeeding counseling improves maternal-infant feeding interaction in those exposed to controlling behavior or emotional violence: MINIMat study in Bangladesh. Paper presented at Annual Meeting of the American-Society-for-Pharmacology-and-Experimental-Therapeutics (ASPET) at Experimental Biology Meeting, APR 22-26, 2017, Chicago, IL. The FASEB Journal, 31(1), Article ID 959.11.
Open this publication in new window or tab >>Breastfeeding counseling improves maternal-infant feeding interaction in those exposed to controlling behavior or emotional violence: MINIMat study in Bangladesh
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2017 (English)In: The FASEB Journal, ISSN 0892-6638, E-ISSN 1530-6860, Vol. 31, no 1, article id 959.11Article in journal, Meeting abstract (Other academic) Published
National Category
Nutrition and Dietetics Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-335020 (URN)000405461405044 ()
Conference
Annual Meeting of the American-Society-for-Pharmacology-and-Experimental-Therapeutics (ASPET) at Experimental Biology Meeting, APR 22-26, 2017, Chicago, IL
Available from: 2017-12-01 Created: 2017-12-01 Last updated: 2017-12-15Bibliographically approved
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