Katelyn J Rittenhouse, Bellington Vwalika, Yuri V Sebastião, Rachel S Resop, Humphrey Mwape, Kristina De Paris, Mwansa K Lubeya, Margaret P Kasaro, Jeffrey S A Stringer, Joan T Price
{"title":"Mid-Trimester Allostatic Load and Spontaneous Preterm Birth in a Cohort of Pregnant Women Living with HIV in Zambia.","authors":"Katelyn J Rittenhouse, Bellington Vwalika, Yuri V Sebastião, Rachel S Resop, Humphrey Mwape, Kristina De Paris, Mwansa K Lubeya, Margaret P Kasaro, Jeffrey S A Stringer, Joan T Price","doi":"10.1007/s10995-025-04186-4","DOIUrl":"https://doi.org/10.1007/s10995-025-04186-4","url":null,"abstract":"<p><strong>Objectives: </strong>Maternal HIV is associated with preterm birth (PTB). In resource-rich settings, spontaneous preterm birth (SPTB) has been linked to biomarkers of stress. We examined the association between allostatic load and SPTB among women with HIV.</p><p><strong>Methods: </strong>In a nested case-cohort analysis of a randomized trial of intramuscular progesterone to prevent PTB in women with HIV in Lusaka, Zambia, we measured 15 midtrimester plasma biomarkers from 4 domains: cardiovascular, immune, metabolic, and neuroendocrine. SPTB was defined as delivery <37wks preceded by spontaneous labor or membrane rupture. A composite ALI was calculated by summing Z-scores from all markers (ALI-15); another was calculated from a 7 marker subset (ALI-7) with Z-score differences >0.1 between outcome groups. We estimated SPTB time-to-event curves and hazard ratios (HR) between ALI quartiles.</p><p><strong>Results: </strong>Of 800 women enrolled in IPOP (2015-2017), 51 (6%) had SPTB. We randomly selected 107 participants, including 6 with SPTB (cases). We then selected all remaining cases (n=45), yielding a final sample of 152. Z-score distributions of systolic blood pressure, heart rate, HDL, triglycerides, hemoglobin A1C, albumin, and 25-OH Vitamin D were included in ALI-7. Participants in the fourth quartile of ALI-7 were more likely to experience SPTB (HR 2.49, 95% CI 1.15-5.40) than participants in the second quartile; this association was attenuated when quartile groups were defined by ALI-15 (HR 1.24, 95% CI 0.59-2.60).</p><p><strong>Conclusions: </strong>High ALI among women with HIV was associated with SPTB. A seven marker ALI appeared a more meaningful indicator of risk than one composed of all measured markers.</p>","PeriodicalId":48367,"journal":{"name":"Maternal and Child Health Journal","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145356536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Serwaa S Omowale, Cherell Cottrell-Daniels, Kobi Miller, Linda Jones, Tracy Jones, Maile Chand, Brionna McGhee, Brittany Slatton, Miriam Kuppermann
{"title":"Community-Based Approaches to Developing a Community-Level Intervention to Improve Black Maternal and Infant Health.","authors":"Serwaa S Omowale, Cherell Cottrell-Daniels, Kobi Miller, Linda Jones, Tracy Jones, Maile Chand, Brionna McGhee, Brittany Slatton, Miriam Kuppermann","doi":"10.1007/s10995-025-04183-7","DOIUrl":"https://doi.org/10.1007/s10995-025-04183-7","url":null,"abstract":"<p><strong>Purpose: </strong>Persistent racial inequities and inadequate healthcare for Black women during childbirth and postpartum have led to disturbing maternal and infant mortality disparities in the United States. The purpose of the current manuscript is to describe community-based approaches to inform the development of a maternal and child health intervention.</p><p><strong>Description: </strong>To address these health disparities, a community-based research team was formed to develop a population-specific community-level intervention that pairs social workers and doulas to improve Black maternal and infant health.</p><p><strong>Assessment: </strong>A community-based research team was established with a birth doula, a clinical social worker, a Black mother, community research scientists, and a community research assistant from the San Francisco Bay Area, California. Moreover, the team members brought their lived experiences and professional expertise, which informed our research approach. The community team members were integral in developing research protocols and approaches. We leveraged university infrastructure, trained team members in research methods, and compensated team members for their expertise.</p><p><strong>Conclusion: </strong>This ongoing community-based research approach will build long-term capacity and engagement to develop a community-level population-specific intervention to improve Black maternal and infant health outcomes.</p>","PeriodicalId":48367,"journal":{"name":"Maternal and Child Health Journal","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145313810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hannah L F Cooper, Rohan R D'Souza, Howard H Chang, Emily Peterson, Erin Rogers, Simone Wien, Sarah C Blake, Michael R Kramer
{"title":"Patterns of Non-fatal Overdose and Injection-Related Bacterial Infections During Pregnancy and the Postpartum Year Among New York State Residents.","authors":"Hannah L F Cooper, Rohan R D'Souza, Howard H Chang, Emily Peterson, Erin Rogers, Simone Wien, Sarah C Blake, Michael R Kramer","doi":"10.1007/s10995-025-04182-8","DOIUrl":"10.1007/s10995-025-04182-8","url":null,"abstract":"<p><strong>Objectives: </strong>Overdoses are a leading cause of maternal mortality in the US, but limited evidence exists about patterns of nonfatal overdose, a key risk factor for subsequent fatal overdose, or of other drug-related harms. Here, we estimate prevalences of nonfatal overdose and injection-related endocarditis and abscesses/cellulitis across the 21 months spanning pregnancy and the postpartum year.</p><p><strong>Methods: </strong>Among people who experienced an in-hospital birth in New York State between 9/1/2016 and 1/1/2018 (N = 330,872), we estimated the prevalences of hospital-based diagnoses of nonfatal overdose and of injection-related bacterial infections (i.e., endocarditis, abscesses, and cellulitis) across these 21 months; by trimester and postpartum quarter; and by social position (e.g., race/ethnicity, rurality, payor).</p><p><strong>Results: </strong>The 21-month nonfatal overdose prevalence was 158/100,000 births (CI: 145/100,000, 172/100,000); the 21-month prevalence of injection-related bacterial infections was 56/100,000 births (CI: 49/100,000, 65/100,000). There was a trend such that rates of overdose and of injection-related bacterial infections declined as pregnancy progressed and rebounded postpartum. Rates of all outcomes were highest outside of large metropolitan areas and among publicly insured residents.</p><p><strong>Conclusions for practice: </strong>The trend toward diminished rates during pregnancy is supported by past qualitative studies. If confirmed by future research in other geographical regions and with larger sample sizes, this finding holds promise for programmatic and policy interventions. Interventions co-designed with people who use drugs could complement and support harm reduction efforts that pregnant people are already engaging in independently. Such efforts can help people who use drugs survive the pregnancy and postpartum year.</p>","PeriodicalId":48367,"journal":{"name":"Maternal and Child Health Journal","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145287299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Development and Psychometric Properties of the Diarrhea Management Scale for Mothers (DiMaM).","authors":"Zeynep Aközlü, Ayşe Göbekli, Suzan Yıldız","doi":"10.1007/s10995-025-04176-6","DOIUrl":"10.1007/s10995-025-04176-6","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to develop and evaluate the psychometric properties of a diarrhea management scale for mothers with children aged 0-24 months.</p><p><strong>Methods: </strong>This methodological study was conducted between February and June 2023 with 449 mothers in the pediatric emergency department of a training and research hospital in Istanbul. Data were collected using a sociodemographic data form and the Diarrhea Management Scale for Mothers (DiMaM). The scale's validity and reliability were analyzed using the Kaiser-Meyer-Olkin coefficient, Bartlett's Test of Sphericity, Cronbach's alpha reliability coefficient, fit indices, independent samples t-test, test-retest analysis, mean item scores of the 27% lower and upper groups, and item-total correlation statistics.</p><p><strong>Results: </strong>Factor analysis revealed five factors explaining 71.466% of the total variance. The Cronbach's alpha coefficient was 0.887 for the overall scale, 0.913 for the intestinal and stool monitoring subscale, 0.762 for the symptom monitoring subscale, 0.735 for the therapeutic interventions subscale, 0.683 for the hygiene and responsibility subscale, and 0.743 for the nutrition and fluid supplementation subscale. Confirmatory factor analysis indicated acceptable fit indices for the scale. Standardized factor loadings ranged from 0.549 to 0.930, and Intraclass Correlation Coefficient values ranged from 0.886 to 0.916.</p><p><strong>Conclusions for practice: </strong>DiMaM was determined to be a valid and reliable tool for assessing diarrhea management in the home environment for mothers with children aged 0-24 months.</p>","PeriodicalId":48367,"journal":{"name":"Maternal and Child Health Journal","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sheevaun Khaki, Eli Binder, Robert Cicco, Ivan Hand, Julia Hecht, Lynn Iwamoto, Julie Kessel, Betty Vohr, Deepa Sekhar
{"title":"Variations in Screening Practices for Congenital Cytomegalovirus Infections Among Birthing Hospitals in the United States.","authors":"Sheevaun Khaki, Eli Binder, Robert Cicco, Ivan Hand, Julia Hecht, Lynn Iwamoto, Julie Kessel, Betty Vohr, Deepa Sekhar","doi":"10.1007/s10995-025-04175-7","DOIUrl":"https://doi.org/10.1007/s10995-025-04175-7","url":null,"abstract":"<p><strong>Objective: </strong>Evaluate screening practices for congenital cytomegalovirus (cCMV), the most common infectious cause of childhood deafness, in American birthing hospitals.</p><p><strong>Study design: </strong>A survey was developed and distributed to hospitals across the US including the Northeast, Midwest, West, and Southwest between November-December 2023 to understand cCMV screening practices. Summary data were calculated. Hospital characteristics associated with screening were analyzed using a logistic regression model. Hospital practice was reported as a function of legislative mandate.</p><p><strong>Results: </strong>134 responses were received (28.5% response rate). 78 respondents (58.2%) indicated their hospital screens for cCMV. Common screening indications were newborn hearing screen referral (67.5%) and symptoms that could be attributed to cCMV (57.1%). Odds ratio of cCMV screening for states with screening legislation versus without was 18.0 (p < 0.001). Odds ratio of cCMV screening for urban, level 3 facilities versus rural, level 1 facilities was 6.7 (p < 0.02).</p><p><strong>Conclusion: </strong>Wide variability exists in cCMV screening practices. Legislative screening mandates are associated with higher screening rates. Opportunity exists for development of screening guidelines for newborns at risk for cCMV infection.</p>","PeriodicalId":48367,"journal":{"name":"Maternal and Child Health Journal","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145252097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lin H Tian, Sarah C Tinker, Lauren A Russell, Laurel Joncas-Schronce, Melissa L Danielson, Asha Z Ivey-Stephenson, April D Summers, Marshalyn Yeargin-Allsopp, Matthew J Maenner
{"title":"Prevalence and Co-occurring Developmental, Neurological, and Mental Health Conditions of Cerebral Palsy Among Children in the United States: 2016-2021.","authors":"Lin H Tian, Sarah C Tinker, Lauren A Russell, Laurel Joncas-Schronce, Melissa L Danielson, Asha Z Ivey-Stephenson, April D Summers, Marshalyn Yeargin-Allsopp, Matthew J Maenner","doi":"10.1007/s10995-025-04177-5","DOIUrl":"https://doi.org/10.1007/s10995-025-04177-5","url":null,"abstract":"<p><strong>Introduction: </strong>Monitoring cerebral palsy (CP) prevalence and co-occurring conditions is crucial for planning lifelong support, but recent national estimates are somewhat limited.</p><p><strong>Methods: </strong>We analyzed data on U.S. children aged 2-17 years from the 2016-2021 National Survey of Children's Health, conducted annually using a cross-sectional design, to calculate nationally representative prevalence estimates of ever-diagnosed CP, overall and by selected demographic and perinatal characteristics. Three-year estimates were compared to evaluate changes over time. Co-occurring conditions were assessed among children aged 3-17 years with a current CP diagnosis. We estimated prevalence ratios (PR) to quantify differences between groups.</p><p><strong>Results: </strong>The overall prevalence of CP was 3.1 per 1,000 children, with a higher prevalence among boys (3.6/1,000) than girls (2.5/1,000) and children born with low and very low birthweight (46.6 and 7.1/1,000, respectively) and premature (12.7/1,000); differences by race/ethnicity did not reach statistical significance (non-Hispanic [NH] White: 2.9, NH Black: 4.2, and NH other: 4.5/1,000. There were no clear changes in CP prevalence over time, but caregiver-rated severe CP increased from 16.8% (2016-2018) to 30.3% (2019-2021). Most children with CP had at least one co-occurring condition, about four times more prevalent than in children without CP, with the largest differences for intellectual disability (PR = 43) and epilepsy or seizure disorder (PR = 69).</p><p><strong>Discussion: </strong>There is a significantly higher prevalence of co-occurring developmental, neurological, and mental health conditions among children with CP compared to those without, highlighting the diverse services and resources that may be needed to optimally support this population as they transition into adulthood.</p>","PeriodicalId":48367,"journal":{"name":"Maternal and Child Health Journal","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145233762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Amy K Connery, Sylvia Becker-Dreps, Diva M Calvimontes, Yannik Roell, Alison M Colbert, Daniel Olson, Edwin J Asturias, Molly M Lamb
{"title":"Social, Demographic and Health Risk Factors for Head Growth in Infants in Rural Guatemala: A Prospective Cohort Study.","authors":"Amy K Connery, Sylvia Becker-Dreps, Diva M Calvimontes, Yannik Roell, Alison M Colbert, Daniel Olson, Edwin J Asturias, Molly M Lamb","doi":"10.1007/s10995-025-04144-0","DOIUrl":"10.1007/s10995-025-04144-0","url":null,"abstract":"<p><strong>Objectives: </strong>We explored social, demographic, and health risk factors for occipitofrontal circumference (OFC) growth in infants living in a rural, low-resource region of Guatemala.</p><p><strong>Methods: </strong>OFC was measured at enrollment (0.1-2.9 months of age) and one year later (11.5-16.1 months of age) for 430 infants participating in a prospective cohort study conducted between 2017 and 2019. Potential predictors were collected at enrollment or were measured during the year of the study. We performed a two-stage risk factor analysis, using univariate regression modeling to identify potential risk factors, followed by multivariable regression modeling to identify independent, significant risk factors for smaller OFC at birth and 1 year in this low resource setting.</p><p><strong>Results: </strong>Mean OFC at enrollment was -0.4 (1.2) and at 1 year was -1.1 (0.9). Probable zika exposure in utero and shorter maternal height were independently, significantly associated with smaller OFC at both enrollment and 1 year. Exposure to cigarette smoking in utero was independently significantly associated with smaller OFC at enrollment. Infant complications at birth, microcephaly at enrollment and stunting at enrollment were also independently significantly associated with smaller OFC at 1 year (all p-values < 0.05). No exposures measured during the study were associated with OFC at 1 year.</p><p><strong>Conclusions: </strong>All the independent predictors of small OFC during the study period were present at enrollment (within the first 3 months of life), including maternal height, and smoking and ZIKV exposure during pregnancy. Exposures after the first three months of life were not predictive of OFC at one year. Continued work to identify specific risk factors and develop targeted prevention programs is warranted.</p>","PeriodicalId":48367,"journal":{"name":"Maternal and Child Health Journal","volume":" ","pages":"1479-1487"},"PeriodicalIF":1.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Siran He, Omoye Imoisili, Lyudmyla Kompaniyets, Elizabeth A Lundeen, Elena V Kuklina, Sandra L Jackson
{"title":"Hypertension and Polycystic Ovary Syndrome Among Women in a Nationwide Electronic Health Records Dataset in the United States.","authors":"Siran He, Omoye Imoisili, Lyudmyla Kompaniyets, Elizabeth A Lundeen, Elena V Kuklina, Sandra L Jackson","doi":"10.1007/s10995-025-04155-x","DOIUrl":"10.1007/s10995-025-04155-x","url":null,"abstract":"<p><strong>Introduction: </strong>Both hypertension and polycystic ovary syndrome (PCOS) are risk factors for future cardiovascular diseases among women of reproductive age (18-44 years). We constructed an electronic health record (EHR)-based PCOS phenotype, reported PCOS prevalence, and investigated the association of PCOS and hypertension in the United States (US).</p><p><strong>Methods: </strong>This cross-sectional study used 2022 IQVIA's Ambulatory Electronic Medical Record (AEMR)-US data (May 2023 release). We constructed a phenotype for PCOS and reported PCOS prevalence for eligible women. We then described hypertension prevalence and hypertension control estimates stratified by PCOS status. Lastly, we calculated adjusted prevalence ratios (aPR) for hypertension and hypertension control by PCOS status, adjusting for age, race, and body mass index (BMI).</p><p><strong>Results: </strong>We analyzed records for 1,301,425 eligible women, with mean (standard deviation) age of 31.5 (7.9) years. The prevalence of PCOS was 2.1%, but increased with weight category, reaching 6.7% among those with class 3 obesity (BMI ≥ 40 kg/m<sup>2</sup>). Women with PCOS had 50% higher prevalence of hypertension than those without PCOS (aPR 1.50; 95% confidence interval [CI]: 1.48-1.52; p < 0.001), and slightly higher hypertension control prevalence (aPR 1.14; 95% CI: 1.12-1.17; p < 0.001).</p><p><strong>Discussion: </strong>Using a nationwide EHR dataset, we observed that women with PCOS had substantially higher hypertension prevalence than those without PCOS. PCOS prevalence was lower than previous estimates from global surveys. Following guideline-recommended blood pressure screening for women with PCOS could reduce the risk of long-term cardiovascular disease.</p>","PeriodicalId":48367,"journal":{"name":"Maternal and Child Health Journal","volume":" ","pages":"1352-1359"},"PeriodicalIF":1.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12484343/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144974560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mei-Chen Su, An-Shine Chao, Min-Yu Chang, Yao-Lung Chang, Jui-Chiung Sun
{"title":"Effects of a Mobile Health Intervention on Weight Control and Pregnancy Outcomes in Overweight Pregnant Women: A Randomized Controlled Trial.","authors":"Mei-Chen Su, An-Shine Chao, Min-Yu Chang, Yao-Lung Chang, Jui-Chiung Sun","doi":"10.1007/s10995-025-04135-1","DOIUrl":"10.1007/s10995-025-04135-1","url":null,"abstract":"","PeriodicalId":48367,"journal":{"name":"Maternal and Child Health Journal","volume":" ","pages":"1445-1457"},"PeriodicalIF":1.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144620909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Determinants, Impact and Optimal Resource Allocation of Zambia's Scaling Up Nutrition Program.","authors":"Ann Levin, Sikota Sharper, Athena Pantazis","doi":"10.1007/s10995-025-04169-5","DOIUrl":"10.1007/s10995-025-04169-5","url":null,"abstract":"<p><strong>Objectives: </strong>Zambia's Scaling Up Nutrition (SUN) Program is a multi-sectoral program with a package of nutrition-specific and nutrition-sensitive interventions to reduce stunting in children. The purpose of the study was to conduct an economic analysis of the SUN Most Critical Days Program (MCDP) II activities during 2018-2022.</p><p><strong>Methods: </strong>The economic analysis evaluated SUN/MCDP II nutrition interventions through three analyses: (i) estimating their impact on mortality and morbidity since 2018 with the LiST tool, (ii) identifying the determinants of stunting with a Oaxaca Blinder counterfactual decomposition, and (iii) assessing the efficient resource allocation of SUN/MCDP II resources using the Optima Nutrition Tool.</p><p><strong>Results: </strong>The LiST modelling analysis estimated that since 2018, SUN/MCDP II interventions reduced deaths, diarrhoeal incidence, and stunting among children under 5 years of age in all 30 districts. Vitamin A supplementation was the largest contributor to reductions in deaths and diarrhoeal incidence, The Oaxaca Blinder counterfactual decomposition analysis found that the main contributors to stunting decline were access to piped water, maternal education, child birth weight, and basic sanitation in Zambia. The Optima Nutrition analysis revealed that stunting decline could be maximized if more funding is put into the interventions of Vitamin A and WASH interventions as well as adding some other interventions.</p><p><strong>Conclusion for practice: </strong>The SUN Program has led to a reduction in childhood stunting as well as mortality. The Program's package of interventions could be further enhanced through optimizing the allocation of resources.</p>","PeriodicalId":48367,"journal":{"name":"Maternal and Child Health Journal","volume":" ","pages":"1405-1414"},"PeriodicalIF":1.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}