Nutrition support during pregnancy improves birth outcomes, global study finds

George Mason-led research finds that food-based prenatal supplements improve birth weights across Africa and South Asia.

George Mason University

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In parts of the world where daily nutrition is unstable, pregnancy and newborn health are more precarious. A new study led by epidemiologist Dongqing Wang of the George Mason University College of Public Health adds to the evidence that improving maternal nutrition during pregnancy may be a key intervention to improve birth outcomes.

Looking across eight clinical trials across Africa and South Asia, the study finds that balanced energy and protein (BEP) supplements—food-based products like beverages or nutrient-dense pastes designed to increase calorie and protein intake—are associated with healthier birth weights and fewer high-risk newborns in low- and middle-income countries. The findings were published in PLOS Medicine.

“In settings where pregnant women can’t access sufficient calories and protein, it is important to act early,” said Wang, an assistant professor of epidemiology in the Department of Global and Community Health. “Improving maternal nutrition can reduce the risk of vulnerable birth outcomes.”

Why this matters

Maternal malnutrition puts infants at higher risk of death, illness, and developmental delays.

Interventions have often focused on micronutrient supplements, but this study shows that food-based approaches to increase calorie and protein intake may better support fetal growth. BEP supplements can also be delivered through existing maternal health programs, making them a practical solution to scale. Wang is also currently conducting further research in Ethiopia that examines the cost-effectiveness of different approaches to BEP supplementation.

Study details

Wang and his colleagues combined individual-level data from randomized controlled trials conducted in Nepal, The Gambia, Pakistan, and several other low- and middle-income settings. The team compared outcomes for pregnant individuals who received BEP supplements with those who did not.

Key findings include:

• BEP supplements were associated with higher birth weights and a lower risk of babies being born with low birth weight or small for their gestational age.
• The effects were particularly notable forbabiessmall for their gestational age, a group with elevated risk of neonatal mortality.
• Benefits appeared stronger among women who began supplementation earlier in pregnancy, particularly before20 weeks.

Wang worked with a global network of researchers from institutions including Harvard T.H. Chan School of Public Health, the Food and Agriculture Organization of the United Nations, Aga Khan University and partners across Europe, South Asia and Africa.

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Journal

PLOS Medicine

Article Title

The effect of prenatal balanced energy and protein supplementation on small vulnerable newborn types in low- and middle-income countries: A systematic review and meta-analysis of individual participant data

 

Severe childhood malaria linked to cognitive impairment later in life

Indiana University

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image: 

A mother and her child providing consent to participate in the Malarial Impact on Neurobehavioral Development (MIND) study.

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Credit: Photo courtesy Chandy John, IU School of Medicine

INDIANAPOLIS — Severe childhood malaria is linked to long-term cognitive impairment, according to a new study from Indiana University School of Medicine researchers and their collaborators at Makerere University in Uganda. 

The findings, recently published in JAMA, suggest children who survive cases of cerebral malaria and severe malarial anemia experience cognitive and academic impairment that persists into adolescence. The correlation highlights an urgent need for the development of better prevention strategies and more effective therapies to minimize the lasting effects of one of the world’s most dangerous diseases. 

The World Health Organization reported 282 million malaria cases in 2024, with children under 5 accounting for about 75% of 610,000 global deaths. 

"Cerebral malaria and severe malarial anemia, which affect more than a million children every year, are not only causes of death in children, but also associated with very long-term costs in terms of a child’s thinking and their academic achievement," said Chandy John, MD, the Ryan White Professor of Pediatrics at the IU School of Medicine, who co-led the study. "These costs, particularly in the area of math skills, can affect their ability to do well in school, to go to college and to get a good job."

Malaria is caused by mosquito-transmitted parasites, with symptoms ranging from mild to life-threatening. Severe cases can cause complications to blood cell production resulting in malarial anemia, and serious neurological issues leading to coma, which defines cerebral malaria. 

In the Malarial Impact on Neurobehavioral Development (MIND) study, children from two prior cohort studies of severe malaria were followed up four and 15 years after their initial episode, and their scores in cognition and academic achievement were compared to those of children in the community who did not have severe malaria. They found that children who survived cerebral malaria and severe malarial anemia experienced cognitive impairment, with cognition scores the equivalent of 3 to 7 IQ points below their community peers. 

Specific clinical factors in children with cerebral malaria or severe malarial anemia, such as the presence of acute kidney injury and elevated levels of uric acid, which is necessary for some body functions but can be toxic when present in too high levels, were found to be associated with worse long-term cognitive outcomes. 

The group’s future work will focus on determining if cerebral malaria and severe malarial anemia are causing the cognitive impairment, and how to prevent it. 

"Cohort studies can show an association, but they can’t prove that these illnesses caused the impairment," John said. "Instead, we can look at potential pathways in the body and the brain and see how they relate to cognition. That’s what we’re doing in our current study, SMART Brain."

SMART Brain, short for Severe Malaria and Risk to The Brain, will allow the scientists to use models of the brain to explore further the link between specific processes that occur in severe malaria and brain injury. 

"If we can identify pathways that lead to brain injury, then we can come up with interventions that may prevent brain injury, and test these in clinical trials," John said. "That could potentially protect the brain and improve cognitive and academic outcomes for hundreds of thousands of children in countries with malaria."  

IU School of Medicine’s Kagan Mellencamp, Jie Ren, Andrea Conroy, Dibyadyuti Datta, Christian Kautzman and Michael Goings are co-authors on the study. Additional authors include Paul Bangirana, Jacqueline Nakitende, Ruth Namazzi and Richard Idro from Makerere University, Robert Opoka from Aga Khan University and Bjarne Robberstad from University of Bergen. 

This research was supported by funding from the National Institutes of Health. 

About the Indiana University School of Medicine 

The IU School of Medicine is the largest medical school in the U.S. and is annually ranked among the top medical schools in the nation by U.S. News & World Report. The school offers high-quality medical education, access to leading medical research and rich campus life in nine Indiana cities, including rural and urban locations consistently recognized for livability. According to the Blue Ridge Institute for Medical Research, the IU School of Medicine ranks No. 15 in 2025 National Institutes of Health funding among all public medical schools in the country. 

Writer: Jackie Maupin, jacmaup@iu.edu 

For more news, visit the IU School of Medicine Newsroom: medicine.iu.edu/news  

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Journal

JAMA

Employee conduct

This approach is best illustrated in cases of employees prone to absenteeism, a leading source of misconduct the world over. 

Parvez Rahim 

Published December 20, 2025 

DAWN

The writer is a consultant in human resources at the Aga Khan University Hospital.

THE Industrial and Commercial Emp­loyment (Standing Orders) Ordinance, 1968, is the most critical and frequently referred to labour enactment in Pakistan. It contains provisions relating to the classification of workmen, mandatory issuing of appointment letters, payment of profit bonus, retrenchment, termination of employment and a standing order relating to punishments.

Standing Order (SO) 15, relating to punishments, is one of the most used provisions of labour laws, which classifies the offences committed by employees into two categories. The first is in the case of an employee guilty of offences that aren’t serious — the employee is liable to be fined a nominal amount. The other is in the case of an employee guilty of an act of commission or omission, which has serious implications for the organisation — that employee is liable to be dismissed from service.

There is a comprehensive list of ‘misconducts’ in the SO, for which an employee may either be (i) fined; or (ii) his increment or promotion withheld for up to one year; or (iii) relegated to a lower post; or (iv) dismissed from service.

The key misconducts include “willful insubordination or disobedience to any lawful and reasonable order of a superior; theft, fraud, or dishonesty in connection with the employer’s business or property; willful damage to or loss of employer’s goods or property; habitual absence without leave or absence without leave for more than 10 days; riotous or disorderly behaviour during working hours or any act subversive of discipline; and habitual negligence and neglect of work.”

Employers must adopt a reformative approach.

Where possible the employers should focus on the rehabilitation of offenders to reintegrate them as responsible employees. This reformative approach emphasises changing an individual’s behaviour by addressing the root causes of their disruptive activity through counselling, psychological treatment and the introduction of incentives. It contrasts with retribution and deterrence.

This approach is best illustrated in cases of employees prone to absenteeism, a leading source of misconduct the world over. Excessive absenteeism is rampant in in both the private and public sectors. The most common reason given is sickness. Illness can be feigned and neither the company doctor or some other medic can be sure whether the absence is related to sickness.

Absenteeism leads to escalation in the cost of running a business. There are hidden costs such as overtime to cover for sick employees, temporary help to replace absentees, supervisory time spent to find a person to cover, and lowered productivity on the part of those who have to work harder for someone who is chronically absent. As people do get sick, it is unrealistic to set a goal of zero absenteeism. The right objective is to have programmes that penalise those who abuse their sick leave privilege. It is also desirable to reward employees who have good attendance records.

Generally, employers have a zero-tolerance policy for fraud and dishonesty by employees. While there is nothing wrong in having such a policy, one must know the reasons behind such actions. Employees commit fraud due to pressure, opportunity and the belief that their behaviour is justified even if not appropriate. They are often driven by personal financial issues, a sense of being undervalued, and weak internal controls. Other contributory factors include addiction, a belief that they deserve more compensation, and sometimes an inability to distinguish between right and wrong actions.

Actions subversive of discipline by employees are also common. These stem from organisatio­nal shortcomings, psychological factors and personal issues. They invol­­ve lack of clarity, fairness and support at the workplace rather than malicious intent. Poor management, such as autocratic attitudes, favouritism, or a manager’s own failure to follow rules, can damage morale and encourage insubordination.

Employees indulge in disorderly behaviour due to feelings of unfairness, lack of support and poor management practices. This misconduct is frequently a symptom of deeper workplace issues. Managers often complain that a certain employee is consistently underperforming and recommend strict action. Unless precise allegations of habitual negligence against the employee are proved in an internal inquiry, action on the basis of vague statements by the supervisor will backfire.

Interestingly, cases of misconduct are far higher among men than women working in a similar capacity.

While one is not advising employers to refrain from taking action against employees guilty of serious misconduct, they should tighten financial controls and train managers in how to supervise employees with fairness. Companies managed professionally hardly encounter any cases of indiscipline.

The writer is a consultant in human resources at the Aga Khan University Hospital.

Published in Dawn, December 20th, 2025

Work at home

Parvez Rahim 

December 12, 2025 

IN Pakistan, we have two categories of individuals working within households — domestic workers and home-based workers. There is a difference in the work each does. Domestic workers, commonly refer­red to as ‘maasi’ are employed for regular household chores like cooking, cleaning and laundry. They can work either part-time or full-time, usually on the basis of informal verbal contracts. They may also be engaged to care for children, the elderly or the sick.

The number of domestic workers ranges from around 4.5 million to 8.5m. The ILO reports 8.5m, while another source estimates 4.5m. However, these figures cannot be authenticated as it is difficult to collect statistics for individuals working in homes, as they are widely scattered. There is also a strong likelihood that these numbers overlap with those of home-based workers.

The latter category is more formal and closer to the jobs performed by their counterparts in industrial and commercial est­ablishments. They perform a wide variety of tasks, primarily in manufacturing, ie, garments, carpets, footwear, jewellery, etc, and services including virtual assistance, customer service data entry, writing, etc. The work is often categorised as traditional, manual labour, intensive work, or modern skill-based professional activity.

Official estimates place the number of home-based workers in Pakistan at around 4.4m to 4.8m, while unofficial sources suggest the total could be as high as 20m. Out of the 20m, 12m are women, which comes to 60pc. Their output may not be less than that of men but they are still paid less than them.


Karachi’s women have played a notable role in forming the HBWWF.

A report in this paper says that “Globally, women make up about two-thirds of the health workforce but earn, on average, 20pc less than men and remain underrepresented in leadership positions”.

Karachi’s women have played a remarkable role in forming the Home-Based Women Workers Federation in December 2009. The HBWWF has been advocating for the rights of women with more vigour and enthusiasm than its male-dominated counterparts. It was officially registered with a membership of about 1,000 but now has over 4,500 members in Sindh, Balochistan and Punjab. There is also a broader union called the Federation of Sindh Home-Based Workers, which is a federation of various unions in Sindh.

HBWWF had persuaded the Sindh government to legislate the Sindh Home-Based Workers Act, 2018. This law relates to the protection of rights of persons who work in the informal or unorganised sector carrying out remunerative work within their homes or surroundings. The act stipulates that the wages of home-based workers will not be less than the minimum wages under the Sindh Minimum Wages Act, 2015. They are also eligible for “all those social, medical and maternity benefits, compensations and marriages and death grants” available under the labour laws.

Thereafter, the Punjab Domestic Workers Act, 2019, was enacted followed by the Islamabad Capital Territory (ICT) Domestic Workers Act, 2022. They provide for issuance of appointment letters to domestic workers, regulation of daily working hours, grant of sick leaves and festival holidays, maternity leave for female workers and minimum wages as per the law. Termination of employment is subject to a month’s prior notice in writing either by the domestic worker or employer and a month’s wages is to be paid in lieu of notice.

A dispute resolution committee will be formed to resolve disagreements between employers and workers. No one under 15 years will be allowed to work in households in any capacity.

These provisions, derived from various labour laws, have never been fully co­­mplied with by ent­repreneurs of industrial and comme­­r­-

cial establishments. How can we expect millions of households in Pakistan, with limited inco­mes and no knowledge of laws, to ad­­h­ere to them? In fact, these provisions sho­­uld be included in the act for home-based workers, whose nature of work and discipline are closer to that of factory workers. Consequently, neither the Punjab nor the ICT law has been implemented, nor have the respective governments tried to enforce them.

Recently, Saudi Arabia issued guidelines for the conduct of domestic workers and their employers. As domestic workers there belong to different nationalities, it is important for the government to regulate their conduct through these guidelines. Unlike Pakistan, where most laws go unhe­eded, the Saudi government will ensure their compliance in letter and in spirit from the beginning.

The Punjab government and ICT are advised to abrogate their respective acts and issue realistic guidelines to be followed by employers and domestic workers. It will also be convenient for the labour department to check compliance.

The writer is a consultant in human resources at the Aga Khan University Hospital.

Published in Dawn, December 12th, 2025

 

‘No food, no business’: Kenyan women reveal hidden links between climate change and mental health

Copyright AP Photo/Inaara Gangji

By Craig Saueurs & Desmond Tiro, Inaara Gangji and AP News

Published on 13/10/2025 - EURONEWS

Researchers in Madagascar, Spain and the Netherlands have also found links between climate change and depression and anxiety.

Across rural Kenya, extreme heat, failed rains and unpredictable seasons are doing more than devastating harvests. They’re taking a psychological toll.

In Kaloleni, one of the country’s poorest areas, researchers are uncovering how climate change is driving anxiety, depression and suicidal thoughts, particularly among women who shoulder the burden of keeping their families fed.

Here, homes are mostly built of mud and have no indoor plumbing, and during hot spells and droughts, the region’s all-important maize crops wither.

“These communities are struggling to grow their crops and have to spend money on food,” said Zul Merali from The Aga Khan University, who has set up a local institute for mental and brain health. “This creates a lot of pressure, particularly on women, because they are in charge of making sure that kids and families are fed.”

The human toll of climate stress

This farming community is one of the most studied populations in Kenya.

A network of community health workers visits all households every month to check how people are doing. They fill in questionnaires that the government uses to understand needs in rural communities.

Humphrey Kitsao is a community health promoter who looks after 115 households in Kilifi County totalling 532 people. He’s done this work for 18 years and says he’s seen a lot of change.

“People here still farm, but their income isn’t like before,” he told The Associated Press. “They have to spend a lot of money on their farms, but often there is no harvest.”

Jasmit Shah is a data scientist at The Aga Khan University’s Brain and Mind Institute who wanted to research the impact of climate change on the mental health of women in Kenya’s rural farming communities. While climate anxiety has been studied in the United States and Europe, no study on mental health had been done with women in this region.

The university was already supporting Kenya’s government in its data collection in Kilifi County. For its own research on mental health and climate change, it only had to add some questions.

“The questions are quantitative: Do you have any suicidal thoughts, and if you do, do you have them every day, several days a week, a few times a month?” Shah said.

“Then we asked them a set of about 15 questions related to climate shocks and looked at the correlation between climate shocks and people saying that they are having suicidal thoughts.”

Shah said the survey of nearly 15,000 women produced some concerning signs. For example, he said, it appears that droughts and heat waves are linked with much higher levels of suicidal thoughts.

Climate change is causing anxieties around the world

The links between climate change and mental health are becoming increasingly clear around the world.

In Europe, researchers have found that long-term exposure to cold led to anxiety, depression and other issues among adolescents and young adults in the Netherlands. Higher heat in Spain, on the other hand, has been tied to attention problems.

In rural areas, especially in developing regions, the effects are often more tangible.

Earlier this year, researchers revealed that climate change is causing a mental health crisis among adolescents in Madagascar, where fears of food insecurity and futures stolen by droughts and storms have led to spikes in anxiety and depression in rural areas.

In Kaloleni, Kenya, 41-year-old farmer and mother of four Elizabeth Amina Kadenge said her maize harvest had been wiped out by drought at the time of the study. This year, it was wiped out again – by too much rain.

“It has been very stressful because farming is also my business,” Kadenge said. “When I farm the way I know, some of my maize is for food, and some of it is for my business. But if it fails, I have no food and no business.”

Kadenge has addressed her anxiety around the unreliable weather by switching to planting cassava, which is less fickle. But maize takes three months from planting to harvest. Cassava takes a year. If the family is hungry, they must uproot it before it’s big enough to sell and use it for food “because we have no other option.”

Breaking the silence on mental health

With such serious problems in rural Kenya, mental health often isn’t a priority. “We don’t talk about it a lot, not only in that community, but everywhere,” Shah said.

Mercy Githara is the mental health and psychosocial manager at the Kenya Red Cross. In her experience, the mental fallout from droughts or floods is very real.

“There is a lot of psychological distress among these communities, and some of them have developed mental health conditions such as depression,” she said.

She wants to see a greater emphasis on mental health. “Ensure that communities that are facing climate change can be able to access mental health services,” she said.

Shah is hopeful it’s already starting to happen. He noted the government’s community health promoters’ program across Kenya and the mental health training for participants. “So if they see a problem with a certain household or individual, they can refer them to a facility where they can be seen by a health professional.”

Such support could be needed for the long run.

“Climate change is not going to be a short-term thing,” Merali said. “It’s here to stay.”

The Lancet: Tens of thousands of children aged under five suffering acute malnutrition in Gaza, recent estimates suggest

The Lancet

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Between Jan 2024 and Aug 2025, peaks in the prevalence of acute malnutrition match periods of severe aid restrictions.

 

More than 54,600 children in Gaza are estimated to be acutely malnourished, including over 12,800 severely so, with few therapeutic options available to them. With measurements up to the middle of August 2025, the study comprehensively tracks wasting among children during the war, estimates population prevalence, and highlights unprecedented increases in child malnutrition following periods of blockades and severe aid restrictions.

 

Published in The Lancet, the study was led by the UN Relief and Works Agency for Palestine Refugees in the Near East (UNRWA). Between January 2024 and mid-August 2025, UNRWA staff screened 219,783 children aged 6-59 months, measuring mid-upper arm circumference (MUAC) at 16 functioning health centres and 78 medical points in shelters and tented encampments across five governorates in the Gaza Strip. The researchers then estimated the prevalence of acute malnutrition, based on the total estimated number of children in that age group in the territory (346,000).

 

Based on evidence of child malnutrition collected from multiple aid agencies, on 15 August 2025 the UN Integrated Food Security Phase Classification (IPC) confirmed famine in the Governate of Gaza City, with the rest of the Gaza Strip facing critical conditions or the prospect of famine. The study reenforces the IPC’s confirmation of famine in Gaza City Governorate, and provides evidence of how child malnutrition has evolved during the war.

 

Wasting, or acute malnutrition, is defined as a child being too thin for their height, indicating rapid weight loss and severe lack of energy, protein and other nutrients. Wasting can also be assessed by measuring the circumference of a child’s upper arm with a calibrated tape, as done in this study, with a thin arm highly correlating to a thin body. It is a life-threatening condition, and children require regular treatment with therapeutic food over several weeks, or in extreme cases and when possible, hospitalisation.

 

During the 20-month surveillance period, the number of MUAC screenings varied from 722 to 23,651 per month. Prevalence of wasting in January 2024 was 4.7% (34 out of 722 children), rising to 8.9% (1,281/14,387) in July 2024. The end of 2024 saw severe aid restrictions, with UN sources reporting daily averages of 42 to 92 aid trucks per day crossing into Gaza, compared to 300 to 600 per day pre-war. In January 2025, prevalence of wasting was 14.3% (1,661/11,619).

 

In early 2025, a six-week ceasefire allowed for increased aid to enter the Gaza Strip, and wasting declined to 5.5% by March 2025 (831 out of 15,165 children). A subsequent 11-week blockade followed, with severe restrictions on the entry of food, water, fuel, medicines and other essentials, was in place until late May 2025.

 

The latest measurements, taken through mid-August 2025, found that 15.8% (1,213/7,668) of screened children were wasted, 3.7% (280/7,668) severely so. Extrapolated to the estimated total population of the Gaza Strip, this is equivalent to over 54,600 children aged 6-59 months in need of urgent therapeutic nutrition and medical care, including 12,800 severely wasted children with little chance of rehabilitation given the inadequate amounts of food crossing the borders, and the cripped health and nutrition services. 

 

Trends were most extreme in some areas – for instance, in Rafah there was an increase in wasting malnutrition from 7.1% (273/3,855) in April 2024 to 31.5% (63/200) in January 2025, decreasing to 8% in April 2025, in association with the ceasefire, although screening was ceased in this area shortly after. In Gaza City, prevalence rose six-fold from 5.4% (373/6,908) in March 2025, to 28.8% (631/2,194) in mid-August 2025.

Dr Akihiro Seita, the UNRWA Director of Health and a senior author of the paper notes: “Since October 7, 2023, an unprecedented war has unfolded across the Gaza Strip. From the outset, the territory’s infrastructure has been destroyed, the population repeatedly displaced and, with few exceptions, humanitarian aid has been severely restricted. Given the long failure to stop the war and prevent encroaching famine despite a global capacity to do so, unless there is a lasting cessation of the conflict coupled with unimpeded, competent, international humanitarian nutritional, medical, economic and social services, a further deterioration in early childhood nutrition with increased mortality are inevitable in the Gaza Strip.”

Dr Masako Horino, nutrition epidemiologist, UNRWA and lead scientist for the study, adds: “Evidence prior to Oct 2023 indicated that children in Palestine refugee families in the Gaza Strip were food insecure and had poor dietary diversity. Yet, they were only marginally underweight. This paradox was likely explained by these families’ regular access to food aid. Following two years of war and severe restrictions in humanitarian aid, tens of thousands of pre-school aged children in the Gaza Strip are now suffering from preventable acute malnutrition and face an increased risk of mortality.”

The authors note that data collected was limited to available, functioning UNRWA facilities. Two-thirds of screenings were conducted in Khan Younis and Middle areas, due to challenges of operating health centres in other areas. A total of 265,974 screenings were done for 219,783 children, indicating some children were screened more than once over time. Researchers faced considerable challenges including lack of identity information, and unsafe locations making data collection challenging.

In a linked Comment, Zulfiqar A Bhutta (Aga Khan University, Pakistan & Hospital for Sick Children, Canada), Jessica Fanzo (Columbia University, USA) and Paul H Wise (Stanford University School of Medicine, USA), who were not involved in the study, write: “These temporal data strongly suggest that restrictions on food and assistance have resulted in severe malnutrition among children in the Gaza Strip, a reality that will undoubtedly impact their future health and development outcomes for generations... Although immediate attention has been paid to the short-term outcomes of starvation, there should also be serious concern for the well documented long-term effects, such as intergenerational consequences of starvation and food restriction in children, including inordinately high risks of non-communicable diseases and reduced life expectancy.”

NOTES TO EDITORS

This study was funded by the UN Relief and Works Agency for Palestine Refugees in the Near East (UNRWA).

Quotes from Authors cannot be found in the text of the Article but have been supplied for the press release. The Comment quote is taken directly from the linked Comment.

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Journal

The Lancet

DOI

10.1016/S0140-6736(25)01820-3 

Method of Research

Observational study

Subject of Research

People

Article Title

Assessment of malnutrition in preschool-aged children by mid-upper arm circumference in the Gaza Strip (January, 2024–August, 2025): a longitudinal, crosssectional, surveillance study

Article Publication Date

8-Oct-2025

COI Statement

See paper