Background: Stunting prevalence in children less than 5 years has remained stagnated in Peru from 1992 to 2007, with a rapid reduction thereafter. We aimed to assess the role of different predictors on stunting reduction over time and across departments, from 2000 to 2012. Methods: We used various secondary data sources to describe time trends of stunting and of possible predictors that included distal to proximal determinants. We determined a ranking of departments by annual change of stunting and of different predictors. To account for variation over time and across departments, we used an ecological hierarchical approach based on a multilevel mixed-effects regression model, considering stunting as the outcome. Our unit of analysis was one department-year. Results: Stunting followed a decreasing trend in all departments, with differing slopes. The reduction pace was higher from 2007–2008 onwards. The departments with the highest annual stunting reduction were Cusco (−2.31%), Amazonas (−1.57%), Puno (−1.54%), Huanuco (−1.52%), and Ancash (−1.44). Those with the lowest reduction were Ica (−0.67%), Ucayali (−0.64%), Tumbes (−0.45%), Lima (−0.37%), and Tacna (−0.31%). Amazon and Andean departments, with the highest baseline poverty rates and concentrating the highest rural populations, showed the highest stunting reduction. In the multilevel analysis, when accounting for confounding, social determinants seemed to be the most important factors influencing annual stunting reduction, with significant variation between departments. Conclusions: Stunting reduction may be explained by the adoption of anti-poverty policies and sustained implementation of equitable crosscutting interventions, with focus on poorest areas. Inclusion of quality indicators for reproductive, maternal, neonatal and child health interventions may enable further analyses to show the influence of these factors. After a long stagnation period, Peru reduced dramatically its national and departmental stunting prevalence, thanks to a combination of social determinants and crosscutting factors. This experience offers useful lessons to other countries trying to improve their children’s nutrition. / Revisión por pares

The upward trend in the prevalence of childhood mental disorders observed in the UK over the previous two decades, together with UK’s poor performance in recent international comparisons of child well-being, has brought childhood social and emotional well-being (SEW) to the forefront of policy. Key to tackling this issue is to understand what causes SEW in childhood, what interventions are successful in improving it, and what are its late-life consequences. This thesis furthers the literature in each of these areas. Firstly, we examine whether foetal (or in-utero) exposure to influenza hampers the development of childhood SEW. To do so, we examine the use of an instrumental variables approach, whereby the severity of the 1957 Asian Flu epidemic in the local authority of birth is used as an instrument for whether mothers self-report contracting influenza during pregnancy. We establish that exposure has little effect on childhood SEW, but that it results in a 60% increase in the risk of being stillborn, suggesting an increasing focus on influenza vaccination during pregnancy is needed. Secondly, we investigate the long-term effectiveness of school-based interventions to improve SEW. In order to overcome the absence of long follow-up in trial datasets, we develop a new modelling approach which involves the matching of trial participants to individuals in birth cohort datasets. An application of this method found that a Promoting Alternative Thinking Strategies (PATHS) intervention implemented in Greater Manchester schools led to a statistically significant improvement in childhood SEW, and had a positive, although statistically insignificant, effect on health across the life-course. Finally, we address the paucity of studies examining the effects of childhood SEW on late-life health and labour market outcomes. To do so, we develop a method for generating predictions of the effects of childhood characteristics beyond the currently available follow-up periods in birth cohort datasets, adapting an existing mediation analysis framework. Applying this method, we establish that a one-standard deviation improvement in childhood SEW leads to an increase of up to 0.18 accumulated quality-adjusted-life-years in late-life, and an increase in pre-tax labour income in late-life of up to £23,850. Both of these effects are primarily driven by large positive effects of childhood SEW on educational attainment, employment, income and health in mid-life. Childhood SEW is a predictor of important outcomes throughout the lifecourse. More research is needed to identify its causes and interventions to successfully improve it.

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Ethnic minority children living in relative poverty are a high-risk group for poor outcomes in all aspects of wellbeing. The relationship and interactions between child and parent are a key part of child development and a platform for providing positive experiences which can benefit a child’s wellbeing. There is therefore a need to identify what facilitates wellbeing for ethnic minority children in low-socioeconomic status families. By focusing on protective and promotive factors encompassing the parent-child relationship, factors can be identified which can use family strengths as a basis for interventions and practice within healthcare, social work and education, which is what this systematic literature review set out to do. Through a diligent search of the literature, 12 articles were identified for review according to the inclusion and exclusion criteria, containing research on African American, Roma, Native American and Hispanic/Latino youth. The results inform how child wellbeing can be facilitated through several parental factors, including parental involvement and support, maternal attachment, paternal warmth and ethnic identity and ethnic socialization. The findings also indicate a need for further studies on paternal influence on wellbeing in especially Native American and Roma youth, as well as the impact of ethnic socialization on youth wellbeing. Parents have an important role to play in child wellbeing and are vital partners alongside the child when planning interventions. Considerations naturally need to be shown for each ethnic minority, the child’s setting and its individual characteristics.