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Importance: Body mass index (BMI) lower than 16 is the most severe category of adult undernutrition and is associated with substantial morbidity, increased mortality, and poor maternal-fetal outcomes such as low-birth-weight newborns. Little is known about the prevalence and distribution of BMI lower than 16 in low- and middle-income countries (LMIC).Objective: To determine the prevalence and distribution of BMI lower than 16 and its change in prevalence over time in women in LMIC.Design, Settings, and Participants: Cross-sectional data analysis composed of nationally representative surveys from 1993 through 2012 from the Demographic and Health Surveys Program. Women aged 20 through 49 years from 60 LMIC (N = 500,761) and a subset of 40 countries with repeated surveys (N = 604,144) were examined.Exposures: Wealth was measured using a validated asset index, age was categorized in deciles, education by highest completed level (none, primary, secondary, or greater), and place of residence as urban vs rural.Main Outcomes and Measures: The primary outcome was BMI lower than 16. Analyses assessed the prevalence of BMI lower than 16, its association with sociodemographic factors, and change in prevalence. Logistic regression models were used to calculate odds ratios (ORs), adjusting for survey design and age structure.Results: Among countries examined, the pooled, weighted, and age-standardized prevalence of BMI lower than 16 was 1.8% (95% CI, 1.7% to 1.8%) with the highest prevalence in India (6.2% [95% CI, 5.9% to 6.5%]), followed by Bangladesh (3.9% [95% CI, 3.4% to 4.3%]), Madagascar (3.4% [95% CI, 2.8% to 4.0%], Timor-Leste (2.9% [95% CI, 2.4% to 3.2%]), Senegal (2.5% [95% CI, 1.9% to 3.2%]), and Sierra Leone (2.2% [95% CI, 1.3% to 3.0%]); and 6 countries had prevalences lower than 0.1% (Albania, Bolivia, Egypt, Peru, Swaziland, and Turkey). The prevalence of BMI lower than 16 in women with a secondary or higher education level was 0.51% (95% CI, 0.47% to 0.55%), and in mutually adjusted models, a less than primary education level was associated with an OR of 1.4 (95% CI, 1.2 to 1.6). The prevalence of BMI lower than 16 was 0.43% (95% CI, 0.37% to 0.48%) in the highest wealth quintile with an OR of 3.0 (95% CI, 2.4 to 3.7) in the lowest wealth quintile. Among the 24 of 39 countries with repeated surveys, there was no decrease in prevalence. In Bangladesh and India, rates were declining with an average absolute change annually of -0.52% (95% CI, -0.58% to -0.46%) in Bangladesh and -0.11% (95% CI, -0.12% to -0.10%) in India.Conclusions and Relevance: Among women in 60 LMIC, the prevalence of BMI lower than 16 was 1.8%, and was associated with poverty and low education levels. Prevalence of BMI lower than 16 did not decrease over time in most countries studied. [ABSTRACT FROM AUTHOR]

The article discusses rotavirus prevalence in developing countries, the introduction of live, oral attenuated rotavirus vaccines, and a study in Nicaragua to assess the connection between RotaTeq, a pentavalent rotavirus vaccine (RV5), and severe diarrhea requiring intravenous (IV) fluid replacement or hospital admission. The children studied had a diagnosis of rotavirus diarrhea and were eligible for RV5 vaccine. A control group was selected by matching the birth date of each case of diarrhea in the study. The study found that children vaccinated with RV5 had a lower risk of severe diarrhea from rotavirus.

This article comments on the use of the poliomyelitis (polio) vaccine to eradicate the disease in much of the world. This discussion marks the 55th anniversary of the 1953 publication of "Studies in Human Subjects on Active Immunization against Poliomyelitis" by Jonas Salk. The commentary relates research developing a polio vaccine to efforts at the disease's eradication that are ongoing in 2008. The eradication of Polio in the developed world, and much of the developing world, is described. Problems encountered in the eradication of Polio in Nigeria, India, Afghanistan, and Pakistan are described.

The article looks at the implications of electronic cigarettes (e-cigarettes) and other electronic nicotine delivery systems (ENDS) for global public health. While supporters of ENDS claim that they are a tool for harm reduction and smoking cessation, opponents are concerned about their health effects and the advertising of ENDS to youth and nonsmokers. Topics include nicotine addiction, ENDS use in low and middle income countries (LMICs), and the tobacco industry.