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Sinuraya RK, Alfian SD, Abdulah R, Postma MJ, Suwantika AA. Comprehensive childhood vaccination and its determinants: Insights from the Indonesia Family Life Survey (IFLS). J Infect Public Health 2024; 17:509-517. [PMID: 38295674 DOI: 10.1016/j.jiph.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 12/28/2023] [Accepted: 01/07/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND Immunization is the most effective intervention for reducing morbidity and mortality rates associated with vaccine-preventable diseases. Despite the Indonesian government's inclusion of several childhood vaccinations in the national immunization program (NIP), the number of unvaccinated or partially vaccinated children remains high. This observational study aimed to determine the completeness of childhood immunization and the factors influencing it in Indonesia. METHODS Data were extracted from the fifth wave of the Indonesia Family Life Survey (IFLS). The sample (n = 16,236) consists of children residing in 13 provinces, representing over 80% of Indonesia's population. The difference between groups was tested using the chi-square test. Logistic regression was performed to identify the variables associated with the completeness of basic immunization. Immunization is categorized as complete when children have received all the mandatory vaccines recommended by the Ministry of Health. We examined and compared the results using complete case analysis, inverse probability weighting, and multiple imputations. RESULTS The highest percentages of complete vaccinations were polio, tuberculosis, and DPT. Children who live in Sumatera and Kalimantan were more likely to be fully immunized, with ORs of 0.6 (95%CI 0.48-0.74) and 0.54 (0.37-0.80), respectively. Children who live in urban areas, have mothers who received the tetanus vaccine during pregnancy, have mothers with a higher level of education and health insurance, have fathers aged 41-50, and live with a large number of family members were more likely to be fully immunized (p < 0.05). CONCLUSION Socioeconomic determinants were strongly correlated with the completeness of childhood vaccination in Indonesia.
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Affiliation(s)
- Rano K Sinuraya
- Unit of Global Health, Department of Health Sciences, University of Groningen/ University Medical Center Groningen, Groningen, the Netherlands; Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, West Java, Indonesia; Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Sofa D Alfian
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, West Java, Indonesia; Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Rizky Abdulah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, West Java, Indonesia; Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Maarten J Postma
- Unit of Global Health, Department of Health Sciences, University of Groningen/ University Medical Center Groningen, Groningen, the Netherlands; Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, West Java, Indonesia; Department of Economics, Econometrics & Finance, Faculty of Economics & Business, University of Groningen, Groningen, the Netherlands
| | - Auliya A Suwantika
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, West Java, Indonesia; Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, West Java, Indonesia.
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Xie K, Marathe A, Deng X, Ruiz-Castillo P, Imputiua S, Elobolobo E, Mutepa V, Sale M, Nicolas P, Montana J, Jamisse E, Munguambe H, Materrula F, Casellas A, Rabinovich R, Saute F, Chaccour CJ, Sacoor C, Rist C. Alternative approaches for creating a wealth index: the case of Mozambique. BMJ Glob Health 2023; 8:e012639. [PMID: 37643807 PMCID: PMC10465889 DOI: 10.1136/bmjgh-2023-012639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/31/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION The wealth index is widely used as a proxy for a household's socioeconomic position (SEP) and living standard. This work constructs a wealth index for the Mopeia district in Mozambique using data collected in year 2021 under the BOHEMIA (Broad One Health Endectocide-based Malaria Intervention in Africa) project. METHODS We evaluate the performance of three alternative approaches against the Demographic and Health Survey (DHS) method based wealth index: feature selection principal components analysis (PCA), sparse PCA and robust PCA. The internal coherence between four wealth indices is investigated through statistical testing. Validation and an evaluation of the stability of the wealth index are performed with additional household income data from the BOHEMIA Health Economics Survey and the 2018 Malaria Indicator Survey data in Mozambique. RESULTS The Spearman's rank correlation between wealth index ventiles from four methods is over 0.98, indicating a high consistency in results across methods. Wealth rankings and households' income show a strong concordance with the area under the curve value of ~0.7 in the receiver operating characteristic analysis. The agreement between the alternative wealth indices and the DHS wealth index demonstrates the stability in rankings from the alternative methods. CONCLUSIONS This study creates a wealth index for Mopeia, Mozambique, and shows that DHS method based wealth index is an appropriate proxy for the SEP in low-income regions. However, this research recommends feature selection PCA over the DHS method since it uses fewer asset indicators and constructs a high-quality wealth index.
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Affiliation(s)
- Kexin Xie
- Department of Statistics, Virginia Tech, Blacksburg, Virginia, USA
| | - Achla Marathe
- Network Systems Science and Advanced Computing Division, Biocomplexity Institute, University of Virginia, Charlottesville, Virginia, USA
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Xinwei Deng
- Department of Statistics, Virginia Tech, Blacksburg, Virginia, USA
| | - Paula Ruiz-Castillo
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | | | - Eldo Elobolobo
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Victor Mutepa
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Mussa Sale
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Patricia Nicolas
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Julia Montana
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Edgar Jamisse
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | | | | | - Aina Casellas
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Regina Rabinovich
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
- Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Francisco Saute
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Carlos J Chaccour
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
- Facultad de Medicina, Universidad de Navarra, Pamplona, Spain
| | | | - Cassidy Rist
- Department of Population Health Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia, USA
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Moeeni M, Nosratnejad S, Rostampour M, Ponnet K. To what extent has the Iranian Health Transformation Plan addressed inequality in healthcare financing in Iran? Int J Equity Health 2023; 22:62. [PMID: 37024883 PMCID: PMC10080967 DOI: 10.1186/s12939-023-01880-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 03/31/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND One of the major goals of health systems is providing a financing strategy without inequality; this has a significant impact on people's access to healthcare. The present study aimed to investigate the inequality in households' financial contribution (HFC) to health expenditure both before and after the implementation of the Iranian Health Transformation Plan (HTP) in 2014. METHODS This study is a secondary analysis of two waves of a national survey conducted in Iran. The data were collected from the Households Income and Expenditure Survey in 2013 and 2015. The research sample included 76,195 Iranian households. The inequality in households' financial contributions to the health system was assessed using the Gini coefficient, and the concentration index (CI). In addition, by using econometric modeling, the relationship between the implementation of the HTP and inequality in HFC was studied. The households' financial contribution included healthcare and health insurance prepayments. RESULTS The Gini coefficient values were 0.67 and 0.65 in 2013 and 2015, respectively, indicating a medium degree of inequality in HFC in both years. The CI values were 0.54 and 0.56 in 2013 and 2015, respectively, suggesting that inequalities in HFC were in favor of higher income quintiles in the years before and after the implementation of the HTP. Regression analysis showed that households with a female head, with an unemployed head, or with a head having income without a job were contributing more to financing health expenditure. The presence of a household member over the age of 65 was associated with a higher level of HFC. The implementation of the HTP had a negative relationship with the HFC. CONCLUSION The HTP, aiming to address inequality in the financing system, did not achieve the intended goal as expected. The implementation of the HTP neglected certain factors at the household level, such as the presence of family members older than the age of 65, a female household head, and unemployment. This resulted in a failure to reduce the inequality of the HFC. We suggest that, in the future, policymakers take into account factors at the household level to reduce inequality in the HFC.
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Affiliation(s)
- Maryam Moeeni
- Social Determinants of Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shirin Nosratnejad
- Iranian Center of Excellence in Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Manizhe Rostampour
- Iranian Center of Excellence in Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Koen Ponnet
- Faculty of Social Sciences, Imec-Mict-Ghent University, Ghent, Belgium
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Daniel D, Nastiti A, Surbakti HY, Dwipayanti NMU. Access to inclusive sanitation and participation in sanitation programs for people with disabilities in Indonesia. Sci Rep 2023; 13:4310. [PMID: 36922602 PMCID: PMC10017721 DOI: 10.1038/s41598-023-30586-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 02/27/2023] [Indexed: 03/17/2023] Open
Abstract
Access to inclusive sanitation for people with disabilities (PWDs) remains a global challenge, including in Indonesia, where 10-15% of its population is disabled. Inclusive sanitation facilities can be achieved when PWDs are involved in the sanitation-related decision-making process, e.g., designing toilet that meets their needs. This study aims to investigate the situation of the sanitation facility in houses of PWDs and understand knowledge, attitude, and practices related to PWD participation in sanitation programs using a case study in two provinces in Indonesia: Nusa Tenggara Barat and Nusa Tenggara Timur. Quantitative data were taken from 129 PWD households, and qualitative data were from in-depth interviews with relevant stakeholders. The latter was presented in a causal loop diagram. Less than 5% had inclusive sanitation at home, mainly due to no supportive tools and bins. The knowledge levels related to sanitation and PWDs participation in sanitation programs were relatively low. Economic condition was one of the barriers for PWDs to participate in the sanitation program. Statistical analysis found that a higher household head education level was associated with a more positive attitude and higher PWD participation in sanitation programs. Although Indonesian law supports PWD participation, the implementation remains a challenge. This study also underlines the need for capacity building in facilitating PWDs' involvement in sanitation programs and community meetings. Finally, barriers to PWD participation can come from different levels and actors, e.g., the family, the community, the district level, and the PWD itself, indicating the need to involve actors at all levels to enhance PWD participation in the sanitation program that leads to inclusive sanitation facilities for all groups.
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Affiliation(s)
- D Daniel
- Department of Health Behavior, Environment, and Social Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Anindrya Nastiti
- Faculty of Civil and Environmental Engineering, Institut Teknologi Bandung, Bandung, Indonesia. .,Center for Environmental Studies, Institut Teknologi Bandung, Bandung, Indonesia.
| | - Hana Yesica Surbakti
- Department of Public Health, The Graduate School, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Ni Made Utami Dwipayanti
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Denpasar, Indonesia
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Engidaw MT, Gebremariam AD, Kefale B, Tesfa D, Tiruneh SA, Shiferaw YF. Impact of the Productive SafetyNet Program on the minimum acceptable diet in the rural community of South Gondar Zone, Northwest Ethiopia. FRONTIERS IN SUSTAINABLE FOOD SYSTEMS 2023. [DOI: 10.3389/fsufs.2022.977727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BackgroundEven though numerous factors contribute to undernutrition, it can happen immediately due to poor intake and illness. A minimum acceptable diet is one of the proxy measures for adequate consumption, which is an impact indicator for the Productive SafetyNet Program (PSNP). As a result, this study aimed to assess the impact of PSNP on the minimum acceptable diet among rural infants in the South Gondar Zone, Northwest Ethiopia.MethodsA community-based cross-sectional study design was employed in the selected woredas (districts) of South Gondar Zone, Northwest Ethiopia, from 1 December 2017 to 30 January 2017. A total of 442 participants' data were collected during this time period through interviews with their mothers or caregivers. A multistage sampling technique was employed to select study subjects and interviewees using a structured questionnaire. Stata version 16 (MP) was employed to carry out a statistical analysis. A binary logistic regression model was employed to identify significant variables. The statistical significance was declared at a p-value of more than 0.05.ResultsThe highest proportion of adequate diet diversity scores (261 [59.05%]) was from households who graduated (not part of it) from PSNPs. In this study, the magnitude of adequate dietary diversity, meal frequency, and minimum acceptable diet was 79.86, 82.58, and 66.52%, respectively. Marital status (AOR = 3.98, 95% CI: 1.39, 11.40), child age (AOR = 2.82, 95% CI: 1.78, 4.47), the educational status of the father (AOR = 0.56, 95% CI: 0.35, 0.89), the wealth index (AOR = 0.27, 95% CI: 0.12, 0.64), and the place of delivery (AOR = 3.14, 95% CI: 1.47, 6.73) were significant predictors for minimum acceptable diet uptake by children.ConclusionIn this study, two-thirds of the infants had/received a minimum acceptable diet. Furthermore, infants from households with Productive SafetyNet users had a low minimum acceptable diet. Marital status, the educational status of the father, child age, the wealth index, and the place of delivery were associated factors with having an adequate intake of minimum acceptable diet by the children. Therefore, efforts to address sociodemographic and child-related factors during routine care are crucial.
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Azizabadi Z, Aminisani N, Emamian MH. Socioeconomic inequality in depression and anxiety and its determinants in Iranian older adults. BMC Psychiatry 2022; 22:761. [PMID: 36471352 PMCID: PMC9721087 DOI: 10.1186/s12888-022-04433-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 11/28/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Older adults with lower socioeconomic status are more vulnerable to stressful life events and at increased risk of common mental health disorders like anxiety and depression. This study investigates the socioeconomic inequality in depressive symptoms and anxiety. METHODS The data were from 7462 participants of the Neyshabur longitudinal study of ageing registered during 2016-2018. The outcome variables were anxiety and depressive symptoms. Anxiety was defined by the "Hospital Anxiety and Depression scale Questionnaire", and depressive symptoms was defined and measured by the "short-term form of the Epidemiological Center Questionnaire." The socioeconomic status was defined using principal component analysis of home assets. The Concentration Index (C) was used to measure socioeconomic inequality in anxiety and depressive symptoms. Concentration index was decomposed to its determinants to determine the role of the independent variables on inequality. RESULTS The prevalence of depressive symptoms and anxiety was 12.2% (95% CI: 11.4, 12.9) and 7.0% (95% CI: 6.4, 7.5), respectively. Moreover, the C for anxiety was -0.195 (95% CI: -0.254, -0.136) and for depressive symptoms was -0.206 (95% CI: -0.252, -0.159), which indicate a considerable inequality in favor of high socioeconomic group for anxiety and depressive symptoms. Decomposition of the concentration Index showed that education, unemployment and male sex were the most important positive contributors to the observed inequality in anxiety and depressive symptoms, while age and number of grandchildren were main negative contributors of this inequality. CONCLUSION Low socioeconomic groups were more affected by anxiety and depressive symptoms. Any intervention for alleviation of inequality in anxiety and depression should be focus on education and employment of people, especially in younger elderly.
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Affiliation(s)
- Zahra Azizabadi
- grid.444858.10000 0004 0384 8816Student Research Committee, School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Nayyereh Aminisani
- grid.502998.f0000 0004 0550 3395Healthy Ageing Research Centre, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Mohammad Hassan Emamian
- Ophthalmic Epidemiology Research Center, Shahroud University of Medical Sciences, Shahroud, Iran.
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Nicolaou L, Underhill L, Hossen S, Simkovich S, Thangavel G, Rosa G, McCracken JP, Davila-Roman V, Fuentes LDL, Quinn AK, Clark M, Diaz A, Pillarisetti A, Steenland K, Waller LA, Jabbarzadeh S, Peel JL, Checkley W. Cross-sectional analysis of the association between personal exposure to household air pollution and blood pressure in adult women: Evidence from the multi-country Household Air Pollution Intervention Network (HAPIN) trial. ENVIRONMENTAL RESEARCH 2022; 214:114121. [PMID: 36029836 PMCID: PMC9492861 DOI: 10.1016/j.envres.2022.114121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/20/2022] [Accepted: 08/13/2022] [Indexed: 06/18/2023]
Abstract
Elevated blood pressure (BP) is a leading risk factor for the global burden of disease. Household air pollution (HAP), resulting from the burning of biomass fuels, may be an important cause of elevated BP in resource-poor communities. We examined the exposure-response relationship of personal exposures to HAP -fine particulate matter (PM2.5), carbon monoxide (CO), and black carbon (BC) - with BP measures in women aged 40-79 years across four resource-poor settings in Guatemala, Peru, India and Rwanda. BP was obtained within a day of 24-h personal exposure measurements at baseline, when participants were using biomass for cooking. We used generalized additive models to characterize the shape of the association between BP and HAP, accounting for the interaction of personal exposures and age and adjusting for a priori identified confounders. A total of 418 women (mean age 52.2 ± 7.9 years) were included in this analysis. The interquartile range of exposures to PM2.5 was 42.9-139.5 μg/m3, BC was 6.4-16.1 μg/m3, and CO was 0.5-2.9 ppm. Both SBP and PP were positively associated with PM2.5 exposure in older aged women, achieving statistical significance around 60 years of age. The exact threshold varied by BP measure and PM2.5 exposures being compared. For example, SBP of women aged 65 years was on average 10.8 mm Hg (95% CI 1.0-20.6) higher at 232 μg/m3 of PM2.5 exposure (90th percentile) when compared to that of women of the same age with personal exposures of 10 μg/m3. PP in women aged 65 years was higher for exposures ≥90 μg/m3, with mean differences of 6.1 mm Hg (95% CI 1.8-10.5) and 9.2 mm Hg (95% CI 3.3-15.1) at 139 (75th percentile) and 232 μg/m3 (90th percentile) respectively, when compared to that of women of the same age with PM2.5 exposures of 10 μg/m3. Our findings suggest that reducing HAP exposures may help to reduce BP, particularly among older women.
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Affiliation(s)
- Laura Nicolaou
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA; Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, USA
| | - Lindsay Underhill
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA; Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, USA
| | - Shakir Hossen
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA; Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, USA
| | - Suzanne Simkovich
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA; Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, USA; Division of Healthcare Delivery Research, MedStar Health Research Institute, Hyattsville, USA; Division of Pulmonary and Critical Care Medicine, Georgetown University School of Medicine, Washington, USA
| | - Gurusamy Thangavel
- Sri Ramachandra Institute for Higher Education and Research, Chennai, India
| | - Ghislaine Rosa
- Faculty of Infectious and Tropical Diseases, London School of Tropical Medicine and Hygiene, London, UK
| | - John P McCracken
- Center for Health Studies, Universidad Del Valle de Guatemala, Guatemala City, Guatemala; Global Health Institute, Epidemiology and Biostatistics Department, University of Georgia, Athens, GA, USA
| | | | | | - Ashlinn K Quinn
- Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
| | - Maggie Clark
- Department of Environmental & Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Anaite Diaz
- Center for Health Studies, Universidad Del Valle de Guatemala, Guatemala City, Guatemala
| | - Ajay Pillarisetti
- Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
| | - Kyle Steenland
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lance A Waller
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Shirin Jabbarzadeh
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jennifer L Peel
- Department of Environmental & Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA; Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, USA; Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA.
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Socioeconomic status and self-rated health in Iran: findings from a general population study. Cost Eff Resour Alloc 2022; 20:30. [PMID: 35768798 PMCID: PMC9241314 DOI: 10.1186/s12962-022-00364-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 06/22/2022] [Indexed: 11/10/2022] Open
Abstract
Background There are large gaps in health and well-being among different groups of the society. Socioeconomic factors play a significant role in determining the health status of the society. The present study was conducted to examine socioeconomic inequality in health status among the adult population of Khorramabad city, the capital of Lorestan province, wester part of Iran. Methods A cross-sectional study was conducted on 1348 participants selected through multistage sampling. A valid and reliable questionnaire was used for data collection. The wealth index as an indicator of the socioeconomic status (SES) was used to categorize the subjects in terms of the SES. The concentration index and concentration curve was used to measure socioeconomic inequity in poor self-rated health (SRH) of population. Finally, after determine the status of inequity in poor SRH, a decomposition analysis approach was used to identify the most important determinants of this inequity. Results The prevalence of poor SRH was 18.91% in all subjects, 38.52% in the lowest SES group, and 11.15% in the highest SES group. The value of the concentration index for poor SRH was − 0.3243 (95% CI − 0.3996 to − 0.2490), indicating that poor SRH was more concentrated among the poor. The results of decomposition analysis showed that SES (41.2%), higher body mass index (28.6%) and lack of physical activity (26.9%) were the most important factors associated with the concentration of poor SRH in the poor groups. Conclusion Identification of socioeconomic factors affecting on health status is the first step for proper policymaking. Policymakers and health system managers at the national and subnational levels can use the results of this study as well as other similar domestic studies to design and implement proper interventions to promote equity and improve the health status of population.
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Prevalence of Intestinal Parasites among Immunocompromised Patients, Children, and Adults in Sana'a, Yemen. J Trop Med 2022; 2022:5976640. [PMID: 35719317 PMCID: PMC9200594 DOI: 10.1155/2022/5976640] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/24/2022] [Indexed: 12/04/2022] Open
Abstract
Intestinal parasite infection (IPI) is still a very important public health issue. The severity of the parasitic disease has been reported as a high infection in immunocompromised patients and children. Hence, this study aimed to investigate the prevalence of intestinal parasites among immunocompromised patients and children with various gastrointestinal system complications in Sana'a city, Yemen, with different variables, including genus and age, and explore the risk factors associated with parasitic intestinal infections. The study socioeconomic data and certain behavioral and environmental risk factors and stool samples were collected from immunocompromised adult and children's patients, including children (one to eight years old), pregnant women, diabetes mellitus patients, cancer patients, HIV patients, and older adults. Out of 436 fecal samples, the overall prevalence rate of IPIs among immunocompromised patients and children in Sana'a was 51.8%. In contrast, the rate of infection in children (26.1%) was higher than that in old patients (25.7%) and in females (38.5%) and higher than that in males (13.3%). The protozoa (44.5%) have been shown more than intestinal helminths (7.3%) in samples, and the most common intestinal protozoan was Giardia lamblia and Entamoeba histolytica (13.8% and 12.8%), respectively. The most common intestinal helminthiasis was Hymenolepis nana with 1.8%. Concluding that the rate of infection was high for several reasons, including lack of commitment to hygiene as not handwashing after using the toilet (88.9%), eating uncovered food (56.3%), poor sanitation as lack of water sources (59.5%), reduced health education, and presence of other family members infected by parasites (61.3%). Interventions are required to reduce intestinal parasites, including health education on personal hygiene for patients, increasing awareness, and improving the environment and healthcare system.
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Ali HA, Hartner AM, Echeverria-Londono S, Roth J, Li X, Abbas K, Portnoy A, Vynnycky E, Woodruff K, Ferguson NM, Toor J, Gaythorpe KAM. Vaccine equity in low and middle income countries: a systematic review and meta-analysis. Int J Equity Health 2022; 21:82. [PMID: 35701823 PMCID: PMC9194352 DOI: 10.1186/s12939-022-01678-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/17/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Evidence to date has shown that inequality in health, and vaccination coverage in particular, can have ramifications to wider society. However, whilst individual studies have sought to characterise these heterogeneities in immunisation coverage at national level, few have taken a broad and quantitative view of the contributing factors to heterogeneity in immunisation coverage and impact, i.e. the number of cases, deaths, and disability-adjusted life years averted. This systematic review aims to highlight these geographic, demographic, and sociodemographic characteristics through a qualitative and quantitative approach, vital to prioritise and optimise vaccination policies. METHODS A systematic review of two databases (PubMed and Web of Science) was undertaken using search terms and keywords to identify studies examining factors on immunisation inequality and heterogeneity in vaccination coverage. Inclusion criteria were applied independently by two researchers. Studies including data on key characteristics of interest were further analysed through a meta-analysis to produce a pooled estimate of the risk ratio using a random effects model for that characteristic. RESULTS One hundred and eight studies were included in this review. We found that inequalities in wealth, education, and geographic access can affect vaccine impact and vaccination dropout. We estimated those living in rural areas were not significantly different in terms of full vaccination status compared to urban areas but noted considerable heterogeneity between countries. We found that females were 3% (95%CI[1%, 5%]) less likely to be fully vaccinated than males. Additionally, we estimated that children whose mothers had no formal education were 28% (95%CI[18%,47%]) less likely to be fully vaccinated than those whose mother had primary level, or above, education. Finally, we found that individuals in the poorest wealth quintile were 27% (95%CI [16%,37%]) less likely to be fully vaccinated than those in the richest. CONCLUSIONS We found a nuanced picture of inequality in vaccination coverage and access with wealth disparity dominating, and likely driving, other disparities. This review highlights the complex landscape of inequity and further need to design vaccination strategies targeting missed subgroups to improve and recover vaccination coverage following the COVID-19 pandemic. TRIAL REGISTRATION Prospero, CRD42021261927.
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Affiliation(s)
- Huda Ahmed Ali
- grid.7445.20000 0001 2113 8111Imperial College London, Praed Street, London, UK
| | - Anna-Maria Hartner
- grid.7445.20000 0001 2113 8111Imperial College London, Praed Street, London, UK
| | | | - Jeremy Roth
- grid.7445.20000 0001 2113 8111Imperial College London, Praed Street, London, UK
| | - Xiang Li
- grid.7445.20000 0001 2113 8111Imperial College London, Praed Street, London, UK
| | - Kaja Abbas
- grid.8991.90000 0004 0425 469XLondon School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Allison Portnoy
- grid.38142.3c000000041936754XCenter for Health Decision Science, Harvard T H Chan School of Public Health, Cambridge, USA
| | - Emilia Vynnycky
- grid.271308.f0000 0004 5909 016XPublic Health England, London, UK
| | - Kim Woodruff
- grid.7445.20000 0001 2113 8111Imperial College London, Praed Street, London, UK
| | - Neil M Ferguson
- grid.7445.20000 0001 2113 8111Imperial College London, Praed Street, London, UK
| | - Jaspreet Toor
- grid.7445.20000 0001 2113 8111Imperial College London, Praed Street, London, UK
| | - Katy AM Gaythorpe
- grid.7445.20000 0001 2113 8111Imperial College London, Praed Street, London, UK
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Szabo S, Ahmed S, Wiśniowski A, Pramanik M, Islam R, Zaman F, Kuwornu JKM. Remittances and food security in Bangladesh: an empirical country-level analysis. Public Health Nutr 2022; 25:1-11. [PMID: 35616088 PMCID: PMC9991786 DOI: 10.1017/s1368980022001252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 02/28/2022] [Accepted: 05/12/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To examine the association between remittances and food security in Bangladesh, controlling for other key factors. DESIGN The secondary data analysis was performed on the most recent (2016) nationally representative Household Income and Expenditure Survey. We used logistic regression models to measure the association between food security of the household and remittances received. The household food security was measured based on expenditure on food items and the energy intake of the household members. The key explanatory variables included the receipt of remittances by the household and household-level socio-economic characteristics. SETTING Bangladesh. PARTICIPANTS Totally, 45 977 households across seven divisions of Bangladesh. RESULTS Findings suggested that remittances have a significant positive effect on food security. Further, the households with female heads were significantly more likely to be food insecure. The wealth status and geographical locations were significantly associated with food security status in Bangladesh. CONCLUSIONS The findings highlight the importance of considering remittance as one of the key factors, while stakeholders implement nutritional interventions in Bangladesh and other low-income settings. Future research should consider this as an important determinant while further examining food security in such settings.
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Affiliation(s)
- Sylvia Szabo
- Department of Social Welfare and Counseling, College of Future Convergence, Dongguk University, Seoul, South Korea
| | - Sayem Ahmed
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Mathematical Modelling Group, Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
| | | | - Malay Pramanik
- Department of Development and Sustainability, Asian Institute of Technology, Pathum Thani, Thailand
| | - Rashadul Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ferdousi Zaman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- World Health Organization, Dhaka, Bangladesh
| | - John KM Kuwornu
- Department of Agricultural Economics, Agribusiness and Extension, University of Energy and Natural Resources, Sunyani, Ghana
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Davila RL, McCarthy AS, Gondwe D, Kirdruang P, Sharma U. Water, Walls, and Bicycles: Wealth Index Composition Using Census Microdata. JOURNAL OF DEMOGRAPHIC ECONOMICS 2022; 88:79-120. [PMID: 36313399 PMCID: PMC9603640 DOI: 10.1017/dem.2020.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
In this study, we produce a valid and consistent variable for socioeconomic status at the household level with census microdata from ten developing countries available from the Integrated Public Use Microdata Series - International (IPUMS-I), the world's largest census database. We use principal components analysis to compute a wealth index based on asset ownership, utilities, and dwelling characteristics. We validate the index by verifying socioeconomic gradients on school enrollment and educational attainment. Given that the availability of socioeconomic indicators varies considerably across samples of census microdata, we implement a stepwise elimination procedure on the wealth index to identify the conditions that produce an internally consistent index. Using the results of the stepwise methodology, we propose which indicators are most important in measuring household socioeconomic status. The development of the asset index for such a large archive of international census microdata is a very useful public resource for researchers.
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Affiliation(s)
| | | | | | | | - Uttam Sharma
- Institute for Social and Environmental Research, Nepal
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Lin S, Zhang Y, Jiang L, Li J, Chai J, Pei L, Shang X. Interactive Effects of Maternal Vitamin D Status and Socio-Economic Status on the Risk of Spontaneous Abortion: Evidence from Henan Province, China. Nutrients 2022; 14:nu14020291. [PMID: 35057472 PMCID: PMC8780117 DOI: 10.3390/nu14020291] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/04/2022] [Accepted: 01/07/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Maternal vitamin D deficiency might generate adverse reproductive outcomes, and socio-economic inequalities in micronutrient-related diseases have often been found. This study aimed to explore the interactive effects of maternal vitamin D status and socio-economic status (SES) on risk of spontaneous abortion. Methods: A population-based case–control study was conducted including 293 women with spontaneous abortion and 498 control women in December 2009 and January, 2010 in Henan Province, China. Information on pregnancy outcomes, maternal demographic, lifestyle and exposure factors and blood samples were collected at the same time. Vitamin D deficiency was defined as 25(OH)D < 20 ng/mL. SES index was constructed with principal component analysis by aggregating women’s and their husbands’ education level and occupation, and household income and expenditure. Interactive effects were assessed on a multiplicative scale with ratio of the odds ratio (ROR). Results: Compared to those with high SES and vitamin D sufficiency, women with vitamin D deficiency and low SES index had an increased risk of spontaneous abortion (aOR: 1.99; 95% CI: 1.23–3.23). The ROR was 2.06 (95% CI: 1.04–4.10), indicating a significant positive multiplicative interaction. Conclusions: Maternal low SES may strengthen the effect of vitamin D deficiency exposure on spontaneous abortion risk in this Chinese population.
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Affiliation(s)
- Shiqi Lin
- Institute of Population Research and China Center on Population Health and Development, Peking University, Beijing 100871, China; (S.L.); (Y.Z.); (J.L.)
| | - Yuan Zhang
- Institute of Population Research and China Center on Population Health and Development, Peking University, Beijing 100871, China; (S.L.); (Y.Z.); (J.L.)
| | - Lifang Jiang
- National Health Commission Key Laboratory of Birth Defects Prevention, Henan Key Laboratory of Population Defects Prevention, Zhengzhou 450002, China; (L.J.); (J.C.)
| | - Jiajia Li
- Institute of Population Research and China Center on Population Health and Development, Peking University, Beijing 100871, China; (S.L.); (Y.Z.); (J.L.)
| | - Jian Chai
- National Health Commission Key Laboratory of Birth Defects Prevention, Henan Key Laboratory of Population Defects Prevention, Zhengzhou 450002, China; (L.J.); (J.C.)
| | - Lijun Pei
- Institute of Population Research and China Center on Population Health and Development, Peking University, Beijing 100871, China; (S.L.); (Y.Z.); (J.L.)
- Correspondence: (L.P.); (X.S.)
| | - Xuejun Shang
- Department of Andrology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210002, China
- Correspondence: (L.P.); (X.S.)
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Contextual Determinants of General Household Hygiene Conditions in Rural Indonesia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111064. [PMID: 34769584 PMCID: PMC8582855 DOI: 10.3390/ijerph182111064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 10/14/2021] [Accepted: 10/19/2021] [Indexed: 11/17/2022]
Abstract
Household hygiene is critical to prevent pathogen transmission at the household level. Assessing household hygiene conditions and their determinants are needed to improve hygiene conditions, especially in rural and less developed areas where the housing conditions are relatively worse than they are in urban areas. This study used data from 278 household interviews and observations in rural areas in the district of East Sumba, province East Nusa Tenggara, Indonesia. The data were analyzed using statistical methods. In general, the household hygiene conditions in the study need to be improved. The main potential sources of pathogen transmission were from the surrounding environment, i.e., non-permanent floor and garbage, and personal hygiene, i.e., handwashing facilities with water and soap were only observed in the homes of four out of ten respondents. The presence of livestock roaming freely in the house’s yard was another source of contamination. Easy access to water and wealth significantly influenced the hygiene conditions. Implementing low-cost interventions, i.e., cleaning the house of garbage and animal feces and cleaning nails, should be the priority in immediate intervention, while providing easier access to water supply, especially during the dry season, could be a long-term intervention. This paper also argues that analyzing household hygiene conditions or practices should be complemented by analyzing contextual determinants of the hygiene conditions or practices, so that we can develop more precise intervention by considering the local or household context.
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Mukunya D, Tumwine JK, Ndeezi G, Tumuhamye J, Tongun JB, Kizito S, Napyo A, Achora V, Odongkara B, Arach AA, Nankabirwa V. Inequity in utilization of health care facilities during childbirth: a community-based survey in post-conflict Northern Uganda. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-019-01114-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Abstract
Aim
To assess inequity in utilization of health care facilities during childbirth and factors associated with home births in Lira district, Northern Uganda.
Subjects and methods
In 2016, we surveyed 930 mothers with children under the age of 2 years in Lira district, Northern Uganda. We used multiple correspondence analysis to construct the wealth index in quintiles, based on household assets. The concentration index is the measure of socioeconomic inequality used in this article, which we calculated using the Stata DASP package. We also conducted multivariable logistic regression to assess factors associated with home births.
Results
A third of mothers (n = 308) gave birth from home [33%, 95% confidence interval (CI) (26%–41%)]. Giving birth at a health facility was pro-rich with a concentration index of 0.10 [95% CI (0.05–0.14)]. Upon decomposing the concentration index, the most important determinant of inequity was the mother's residence. Factors associated with home births in multivariable logistic regression included rural residence [adjusted odds ratio (AOR) 3.1, 95% CI (1.8–5.3)], precipitate labor [AOR 4.18, 95% CI (2.61–6.71)], and labor starting in the evening or at night. Mothers who had previously given birth from home were more likely to give birth at home again [AOR 40.70, 95% CI (18.70–88.61)], whereas mothers who had experienced a complication during a previous birth were less likely to give birth at home [AOR 0.45, 95% CI (0.28–0.95)].
Conclusion
There was inequity in the utilization of health facilities for childbirth. Programs that promote health facility births should prioritize poorer mothers and those in rural areas.
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Oduse S, Zewotir T, North D. The impact of antenatal care on under-five mortality in Ethiopia: a difference-in-differences analysis. BMC Pregnancy Childbirth 2021; 21:44. [PMID: 33423662 PMCID: PMC7798199 DOI: 10.1186/s12884-020-03531-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 12/26/2020] [Indexed: 12/01/2022] Open
Abstract
Background Sub-Saharan Africa, as opposed to other regions, has the highest under-five mortality rates yet makes the least improvement in reducing under-five mortality. Despite the decline, Ethiopia is among the top ten countries contributing the most to global under-five mortalities. This article examines the impact of the number of antenatal care and the timing of first antenatal care on child health outcomes. We specifically investigated if the utilization of antenatal care services positively affects the reduction of under-five mortality. Methods We employ a difference-in-differences design with propensity score matching to identify direct causal effects of antenatal care on under-five mortality based on the Ethiopian Demographic Health Survey data of 2011 and 2016. Our sample includes 22 295 women between the ages of 14–49 who had antenatal care visits at different times before delivery. Results The study revealed 1 481 cases of reported under-five mortality. 99.0% of that under-five mortality cases are women who had less than eight antenatal care visits, while only 1% of that is by women who had eight or more antenatal care visits. Antenatal care visit decreases the likelihood of under-five mortality in Ethiopia by 45.2% (CI = 19.2–71.3%, P-value < 0.001) while the timing of first antenatal care within the first trimester decreases the likelihood of under-five mortality by 10% (CI = 5.7–15.6%, P-value < 0.001). Conclusions To achieve a significant reduction in the under-five mortality rate, Intervention programs that encourages more antenatal care visits should be considered. This will improve child survival and help in attaining Sustainable Development Goal targets.
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Affiliation(s)
- Samuel Oduse
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, 4001, Durban, South Africa.
| | - Temesgen Zewotir
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, 4001, Durban, South Africa
| | - Delia North
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, 4001, Durban, South Africa
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Hirose A, Kajungu D, Tusubira V, Waiswa P, Alfven T, Hanson C. Postneonatal under-5 mortality in peri-urban and rural Eastern Uganda, 2005-2015. BMJ Glob Health 2020; 5:e003762. [PMID: 33334903 PMCID: PMC7747610 DOI: 10.1136/bmjgh-2020-003762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/29/2020] [Accepted: 11/17/2020] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Community and individual sociodemographic characteristics play an important role in child survival. However, a question remains how urbanisation and demographic changes in sub-Saharan Africa affect community-level determinants for child survival. METHODS Longitudinal data from the Iganga/Mayuge Health and Demographic Surveillance Site was used to obtain postneonatal under-5 mortality rates between March 2005 and February 2015 in periurban and rural areas separately. Multilevel survival analysis models were used to identify factors associated with mortality. RESULTS There were 43 043 postneonatal under-5 children contributing to 116 385 person years of observation, among whom 1737 died. Average annual crude mortality incidence rate (IR) differed significantly between periurban and rural areas (9.0 (8.1 to 10.0) per 1000 person-years vs 18.1 (17.1 to 19.0), respectively). In periurban areas, there was evidence for decreasing mortality from IR=11.3 (7.7 to 16.6) in 2006 to IR=4.5 (3.0 to 6.9) in 2015. The mortality fluctuated with no evidence for reduction in rural areas (IR=19.0 (15.8 to 22.8) in 2006; IR=15.5 (13.0 to 18.6) in 2015). BCG vaccination was associated with reduced mortality in periurban and rural areas (adjusted rate ratio (aRR)=0.45; 95% CI 0.30 to 0.67 and aRR=0.56; 95% CI 0.41 to 0.76, respectively). Maternal education level within the community was associated with reduced mortality in both periurban and rural sites (aRR=0.83; 95% CI 0.70 to 0.99; aRR=0.90; 95% CI 0.81 to 0.99). The proportion of households in the poorest quintile within the community was associated with mortality in rural areas only (aRR=1.08; 95% CI 1.00 to 1.18). In rural areas, a large disparity existed between the least poor and the poorest (aRR=0.50; 95% CI 0.27 to 0.92). CONCLUSION We found evidence for a mortality decline in peri-urban but not rural areas. Investments in the known key health (eg, vaccination) and socio-economic interventions (education, and economic development) continue to be crucial for mortality declines. Focused strategies to eliminate the disparity between wealth quintiles are also warranted. There may be equitable access to health services in peri-urban areas but improved metrics of socioeconomic position suitable for peri-urban residents may be needed.
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Affiliation(s)
- Atsumi Hirose
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- School of Public Health, Imperial College London, London, UK
| | - Dan Kajungu
- Makerere University Centre for Health and Population Research, Kampala, Uganda
| | - Valerie Tusubira
- Makerere University Centre for Health and Population Research, Kampala, Uganda
| | - Peter Waiswa
- School of Public Health, Makerere University, Kampala, Uganda
| | - Tobias Alfven
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Disease Control, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, UK
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Daniel D, Sirait M, Pande S. A hierarchical Bayesian Belief Network model of household water treatment behaviour in a suburban area: A case study of Palu-Indonesia. PLoS One 2020; 15:e0241904. [PMID: 33156850 PMCID: PMC7647107 DOI: 10.1371/journal.pone.0241904] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 10/22/2020] [Indexed: 11/21/2022] Open
Abstract
Understanding the determinants of household water treatment (HWT) behavior in developing countries is important to increase the rate of its regular use so that households can have safe water at home. This is especially so when the quality of the water source is not reliable. We present a hierarchical Bayesian Belief Network (BBN) model supported by statistical analysis to explore the influence of household’s socio-economic characteristics (SECs) on the HWT behavior via household’s psychological factors. The model uses eight SECs, such as mother’s and father’s education, wealth, and religion, and five RANAS psychological factors, i.e., risk, attitude, norms, ability, and self-regulation to analyse HWT behavior in a suburban area in Palu, Indonesia. Structured household interviews were conducted among 202 households. We found that mother’s education is the most important SEC that influences the regular use of HWT. An educated mother has more positive attitude towards HWT and is more confident in her ability to perform HWT. Moreover, self-regulation, especially the attempt to deal with any barrier that hinders HWT practice, is the most important psychological factor that can change irregular HWT users to regular HWT users. Hence, this paper recommends to HWT-program implementers to identify potential barriers and discuss potential solutions with the target group in order to increase the probability of the target group being a regular HWT user.
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Affiliation(s)
- D. Daniel
- Department of Water Management, Delft University of Technology, Delft, The Netherlands
- * E-mail:
| | - Mita Sirait
- Department of Ministry Quality and Impact, Health Units, Wahana Visi Indonesia, Tangerang Selatan, Indonesia
| | - Saket Pande
- Department of Water Management, Delft University of Technology, Delft, The Netherlands
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Mechtenberg A, McLaughlin B, DiGaetano M, Awodele A, Omeeboh L, Etwalu E, Nanjula L, Musaazi M, Shrime M. Health care during electricity failure: The hidden costs. PLoS One 2020; 15:e0235760. [PMID: 33147212 PMCID: PMC7641375 DOI: 10.1371/journal.pone.0235760] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 06/22/2020] [Indexed: 11/18/2022] Open
Abstract
Background Surgery risks increase when electricity is accessible but unreliable. During unreliable electricity events and without data on increased risk to patients, medical professionals base their decisions on anecdotal experience. Decisions should be made based on a cost-benefit analysis, but no methodology exists to quantify these risks, the associated hidden costs, nor risk charts to compare alternatives. Methods Two methodologies were created to quantify these hidden costs. In the first methodology through research literature and/or measurements, the authors obtained and analyzed a year’s worth of hour-by-hour energy failures for four energy healthcare system (EHS) types in four regions (SolarPV in Iraq, Hydroelectric in Ghana, SolarPV+Wind in Bangladesh, and Grid+Diesel in Uganda). In the second methodology, additional patient risks were calculated according to time and duration of electricity failure and medical procedure impact type. Combining these methodologies, the cost from the Value of Statistical Lives lost divided by Energy shortage ($/kWh) is calculated for EHS type and region specifically. The authors define hidden costs due to electricity failure as VSL/E ($/kWh) and compare this to traditional electricity costs (always defined in $/kWh units), including Levelized Cost of Electricity (LCOE also in $/kWh). This is quantified into a fundamentally new energy healthcare system risk chart (EHS-Risk Chart) based on severity of event (probability of deaths) and likelihood of event (probability of electricity failure). Results VSL/E costs were found to be 10 to 10,000 times traditional electricity costs (electric utility or LCOE based). The single power source EHS types have higher risks than hybridized EHS types (especially as power loads increase over time), but all EHS types have additional risks to patients due to electricity failure (between 3 to 105 deaths per 1,000 patients). Conclusions These electricity failure risks and hidden healthcare costs can now be calculated and charted to make medical decisions based on a risk chart instead of anecdotal experience. This risk chart connects public health and electricity failure using this adaptable, scalable, and verifiable model.
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Affiliation(s)
- Abigail Mechtenberg
- Center for Sustainable Energy, University of Notre Dame, South Bend, Indiana, United States of America
- Department of Physics and Preprofessional Studies, College of Science, University of Notre Dame, South Bend, Indiana, United States of America
- * E-mail:
| | - Brady McLaughlin
- Center for Sustainable Energy, University of Notre Dame, South Bend, Indiana, United States of America
- Department of Physics and Preprofessional Studies, College of Science, University of Notre Dame, South Bend, Indiana, United States of America
| | - Michael DiGaetano
- Center for Sustainable Energy, University of Notre Dame, South Bend, Indiana, United States of America
- Department of Physics and Preprofessional Studies, College of Science, University of Notre Dame, South Bend, Indiana, United States of America
| | - Abigail Awodele
- Center for Sustainable Energy, University of Notre Dame, South Bend, Indiana, United States of America
- Department of Physics and Preprofessional Studies, College of Science, University of Notre Dame, South Bend, Indiana, United States of America
| | - Leslie Omeeboh
- Center for Sustainable Energy, University of Notre Dame, South Bend, Indiana, United States of America
- Department of Physics and Preprofessional Studies, College of Science, University of Notre Dame, South Bend, Indiana, United States of America
| | - Emmanuel Etwalu
- College of Engineering, Design, Art, and Technology (CEDAT), Makerere University, Kampala, Uganda
| | | | - Moses Musaazi
- College of Engineering, Design, Art, and Technology (CEDAT), Makerere University, Kampala, Uganda
| | - Mark Shrime
- Harvard Medical School, Harvard University, Boston, MA, United States of America
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Engidaw MT, Gebremariam AD. The effect of productive SafetyNet program on wasting among under-five children in the rural community of South Gondar Zone, Northwest Ethiopia. ACTA ACUST UNITED AC 2020; 78:96. [PMID: 33062266 PMCID: PMC7552550 DOI: 10.1186/s13690-020-00481-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/06/2020] [Indexed: 12/03/2022]
Abstract
Background Undernutrition is a significant public health problem in a developing country like Ethiopia. Even if the cause of malnutrition is multifactorial, it is mainly related to socioeconomical, political, and health-related problems. All these problems will lead to more severe nutrient deficiencies among households without assets. The Productive SafetyNet program is implemented for beneficiaries in the rural community to prevent household assets depletion. So, this study aimed to assess the effect of a Productive SafetyNet program on wasting among under-five children in the rural community of South Gondar Zone. Methods A community-based cross-sectional study was done among 803 children paired with their mother/caregivers. Particepnts were selected by a simple random sampling technique. The data were collected by using a structured and pre-tested questionnaire. AnthroPlus software was used to analyse anthropometric data. The data entry employed by EpiInfo version 7.0 software for Windows. Then, the data exported to SPSS version 20.0 to carryout further statistical analysis. The anthropometric index (weight for height) was constructed to determine wasting. Both binary and multivariable logistic regression models were used to identify associated factors. Finally, P-Value ≤0.05 was used to declare statistical significance. Results In this study, the response rate was 95.76%. Of the total participants, 195(25.36%) children were from SafetyNet program beneficiaries. The overall prevalence of wasting was 29.9% (95% CI: 26.6, 33.2%). More than One-fourth of the children from SafetyNet beneficiary households were wasted. While considering all other variables constant, Productive SafetyNet Program reduce wasting by 46% (COR = 0.54. 95% CI (0.37, 0.79)). Wasting were significantly associated with marital status (divorced and/or separated: AOR = 3.33, 95% CI (1.71, 6.45)), being on the SafetyNet program (AOR: 0.63, 95% CI (0.40, 0.99)), family size (AOR = 0.13, 95% CI (0.09, 0.21)), father educational status (AOR: 0.25, 95% CI (0.09, 0.66)), age of the child (AOR = 0.51, 95% CI (0.33, 0.77)), and child dietary diversity score (AOR = 2.99, 95% CI (1.67, 5.35)). Conclusion Wasting was a severe public health problem. In this study, the Productive SafetyNet Program reduce wasting significantly. Marital status, SafetyNet program status, family size, father educational status, age of the child, and dietary diversity were factors associated with wasting among children. Early detection of household asset depletion and SafetyNet program implementation is vital with the usual nutritional assessment and counseling.
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Affiliation(s)
- Melaku Tadege Engidaw
- Public Health Department, College of Health Sciences, Debre Tabor University, P.o.Box: 031, Debre Tabor, Ethiopia
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Zhang H, Zhao Y, Pedersen J. Capital assets framework for analysing household vulnerability during disaster. DISASTERS 2020; 44:687-707. [PMID: 31334856 PMCID: PMC7540384 DOI: 10.1111/disa.12393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This paper examines the vulnerability of households to disasters, using an asset vulnerability framework to represent livelihoods. Such frameworks are widely employed to analyse household poverty and focus on living conditions and well-being rather than money-metric measures of consumption and income. The conceptualisation of household vulnerability is a challenge in current studies on coping with disasters. The paper considers whether a capital assets framework is useful in identifying and assessing household vulnerability in the context of the Wenchuan earthquake in China in 2008. The framework has five categories of assets (financial, human, natural, physical, and social capital) and attempts to measure the resilience and vulnerability of households. When applied to a major disaster, asset-based methods face the problem of heterogeneity of the population, such as with regard to livelihood type or residence. Moreover, the effect of external interventions, such as the provision of relief assistance, must be taken into account.
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Affiliation(s)
- Huafeng Zhang
- ResearcherThe Fafo Institute for Labour and Social ResearchNorway
| | - Yandong Zhao
- ResearcherChinese Academy of Science and Technology for DevelopmentChina
| | - Jon Pedersen
- ResearcherThe Fafo Institute for Labour and Social Research Norway
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Mshamu S, Peerawaranun P, Kahabuka C, Deen J, Tusting L, Lindsay SW, Knudsen J, Mukaka M, von Seidlein L. Old age is associated with decreased wealth in rural villages in Mtwara, Tanzania: findings from a cross-sectional survey. Trop Med Int Health 2020; 25:1441-1449. [PMID: 32985048 PMCID: PMC7756872 DOI: 10.1111/tmi.13496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective In many countries, housing is used for wealth accumulation and provides financial security in old age. We tested the hypothesis that household wealth, measured by housing quality and ownership of durable assets, would increase with age of the household head. Methods We conducted a survey of household heads in 68 villages surrounding Mtwara town, Tanzania and recorded relevant demographic, housing and social characteristics for each household. The primary analysis assessed the relationship between age of the household head, quality of the house structure and socio‐economic score (SES) using multivariate analysis. Principal Components Analysis (PCA) was used as a data reduction tool to estimate the social‐economic status of subjects based on relevant variables that are considered as proxy for SES. Results Of 13 250 household heads were surveyed of whom 49% were male. Those at least 50 years old were more likely to live in homes with an earth floor (86%) compared to younger household heads (80%; P < 0.0001), wattle and daub walls (94% vs. 90%; P < 0.0001) and corrugated iron roofs (56% vs. 52%; P < 0.0001). Wealth accumulation in the villages included in the study tends to be an inverted V‐relationship with age. Housing quality and SES rose to a peak by 50 years and then rapidly decreased. Households with a large number of members were more likely to have better housing than smaller households. Conclusions Housing plays a critical role in wealth accumulation and socio‐economic status of a household in rural villages in Tanzania. Households with a head under 50 years were more likely to live in improved housing and enjoyed a higher SES, than households with older heads. Larger families may provide protection against old age poverty in rural areas. Assuring financial security in old age, specifically robust and appropriate housing would have wide‐ranging benefits.
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Affiliation(s)
- Salum Mshamu
- CSK Research Solutions Ltd., Dar es Salaam, Tanzania
| | - Pimnara Peerawaranun
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | | | - Lucy Tusting
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Jakob Knudsen
- School of Architecture, The Royal Danish Academy of Fine Arts, Copenhagen, Denmark
| | - Mavuto Mukaka
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, UK
| | - Lorenz von Seidlein
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, UK
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23
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Celhay P, Martinez S, Vidal C. Measuring socioeconomic gaps in nutrition and early child development in Bolivia. Int J Equity Health 2020; 19:122. [PMID: 32690012 PMCID: PMC7370503 DOI: 10.1186/s12939-020-01197-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 05/19/2020] [Indexed: 12/05/2022] Open
Abstract
Background A large body of evidence shows that socioeconomic status (SES) is strongly associated to children’s early development, health and nutrition. Few studies have looked at within sample differences across multiple measures of child nutrition and development. This paper examines SES gaps in child nutritional status and development in Bolivia using a representative sample of children 0–59 months old and a rich set of outcomes, including micronutrient deficiencies, anthropometic measures, and gross motor and communicative development. Methods We construct direct and proxy measures of living standards based on household expenditures and on ownership of assets combined with access to services and dwelling characteristics. The data for this study come from a nationally representative household survey in Bolivia that contains information on health, nutrition, and child development tests. We used a regression framework to assess the adjusted associations between child development outcomes and socioeconomic status, after controlling for other demographic factors that might affect child’s development. The SES gap in child development was estimated by OLS. To explore when the development gaps between children in different socioeconomic groups start and how they change for children at different ages, we analyze the differences in outcomes between the poorest (Q1) and richest (Q5) quintiles by child’s age by estimating kernel weighted local polynomial regressions of standardized scores for all child development indicators. Results There are large and statistically significant differences in all anthropometrics z-scores between children in Q5 and children in Q1: height for age (0.95 SD), weight for age (0.70 SD), and weight for height (0.21 SD). When we divide the sample into children at the bottom and top consumption quintiles the results show that 68.6% of children in the poorest quintile are anemic. While this percentage falls to 40.9% for children in the richest quintile, it remains high compared to other countries in the region. The prevalence of vitamin A deficiency is 29.9% for children in the richest quintile and almost 10 percentage points higher for those at the bottom quintile (39.0%); the prevalence of Iron deficiency for children in the top and bottom quintiles is 16.4% and 23.8%, respectively. Compared to the most deprived quintile, children in the wealthiest quintile are less likely to have iron deficiency, anemia, to be stunted, and to have a risk of delays in gross motor and communicative development. At age three, most of these gaps have increased substantially. Our findings are robust to the choice of socioeconomic measurement and highlight the need for targeted policies to reduce developmental gaps. Conclusion These findings highlight the need for targeted public policies that invest in multiple dimensions of child development as early as possible, including health, nutrition and cognitive and verbal stimulation. From a policy perspective, the large socioeconomic gaps in nutrition outcomes documented here reinforce the need to strengthen efforts that tackle the multiple causes of malnutrition for the poorest.
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Affiliation(s)
- Pablo Celhay
- School of Government, Pontificia Universidad Católica de Chile and Millennium Nuclei for the Study of the Life Course and Vulnerability, Avda. Vicuña Mackenna 4860 - Macul, Santiago, Chile.
| | - Sebastian Martinez
- Inter-American Development Bank, 1300 New York Avenue, NW, Washington, DC, 20577, USA
| | - Cecilia Vidal
- Inter-American Development Bank, 1300 New York Avenue, NW, Washington, DC, 20577, USA
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24
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Munoz-Pizza DM, Villada-Canela M, Reyna MA, Texcalac-Sangrador JL, Osornio-Vargas ÁR. Air pollution and children’s respiratory health: a scoping review of socioeconomic status as an effect modifier. Int J Public Health 2020; 65:649-660. [DOI: 10.1007/s00038-020-01378-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 04/21/2020] [Accepted: 04/27/2020] [Indexed: 11/30/2022] Open
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Karlsson O, Kim R, Joe W, Subramanian S. The relationship of household assets and amenities with child health outcomes: An exploratory cross-sectional study in India 2015-2016. SSM Popul Health 2020; 10:100513. [PMID: 31799364 PMCID: PMC6881648 DOI: 10.1016/j.ssmph.2019.100513] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 11/02/2019] [Accepted: 11/03/2019] [Indexed: 11/29/2022] Open
Abstract
Healthy development of children in India is far from ensured. Proximate determinants of poor child health outcomes are infectious diseases and undernutrition, which are linked to socioeconomic status. In low- and middle-income countries, researchers rely on wealth indices, constructed from information on households' asset ownership and amenities, to study socioeconomic disparities in child health. Some of these wealth index items can, however, directly affect the proximate determinants of child health. This paper explores the independent association of each item used to construct the Demographic and Health Surveys' wealth index with diverse child health outcomes. This cross-sectional study used nationally representative sample of 245,866 children, age 0-59 months, from the Indian National Family Health Surveys conducted in 2015-16. The study used conditional Poisson regression models as well as a range of sensitivity specifications. After controlling for socioeconomic status, health care use, maternal factors, community-level factors, and all wealth index items, the following wealth index items were the most consistently associated with child health; type of toilet facilities, water source, refrigerator, pressure cooker, type of cooking fuel, land usable for agriculture, household building material, mobile phone, and motorcycle/scooter. The association with type of toilet facilities and water source was particularly strong for mortality, showing a 16-35% and 14-28% lower mortality, respectively. Most items used to construct the Demographic and Health Surveys' wealth index only indicate household socioeconomic status, while a few items may affect child health directly, and can be useful targets for policy intervention.
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Affiliation(s)
- Omar Karlsson
- Takemi Program in International Health, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, United States
- Centre for Economic Demography, Lund University, P.O. Box 7083, 220 07, Lund, Sweden
| | - Rockli Kim
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, 9 Bow Street, Cambridge, MA, 02138, United States
| | - William Joe
- Population Research Centre, Institute of Economic Growth, Delhi University North Campus, Delhi, 110007, India
| | - S.V. Subramanian
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, 9 Bow Street, Cambridge, MA, 02138, United States
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, United States
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Assessing Drinking Water Quality at the Point of Collection and within Household Storage Containers in the Hilly Rural Areas of Mid and Far-Western Nepal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072172. [PMID: 32218157 PMCID: PMC7178164 DOI: 10.3390/ijerph17072172] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/20/2020] [Accepted: 03/21/2020] [Indexed: 11/16/2022]
Abstract
Accurate assessments of drinking water quality, household hygenic practices, and the mindset of the consumers are critical for developing effective water intervention strategies. This paper presents a microbial quality assessment of 512 samples from household water storage containers and 167 samples from points of collection (POC) in remote rural communities in the hilly area of western Nepal. We found that 81% of the stored drinking water samples (mean log10 of all samples = 1.16 colony-forming units (CFU)/100 mL, standard deviation (SD) = 0.84) and 68% of the POC samples (mean log10 of all samples = 0.57 CFU/100 mL, SD = 0.86) had detectable E. coli. The quality of stored water was significantly correlated with the quality at the POC, with the majority (63%) of paired samples showing a deterioration in quality post-collection. Locally applied household water treatment (HWT) methods did not effectively improve microbial water quality. Among all household sanitary inspection questions, only the presence of livestock near the water storage container was significantly correlated with its microbial contamination. Households' perceptions of their drinking water quality were mostly influenced by the water's visual appearance, and these perceptions in general motivated their use of HWT. Improving water quality within the distribution network and promoting safer water handling practices are proposed to reduce the health risk due to consumption of contaminated water in this setting.
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Paul P. The distributive fairness of out-of-pocket healthcare expenditure in the Russian Federation. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2020; 20:13-40. [PMID: 31197528 PMCID: PMC7010690 DOI: 10.1007/s10754-019-09268-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 06/03/2019] [Indexed: 06/09/2023]
Abstract
This article examines the effects of socioeconomic position and urban-rural settlement on the distribution of out-of-pocket expenditure (OPE) for health in the Russian Federation. Data comes from 2005 to 2016 waves of the Russian Longitudinal Monitoring Survey. Concentration index reflects changes in the distribution of OPE between the worse-off and the better-off Russians over a 12-year period. Finally, unconditional quantile regression-a recentred influence function approach estimates differential impacts of covariates along the distribution of OPE. OPE is concentrated amongst the better-off Russians in 2016. Urban settlements contribute to top end OPE distribution for the richest and town settlements, at the median for the richest and the poorest. Our model for the analysis is unique in the context of study population, as it marginalises the effect over the distributions of other covariates used in the model.
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Affiliation(s)
- Pavitra Paul
- University of Eastern Finland, Kuopio, Finland.
- Aix-Marseille School of Economics, Aix-Marseille Université, Marseille, France.
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28
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Huda TMN, Schmidt WP, Pickering AJ, Unicomb L, Mahmud ZH, Luby SP, Biran A. Effect of Neighborhood Sanitation Coverage on Fecal Contamination of the Household Environment in Rural Bangladesh. Am J Trop Med Hyg 2020; 100:717-726. [PMID: 30675846 DOI: 10.4269/ajtmh.16-0996] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Enteric pathogens can be transmitted within the household and the surrounding neighborhood. The objective of this study was to understand the effect of neighborhood-level sanitation coverage on contamination of the household environment with levels of fecal indicator bacteria in rural Bangladesh. We conducted spot-check observations of sanitation facilities in neighboring households (NHs) within a 20-m radius of target households with children aged 6-24 months. Sanitation facilities were defined as improved (a private pit latrine with a slab or better) or unimproved. Fecal coliforms (FCs) on children's hands and sentinel toy balls were measured and used as indicators of household-level fecal contamination. We visited 1,784 NHs surrounding 428 target households. On average, sentinel toy balls had 2.11(standard deviation [SD] = 1.37) log10 colony-forming units (CFUs) of FCs/toy ball and children's hands had 2.23 (SD = 1.15) log10 CFU of FCs/two hands. Access to 100% private improved sanitation coverage in the neighborhood was associated with a small and statistically insignificant difference in contamination of sentinel toy balls (difference in means = -0.13 log10 CFU/toy ball; 95% confidence intervals [CI]: -0.64, 0.39; P = 0.63) and children's hands (difference in means = -0.11 log10 CFU/two hands; 95% CI: -0.53, 0.32; P = 0.62). Improved sanitation coverage in the neighborhood had limited measurable effect on FCs in the target household environment. Other factors such as access to improved sanitation in the household, absence of cow dung, presence of appropriate water drainage, and optimal handwashing practice may be more important in reducing FCs in the household environment.
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Affiliation(s)
- Tarique Md Nurul Huda
- icddr,b, Dhaka, Bangladesh.,London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | | | | | | | - Adam Biran
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Rizal MF, van Doorslaer E. Explaining the fall of socioeconomic inequality in childhood stunting in Indonesia. SSM Popul Health 2019; 9:100469. [PMID: 31485478 PMCID: PMC6715956 DOI: 10.1016/j.ssmph.2019.100469] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 08/11/2019] [Accepted: 08/14/2019] [Indexed: 11/27/2022] Open
Abstract
In spite of the enormous economic progress and development witnessed in Indonesia in the last few decades, still more than 30% of Indonesian children under the age of five suffer from stunting, or low height for age. This concern is exacerbated by the fact that stunting remains more concentrated among the poorer households, leading to further intergenerational transmission of poverty and ill health. We examine recent trends in the evolution of the prevalence of childhood stunting and severe stunting, its socioeconomic inequality and the factors that appear to have contributed to these developments. Using the two most recent waves of the Indonesia Family Life Survey (IFLS), we study the changes in the prevalence of (severe) stunting between 2007 and 2014 for children aged 0-59 months and their socioeconomic-inequality using the Erreygers Concentration Index (EI) and its regression-based decomposition. We find a significant drop in the rate of severe stunting but not in stunting, as well as a significant reduction in the degree of absolute inequality of stunting. A decomposition analysis shows that household wealth, maternal education, institutional delivery, and availability of adequate sanitation contribute most to socioeconomic inequality in under-five stunting. Further analysis of the change in inequality over time indicates that the reduction in the association of wealth with stunting and a substantial improvement of health care access of the poor (as proxied by immunizations and institutional deliveries) play the most important role in narrowing the stunting gap between richer and poorer kids. General economic growth, poverty reduction, and implementation of pro-poor health and social programs during the studied period such as the expansion of health insurance coverage for the poor (Jamkesmas) and Conditional Cash Transfer program (Program Keluarga Harapan, PKH) are some plausible explanations of the observed result.
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Affiliation(s)
- Muhammad Fikru Rizal
- Center for Health Financing Policy and Health Insurance Management, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Eddy van Doorslaer
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Department of Applied Economics, Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Hong SA, Winichagoon P, Khang YH. Rural–urban differences in socioeconomic inequality trends for double burden of malnutrition in Thailand 2005–2016. Eur J Clin Nutr 2019; 74:500-508. [DOI: 10.1038/s41430-019-0510-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 09/17/2019] [Accepted: 09/25/2019] [Indexed: 01/21/2023]
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Wang D. Reduction but not elimination: health inequalities among urban, migrant, and rural children in China-the moderating effect of the fathers' education level. BMC Public Health 2019; 19:1219. [PMID: 31484566 PMCID: PMC6724264 DOI: 10.1186/s12889-019-7522-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 08/21/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Given the urban-rural structure and the increase in rural-to-urban migration, three types of children have emerged in contemporary China: rural, urban, and migrant children. Health disparities among these types of children have caused widespread concern, being the main contributor to health inequalities among children in China. The purpose of this study was to investigate health disparities among these children and the mechanisms underlining them. METHODS This research applied multiple linear regression to data obtained from the Chinese Education Panel Survey (CEPS), a national representative survey of 7772 students from 2014 to 2015. Multiple linear regression with interactive terms was used to explore how gender and father's education moderate the degree of health inequalities among the children. 'Height for age Z-scores' (HAZ) was deployed as the indicator of the children's health status, with larger scores indicating better health status. RESULTS The findings of the current study were threefold: First, this study found significant health disparities among the three types of children. Urban children are generally the healthiest (M = 1.064), followed by migrant children, (M = 0.779) and rural children (M = 0.612). Second, fathers' education significantly compensates for the heath disparities among the children. Fathers' education has a larger effect in compensating a rural-migrant difference (b = - 0.018, P < 0.05) than a rural-urban difference (b = - 0.016, P < 0.1). Third, the compensating effect of the fathers' education varies by gender. The compensating effect is larger for boys (b = 0.028, P < 0.001) than for girls (b = 0.025, P < 0.01). CONCLUSIONS This study found significant health inequalities among urban, migrant, and rural children, which might be shaped by the distinction of urban-rural structure and the process of rural-to-urban migration in contemporary China. Fathers' education also plays an important role in narrowing-but not eliminating-the health inequality between urban and rural children. Furthermore, the compensating effect of fathers' education is higher for boys than for girls, reflecting the patriarchal tradition in China. The currents study suggests that to promote the healthy growth of children, it is necessary to consider the health inequalities among different types of children when developing health-related policies. Factors like family socioeconomic status and gender may likewise play an important role in the implementation of policies.
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Affiliation(s)
- Dianxi Wang
- Institute of Evidence Law and Forensic Science, China University of Political Science and Law, No. 25, Xitucheng Road, Haidian District, Beijing, Zip Code:100088, China.
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Victora C, Boerma T, Requejo J, Mesenburg MA, Joseph G, Costa JC, Vidaletti LP, Ferreira LZ, Hosseinpoor AR, Barros AJD. Analyses of inequalities in RMNCH: rising to the challenge of the SDGs. BMJ Glob Health 2019; 4:e001295. [PMID: 31297251 PMCID: PMC6590961 DOI: 10.1136/bmjgh-2018-001295] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/19/2019] [Accepted: 02/25/2019] [Indexed: 01/31/2023] Open
Abstract
The Sustainable Development Goal (SDG) 17.18 recommends efforts to increase the availability of data disaggregated by income, gender, age, race, ethnicity, migratory status, disability and geographic location in developing countries. Surveys will continue to be the leading data source for disaggregated data for most dimensions of inequality. We discuss potential advances in the disaggregation of data from national surveys, with a focus on the coverage of reproductive, maternal, newborn and child health indicators (RMNCH). Even though the Millennium Development Goals were focused on national-level progress, monitoring initiatives such as Countdown to 2015 reported on progress in RMNCH coverage according to wealth quintiles, sex of the child, women’s education and age, urban/rural residence and subnational geographic regions. We describe how the granularity of equity analyses may be increased by including additional stratification variables such as wealth deciles, estimated absolute income, ethnicity, migratory status and disability. We also provide examples of analyses of intersectionality between wealth and urban/rural residence (also known as double stratification), sex of the child and age of the woman. Based on these examples, we describe the advantages and limitations of stratified analyses of survey data, including sample size issues and lack of information on the necessary variables in some surveys. We conclude by recommending that, whenever possible, stratified analyses should go beyond the traditional breakdowns by wealth quintiles, sex and residence, to also incorporate the wider dimensions of inequality. Greater granularity of equity analyses will contribute to identify subgroups of women and children who are being left behind and monitor the impact of efforts to reduce inequalities in order to achieve the health SDGs.
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Affiliation(s)
- Cesar Victora
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.,International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Ties Boerma
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | | | - Gary Joseph
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Janaína Calu Costa
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Luis Paulo Vidaletti
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | | | - Ahmad Reza Hosseinpoor
- Partnership for Maternal, Newborn & Child Health, World Health Organization, Geneva, Switzerland
| | - Aluisio J D Barros
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
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Understanding the effect of socio-economic characteristics and psychosocial factors on household water treatment practices in rural Nepal using Bayesian Belief Networks. Int J Hyg Environ Health 2019; 222:847-855. [PMID: 31047815 DOI: 10.1016/j.ijheh.2019.04.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/14/2019] [Accepted: 04/15/2019] [Indexed: 11/24/2022]
Abstract
About 20 Million (73%) people in Nepal still do not have access to safely managed drinking water service and 22 million (79%) do not treat their drinking water before consumption. Few studies have addressed the combination of socio-economic characteristics and psychosocial factors that explain such behaviour in a probabilistic manner. In this paper we present a novel approach to assess the usage of household water treatment (HWT), using data from 451 households in mid and far-western rural Nepal. We developed a Bayesian belief network model that integrates socio-economic characteristics and five psychosocial factors. The socio-economic characteristics of households included presence of young children, having been exposed to HWT promotion in the past, level of education, type of water source used, access to technology and wealth level. The five psychosocial factors capture households' perceptions of incidence and severity of water-borne infections, attitudes towards the impact of poor water quality on health, water treatment norms and the knowledge level for performing HWT. We found that the adoption of technology was influenced by the psychosocial factors norms, followed by the knowledge level for operating the technology. Education, wealth level, and being exposed to the promotion of HWT were the most influential socio-economic characteristics. Interestingly, households who were connected to a piped water scheme have a higher probability of HWT adoption compared to other types of water sources. The scenario analysis revealed that interventions that only target single socio-economic characteristics do not effectively boost the probability of HWT practice. However, interventions addressing several socio-economic characteristics increase the probability of HWT adoption among the target groups.
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Najnin N, Leder K, Forbes A, Unicomb L, Winch PJ, Ram PK, Nizame FA, Arman S, Begum F, Biswas S, Cravioto A, Luby SP. Impact of a Large-Scale Handwashing Intervention on Reported Respiratory Illness: Findings from a Cluster-Randomized Controlled Trial. Am J Trop Med Hyg 2019; 100:742-749. [PMID: 30608050 PMCID: PMC6402932 DOI: 10.4269/ajtmh.18-0644] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 11/02/2018] [Indexed: 12/14/2022] Open
Abstract
We assessed the impact of handwashing promotion on reported respiratory illness as a secondary outcome from among > 60,000 low-income households enrolled in a cluster-randomized trial conducted in Bangladesh. Ninety geographic clusters were randomly allocated into three groups: cholera-vaccine-only; vaccine-plus-behavior-change (handwashing promotion and drinking water chlorination); and control. Data on respiratory illness (fever plus either cough or nasal congestion or breathing difficulty within previous 2 days) and intervention uptake (presence of soap and water at handwashing station) were collected through monthly surveys conducted among a different subset of randomly selected households during the intervention period. We determined respiratory illness prevalence across groups and used log-binomial regression to examine the association between respiratory illness and presence of soap and water in the handwashing station. Results were adjusted for age, gender, wealth, and cluster-randomized design. The vaccine-plus-behavior-change group had more handwashing stations with soap and water present than controls (45% versus 25%; P < 0.001). Reported respiratory illness prevalence was similar across groups (vaccine-plus-behavior-change versus control: 2.8% versus 2.9%; 95% confidence interval [CI]: -0.008, 0.006; P = 0.6; cholera-vaccine-only versus control: 3.0% versus 2.9%; 95% CI: -0.006, 0.009; P = 0.4). Irrespective of intervention assignment, respiratory illness was lower among people who had soap and water present in the handwashing station than among those who did not (risk ratioadjusted: 0.82; 95% CI: 0.69-0.98). With modest uptake of the handwashing intervention, we found no impact of this large-scale intervention on respiratory illness. However, those who actually had a handwashing station with soap and water had less illness. This suggests improving the effectiveness of handwashing promotion in achieving sustained behavior change could result in health benefits.
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Affiliation(s)
- Nusrat Najnin
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Karin Leder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Andrew Forbes
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Leanne Unicomb
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Peter J. Winch
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Fosiul A. Nizame
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shaila Arman
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Farzana Begum
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shwapon Biswas
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Department of Medicine, Rangpur Medical College Hospital, Rangpur, Bangladesh
| | - Alejandro Cravioto
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Facultad de Medicina, Universidad Nacional Autónoma de Mexico, Ciudad de Mexico, Mexico
| | - Stephen P. Luby
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Stanford University, Stanford, California
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Butame SA. The prevalence of modern contraceptive use and its associated socio-economic factors in Ghana: evidence from a demographic and health survey of Ghanaian men. Public Health 2019; 168:128-136. [PMID: 30769244 DOI: 10.1016/j.puhe.2018.12.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 11/06/2018] [Accepted: 12/21/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study estimated the prevalence of modern contraceptive use (MCU) and the sociodemographic factors associated with MCU among sexually active men in Ghana. The study is informed by the Health Belief Model, which is used as a conceptual framework for understanding MCU. STUDY DESIGN This was a cross-sectional study of 2014 Ghana Demographic and Health Survey data. METHODS Analysis was limited to 3373 men who reported being sexually active within the 24-months prior to the survey data collection. Descriptive statistics, Chi-squared test, and multivariable logistic regression analyses were used to estimate the prevalence of MCU and the associated factors affecting contraception use. RESULTS The sexually active men ranged in age from 15 to 59 years of whom 26.20% used modern contraceptives. Men who had discussed family planning with a health worker were more likely to use contraceptives compared with men who did not (adjusted odds ratio [AOR] = 1.54; 95% confidence interval [CI] = 1.14-2.08). Men who were undecided about having additional children were more likely to be using modern contraception compared with men who wanted more children (AOR = 1.85; 95% CI = 1.06-3.22). Men with at least a primary education were more likely to use contraception compared with men with no education (AOR = 1.80; 95% CI = 1.23-2.63). Finally, men with multiple sexual partners were more likely to use contraception compared with men with a single sexual partner (AOR = 1.42; 95% CI = 1.09-1.85). CONCLUSION There was a low prevalence of MCU among sexually active Ghanaian men. MCU was associated with factors such as education and age.
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Affiliation(s)
- S A Butame
- Florida State University, College of Medicine, Center for Translational and Behavioral Sciences, 115 W Call Street, Tallahassee, FL 32306, USA.
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Ponce de Leon RG, Ewerling F, Serruya SJ, Silveira MF, Sanhueza A, Moazzam A, Becerra-Posada F, Coll CVN, Hellwig F, Victora CG, Barros AJD. Contraceptive use in Latin America and the Caribbean with a focus on long-acting reversible contraceptives: prevalence and inequalities in 23 countries. Lancet Glob Health 2019; 7:e227-e235. [PMID: 30683240 PMCID: PMC6367565 DOI: 10.1016/s2214-109x(18)30481-9] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 09/16/2018] [Accepted: 10/16/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND The rise in contraceptive use has largely been driven by short-acting methods of contraception, despite the high effectiveness of long-acting reversible contraceptives. Several countries in Latin America and the Caribbean have made important progress increasing the use of modern contraceptives, but important inequalities remain. We assessed the prevalence and demand for modern contraceptive use in Latin America and the Caribbean with data from national health surveys. METHODS Our data sources included demographic and health surveys, multiple indicator cluster surveys, and reproductive health surveys carried out since 2004 in 23 countries of Latin America and the Caribbean. Analyses were based on sexually active women aged 15-49 years irrespective of marital status, except in Argentina and Brazil, where analyses were restricted to women who were married or in a union. We calculated contraceptive prevalence and demand for family planning satisfied. Contraceptive prevalence was defined as the percentage of sexually active women aged 15-49 years who (or whose partners) were using a contraceptive method at the time of the survey. Demand for family planning satisfied was defined as the proportion of women in need of contraception who were using a contraceptive method at the time of the survey. We separated survey data for modern contraceptive use by type of contraception used (long-acting, short-acting, or permanent). We also stratified survey data by wealth, area of residence, education, ethnicity, age, and a combination of wealth and area of residence. Wealth-related absolute and relative inequalities were estimated both for contraceptive prevalence and demand for family planning satisfied. FINDINGS We report on surveys from 23 countries in Latin America and the Caribbean, analysing a sample of 212 573 women. The lowest modern contraceptive prevalence was observed in Haiti (31·3%) and Bolivia (34·6%); inequalities were wide in Bolivia, but almost non-existent in Haiti. Brazil, Colombia, Costa Rica, Cuba, and Paraguay had over 70% of modern contraceptive prevalence with low absolute inequalities. Use of long-acting reversible contraceptives was below 10% in 17 of the 23 countries. Only Cuba, Colombia, Mexico, Ecuador, Paraguay, and Trinidad and Tobago had more than 10% of women adopting long-acting contraceptive methods. Mexico was the only country in which long-acting contraceptive methods were more frequently used than short-acting methods. Young women aged 15-17 years, indigenous women, those in lower wealth quintiles, those living in rural areas, and those without education showed particularly low use of long-acting reversible contraceptives. INTERPRETATION Long-acting reversible contraceptives are seldom used in Latin America and the Caribbean. Because of their high effectiveness, convenience, and ease of continuation, availability of long-acting reversible contraceptives should be expanded and their use promoted, including among young and nulliparous women. In addition to suitable family planning services, information and counselling should be provided to women on a personal basis. FUNDING Wellcome Trust, Pan American Health Organization.
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Affiliation(s)
- Rodolfo Gomez Ponce de Leon
- Latin American Center for Perinatology/Women's Health and Reproductive Health of the Pan American Health Organization (CLAP/WR-PAHO/WHO), Montevideo, Uruguay
| | - Fernanda Ewerling
- International Center for Equity in Health (ICEH), Federal University of Pelotas, Pelotas, RS, Brazil; Faculty of Medicine, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Suzanne Jacob Serruya
- Latin American Center for Perinatology/Women's Health and Reproductive Health of the Pan American Health Organization (CLAP/WR-PAHO/WHO), Montevideo, Uruguay
| | - Mariangela F Silveira
- Latin American Center for Perinatology/Women's Health and Reproductive Health of the Pan American Health Organization (CLAP/WR-PAHO/WHO), Montevideo, Uruguay; Faculty of Medicine, Federal University of Pelotas, Pelotas, RS, Brazil
| | | | - Ali Moazzam
- Department of Reproductive Health and Research (RHR), World Health Organization, Geneva, Switzerland
| | | | - Carolina V N Coll
- International Center for Equity in Health (ICEH), Federal University of Pelotas, Pelotas, RS, Brazil; Faculty of Medicine, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Franciele Hellwig
- International Center for Equity in Health (ICEH), Federal University of Pelotas, Pelotas, RS, Brazil; Faculty of Medicine, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Cesar G Victora
- International Center for Equity in Health (ICEH), Federal University of Pelotas, Pelotas, RS, Brazil; Faculty of Medicine, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Aluisio J D Barros
- International Center for Equity in Health (ICEH), Federal University of Pelotas, Pelotas, RS, Brazil; Faculty of Medicine, Federal University of Pelotas, Pelotas, RS, Brazil.
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Riumallo-Herl C, Canning D, Kabudula C. Health Inequalities in the South African elderly: The Importance of the Measure of Social-Economic Status. JOURNAL OF THE ECONOMICS OF AGEING 2019; 14:100191. [PMID: 31745451 PMCID: PMC6863518 DOI: 10.1016/j.jeoa.2019.01.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A common approach when studying inequalities in health is to use a wealth index based on household durable goods as a proxy for socio-economic status. We test this approach for elderly health using data from an aging survey in a rural area of South Africa and find much steeper gradients for health with consumption adjusted for household size than with the wealth index. These results highlight the importance of the measure of socioeconomic status used when measuring health gradients, and the need for direct measures of household consumption or income in ageing studies.
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Affiliation(s)
| | - David Canning
- Global Health and Population, Harvard T.H. Chan School of Public Health
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Kalembo FW, Kendall GE, Ali M, Chimwaza AF. Socio-demographic, clinical, and psychosocial factors associated with primary caregivers' decisions regarding HIV disclosure to their child aged between 6 and 12 years living with HIV in Malawi. PLoS One 2019; 14:e0210781. [PMID: 30645639 PMCID: PMC6333381 DOI: 10.1371/journal.pone.0210781] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 01/02/2019] [Indexed: 11/19/2022] Open
Abstract
The World Health Organisation (WHO) recommends that children living with HIV should be informed about their HIV status within the ages of 6 to 12 years using age-appropriate resources. The aim of this study was to assess the socio-demographic, clinical and psychosocial factors associated with primary caregivers’ decisions to disclose HIV to children living with HIV aged 6 to 12 years in Malawi. A cross-sectional study of 429 primary caregivers of children living with HIV were systematically recruited from all regions of the country. Information on HIV disclosure, family and child socio-demographic characteristics, child clinical characteristics, and child and family psychosocial characteristics was collected using validated instruments. Logistic regression was used to analyse data. The prevalence of non-disclosure of HIV status to children was 64 per cent. Concerns about the child’s inability to cope with the news (29%), a lack of knowledge on how to disclose HIV status (19%), and fear of stigma and discrimination (17%) were the main reasons for non-disclosure. On multivariate analysis, the odds of non-disclosure were higher among primary caregivers who were farmers (aOR 3.0; 95% CI: 1.1–8.4), in younger children (6–8 years) (aOR 4.1; 95% CI: 2.3–7.4), in children who were in WHO HIV clinical stage one (aOR 3.8; 95% CI: 1.4–10.2), and in children who were not asking why they were taking ARVs (aOR 2.9; 95% CI: 1.8–4.8). On the other hand, nondisclosure of HIV status was less likely in underweight children (aOR 0.6; 95% CI: 0.3–0.9). Many children living with HIV in Malawi are unaware of their HIV status. Non-disclosure is associated with a number of clinical and demographic characteristics. The findings highlight the need to provide guidance and support to primary caregivers to help them to effectively disclose HIV status to their children.
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Affiliation(s)
- Fatch Welcome Kalembo
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia
- Faculty of Health Sciences, Mzuzu University, Mzuzu, Malawi
- * E-mail:
| | - Garth E. Kendall
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia
| | - Mohammed Ali
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia
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Bhopal S, Roy R, Verma D, Kumar D, Avan B, Khan B, Gram L, Sharma K, Amenga-Etego S, Panchal SN, Soremekun S, Divan G, Kirkwood BR. Impact of adversity on early childhood growth & development in rural India: Findings from the early life stress sub-study of the SPRING cluster randomised controlled trial (SPRING-ELS). PLoS One 2019; 14:e0209122. [PMID: 30625145 PMCID: PMC6326522 DOI: 10.1371/journal.pone.0209122] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 11/29/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Early childhood development is key to achieving the Sustainable Development Goals and can be negatively influenced by many different adversities including violence in the home, neglect, abuse and parental ill-health. We set out to quantify the extent to which multiple adversities are associated with impaired early childhood growth & development. METHODS This was a substudy of the SPRING cluster randomised controlled trial covering the whole population of 120 villages of rural India. We assessed all children born from 18 June 2015 for adversities in the first year of life and summed these to make a total cumulative adversity score, and four subscale scores. We assessed the association of each of these with weight-for-age z-score, length-for-age z-score, and the motor, cognitive and language developmental scales of the Bayley Scales of Infant Development III assessed at 18 months. RESULTS We enrolled 1726 children soon after birth and assessed 1273 of these at both 12 and 18 months of age. There were consistent and strongly negative relationships between all measures of childhood adversity and all five child growth & development outcome measures at 18 months of age. For the Bayley motor scale, each additional adversity was associated with a 1.1 point decrease (95%CI -1.3, -0.9); for the cognitive scales this was 0.8 points (95%CI -1.0, -0.6); and for language this was 1.4 points (95%CI -1.9, -1.1). Similarly for growth, each additional adversity was associated with a -0.09 change in weight-for-age z-score (-0.11, -0.06) and -0.12 change in height-for-age z-score (-0.14, -0.09). DISCUSSION Our results are the first from a large population-based study in a low/middle-income country to show that each increase in adversity in multiple domains increases risk to child growth and development at a very early age. There is an urgent need to act to improve these outcomes for young children in LMICs and these findings suggest that Early Childhood programmes should prioritise early childhood adversity because of its impact on developmental inequities from the very start.
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Affiliation(s)
- Sunil Bhopal
- Maternal & Child Health Intervention Research Group, Department of Population Health, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Northern School of Paediatrics, Newcastle upon Tyne, United Kingdom
| | - Reetabrata Roy
- Maternal & Child Health Intervention Research Group, Department of Population Health, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Divya Kumar
- Maternal & Child Health Intervention Research Group, Department of Population Health, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Sangath, New Delhi, India
| | - Bilal Avan
- Maternal & Child Health Intervention Research Group, Department of Population Health, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Bushra Khan
- Department of Psychology, University of Karachi, Karachi, Pakistan
| | - Lu Gram
- Institute for Global Health, University College London, London, United Kingdom
| | | | | | | | - Seyi Soremekun
- Maternal & Child Health Intervention Research Group, Department of Population Health, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Betty R. Kirkwood
- Maternal & Child Health Intervention Research Group, Department of Population Health, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Munthali RJ, Manyema M, Said-Mohamed R, Kagura J, Tollman S, Kahn K, Gómez-Olivé FX, Micklesfield LK, Dunger D, Norris SA. Body composition and physical activity as mediators in the relationship between socioeconomic status and blood pressure in young South African women: a structural equation model analysis. BMJ Open 2018; 8:e023404. [PMID: 30573484 PMCID: PMC6303607 DOI: 10.1136/bmjopen-2018-023404] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 11/08/2018] [Accepted: 11/09/2018] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Varying hypertension prevalence across different socioeconomic strata within a population has been well reported. However, the causal factors and pathways across different settings are less clear, especially in sub-Saharan Africa. Therefore, this study aimed to compare blood pressure (BP) levels and investigate the extent to which socioeconomic status (SES) is associated with BP, in rural and urban South Africa women. SETTING Rural and urban South Africa. DESIGN Cross-sectional. PARTICIPANTS Cross-sectional data on SES, total moderate and vigorous physical activity (MVPA), anthropometric and BP were collected on rural (n=509) and urban (n=510) young black women (18-23 years age). Pregnant and mentally or physically disabled women were excluded from the study. RESULTS The prevalence of combined overweight and obesity (46.5% vs 38.8%) and elevated BP (27.0% vs 9.3%) was higher in urban than rural women, respectively. Results from the structural equation modelling showed significant direct positive effects of body mass index (BMI) on systolic BP (SBP) in rural, urban and pooled datasets. Negative direct effects of SES on SBP and positive total effects of SES on SBP were observed in the rural and pooled datasets, respectively. In rural young women, SES had direct positive effects on BMI and was negatively associated with MVPA in urban and pooled analyses. BMI mediated the positive total effects association between SES and SBP in pooled analyses (ß 0.46; 95% CI 0.15 to 0.76). CONCLUSIONS Though South Africa is undergoing nutritional and epidemiological transitions, the prevalence of elevated BP still varies between rural and urban young women. The association between SES and SBP varies considerably in economically diverse populations with BMI being the most significant mediator. There is a need to tailor prevention strategies to take into account optimising BMI when designing strategies to reduce future risk of hypertension in young women.
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Affiliation(s)
- Richard J Munthali
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mercy Manyema
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- DST-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Rihlat Said-Mohamed
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Juliana Kagura
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
- Umeå Centre for Global Health Research, Umeå, Sweden
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
- Umeå Centre for Global Health Research, Umeå, Sweden
| | - F Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lisa K Micklesfield
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - David Dunger
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Paediatrics, MRL Wellcome Trust-MRC Institute of Metabolic Science, NIHR Cambridge Comprehensive Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Shane A Norris
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Manu A, Ewerling F, Barros AJ, Victora CG. Association between availability of children's book and the literacy-numeracy skills of children aged 36 to 59 months: secondary analysis of the UNICEF Multiple-Indicator Cluster Surveys covering 35 countries. J Glob Health 2018; 9:010403. [PMID: 30410746 PMCID: PMC6204005 DOI: 10.7189/jogh.09.010403] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Stimulating home environments that have children's books, pictures and play toys facilitate caregiver-child interactions and enhance children's development. Although this has been demonstrated in small-scale intervention studies, it is important to document whether book ownership is beneficial at large scale in low and middle-income settings. Methods We conducted a secondary analysis using data from the multiple-indicator cluster survey, covering 100 012 children aged 36-59 months, from 35 countries. The outcome was children being on-track for a literacy-numeracy index (LNI) constructed from three questions assessing children's ability to identify/name at least 10 letters of the alphabet, read at least four simple popular words and know the names and symbols of all numbers from 1-10. The main exposure was availability of children's book to the child within household. Analysis considered the survey design, assessed and ranked risk ratios of being on track, adjusting for potential confounders such as child's age (in months), maternal education, household wealth index quintile and area of residence (rural/urban). Ecological analysis was performed using meta-regression after grouping countries by World Bank income groups (low- to high-income). Results Only half (51.8%) of children from all the countries analysed have at least one children's book at home and less than one-third (29.9%; 95% confidence interval (CI) = 23.5%, 36.3%) are on track for literacy-numeracy. After adjusting for confounders, the likelihood of being on track in literacy-numeracy almost doubled if at least one book was available at home compared to when there was none: RR = 1.89 (95% CI = 1.75, 2.03). There was an economic gradient showing that the likelihood of children being on track for LNI decreased with the country's income group: adjusted-RR ranged from 1.65 in upper middle income to 2.23 in LIC (F-test P-value <0.0001). Only three high-income countries were included, and children's books were universally available resulting in wide confidence intervals for the effect. Conclusions These findings are policy-relevant, as they corroborate the results from small scale experiments. Making children's book available to children is a cheap and feasible intervention that could change home dynamics to improve the future economic fortunes of children especially in the poorest countries.
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Affiliation(s)
- Alexander Manu
- London School of Hygiene & Tropical Medicine, London, UK.,Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Fernanda Ewerling
- International Centre for Equity in Health, University of Pelotas, Pelotas, Brazil
| | - Aluisio Jd Barros
- International Centre for Equity in Health, University of Pelotas, Pelotas, Brazil
| | - Cesar G Victora
- International Centre for Equity in Health, University of Pelotas, Pelotas, Brazil
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Wong KLM, Brady OJ, Campbell OMR, Benova L. Comparison of spatial interpolation methods to create high-resolution poverty maps for low- and middle-income countries. J R Soc Interface 2018; 15:20180252. [PMID: 30333244 PMCID: PMC6228471 DOI: 10.1098/rsif.2018.0252] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 09/17/2018] [Indexed: 11/12/2022] Open
Abstract
High-resolution poverty maps are important tools for promoting equitable and sustainable development. In settings without data at every location, we can use spatial interpolation (SI) to create such maps using sample-based surveys and additional covariates. In the model-based geostatistics (MBG) framework for SI, it is typically assumed that the similarity of two areas is inversely related to their distance between one another. Applications of spline interpolation take a contrasting approach that an area's absolute location and its characteristics are more important for prediction than distance to/characteristics of other locations. This study compares prediction accuracy of the MBG approach with spline interpolation as part of a generalized additive model (GAM) for four low- and middle-income countries. We also identify any potentially generalizable data characteristics influencing comparative accuracy. We found spatially scattered pockets of wealth in Malawi and Tanzania (corresponding to the major cities), and overarching spatial gradients in Kenya and Nigeria. Spline interpolation/GAM performed better than MBG for Malawi, Nigeria and Tanzania, but marginally worse in Kenya. We conclude that the spatial patterns of wealth and other covariates should be carefully accounted for when choosing the best SI approach. This is particularly pertinent as different methods capture geographical variation differently.
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Affiliation(s)
- Kerry L M Wong
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Oliver J Brady
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
- Centre for Mathematical Modelling for Infectious Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Oona M R Campbell
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Lenka Benova
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
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Raza O, Lodhi FS, Morasae EK, Majdzadeh R. Differential achievements in childhood immunization across geographical regions of Pakistan: analysis of wealth-related inequality. Int J Equity Health 2018; 17:122. [PMID: 30119670 PMCID: PMC6098575 DOI: 10.1186/s12939-018-0837-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 08/07/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Childhood immunization is one of the most cost-effective interventions for child health. Still, many children are not able to receive completed immunization status. Wealth - related inequality in immunization is considered a major reason for equitable coverage of immunization in Pakistan. Therefore, we examine wealth-related inequality in completed childhood immunization and to assess achievement indices across geographical regions in Pakistan. METHODS The analysis was based on a nationally representative demographic and health survey (DHS) of Pakistan, conducted in 2012-13. We examined completed childhood (12-23 months) immunization in the various regions of the country and we used concentration, extended concentration and achievement indices to demonstrate inequality across geographical regions in Pakistan. RESULTS Inequality in completed childhood immunization was seen in Pakistan with concentration index (CI) of 0.181 (95% CI: 0.164-0.209). Regions with high average of complete immunization showed lower inequality except for Sindh. Despite having better average immunization coverage in Kyber Pakhtunkhwa, the relative change of 128% in concentration index (CI) from C2 (standard CI) to C5 (when poorer quantile received highest weights) shows this to be also the most inequitable regions. Four parameters of inequality aversion (v = 2, 3, 4 & 5) demonstrated that 'dis - achievement' in completed immunization is densely concentrated among the poorer regions. Balochistan, Sindh and Gilgit Baltistan exhibited broader inequality gaps (93.75%, 83.35%, and 54.93%, respectively) at higher aversion parameter. CONCLUSIONS As hypothesized, achievement index uncovers 'penalized' immunization coverage amongst the poorest population. Thus any policy that stringently focuses on improving average immunization rate without any strategy to deal with inequality will only improve immunization rate within wealthier groups. Based on these results, it is advisable to public health policy makers to use both aspect of information: average and degree of inequality in immunization coverage.
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Affiliation(s)
- Owais Raza
- Department of Epidemiology and Biostatistics, School of Public Health, International campus, Tehran University of Medical Sciences, 5th Floor, Poursina Street, Keshavarz Boulevard, PO Box: 14155-6446, Tehran, Iran, Islamic Republic of.
| | - Fahad Saqib Lodhi
- Department of Epidemiology and Biostatistics, School of Public Health, International campus, Tehran University of Medical Sciences, 5th Floor, Poursina Street, Keshavarz Boulevard, PO Box: 14155-6446, Tehran, Iran, Islamic Republic of
| | | | - Reza Majdzadeh
- Department of Epidemiology and Biostatistics, School of Public Health, International campus, Tehran University of Medical Sciences, 5th Floor, Poursina Street, Keshavarz Boulevard, PO Box: 14155-6446, Tehran, Iran, Islamic Republic of.,Knowledge Utilization Research Center and Center for Community-Based Participatory-Research, Tehran, Iran
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de Jonge E, Azad K, Hossen M, Kuddus A, Manandhar DS, van de Poel E, Roy SS, Saville N, Sen A, Sikorski C, Tripathy P, Costello A, Houweling TAJ. Socioeconomic inequalities in newborn care during facility and home deliveries: a cross sectional analysis of data from demographic surveillance sites in rural Bangladesh, India and Nepal. Int J Equity Health 2018; 17:119. [PMID: 30111319 PMCID: PMC6094873 DOI: 10.1186/s12939-018-0834-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 08/01/2018] [Indexed: 11/19/2022] Open
Abstract
Background In Bangladesh, India and Nepal, neonatal outcomes of poor infants are considerably worse than those of better-off infants. Understanding how these inequalities vary by country and place of delivery (home or facility) will allow targeting of interventions to those who need them most. We describe socio-economic inequalities in newborn care in rural areas of Bangladesh, Nepal and India for all deliveries and by place of delivery. Methods We used data from surveillance sites in Bangladesh, India and from Makwanpur and Dhanusha districts in Nepal, covering periods from 2001 to 2011. We used literacy (ability to read a short text) as indicator of socioeconomic status. We developed a composite score of nine newborn care practices (score range 0–9 indicating infants received no newborn care to all nine newborn care practices). We modeled the effect of literacy and place of delivery on the newborn care score and on individual practices. Results In all study sites (60,078 deliveries in total), use of facility delivery was higher among literate mothers. In all sites, inequalities in newborn care were observed: the difference in new born care between literate and illiterate ranged 0.35–0.80. The effect of literacy on the newborn care score reduced after adjusting for place of delivery (range score difference literate-illiterate: 0.21–0.43). Conclusion Socioeconomic inequalities in facility care greatly contribute to inequalities in newborn care. Improving newborn care during home deliveries and improving access to facility care are a priority for addressing inequalities in newborn care and newborn mortality. Electronic supplementary material The online version of this article (10.1186/s12939-018-0834-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Erik de Jonge
- Department of Public Health, Erasmus University Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, the Netherlands.
| | - Kishwar Azad
- Perinatal Care Project, Diabetic Association of Bangladesh, 122 KaziNazrul Islam Avenue, Dhaka, 1000, Bangladesh
| | - Munir Hossen
- Perinatal Care Project, Diabetic Association of Bangladesh, 122 KaziNazrul Islam Avenue, Dhaka, 1000, Bangladesh
| | - Abdul Kuddus
- Perinatal Care Project, Diabetic Association of Bangladesh, 122 KaziNazrul Islam Avenue, Dhaka, 1000, Bangladesh
| | - Dharma S Manandhar
- Mother Infant Research Activities (MIRA), YB Bhavan, Thapathali, Kathmandu, 921, Nepal
| | - Ellen van de Poel
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Swati Sarbani Roy
- Ekjut, Plot 556B, Potka, Chakradharpur, West Singhbhum, Jharkhand, India
| | - Naomi Saville
- Institute for Global Health, University College London, London, UK
| | - Aman Sen
- Mother Infant Research Activities (MIRA), YB Bhavan, Thapathali, Kathmandu, 921, Nepal
| | | | - Prasanta Tripathy
- Ekjut, Plot 556B, Potka, Chakradharpur, West Singhbhum, Jharkhand, India
| | - Anthony Costello
- Institute for Global Health, University College London, London, UK
| | - Tanja A J Houweling
- Department of Public Health, Erasmus University Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, the Netherlands.,Institute for Global Health, University College London, London, UK
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Chasekwa B, Maluccio JA, Ntozini R, Moulton LH, Wu F, Smith LE, Matare CR, Stoltzfus RJ, Mbuya MNN, Tielsch JM, Martin SL, Jones AD, Humphrey JH, Fielding K. Measuring wealth in rural communities: Lessons from the Sanitation, Hygiene, Infant Nutrition Efficacy (SHINE) trial. PLoS One 2018; 13:e0199393. [PMID: 29953495 PMCID: PMC6023145 DOI: 10.1371/journal.pone.0199393] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 05/25/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Poverty and human capital development are inextricably linked and therefore research on human capital typically incorporates measures of economic well-being. In the context of randomized trials of health interventions, for example, such measures are used to: 1) assess baseline balance; 2) estimate covariate-adjusted analyses; and 3) conduct subgroup analyses. Many factors characterize economic well-being, however, and analysts often generate summary measures such as indices of household socio-economic status or wealth. In this paper, a household wealth index is developed and tested for participants in the cluster-randomized Sanitation, Hygiene, Infant Nutrition Efficacy (SHINE) trial in rural Zimbabwe. METHODS Building on the approach used in the Zimbabwe Demographic and Health Survey (ZDHS), we combined a set of housing characteristics, ownership of assets and agricultural resources into a wealth index using principal component analysis (PCA) on binary variables. The index was assessed for internal and external validity. Its sensitivity was examined considering an expanded set of variables and an alternative statistical approach of polychoric PCA. Correlation between indices was determined using the Spearman's rank correlation coefficient and agreement between quintiles using a linear weighted Kappa statistic. Using the 2015 ZDHS data, we constructed a separate index and applied the loadings resulting from that analysis to the SHINE study population, to compare the wealth distribution in the SHINE study with rural Zimbabwe. RESULTS The derived indices using the different methods were highly correlated (r>0.9), and the wealth quintiles derived from the different indices had substantial to near perfect agreement (linear weighted Kappa>0.7). The indices were strongly associated with a range of assets and other wealth measures, indicating both internal and external validity. Households in SHINE were modestly wealthier than the overall population of households in rural Zimbabwe. CONCLUSION The SHINE wealth index developed here is a valid and robust measure of wealth in the sample.
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Affiliation(s)
- Bernard Chasekwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - John A. Maluccio
- Department of Economics, Middlebury College, Middlebury, VT, United States of America
| | - Robert Ntozini
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Lawrence H. Moulton
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Fan Wu
- Department of Economics, Middlebury College, Middlebury, VT, United States of America
| | - Laura E. Smith
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, NY, United States of America
| | - Cynthia R. Matare
- Program in International Nutrition, Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States of America
| | - Rebecca J. Stoltzfus
- Program in International Nutrition, Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States of America
| | - Mduduzi N. N. Mbuya
- Global Alliance for Improved Nutrition (GAIN), Washington, DC, United States of America
| | - James M. Tielsch
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, United States of America
| | - Stephanie L. Martin
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC, United States of America
| | - Andrew D. Jones
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, United States of America
| | - Jean H. Humphrey
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Katherine Fielding
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Were V, Buff AM, Desai M, Kariuki S, Samuels A, Ter Kuile FO, Phillips-Howard PA, Patrick Kachur S, Niessen L. Socioeconomic health inequality in malaria indicators in rural western Kenya: evidence from a household malaria survey on burden and care-seeking behaviour. Malar J 2018; 17:166. [PMID: 29661245 PMCID: PMC5902919 DOI: 10.1186/s12936-018-2319-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 04/11/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Health inequality is a recognized barrier to achieving health-related development goals. Health-equality data are essential for evidence-based planning and assessing the effectiveness of initiatives to promote equity. Such data have been captured but have not always been analysed or used to manage programming. Health data were examined for microeconomic differences in malaria indices and associated malaria control initiatives in western Kenya. METHODS Data was analysed from a malaria cross-sectional survey conducted in July 2012 among 2719 people in 1063 households in Siaya County, Kenya. Demographic factors, history of fever, malaria parasitaemia, malaria medication usage, insecticide-treated net (ITN) use and expenditure on malaria medications were collected. A composite socioeconomic status score was created using multiple correspondence analyses (MCA) of household assets; households were classified into wealth quintiles and dichotomized into poorest (lowest 3 quintiles; 60%) or less-poor (highest 2 quintiles; 40%). Prevalence rates were calculated using generalized linear modelling. RESULTS Overall prevalence of malaria infection was 34.1%, with significantly higher prevalence in the poorest compared to less-poor households (37.5% versus 29.2%, adjusted prevalence ratio [aPR] 1.23; 95% CI = 1.08-1.41, p = 0.002). Care seeking (aPR = 0.95; 95% CI 0.87-1.04, p = 0.229), medication use (aPR = 0.94; 95% CI 0.87-1.00, p = 0.087) and ITN use (aPR = 0.96; 95% CI = 0.87-1.05, p = 0.397) were similar between households. Among all persons surveyed, 36.4% reported taking malaria medicines in the prior 2 weeks; 92% took artemether-lumefantrine, the recommended first-line malaria medication. In the poorest households, 4.9% used non-recommended medicines compared to 3.5% in less-poor (p = 0.332). Mean and standard deviation [SD] for expenditure on all malaria medications per person was US$0.38 [US$0.50]; the mean was US$0.35 [US$0.52] amongst the poorest households and US$0.40 [US$0.55] in less-poor households (p = 0.076). Expenditure on non-recommended malaria medicine was significantly higher in the poorest (mean US$1.36 [US$0.91]) compared to less-poor households (mean US$0.98 [US$0.80]; p = 0.039). CONCLUSIONS Inequalities in malaria infection and expenditures on potentially ineffective malaria medication between the poorest and less-poor households were evident in rural western Kenya. Findings highlight the benefits of using MCA to assess and monitor the health-equity impact of malaria prevention and control efforts at the microeconomic level.
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Affiliation(s)
- Vincent Were
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya. .,Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Ann M Buff
- Malaria Branch, Division of Parasitic Diseases and Malaria,Center for Global Health, Centers for Disease Control and Prevention, Atlanta, USA.,U.S. President's Malaria Initiative, Nairobi, Kenya
| | - Meghna Desai
- Malaria Branch, Division of Parasitic Diseases and Malaria,Center for Global Health, Centers for Disease Control and Prevention, Atlanta, USA
| | - Simon Kariuki
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Aaron Samuels
- Malaria Branch, Division of Parasitic Diseases and Malaria,Center for Global Health, Centers for Disease Control and Prevention, Atlanta, USA
| | | | | | - S Patrick Kachur
- Malaria Branch, Division of Parasitic Diseases and Malaria,Center for Global Health, Centers for Disease Control and Prevention, Atlanta, USA
| | - Louis Niessen
- Liverpool School of Tropical Medicine, Liverpool, UK
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Yates TA, Ayles H, Leacy FP, Schaap A, Boccia D, Beyers N, Godfrey-Faussett P, Floyd S. Socio-economic gradients in prevalent tuberculosis in Zambia and the Western Cape of South Africa. Trop Med Int Health 2018; 23:375-390. [PMID: 29432669 PMCID: PMC6022780 DOI: 10.1111/tmi.13038] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Objective To describe the associations between socio‐economic position and prevalent tuberculosis in the 2010 ZAMSTAR Tuberculosis Prevalence Survey, one of the first large tuberculosis prevalence surveys in Southern Africa in the HIV era. Methods The main analyses used data on 34 446 individuals in Zambia and 30 017 individuals in South Africa with evaluable tuberculosis culture results. Logistic regression was used to estimate adjusted odds ratios for prevalent TB by two measures of socio‐economic position: household wealth, derived from data on assets using principal components analysis, and individual educational attainment. Mediation analysis was used to evaluate potential mechanisms for the observed social gradients. Results The quartile with highest household wealth index in Zambia and South Africa had, respectively, 0.55 (95% CI 0.33–0.92) times and 0.70 (95% CI 0.54–0.93) times the adjusted odds of prevalent TB of the bottom quartile. College or university‐educated individuals in Zambia and South Africa had, respectively, 0.25 (95% CI 0.12–0.54) and 0.42 (95% CI 0.25–0.70) times the adjusted odds of prevalent TB of individuals who had received only primary education. We found little evidence that these associations were mediated via several key proximal risk factors for TB, including HIV status. Conclusion These data suggest that social determinants of TB remain important even in the context of generalised HIV epidemics.
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Affiliation(s)
- Tom A Yates
- Institute for Global Health, University College London, London, UK
| | - Helen Ayles
- ZAMBART, School of Medicine, University of Zambia, Lusaka, Zambia.,Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Finbarr P Leacy
- Data Science Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - A Schaap
- ZAMBART, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Delia Boccia
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Nulda Beyers
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Peter Godfrey-Faussett
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Sian Floyd
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Madziyire MG, Polis CB, Riley T, Sully EA, Owolabi O, Chipato T. Severity and management of postabortion complications among women in Zimbabwe, 2016: a cross-sectional study. BMJ Open 2018; 8:e019658. [PMID: 29440163 PMCID: PMC5829940 DOI: 10.1136/bmjopen-2017-019658] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Abortion complications cause significant morbidity and mortality. We aimed to assess the severity and factors associated with abortion complications (induced or spontaneous), and the management of postabortion care (PAC) in Zimbabwe. DESIGN Prospective, facility-based 28 day survey among women seeking PAC and their providers. SETTING 127 facilities in Zimbabwe with the capacity to provide PAC, including all central and provincial hospitals, and a sample of primary health centres (30%), district/general/mission hospitals (52%), private (77%) and non-governmental organisation (NGO) (68%) facilities. PARTICIPANTS 1002 women presenting with abortion complications during the study period. MAIN OUTCOME MEASURES Severity of abortion complications and associated factors, delays in care seeking, and clinical management of complications. RESULTS Overall, 59% of women had complications classified as mild, 19% as moderate, 19% as severe, 3% as near miss and 0.2% died. A median of 47 hours elapsed between experiencing complication and receiving treatment; many delays were due to a lack of finances. Women who were rural, younger, not in union, less educated, at later gestational ages or who had more children were significantly more likely to have higher severity complications. Most women were treated by doctors (91%). The main management procedure used was dilatation and curettage/dilatation and evacuation (75%), while 12% had manual vacuum aspiration (MVA) or electrical vacuum aspiration and 11% were managed with misoprostol. At discharge, providers reported that 43% of women received modern contraception. CONCLUSION Zimbabwean women experience considerable abortion-related morbidity, particularly young, rural or less educated women. Abortion-related morbidity and concomitant mortality could be reduced in Zimbabwe by liberalising the abortion law, providing PAC in primary health centres, and training nurses to use medical evacuation with misoprostol and MVA. Regular in-service training on PAC guidelines with follow-up audits are needed to ensure compliance and availability of equipment, supplies and trained staff.
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Affiliation(s)
- Mugove Gerald Madziyire
- Department of Obstetrics and Gynaecology, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | | | | | | | | | - Tsungai Chipato
- Department of Obstetrics and Gynaecology, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
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Huda TMN, Schmidt WP, Pickering AJ, Mahmud ZH, Islam MS, Rahman MS, Luby SP, Biran A. A Cross Sectional Study of the Association between Sanitation Type and Fecal Contamination of the Household Environment in Rural Bangladesh. Am J Trop Med Hyg 2018; 98:967-976. [PMID: 29436345 DOI: 10.4269/ajtmh.16-0724] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
We conducted a cross sectional study to assess 1) the association between access to basic sanitation and fecal contamination of sentinel toy balls and 2) if other sanitation factors such as shared use and cleanliness are associated with fecal contamination of sentinel toy balls. We assessed sanitation facilities in 454 households with a child aged 6-24 months in rural Bangladesh. We defined "basic" sanitation as access to improved sanitation facilities (pit latrine with a slab or better) not shared with other households. In each household, an identical toy ball was given to the target child. After 24 hours, the balls were rinsed to enumerate fecal coliforms as an indicator of household fecal contamination. Households with basic sanitation had lower fecal coliform contamination than households with no access to basic sanitation (adjusted difference in means: -0.31 log10 colony forming units [CFU]/toy ball; 95% confidence interval [CI]: -0.61, -0.01). Shared sanitation facilities of otherwise improved type were more likely to have visible feces on the latrine slab compared with private facilities. Among households with access to improved sanitation, households with no visible feces on the latrine slab had less toy ball contamination than households with visible feces on the latrine slab (adjusted difference in means: -0.38 log10 CFU/toy ball; 95% CI: -0.77, 0.02). Access to basic sanitation may prevent fecal contamination of the household environment. An Improved sanitation facility used by an individual household may be better in preventing household fecal contamination compared with improved facilities shared with other households.
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Affiliation(s)
- Tarique Md Nurul Huda
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.,London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | - Zahid Hayat Mahmud
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammad Sirajul Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Sajjadur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Adam Biran
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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50
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Tawiah T, Malam K, Kwarteng A, Bart-Plange C, Febir L, Aubyn V, Obermann K, Owusu-Agyei S, Asante KP. Improving the first-line treatment of febrile illnesses in Ghana: willingness to pay for malaria rapid diagnostic tests at licensed chemical shops in the Kintampo area. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2018; 16:4. [PMID: 29434526 PMCID: PMC5793370 DOI: 10.1186/s12962-018-0090-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 01/23/2018] [Indexed: 11/10/2022] Open
Abstract
Background Use of malaria rapid diagnostic test (mRDT) enhances patient management and reduces costs associated with the inappropriate use of antimalarials. Despite its proven clinical effectiveness, mRDT is not readily available at licensed chemical shops in Ghana. Therefore, in order to improve the use of mRDT, there is the need to understand the willingness to pay for and sell mRDT. This study assessed patients’ willingness to pay and licensed chemical operators’ (LCS) willingness to sell mRDTs. Methods The study was a cross-sectional survey conducted in Kintampo North Municipality and Kintampo South District of Ghana. Contingent valuation method using the dichotomous approach was applied to explore patient’s willingness to pay. In-depth interviews (IDIs) were used to obtain information from licensed chemical operators’ willingness to sell. Results Majority 161 (97%) of the customers were willing to pay for mRDT while 100% of licensed chemical operators were also willing to sell mRDT. The average lowest amount respondents were willing to pay was Ghana cedis (GH¢) 1.1 (US$ 0.26) and an average highest amount of GH¢ 2.1 (US$ 0.49). LCS operators were willing to sell the test kit at an average lowest price of GH¢1 (US$ 0.23) and average highest price of GH¢2 (US$ 0.47). Conclusion Community members were willing to pay for mRDT and LCS operators are willing to sell mRDTs. However, the high cost of the mRDT is likely to prevent the widespread use of mRDT. There is a clear need to find system-compatible ways to subsidize the use of mRDT via National Health Insurance scheme.
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Affiliation(s)
- Theresa Tawiah
- Kintampo Health Research Center, P. O Box 200, Kintampo, Ghana
| | - Keziah Malam
- 2National Malaria Control Programme, Ghana Health Service, Accra, Ghana
| | | | | | - Lawrence Febir
- Kintampo Health Research Center, P. O Box 200, Kintampo, Ghana
| | - Vivian Aubyn
- 2National Malaria Control Programme, Ghana Health Service, Accra, Ghana
| | - Konrad Obermann
- 3Mannheimer Institut of Public Health, Heidelberg University, Heidelberg, Germany
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