Mitigating wildfire smoke inside homes: Evidence from Oregon, September 2020

The smoke produced by wildfires can travel great distances and lead to respiratory and/or cardiovascular health impacts through inhalation. Individuals can reduce exposure by implementing smoke mitigation measures in their homes and beyond. In this article, we examine household level survey data (n = 543) on wildfire smoke mitigation in response to the September 2020 wildfires that occurred in the state of Oregon (and beyond). The air quality was hazardous for about 10 days in many affected regions. This study assessed the implementation of six commonly referenced approaches to reducing exposure to smoke: staying indoors; keeping doors and windows closed, turning on HVAC; using air purifiers; replacing air filters, and wearing face masks. We found high levels of implementation of staying indoors and keeping doors and windows closed; however, statistical analysis of socioeconomic demographics suggests that respondents vary in the implementation of the other measures. Income, number of exposure days, and access to information on smoke mitigation were positively associated with the implementation. Given the importance of information access for implementation for three of the measures, we also present data on how different age groups prefer to be contacted about air quality and smoke mitigation. For example, participants above 65 years of age prefer local TV as opposed to social media, whereas text messages were favored by all age groups. These survey results will help to inform the design of campaigns to engage community members differentially and potentially affect best communication practices and other assistance/preparation for smoke mitigation across demographics.

Too Little, Not Enough: Impact of Safety Nets on Food Security Among Households with Disabled Members in Nigeria

This study assessed the impact of safety nets on food insecurity in households with people with disabilities (PWD) in Nigeria. Using data from the 2019 Nigeria General Household Survey, we assessed the risk of experiencing food insecurity among households and the moderating role of safety nets using households without PWDs as a reference. PWD households were three times more likely to experience severe food insecurity compared to households without PWDs. The impact of the safety net program on the risk of food insecurity showed that receiving social benefits had little effect among households with disabled members experiencing severe food insecurity.

Transmission Patterns of Norovirus From Infected Children to Household Members in León, Nicaragua

Norovirus is a common and highly transmissible gastrointestinal pathogen. Among 34 Nicaraguan households with a norovirus-infected child, 48% experienced norovirus transmission within 1 week, infecting 18% of household members; GII norovirus was more commonly transmitted than GI. Pediatric norovirus vaccines could prevent both index cases and transmission to close contacts.

Factors that influence married/partnered women's decisions to use contraception in Zambia

According to the Demographic and Health Surveys (DHSs), Zambia has shown an increasing trend in the percentage of married women using contraceptives in the last three decades. As of 2018, this percentage increased from 34.2% in 2001 to 40.8% in 2007 and from 45% in 2013 to 48% in 2018. Despite the increasing trend in contraceptive use, the unmet needs remain relatively high. The low percentage of contraception use translates into 20% of women of reproductive age who are either married/partnered and want to stop or delay childbearing but are not using contraception. This study analyzed factors other than availability that influence women's ability to make or influence the decision to use contraception using logistic regression using data from the Zambia 2013/2014 and 2018 DHSs. Furthermore, adjusted odds ratios and predicted probabilities were estimated using the fitted logistic regression. Data on 8,335 women were analyzed, and 13.7% (n = 1,145) had their husband as the sole decision maker for contraception use, while 86.3% (n = 7,189) made the decisions or participated in making the decision. Contrary to most literature, those with primary or secondary school education were less likely to decide than those without education. The data also associate women who contribute to daily household decisions to having a say in deciding to use contraception. Lastly, women using reversible contraception methods, other methods, hormonal methods, and fertility awareness were associated with less likelihood to decide on using contraceptives than those using barrier methods. Women with lower household decision-making powers are less likely to make or influence decisions to use contraception. Consequently, there is a need to prioritize such women in interventions aimed at increasing contraception use decision-making. Furthermore, more studies are required to investigate why uneducated women in Zambia are more likely to choose contraception. Also, the vast odds ratio difference between all other methods compared to barrier methods (condoms) indicates underlying factors that play a role, which warrants further studies.

Double burden of malnutrition and associated factors among mother-child pairs at household level in Bahir Dar City, Northwest Ethiopia: community based cross-sectional study design

Introduction

The double burden of malnutrition refers to the simultaneous presence of under nutrition and overweight, obesity, or diet-related non-communicable diseases which might occur at the population, household, and individual level. The simultaneous presence of overweight/obese mothers with undernourished children in the same household, as well as overweight children with underweight mothers, holds particular significance. This phenomenon primarily impacts low-income and middle-income countries. The prevalence of double-burden malnutrition at the household level has increased significantly in sub-Saharan African countries. However, there is limited knowledge regarding the extent and factors associated with the double burden of malnutrition among mother-child pairs in Ethiopia. Consequently, the objective of this study was to assess the prevalence and determinants of the double burden of malnutrition among mother-child pairs at the household level in Bahir Dar City, Ethiopia.

Method

In the year 2021, a community-based cross-sectional study design was employed among 702 mother-child pairs in Bahir Dar City from February 28 to March 23. A multistage sampling technique was used to identify study participants who were interviewed using an interviewer-administered questionnaire. The nutritional status of children was evaluated using WHO Anthro Software. To determine the strength of the association, multivariable logistic regression analysis was performed, and adjusted odds ratios with their respective 95% confidence intervals were computed.

Results

The prevalence of the double burden of malnutrition among mother-child pairs was 14.5% (95% CI: 12.8, 15.7%}. Participants who were in the richest wealth index were 2.72 {AOR = 2.72, 95% CI 2.01, 5.63} times more odds of double burden of malnutrition than the poorest. The odds of the double burden of malnutrition among children who had high dietary diversity decreased by 63% {AOR = 0.37, 95% CI 0.22, 0.61} than low dietary diversity. Food secure households were 1.96 {AOR = 1.96, 95% CI 1.13, 3.39} times more likely to have the double burden of malnutrition than food insecure households. The odds of the double burden of malnutrition among mothers who completed college and above decreased by 74% {AOR = 0.26 95% CI 0.121, 0.549} than those unable to read and write.

Conclusions and recommendation

The magnitude of the double burden of malnutrition was lower than the Ethiopian Demographic and Health Survey. Wealth index, dietary diversity, food security, and educational status were significantly associated with the double burden of malnutrition. Therefore, it is recommended to implement public health interventions that target the identified associated factors in order to reduce the burden of double malnutrition.

Experiences of Stigmatization and Discrimination in Accessing Health Care Services Among People Living with HIV (PLHIV) in Akwa Ibom State, Nigeria

Background

Recent advances in care and treatment have turned HIV into a "chronic but manageable condition". Despite this, some people living with HIV (PLHIV) continue to suffer from stigma and discrimination in accessing health care services. This study examined the experience of stigma and discrimination and access to health care services among PLHIV in Akwa Ibom State.

Methods

The Center for Clinical Care and Clinical Research (CCCRN), implementing a USAID-funded Integrated Child Health and Social Services Award (ICHSSA 1) project, conducted a community-based cross-sectional survey in 12 randomly selected local government areas in Akwa Ibom State, Nigeria. A structured quantitative questionnaire was used for data collection. In total, 425 randomly selected PLHIV were interviewed after providing informed consent. Descriptive statistics and bivariate analyses were conducted using the data analytical application Stata 14.

Results

The study revealed that 215 PLHIV (50.4%) had been denied access to health care services, including dental care, because of their HIV status in Akwa Ibom State. Respondents reported being afraid of: gossip (78%), being verbally abused (17%), or being physically harassed or assaulted because of their positive status (13%). Self-stigmatization was also evident; respondents reported being ashamed because of their positive HIV status (29%), exhibiting self-guilt (16%), having low self-esteem (38%), and experiencing self-isolation (36%). Women, rural residents, PLHIV with no education, unemployed, single, young people aged between 19 and 29 years, and older adults were more likely to experience HIV-related stigmatization.

Conclusion

Data from the study revealed that the percentage of PLHIV who experience health-related stigmatization because of their HIV status is high in Akwa Ibom State. This finding calls for the prioritization of interventions to reduce stigma, enhance self-esteem, and promote empathy and compassion for PLHIV. It also highlights the need for HIV education for family and community members and health care providers, to enhance the knowledge of HIV and improve acceptance of PLHIV within families, communities, and health care settings.

Determinants of financial inclusion in households in Peru

The issue of financial inclusion considers access to and use of quality financial services by household members and different types of companies around the world, allowing us to reach the opportunities that the globalized world offers us. The objective of this research was to identify the socioeconomic factors that determined the inclusion of households in the financial system in Peru in the period of 2021. A quantitative approach was considered, which was non-experimental with a descriptive and correlational design and in which 81,441 pieces of data were obtained from the National Household Survey (ENAHO) of the National Institute of Statistics and Informatics, applying a logit binomial regression. It was determined that 47.02% of households were included in the financial system; 61.93% of those surveyed had their residence in the urban area; on average, respondents had incomplete secondary education; the age of the respondents on average was from 25 to 44 years; the average economic income of the household was less than $251 per month; 72.18% were represented by men as heads of the household and the rest by women; most of the respondents had a cohabiting marital status; the social conditions showed that 23.82% were in the group of being poor; and the majority of households did not have a property title. The determinants of financial inclusion in Peruvian households for 2021 were the area of residence, educational level, age of the respondent, economic income, gender of the respondent, marital status, social status, and property title.

A 30-year trend of dairy consumption and its determinants among income groups in Iranian households

Introduction

Milk and dairy products provide essential nutrients and have the potential to prevent chronic diseases, thus reducing healthcare costs. However, there is a lack of consistent and updated data on dairy consumption trends in Iran. This study aims to analyze the trends in dairy consumption among Iranian households from 1991 to 2021, focusing on household-level determinants across different expense groups.

Methods

The study uses data from the Iranian Household Expenditure and Income Survey conducted annually from 1991 to 2021 to analyze households' dairy consumption. The data includes values and expenses of food and non-food items purchased in the previous month, as well as demographic characteristics of household members. The households were categorized into 10 deciles based on their gross expense. The econometric model used weighted mean per capita milk, yogurt, cheese, and total dairy consumption based on milk equivalent for each decile. The model takes into account changes in income, prices, household composition, education level, occupation, and residency area using panel data. Data preparation and model estimation were performed using RStudio and STATA17 software.

Results

Based on the findings, in 1991, per capita milk, yogurt, and cheese consumption were 26.77 kg, 16.63 kg, and 2.42 kg, respectively. By 2021, these figures changed to 22.68 kg, 11.06 kg, and 3.79 kg, reflecting a decrease in milk and yogurt consumption but an increase in cheese consumption. Family size was positively correlated with yogurt consumption and head of the household spouse's job score were positively correlated with milk, yogurt and cheese consumption. Also, the presence of under five-year-old children and older adults members (over the age of 60) in the household was inversely related with yogurt and cheese consumption. Female-headed households tended to purchase more cheese, while their milk purchase level was significantly lower. Residing in urban areas was negatively related to milk, while cheese and total dairy consumption was higher in urban areas.

Discussion

The findings highlight the importance of targeted dairy subsidy interventions and educational programs to improve dairy consumption in Iranian households, especially among vulnerable groups. This will require urging policymakers and food system stakeholders for effective strategies that address macro-level factors to promote dairy consumption.

Understanding Households' Willingness to Pay for Improved Sanitation Services in Benin: A Study Protocol

Nowadays, in Benin, latrine construction by households highly depends on their financial contributions. However, empirical evidence shows that many households are unwilling to invest in adequate sanitation services. The study aims to determine the household's willingness to pay for improved sanitation services and the associated factors. The study population will include households lacking unimproved sanitation facilities. The household heads will be eligible for survey participation. We will perform a contingent valuation to determine households' willingness to pay for a Ventilated Improved Pit (VIP) latrine. Following a description of the surveyed population, we will assess willingness to pay using the 'doubleb' command in Stata. Subsequently, we will conduct multivariate logistic regression to determine the factors associated with willingness to pay. The expected results will be: a description of the basic characteristics of households without improved sanitation services, an estimation of household willingness to pay for VIP latrines using the contingent valuation, and factors associated with household willingness to pay for VIP latrines. This study will contribute to the literature on household demand for improved sanitation services in Benin.

The Influence of Household and Community Food Environments on Food Insecurity in Limpopo Province, South Africa

Insufficient access to enough quality food remains a public health challenge in South Africa. This study aimed to report the influence of community and the household environment, food system inventories, and food procurement on household food security. The findings alluded that food insecurity is prevalent among the rural areas in South Africa. Large household sizes and a limited access to and use of water and food storage facilities for food preservation are the major household determinants. A multi-sectoral nutrition-planning approach that accelerates the achievement of the Sustainable Development Goals should be reinforced. We recommend the promotion of food production for consumption in rural communities.

Food Insecurity and its Association with Dietary Diversity: A Cross-Sectional Study in Rural Households in Jammu

Background

Food insecurity is a matter of public health concern as it is associated with adverse health outcomes particularly among vulnerable population. Accessibility and availability of nutritious and culturally appropriate food is paramount to achieve zero hunger. To assess the prevalence of household food insecurity, to estimate the household dietary diversity and its association with household food insecurity.

Material and Methods

Using multistage sampling 381 rural households were surveyed. Household Food Insecurity Access Scale and House hold Dietary Diversity Scale were used as study instruments. Chi square test was used to compare the two groups and P < 0.05 was considered to be statistically significant.

Results

Prevalence of household insecurity was 33.3% (127) among the surveyed households and 8.1% (31) had severe food insecurity. The mean HFIS score was 6.85 ± 4.82. The household Dietary diversity score was 8.14 ± 1.54 for food secure and 6.51 ± 1.38 for severely food insecure households. There was a statistically significant difference in intake of milk and milk products, fruits, eggs and meat/poultry among food secure and insecure households (P < 0.001 respectively).

Conclusion

Food insecurity was high in rural households and was associated with lower dietary intake of foods from protein group, necessitating a need to reinforce the food security programmes in rural India with focus to enhance protein rich diet.

Impact of functional independence and sociodemographic factors on post-stroke discharge destination in a super-aged rural community in Japan

Objective: This study aimed to clarify the factors influencing the discharge destination of stroke patients in a super-aged rural community in Japan, focusing on functional independence and sociodemographic factors. Patients and Methods: We enrolled patients recovering from stroke with supratentorial lesions who were admitted to our convalescent rehabilitation hospital. The motor components of the Functional Independence Measure (FIM-motor) were assessed for each patient at admission and discharge as explanatory variables. An increase in the FIM-motor scores during hospitalization was also recorded. Additionally, sociodemographic data such as sex, age, and clinical characteristics, such as type of stroke, history of stroke, days from stroke onset to transfer to our convalescent rehabilitation hospital, total duration of hospital stay including acute care, number of co-resident household members, living with a spouse, and number of children were collected. As target values, discharge outcomes were categorized into two groups: returning home and going to a nursing home. Logistic regression analysis was performed. Results: The study sample comprised 160 patients (mean age ± standard deviation, 74.80 ± 12.19 years). Of these, 114 were discharged to their homes, and 46 were transferred to nursing homes. The results of multivariate logistic regression analysis indicated that higher FIM-motor scores at discharge, greater number of co-resident household members, and living with one's spouse were the most powerful predictors of a higher probability of returning home. Conclusion: This study demonstrated that functional independence levels and the number of co-resident household members were crucial factors in predicting the discharge destination of patients after stroke in a super-aged rural community in Japan. These findings imply that for older patients with lower functional independence, supportive social networks are essential for home discharge, offering clues for providing long-term healthcare in super-aged rural communities worldwide.

Acute Carbon Monoxide Poisoning in a Filipino Household: A Case Report

There are multiple reports already regarding acute carbon monoxide (CO) poisoning in the Philippines secondary to the misuse of portable generators, especially during times of typhoons. We present a case of unintentional carbon monoxide poisoning in a Filipino household wherein our index patient is among the five members who were unconscious before they were rushed to the hospital. Three of the household members, on the other hand, were found dead. The index patient had an increased serum fraction percentage of carboxyhemoglobin level and presented with rhabdomyolysis during admission. Neuroimaging confirmed a hypoxic-ischemic encephalopathy secondary to carbon monoxide intoxication. Even without hyperbaric oxygen therapy, the patient improved with adequate hydration, early rehabilitation, and trauma-focused psychotherapy.

Household Transmission of Viral Acute Gastroenteritis Among Participants Within an Integrated Health Care Delivery System, 2014-2016

Background

While enteric viruses are highly transmissible, household factors associated with transmission are less well documented. We identified individual- and household-level factors associated with viral acute gastroenteritis (AGE) transmission in a large health care network in the United States.

Methods

Patients presenting with AGE were enrolled from April 2014 to September 2016. Patients and symptomatic household members were interviewed, and stool specimens were collected and tested for viral pathogens. Within a household, primary cases were those with the earliest symptom onset and a positive viral test result; secondary cases were household contacts (HHCs) with symptom onset 1-7 days from the primary case onset. Transmission households had at least 1 secondary case.

Results

Our analysis included 570 primary cases with 1479 HHCs. The overall secondary attack rate was 23%. HHCs were likely to become secondary cases (n = 338) if they were <5 years old (adjusted odds ratio [aOR], 1.8; 95% CI, 1.2-2.6). Secondary transmission was likely to occur if the primary case was aged <5 years (aOR, 2.2; 95% CI, 1.4-3.6) or 5 to 17 years (aOR, 3.3; 95% CI, 1.9-5.7), was norovirus positive (aOR, 2.7; 95% CI, 1.9-3.7), had a diapered contact (aOR: 2.2, 95% CI: 1.6-3.2), or reported symptoms for >4 days (aOR, 1.5; 95% CI, 1.1-2.1). Households with ≥3 members (aOR, 2.1; 95% CI, 1.1-4.5) were more likely to experience transmission.

Discussion

Risk of AGE transmission within households increased if the primary case was younger, was norovirus positive, had a longer symptom duration, or had a diapered contact. Targeted prevention messaging around appropriate cleaning, disinfection, and isolation of persons with AGE should be encouraged.

Association between household and outdoor air pollution and risk for metabolic syndrome among women in Beijing, China

This study explored whether household and outdoor air pollution is associated with a greater risk for metabolic syndrome (MetS) among women. In all 11,860 women who cooked with clean energy were included in the analysis. Cooking frequency, range hood use during cooking, passive smoking exposure, and solid fuel use for heating were used to represent household air pollution. The 2-year average concentration of PM2.5, and face mask usage were used to reflect outdoor air pollution exposure. An index of air pollution exposure was also constructed. Multivariable logistic regression models were used to estimate the association between air pollution and risk for MetS, and a positive correlation was found. Our results indicated that household cooking used clean energy and exposure to a high level of outdoor PM2.5 without face mask usage may contribute to an increased risk for MetS among women.

Household Need and Unmet Need for Caregivers of Older Persons in Thailand

The need for caregivers is a crucial issue in Thailand. This research examined levels and trends of household needs and unmet needs for caregivers of older persons and explored potential factors associated with these needs. The analysis utilized data from the Survey of Older Persons in Thailand 2007, 2011, 2014, and 2017. The household need for a caregiver of older persons was defined as a household with one or more older people who needed a caregiver to help them perform basic activities of daily living. The unmet need for a caregiver referred to households where at least one older person in the household needed care but did not receive it. Findings illustrated the increasing levels and trends of household needs as well as unmet needs over time. In terms of potential determinants, older person households in Bangkok and households with higher socioeconomic status were more likely to be the household need for caregivers. In contrast, those households in the Northeastern, the poorest region, were more likely to be the unmet need household. These findings are indicative of the rising demand for long-term care services in Thailand. However, it is vital to consider unmet household needs, especially in the worse-off area, when designing national policies.

SARS-CoV-2 seroprevalence in French 9-year-old children and their parents after the first lockdown in 2020

Introduction

Children have been significantly less affected by COVID-19 than adults and presented with milder and less symptomatic forms of the disease. However, there has been suggestion that children older than 10 years and adolescents exhibits features closer to that of young adults. Most studies combine children in different age-groups and lack sufficient numbers to explore in detail age specificities. We report data on a population-based sample of 2,555 children at the pivotal age of 9 years.

Methods

In April 2020, the participants in two French nationwide cohorts of children, Elfe and Epipage2, were invited to take part into an online survey about Covid related symptoms and family life during the lockdown. A second questionnaire was sent on May 5. This questionnaire also proposed to the child included in the cohort and to one of his/her parents to take part into a capillary blood collection for Covid serology. Families who agreed to the serological survey were sent kits for dried blood spots self-sampling (DBS) with instructions. Samples were processed with a commercial Elisa test (Euroimmun®, Lübeck, Germany) to detect anti-SARS-CoV-2 antibodies (IgG) directed against the S1 domain of the spike protein of the virus.

Results

Children's acceptance rate for the serological survey was around 60%. 2,555 serological results were analyzed. The weighted prevalence of a positive Elisa Spike serology was 2.8% in 9 yr-old children (95% CI: 1.7%-4.0%). Positive serology was found in 8.6% (7.4%-9.7%) of parents who provided blood. There was a significant association (p < 0.001) between serology of the child and parent from the same household with an odds ratio of 13.8 (7.9-24.2).

Discussion

We have shown that 9-yr old children had a lower susceptibility to SARS-Cov2 infection than adults with the initial Chinese strain, similar to younger children and estimated that around 3% of them have developed antibodies against SARS-Cov2 in France after the first wave of the Covid-19 epidemics.

Assessment of malaria prevention knowledge, attitude, and practice and associated factors among households living in rural malaria-endemic areas in the Afar Pastoral Region of Ethiopia

Background

Malaria morbidity has reduced significantly in most regions of Ethiopia, but it is still a serious issue in the northeast, particularly in the Afar region.

Objective

The study aimed to evaluate household heads' knowledge, attitudes, and practices toward malaria prevention and its associated factors in rural Ada'ar woreda district in the Afar region.

Methods

A community-based cross-sectional study was conducted among 422 households living in Ada'ar woreda district. A systematic sampling technique was used to select households. A pre-tested, structured questionnaire was used to interview randomly selected adult household heads. Frequency and percentage were computed. Logistic regression was used to determine the association between independent and dependent variables. Statistical significance was considered to be a p-value <0.05.

Results

Nearly two-thirds (64.2%) of household heads had good knowledge of malaria prevention, and 46.9% had a positive attitude toward it. About 17.3 and 56.9% of study participants had good malaria prevention practices and good healthcare seeking behaviors, respectively. Illiterate (AOR = 2.62, 95% CI: 1.49-4.63) and low-income (AOR = 2.6, 95% CI: 1.2-5.6) participants were more likely to have poor knowledge of malaria prevention (malaria signs and symptoms, malaria transmissions, and malaria prevention methods). Married participants (AOR = 2.52, 95% CI: 1.02-6.29) and illiterates (AOR = 2.83, 95% CI: 1.69-4.73) had negative attitudes toward malaria prevention. Household heads with poor knowledge of malaria prevention had 85% higher rates of practicing poor malaria prevention methods (regular bed nets used; AOR = 1.85, 95% CI: 1.2-2.8). Young adults (18-25 years) were more likely to have poor healthcare seeking behaviors (AOR = 3.5, 95% CI: 1.73-7.1), while pastoralists had a lower likelihood (AOR = 0.46, 95% CI: 0.28-0.8).

Conclusion

Knowledge, attitude, and practices toward malaria prevention remain a problem in malaria-endemic rural areas of the Afar region of Ethiopia. There is a need for the implementation of interventions that will focus on increasing knowledge of malaria prevention and encouraging positive attitudes toward it, as well as promoting regular bed net usage and healthcare seeking behaviors.

"Whoever takes the dog gets the house": How older adults negotiate, budget, and deploy resources for multispecies family health and well-being

In this study, we interrogate the ways that older adult pet owners exercise their agency within the limits of their social statuses to allocate their resources for the management of the health needs of their multispecies families. Guided by fundamental cause theory, we consider how the participants' memberships in socially constructed categories can impact their experiences with household health management. We conducted focus groups with 30 community-dwelling older adults who owned pets. Using a thematic analytic approach, we found that the participants' bonds with their pets led them to negotiate priorities and make concessions for the benefit of the household.

Predicting food waste in households with children: socio-economic and food-related behavior factors

Introduction

The consumption phase accounts for approximately half of the food waste generated within the food system. Numerous studies have identified families with children as the primary contributors to food waste. The aims of this paper is to enhance the comprehension of food waste behaviors in households with children by characterizing it and studying how socioeconomic characteristics and food-related behaviors can predict it.

Methods

A survey was conducted among 806 families with children, categorized by the child's age and family structure. The study utilized descriptive statistics to summarize the food waste behaviors and binary regression to evaluate the predictive abilities of 12 variable related to the socio-economic characteristic, purchase, and preparation behaviors and diet quality factors.

Results

Perishable food items, such as fruits, vegetables, cereal-based product, and dairy products, were the primary items wasted in households with children. Two patterns of food waste were identified: inadequate food management leading to small amounts of waste in families with young and middle-aged children, and over-purchasing perishable items leading to waste in other households with children. Household type and purchasing habits were significant predictors, while the purchaser's age and buying channel showed lower predictive capacity.

Discussion

Policies to reduce food waste should prioritize raising awareness among children, promoting good practices at the household level, and creating favorable conditions during purchases. Strategies include enlisting children's participation in meal planning and food preparation as well as limiting the promotion of ultra-processed products and incentivizing the sale of bulk products at supermarket.

Inequalities in Consumption Expenditure on Pharmaceuticals: Evidence from Malaysia

Pharmaceuticals play an important role in health improvements. This study is the first of its kind to examine the influences of household heads' sociodemographic characteristics and household profiles on pharmaceuticals expenditure among households of different income levels. The country of interest is a fast-growing developing country. Data from the Malaysian Household Expenditure Surveys 2014 and 2016 were used in the pooled cross-sectional analyses. Double-hurdle models were used to analyze consumption and amount decisions of pharmaceuticals. Analyses stratified by income were conducted. Results showed that households headed by younger adults (<60 years), males, less educated individuals, Bumiputera, and divorced/widowed adults were less likely to consume and spent less on pharmaceuticals compared with households headed by older adults (≥60 years), females, more educated individuals, non-Bumiputera, and single adults. These differentials varied across income groups. In conclusion, household heads' age, gender, educational levels, ethnicity, marital status, and household profiles are important determining factors of expenditure on pharmaceuticals among low-, middle- and high-income households.

Corrigendum: Effects of household access to water, sanitation, and hygiene services on under-five mortality in Sub-Saharan Africa

[This corrects the article DOI: 10.3389/fpubh.2023.1136299.].

Impacts of climate change on household food security in Matande communal lands, Mwenezi district in Zimbabwe

Mwenezi district is a drought prone area characterised by high temperatures, droughts, rainfall deficit, crop failures and chronic food deficiencies. Rainfed agriculture can no longer be sustained without any innovations. The study explored the impacts of climate change on household food security among the vulnerable populations of Matande communal lands, Mwenezi district in Zimbabwe. The study is guided by the Sustainable Livelihoods Framework (SLF). An exploratory sequential research design was adopted, and a total of 78 respondents were selected from the population of 371 households using purposive and cluster sampling techniques. Data collection was triangulated through the use of household survey, focus group discussions, key informant interviews and observations. The thematic approach and SPSS software were used to analyse qualitative and quantitative data, respectively. Results demonstrated that climate change propelled increases of pests and diseases for both livestock and crops, reduction of meals uptake per day, biodiversity loss and dwindled crop production. Livestock increases were recorded despite the changing climate shows a nexus with food insecurity. The research called for the adoption of drought-tolerant crops, capacity building through climate change resilience programmes, livestock centric in diversification, improved formal markets for livestock and tapping of underground water for irrigation and other purposes to complement existing water bodies to prevent them drying up early.

Contribution

There is deepening aridification in Mwenezi district because of climate change resulting in the continuous obliteration for the worst of agro-ecological regions iv and v reclassified into a and b. This confirmed the heterogeneity of various climatic conditions and variability within the same geographical context. However, vulnerability continues to be generalised into regions. The study investigates the impacts of climate change typical to Matande communal lands with the view to generate knowledge relevant to review adaptation practices specific to the researched area in order to escalate community resilience.

The Impact of Long-Term Care Needs on the Socioeconomic Deprivation of Older People and Their Families: Results from Mixed-Methods Scoping Review

BACKGROUND

Long-term care (LTC), poverty, and socioeconomic deprivation are globally significant social issues. Ongoing population aging trends and the recent social and health emergencies caused by the COVID-19 pandemic crisis have highlighted the need for macro-level LTC and welfare system sustainability strategies.

AIMS

This scoping review (ScR) explores the relationship between LTC needs, the health status of older people, and the risk of socioeconomic deprivation for their households.

METHODS

The methodology considers different relevant sources: (a) the guidelines for ScR proposed by Lockwood et al.; (b) the recommendations of Munn et al.; (c) the PRISMA guideline for scoping reviews; and (d) the Joanna Briggs Institute (JBI) checklist. Sixty-three papers are included in the mixed-methods analysis.

RESULTS

The findings reveal the existence of a debate that seeks to understand the different characteristics of the relationship between the investigated issues. Relevant gaps in the literature are identified in terms of the concepts and approaches of the studies analyzed.

CONCLUSIONS

The results indicate that the reciprocal relationship between LTC needs, supply, and the risk of socioeconomic deprivation is understudied. Future studies should focus on the causal relationship between the two phenomena and identify any internal factors that may be involved.

Investigating the effectiveness of protection motivation theory in predicting behaviors relating to natural disasters, in the households of southern Iran

Background

Disasters can lead to large human casualties, destruction of property and economic and environmental resources. The purpose of the present study was to answer the question whether the Protection Motivation Theory (PMT) is effective in predicting behaviors related to the harmful effects of natural disasters in the households of southern Iran.

Materials and methods

This quantitative and cross-sectional study was conducted on 528 households in Jiroft city. Sampling was done by combined method (the combination of cluster, simple random, proportional and systematic random sampling). A total of 528 households were included. The tools for collecting data were demographic information and a researcher-made questionnaire related to PMT constructs and preventive behaviors from the harmful effects of natural disasters. Data was analyzed using SPSS v21 software, and the necessary analyzes (descriptive tests, chi-square, one-way ANOVA and Pearson's correlation test) were performed at a significance level of 0.05. Using Amos v 21 software, the predictors of safety behaviors were determined using path analysis.

Results

The results showed 51.7% lived in the city and 62.1% of residential buildings were of brick without markings. There is a significant difference between preventive behaviors and direct exposure to disasters (p < 0.001), education (p = 0.004), monthly income (p = 0.004) and source of information (p = 0.040). There was also a significant correlation between preventive behaviors and the number of vulnerable family members (p = 0.001, r = 0.160). The adjusted model of the path analysis test showed that protection motivation (β = 0.547), fear (β = 0.147) and perceived vulnerability (β = 0.135) had the greatest role among the constructs of the protection motivation theory.

Conclusion

According to the results of the study, it is suggested that health planners design and implement educational interventions based on the structures of the mentioned model to increase the preparedness of households against natural disasters.

Alcohol's harm to others in 2021: Who bears the burden?

BACKGROUND AND AIMS

Alcohol's harm to others (AHTO) has become a key driver of national and international alcohol policy. This study aimed to produce a contemporary, comprehensive estimate of the correlates and harms from others' drinking in 2021 in Australia.

DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS

Across Australia, 2574 adults (1380 women; 1172 men) were sampled via two cross-sectional survey modes: a random-digit dial mobile phone sample of 1000 people and 1574 people from the Life in Australia™ panel survey. In 2021 participants were asked about harms they had experienced from the drinking of family, friends, co-workers and the public in the past year. Applying combined sample weights from each mode, bivariable and adjusted multivariable logistic regressions were used to analyse differences in rates of AHTO by participant gender, age, residence in rural or metropolitan regions, country of birth, education and employment.

FINDINGS

In 2021, 23.6% reported being negatively affected by strangers' drinking and 21.3% by the drinking of someone they knew, with 34.3% reporting being negatively affected a lot or a little by either; 42.4% of respondents reported specific harms from strangers' drinking. Thus, 48.1% of respondents reported any harm (negative effects or specific harms) from others' drinking. Women, younger people, Australian-born and heavier episodic drinkers reported significantly higher rates of AHTO compared with other respondents. Smaller percentages (7.5%) of participants reported being harmed substantially by others' drinking, including by people they knew (5.8%) or strangers (2.3%). Stratified analyses showed that heavier drinking, furloughed, younger men who were born overseas in English-speaking countries were affected by others' drinking, whereas women were affected regardless of these factors (apart from age).

CONCLUSIONS

More than one-third of Australian adults appear to have been negatively affected by others' drinking in 2021, with women, younger people and heavier drinkers at greater risk. Substantial harm appears to be more likely to arise from the drinking of people Australians know than from strangers' drinking.

Serum iron levels in tuberculosis patients and household contacts and its association with natural resistance-associated macrophage protein 1 polymorphism and expression

BACKGROUND

Iron deficiency can impair immune function, increasing tuberculosis (TB) susceptibility and severity. The research aimed to investigate iron deficiency anemia in TB patients and household contacts and its association with natural resistance-associated macrophage protein 1 (NRAMP1) polymorphism and expression.

METHODS

The levels of iron, ferritin, and transferrin were measured in the serum by ELISA (Enzyme-Linked Immunosorbent Assay). NRAMP1 polymorphisms were determined by polymerase chain reaction (PCR) and sequencing. NRAMP1 gene expression was measured by real-time PCR. Interferon-gamma release assay (IGRA) checked on household contacts to screen household contacts with positive IGRA as the control.

RESULTS

This study involved 35 TB cases and 35 TB contacts. The results showed that the serum Fe levels were found to be lower in the TB case group (median 149.6 μmol/L) than in the positive IGRA household contacts group (median 628.53 μmol/L) with a p-value <0.001. Meanwhile, ferritin levels in TB cases tended to be higher, in contrast to transferrin, which was found to tend to be lower in TB cases than household contacts but did not show a significant difference. This study found no association between the polymorphism of exon 15 D543 and active TB. However, NRAMP1 gene expression was lower in TB cases than in positive IGRA household contacts (p = 0.011). Besides, there was a positive correlation between NRAMP1 gene expression and serum Fe levels (r = 0.367, p = 0.006). TB was associated with decreased NRAMP1 gene expression (OR 0.086 95% CI 0.02-0.366, p = 0.001). Besides, TB was associated with low Fe levels (OR 0.533 95% CI 0.453-0.629, p < 0.001).

CONCLUSION

Comparing the TB case to the household contacts group, decreased serum Fe levels were discovered in the TB case group. This study also shows a correlation of NRAMP1 gene expression to Fe levels in TB patients and household contacts and describes that TB may lead to decreased Fe levels by downregulating NRAMP1 expression.

Vaccine Effectiveness Against Severe Acute Respiratory Syndrome Coronavirus 2 Delta and Omicron Infection and Infectiousness Within Households in the Netherlands Between July 2021 and August 2022

BACKGROUND

We aimed to estimate vaccine effectiveness against infection (VE-infection) and against further transmission (VE-infectiousness) in a household setting during Delta and Omicron. Knowing these effects can aid policy makers in deciding which groups to prioritize for vaccination.

METHODS

Participants with a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test were asked about coronavirus disease 2019 (COVID-19) vaccination status and SARS-CoV-2 testing of their household members 1 month later. VE-infection and VE-infectiousness were estimated using generalized estimating equation logistic regression adjusting for age, vaccination status, calendar week, and household size.

RESULTS

A total of 3399 questionnaires concerning 4105 household members were included. During the Delta period, VE-infection and VE-infectiousness of primary series were 47% (95% confidence interval [CI], -27% to 78%) and 70% (95% CI, 28% to 87%), respectively. During the Omicron period, VE-infection was -36% (95% CI, -88% to 1%) for primary series and -28% (95% CI, -77% to 7%) for booster vaccination. VE-infectiousness was 45% (95% CI, -14% to 74%) for primary series and 64% (95% CI, 31% to 82%) for booster vaccination.

CONCLUSIONS

Our study shows that COVID-19 vaccination is effective against infection with SARS-CoV-2 Delta and against infectiousness of SARS-CoV-2 Delta and Omicron. Estimation of VE against infection with SARS-CoV-2 Omicron was limited by several factors. Our results support booster vaccination for those in close contact with vulnerable people to prevent transmission.

Associations among Food Systems, Food Environments, Food Choices, Food Security, and Nutrition Transition in Limpopo Province, South Africa: A Cross-Sectional Study

A cross-sectional study was applied to investigate the influence of food systems and food environments on food choices and nutrition transition of households in Limpopo province, South Africa. A sample of 429 households was systematically selected using a paper selection draw from three districts. This paper determines the association among food systems, food environments, food choices, and nutritional measurements of the respondents. A validated questionnaire was used. Most of the respondents responsible for food procurement were females (80.4%). There was a significant association (p < 0.001) between proximity to food stores and dietary diversity of the households. Staple foods such as bread, maize, rice, samp, and mealie rice were available in almost all surveyed households (95.6%). More than half of the households (59.8%) had home gardens in their yards. Almost half of the households (48.4%) had a low Dietary Diversity Score. The study further revealed that 46.0% of households were food secure. Over a third (36.2%) of the respondents were obese, and 32.5% were diabetic. The mean total blood cholesterol was 3.69 ± 0.74 mmol/L. A high percentage of both females (89.6%) and males (91.5%) had normal hemoglobin levels. Almost half of the respondents had normal systolic blood pressure levels (45.6%), and nearly a quarter had high diastolic levels (21.4%). The 25 coping strategies were applied during food shortage periods. Even though the food environments provided both obesogenic and protective foods, the consumption of unhealthy foods was high.

Attribution Analysis of Household Foodborne Disease Outbreaks in China, 2010-2020

Foodborne diseases have become a serious public health problem worldwide, and foodborne disease outbreaks have placed a heavy disease burden on China. Foodborne disease outbreaks occur most frequently among families in China. The objectives of this study were to analyze the cause of household foodborne disease outbreaks in China from 2010 to 2020 and to identify where preventive measures could be targeted. All data were obtained from the China Foodborne Disease Surveillance System Report. A total of 17,985 outbreaks, which resulted in 73,252 illnesses, 38,829 hospitalizations, and 1269 deaths, were reported in this period. Most household outbreaks of foodborne diseases occurred in May-October, and the highest number occurred in July (3620 outbreaks, 20%). The province with the highest number of outbreaks was Yunnan Province (4829 outbreaks), followed by Hunan Province (2264 outbreaks). The attribution analysis revealed that fungi (mainly poisonous mushrooms) were the most implicated food category, with 8873 (49.3%) cases. The second was poisonous plants and their products, with 1552 (8.6%) cases. Fungi were the primary etiologic agent, with 31,125 illnesses, accounting for 42.5% of the incidents. Inedibility and misuse (9423 outbreaks), unknown origin (2505 outbreaks), and improper processing (2365 outbreaks) were the main contributing factors causing outbreaks of foodborne diseases. The results show that southwest China was a high-risk area for household foodborne diseases. Therefore, public health institutions should strengthen supervision and food safety education of residents to reduce the outbreaks of household foodborne diseases.

Household Contact Tuberculosis Screening Adherence and Associated Factors Among Pulmonary Tuberculosis Patients on Follow-Up at Health Facilities in Shashamane Town, Southeast Ethiopia

Background

The greatest risk of getting tuberculosis (TB) infection is contact with patients who have pulmonary tuberculosis (PTB). The World Health Organization (WHO) strongly recommends tuberculosis screening for all household contacts of PTB patients. However, there is no information on household contact screening adherence among PTB patients in Shashamane town.

Methods

A facility-based mixed-method cross-sectional study was conducted from July 1 to November 30, 2021 among consecutively selected 392 PTB patients and 23 purposely selected key informants. Data were collected using a pre-tested interviewer administered questionnaire and leading questions. Data analysis was made using SPSS version 25 and in-depth interview information was analyzed based on thematic areas. Bivariable followed by multivariable logistic regression with 95% CI were conducted. P-value<0.05 was considered to identify statistically significant factors.

Results

The overall adherence to household contact screening (HHCS) was 44.4% (95% CI: 39.3, 49.1). Having under fifteen years of contact (AOR=2.386, 95% CI: 1.44, 3.96), diploma and above education status (AOR=3.43, 95% CI: 1.286, 9.15), good knowledge (AOR=2.999, 95% CI: 1.79, 5.03), favorable attitude (AOR=2.409, 95% CI: 1.45, 4.02), getting health education (AOR=3.287, 95% CI: 1.92, 5.63) and smear positive type of PTB (AOR=2.156, 95% CI: 1.28, 3.62) were factors significantly associated with HHCS adherence. Workload, facility readiness and care provide commitments were also identified from qualitative data.

Conclusion and Recommendation

HHCS adherence in our study was sub-optimal referenced to WHO and national recommendations that all household contact should be screened. Having age less than fifteen years contact, education status, knowledge, attitude, receiving health education and type of pulmonary tuberculosis were factors associated with adherence. We recommend increasing community awareness of TB, providing health education TB patients and their families, strengthening positive attitudes toward HHC screening and strengthening the commitment of health professionals to screen for HHCs.

Risk assessment and antibody responses to SARS-CoV-2 in healthcare workers

Background

Preventing infection in healthcare workers (HCWs) is crucial for protecting healthcare systems during the COVID-19 pandemic. Here, we investigated the seroepidemiology of SARS-CoV-2 in HCWs in Norway with low-transmission settings.

Methods

From March 2020, we recruited HCWs at four medical centres. We determined infection by SARS-CoV-2 RT-PCR and serological testing and evaluated the association between infection and exposure variables, comparing our findings with global data in a meta-analysis. Anti-spike IgG antibodies were measured after infection and/or vaccination in a longitudinal cohort until June 2021.

Results

We identified a prevalence of 10.5% (95% confidence interval, CI: 8.8-12.3) in 2020 and an incidence rate of 15.0 cases per 100 person-years (95% CI: 12.5-17.8) among 1,214 HCWs with 848 person-years of follow-up time. Following infection, HCWs (n = 63) mounted durable anti-spike IgG antibodies with a half-life of 4.3 months since their seropositivity. HCWs infected with SARS-CoV-2 in 2020 (n = 46) had higher anti-spike IgG titres than naive HCWs (n = 186) throughout the 5 months after vaccination with BNT162b2 and/or ChAdOx1-S COVID-19 vaccines in 2021. In a meta-analysis including 20 studies, the odds ratio (OR) for SARS-CoV-2 seropositivity was significantly higher with household contact (OR 12.6; 95% CI: 4.5-35.1) and occupational exposure (OR 2.2; 95% CI: 1.4-3.2).

Conclusion

We found high and modest risks of SARS-CoV-2 infection with household and occupational exposure, respectively, in HCWs, suggesting the need to strengthen infection prevention strategies within households and medical centres. Infection generated long-lasting antibodies in most HCWs; therefore, we support delaying COVID-19 vaccination in primed HCWs, prioritising the non-infected high-risk HCWs amid vaccine shortage.

Association of close-range contact patterns with SARS-CoV-2: a household transmission study

Background

Households are an important location for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission, especially during periods when travel and work was restricted to essential services. We aimed to assess the association of close-range contact patterns with SARS-CoV-2 transmission.

Methods

We deployed proximity sensors for two weeks to measure face-to-face interactions between household members after SARS-CoV-2 was identified in the household, in South Africa, 2020-2021. We calculated the duration, frequency, and average duration of close-range proximity events with SARS-CoV-2 index cases. We assessed the association of contact parameters with SARS-CoV-2 transmission using mixed effects logistic regression accounting for index and household member characteristics.

Results

We included 340 individuals (88 SARS-CoV-2 index cases and 252 household members). On multivariable analysis, factors associated with SARS-CoV-2 acquisition were index cases with minimum C_t value <30 (aOR 16.8 95% CI 3.1-93.1) vs >35, and female contacts (aOR 2.5 95% CI 1.3-5.0). No contact parameters were associated with acquisition (aOR 1.0-1.1) for any of the duration, frequency, cumulative time in contact, or average duration parameters.

Conclusions

We did not find an association between close-range proximity events and SARS-CoV-2 household transmission. Our findings may be due to study limitations, that droplet-mediated transmission during close-proximity contacts plays a smaller role than airborne transmission of SARS-CoV-2 in the household, or due to high contact rates in households.

Funding

Wellcome Trust (Grant number 221003/Z/20/Z) in collaboration with the Foreign, Commonwealth, and Development Office, United Kingdom.

A Scoping Review of Household Factors Contributing to Dietary Quality and Food Security in Low-Income Households with School-Age Children in the United States

Low-income and food-insecure households are at risk of poor dietary quality and even more severe food insecurity. Especially in childhood, consuming a nutritionally adequate diet is an essential driver of health, growth, and development. Household-level factors can present challenges to support the nutritional needs of low-income and food-insecure household members. The aim of this scoping review is to identify the contributing household factors to dietary quality and food security in US households of school-aged children 5 to 19 years and synthesize the evidence around emergent themes for application to future interventions. The scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols Extension for Scoping Reviews using search terms addressing food insecurity, low income, and dietary behaviors in the database PubMed. Screening by 3 independent reviewers of the title, abstract, and full study phases identified 44 studies. The 5 themes around which the studies grouped were: parental behaviors, child/adolescent behaviors, food procurement behaviors, food preparation behaviors, and household environment factors. Most studies were cross-sectional (n = 41, 93%) and focused on parental behaviors (n = 31, 70%), followed by food preparation and procurement behaviors. The themes identified were interrelated and suggest that incorporating education on parent and child behaviors that influence food procurement and preparation, along with strengthening organization and planning in the household environment, may hold promise to improve dietary quality and food security among food-insecure and low-income households. The findings can be used to inform future nutrition education interventions aimed at improving dietary quality and food security in households with school-aged children.

A Prospective Study of Key Correlates for Household Transmission of Severe Acute Respiratory Syndrome Coronavirus 2

Background

Randomized controlled trials evaluated monoclonal antibodies for the treatment (Study 2067) and prevention (Study 2069) of coronavirus disease 2019 (COVID-19). Household contacts of the infected index case in Study 2067 were enrolled in Study 2069 and prospectively followed; these cohorts provided a unique opportunity to evaluate correlates of transmission, specifically viral load.

Methods

This post hoc analysis was designed to identify and evaluate correlates of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission, adjusting for potential confounding factors related to source SARS-CoV-2 viral load and risk of SARS-CoV-2 acquisition in this population. Correlates of transmission were evaluated in potential transmission pairs (any infected household member plus susceptible household contact).

Results

In total, 943 participants were included. In multivariable regression, 2 potential correlates were determined to have a statistically significant (P < .05) association with transmission risk. A 10-fold increase in viral load was associated with a 40% increase in odds of transmission; sharing a bedroom with the index participant was associated with a 199% increase in odds of transmission.

Conclusions

In this prospective, post hoc analysis that controlled for confounders, the 2 key correlates for transmission of SARS-CoV-2 within a household are sharing a bedroom and increased viral load, consistent with increased exposure to the infected individual.

SARS-CoV-2 Variants and Age-Dependent Infection Rates among Household and Nonhousehold Contacts

To determine the effects of age and variants of concern on transmission of SARS-CoV-2, we analyzed infection rates among close contacts over 4 periods in Toyama Prefecture, Japan. Among household contacts, odds of infection were 6.2 times higher during the period of the Omicron variant than during previous periods, particularly among children and adolescents.

Baseline Seroprevalence of SARS-CoV-2 Specific Antibodies in Hot Spot Areas of Great Tunis, up to 3 Months Post Disease Onset in Tunisia

The extent of the SARS-CoV-2 circulation and the COVID-19 epidemic in Tunisia three months after virus circulation was unknown. The aim of this study was to determine the extent of SARS-CoV-2 infection among household contacts of confirmed COVID-19 cases living in Hot spot areas of Great Tunis, Tunisia by estimating the seroprevalence of antibodies anti SARS-CoV-2 and to identify factors associated to seroprevalence at the first stage of the pandemic in order to guide decision making and to constitute a baseline for further longitudinal analysis of protective immunity to SARS-CoV-2. The National Observatory of New and Emerging Diseases (ONMNE), Ministry of Health Tunisia (MoH), with the support of the Office of the World Health Organization Representative in Tunisia and the WHO Regional Office for the Eastern Mediterranean (EMRO)), conducted a household cross-sectional survey on April 2020 in Great Tunis (Tunis, Ariana, Manouba and Ben Arous). The study was based on the WHO seroepidemiological investigation protocol for SARS-CoV-2 infection. SARS-CoV-2 specific antibodies (IgG and IgM) were qualitatively detected using a lateral immunoassay that detect SARS-CoV-2 nucleocapsid protein and administered by the interviewers. The included subjects were confirmed COVID-19 cases and their households contacts resided in hot spot areas (cumulative incidence rate ≥ 10 cases/100,000 inhabitants) of Great Tunis. Results: In total, 1165 subjects were enrolled: 116 confirmed COVID-19 cases (43 active cases and 73 convalescents cases) and 1049 household contacts resided in 291 households. The median age of participants was 39.0 with 31 years' interquartile range (Min = 8 months; Max = 96 years). The sex ratio (M/F) was 0.98. Twenty-nine per cent of participants resided in Tunis. The global crude seroprevalence among household contacts was 2.5% (26/1049); 95% CI 1.6-3.6%, 4.8%; 95% CI 2.3-8.7% in Ariana governorate and 0.3%; 95% CI 0.01%-1.8% in Manouba governorate. In multivariate analysis, the associated factors independently related to seroprevalence were age ≥25 years (aOR = 5.1; 95% CI 1.2-22.0), history of travel outside Tunisia since January 2020 (aOR = 4.6; 95% CI 1.7-12.9), symptomatic illness in the previous four months (aOR = 3.5; 95% CI 1.4-9.0) and governorate of residence (p = 0.02). The low seroprevalence estimated among household contacts in Great Tunis reflect the effect of public health measures early taken (national lockdown, borders closed, remote work), the respect of non-pharmaceutical interventions and the efficacy of COVID-19 contact-tracing and case management at the first stage of the pandemic in Tunisia.

Chinese culture became more individualistic: Evidence from family structure, 1953-2017

Previous research has indicated that some aspects of Chinese culture became more individualistic. However, prior studies have suggested a decrease in individualism in other aspects of China. Thus, it was unclear whether China became more individualistic. Therefore, the current research investigated whether Chinese culture became more individualistic by examining historical changes in family structure. Specifically, I analyzed temporal shifts in the divorce rate and household size, which have been confirmed as valid representative indicators of individualism. Results showed that the divorce rate increased between 1978 and 2017 and household size decreased between 1953 and 2017, indicating a rise in individualism. Moreover, analyses suggested that the one-child policy was unlikely the sole and major factor in the decrease in household size. Additionally, the aggregated score of divorce rate and household size demonstrated a clear increase in individualism. Therefore, the present research provided further evidence of the rise in individualism in China.

The long-term impact of HIV/AIDS on socio-economic status: a comparative analysis of households headed by HIV-positive and HIV-negative individuals in Western Kenya

HIV/AIDS is known to have adverse effects on individual and family socio-economic status due to the loss of productive time and over-expenditure in treatment. However, empirical data on how HIV/AIDS affects households' socio-economic status are insufficient. We linked socio-economic data from a Health and Demographic Surveillance System (HDSS) that implements an HIV/AIDS Longitudinal bio-behavioural survey (LBBS) to understand the long-term impact of HIV/AIDS on households' socio-economic status between 2010 and 2018. We compared changes in socio-economic status between households headed by HIV-negative and -positive individuals. A logistic regression was used to assess factors that influence socio-economic status. The level of education and household size were not significant predictors of households' socio-economic status. Households headed by HIV-positive individuals could maintain their baseline socio-economic status (unadjusted RRR = 1.17, 95% CI: 1.01, 1.36) but improvement chances were reduced despite a non-significant association (unadjusted RRR = 0.98, 95% CI: 0.80, 1.20). While HIV/AIDS is known to disrupt economic growth, in this setting, being a male household head, old and widowed reduces chances of improved socio-economic status. The elderly people, widows and widowers are disadvantaged. Consequently, there is a need for special programmes, which seek to empower the identified vulnerable groups economically. .

Effects of household access to water, sanitation, and hygiene services on under-five mortality in Sub-Saharan Africa

Introduction

Sub-Saharan Africa has the highest under-five mortality rate and is among the regions where people have the least access to adequate Water, Sanitation, and Hygiene (WASH) services. The work aimed to investigate the effects of WASH conditions faced by children on under-five mortality in Sub-Saharan Africa.

Methods

We carried out secondary analyses using the Demographic and Health Survey datasets of 30 countries in Sub-Saharan Africa. The study population consisted of children born within 5 years preceding the selected surveys. The dependent variable was the child's status (1 = deceased versus 0 = alive) on the survey day. The individual WASH conditions in which children live were assessed in their immediate environment, i.e., at the level of their households of residence. The other explanatory variables were related to the child, mother, household, and environment. Following a description of the study variables, we identified the predictors of under-five mortality using a mixed logistic regression.

Results

The analyses involved 303,985 children. Overall, 6.36% (95% CI = 6.24-6.49) of children died before their fifth birthday. The percentage of children living in households with access to individual basic WASH services was 58.15% (95% CI = 57.51-58.78), 28.18% (95% CI = 27.74-28.63), and 17.06% (95% CI = 16.71-17.41), respectively. Children living in households using unimproved water facilities (aOR = 1.10; 95% CI = 1.04-1.16) or surface water (aOR = 1.11; 95% CI = 1.03-1.20) were more likely to die before five than those coming from households with basic water facilities. The risk of under-five mortality was 11% higher for children living in households with limited sanitation facilities (aOR = 1.11; 95% CI = 1.04-1.18) than for those with basic sanitation services. We found no evidence to support a relationship between household access to hygiene services and under-five mortality.

Conclusion

Interventions to reduce under-five mortality should focus on strengthening access to basic water and sanitation services. Further studies are needed to investigate the contribution of access to basic hygiene services on under-five mortality.

Household heads satisfaction and associated factors on community-based health insurance scheme in Gudeya Bila District, Oromia, Ethiopia

Background

Community-Based Health Insurance (CBHI) scheme refers to a non-profit type of health insurance for the informal sector. There is a paucity of information on this topic in Gudeya Bila, Ethiopia. This study aimed to assess the level of household (HH) satisfaction with the CBHI scheme and its associated factors.

Method

A community-based cross-sectional study design was employed from November 1-30, 2020, and a sample of 630 HHs who enrolled in the CBHI scheme were included. A multi-stage sampling and systematic random sampling were employed. Data was entered into Epidata version 3.1 and analyzed using SPSS for windows program version 25. A 95% CI was calculated and variables having p-value < 0.05 were considered statistically significant. Descriptive statistics, bivariate, and multivariable logistic regression analyses were performed.

Result

All HHs heads (630) with a response rate of 100% were involved in the study. The overall HH satisfaction on CBHI was 56.2%. Attending CBHI scheme-related meetings (AOR = 1.948, 95% CI = 1.16-3.27), healthcare provider respectfulness (AOR = 9.209, 95% CI = 2.73-31.06), able to get the ordered laboratory test service (AOR = 2.143, 95% CI = 1.127-4.072) and having paid extra money for drug supply at private health facilities (AOR = 0.492, 95% CI = 0.285-0.847) were independent predictors.

Conclusion

HH satisfaction level on CBHI scheme was moderate. Attending CBHI scheme-related meetings, health-care provider respectfulness, being able to get the ordered laboratory test services and extra payments for drug supply were significant predictors of satisfaction with CBHI. Therefore, attention should be given to increasing the satisfaction of HHs with CBHI through improving the quality of health services.

Household secondary attack rate in mild COVID-19

Background

The coronavirus disease 2019 (COVID-19) pandemic has reached a staggering number of almost 280 million cases worldwide, with over 5.4 million deaths as of 29 December 2021. A further understanding of the factors related to the household spread of the infection might help to bring about specific protocols to curb such transmission.

Objective

This study aims to find the secondary attack rate (SAR) and factors affecting SAR among the households of mild COVID-19 cases.

Methods

An observational study was designed where data of patients admitted at All India Institute of Medical Sciences, New Delhi due to mild COVID-19 were collected, and outcome was noted after the discharge of the patient. Index cases who were the first in the household to have a positive infection only were included. Based on these data, the overall household SAR, factors related to the index case and contacts that affected transmissibility were noted.

Results

A total of 60 index cases having contacts with 184 household members were included in the present study. The household SAR was measured to be 41.85%. At least one positive case was present in 51.67% households. Children below 18 years old had lower odds of getting a secondary infection compared to adults and elderly [odds ratio (OR) = 0.46, 95%CI = 0.22-0.94, p = 0.0383). An exposure period of more than a week was significantly associated with a higher risk of infection (p = 0.029). The rate of transmissibility drastically declined with effective quarantine measures adopted by the index case (OR = 0.13, 95%CI = 0.06-0.26, p < 0.00001). Symptomatic index cases contributed more to the SAR than asymptomatic primaries (OR = 4.74, 95%CI = 1.03-21.82, P = 0.045). Healthcare worker index cases had lower rates of spread (OR = 0.29, 95%CI = 0.15-0.58, P = 0.0003).

Conclusion

The high SAR shows the household is a potential high-risk unit for transmissibility of COVID-19. Proper quarantine measures of all those exposed to the index case can mitigate such spread and lead to reduction of risk of COVID-19 within a household.

Prevalence and Correlates of Stunting among Children Aged 6-23 Months from Poor Households in Rwanda

Stunted linear growth continues to be a public health problem that overwhelms the entire world and, particularly, developing countries. Despite several interventions designed and implemented to reduce stunting, the rate of 33.1% is still high for the proposed target of 19% in 2024. This study investigated the prevalence and associated factors of stunting among children aged 6-23 months from poor households in Rwanda. A cross-sectional study was conducted among 817 mother-child dyads (two individuals from one home) living in low-income families in five districts with a high prevalence of stunting. Descriptive statistics were used to determine the prevalence of stunting. In addition, we used bivariate analysis and a multivariate logistic regression model to measure the strength of the association between childhood stunting and exposure variables. The prevalence of stunting was 34.1%. Children from households without a vegetable garden (AOR = 2.165, p-value < 0.01), children aged 19-23 months (AOR = 4.410, p-value = 0.01), and children aged 13-18 months (AOR = 2.788, p-value = 0.08) showed increased likelihood of stunting. On the other hand, children whose mothers were not exposed to physical violence (AOR = 0.145, p-value < 0.001), those whose fathers were working (AOR = 0.036, p-value = 0.001), those whose parents were both working (AOR = 0.208, p-value = 0.029), and children whose mothers demonstrated good hand washing practice (AOR = 0.181, p-value < 0.001) were less likely to be stunted. Our findings underscore the importance of integrating the promotion of handwashing practices, owning vegetable gardens, and intimate partner violence prevention in the interventions to fight child stunting.

Jordan's Population-Based Food Consumption Survey: Protocol for Design and Development

BACKGROUND

One of the factors influencing health and well-being is dietary patterns. Data on food consumption are necessary for evaluating and developing community nutrition policies. Few studies on Jordanians' food consumption and dietary habits at various ages have been conducted, despite the increased prevalence of overweight, obesity, and chronic diseases. This will be the first study focusing on Jordanians' food consumption patterns that includes children, adolescents, adults, and older adults.

OBJECTIVE

This cross-sectional study aims to describe the design and methodology of the Jordan's Population-based Food Consumption Survey, 2021-2022, which was developed to collect data on food consumption, including energy, nutrients, and food group intake, from a representative sample of Jordanians and to determine the prevalence of overweight and obesity and their relationship to food consumption.

METHODS

Participants were selected by stratified random sampling, using the Estimated Population of the Kingdom by Governorate, Locality, Sex, and Households, 2020 as the sampling frame. The food consumption survey sample was at the population level, representing gender and age classes (8-85 years old). The data collection period was 6 months. Food consumption was assessed using 24-hour dietary recall (2 nonconsecutive days, 1 week apart) interviews representing weekdays and weekends. In addition to data on food consumption, information on the use of food supplements, sociodemographic and socioeconomic status, and health was gathered. Weight, height, and waist circumference were all measured.

RESULTS

The survey included 632 households with 2145 participants, of which 243 (11.3%) were children, 374 (17.4%) were adolescents, 1428 (66.6%) were adults, and 99 (4.6%) were older adults. Three food consumption databases were used to stratify the mean 24-hour dietary recall food consumption into energy intake, carbohydrates, proteins, fats, fiber, vitamins and minerals, and food groups. BMI was calculated and classified as normal, overweight, or obese. Central obesity was classified as normal or abnormal based on the waist-to-height ratio. The survey results will be disseminated based on age, energy, nutrient, and food group consumption. The prevalence of overweight and obesity by age group will be presented, as well as a comparison to the situation in Eastern Mediterranean countries.

CONCLUSIONS

The survey data will be helpful in nutritional studies, assessing changes in dietary patterns, and developing and evaluating nutrition or health policies. It will be a solid base for developing a future national surveillance system on food consumption patterns with comprehensive food consumption, physical activity, biochemical, and blood pressure data.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/41636.

Prevalence and Determinants of Household Medication Storage During the COVID-19 Outbreak in Southwest Ethiopia

Background

Most households worldwide keep medicines on hand for various reasons, including emergency use, treatment of acute and chronic diseases, and anticipated future use. Being infected or fear of getting COVID-19 in the current pandemic could increase the storage of drugs at home. Thus, this study aimed to assess the prevalence of household storage of medicines and associated factors in southwest Ethiopia during the COVID-19 outbreak.

Methods

A cross-sectional household survey was conducted from February 1 to May 30, 2022. Data on the extent of storage, storage conditions, their current status, disposal methods, among others, were collected through structured interviews and observations. The data were entered into EPI info, exported, and analyzed using Statistical Packages for Social Sciences (SPSS). Bivariate followed by multivariate logistic regression was used to identify associated factors. P-value <0.05 was used as a cut-off point to decide statistical significance.

Results

The magnitude of household medication storage was 48% (95% CI). Analgesics (28.7%) and antibacterial (21.1%) agents were the most predominant class of drugs stored in the households. The most significant proportion of the home-stored medications (34.7%) was reserved for future use, and 31.8% were for treating current medical conditions. The majority of the respondents (84.1%) had never heard/learned about the safe disposal ways of drugs. The presence of children aged less than 5 years in a household [AOR = 1.90 (1.19, 3.05)] and the existence of chronically sick patients in a household [AOR = 4.3 (2.25, 8.45)] were factors significantly associated with household medication storage.

Conclusion

The current study revealed a high prevalence of home medication storage; thus, to lessen or eliminate the negative consequences of storing medications at home, it is necessary to review the medication utilization chain and offer community-based training on proper medication storage and disposal techniques, including establishing take-back programs.

The medication self-management work system of patients and informal carers from a human factors & ergonomics perspective: A scoping review protocol

Background: Healthcare is increasingly delivered closer to the patients' homes, which increases the level of responsibility that patients and informal carers take for managing their medication-taking, although this is associated with hazards. Medication self-management has been conceptualised as work taking place in non-formal settings ( e.g., households), which are complex systems. Human factors and ergonomics (HFE) models provide a framework for studying such systems. The Systems Engineering Initiative for Patient Safety (SEIPS) is one framework that considers work system elements and how they interact with each other to shape processes that lead to outcomes ( e.g., safety). Given the increasing amount of diverse research on patient and carer work and on system-shaping factors, the objectives of this review are to: (i) identify available evidence in a structured and systems-oriented way, (ii) explore approaches that have been applied and (iii) highlight research gaps. Methods: An evidence-informed patient, public and carer involvement (PPCI) approach will be implemented at all post-protocol stages to ensure the relevance, uptake and translation of the scoping review. The review will systematically search MEDLINE, Embase, PsycInfo, CINAHL and Web of Science to identify relevant qualitative studies. The methodological approach will be guided by Johanna Briggs Institute methodology and will be reported according to the PRISMA-ScR standards. Data charting and qualitative content analysis directed by SEIPS will explore how the work system and its constituting elements have been described in the literature and identify specific gaps and opportunities for future research. Borrowing from realist approaches, included studies will be assessed in terms of richness and relevance to our review question. Discussion: Strengths of this scoping review include PPCI and a converging focus on medication safety, medication self-management and HFE. Ultimately, this approach will advance our understanding of this complex system and guide opportunities to broaden and strengthen the evidence base.

Family Household Characteristics and Stunting: An Update Scoping Review

Stunting remains a public health concern in developing countries. Factors related to stunting have been categorized using various frameworks. Family plays an important role in providing nutrients for children; however, no review specifies this aspect for identifying family characteristics related to stunting. This study aimed to identify family household characteristics related to stunting among children aged less than 5 years. A scoping review was undertaken with sources from PubMed, CINAHL, and Scopus, using the keywords "family characteristics" AND "growth". Inclusion criteria were (1) correlational study; (2) published between 2018 and 31 July 2022; (3) families with children under the age of 5 years; and (4) independent variable any measure of stunting factors from family and household factors. Of 376 articles, only 20 met the inclusion criteria of the study. The family household characteristics included individual factors (sex age, history of diarrhea, and birthplace), family factors (family headship, primary caregiver/mother, social-cultural orientation, and family system factors), and environmental factors. Various child variables, family factors, and environmental factors (the type of home, floor type, water access, source of drinking water, and household electricity) were identified as being associated with stunting. Therefore, these factors should be evaluated to prevent and control stunting, and they should be incorporated into health programs targeting stunting.

Effects of Second Dose of SARS-CoV-2 Vaccination on Household Transmission, England

A single SARS-CoV-2 vaccine dose reduces onward transmission from case-patients. We assessed the potential effects of receiving 2 doses on household transmission for case-patients in England and their household contacts. We used stratified Cox regression models to calculate hazard ratios (HRs) for contacts becoming secondary case-patients, comparing contacts of 2-dose vaccinated and unvaccinated index case-patients. We controlled for age, sex, and vaccination status of case-patients and contacts, as well as region, household composition, and relative socioeconomic condition based on household location. During the Alpha-dominant period, HRs were 0.19 (0.13-0.28) for contacts of 2-dose BNT162b2-vaccinated case-patients and 0.54 (0.41-0.69) for contacts of 2-dose Ch4dOx1-vaccinated case-patients; during the Delta-dominant period, HRs were higher, 0.74 (0.72-0.76) for BNT162b2 and 1.06 (1.04-1.08) for Ch4dOx1. Reduction of onward transmission was lower for index case-patients who tested positive ≥2 months after the second dose of either vaccine.

Prevalence of leftover medicines, disposal practices, and associated factors in Arba Minch Town, Southern Ethiopia

Objective

The increased prevalence of leftover medicines in the community is currently a global concern due to the detrimental effects on the environment and health. However, several developing countries have failed to give sufficient consideration to the issue. The primary purpose of this study was to describe the prevalence of leftover medicines, disposal practices, and the factors affecting those in households in Arba Minch Town, Southern Ethiopia.

Methods

A community-based, descriptive cross-sectional study was conducted among households in Bere Edigetber and Nech Sar of Arba Minch town, from June 25 to August 27, 2022. Data were gathered through face-to-face interviews with revalidated structured questionnaires. A multistage sampling technique was utilized to select each household.

Results

Three hundred forty-eight households agreed to participate in a study, resulting in a 94.8% response rate. Of the study participant, 172 (49.4%) of the households had leftover medicines, with antibiotics being the most common (64% of 172). Subsidy of symptoms and saving for later use were two frequently cited reasons for the presence of leftover medicines in the house. Throwing leftover medicines in household garbage was the preferred method of disposal (>60%). Only 0.1% of respondents considered returning leftover medicines to healthcare facilities or professionals. A binary regression analysis identified four predictors for having leftover medicines. Medicines obtained without prescription were the strongest predictor (odds ratio = 3.7; p < 0.001), followed by higher family monthly income (odds ratio = 2.5; p = 0.005), those waived paying for medicine (odds ratio = 0.294; p = 0.049), and those used medications for acute diseases (p = 0.048; odds ratio = 0.450). Respondents who had prior information on safe medicine disposal were 2.3 (p = 0.04) more likely to dispose of possessed leftover medicines rather than keep them for future use.

Conclusions

This study revealed a high prevalence of leftover medicines and their improper disposal in Arba Minch town. The preferred methods of leftover medicine disposal in this study deviate from conventional standards. Significant factor variables that predict having leftover medicines are attributed to purchasing medicine without a prescription, higher family monthly income, those waived paying for medicine, and those who used medications for acute diseases. Prior knowledge of proper disposal practices predicated the decision to dispose of on-hand leftover medicines or keep them for future use. These findings would be critical in developing strategies to reduce leftover medicines and promote proper disposal practices.

Out-of-pocket healthcare expenditures of Turkish households living with rare diseases

Introduction

This study aims to determine the out-of-pocket health expenditures of households in Turkey where individuals with rare diseases are residing.

Methods

The research population consisted registered members of associations who are members of the Rare Diseases Network. In addition to the general analysis including all participants, expenditures based on characteristics of disease holders were also calculated.

Results

A total of 439 participants were included in the analysis. We determined that special nutrition was the highest expenditure group and emergency departments were the lowest expenditure group. When all the participants were evaluated, the average cost of rare diseases was found to be Ł22,743 (€2,877). A significant relationship was found between income status and out-of-pocket health expenditures (p = 0.012).

Discussion

Policy makers should consider inclusion of special nutritional products and medical/non-medical devices used in treatment of rare diseases within the scope of reimbursement and the development of orphan drug legislation as the first actions to be taken.