Cross-sectional Household Survey Research Articles

Public perceptions of Ebola vaccines and confidence in health services to treat Ebola, malaria, and tuberculosis: Findings from a cross-sectional household survey in Uganda, 2020.

Uganda used Ebola vaccines as part of its preparedness and response during the 2018-2020 10th Ebola virus disease (EVD) outbreak in neighboring Democratic Republic of the Congo (DRC). We evaluated the public's perceptions of Ebola vaccines and compared their confidence in health services to treat Ebola versus malaria and tuberculosis as part of a survey on Ebola knowledge, attitudes, and practices (KAP) conducted in March 2020. A cross-sectional household survey was implemented in six districts in Uganda using multi-stage cluster sampling to randomly select participants. The districts were purposively selected from districts classified by the government as at high- or low-risk for an EVD outbreak. We describe perceptions of Ebola vaccines and confidence in health services to treat Ebola, tuberculosis, and malaria. Modified Poisson regression modeling was used to identify the demographic correlates of these outcomes. Among 3,485 respondents, 18% were aware of Ebola vaccines. Of those, 92% agreed that the vaccines were needed to prevent Ebola. Participants aged 15-24 years were 4% more likely to perceive such need compared to those 60 years and older (adjusted prevalence ratio [aPR] 1.04, 95% confidence interval [CI] 1.0-1.08). The perceived need was 5% lower among participants with at least some secondary education compared to uneducated participants (aPR 0.95; 0.92-0.99). Overall, 81% of those aware of the vaccines believed that everyone or most people in their community would get vaccinated if offered, and 94% said they would likely get vaccinated if offered. Confidence in health services to treat Ebola was lower compared to treating malaria or tuberculosis (55% versus 93% and 77%, respectively). However, participants from the EVD high-risk districts were 22% more likely to be confident in health services to treat Ebola compared to those in low-risk districts (aPR: 1.22; 95% CI: 1.08, 1.38). Our findings suggest that intent to take an Ebola vaccine during an outbreak was strong, but more work needs to be done to increase public awareness of these vaccines. The public's high confidence in health services to treat other health threats, such as malaria and tuberculosis, offer building blocks for strengthening their confidence in health services to treat EVD in the event of an outbreak.

Impact of 1,7-malaria reactive community-based testing and response (1,7-mRCTR) approach on malaria prevalence in Tanzania

BackgroundProgress in malaria control has stalled in recent years and innovative surveillance and response approaches are needed to accelerate malaria control and elimination efforts in endemic areas of Africa. Building on a previous China-UK-Tanzania pilot study on malaria control, this study aimed to assess the impact of the 1,7-malaria Reactive Community-Based Testing and Response (1,7-mRCTR) approach implemented over two years in three districts of Tanzania.MethodsThe 1,7-mRCTR approach provides community-based malaria testing via rapid diagnostic tests and treatment in villages with the highest burden of malaria incidence based on surveillance data from health facilities. We used a difference-in-differences quasi-experimental design with linear probability models and two waves of cross-sectional household surveys to assess the impact of 1,7-mRCTR on malaria prevalence. We conducted sensitivity analyses to assess the robustness of our results, examined how intervention effects varied in subgroups, and explored alternative explanations for the observed results.ResultsBetween October 2019 and September 2021, 244,771 community-based malaria rapid tests were completed in intervention areas, and each intervention village received an average of 3.85 rounds of 1-7mRCTR. Malaria prevalence declined from 27.4% at baseline to 11.7% at endline in the intervention areas and from 26.0% to 16.0% in the control areas. 1,7-mRCTR was associated with a 4.5-percentage-point decrease in malaria prevalence (95% confidence interval: − 0.067, − 0.023), equivalent to a 17% reduction from the baseline. In Rufiji, a district characterized by lower prevalence and where larviciding was additionally provided, 1,7-mRCTR was associated with a 63.9% decline in malaria prevalence.ConclusionsThe 1,7-mRCTR approach reduced malaria prevalence. Despite implementation interruptions due to the COVID-19 pandemic and supply chain challenges, the study provided novel evidence on the effectiveness of community-based reactive approaches in moderate- to high-endemicity areas and demonstrated the potential of South-South cooperation in tackling global health challenges.Graphical

Contraceptive use by number of living children in Ghana: Evidence from the 2017 maternal health survey

Background There is a significant literature describing the link between parity and contraceptive use. However, there is limited knowledge about the disaggregation by parity of the type of contraceptives. In this study, we describe the use of contraceptives by parity among women of reproductive age in Ghana, focusing on use of highly effective methods (injection, pill, intrauterine device, implant, and sterilization). Methods Using the 2017 Ghana Maternal Health Survey, a nationally-representative cross-sectional household survey, we describe contraceptive method use by number of living children among sexually active women of reproductive age. We then estimated predictors of use of highly effective contraception in a multilevel logistic regression model. Results Most women in this survey are not using any method of contraception, although this varies by whether or not they have begun childbearing. Contraceptive method use varies by number of living children. Before having children, natural (periodic abstinence and withdrawal) and episodic (condoms) methods dominate. Once a woman has one living child, method preference changes to injectables and implants. Factors associated with using a highly effective method of contraception are: having >3 children, being in a relationship, having had an abortion, being younger than age 30, and having had sexual intercourse within days of answering the survey (p < .001 for all). Conclusion In this analysis, the number of living children a woman has, her age, and timing of last intercourse are the most significant predictors of using a highly effective method of contraception. However, the majority of participants in this study report not using any method of contraception to avoid unwanted pregnancies. Future research that attempts to unpack the disconnect between not wanting to become pregnant and not using contraception is warranted.

A repeated cross-sectional study of the association of community health worker intervention with the maternal continuum of care in rural Liberian communities

BackgroundThe maternal continuum of care (CoC) (antenatal care, facility-based delivery, postnatal care) is critical to maternal and neonatal health and reducing mortality, but completion in rural areas of low- and middle-income countries is often limited. We used repeated cross-sectional household surveys from a rural Liberian county to explore changes in rates of completion of all steps and no steps in the maternal CoC after implementation of the National Community Health Assistant Program (NCHAP), a community health worker (CHW) intervention designed to increase care uptake for families over five kilometers from a facility.MethodsWe analyzed repeated cross-sectional household surveys of women aged 18–49 served by NCHAP in Rivercess County, Liberia. We measured survey-weighted, before-to-after implementation difference in completion of all steps and no steps in the maternal CoC. We used multivariable regression to explore covariates associated with completion rates before and after NCHAP implementation.ResultsData from surveys conducted at three timepoints (2015, n = 354; 2018, n = 312; 2021, n = 302) were analyzed. A significant increase in completing the full maternal CoC (2015:23.6%, 2018:53.4%, change:29.7% points (pp), 95% confidence interval (CI) [21.0,38.4]) and a decrease in completing no steps in the CoC (2015:17.6%, 2018:4.0%, change: -12.4pp [-17.6, -7.2]) after implementation of NCHAP were observed from 2015 to 2018, with rates maintained from 2018 to 2021. Living farther from a facility was consistently associated with less care across the continuum. Following implementation, living in a motorbike accessible community was associated with completing the CoC while living in a mining community was negatively associated with omitting the CoC. Household wealth was associated with differences in rates pre-NCHAP but not post-NCHAP.ConclusionsFollowing NCHAP implementation, completion rate of the full maternal CoC in Rivercess County more than doubled while the rate of completing no steps in the continuum fell below 5%. These rates were sustained over time including during COVID-19 with reduced differences across wealth groups, although far distances remained a risk for less care. CHW programs providing active outreach to remote communities can be important tools for improving uptake of interventions and reducing risk of no formal care during and after pregnancy.

COVID-19 in Baghdad, Iraq: adaptive and emotional findings in a household cluster survey.

The objective of this study was to assess the impact of COVID-19 infection on households in Baghdad, Iraq. A cross-sectional household survey was conducted in early 2022; 41 clusters were selected proportional to population size from the districts of the Baghdad governorate. Households were randomly selected for inclusion. The head of household or senior female member present was interviewed to obtain a listing of COVID-19 infections, deaths, and vaccinations among members of the household and to understand if social and economic changes occurred during the pandemic. All analyses incorporated the complex survey design and sample weights for clustering. The findings revealed that there were 1,464 cases of COVID-19 (37.1%) and 34 reported fatalities among the 927 households enrolled in this study. One or more COVID-19 immunizations were received by 50.9% of household members. Preventive measures against COVID-19 were widely reported to be being practiced but were not more commonly reported in households having reported a clinical case of infection. While some households where infections had occurred stated that their household expenses were increased, overall, infections were not associated with significantly increased household costs. In households where COVID-19 had occurred, senior members reported a substantial increase in emotional and psychological problems compared with uninfected households. COVID-19 deaths were rare, though infections were common, suggesting an effect of vaccination and other efforts. The household economic implications were minimal in houses with and without COVID-19-infected members. COVID-19 had mental health consequences on affected and unaffected populations alike. It is conceivable that the fear and uncertainty generated by the pandemic had an effect on senior household members which was out of keeping with the other effects in the households sampled. This suggests that there may be a persisting need for mental health services for a protracted period to manage the consequences of mental health needs arising from the pandemic.

Assessing the histidine-rich protein 2/3 gene deletion in Plasmodium falciparum isolates from Burkina Faso

BackgroundDual hrp2/hrp3 genes deletions in P. falciparum isolates are increasingly reported in malaria-endemic countries and can produce false negative RDT results leading to inadequate case management. Data on the frequency of hrp2/hrp3 deleted parasites are rarely available and it has become necessary to investigate the issue in Burkina Faso.MethodsPlasmodium falciparum-positive dried blood spots were collected during a cross-sectional household survey of the malaria asymptomatic children from Orodara, Gaoua, and Banfora. Amplicons from the target regions (exon 2 of hrp2 and hrp3 genes) were generated using multiplexed nested PCR and sequenced according to Illumina’s MiSeq protocol.ResultsA total of 251 microscopically positive parasite isolates were sequenced to detect hrp2 and hrp3 gene deletions. The proportion of RDTs negative cases among microscopy positive slides was 12.7% (32/251). The highest prevalence of negative RDTs was found in Orodara 14.3% (5/35), followed by Gaoua 13.1%(24/183), and Banfora 9.1% (3/33). The study found that 95.6% of the parasite isolates were wild type hrp2/ hrp3 while 4.4% (11/251) had a single hrp2 deletion. Of the 11 hrp2 deletion samples, 2 samples were RDT negative (mean parasitaemia was 83 parasites/ μL) while 9 samples were RDT positive with a mean parasitaemia of 520 parasites /μL (CI95%: 192–1239). The highest frequency of hrp2 deletion 4/35 (11.4%) was found in Orodara, while it was similar in the other two sites (< 3.5%). No single deletion of the hrp3 or dual deletion hrp2/3 gene was detected in this study.ConclusionThese results demonstrate that P. falciparum isolates lacking hrp2 genes are present in 4.4% of samples obtained from the asymptomatic children population in three sites in Burkina Faso. These parasites are circulating and causing malaria, but they are also still detectable by HRP2-based RTDs due to the presence of the intact pfhrp3 gene.

Prevalence and risk factors associated with malaria infection in children under two years of age in southern Togo prior to perennial malaria chemoprevention implementation

BackgroundMalaria remains the leading cause of mortality and morbidity in young children in sub-Saharan Africa. To prevent malaria in children living in moderate-to-high malaria transmission areas, the World Health Organization has recommended perennial malaria chemoprevention (PMC). Prior to piloting PMC implementation in southern Togo, a household survey was conducted to estimate malaria infection prevalence in children under 2 years of age (U2).MethodsA cross-sectional community-based household survey was conducted in the Haho district in the Togo Plateaux region. A three-stage random sampling method was used to select study participants aged 10–23 months whose caretakers gave informed consent. The prevalence of Plasmodium infection, defined as a positive rapid diagnostic test (RDT), was estimated with 95% confidence interval (CI). Clinical malaria was defined as having a positive RDT plus fever (≥ 37.5 °C) or history of fever in the last 24 h. Mixed-effects logistic regression models were used to assess the child’s, caretaker’s, and household’s factors associated with malaria infection.ResultsA total of 685 children were included in the survey conducted January–February in 2022 (dry season). Median age was 17 months (interquartile range: 13–21). About 80% of the children slept under a bed net the night before the interview. Malaria infection prevalence was 32.1% (95% CI 27.7–37.0) with significant area variation (cluster range: 0.0–73.3). Prevalence of clinical malaria was 15.4% (95% CI 12.2–19.2). Children whose caretakers were animist (aOR: 1.71, 95% CI 1.19–2.46) and those living in mother-headed households (aOR: 2.39, 95% CI 1.43–3.99) were more likely to have a positive RDT. Living more than 5 km away from the nearest health facility (aOR: 1.60, 95% CI 1.04–2.44) and presence of two or more under-5-years children in the household (aOR: 1.44, 95% CI 1.01–2.07) were also associated with increased risk of infection.ConclusionOne-third of the children U2 who participated in this survey had malaria infection, thus PMC could be a promising strategy to reduce malaria burden in young children in Plateaux region. Reinforcement of outreach services and targeting the poorest households should be prioritized to reduce the inequity in malaria prevention in children exposed to the infection.

Caregiver acceptance of malaria vaccination for children under 5 years of age and associated factors: cross-sectional household survey, Guinea and Sierra Leone, 2022

BackgroundMalaria is a leading cause of death and reduced life span in Guinea and Sierra Leone, where plans for rolling out the malaria vaccine for children are being made. There is little evidence about caregiver acceptance rates to guide roll-out policies. To inform future vaccine implementation planning, this analysis aimed to assess potential malaria vaccine acceptance by caregivers and identify factors associated with acceptance in Guinea and Sierra Leone.MethodsA cross-sectional household survey using lot quality assurance sampling was conducted in three regions per country between May 2022 and August 2022. The first survey respondent in each household provided sociodemographic information. A household member responsible for childcare shared their likelihood of accepting a malaria vaccine for their children under 5 years and details about children’s health. The prevalence of caregiver vaccine acceptance was calculated and associated factors were explored using multivariable logistic regression modelling calculating adjusted odds ratios (aOR) with 95% confidence intervals (CI).ResultsCaregivers in 76% of 702 sampled households in Guinea and 81% of 575 households in Sierra Leone were accepting of a potential vaccine for their children. In both countries, acceptance was lower in remote areas than in urban areas (Guinea: aOR 0.22 [95%CI 0.09–0.50], Sierra Leone: 0.17 [0.06–0.47]). In Guinea, acceptance was lower among caregivers living in the richest households compared to the poorest households (0.10 [0.04–0.24]), among those whose children were tested for malaria when febrile (0.54 [0.34–0.85]) and in households adopting more preventative measures against malaria (0.39 [0.25–0.62]). Better knowledge of the cause of malaria infection was associated with increased acceptance (3.46 [1.01–11.87]). In Sierra Leone, vaccine acceptance was higher among caregivers living in households where the first respondent had higher levels of education as compared to lower levels (2.32 [1.05–5.11]).ConclusionIn both countries, malaria vaccine acceptance seems promising for future vaccine roll-out programmes. Policy makers might consider regional differences, sociodemographic factors, and levels of knowledge about malaria for optimization of implementation strategies. Raising awareness about the benefits of comprehensive malaria control efforts, including vaccination and other preventive measures, requires attention in upcoming campaigns.

Seeking and reaching emergency care: A cross sectional household survey across two Liberian counties.

The overwhelming burden of morbidity and mortality from injury and medical conditions requiring acute care are borne by low- and middle-income countries lacking accessible, quality care systems. Current evidence suggests the lack of prehospital care systems likely contributes to this disproportionate burden. As an initial step in a longitudinal, collaborative effort to strengthen the chain of survival for emergency conditions in Liberia, baseline attitudes and behaviors in accessing and utilizing emergency care were characterized. A multistage, proportional, cluster sampling frame was employed to conduct a cross-sectional, community-based survey of 800 households across rural Lofa County and the greater capital (Monrovia) metropolitan area. The primary outcome was facility-based utilization of emergency care within the 12 months prior to survey administration. 43.9% of individuals surveyed reported a visit to an emergency unit in the last year. Multivariable logistic regression revealed increased adjusted odds of facility-based emergency care utilization in households that were low-income, non-English-speaking, lacking electricity, or had a non-durable roof. Among these individuals, 23.6% had sought care from a community health worker, family/friend, clinic, pharmacy, or traditional healer prior. The majority of persons seeking care do so without ambulance services. 34.8% of all households have called a community member for a medical emergency, but 88.9% of survey respondents report no first aid training and cite barriers to rendering aid. This represents the first household survey to assess the perceptions and utilization of emergency care in Liberia. Formal pre-hospital care provision is limited and substantial barriers to emergency care access exist. First aid training and acceptance is lacking, despite frequent reliance on community-based aid during emergencies.

The Role of Audience Monitoring Surveys (AMS) In Strengthening Radio Talk Shows (RTS) By UNICEF Ethiopia on Female Genital Mutilation (FGM) and Child Marriage Programs

Female Genital Mutilation (FGM) and child marriage (CM) are some of the worst harmful practices rampant in Ethiopia. Population Media Center-Ethiopia (PMC-E), in partnership with UNICEF and UNFPA, have been broadcasting radio talk shows (RTS) in select regions of the country to address these issues. The main objective of this study was to establish the popularity and relevance of these shows in addressing the issue of FGM and CM. Specific objectives were establishing respondent awareness of the shows, analyzing the knowledge gained from the issues raised in the shows, establishing the convenience of RTS broadcasting times to listeners, and offering suggestions for improvement. The study used a cross-sectional population-based household survey design in which men and women aged 15 – 49 years were interviewed in two phases. A total of 860 respondents in Phase I and 741 in Phase II were interviewed using questionnaires. Data was analyzed descriptively. Findings show that the reach of RTS was not good, attributable to lack of access to radio, mobile phone, or/and lack of electricity or time to listen to the shows. The content, time and presenter skills and creativity were convenient to listeners and the popular topics discussed were FGM, CM, and gender equality. There was a significant difference between people who listened to the shows and those who didn’t in regard to understanding FGM and CM issues. The study recommends government of Ethiopia subsidize the cost of radios purchased by people in target areas as well as promote the use of alternative media to present topics discussed in the RTS.

Adolescent mental health in post-conflict communities: results from a cross-sectional survey in Northern Uganda

PurposeThis study evaluated adolescents' mental health their knowledge, attitudes, and beliefs about mental health conditions, and their access to critical mental health services in Lira District, northern Uganda. The political history of the region, the epicenter of the decades-long conflict between the Lord’s Resistance Army and the Ugandan government, makes for an interesting case study of the political and social determinants of mental health of those directly impacted by conflict, and on subsequent generations growing up in post-conflict communities.MethodsThis paper presents the results of a community-based participatory research study carried out by youth public health ambassadors in Lira District, Uganda. The study consisted of a mixed methods cross-sectional survey of households, schools, and healthcare facilities.ResultsThe study found 66% of adolescents indicated poor well-being and possible symptoms of depression and 41% of adolescents reported at least 4 childhood trauma events. Over 35% reported feeling extremely sad and 60% reported feeling socially isolated during the COVID lockdowns that lasted from 2020 to 2021. Nearly half of the adolescents aged 14–17 surveyed (N = 306) believed that witchcraft caused mental health problems, while less than 20% believed that traumatic experiences could be a cause. Forty percent of respondents had no idea of where to seek mental health care, and few facilities had mental health services available.DiscussionThese findings illustrate the need to study the political and social determinants of mental health, especially on those directly impacted by armed conflict and for the generations growing up in post-conflict communities as they seek to rebuild.

Food insecurity and associated factors among households with under-5 children in slum communities in Ibadan, Nigeria

IntroductionFood insecurity is a leading cause of childhood morbidity and mortality. This study assessed the prevalence of household food insecurity and its associated factors among under-5 children in Ibadan, Nigeria.MethodsThis was a cross-sectional household survey of 1,027 under-5 children and their caregivers in urban and rural slums in Ibadan. We used an electronic interviewer-administered, semi-structured questionnaire adapted from the Nigeria Demographic Health Survey and Household Food Insecurity Access Scale was used to report sociodemo-economic characteristics, food insecurity, and anthropometric measurement. The household food insecurity scale consisted of nine questions graded from 0 (Never) to 3 (Often) computed to determine the presence of food insecurity. Nutrition indices were computed, and the results were classified according to World Health Organization 2006 cut-off points. Chi-square tests were used to assess associations between food insecurity and the independent variables. Binary logistic regression analyses were conducted to identify the predictors of food insecurity (α = 0.05).ResultsThe mean ages of the caregivers and under-5 children were 31.7 ± 7.47 years and 34.49 ± 15.8 months respectively. Overall, 530 (51.7%) children were females, and 765 (74.5%) had normal weight for height. In all, 195 (19.0%) households had food insecurity, while 832 (81.0%) households had food security (Chi-square = 103.364, p = < 0.001). Under-5 children living in urban slums were seven times more likely to experience household food insecurity compared to those in rural slums (AOR = 6.859, 95%CI = 4.524–10.509, p = < 0.001).DiscussionHousehold food insecurity was more prevalent in urban slums. Strengthening of the school health program would help identify children with nutritional deficits, and improve the overall health status of children living in slum communities.

Attitudes to long-term care in India: a secondary mixed-methods analysis

BackgroundIndia is the world's most populous country, and overseas Indians the world's largest diaspora. Many of the more than 1·4 million UK-based Indians will be providing care at a distance for parents living in India. Globalisation has contributed to a shift in India from traditional joint family systems to more nuclear structures. We investigated how commonly Indian parents consider and use long-term care facilities and attitudes to their use. MethodsWe did a secondary mixed-methods statistical analysis of the LASI (Longitudinal Ageing Study in India), a national, cross-sectional household survey administered in 2017–18 to 73 396 randomly selected adults aged 45 years and older in all Indian states and Union Territories (42 261 [58%] women, 31 135 [42%] men). We report the proportion and sociodemographic predictors of respondents’ parent(s) living in a care home. We also did a secondary thematic analysis of the qualitative interviews from the Moving Pictures India Study, exploring attitudes to long-term care in 2022. These interviews included 19 carers (nine [47%] women; age range 31–79 years) for people with dementia and 25 professionals (19 [76%] women; age range 24–56 years) purposively selected for diversity from networks of the team based at a Bangalore hospital, India. Findings24 LASI participants reported that their parent was living in a long-term care facility (father [n=8], mother [n=15], both parents [n=1]). Although rare overall, use and consideration of use of long-term care were more frequently reported in urban areas (n=14, 58%), by people in middle-income quintiles (n=17, 71%) with higher levels of education (n=7, 29%), who rated their health as good or very good (n=15, 63%). The themes identified in qualitative interviews were the use of long-term care facilities as a last resort, social expectations, and limited availability of long-term care facilities. InterpretationAlthough interviews were only conducted in Bangalore and respondents could misrepresent living arrangements due to ongoing societal stigma, the data show that very few people reside in old age homes across India, with strong preference towards intergenerational and community care. With the UK home to a growing diaspora of nuclear Indian families, our findings illustrate the contexts in which they provide care at a distance, navigating cross-cultural attitudes and social norms around long-term care. FundingAlzheimer's Association US.

Machine learning algorithms for prediction of double burden of malnutrition among Tunisian adults

Abstract Background Malnutrition, referring to both nutritional deficits and excess adiposity (EA), currently affects one third of the world population. In Tunisia, nutritional deficits are still major challenges in a context of epidemiological and nutritional transition. The objectives of our study were to identify the potential risk factors of DBM and propose a better machine learning (ML) based model for predicting DBM among Tunisian adults. Methods About 7963 respondents aged 20 years and over were taken from Tunisian Health Examination Survey (THES), a cross-sectional national household survey undertaken in 2016. DBM was defined as the association of EA and anemia. EA was defined as a waist-to-height ratio ≥0.6 and /or overweight: BMI ≥25kg/m2. Anemia was defined as hemoglobin (Hb)&amp;lt;13g/L in men and Hb &amp;lt; 12g/L in women. The potential risk factors for malnutrition were extracted using logistic regression (LR). Five ML algorithms including Naïve Bayes, support vector machine (SVM), artificial neural network (ANN), AdaBoost and random forest (RF) were employed for predicting DBM and their performance was evaluated using accuracy, precision, recall, and area under the curve (AUC). Results LR illustrated that age, sex, region, wealth index, educational level and marital status were identified as potential risk factors for DBM. AdaBoost had the highest accuracy (89.8%), followed by SVM (89.6%). Naïve Bayes had the highest Recall (98.1%) and the most performant AUC (91.4%), while RF had the highest Precision (70.8%). The ANN had an accuracy of 89%, a precision of 70.4%, a recall of 78.7% and an AUC of 0.851. Conclusions The study demonstrated the efficacy of ML algorithms in predicting DBM in Tunisian adults. AdaBoost and SVM showed the highest accuracy, and could be utilized as an early detection tool to manage DBM and alleviate the burden on the healthcare system. However, larger and more diverse datasets are needed for further validation. Key messages • Double burden of malnutrition, defined as the coexistence of undernutrition and overnutrition, is a significant issue globally and a major challenge in Tunisia. • Machine learning algorithms, particularly AdaBoost and SVM, can be effective tools for predicting and managing double burden of malnutrition in Tunisian adults.

The overweight epidemic increasingly hits children of lower educated parents in Belgium

Abstract Background Childhood overweight has a negative impact on children's (mental) health. Although the prevalence of overweight among children is high in Western countries, the increasing trend seems to be levelling off since 2000. The purpose of this study is to examine this trend over the past two decades in Belgium and whether this trend differs by the parents’ socioeconomic status (SES). Methods Data from the Belgian Health Interview Survey (HIS), a representative cross-sectional household survey conducted in 1997, 2001, 2004, 2008, 2013 and 2018, was used. Study participants include children aged 2-17 years. The highest educational level among parents is used as a proxy for SES and is dichotomized into lower (at most a higher secondary degree versus high (higher education). Since the BMI (kg/m2) in children is instable, age/sex-specific cutoff points are used to estimate the weighted prevalence (95% confidence interval) of self-reported overweight (including obesity), by SES and year. Significant differences (p&amp;lt;.05) of the association between overweight and SES 1997 is assessed through logistic regression controlled for age and sex using 1997 as reference year. Results The overall prevalence of overweight among children is significantly higher in 2018 (19.0% (16.4-21.6%)) than in 1997 (13.6% (11.2-16.0%)), but no difference compared to the intervening years. Among the lower educated, this prevalence increased from 16.8% (13.2-20.4%) in 1997 to 27.8% (23.3-32.4%) in 2018; and among the high educated from 8.8% (6.0-11.5%) to 12.9% (10.0-15.8%). Compared to 1997, the difference between the low and the high educated increased significantly since 2008. Conclusions Two decades of HIS have shown that the SES is becoming an even more important risk factor for overweight among children. Health promotion on nutrition and physical activity at school has the potential to reach children from all socioeconomic backgrounds, making it an important means of tackling health inequalities. Key messages • Efforts to monitor the evolution of overweight and its determinants among (deprived) children. • Health-promoting schools are a nice initiative to reduce overweight among (deprived) children.

Machine learning modeling for identifying predictors of unmet need for family planning among married/in-union women in Ethiopia: Evidence from performance monitoring and accountability (PMA) survey 2019 dataset.

Unmet need for contraceptives is a public health issue globally that affects maternal and child health. Reducing unmet need reduces the risk of abortion or childbearing by preventing unintended pregnancy. The unmet need for family planning is a frequently used indicator for monitoring family planning programs. This study aimed to identify predictors of unmet need for family planning using advanced machine learning modeling on recent PMA 2019 survey data. The study was conducted using secondary data from PMA Ethiopia 2019 cross-sectional household and female survey which was carried out from September 2019 to December 2019. Eight machine learning classifiers were employed on a total weighted sample of 5819 women and evaluated using performance metrics to predict and identify important predictors of unmet need of family planning with Python 3.10 version software. Data preparation techniques such as removing outliers, handling missing values, handling unbalanced categories, feature engineering, and data splitting were applied to smooth the data for further analysis. Finally, Shapley Additive exPlanations (SHAP) analysis was used to identify the top predictors of unmet need and explain the contribution of the predictors on the model's output. Random Forest was the best predictive model with a performance of 85% accuracy and 0.93 area under the curve on balanced training data through tenfold cross-validation. The SHAP analysis based on random forest model revealed that husband/partner disapproval to use family planning, number of household members, women education being primary, being from Amhara region, and previously delivered in health facility were the top important predictors of unmet need for family planning in Ethiopia. Findings from this study suggest various sociocultural and economic factors might be considered while implementing health policies intended to decrease unmet needs for family planning in Ethiopia. In particular, the husband's/partner's involvement in family planning sessions should be emphasized as it has a significant impact on women's demand for contraceptives.

Abnormal cervical cancer screening results among US Veteran and non-Veteran participants in the National Health Interview Survey (NHIS)

Female Veterans report cervical cancer risk factors at higher rates than non-Veterans. Using data from the National Health Interview Survey (NHIS), we tested whether Veterans with a recent cervical cancer screening test were more likely than non-Veterans to have received an abnormal result. NHIS is a population-based cross-sectional household survey with a stratified, multistage sampling design. We pooled screening data from 2010, 2015, and 2018, and restricted the sample to female participants without a hysterectomy who had a cervical cancer screening test in the prior 3 years. The primary outcome was self-reported abnormal result on a Pap and/or HPV test in the prior 3 years. Our main predictor was Veteran status. We used survey-weighted multivariable logistic regression to estimate odds of an abnormal screening result in the prior 3 years as a function of Veteran status, controlling first for age and survey year, then adding sociodemographic and health factors in subsequent models. The sample included 380 Veterans and 25,102 non-Veterans (weighted total population 104.9 million). Overall, 19.0% of Veterans and 13.7% of non-Veterans reported an abnormal cervical cancer screening test result in the prior 3 years (unadjusted p = 0.03). In the adjusted regression model, the previously observed association between Veteran status and abnormal screening result was explained by differences in sociodemographic and health factors between Veterans and non-Veterans (aOR 1.21, 95%CI 0.78–1.87). Nearly 1 in 5 Veterans with a recent cervical cancer screening test received an abnormal result. Clinicians should address modifiable risk factors and provide evidence-based follow-up for abnormal results.

Effect of Drinking Water and Sanitation on Child Undernutrition and Diarrhea in Lao PDR.

Childhood undernutrition and diarrhea remain a global health burden in the 21st century. We assessed the effect of access to basic drinking water and sanitation at home on reducing children's likelihood of being undernourished and experiencing diarrhea in Laos. We pooled two rounds of nationally representative cross-sectional household surveys: the Lao Social Indicator Surveys 2011/2012 and 2017, encompassing 23 070 children aged <5 years. We employed multivariate multilevel logistic regression for the analysis. The results showed that access to basic drinking water was associated with a reduced likelihood of undernutrition and was effective in improving child undernutrition. Moreover, access to basic sanitation reduced diarrhea in addition to undernutrition. Notably, sanitation facilities only mitigated childhood stunting and diarrhea when basic drinking water facilities were present in the household. We also confirmed that socio-economic disparities existed among children accessing basic drinking water and sanitation. Consequently, further efforts are needed toward equitable access to these facilities in Laos.

Assessing caregivers’ perceptions of treatment-seeking for suspected severe malaria in the Democratic Republic of the Congo

BackgroundMalaria remains a major public health issue in the Democratic Republic of the Congo (DRC), accounting for 44% deaths among outpatient visits in children < 5 years of age, and 22% of facility deaths. Understanding determinants of caregivers’ treatment-seeking patterns and decision-making is crucial in reducing the malaria burden.MethodsIn the frame of the Community Access to Rectal Artesunate for Malaria (CARAMAL) project, cross-sectional household surveys that randomly sampled villages and households were carried-out in three rural DRC health zones prior to the rollout of pre-referral Rectal Artesunate (RAS) and then 9 and 19 months after RAS rollout (post-RAS). Data were captured electronically through face-to-face interviews with the main caregivers of children < 5 years. Capillary blood samples of the children were tested for malaria and anaemia. The main study outcome was whether caregiver “sought treatment outside home” when the child had fever. Multilevel mixed effects logistic regression models using village as random effect and health zone as a fixed effect was performed to assess treatment-seeking predictors.Results2439 household interviews were completed (pre-RAS 888 and post-RAS 1551), including 316 and 653 treatment-seeking interviews. Overall, 3499 children < 5 years were tested for malaria and anaemia (pre-RAS 1,315 and post-RAS 2184). Caregiver’s recognition of severe malaria signs was poor, while knowledge of symptoms of uncomplicated malaria seemed high. Despite this, danger signs significantly increased the odds of seeking treatment (aOR = 2.12, 95%CI 1.03–4.38), the same was found for the “least poor” quintile (aOR = 3.01, 95%CI 1.03–8.82), as well as residents of Kingandu (aOR = 2.78, 95%CI 1.01–7.65). “Doing something at home” against fever negatively affected treatment-seeking in both study phases. RAS acceptance was high, at almost 100%. Malaria prevalence was higher post-RAS (45.2%) compared to pre-RAS (34.4%), p = 0.003, but anaemia, although high (≥ 75%), was similar in both study phases (p = 0.92).ConclusionIn remote communities with high malaria prevalence in the DRC, malaria remains a major problem. Improving the recognition of danger signs of severe disease and introducing pre-referral RAS may improve treatment-seeking and contribute to reducing malaria-related mortality among children—if quality of care can be guaranteed.

Assessment of medicines and potential pharmaceutical wastes management among households in Lamongan, Indonesia

Background: Storing medicines at home has been linked with irrational use, misuse, and pharmaceutical waste leading to an increased burden on the health system. Objective: This study examined the practice of storing and handling medicines at home, calculated the potential economic loss of pharmaceutical wastes, and measured the knowledge, attitude and practice (KAP) of household medicine management. Method: A cross-sectional household survey using a pre-validated ReDiUM (Return and Disposal of Unused Medications) questionnaire was conducted in Lamongan, Indonesia. A convenience sampling of 100 families was done and the findings were subsequently analysed. Results: A low portion of families (37%) obtained medicines from authorised pharmacies. The majority (68%) mentioned that housewives managed the medicines at home. More than half (57%) stated that they still keep the leftover medicines and only one-third of the respondents (37%) stored them in the medicine basket. As a result, potential economic loss was estimated at around $2 per family. The Spearman rank correlation coefficient test showed a strong positive association between knowledge and attitude (p &lt; 0.05) Conclusion: Management of medicines at home has been an underrated topic within contemporary pharmacy research despite its potential threat to community health.