Emergency Fund Research Articles

IHR-PVS National Bridging Workshop for Somalia: An interactive and participatory approach for operationalizing the One Health roadmap

BackgroundNational Bridging Workshops (NBW) are a tool for reviewing collaboration gaps between line ministries relevant to the One Health framework. MethodsThe NBW for Somalia was held on November 11–13, 2023 in Nairobi, Kenya with support from WHO and WOAH. Participants included representatives from the Somali government both national and sub-national (including Ministry of Health; Ministry of Livestock, Forestry and Range; Ministry of Agriculture and Irrigation; and Ministry of Environment and Climate Change). Other participants included representatives from non-governmental organizations, academia and the quadripartite. Structured sessions guided participants through a step-by-step process, starting from identifying gaps to collectively developing solutions. The design of these sessions aimed to foster active engagement and collaboration with the outcomes of each session contributing to the subsequent one. ResultsA total of 60 participants partook in the exercise, representing human health (35%), animal health (27%), agriculture (13%), environmental health (7%) and other relevant sectors (18%). Eighty-three percent of participants represented the national level and 17% the sub-national level. The collaborative effort yielded a joint roadmap comprising 36 activities and 11 objectives. Priority objectives included: development of national joint surveillance systems for selected One Health threats (41/47 votes, or 87% of the total votes); establishment of a high-level ministerial system to govern and coordinate One Health activities (30/47; 64%); and establishment of emergency funding structures for priority zoonotic diseases along with development of a 5-year national investment plan for One Health (27/47; 57%). A total of 94% of activities required low or moderate cost to be implemented, and 90% of activities were identified to have a likely high impact on multisectoral collaboration. The timeline for implementing the activities is projected to span one to two years. ConclusionThe workshop promoted high-level engagement, national ownership, and leadership in addressing health threats at the human-animal-environment interface. The resulting co-created roadmap will be integrated into the National Action Plan for Health Security, supporting ongoing One Health efforts in Somalia.

The Role of Breastfeeding in Acute Respiratory Infections in Infancy.

Acute respiratory infections (ARIs) affect the respiratory tract, are often caused by viruses such as respiratory syncytial virus and rhinovirus, and present symptoms such as coughing, fever, respiratory distress, and breathing difficulty. The global adherence to exclusive breastfeeding (BF) for the first 6 months of life has reached 44%, supported by the World Health Organization and United Nations International Children's Emergency Fund efforts. BF provides vital nutrients and contributes to infant immune system development, protecting against infections. The role of BF in preventing and reducing complications of ARIs in infants is gaining attention, prompting a review of current data and future research needs. This review aims to summarize the evidence on the role of BF in reducing the risk and severity of ARIs in infants, elucidate the adaptations in breast milk composition during infections, and identify relevant research needs. Human milk (HM) is rich in immunoglobulins, antimicrobial peptides, and immunomodulatory factors that protect against various pathogens, including respiratory viruses. Several studies have demonstrated that BF is associated with a significant reduction in hospitalization, oxygen requirements, and mortality in infants with ARIs. The effectiveness of BF varies according to the specific respiratory virus, and a longer duration of exclusive BF appears to enhance its protective effect. It is documented that the composition of HM adjusts dynamically in response to infections, fortifying the infant's immune defenses. Specific immunological components of HM, including leukocytes and immunoglobulins, increase in response to infection in the infant, contributing to the enhancement of the immune defense in infants. Immune-boosting microRNAs enhance immune transfer to the infants and promote early gut maturation, and the HM microbiome along with other factors modifies the infant's gut microbiome and immune system. BF defends infants from respiratory infections, and the investigation of the microRNAs in HM offers new insights into its antiviral properties. The promotion of BF, especially in vulnerable communities, is of paramount importance in alleviating the global burden of ARIs in infancy.

Prevalence of Fluorosis in Endemic Area of Sonebhadra, Uttar Pradesh: A Pilot Epidemiological Survey

Abstract Background: A long-term excess of fluoride ingestion from drinking water, food substances, and industrial pollution may result in fluorosis, a public health hazard. This survey aims to investigate the prevalence of dental and skeletal fluorosis, as well as the role of dietary variables. Materials and Methods: A cross-sectional survey was conducted in Sonebhadra district. The Dean’s Fluorosis Index and physical exercises demonstrated by the United Nations International Children’s Emergency Fund for diagnosing dental and skeletal fluorosis, respectively. The dietary habits of the participants were ascertained using a prevalidated questionnaire. Results: The participants’ socioeconomic status varied widely with heterogeneity. The frequent abnormalities found were genu varum (21.5%), genu valgum (6.8%), dental fluorosis (52.3%), and skeletal fluorosis (25.8%). Consequently, eight cases reported of multiple deformities. Conclusion: The findings showed the increased prevalence of moderate-to-severe fluorosis in fluoride endemic areas of Sonebhadra district. Dental fluorosis was more common in those aged 18–64 years, particularly in males, but skeletal fluorosis increased with age.

Multiple Linear Regression Analysis of Factors Contributing to the Spread of Cholera in Kenya from 2000 to 2022

Cholera is a deadly disease caused by consumption of either food or water that is contaminated with bacterium known as Vibro cholerae. In the 19<sup>th</sup> century, Cholera had spread across the globe from its original source in Ganges Delta, India. This research aimed to investigated the factors contributing to the spread of Cholera in Kenya from 2000 to 2022. The key objective was to fit a multiple linear regression model which aid in determining the goodness of fit as well as examining the relationship between different types of drinking water and spread of Cholera. Secondary data was obtained from United Nations International Children’s Emergency Fund (UNICEF) and World Health Organization (WHO). The results showed a strong positive linear relationship between Surface water and proportion of population affected by Cholera. 88% total variation in the proportion of population being affected by Cholera can be explained by the Unimproved Basic water (UBW), Surface water (SW) and Least Basic drinking water (LBW). Significantly this research encouraged the use of the least basic drinking water which clearly showed an inverse proportion to the proportion of population affected by Cholera. In addition to that, the researchers recommend improved access to clean water and create awareness on the dangers of using untreated water.

Insurance Sector Performance and the Nigeria’s Economic Growth

The study examines insurance industry’s contribution to economic growth in Nigeria. For estimation analysis, the study employed Autoregressive Distributive Lag (ARDL) bond test, Error Correction Mechanism (ECM) and Diagnostic test.). The findings revealed that at 5% level of significance in the short run, life premium (LP) related positively with growth rate (GR) in an insignificant manner while non-life premium (NLP) contributed negatively and insignificantly to growth rate. However, in the long run, life and nonlife insurance premium influences the growth of the Nigerian economy. Therefore, the study concludes that without insurance coverage, substantial emergency funds would be looked-for to protect firms against risks. Based on the findings, the study recommends among others that life insurance companies should come up with life products mainly designed for the low-paid earners to enhance penetration, deepen the market and to create more awareness to improve the participation of product industry and firms as this will intensify the activities of the insurance industry in Nigeria. Also, insurance companies should increase diversification of insurance products mostly in non-life businesses being embarked upon.

Meningkatkan Literasi Keuangan dan Akuntansi dalam Masyarakat

Socialization activities to improve financial and accounting literacy in the community were carried out in Rumah Tiga Village, focusing on the role of financial and accounting literacy in family financial management. Rumah Tiga Village was chosen because it still needs understanding and skills about financial management and accounting to support economic development and community welfare. The methods used in this activity include practical demonstrations, surveys to the community, as well as cooperation with Rumah Tiga Village officials. The main focus of this socialization was to increase understanding of household financial management, achieving future financial goals, the importance of long-term savings, education on future investments, and emergency funds to avoid future financial difficulties. The role of accounting in recording income and expenses, preparing budgets, and understanding how to make household financial reports are important points for the community to become better at managing their finances. The implementation of this socialization activity is tailored to the needs of the village community, involving cooperation with the village government to increase understanding of financial literacy and accounting. It is hoped that this activity can provide good knowledge to the Rumah Tiga community about financial literacy and accounting in the community.

Youth mental health in a Canadian community sample during COVID-19: Exploring the role of perceived sense of belonging.

Research has linked broad societal changes related to the COVID-19 pandemic and poorer mental health in young people. There remains a pressing need for studies examining the factors that are associated with better mental health and well-being. The current study addresses this gap using a community-based survey called the Waterloo Region Youth Impact Survey. It was designed in partnership with local youth and the Canadian Index of Well-Being in accordance with United Nations International Children's Emergency Fund guidelines. Using a convenience sampling methodology, this survey was developed to explore the domains, rates, and correlates of well-being and mental health among youth during the pandemic (N = 297). Confirmatory factor analysis was used to identify dimensions related to children's social environment (friends, school, family), sense of belonging, mental health, and well-being. Subsequently, a mediation model was tested. The relationship between children's environments and mental health and well-being operated via perceived sense of belonging. Findings shed light on patterns of youth mental health and well-being during the pandemic, illustrating the role of belonging as a promotive factor with public health relevance.

Preparing Vulnerable Communities: Disaster Mitigation Strategies for Economically Depressed Areas in Oklahoma

When disasters strike, vulnerable areas that are economically disadvantaged are adversely affected economically, culturally, and healthily, as the lack of resources and vulnerabilities amplify their problems. This research focuses on the population specifics of disaster vulnerabilities and targeted policies for economically depressed neighborhoods in Oklahoma. Relative to less susceptible entities, poor people are likelier to take damage from tornados, winter storms, wildland fires, and flooding because they lack the resources required for preparation, response, and recovery. Through an equity-focused lens, the study examines four key factors amplifying disaster risk: those due to aging critical infrastructure, lack of insurance and savings, health disparities, or the failure to plan adequately. Collapsed stormwater drainage systems, roads, bridges, and water pipes in financially deprived communities experience cracks in a hurry during duresses. With little or no funds, families earning every paycheck cannot afford to purchase rescue insurance or, in the case of names, save money to build an emergency fund, including money to cover repair costs, temporary housing, and other costs. This is, of course, made even worse by any previously existing medical, disability, or mental health issues as well, with poorer health outcomes than might usually be expected since access to healthcare services, treatments, and medications is also disrupted. Lastly, language and education barriers lead to the lower development of disaster plans; the delays include access to early warning systems and a need for more awareness of risks among vulnerable groups. Given these weaknesses, the study offers policymakers, funders, and resilience practitioner’s implementable policy, investment, and community-oriented intervention recommendations. The hazards can be lessened by prioritizing infrastructure upgrades, insurance reduction, and commitment to spread-out shelters and relief supplies. Long-term recovery programs financed specifically by equal aid promote program equity of rebuilding. Regarding inclusive messaging on public preparation and early warnings, local trusted institutions should be appropriated to reach a diverse population. Collaborative networks among government agencies, relief organizations, businesses, and grassroots associations can bolster response capacity. Their unified efforts on localized resilience initiatives advance strategic plans for the state's most economically fragile neighborhoods. Implementation should focus on those with the highest vulnerability markers and the least ability to prepare, respond, and recover independently— metrics assessing community functionality, equity factors, and recovering spending offer evidence-based progress milestones. With climate change projected to increase disaster severity in Oklahoma, research-driven and equitable resilience policies for marginalized communities can reduce prolonged suffering. Tailored preparation, outreach, critical system backups, and financial support lessen acute shocks and accelerate recovery. However, sustainable policy change relies on addressing root socioeconomic inequalities through systemic interventions beyond immediate disaster management.

Gabriela Mistral: Nourished by and Constructed from the Sap and Blood of Life

Gabriela Mistral (1889-1957) was the first Latin American to win the Nobel Prize for Literature and was a mentor to Pablo Neruda who also went on to become a Nobel laureate, yet Mistral’s work is rarely studied in English translation today. This article aims to bring attention to the author’s life and legacy, particularly through her diplomatic work and writing, with an emphasis on Mistral’s poetry in the hope of returning Gabriela Mistral to a place of distinction and standing that encourages future reading and study. Illustrative of the author’s voice, excerpts of Mistral’s work are woven throughout. The article traces key moments in Mistral’s life from childhood in the Elqui Valley of Chile through her years as a rural schoolteacher and onward to her position as a leader in education reform in Mexico. Through both her writing and diplomatic work, Mistral gained worldwide prominence. Her work through the League of Nations demonstrated an ongoing concern for human rights and especially for the rights of children and women in poverty and in the workplace. She was instrumental in the founding of the United Nations Children’s Emergency Fund (UNICEF) and an advocate for writers and artists and their crucial role in illuminating important societal issues. The article highlights Mistral’s 1937 talk before the Committee on Letters and Arts in Paris and addresses her connection with Pablo Neruda and the story of Juan Miguel, whom she adopted and called Yin-Yin; Yin-Yin died tragically at age seventeen. Finally, the article provides an overview of the life influences, themes, and timing of each of Mistral’s four major collections of poetry in their English translation by Doris Dana (1971): Desolation (1922), Tenderness (1924), Felling (1938) and Wine Press (1954).

Pandemic highlights virtues of proper contingency planning, emergency funds

Over the last few years, one thing that has become clear is that being prepared for major challenges—both in terms of finances and limits on operations—helps a lot when unanticipated, “black swan”‐type events arise.

Receipt of COVID-19 emergency funds and engagement in sex work during COVID-19 among people who use drugs: evidence from Vancouver, Canada

BackgroundDuring the early period of the COVID-19 pandemic, public health orders disrupted income generation in numerous sectors and many governments provided emergency financial support. Access to government support and changes in engagement in sex work during the early period of the pandemic among people who use drugs (PWUD) are not well described. In the present study, we investigate the prevalence and correlates of engaging in sex work during the COVID-19 pandemic, among PWUD in Vancouver, Canada.MethodsData derived from three harmonized cohorts of PWUD. Using multivariable logistic regression, we characterized factors associated with engaging in sex work in the last month between July 17 and November 30, 2020. Reports of changes in frequency of engagement in sex work since the pandemic were also collected.ResultsOf the 864 individuals included in this analysis, 55 (6.4%) reported sex work engagement in the last month. Among these participants, 40.7% reported receiving COVID-19 income support in the past month vs. 52.7% of the rest of the sample, though receipt of income support in the past six months was similar between the two groups (72.2% vs. 75.7%, p = 0.624). In multivariable analysis, receipt of financial support in the last month was negatively associated with engagement in sex work in the last month (adjusted odds ratio [AOR] = 0.44 [95% confidence interval [CI]: 0.24–0.81]). Among 69 participants who responded to a question regarding changes in engagement in sex work, 38 (55.1%) reported a decrease, 11 (15.9%) reported an increase, 19 (27.5%) reported no change, and 1 (1.4%) reported cessation.ConclusionsFindings document that engagement in sex work appears to have declined early in the pandemic. Participants who received income support in the past month were less likely to report recent engagement in sex work. Findings suggest that recent receipt of income support may have contributed to reductions in engagement in sex work. Additional investigation is warranted.

Development of a Local Government Service Delivery Framework in Zambia: A Case of the Lusaka City Council, Ndola City Council and Kafue Town Council Roads and Storm Drain Department

The main aim of this study was to establish a framework to improve the service delivery on the maintenance of roads and storm drains in Lusaka by establishing the factors that impact the quality of service delivery and how these can be implemented by the Roads and Storm Drain Department on maintenance. The study included data collection and analysis of two additional councils such as Ndola City Council and Kafue Town Council to further substantiate the findings. The study considered four factors which included service quality as the dependent variable; and financing factors, administrative factors and institutional capacity as independent variables. The study made use of secondary data which was collected using a semi-structured questionnaire and followed a mixed methods research design. Data analysis was done using descriptive analysis and mean and standard deviation analysis for quantitative data alongside qualitative data analysis. In order to ensure an inclusive approach to improve the timely provision of road and storm drain maintenance in the bid to ensure improved service delivery, the study argues that first and foremost, stakeholder engagement should be prioritized. Matters should be considered on merit and based on urgency. The study further notes that locality and having the right logistics in terms of equipment and manpower available so the timeliness is a constrained factor. However, this can only be achieved given the adoption of a deliberate systematic and approved framework on roads and storm drain maintenance. The study further outlines that the framework should ensure to avoid tedious processes but should ensure to maintain high integrity of the processes through transparency and accountability. The study further finds that there is need for a clearly defined source of funding for matters relevant to road and storm drain maintenance, having a dedicated fund and should further have an emergency fund available solely for the purposes of roads and storm drain maintenance.

An Assessment of Knowledge of Health Workers in Hospitals of Southern Province of Zambia, Towards Marketing of Breastmilk Substitutes Regulations

Background: Optimal breastfeeding practices have been undermined by unregulated marketing of breastmilk substitutes worldwide, resulting in about 820, 000 preventable deaths per year among children under five years globally. The International Code (thereafter called the Code) of Marketing Breastmilk Substitutes was developed by the World Health Organization, the United Nations Children's Emergency Fund and stakeholders to protect, promote and support breastfeeding. Member states are expected to domesticate the Code. Zambia enacted Statutory Instrument No. 48 of 2006, Regulations on marketing of breastmilk substitutes. Successful implementation calls for a good level of knowledge among health workers. However, we found no study, in Zambia on the marketing of breastmilk substitutes Regulations. Objective: To assess the level of knowledge of health workers on Zambia’s Regulations on marketing breastmilk substitutes. Study design and methods: A mixed-method cross-sectional study. Data was collected online and in person. Probability proportional to size calculation yielded an estimated sample size of 384. A sample size of 410 after adjusting upwards assumed non-response rate, 401 participants responded. Quantitative data were analyzed using the Social Statistical Package for Social Sciences. Knowledge results were described by frequencies and percentages. Tests were conducted using univariable linear and multivariable regression analysis. A p-value of <0.05 was considered statistically significant. Thematic analysis was used for qualitative data analysis. Results: The mean overall level of good knowledge of health workers was 0.339 or 34% [SE: 0.0221; 95%CI: (0.2959, 0.3828)]. Conclusion: The level of knowledge among health workers in hospitals of Southern Province, Zambia was poor.

Rule of Law and Human Rights: Analysis of International Standards and Case Law

The EU's human rights policies and actions have two main components: protecting the fundamental rights of EU citizens and promoting human rights around the world. One of the aspects that the UN focuses on is the relationship between democracy and human rights, as the organisation upholds the importance of equal political participation of citizens of its states and full respect for human rights, including the recognition, protection and promotion. As defined by the United Nations International Children's Emergency Fund (UNICEF), human rights are norms that recognise and protect the dignity of all people, meaning they apply to everyone, without distinction of race, gender, education, political opinion, sexual orientation or any other type of moral judgement. The realisation of human rights also obliges states to be responsible for protecting these norms and prohibits certain acts that violate them. Human rights can be said to be one of the greatest achievements of mankind. One of the most important human rights documents is the Universal Declaration of Human Rights, signed in 1948 at the UN General Assembly. Consisting of 30 articles, the Declaration formalises all the theoretical developments made earlier on civil, political, social, economic and cultural rights. Another innovation of the Declaration was the inclusion of human rights in the universal character, becoming the rights of all peoples. Thus, for the UN, human rights "are universal legal guarantees that protect individuals and groups from acts and omissions by governments that violate human dignity"3. Human rights are fundamental and therefore inalienable human rights, i.e. those rights whose violation would lead to an attack on the very essence of humanity. For this reason, it is important that everyone is aware of and knows about human rights, their content and the forms of protection provided for them, as everyone should be able to enjoy their fundamental rights for the sole purpose of living in peace, without distinction. Human rights, democracy and the rule of law create an environment in which countries can promote development, protect people from discrimination and ensure equal access to justice for all.

Economics of HIV Prevention: Understanding the Empirical Intersection between Commodity Price Shocks, Health Spending and HIV Infections in Developing Countries

Background: This study seeks to understand the empirical nature of macro-financial factors associated with the worsening of HIV infections and the risks that need to be carefully monitored for a sustainable improvement in HIV outcomes as developing countries seek to achieve the United Nations 95-95-95 targets. Methods: The author used a panel VAR model to study the long-term endogenous relationships between percentage changes in the annual spot price of the most traded commodities, GDP per capita, health spending, and the HIV infection rate of developing countries. Results: The author discovered that shocks of global commodity prices negatively impact GDP per capita, real government health spending, and real private health spending. These shocks have adverse spillover effects characterized by worsening HIV infections. The reactions from price shocks suggest that GDP per capita contract immediately when a commodity price shock hits developing economies. Real government health spending and real private health spending also contract instantly. HIV infections begin worsening three years after the shock in the energy and precious metal blocks of countries. HIV infections also begin to worsen two years after shocks in the agricultural block of counties. These impacts are statistically significant and can potentially reverse the positive HIV infection gains achieved in the previous years. Emergency funds, insurance schemes, and international aid for HIV need to discharge more funds to counter these shocks. Conclusions: There is a significant risk of reversing HIV infection outcomes arising from commodity price shocks. Funding agencies must protect HIV prevention services from global macro-economic shocks as countries move closer to the United Nations 95-95-95 targets.

Exploring trends and determinants of basic childhood vaccination coverage: Empirical evidence over 41 years.

Vaccination is widely considered to be one of the most important prevention measures as a health strategy. This paper examines trends in basic childhood vaccination coverage and which country and time-dependent determinants may have influenced childhood immunization rates (1-dose BCG, 1- and 3-dose DTP (diphtheria, tetanus, pertussis), 1-dose measles, and 3-dose polio) between 1980 and 2020 across 94 countries. We identify economic, inequality, demographic, health, education, labor market, environmental, and political stability factors of immunization. To do this, we use data from the annual WHO and United Nations International Children's Emergency Fund (UNICEF) coverage estimates. The empirical analysis consists of generalized estimating equation models to assess relationships between immunization rates and socioeconomic factors. Additionally, we follow the Barro and Sala-i-Martín approach to identify conditional convergence. Our findings show the strongest positive statistically significant association between immunization rates and GDP per capita, as well as births attended by skilled health staff. Moreover, our research demonstrates conditional convergence, indicating that countries converge towards different steady states. The present study brings new insights to investigating the determinants of childhood vaccination coverage and provides significant implications for health policies.

A STUDY ON COLD CHAIN MAINTENANCE AND VACCINE MANAGEMENT PRACTICES OF URBAN GOVERNMENT HEALTH FACILITIES IN JABALPUR DISTRICT, INDIA

Introduction: Efficient cold chain and vaccine logistics management are made possible by the health system's processes, practices, and policies, which are evaluated by Effective Vaccine Management, a diagnostic tool. A significant number of urban Jabalpur children receive vaccinations from a government health facility.The aim of the study wasto Assessthe cold chain maintenance and vaccine management practices at urban government Cold Chain Points of Jabalpur district.Methods:A cross-sectional study was carried out at all of 13 urban government ColdChain Points across Jabalpur district. Globally validated World Health Organization -United Nations International Children's Emergency Fund Effective Vaccine Management tool was used for this study. Criteria wise and Consolidated Effective Vaccine Management scores were calculated as per World Health Organization guidelines. Results: All the urban service point stores or cold chain points scored more than the target 80% in two criteria: storage capacity and building. The consolidated criteria score of all the cold chain points in urban Jabalpur, criteria like maintenance, stock management, management information system, and supportive functions, were lagging behind the 80% mark. Low scores in maintenance, stock management, and management information system and supportive functions criteria are somehow a setback for all the preparationand hard work done towards optimal vaccine management and supply chain in the area. Conclusion: The overall performance of the urban cold chain points in Jabalpur district was far better as compared to the state-level effective vaccine management assessment done in Madhya Pradesh in 2011 and 2016. Planned preventive maintenance for buildings and equipment needs to be strengthened. Issues like Lack of information for stock management, need for periodic refresher trainings are to be emphasized.

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A Risk Assessment and Planning Tool to Prevent Sudden Unexpected Death in Infancy: Development and Evaluation of The Baby Sleep Planner.

Successful national safer sleep campaigns in the United Kingdom have lowered the death rates from sudden unexpected death in infancy (SUDI) over the past 3 decades, but deaths persist in socioeconomically deprived families. The circumstances of current deaths suggest that improvements in support for some families to follow safer sleep advice more consistently could save lives. This study aimed to develop and evaluate a risk assessment and planning tool designed to improve the uptake of safer sleep advice in families with infants at increased risk of SUDI. A co-design approach was used to develop the prototype interface of a web-based tool with 2 parts: an individual SUDI risk assessment at birth and a downloadable plan for safety during times of disruption. The advice contained within the tool is concordant with national guidance from the Lullaby Trust, the United Nations International Children's Emergency Fund (UNICEF), and the National Institute for Health and Care Excellence. User testing of the prototype tool was conducted by inviting health visitors, midwives, and family nurses to use it with families eligible for additional support. Qualitative interviews with health professionals and families allowed for iterative changes to the tool and for insights into its function and influence on parental behavior. A total of 22 health professionals were enrolled in the study, of whom 20 (91%) were interviewed. They reported appreciating the functionality of the tool, which allowed them to identify at-risk families for further support. They felt that the tool improved how they communicated about risks with families. They suggested expanding its use to include relevance in the antenatal period and having versions available in languages other than English. They reported using the tool with 58 families; 20 parents gave consent to be interviewed by the research team about their experiences with the tool. Families were positive about the tool, appreciated the trustworthy information, and felt that it was useful and appropriate and that the plans for specific infant sleeps would be of benefit to them and other family members. Our tool combines risk assessment and safety planning, both of which have the potential to improve the uptake of lifesaving advice. Refinements to the tool based on these findings have ensured that the tool is ready for further evaluation in a larger study before being rolled out to families with infants at increased risk.

Cost of mate choice: Changing patterns of global age disparity in marriage and their consequences to women's health including maternal mortality and menopause.

Consistent across cultures and throughout time is the male preference for younger females. Given its prevalence, the mate choice theory proposes that age-disparate relationships may have contributed to the evolution of maternal mortality and menopause. The objective is to document evidence for age disparity in marriage from past and present populations and evaluate their relevance to maternal mortality and menopause. Cross-sectional data were collected from various regions and time points, ranging from the Roman era to the current decade. To analyze both the age disparity in marriage and age at marriage, data were collected from Ancestry.ca for Quebec, Massachusetts, India, South Africa, and England and Wales. Additional data were taken from the United Nations as a more recent and comprehensive source. To analyze the relationships between age disparity in marriage and different social factors, data on gross domestic product, maternal mortality rates, fertility, primary school enrollment, child marriage rates, and percentage of women in the total labor force were collected from the World Health Organization, World Bank, and United Nations International Children's Emergency Fund. The results showed that males were significantly older than females at first marriage in all populations and time frames sampled, supporting the assumption underlying the mate choice theory. Maternal mortality rates were strongly associated with age-disparate relationships, increasing by 275 per 100,000 live births for each additional year in the age disparity. The results from this study provide support for the assumption underlying the mate choice theory of maternal mortality and menopause.