Quintile Of Consumption Research Articles

Habitual dietary sodium intake is inversely associated with coronary flow reserve in middle-aged male twins

Evidence links dietary sodium to hypertension and cardiovascular disease (CVD), but investigation of its influence on cardiovascular function is limited. We examined the relation between habitual dietary sodium and coronary flow reserve (CFR), which is a measure of overall coronary vasodilator capacity and microvascular function. We hypothesized that increased sodium consumption is associated with lower CFR. Habitual daily sodium intake for the previous 12 mo was measured in 286 male middle-aged twins (133 monozygotic and dizygotic pairs and 20 unpaired twins) by using the Willett food-frequency questionnaire. CFR was measured by positron emission tomography [N(13)]-ammonia, with quantitation of myocardial blood flow at rest and after adenosine stress. Mixed-effects regression analysis was used to assess the association between dietary sodium and CFR. An increase in dietary sodium of 1000 mg/d was associated with a 10.0% lower CFR (95% CI: -17.0%, -2.5%) after adjustment for demographic, lifestyle, nutritional, and CVD risk factors (P = 0.01). Across quintiles of sodium consumption, dietary sodium was inversely associated with CFR (P-trend = 0.03), with the top quintile (>1456 mg/d) having a 20% lower CFR than the bottom quintile (<732 mg /d). This association also persisted within pairs: a 1000-mg/d difference in dietary sodium between brothers was associated with a 10.3% difference in CFR after adjustment for potential confounders (P = 0.02). Habitual dietary sodium is inversely associated with CFR independent of CVD risk factors and shared familial and genetic factors. Our study suggests a potential novel mechanism for the adverse effects of dietary sodium on the cardiovascular system. This trial was registered at clinicaltrials.gov as NCT00017836.

Meat consumption in relation to mortality from cardiovascular disease among Japanese men and women

Although high or low (no) meat consumption was associated with elevated or reduced mortality from cardiovascular disease, respectively, few studies have investigated the association between moderate meat consumption and cardiovascular disease. We aimed to evaluate the associations between moderate meat consumption and cardiovascular disease mortality. We conducted a prospective cohort study of 51,683 Japanese (20,466 men and 31,217 women) aged 40-79 years living in all of Japan (The Japan Collaborative Cohort Study; JACC Study). Consumptions of meat (beef, pork, poultry, liver and processed meat) were assessed via a food frequency questionnaire administrated at baseline survey. Hazard ratios (HRs) of mortality from cardiovascular disease were estimated from Cox proportional hazards regression models according to quintiles of meat consumption after adjustment for potential confounding variables. During 820,076 person-years of follow-up, we documented 2685 deaths due to total cardiovascular disease including 537 ischemic heart diseases and 1209 strokes. The multivariable HRs (95% confidence interval) for the highest versus lowest quintiles of meat consumption (77.6 versus 10.4 g/day) among men were 0.66 (0.45-0.97) for ischemic heart disease, 1.10 (0.84-1.43) for stroke and 1.00 (0.84-1.20) for total cardiovascular disease. The corresponding HRs (59.9 versus 7.5 g/day) among women were 1.22 (0.81-1.83), 0.91 (0.70-1.19) and 1.07 (0.90-1.28). The associations were similar when the consumptions of red meat, poultry, processed meat and liver were examined separately. Moderate meat consumption, up to ~100 g/day, was not associated with increased mortality from ischemic heart disease, stroke or total cardiovascular disease among either gender.

The effect of dairy consumption on blood pressure in mid-childhood: CAPS cohort study

It has been postulated that a higher dairy consumption may affect blood pressure regulation. The aim of this study was to examine the association between dairy consumption and blood pressure in mid-childhood. Subjects (n = 335) were participants of a birth cohort at high risk of asthma with information on diet at 18 months and blood pressure at 8 years. Multivariate analyses were used to assess the association of dairy consumption (serves) and micronutrient intakes (mg). In a subgroup of children (n = 201), dietary intake was also measured at approximately 9 years. Children in the highest quintile of dairy consumption at 18 months had lower systolic blood pressure (SBP) and diastolic blood pressure (DBP) at 8 years (2.5 mm Hg, P=0.046 and 1.9 mm Hg, P = 0.047, respectively) than those in the lowest quintiles. SBP was lowest among children in the highest quintiles of calcium, magnesium and potassium intakes. Significant negative linear trends were observed between SBP and intakes of dairy serves, calcium, magnesium and potassium. Furthermore, SBP and DBP were lowest in the group of children that consumed at least two dairy serves at both 18 months and the follow-up dietary data collection at 9 years, compared with all other children (SBP 98.7 vs 101.0 mm Hg, P = 0.07; and DBP 56.5 vs 59.3 mm Hg, P = 0.006, respectively). These results are consistent with a protective effect of dairy consumption in childhood on blood pressure at age 8 years.

Distribution Effects Of Gasoline Taxes In The South: Comparison Of the Expenditure and Income Approaches

Variations in the spending on gasoline and motor oil by quintiles are determined using both an income and expenditure base. Total expenditure data in relationship to expenditures on gasoline and motor oil in the Southern urban areas in 1990 are a relatively stable percent over the first four expenditure quintiles, 4.4 to 4.5 percent. Using income before taxes, depicts a continual decrease in the percent of income spent on gasoline, as expected. In the Southern states a gasoline tax loses much of its regressivity when permanent income is used as the base, and becomes markedly regressive when income before taxes becomes the basis for determining the tax burden.

Moderating Effects of Interactions Between Dietary Intake and Socioeconomic Status on the Prevalence of Metabolic Syndrome

The purpose of this study is to examine how nutrients can affect the relationship between the development of metabolic syndrome (MS) and socioeconomic factors. This study was based on data obtained from the 2005 Korea National Health and Nutrition Examination Survey was conducted as a health survey of nationally representative samples of non-institutionalized Korean. The final sample was composed of 3146 people over 40 years of age. The relationship between the prevalence of MS and socioeconomic factors was associated with the consumption of nutrients. The slope of the graphs increased sequentially from the 1st quintile to 5th quintile of nutrient consumption. However, the directions of the 4th and 5th quintile were reversed from that of the 1st, 2nd, and 3rd quintile in reference to the horizontal axis. That is, the 1st, 2nd, and 3rd quintiles indicate that higher household income was associated with lower prevalence of MS. However, the plots for the 4th and 5th quintile indicate that higher the household income was associated with higher the prevalence of MS. This tendency was shown in all the models that yielded statistically significant confirmation of moderating effects. The association between the prevalence of MS and different socioeconomic status varies according to the level of nutrient consumption.

Socioeconomic disparities and the familial coexistence of child stunting and maternal overweight in guatemala

The double burden of malnutrition, defined here as households with a stunted child and an overweight mother (SCOM), is a growing problem in Guatemala. We explored the magnitude of SCOM and the identification of socio-economic factors associated with this malnutrition duality. From the 2000 Living Standards Measurement Study from Guatemala, we obtained a sample of 2492 households with pairs of children 6–60 months and their mothers (18–49 years) and estimated the prevalence of SCOM. Economic characteristics of this sample were assessed with the Concentration Index (CI). Results revealed higher prevalence of child stunting, but a lower prevalence of maternal overweight among the poor compared to the rich households. Economic inequality in child stunting was greater than economic inequality in maternal overweight (CI=−0.22 vs. +0.14). SCOM pairs were more prevalent among the poor and middle SES groups as compared to the rich households. A multivariate logistic regression model showed that SCOM was more likely to occur in households from the middle consumption quintile than in those from the first quintile (odds ratio=1.7). The findings reported here add new insights into the complex phenomenon observed in households with both extremes of the malnutrition continuum, and support the need for the identification of economic, social and biological interventions aimed at, on the one hand, the prevention of this duality of the malnutrition in those households where it is still non-existent, and on the other hand, to deter or correct the economic, social and biological environments where those mother–child dyads are already affected by such phenomena.

Fast-food and commercial baked goods consumption and the risk of depression

Whereas the relationship between some components of diet, such as n-3 fatty acids and B-vitamins, and depression risk has been extensively studied, the role of fast-food or processed pastries consumption has received little attention. Consumption of fast food (hamburgers, sausages, pizza) and processed pastries (muffins, doughnuts, croissants) was assessed at baseline through a validated semi-quantitative FFQ. Participants were classified as incident cases of depression if they reported a physician diagnosis of depression or the use of antidepressant medication in at least one of the follow-up questionnaires. Cox regression models were fit to assess the relationship between consumption of fast food and commercial baked goods and the incidence of depression. The SUN (Seguimiento Universidad de Navarra - University of Navarra Follow-up) Project, Spain. Participants (n 8964) from a Spanish cohort. After a median follow-up of 6·2 years, 493 cases of depression were reported. A higher risk of depression was associated with consumption of fast food (fifth (Q5) v. first quintile (Q1): hazard ratio (HR) = 1·36; 95 % CI 1·02, 1·81; P trend = 0·003). The results did not change after adjustment for the consumption of other food items. No linear relationship was found between the consumption of commercial baked goods and depression. Participants belonging to consumption quintiles Q2-Q5 showed an increased risk of depression compared with those belonging to the lowest level of consumption (Q1; HR = 1·38; 95 % CI 1·06, 1·80). Fast-food and commercial baked goods consumption may have a detrimental effect on depression risk.

Red meat consumption and risk of stroke in Swedish men

Red and processed meat consumption has been implicated in several diseases. However, data on meat consumption in relation to stroke incidence are sparse. Our objective was to examine the associations of red meat and processed meat consumption with stroke incidence in men. We prospectively followed 40,291 men aged 45-79 y who had no history of cardiovascular disease or cancer at baseline. Meat consumption was assessed with a self-administered questionnaire in 1997. During a mean follow-up of 10.1 y, 2409 incident casesof stroke (1849 cerebral infarctions, 350 hemorrhagic strokes, and 210 unspecified strokes) were identified from the Swedish Hospital Discharge Registry. Consumption of processed meat, but not of fresh red meat, was positively associated with risk of stroke. The multivariable relative risks (RRs) of total stroke for the highest compared with the lowest quintiles of consumption were 1.23 (95% CI: 1.07, 1.40; P for trend = 0.004) for processed meat and 1.07 (95% CI: 0.93, 1.24; P for trend = 0.77) for fresh red meat. Processed meat consumption was also positively associated with risk of cerebral infarction in a comparison of the highest with the lowest quintile (RR: 1.18; 95% CI: 1.01, 1.38; P for trend = 0.03). The findings from this prospective cohort of men indicate that processed meat consumption is positively associated with risk of stroke. The Cohort of Swedish Men is registered at clinicaltrials.gov as NCT01127711.

Fish Consumption and Risk of Stroke

Evaluation of: Larsson SC, Virtamo J, Wolk A: Fish consumption and risk of stroke in Swedish women. Am. J. Clin. Nutr. 93(3), 487-493 (2010). A population-based prospective study of 34,670 women in the Swedish Mammography Cohort was conducted, aiming to examine the associations between fish consumption and stroke incidence in women. After a mean follow-up of 10.4 years, 1680 cases of stroke were recorded. Fish consumption was inversely associated with risk of total stroke, but not cerebral infarction or hemorrhagic stroke. Compared with women in the lowest quintile of fish consumption, those in the highest quintile had a 16% lower risk of stroke. In addition, consumption of lean fish, but not of other fish types, was inversely associated with risk of stroke.

Consequences, Correlates, and Compliments of Adult Milk Consumption

Milk, being high in protein, calcium, vitamins A, C, and D, is one of the healthier beverages an adult can drink. Even so, milk's nutritional benefits to one's diet may be understated if not examined in the context of the beverages it substitutes for and the foods it compliments. In this study we segment NHANES 2007–2008 participants into three groups: 1) non-users (non-milk drinkers), 2) light users (the lowest consumption quintile of milk drinkers), and 3) heavy users (the highest consumption quintile of milk drinkers). We look at the age and gender controlled cross-elasticities between heavy milk consumption and various other behaviors and food choices. Consistent with expected substitution effects, we find that heavy milk drinkers consume less full calorie soda, less alcohol, and have lower caffeine intakes. Perhaps more surprisingly we find that heavy milk drinkers consume food quite differently than the other two groups. Such patterns include finding that heavy milk drinkers consume 50% more fruit than non-milk drinkers and consume 20% less fast food. There are also key differences in the nutrient intake in the diet. Besides exploring the complimentarity of milk and various foods, we also identify possible spillover costs that are correlated with high levels of adult milk consumption.

Fish consumption and risk of stroke in Swedish women

Epidemiologic studies of fish consumption in relation to risk of stroke have yielded inconsistent results. In this study, we examined the association between fish consumption and stroke incidence in women. We analyzed data from a population-based prospective cohort of 34,670 women in the Swedish Mammography Cohort who were free of cardiovascular disease and cancer at baseline. Information on fish consumption was obtained by a self-administered questionnaire in 1997. Incident cases of stroke were ascertained from the Swedish Hospital Discharge Registry. We used Cox proportional hazards regression to estimate relative risks (RRs) and 95% CIs. Over a mean follow-up of 10.4 y, we ascertained 1680 incident cases of stroke, including 1310 cerebral infarctions, 233 hemorrhagic strokes, and 137 unspecified strokes. Fish consumption was significantly inversely associated with risk of total stroke but not with cerebral infarction or hemorrhagic stroke. Compared with women in the lowest quintile of fish consumption (<1.0 serving of fish/wk), the multivariable RR of total stroke for women in the highest quintile (>3.0 servings of fish/wk) was 0.84 (95% CI: 0.71, 0.98; P for trend = 0.049). Consumption of lean fish but not of other fish types was inversely associated with risk of stroke. The multivariable RR of total stroke was 0.67 (95% CI: 0.49, 0.93; P for trend = 0.07) for ≥3 servings of lean fish/wk compared with that for no consumption. These results suggest that the consumption of fish, especially of lean fish, may reduce risk of stroke in women. This trial was registered at clinicaltrials.gov as NCT01127698.

Different kinds of vegetable oils in relation to individual cardiovascular risk factors among Iranian women

Detrimental effects of trans-fats on lipid profiles, blood pressure and plasma glucose levels have been documented by short-term clinical trials with high doses of trans-fats, but limited observational studies have considered habitual consumption of partially hydrogenated vegetable oil (PHVO) and these outcome variables, particularly hypertension. We aimed to evaluate the association of PHVO and non-hydrogenated vegetable oils (non-HVO) intake with individual cardiovascular risk factors. In a cross-sectional study of 486 Iranian adult women, usual dietary intakes were assessed, and fasting plasma glucose (FPG), lipid profiles and blood pressure were measured. PHVO (commonly used for cooking in Iran) were considered as the PHVO category. Sunflower oil, maize oil, rapeseed oil, soyabean oil and olive oil were defined as the non-HVO category. Diabetes (FPG ≥ 1260 mg/l), dyslipidaemia (based on Adult Treatment Panel III) and hypertension (based on Joint National Committee VI) were defined. The presence of 'at least one risk factor' and 'at least two risk factors' of the three major risk factors for CVD (hypertension, dyslipidaemia and diabetes) was also evaluated. After controlling for age and other potential confounders, a high consumption of HVO was associated with a greater risk of having dyslipidaemia (OR for top v. bottom quintile 5·04; 95 % CI 2·70, 9·36), hypertension (OR for top v. bottom quintile 3·03; 95 % CI 1·55, 6·10), at least one (OR for top v. bottom quintile 8·52; 95 % CI 4·41, 16·41) and at least two risk factors (OR for top v. bottom quintile 3·60; 95 % CI 1·64, 7·74), while those in the top quintile of non-HVO consumption had lower odds for all these conditions. Further adjustment for dietary intakes had little impact on these associations. Even after additional adjustment for BMI, the positive association of HVO and the inverse association of non-HVO with the above-mentioned cardiovascular risk factors remained significant, except for the association between non-HVO and hypertension that became marginally significant. No overall significant associations were found between the consumption of HVO and non-HVO and diabetes. Higher intakes of PHVO were associated with a greater risk of individual cardiovascular risk factors, while those of non-HVO were associated with a reduced risk.

Olive oil consumption and incidence of diabetes mellitus, in the Spanish sun cohort

The beneficial effects of the overall Mediterranean dietary pattern on cardiovascular risk factors and on carbohydrate metabolism are well known; however, it is unclear whether the consumption of olive oil in particular is able to reduce the incidence of type 2 diabetes. To evaluate the specific effect of olive oil consumption on the risk of developing type 2 diabetes mellitus in a large Spanish cohort (the SUN Project). We followed up 10,491 participants for a median of 5.7 years. Habitual diet was assessed at baseline with a semi-quantitative 136-item food-frequency questionnaire previously validated in Spain. The outcome of interest was incident type 2 diabetes diagnosed by a physician and confirmed by review of a medical report. The multivariate-adjusted odds ratios for incident type 2 diabetes for each of the 4 upper quintiles of olive oil consumption using the lowest quintile as the reference were assessed using logistic regression models. At baseline mean age was 38.9 + 11.38 year with a BMI of 23.8 + 3.41 kg/m². Forty two new cases of diabetes mellitus were diagnosed during follow-up. The adjusted odds ratio for the highest vs. the lowest quintile of consumption of olive oil was 1.11 (95% CI: 0.45-2.78; p for trend = 0.32). We found no association between olive oil consumption and the incidence of type 2 diabetes. The lack of association could be attributed to the small number of observed incident cases of diabetes. Further studies in Mediterranean countries with a longer follow-up and a higher baseline risk are needed to evaluate this association.

Red Meat Consumption and Risk of Stroke in Swedish Women

High red meat consumption has been associated with increased risk of some cancers and may also be a risk factor for cardiovascular diseases. However, epidemiological studies of red meat consumption in relation to risk of stroke are very limited. Our objective was to examine the association between red meat consumption and stroke incidence in the Swedish Mammography Cohort. We prospectively followed 34 670 women without cardiovascular disease and cancer at baseline. Participants completed a self-administered questionnaire on diet and other risk factors for cardiovascular diseases in 1997. Cox proportional hazards models were used to estimate multivariable-adjusted relative risks (RR) and 95% CI. During a mean follow-up of 10.4 years, we ascertained 1680 incident cases of stroke, comprising 1310 cerebral infarction, 154 intracerebral hemorrhage, 79 subarachnoid hemorrhage, and 137 unspecified stroke. Total red meat and processed meat consumption was associated with a statistically significant increased risk of cerebral infarction, but not of total stroke, intracerebral hemorrhage, or subarachnoid hemorrhage. The multivariable RR of cerebral infarction for the highest versus the lowest quintile of consumption were 1.22 (95% CI, 1.01-1.46) for red meat and 1.24 (95% CI, 1.04-1.49) for processed meat. Fresh (unprocessed) meat consumption was not associated with total stroke or with any stroke subtype. Findings from this study suggest that red and processed meat consumption may increase the risk of cerebral infarction in women.

Equity aspects of the National Health Insurance Scheme in Ghana: Who is enrolling, who is not and why?

To improve equity in the provision of health care and provide risk protection to poor households, low-income countries are increasingly moving to social health insurance. Using data from a household survey of 3301 households conducted in 2009 this study aims to evaluate equity in enrollment in the National Health Insurance Scheme (NHIS) in Ghana and assess determinants of demand across socio-economic groups. Specifically by looking at how different predisposing (age, gender, education, occupation, family size, marital status, peer pressure and health beliefs etc) enabling (income, place of residence) need (health status) and social factors (perceptions) affect household decision to enrol and remain in the NHIS. Equity in enrollment is assessed by comparing enrollment between consumption quintiles. Determinants of enrolling in and dropping out from NHIS are assessed using a multinomial logit model after using PCA to evaluate respondent's perceptions relating to schemes, providers and community health 'beliefs and attitudes'. We find evidence of inequity in enrollment in the NHIS and significant differences in determinants of current and previous enrollment across socio-economic quintiles. Both current and previous enrollment is influenced by predisposing, enabling and social factors. There are, however, clear differences in determinants of enrollment between the rich and the poor. Policy makers need to recognize that extending enrollment will require recognition of all these complex factors in their design of interventions to stimulate enrollment.

An Analysis of Alternative Weighting System on the National Price Index in Tanzania: The Implication to Poverty Analysis

This paper set out to calculate and compare “plutocratic” inflation to “democratic” inflation in Tanzania using monthly price data from 2003 to 2006 and the 2000/2001 National Household Survey data with the view to assess their impact on the poor. The paper first compares national inflation for plutocratic weighted price index against the inflation based on democratic weighted price index. Then the paper calculates “plutocratic” and “democratic” inflation for poor households and compares this to the non-poor households. Finally, the paper calculates both the “plutocratic” and “democratic” inflation for the households in the lowest quintile of consumption and compare to similar inflation for the highest quintile. The paper finds that the plutocratic weighted inflation tends to be more sensitive to the changes in the prices of goods that are mostly consumed by the rich, while the democratic weighted inflation tends to be more sensitive to changes in the prices of goods consumed by the poor. The paper further finds that inflation rates based on “plutocratic” weights is generally lower than the inflation rate based on “democratic” weight, suggesting that the official inflation rate, which is based on the plutocratic weighting system, understates the inflationary burden to the poor In particular, the democratic inflation is found to be more pro-poor than plutocratic inflation rate. For this reason, the paper recommends that “democratically weighted” inflation should be preferred to “plutocratic weighted” inflation. Key Words: Tanzania, Africa, Inflation, Plutocratic Weights, Democratic Weights, CPI

Long chain n-3 fatty acids intake, fish consumption and suicide in a cohort of Japanese men and women — The Japan Public Health Center-based (JPHC) Prospective Study

Objective Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have been implicated as protective against suicide. However, it is uncertain whether a higher intake of EPA and DHA or of fish, a major source of these nutrients, lowers suicidal risk among Japanese, whose fish consumption and suicide rate are both high. This study prospectively examined the relation between fish, EPA, or DHA intake and suicide among Japanese men and women. Method Subjects were 47,351 men and 54,156 women aged 40–69 years who participated in the JPHC Study, completed a food frequency questionnaire in 1995–1999, and were followed for death through December 2005. We used the Cox proportional hazards regression model to estimate the hazard ratio (HR) and 95% confidence interval (CI) for suicide by quintile of intake. Results A total of 213 and 85 deaths from suicide were recorded during 403,019 and 473,351 person-years of follow-up for men and women, respectively. Higher intakes of fish, EPA, or DHA were not associated with a lower risk of suicide. Multivariate HRs (95% CI) of suicide death for the highest versus lowest quintile of fish consumption were 0.95 (0.60–1.49) and 1.20 (0.58–2.47) for men and women, respectively. A significantly increased risk of suicidal death was observed among women with very low intake of fish, with HRs (95% CI) for those in 0–5th percentile versus middle quintile of 3.41 (1.36–8.51). Conclusions Our overall result does not support a protective role of higher intake of fish, EPA, or DHA against suicide in Japanese men and women.

The impact of alcohol consumption on the risk of cancer among men: A 20-year follow-up study from Finland

Introduction Alcohol consumption is associated with certain cancer types and cancer deaths but there is paucity of information on the relationship between alcohol and total cancer risk. Hence, we examined this association. Methods We analysed data from a prospective population-based cohort study of 2627 men from Eastern Finland who had no history of cancer at baseline. There were 515 incident cancer cases accrued over 52,540 person years during the 20 years of follow-up. Results We observed a linear relationship between alcohol consumption and cancer. Men within the highest quintile of alcohol consumption (>115 g/week) had a 42% increased risk of total cancer compared with those within the lowest quintile (relative risk (RR) 1.42, 95% confidence interval (CI) 1.07–1.88; P trend = 0.03) after adjusting for age, smoking, total energy intake and cardio-respiratory fitness. The results were the same after excluding cancer cases diagnosed during the first 2 years of follow-up. Men who consumed ⩾28.2 g/day of alcohol (median) had a relative risk of 1.22, 95% CI 1.03–1.46; P-value 0.03) compared to those who consumed less. Conclusion About 6.7% of the cancer cases in this cohort were due to alcohol consumption. Strategies to reduce cancer burden need to incorporate reduction in alcohol consumption, probably beyond the level currently recommended.

Negative nutrition impacts from the food price crisis in Latin America

This study examined the effect of the food price crisis (2006–2008) on calorie intakes in Ecuador, Guatemala, Honduras, Nicaragua, Panama, and Peru. Food consumption and socio‐economic data came from household surveys, and food calories from ProPAN and USDA food composition databases. Applying the quadratic almost ideal demand system (QUAIDS) model, we compared calorie intake levels before and after the price shock and analyzed households in relation to calorie adequacy thresholds in strata based on wealth, area of residence, and age of household members. We found that over one‐half (50–80%) of households were in a worse situation in terms of calorie adequacy after the shock, with the largest reductions in calories observed for Ecuador and Panama. Shifts to the left in the frequency distributions of calorie intakes were apparent in the lower end of the tails especially. Consistent inverse relationships between expenditure quintiles and change in calorie intakes were observed, with the top quintile showing positive changes, suggestive of over‐consumption. Poor rural areas were affected by reductions in energy intakes to the same or to a greater extent than urban areas. Programs or policies may be needed to support population sub‐strata in periods of high food prices.

Patient costs for paediatric hospital admissions in Tanzania: a neglected burden?

Tanzania has a policy of free provision of inpatient care for young children in order to promote timely access and thus reduce the current levels of mortality. However, little is known about out-of-pocket costs that may be incurred by families in seeking care for sick children. We conducted this study to identify the magnitude of these costs in relation to family income. Five hundred and ten caretakers were interviewed on the day of discharge of their child from 11 hospitals in north-east Tanzania. Caretakers were asked to report expenditure related to hospitalization in various categories and family wealth was assessed through reported expenditure in the previous month. Food (mean US$2.2, median US$1.6), transport (mean US$1.7, median US$0) and medicines (mean US$1.0, median US$0.4) were the leading categories of expenditure, and overall the mean out-of-pocket expenditure was US$5.5 (median US$3.7) per admission. Mean out-of-pocket expenditure was more than 1.5 times higher for households in the highest monthly expenditure quintile compared with those in the lowest. However, this differential was reversed when expenditure was considered as a proportion of family expenditure in the previous month; for the lowest quintile, families spent more than three-quarters of their total monthly expenditure on a single paediatric admission. Out-of-pocket expenditure on child hospitalization places a considerable burden on poor families. Our findings justify a closer scrutiny of how this expenditure could be reduced, particularly through the provision of adequate food for both children and caretakers and through reducing stock-outs of essential medicines.