High Proportion Of Households Research Articles

Water, Sanitation and Hygiene practices in areas affected by Cyclone Idai in Zimbabwe

ABSTRACT This study aimed to investigate the association between Cyclone Idai and the Water, Sanitation and Hygiene (WASH) practices in Chimanimani and Chipinge districts in Zimbabwe. The WASH parameters assessed included the main water source, the type of toilet in the household, the number of households sharing a toilet and the presence of a handwashing facility for use after using the toilet. The highest proportion of households that were mostly affected used piped water, while those not affected mainly used community boreholes (42.9%), protected wells (24.2%) and surface water (18.7%). Most households that were relocated to camps (70%) used the pit latrine with slabs, while most of the households that were not affected (41.8%) used the bush as their toilet facility. Only households relocated to camps shared toilets. Only the most affected and resettled population groups (in camps) had better access to improved WASH infrastructure. However, the sharing of toilets was high and the use of handwashing facilities was low in all settlement types. There was a significant association between the severity of Cyclone Idai and the main water source, adequacy of drinking water, sharing of toilets and the ability to purify drinking water.

Turtle Economic Value: The non-use value of marine turtles in the Asia-Pacific region

Marine turtle species in the Asia-Pacific region face loss of habitat, population decline and serious risk of extinction. Understanding the associated loss in human welfare can motivate conservation finance, policy reforms and other actions to protect and restore marine turtle populations. This paper estimates non-use values for marine turtles in the Asia-Pacific region using a large-sample (n = 7765) global household survey. The survey focused on six countries in the region (China, Fiji, Indonesia, Malaysia, the Philippines and Vietnam) but received responses from over 80 countries in total. A discrete choice experiment was used to elicit willingness-to-pay (WTP) for marine turtles, defined in terms of population trends (increasing, stable or declining) and species diversity (avoided extinctions). We find that a high proportion of households (82%) expressed a positive WTP for turtle conservation, and that the donation amounts are substantial. The median WTP for ensuring stable marine turtle populations, adjusted for demographic differences between the survey sample and the general population, is estimated at US $79 per household per year. A scenario analysis is used to estimate the economic welfare changes that would result from policy inaction (in which turtle populations continue to decline and two species become extinct) versus strong policy action (resulting in increasing turtle populations and no extinctions). The welfare loss that results from not acting is estimated to be US $40 billion per year, whereas the potential welfare gain from taking policy action to conserve, manage and protect marine turtles is estimated at US $55 billion per year. These results present a strong economic justification for governments across the region to align their environmental policies and budgets with Asia-Pacific peoples' stated WTP for turtle conservation.

The utilization and contribution of timber and non-timber forest products to livelihoods under a changing climate in the Limpopo River Basin

Forest products contribute immensely to rural livelihoods and household income. However, their contribution to climate change adaptation in semi-arid areas, and the limited ecosystem management capacities of rural communities are poorly examined. We examined the influence and challenges of cash income derived from forest products on livelihoods and climate change adaptation using data from 130 household surveys, 20 participatory mapping exercises, several in-depth interviews, and field observations in the Limpopo Basin of Botswana. Households derived livelihoods and/or income from Mopane caterpillars, firewood, timber, palm plants, wild fruits, thatch, medicinal plants, natural dyes, natural pastures, and game meat. Mopane caterpillars, firewood, and other forest products featured in the top ten sources of household income and contributed weighted monthly income of BWP 1,647.27 ± 1,519.04, BWP 1,110.02 ± 1,980.05, and BWP 780.56 ± 1,360.32, respectively (US$1 ≈ BWP13.4). A higher proportion of households (62.3%) were in the low-income category, earning income below BWP5,000/month. Income derived from Mopane caterpillars and firewood made a significant difference between low-income and high-income households (p = 0.006). Generally, higher proportions of high-income households adopted climate change adaptation measures than proportions in the low-income category, indicating the influence of cash income on household adaptations. However, significant differences were only observed in cropland expansion, purchasing of supplementary livestock feed, drilling boreholes/wells, and use of drip irrigation (p < 0.05). We discuss the potential threats, such as the unsustainable harvesting of forest products, caused by an increasing need for cash incomes and the interconnectedness with distant urban markets. Such threats add to the institutional and biophysical challenges, further limiting prospects for effective adaptation in the Limpopo Basin of Botswana. We call on the government to capacitate and strengthen traditional authorities—as custodians of local resources—in the regulation, management, and conservation of forest products to make them more sustainable adaptation options.

Examining the Role of Social Determinants of Health and COVID-19 Risk in 28 African Countries

While the impact of the pandemic has varied between and within countries, there are few published data on the relationship between social determinants of health (SDoH) and COVID-19 in Africa. This ecological cross-sectional study examines the relationship between COVID-19 risk and SDoH among 28 African countries. Included were countries with a recent demographic and health survey (years 2010 to 2018). The response variables were COVID-19 case rates and death rates (reported as of 15 August 2020); and the covariates comprised eight broad topics common to multiple SDoH frameworks aggregated to the country level: geography (urban residence), wealth index, education, employment, crowding, and access to information. A negative binomial regression was used to assess the association between aspects of SDoH and COVID-19 outcomes. Our analysis indicated that 1 in 4 (25.1%) households in study countries are without safe and clean water and a space for handwashing. The odds of COVID-19 morbidity and deaths were higher in countries with a high proportion of households without access to safe and clean water. Having a high proportional of educated women (1.003: 95% CI, 1.001–1.005) and living in a less crowded home (0.959: 95% CI, 0.920–1.000) were negatively associated with COVID-19 deaths, while being insured and owning a mobile phone predicted illness. Overall, aspects of SDoH contribute either negatively or positively to COVID-19 outcomes. Thus, addressing economic and environmental SDoH is critical for mitigating the spread of COVID-19 and re-emerging diseases on the African continent.

A multilevel analysis of the predictors of diarrhea among children under 5 years of age in Eswatini.

Diarrhea remains a public health challenge and persistently affect children under 5 years of age, primarily in developing countries. The aim of the study was to investigate the effects of individual, household and community level factors on child diarrhea. Using combined data 2010 and 2014 Eswatini Multiple Indicator Cluster surveys, data for 4,363 under five children was analysed. Univariable, bivariable and multivariable multilevel logistic regression models were used for data analysis. We found that the prevalence of diarrhea was 16.2%, (95% confidence interval (CI): 15.3-18.1). Higher odds of diarrhea were observed among children aged 6-11 months (AOR: 2.67, 95% CI: 1.93, 3.71) and 12-23 months (AOR=2.12, 95% CI: 1.56, 2.87) compared to those aged less than 6 months. However, lower odds of diarrhea were observed among children aged 36-47 months (AOR=0.68, 95% CI: 0.48, 0.97) and 48-59 months (AOR=0.39, 95% CI: 0.26, 0.58), compared to children aged less than 6 months. Children born to mothers aged 35-39 years had lower odds of having diarrhea, (AOR=0.48, 95%CI: 0.30, 0.79) compared to those born to mothers aged 15-19 years. Higher odds of having diarrhea were observed among children from communities with a low proportion of households with improved toilet facility (AOR=1.29, 95% CI: 1.01, 1.66) compared to those from communities with a high proportion of households with improved toilet facility. We found that individual- and community-level factors were associated with child diarrhea in Eswatini. Programmes and policies that aim to mitigate child morbidity due to diarrhea should pay attention to the individual and community factors.

DOWNLOAD PDF DOWNLOAD XML THE IMPACT OF SOLAR HOME SYSTEMS ON HOUSEHOLD ELECTRICITY CONSUMPTION IN RURAL BANGLADESH

This study examines the impact of Solar Home Systems (SHS) on household electricity consumption in rural Bangladesh using a quantitative cross-sectional design. A survey was conducted on 200 households in four rural districts selected based on their high proportion of households without access to grid electricity. Results showed that households with SHS had significantly higher monthly electricity consumption than those without SHS. The multiple linear regression analysis revealed a positive and significant impact of SHS ownership on household electricity consumption, after controlling for household income, size, education level of the household head, and access to grid electricity. The study highlights the potential of SHS to increase access to electricity and improve the quality of life in rural areas of Bangladesh. Keywords: Solar Home Systems, household electricity consumption, rural Bangladesh, energy access, renewable energy.

Scaling-up Child and Youth Mental Health Services: Assessing Coverage of a County-Wide Prevention and Early Intervention Initiative During One Fiscal Year

PurposeIn the U.S., the percentage of youth in need of evidence-based mental health practices (EBPs) who receive them (i.e., coverage rate) is low. We know little about what influences coverage rates. In 2010, the Los Angeles County Department of Mental Health (LACDMH) launched a reimbursement-driven implementation of multiple EBPs in youth mental health care. This study examines two questions: (1) What was the coverage rate of EBPs delivered three years following initial implementation? (2) What factors are associated with the coverage rates?MethodsTo assess coverage rates of publicly insured youth, we used LACDMH administrative claims data from July 1, 2013 to June 30, 2014 and estimates of the size of the targeted eligible youth population from the 2014 American Community Survey (ACS). The unit of analysis was clinic service areas (n = 254). We used Geographic Information Systems and an OLS regression to assess community and clinic characteristics related to coverage.ResultsThe county coverage rate was estimated at 17%, much higher than national estimates. The proportion of ethnic minorities, individuals who are foreign-born, adults with a college degree within a geographic area were negatively associated with clinic service area coverage rates. Having more therapists who speak a language other than English, providing care outside of clinics, and higher proportion of households without a car were associated with higher coverage rates.ConclusionHeterogeneity in municipal mental health record type and availability makes it difficult to compare the LACDMH coverage rate with other efforts. However, the LACDMH initiative has higher coverage than published national rates. Having bilingual therapists and providing services outside the clinic was associated with higher coverage. Even with higher coverage, inequities persisted.

Socioeconomic and Medical Vulnerabilities Among Syrian Refugees with Non-communicable Diseases Attending Médecins Sans Frontières Services in Irbid, Jordan

Non-communicable diseases (NCDs) are high-prevalence health problems among Syrian refugees. In 2014, Médecins Sans Frontières (MSF) identified unmet NCD care needs and began providing free-of-charge services for Syrian refugees in Irbid, Jordan. This study aimed to describe current socioeconomic and medical vulnerabilities among MSF Irbid Syrian refugee patients and their households and raise awareness of their ongoing health needs that must be addressed. A cross-sectional survey among Syrian refugees attending MSF NCD services in Irbid Governorate, Jordan was conducted by telephone interviews in January 2021 to query sociodemographic characteristics, economic situation, self-reported NCD prevalence, and Ministry of Health (MoH) policy awareness. Descriptive analysis of indicators included proportions or means presented with 95% confidence intervals. The survey included 350 patient-participants in 350 households and 2157 household members. Mean age was 28.3 years. Only 13.5% of household members had paid or self-employed work; 44% of households had no working members. Mean monthly income was 258.3 JOD (95%CI: 243.5–273.1) per household. Mean expenditures were 320.0 JOD (95%CI: 305.1–334.9). Debt was reported by 93% of households. NCD prevalence among adults was 42% (95%CI: 40–45). Hypertension was most prevalent (31.1%, 95%CI: 28.7–33.7), followed by diabetes (21.8%, 95%CI: 19.7–24.1) and cardiovascular diseases (14.4%, 95%CI: 12.6–16.4). Only 23% of interviewees were aware of subsidized MoH rates for NCD care. Twenty-nine percent stated they will not seek MoH care, mainly due to the unaffordable price. Our findings highlight increased vulnerability among MSF Irbid Syrian refugee NCD patients and their households, including: an older population; a high percentage of unemployment and reliance on cash assistance; higher proportion of households in debt and a high number of households having to resort to extreme coping mechanisms when facing a health emergency; and a higher proportion of people with multiple comorbid NCDs and physical disability. Their awareness of subsidised MoH care was low. MoH care is expected to be unaffordable for many. These people are at increased risk of morbidity and mortality. It is vital that health actors providing care for Syrian refugees take action to reduce their risk, including implementing financial support mechanisms and free healthcare.

Recommended daily allowance-based contribution of household\u2019s own agricultural production to food and nutrition security in Karamoja sub-region of Uganda

BackgroundIn Uganda, agriculture is the main pathway for dietary intake among the households. Karamoja sub-region, located in Northeastern part of Uganda is the most food insecure in the country. Although agriculture contributes greatly to Uganda’s food systems, there is inadequate evidence for household energy and nutrient intake from agricultural production in the sub-region. Karamoja sub-region is typical because crop production has increasingly become part of the agricultural system in a largely semi-arid environment, predominantly occupied in pastoralism. Therefore, a cross-sectional study of 520 participants investigated the contribution of household’s own agricultural production to dietary intake, seeking to answer whether or not own agricultural production translates into adequate energy and nutrient intake.ResultsOwn food production did not meet energy and nutrient requirements, contributed disproportionately among the districts to household cumulated annual RDAs. This was reflected in the higher proportion of households in Moroto not attaining the cumulative annual RDA (energy: 100.0; protein 100.0; iron 86.5; and zinc 100.0%) than in Abim (energy: 81.6; protein 53.3; iron 23.7; and zinc 59.9%). Overall in Karamoja sub-region, the total energy and nutrients required by the household and supplied from their agricultural production were 15,589.7 ± 10,230.6 and 4226.0 ± 3980.1 kcal/day for energy, 317.6 ± 202.6 and 154.4 ± 153.7 g/day for proteins, 49.5 ± 30.8 and 50.2 ± 47.6 mg/day for iron, and 52.7 ± 32.6 and 25.4 ± 24.5 mg/day for zinc. Inter-household distribution of the absolute difference between energy and selected nutrients required by the household and that derived from own agricultural production showed deficits in household energy and nutrients needs. Further, polygamy, subsistence farming by spouse, lack of formal education by spouse positively predicted energy and nutrient supplied from own agricultural produce while lack of formal education negatively predicted energy nutrients supplied from agricultural produce. Increase in household size increased energy and nutrient required from agricultural production.ConclusionOwn agricultural production contributes limitedly to household energy and nutrient needs in the sub-region. There are great variations in the households’ capacity to derive energy and nutrients from own agricultural produce in Karamoja sub-region. Polygamy, subsistence farming, education and household size predicted energy and nutrients required from and supplied by agricultural production.

Evaluating energy burden at the urban scale: A spatial regression approach in Cincinnati, Ohio

Energy burden, the proportion of household income spent on energy costs, is driven by numerous social, economic, and material factors which also vary spatially. Efforts to identify high energy burden households have often omitted this spatial component, resulting in an incomplete picture of energy burden dynamics. The goal of this study is to examine the predictors of energy burden at the urban scale using spatial regression. A combination of ordinary least squares regression, geographically weighted regression (GWR), and multiscale geographically weighted regression (MGWR) were used to predict energy burden from a range of socioeconomic and physical predictors in Cincinnati, Ohio. The results indicate that socioeconomic variables, especially income-related variables, are the strongest predictors of energy burden, and that spatial models resulted in a better model fit than non-spatial models. The best fitting model showed that lower median household income, and higher proportions of households in poverty, non-white residents, gas-heated households, and two-family buildings were significant predictors of energy burden. These results highlight the need for more effective income-based targeting of energy assistance programs, and provide an example of how spatial analysis methods can be used to help cities develop data-driven policy to reduce energy burden.

Baseline Prevalence of Trachoma in Refugee Settlements in Uganda: Results of 11 Population-based Surveys

ABSTRACT Purpose There are several settlements in the Northern and Western Regions of Uganda serving refugees from South Sudan and Democratic Republic of Congo (DRC), respectively. Trachoma prevalence surveys were conducted in a number of those settlements with the aim of determining whether interventions for trachoma are required. Methods An evaluation unit (EU) was defined as all refugee settlements in one district. Cross-sectional population-based trachoma prevalence survey methodologies designed to adhere to World Health Organization recommendations were deployed in 11 EUs to assess prevalence of trachomatous inflammation—follicular (TF) in 1–9-year-olds and trachomatous trichiasis (TT) unknown to the health system in ≥15-year-olds. Household-level water, sanitation and hygiene coverage was also assessed in study populations. Results A total of 40,892 people were examined across 11 EUs between 2018 and 2020. The prevalence of TF in 1–9-year-olds was <5% in all EUs surveyed. The prevalence of trachomatous trichiasis (TT) unknown to the health system in ≥15-year-olds was <0.2% in 5 out of 11 EUs surveyed and ≥0.2% in the remaining 6 EUs. A high proportion of households had improved water sources, but a low proportion had improved latrines or quickly (within a 30-minute return journey) accessible water sources. Conclusions Implementation of the antibiotic, facial cleanliness and environmental improvement components of the SAFE strategy is not needed for the purposes of trachoma’s elimination as a public health problem in these refugee settlements; however, intervention with TT surgery is needed in six EUs. Since instability continues to drive displacement of people from South Sudan and DRC into Uganda, there is likely to be a high rate of new arrivals to the settlements over the coming years. These populations may therefore have trachoma surveillance needs that are distinct from the surrounding non-refugee communities.

Are Child Welfare Intervention Rates Higher or Lower in Areas Targeted for Enhanced Early Years Services?

Flying Start is an enhanced early years programme in Wales which is targeted at areas where a high proportion of households with children are recipients of income‐related benefits or tax credits. Child protection interventions are known to be concentrated in more deprived areas. Flying Start could have the effect of reducing risk to children or, conversely, it could result in more children coming to the attention of social services. Administrative data were used to identify children in public care and on child protection registers in Wales on 31 March 2015 and to identify lower super output areas covered by Flying Start services. Child welfare intervention rates were examined, and a comparison was made between areas within deprivation quintiles where Flying Start was operating and areas where it was not. In areas where Flying Start services are provided, child welfare intervention rates are higher than in areas where they are not, after controlling for multiple deprivation. Further work is needed to establish why child welfare intervention rates are higher in Flying Start areas and what effect there might be longer term.‘Child welfare intervention rates were examined, and a comparison was made between areas… where Flying Start was operating and areas where it was not’Key Practitioner Messages In Wales there is a ‘social gradient’ in the rates at which local authorities intervene by placing children in statutory care or making them subject to child protection procedures. For each increase in relative deprivation, there is a corresponding increase in intervention rates. In areas where Flying Start enhanced early years services are provided, child welfare intervention rates are higher than in areas where they are not, after controlling for area‐level deprivation. The link between poverty and risk to children needs to be more clearly acknowledged in the child protection process.

Intra-urban variability of PM2.5 in a dense, low-income settlement on the South African Highveld

High concentrations of the ambient particulate matter remains a concern on the South African Highveld, particularly in densely populated low-income settlements. These areas have several local emission sources that contribute to poor air quality and are often located close to industrial and other urban areas. The local sources vary in magnitude, space, and time. In South Africa, little has been done to assess the impacts of spatiotemporal variability on the credibility of using isolated ambient observations for regulatory purposes. This study aims to evaluate the intra-urban variability of ambient PM2.5 concentrations in a dense, low-income community. Ambient fine particulate matter (PM2.5) in distinct microenvironments of KwaZamokuhle were simultaneously measured at 4 sites between March and June 2018. These measurements were collected using one permanent ambient monitoring station (AMS) and a temporary network of three E-BAM monitors (Site 2, Site 3, and Site 4). The daily PM2.5 concentrations at AMS, Site 2, Site 3, and Site 4 varied from 10 to 86 µg.m-3, 10 to 103 µg.m-3, 11 to 101 µg.m-3, and 9 to 113 µg.m-3, respectively. Extreme PM2.5 concentrations which exceeded the 24h PM2.5 NAAQS of 40 µg.m-3 were seen during the cold period (May and June); meanwhile, the warm period (March and April) recorded relatively lower PM2.5 episodes across different sections of KwaZamokuhle. During May-June, the highest diurnal concentrations of hourly averaged ambient PM2.5 were recorded at Site 4, in a downward sequence, followed by Site 3, Site 2, and AMS. Furthermore, the results showed that across KwaZamokuhle, Site 4 has the highest proportion of households using solid fuels for domestic purposes (cooking and heating) (55%) and the number of informal dwellings (117 households). Therefore, the study highlights the complexity of quantifying ambient air quality in an area where several local emission sources vary in space and time. Attempts to use monitoring data from a single station to assess ambient air quality, quantify human exposure, or evaluate the potential impacts of mitigation strategies in dense, low-income settlements should be done with care.

Intra-urban variability of PM2.5 in a dense, low-income settlement on the South African Highveld

High concentrations of the ambient particulate matter remains a concern on the South African Highveld, particularly in densely populated low-income settlements. These areas have several local emission sources that contribute to poor air quality and are often located close to industrial and other urban areas. The local sources vary in magnitude, space, and time. In South Africa, little has been done to assess the impacts of spatiotemporal variability on the credibility of using isolated ambient observations for regulatory purposes. This study aims to evaluate the intra-urban variability of ambient PM2.5 concentrations in a dense, low-income community. Ambient fine particulate matter (PM2.5) in distinct microenvironments of KwaZamokuhle were simultaneously measured at 4 sites between March and June 2018. These measurements were collected using one permanent ambient monitoring station (AMS) and a temporary network of three E-BAM monitors (Site 2, Site 3, and Site 4). The daily PM2.5 concentrations at AMS, Site 2, Site 3, and Site 4 varied from 10 to 86 µg.m-3, 10 to 103 µg.m-3, 11 to 101 µg.m-3, and 9 to 113 µg.m-3, respectively. Extreme PM2.5 concentrations which exceeded the 24h PM2.5 NAAQS of 40 µg.m-3 were seen during the cold period (May and June); meanwhile, the warm period (March and April) recorded relatively lower PM2.5 episodes across different sections of KwaZamokuhle. During May-June, the highest diurnal concentrations of hourly averaged ambient PM2.5 were recorded at Site 4, in a downward sequence, followed by Site 3, Site 2, and AMS. Furthermore, the results showed that across KwaZamokuhle, Site 4 has the highest proportion of households using solid fuels for domestic purposes (cooking and heating) (55%) and the number of informal dwellings (117 households). Therefore, the study highlights the complexity of quantifying ambient air quality in an area where several local emission sources vary in space and time. Attempts to use monitoring data from a single station to assess ambient air quality, quantify human exposure, or evaluate the potential impacts of mitigation strategies in dense, low-income settlements should be done with care.

Characteristics Associated With Household Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in Ontario, Canada: A Cohort Study.

BackgroundWithin-household transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been identified as one of the main sources of spread of coronavirus disease 2019 (COVID-19) after lockdown restrictions and self-isolation guidelines are implemented. Secondary attack rates among household contacts are estimated to be 5–10 times higher than among non-household contacts, but it is unclear which individuals are more prone to transmit infection within their households.MethodsUsing address matching, a cohort was assembled of all individuals with laboratory-confirmed COVID-19 residing in private households in Ontario, Canada. Descriptive analyses were performed to compare characteristics of cases in households that experienced secondary transmission versus those that did not. Logistic regression models were fit to determine index case characteristics and neighborhood characteristics associated with transmission.ResultsBetween January and July 2020, there were 26 714 individuals with COVID-19 residing in 21 226 households. Longer testing delays (≥5 vs 0 days; odds ratio [OR], 3.02; 95% confidence interval [CI], 2.53–3.60) and male gender (OR, 1.28; 95% CI, 1.18–1.38) were associated with greater odds of household secondary transmission, while being a healthcare worker (OR, .56; 95% CI, .50–.62) was associated with lower odds of transmission. Neighborhoods with larger average family size and a higher proportion of households with multiple persons per room were also associated with greater odds of transmission.ConclusionsIt is important for individuals to get tested for SARS-CoV-2 infection as soon as symptoms appear, and to isolate away from household contacts; this is particularly important in neighborhoods with large family sizes and/or crowded households.

Burden of injuries and its associated hospitalization expenditure in India

Injuries are a major public health concern, affect the most productive age group i.e. (15–60 years) and increases disability adjusted life years (DALYs) and results in a huge financial burden on the household. Disease burden is represented by DALYs and economic burden represents the out of pocket (OOP) and catastrophic health expenditure (CHE). We examined the burden of injury and its impact on household financial burden among the working population (15–60 years) in India. We used data on National and State Level DALYs for Injuries for 2017 from the published National Disease Burden Estimate (NBE, 2019) Study. The cost of treatment was extracted from 75th round of the National Sample Survey Organization (NSSO, 2017–18). DALYs is the sum of YLLs and YLDs. OOPEs were estimated as a per episode of hospitalization expenses after reimbursement and CHE was defined as out of pocket expenditure exceeding 10% of household consumption expenditure. Accidental injuries particularly road traffic injuries have higher DALY rates among 15–60 years in India (1288 DALYs per 100,000). However, the mean OOPE was found to be higher due to intentional self-harm. Persons suffering from injury in states like Punjab, Haryana, UP, Gujarat, Karnataka and Andhra Pradesh approached private facilities more compared to public facilities. Whereas, people from states like Jammu and Kashmir, Orissa, West Bengal, North East availed public facilities more than private. OOPE was found to be five times more in private facilities than in public. The households who sought treatment in private facilities were faced 3 times more to Catastrophic expenditure than those who took the treatment in public hospital of any injury. The present study indicated high DALYs, OOPE and % CHE for injury in India. Higher proportion of households were pushed to catastrophic expenditure due to high OOPE of injury treatment. Disease and economic burden due to road traffic injury and fall was found to be high as compared to other injuries. Our study strengthens the need for executing effective financial protection approach in India like PM-JAY, to minimize the financial burden incurred due to injuries in India.

COMMUNITY-BASED HEALTH INSURANCE SCHEME IN A RURAL COMMUNITY OF NORTH WEST NIGERIA: A ROADMAP TO ACHIEVING UNIVERSAL HEALTH COVERAGE.

Background: Community Based Health Insurance (CBHI) scheme is aimed at reducing out of pocket spending on health care services, ensuring final risk protection to all, especially the poor and the most vulnerable, improvement of quality of health care services, access and utilization as well as the promotion of equity. Objective: This research was aimed at determining willingness to participate in a community-based health insurance scheme among rural households in Katsina State. Method: A cross-sectional descriptive study was conducted in December 2016 among households of Batagarawa LGA, Katsina State. We used a pre-tested, electronic, semi-structured interviewer-administered questionnaire to obtain data from households that were selected using a multistage sampling technique and we analyzed the data using STATA version 13. Results: Most, (28.5%) of the respondents were in the age range of 30-39 years with a mean age of 35.5 years. Males were the dominant household heads (93%). Most were married (90%). Most, (90.5%) of households were willing to pay for a community-based health insurance scheme with a median premium of 100 Naira per household member per month. Conclusions: The high proportion of households willing to pay for the scheme should inform the decision of policy makers to design and maintain Community Based Health Insurance Scheme to improve access to and utilization of quality health care services.

&lt;p&gt;Willingness to Join and Pay for Community-Based Health Insurance Among Rural Households of Selected Districts of Jimma Zone, Southwest Ethiopia&lt;/p&gt;

BackgroundGlobally, millions of people suffer and die because they do not have the money to pay for health care. A voluntary health insurance scheme is a prepayment mechanism to overcome the financial hardship of poor households. There is a high demand to determine the enrolment rate and ability to pay before scale-up of the scheme by the government to be sure of its feasibility and sustainability.ObjectiveTo determine willingness to join and pay for a community-based health insurance scheme and associated factors among rural households of selected districts in Jimma Zone, 2018.MethodsA community-based cross-sectional study design was employed in selected districts of Jimma Zone, Ethiopia. Multistage simple random sampling was used to select 422 households. Data were collected using a semi-structured interviewer-administered questionnaire. A double bounded contingent valuation method was applied to elicit households’ willingness to pay for the scheme. Data were entered into Epi-Data 3.1 and analyzed with SPSS V.23. A binary logistic regression model was fitted to determine the presence of statistically significant associations between the dependent and independent variables at p-value <0.05 and AOR values with 95% CI.ResultsOf 422 sampled respondents, 389 participated in this study with a response rate of 92%. Of these, 305 (78%) were willing to join and 274 (90%) of them were willing to pay. The average amount of money the households were willing to pay per household per annum was 228 ETB (8.27 USD), with a range of 100–500 ETB. The older age groups, poor households, and experience of local risk-sharing schemes were found to be determinants for willingness to join the community-based health insurance. Similarly, having a large family size, and low economic and education status of households were significant predictors of willingness to pay for this scheme.ConclusionA high proportion of households were willing to join and pay for the CBHI scheme. The average amount of money they were willing to pay for the scheme was very slightly lower than what is planned by the government. Thus, the government of Ethiopia should strengthen efforts to scale up this scheme in the rural areas of the country specifically to districts not yet enrolled, to reduce direct out-of-pocket payment at service delivery points. This will also contribute to guaranteeing dwellers of rural areas access to quality health services without facing financial hardship, to achieve universal health coverage for all by the end of 2035.

Income and Poverty in Households in Selected European Countries

Incomes of population and poverty are key elements of the EU cohesion policy which aims at reducing disparities between the levels of development of individual regions. The traditionally appropriate study to evaluate the convergence of the Member States is the European Union Statistics on Income and Living Conditions (EU‑SILC). However, this is not the only source of information on income distribution and social inclusion in the European Union. In this article, the basis for calculations are the results of the fourth European Quality of Life Surveys (EQLS), whose purpose is to measure both objective and subjective indicators of the standard of living of citizens and their households.&#x0D; The aim of the paper is to assess the diversity of distributions of household incomes and the level of income poverty due to the selected socio‑demographic characteristics of the respondent or household in selected European countries in two periods: 2007 and 2016. Countries of the Visegrad Group (Poland, the Czech Republic, Slovakia and Hungary) were selected for the analysis, along with the Weimar Triangle (Poland, Germany, and France). Such a selection allowed us to compare the financial situation of households in Western Europe with those in Central and Eastern Europe. Poland becomes a natural link between all these countries.&#x0D; The article uses modelling methods of income distribution, indicators of distance (overlapping) of distributions and aggregate indicators of the scope, depth and severity of poverty. Those ratios were determined on the basis of the use of relative. In order to ensure comparability of incomes of households with different demographic compositions, the analysis used equivalent incomes.&#x0D; As a result of the preliminary analysis, differences were noted regarding the measured position, variation and asymmetry of equivalent incomes in the studied households. The applied gap measurements showed a significant disparity between the distributions of income in Western European countries (Germany, France) and the countries of the Visegrad Group, but the size of that differentation de creased significantly in 2016 relative to 2007. Important differentiation was also noted in terms of income poverty risk within the Visegrad Group: the highest proportion of households at risk of poverty exists in Poland and the lowest in the Czech Republic.

Cardiovascular Effects of Indoor Air Pollution from Solid Fuel: Relevance to Sub-Saharan Africa.

This research aims to summarize evidence on the cardiovascular effects of indoor air pollution (IAP) from solid fuel and identify areas for research and policy for low- and middle-income countries. IAP affects people from low socioeconomic status in Latin America, Asia, and Africa, who depend upon biomass as a fuel for cooking, heating, and lighting. In these settings, IAP disproportionately affects women, children, the elderly, and people with cardiopulmonary disease. The health effects of IAP include acute respiratory infections, chronic obstructive pulmonary disease, pneumoconiosis, cataract and blindness, pulmonary tuberculosis, adverse effects to pregnancy, cancer, and cardiovascular and cerebrovascular disease. New methods for assessing individual IAP exposure, exposing pathways of IAP-related cardiovascular disease, and performing qualitative research focusing on population preferences regarding strategies to reduce IAP exposure have been the most important developments in tackling the burden of IAP. Unfortunately, major disparities exist regarding research into the cardiovascular effects of IAP, with only few studies coming from sub-Saharan Africa, despite this region having the highest proportion of households using solid fuels. Premature cardiovascular deaths and disability can be averted in low-middle income countries by addressing biomass fuel usage by the most disadvantaged settings. While research is needed to uncover the mechanisms involved in cardiovascular outcomes linked to IAP, immediate action is needed to educate the most affected populations on IAP health hazards and to reduce their exposure to this environmental risk through promoting improved housing and better ventilation, as well as increasing access to affordable clean cooking energy.