Cross-sectional Household Survey Research Articles

Impact of dental caries and Self-perceived oral health on daily lives of children and mothers in rural Egypt: a household survey

BackgroundThe present study assessed the impact of oral health on the daily lives of children and mothers living in a rural area in Northwestern Egypt.MethodsA cross-sectional household survey including children between 6 and 12 years old and their mothers was conducted in rural Egypt, 2019–2020. Data were collected using clinical examination and interview-based questionnaires of children and mothers. Three binary logistic regression models were used to assess the relationship between the dependent variables (oral health impact (yes, no) on avoiding smiling, chewing problems, and missing school (children) and avoiding social events (mothers)), and the explanatory variables: oral health (clinically-assessed caries experience and self-reported oral health) controlling for sociodemographic profile (child age and sex, mother’s education), daily toothbrushing and village of residence.ResultsA total of 211 households with 355 children and 211 mothers were included (91.5% response rate). About 54% of the children were girls, mean (SD) age = 8.7 (2.05) years and 82.3% did not brush their teeth daily. Mother’s mean (SD) age was 31.70 (5.45) years. Because of dental problems, 31.3% of children reported chewing difficulties, 31% avoided smiling compared to 76.3% and 43.6% of mothers. Also, 30.4% of children missed school and 76.8% of mothers reported reduced participation in social activities. In children, the number of decayed anterior teeth was associated with significantly higher odds of avoiding smiling (AOR = 1.22, 95%CI: 1.03, 1.44). In mothers, a greater number of posterior missing teeth was associated with significantly higher odds of chewing difficulties (AOR = 1.21, 95%CI: 1.01, 1.45), and a greater number of all missing teeth was associated with significantly higher odds of reduced participation in social events (AOR = 1.30, 95%CI: 1.30, 1.57). Good/ very good reported oral health in children and mothers was associated with lower odds of avoiding smiling and chewing problems (p < 0.05).ConclusionDecayed anterior teeth in children have a negative impact on smiling whereas missing teeth in mothers affect the ability to chew food and socialize. The psychological, functional, and social impacts of caries in this rural setting needs to be mitigated by improving oral health literacy and access to care.

Changes and correlates of household food insecurity during COVID-19: a repeated cross-sectional survey of low-income households in peri-urban Peru

National lockdowns and containment measures to control the spread of COVID-19 led to increased unemployment, lower household incomes and reduced access to affordable and nutritious foods globally. This study aimed to examine changes and correlates of household food insecurity experience and mitigation strategies adopted in peri-urban Peru during the COVID-19 pandemic. Low income households with children age < 2 years in Lima and Huánuco participated in three repeated cross-sectional surveys from 2020 to 2022 (n = 759). We assessed changes in household food insecurity experience using the Food Insecurity Experience Scale. Correlates of moderate-severe food insecurity were analysed using univariate and multivariable linear mixed-effect regressions. We also assessed perceived impacts of the pandemic on livelihoods, coping strategies and receipt of financial or food assistance. Moderate-severe food insecurity was 47.0% in 2020 (survey 1) decreasing to 31.1% in 2022 (survey 3). In adjusted analyses, food insecurity was higher in households with perceived reduced income (β = 12.69 [6.82; 18.56]); in the lower socio-economic status (SES) tertiles (compared to the relatively highest SES tertile; middle tertile (β = 20.91 [9.89; 31.93]), lowest tertile (β = 39.37 [28.35; 50.40]); in households with ≥ 2 children < 5 years (β = 8.78 [2.05; 15.50]); and in Lima (compared to Huánuco; β = 10.47 [1.27; 19.67]). Food insecurity improved more among the relatively lowest SES compared to the relatively highest SES households between survey 1 and 3 (interaction p = 0.007). In conclusion, almost half of households experienced moderate-severe food insecurity mid-pandemic with greater risk observed in the most socio-economically disadvantaged households. The inequality gap in food insecurity associated with SES narrowed over time likely due to household coping strategies and reduced poverty.

Dissecting Water, Sanitation, and Hygiene (WaSH) to Assess Risk Factors for Cholera in Shashemene, Oromia Region, Ethiopia.

Cholera outbreaks have afflicted Ethiopia, with nearly 100 000 cases and 1030 deaths reported from 2015 to 2023, emphasizing the critical need to understand water, sanitation, and hygiene (WaSH) risk factors. We conducted a cross-sectional household (HH) survey among 870 HHs in Shashemene Town and Shashemene Woreda, alongside extracting retrospective cholera case data from the Ethiopian Public Health Institute database. Relationships between WaSH and sociodemographic/economic-levels of HHs were examined. WaSH status and cholera attack rates (ARs) were described at kebele-level using geospatial mapping, and their association was statistically analyzed. Access to basic drinking water, sanitation, and hygiene facilities was limited, with 67.5% (95% confidence interval, 64.4-70.6), 73.4% (70.3-76.3), and 30.3% (27.3-33.3) of HHs having access, respectively. Better WaSH practices were associated with urban residence (adjusted odds ratio, 1.7, [95% confidence interval, 1.1-2.7]), higher educational levels (2.7 [1.2-5.8]), and wealth (2.5 [1.6-4.0]). The association between cholera ARs and at least basic WaSH status was not statistically significant (multiple R2 = 0.13; P = .36), although localized effects were suggested for sanitation (Moran I = 0.22; P = .024). Addressing gaps in WaSH access and hygiene practices is crucial for reducing cholera risk. Further analyses with meaningful covariates and increased sample sizes are necessary to understand the association between cholera AR and specific WaSH components.

Deployment of attractive targeted sugar baits in western Zambia: installation, monitoring, removal, and disposal procedures during a Phase III cluster randomized controlled trial

BackgroundAttractive Targeted Sugar Baits (ATSBs) offer a complementary vector control strategy to interventions targeting blood feeding or larval control by attacking the sugar feeding behaviour of adult mosquitoes using an attract-and-kill approach. Western Zambia was the first location to receive and deploy ATSB Sarabi version 1.2 stations in a Phase III cluster randomized controlled trial. This paper describes ATSB station installation, monitoring, removal, and disposal, quantifies ATSB station coverage, and reports major reasons for ATSB station replacement.MethodsATSB stations were deployed during two annual transmission seasons, through scheduled installation and removal campaigns. During deployment, monitoring was conducted per protocol to maintain high coverage of the ATSB stations in good condition. Routine monitoring visits during the trial captured details on ATSB station damage necessitating replacement following pre-defined replacement criteria. Annual cross-sectional household surveys measured ATSB station coverage during peak malaria transmission.ResultsA total of 67,945 ATSB stations were installed in Year 1 (41,695 initially installed+ 26,250 installed during monitoring) and 69,494 ATSB stations were installed in Year 2 (41,982 initially installed+ 27,512 installed during monitoring) across 35 intervention clusters to maintain high coverage of two ATSB stations in good condition per eligible household structure. The primary reasons for ATSB station replacement due to damage were holes/tears and presence of mold. Cross-sectional household surveys documented high coverage of ATSB stations across Year 1 and Year 2 with 93.1% of eligible structures having ≥ 2 ATSB stations in any condition.DiscussionATSB station deployment and monitoring efforts were conducted in the context of a controlled cRCT to assess potential product efficacy. Damage to ATSB stations during deployment required replacement of a subset of stations. High coverage of eligible structures was maintained over the two-year study despite replacement requirements. Additional research is needed to better understand the impact of damage on ATSB station effectiveness under programmatic conditions, including thresholds of threats to physical integrity and biological deterioration on product efficacy.ConclusionsOptimizing ATSB stations to address causes of damage and conducting implementation research to inform optimal delivery and cost-effective deployment will be important to facilitate scale-up of ATSB interventions.

A Major Gap Between the Knowledge and Practice of Mothers Towards Early Initiation and Exclusive Breastfeeding in Afghanistan in 2021.

Initiation of breastfeeding right after birth and exclusive breastfeeding for the first 6 months of life is highly recommended. In this survey, we assessed the knowledge and practice of ever-married women towards early initiation of breastfeeding and exclusive breastfeeding in the Nuristan province of Afghanistan. In a cross-sectional household survey, we enrolled 640 ever-married 15-49years women having a child aged 0-23months in the Parun district of Nuristan province from September to October 2021. Using a standardized data collection form and face-to-face interview, we measured self-reported demographic characteristics and the study outcomes (awareness and practice towards the initiation of breastfeeding within an hour of birth and exclusive breastfeeding for the first 6 months of life). We analyzed the data using survey methods and used bivariate and multiple Poisson regression to assess the covariates of the study outcomes. About 46.9% of ever-married women were 25-34years old, 67.5% never attended school, 30.4% were unemployed, and 86.4% had < $60 monthly income. Overall, 56.8% (95% CI 52.9-60.6) of the women had correct knowledge of the early initiation of breastfeeding, and 51.4% (95% CI 47.5-55.3) initiated breastfeeding early for their last baby. Also, 85.9% (95% CI 82.9-88.4) of the women had correct knowledge of exclusive breastfeeding, but only 32.6% (95% CI 29.1-36.4) exclusively breastfed their last baby for 6months after birth. After adjustment for covariates, women who were 45-49years old (Adjusted Prevalence Ratio [APR] = 1.26), Divorced/Separated (APR 1.68), ever attended school (APR 1.39), monthly income > $115 (APR 1.50) were more likely to start early breastfeeding. Moreover, women who were Divorced/Separated (APR 3.53) were more likely to exclusively breastfeed their babies for 6months after birth. Only over half of the women were aware of and initiated early breastfeeding. Although most women knew about exclusive breastfeeding, less than one-third exclusively breast their babies for 6months after birth. We found several contributing factors, such as age, marital status, education, and income that should be considered for targeted interventions.

Water, sanitation, and hygiene (WASH) practices of mothers and the health status of under-five children: a study from Rural Nayagarh, Odisha

ABSTRACT The objective of this study was to assess water, sanitation, and hygiene (WASH) practices of mothers with under-five children in rural pockets of the Nayagarh district, Odisha and examine how those practices are associated with the health status of children. A cross-sectional household survey was carried out with 370 participants having under-five children in rural pockets of the Nayagarh district, Odisha. A multistage sampling strategy was adopted. Participants were interviewed using a pre-tested structured schedule. Household information was analysed using descriptive statistics; logistic regression models were used to determine the association between mothers’ handwashing practices and the health status of their under-five children. Nearly 74.9% of the households in the sample earned less than 40,000 Indian rupees ($481) annually. Nearly 73% of mothers threw the childrens' faecal waste into drains and open garbage. Diarrhoea was strongly associated with mothers who did not encourage their children to wash their hands (p = 0.007). The frequency of mothers' handwashing before feeding was associated with childrens' episodes of fever, common cold, and cough (p = 0.045). A set of targeted interventions, such as health education and socio-behavioural changes, is needed to address significant WASH factors associated with the health of under-five children in rural areas.

Nicotine strength of e-liquids used by adult vapers in Great Britain: A population survey 2016 to 2024.

In March 2024, the UK government announced plans to introduce a Vaping Products Duty that will tax e-liquids based on their nicotine strength. This study examined trends in the nicotine strength of e-liquids used by adult vapers and differences in those currently used across relevant subgroups. Nationally-representative, cross-sectional household survey, July 2016 to January 2024. Great Britain. 7981 adult vapers. Participants were asked whether the e-cigarette they mainly use contains nicotine (yes/no) and the e-liquid strength (no nicotine, >0-≤ 6, 7-11, 12-19 or ≥20 mg/ml). We also collected information on the main device type used (disposable/refillable/pod), age, gender, occupational social grade, history of ≥1 mental health conditions, smoking status and (among past-year smokers) level of cigarette addiction. The proportion of vapers in England using high-strength (≥20 mg/ml) e-liquids increased from an average of 3.8% (95% confidence interval [CI] = 2.9-5.0) up to June 2021 to 32.5% (CI = 27.9-37.4) in January 2024 (the vast majority of whom [93.3% in January 2024] reported using exactly 20 mg/ml; the legal limit). This rise was most pronounced among those using disposable e-cigarettes, those aged 18-24 years and all smoking statuses (including never smokers) except long-term (≥1y) ex-smokers. Of those surveyed in 2022-2024 in Great Britain, overall, 89.5% (CI = 88.1-90.8) said they usually used e-cigarettes containing nicotine, 8.7% (CI = 7.5-10.0) used nicotine-free e-cigarettes, and 1.8% (CI = 1.2-2.4) were unsure. The proportion using ≥20 mg/ml was higher among those mainly using disposable (47.9%) compared with pod (16.3%) or refillable (11.5%) devices; never smokers (36.0%), current smokers (28.8%) or recent (<1y) ex-smokers (27.4%), compared with long-term ex-smokers (13.9%); and younger (16-24y; 44.2%) compared with older (≥25y; range 9.4-25.1%) age groups. There were no notable differences across other subgroups of interest. Use of high-strength nicotine e-liquids in England appears to have increased sharply in recent years. Most adult vapers in Great Britain appear to use e-cigarettes that contain nicotine but different subgroups use different strengths: nicotine strengths tend to be higher among those who mainly use disposable devices and those aged 16-24y, and lower among long-term ex-smokers.

Expanding community case management of malaria to all ages can improve universal access to malaria diagnosis and treatment: results from a cluster randomized trial in Madagascar

BackgroundGlobal progress on malaria control has stalled recently, partly due to challenges in universal access to malaria diagnosis and treatment. Community health workers (CHWs) can play a key role in improving access to malaria care for children under 5 years (CU5), but national policies rarely permit them to treat older individuals. We conducted a two-arm cluster randomized trial in rural Madagascar to assess the impact of expanding malaria community case management (mCCM) to all ages on health care access and use.MethodsThirty health centers and their associated CHWs in Farafangana District were randomized 1:1 to mCCM for all ages (intervention) or mCCM for CU5 only (control). Both arms were supported with CHW trainings on malaria case management, community sensitization on free malaria care, monthly supervision of CHWs, and reinforcement of the malaria supply chain. Cross-sectional household surveys in approximately 1600 households were conducted at baseline (Nov–Dec 2019) and endline (Nov–Dec 2021). Monthly data were collected from health center and CHW registers for 36 months (2019–2021). Intervention impact was assessed via difference-in-differences analyses for survey data and interrupted time-series analyses for health system data.ResultsRates of care-seeking for fever and malaria diagnosis nearly tripled in both arms (from less than 25% to over 60%), driven mostly by increases in CHW care. Age-expanded mCCM yielded additional improvements for individuals over 5 years in the intervention arm (rate ratio for RDTs done in 6–13-year-olds, RRRDT6–13 years = 1.65; 95% CIs 1.45–1.87), but increases were significant only in health system data analyses. Age-expanded mCCM was associated with larger increases for populations living further from health centers (RRRDT6–13 years = 1.21 per km; 95% CIs 1.19–1.23).ConclusionsExpanding mCCM to all ages can improve universal access to malaria diagnosis and treatment. In addition, strengthening supply chain systems can achieve significant improvements even in the absence of age-expanded mCCM.Trial registrationThe trial was registered at the Pan-African Clinical Trials Registry (#PACTR202001907367187).

Burden of chronic pain among adult pastoralists in Ethiopia: a cross-sectional household survey

Abstract Chronic pain is a major global health problem. Untreated pain causes particular suffering in marginalized communities. Most studies investigating chronic pain in sub-Saharan Africa stem from South Africa and Nigeria. Pastoralists are particularly underrepresented in pain research. The main objective of this study is to investigate the burden of chronic pain in adult pastoralists in the Somali Regional State of Ethiopia. We conducted a cross-sectional household survey among adult pastoralists (aged 18 years or older, N = 299) by face-to-face interviews. To randomly select households, we applied GPS-based household localization and recruitment. Chronic pain was self-reported by 17.0% (95% CI: 10.8-25.7) of male and 34.7% (95% CI: 28.4-41.5) of female adult pastoralists. The prevalence of chronic pain increased with age from 5.4% (95% CI: 0.8-30.1; 18-34 years) to 27.1% (95% CI: 15.1-43.7; 35-54 years) to 69.1% (95% CI: 53.7-81.1; 55 years and older). The body sites most commonly affected among those with chronic pain were knees (37.2%), followed by lower back (33.7%) and head (23.3%). The data for the first time provide insights into the burden of chronic pain among Somali pastoralists and reveal associated risk factors. The results support the planning of locally adapted health interventions for pastoralist-specific pain management considering the effects of chronic pain on pastoralists' daily lives.

Cultural Dynamics of Irregular Ethiopian Migration: Insights From Kembata Emigrants to the Republic of South Africa

Executive Summary This paper examines the cultural influences on irregular migration to South Africa from the Kembata-Tembaro Zone of Ethiopia. It reports on a mixed methods study, with a cross-sectional household survey ( n = 316) to examine indicators about society’s perceptions, cultural values, and the impact of remittances on migration. In-depth interviews ( n = 24) with migrant returnees and experts in the Kembata-Tembaro Zone Labor and Social Affairs Office explored their experiences and perceptions of irregular migration. The study established a connection between cultural influences and irregular migration of Ethiopians to the Republic of South Africa. Overall, the study demonstrates that the culture of migration among the Kembatas is primarily driven by a cumulative migration experience facilitated through migrant social networks. Economic incentives, such as prospects of better income and improved living conditions, are the main drivers for individuals to embark on this migratory journey. In addition, social factors, including familial networks, community ties, and remittances from migrants, significantly influence households’ attitudes toward migration. The paper ends with recommendations to address the problems related to irregular Ethiopian migration to South Africa, to enhance the well-being of Kembata emigrants, and to maximize the benefits of migration.

Estimates and predictors of alcohol-related harm to intimate partners in Australia An analysis of a nationally representative survey

Aims: This study explores the prevalence and predictors reported in 2019 by men and women of alcohol-related intimate partner violence (ARIPV), that is, verbal abuse, physical abuse, and being put in fear by intimate partners, when partners were under the influence of alcohol. Methods: Secondary data analysis of the 2019 Australia’s cross-sectional National Drug Strategy Household Survey included 22,015 respondents aged 14 years or older (9,804 men, and 12,211 women). The prevalence of ARIPV and each type of ARIPV (verbal abuse, physical abuse, and being put in fear) in the past year is described, and the predictors of all are analysed using chi-square tests and logistic regressions, overall and separately for men and women. Results: An estimated 3.4% of the Australian adult population (4.7% women, 2.1% men) reported ARIPV in 2019. The prevalence of ARIPV was higher among the participants who were women, middle-aged (35-44 years), had a certificate or diploma, were less advantaged, were divorced, separated, or widowed, single with dependents, living in more regional, and remote areas, and undertook heavy episodic drinking (HED) weekly or less often. Age, marital status, household composition, and weekly, monthly, or ever HED predicted ARIPV for women, while higher education levels and weekly or monthly HED were significant for men. Discussion and conclusions: Women were twice as likely to report intimate partner violence (IPV) from their male partner when they were under the influence of alcohol, as were men. The findings underline that interventions are needed to address IPV from intoxicated partners.

Impact of Improved Maize and Bean Varieties on Household Income and Food Security in Uganda.

The National Agricultural Research Organisation (NARO) and development partners have invested substantial resources in breeding maize and bean varieties over the years. However, the impact of the varieties on productivity, household income and food security is not well documented. This paper evaluated the ex-post impact of adopting NARO released bean and maize varieties over the last five years on the productivity, household income and food security in Uganda. Data were collected from 30 districts in Uganda through a cross-sectional household survey of 1445 households, focus group discussions and key informant interviews. Using propensity score matching and endogenous switching regression models, the results showed that adoption of improved bean and maize varieties significantly increased crop productivity, household income and food security. This evidence suggests that there were tangible benefits from funding the development of bean and maize varieties in Uganda. The results indicate that although adoption of the improved bean and maize varieties increased productivity, it was still far below the research production output. This suggests that in addition to developing and disseminating the appropriate varieties, emphasis should be put on training farmers to use the complimentary inputs and practices to get the full benefit of the improved varieties.

Prevalence, perceptions and associated factors of health insurance enrollment among older persons in selected cash grant communities in Ghana: a cross-sectional mixed method

BackgroundUniversal Health Coverage has been openly recognized in the United Nations health-related Sustainable Development Goals by 2030, though missing under the Millennium Development Goals. Ghana implemented the National Health Insurance Scheme programme in 2004 to improve financial access to healthcare for its citizens. This programme targeting low-income individuals and households includes an Exempt policy for older persons and indigents. Despite population ageing, evidence of the participation and perceptions of older persons in the scheme in cash grant communities is unknown. Hence, this paper examined the prevalence, perceptions and factors associated with health insurance enrollment among older persons in cash grant communities in Ghana.MethodsData were from a cross-sectional household survey of 400 older persons(60 + years) and eight FGDs between 2017 and 2018. For the survey, stratified and simple random sampling techniques were utilised in selecting participants. Purposive and stratified sampling techniques were employed in selecting the focus group discussion participants. Data analyses included descriptive, modified Poisson regression approach tested at a p-value of 0.05 and thematic analysis. Stata and Atlas-ti software were used in data management and analyses.ResultsThe mean age was 73.7 years. 59.3% were females, 56.5% resided in rural communities, while 34.5% had no formal education. Two-thirds were into agriculture. Three-fourth had non-communicable diseases. Health insurance coverage was 60%, and mainly achieved as Exempt by age. Being a female [Adjusted Prevalence Ratio (APR) 1.29, 95%CI:1.00–1.67], having self-rated health status as bad [APR = 1.34, 95%CI:1.09–1.64] and hospital healthcare utilisation [APR = 1.49, 95%CI:1.28–1.75] were positively significantly associated with health insurance enrollment respectively. Occupation in Agriculture reduced insurance enrollment by 20.0%. Cited reasons for poor perceptions of the scheme included technological challenges and unsatisfactory services.ConclusionHealth insurance enrollment among older persons in cash grant communities is still not universal. Addressing identified challenges and integrating the views of older persons into the programme have positive implications for securing universal health coverage by 2030.

Malaria prevalence and use of control measures in an area with persistent transmission in Senegal.

In Senegal, the widespread use of vector control measures has resulted in a significant reduction in the malaria burden and led the country to consider the possibility of elimination. Given this shift and changing context, it is important to characterize the malaria burden across all age groups to guide decision-making on programmatic interventions to interrupt transmission and ultimately eradicate the disease. In Senegal, there is a lack of information on malaria prevalence among certain populations, particularly among adolescents and adults. This study sought to assess the magnitude of malaria infections in all age groups, as well as malaria associated factors in an area of persistent transmission in Senegal. A cross-sectional household survey was conducted in four health posts (Khossanto, Mamakhona, Diakhaling and Sambrambougou), of the health district of Saraya, in November 2021, among individuals over 6 months of age. Households were selected using multistage sampling. Consented participants were screened for malaria parasites by microscopic examination of blood smears, and hemoglobin levels were measured using the Hemocue HB 301TM analyzer. Socio-demographic information of the participants, household heads, household assets, and information on ownership and use of preventive measures were collected using a structured questionnaire. Weighted generalized mixed effects logistic regression model was used to identify factors associated with microscopically confirmed malaria infection. A total of 1759 participants were enrolled in the study. Overall, about 21% of participants were classified as having Plasmodium infection; children aged 5-10 years old (26.6%), adolescents aged 10-19 years old (24.7%), and children under five years of age (20.5%) had higher rates of infection compared to adults (13.5%). Plasmodium falciparum accounted for 99.2% of the malaria infections, and most infections (69%) were asymptomatic. Around one-third of study participants had anemia (hemoglobin level <11.0 g/dl), with under five children bearing the highest burden (67.3%). Multivariate analysis showed that the odds of having a malaria infection were around 2 times higher among participants in Khossanto compared to Diakhaling (aOR = 1.84, 95% CI:1.06-3.20). Participants aged 5-9 years were more likely to have malaria infection compared to under five children (aOR = 1.40, 95% CI:1.02-1.91). Factors associated with anemia were P. falciparum infection (aOR = 1.36, p = 0.027), females (aOR = 2.16, p = 0.000), under-five age group (aOR = 13.01, p = 0.000). Malaria burden was considerable among adolescents and under ten children living in an area of persistent transmission, with adolescents more commonly presenting as asymptomatic. Interventions tailored to this specific group of the population are needed to better control the disease and reduce its burden.

Smokers' perception of the comparative health risks of cigarettes, e-cigarettes and heated tobacco products: a survey among the German population.

Tobacco cigarettes, e-cigarettes and heated tobacco products can pose different health risks (harm continuum). As current tobacco smokers could benefit from switching to less harmful products, we aimed to assess current smokers' perceived comparative health risks of these three products and to explore associations between risk perceptions and specific user characteristics. We analysed data from 11 waves (2019-2021; N=5657 current tobacco smokers) of a representative, cross-sectional household survey conducted in Germany. Associations were assessed with multivariable logistic regression models. 55.2% of smokers (95%CI=53.8-56.5%) ranked cigarettes as the most harmful product. 36.1% of smokers (95%CI=34.8-37.3%) perceived e-cigarettes and 33.8% (95%CI=32.5-35.0%) heated tobacco products as more harmful than cigarettes. Misperceptions that e-cigarettes or heated tobacco products are more harmful to health than cigarettes increased over the 3-year study period and were more common among those with lower educational attainment. Only half of current tobacco smokers in Germany perceive the comparative health risks of cigarettes adequately and such misperceptions have increased recently. As current smokers could benefit most from switching to less harmful products, educational campaigns are needed to inform this group about the health risks of tobacco smoking and the comparative health risks of the various nicotine and tobacco products along the harm continuum.

Factors influencing small holder farmers adoption of climate SMART agriculture practices in Welmera Woreda, Central Ethiopia

Adoption of climate-smart agriculture practices are believed to have significantly lessened the devastating impact of climate change on agriculture. However, in countries like Ethiopia, the adoption and use level of climate-smart agriculture practices remains low. The understanding of farmers’ levels of CSA practice adoption and influencing factors is therefore crucial. The goal of the study is to evaluate the degree to which various CSA practices were being used in the study area, as well as adoption determinants. The study was conducted in Welmera district, Oromia, Ethiopia. Three kebeles were chosen from the district, and a random sample of 306 farmers was picked. We used a cross-sectional household survey, a focus group discussion, and interviews with key informants. A multivariate probit model was employed to investigate the factors influencing the adoption of multiple climate-smart agriculture practices. According to the result, conservation agriculture, integrated soil fertility management, and crop diversification are the most often used CSA practices. The results also revealed that male farmers outperformed female farmers in terms of crop diversity and improved animal feed and feeding practice adoption. The age of farmers has a considerable and unfavorable impact on their likelihood of adopting improved soil fertility management and crop diversification practices. However, it has a positive and considerable impact on the adoption of agroforestry practices. With regards to economic factors, having a relatively big farmland area considerably enhances the adoption of conservation agriculture, enhances soil fertility management and crop diversity, and improves livestock feed and feeding methods and post-harvest technology practice. Improved livestock feed and feeding are more likely to be used with higher farm income. Having a significant number of animals strongly promotes the adoption of conservation agriculture, and access to financial services positively impacts agroforestry, diversification of crops, and postharvest technology practice adoption. Furthermore, institutional factors including access to agricultural extension services and training were discovered to be important and beneficial for crop diversification; similarly, access to field day participation was discovered to have a significant and positive impact on the adoption of conservation agriculture and improved soil fertility management practices. It is critical to raise awareness about climate change among farmers and experts, as well as to incorporate location-specific CSA practices into agricultural programs.

Interpersonal violence against women and maternity care in Migori County, Kenya: evidence from a cross-sectional survey.

Interpersonal violence (IPV) is an issue of major public health concern, with 24% of Kenyan women reporting physical violence perpetrated by a current husband or partner. IPV has profound impacts on physical and mental health outcomes, particularly for pregnant women; it has been found to increase the risk of perinatal mortality, low birth weight, and preterm birth. This study aims to identify variables associated with IPV and assess the effects of IPV experience on prenatal and peripartum maternal healthcare in Migori County, Kenya. Findings build on a previous study that investigated a smaller region of Migori County. Responses to cross-sectional household surveys conducted in six wards of Migori County, Kenya in 2021 from female respondents aged 18 and older were analyzed. The survey contained validated screening tools for interpersonal violence. Group-wise comparisons, and bivariate and multivariate logistic regression analyses were performed to describe community prevalence, factors associated with IPV against women, and the effect of IPV exposure on prenatal and peripartum health care. This study finds that 2,306 (36.7%) of the 6,290 respondents had experienced lifetime IPV. IPV experience was associated with the age group 25-49 (adjusted odds ratio (aOR) 1.208; 95%CI: [1.045-1.397]; p = 0.011), monogamous marriage [aOR 2.152; 95%CI: (1.426-3.248); p < 0.001], polygamous marriage [aOR 2.924; 95%CI: (1.826-4.683); p < 0.001], being widowed/divorced/separated [aOR 1.745; 95%CI: (1.094-2.786); p < 0.001], feeling an attitude of "sometimes okay" toward wife beating [aOR 2.002 95%CI: (1.651, 2.428); p < 0.001], having been exposed to IPV in girlhood [aOR 2.525; 95%CI: (2.202-2.896); p < 0.001] and feeling safe in the current relationship [aOR 0.722; 95%CI: (0.609, 0.855); p < 0.001]. A depression score of mild [aOR 1.482; 95%CI: (1.269, 1.73); p < 0.001] and severe [aOR 2.403; 95%CI: (1.429, 4.039); p = 0.001] was also associated with IPV experience, and women who experienced emotional abuse were much more likely to have experienced IPV [aOR 10.462; 95% CI: (9.037, 12.112); p < 0.001]. Adjusted analyses showed that having experienced IPV was negatively associated with attending at least four antenatal care visits during the most recent pregnancy (OR 0.849, p = 0.044) and with having a skilled birth attendant (OR 0.638, p = 0.007). IPV is prevalent in Migori County, Kenya, with increased prevalence among women aged 25-49, those residing in West Kanyamkago, those in a monogamous or polygamous marriage, those who have been widowed/divorced/separated, and those with severe depressive symptoms. Further, IPV exposure is associated with lower use of maternal care services and may lead to worse maternal health outcomes. There is need for enhanced effort in addressing social and gender norms that perpetuate IPV, and this study can contribute to guiding policy interventions and community responses towards IPV.

Health-related inequalities in out-of-pocket expenditure under universal health coverage in Taiwan: A cross-sectional decomposition analysis.

Studies have investigated income-related inequality in out-of-pocket expenditure (OOPE) on health care but less is known about health-related inequality of OOPE distribution. This study analysed the relationship between health-related inequality and OOPE and the factors contributing to OOPE inequality in Taiwan. We developed a household OOPE questionnaire and conducted a nationally representative cross-sectional survey of households in Taiwan between January and August 2022, using two-stage probability proportional-to-size sampling based on a national address registry in Taiwan. We calculated a concentration index to determine OOPE inequality in health. We then identified factors contributing to OOPE inequality in health distribution by performing a decomposition analysis. A total of 657 people responded to the survey (81.4% response rate). The two largest categories of OOPE were spending on curative care and on medical goods and pharmaceuticals, with concentration indices of -0.265 (p < .001), -0.272 (p = .006) and -0.227 (p = .003), respectively, indicating that the OOPE burden fell disproportionately on people with poor health. Socioeconomic status explained significant proportions of inequality in total, curative and medical goods and pharmaceuticals OOPE. Utilisation of health care increased the OOPE burden among people with poor health while having private health insurance worked in the opposite direction. In Taiwan, people in poor health faced a disproportionately high OOPE burden, indicating that the National Health Insurance scheme may not meet their needs for health care. There is a need for policies to take account of the different factors affecting health inequalities in OOPE in order to enhance equity in Taiwan's universal health system.

Reducing non-communicable diseases among Palestinian populations in Gaza: A participatory comparative and cost-effectiveness modeling assessment.

We sought to assess the effectiveness and cost-effectiveness of potential new public health and healthcare NCD risk reduction efforts among Palestinians in Gaza. We created a microsimulation model using: (i) a cross-sectional household survey of NCD risk factors among 4,576 Palestinian adults aged ≥40 years old in Gaza; (ii) a modified Delphi process among local public health experts to identify potentially feasible new interventions; and (iii) reviews of intervention cost and effectiveness, modified to the Gazan and refugee contexts. The survey revealed 28.6% tobacco smoking, a 40.4% prevalence of hypertension diagnosis (with a 95.6% medication treatment rate), a 25.6% prevalence of diabetes diagnosis (with 95.3% on treatment), a 21.9% prevalence of dyslipidemia (with 79.6% on a statin), and a 9.8% prevalence of asthma or chronic obstructive pulmonary disease (without known treatment). A calibrated model estimated a loss of 9,516 DALYs per 10,000 population over the 10-year policy horizon. The interventions having an incremental cost-effectiveness ratio (ICER) less than three times the GDP per capita of Palestine per DALY averted (<$10,992 per DALY averted)(<$10,992 per DALY averted) included bans on tobacco smoking in indoor and public places [$34 per incremental DALY averted (95% CI: $17, $50)], treatment of asthma using low dose inhaled beclometasone and short-acting beta-agonists [$140 per DALY averted (95% CI: $77, $207)], treatment of breast cancer stages I and II [$730 per DALY averted (95% CI: $372, $1,100)], implementing a mass media campaign for healthier nutrition [$737 per DALY averted (95% CI: $403, $1,100)], treatment of colorectal cancer stages I and II [$7,657 per DALY averted (95% CI: $3,721, $11,639)], and (screening with mammography [$17,054 per DALY averted (95% CI: $8,693, $25,359)]). Despite high levels of NCD risk factors among Palestinians in Gaza, we estimated that several interventions would be expected to reduce the loss of DALYs within common cost-effectiveness thresholds.

Women’s Perception and Readiness regarding Adoption of A Healthy and Sustainable Diet: A Cross-Sectional Study in Enugu City, Nigeria

Background: There is little knowledge about healthy and sustainable diets (HSDs) in Africa. This study assesses women’s readiness to adopt HSDs and its associated factors in Enugu, Nigeria. Methods: This was a cross-sectional household survey in 2021, which assessed women’s (n =450) food choice motives, perceived benefit, and readiness to adopt HSDs. The diets were categorised as pre-contemplation and contemplation (PC/C), preparation and relapse (P/R), and action and maintenance (A/M) stages. Odds ratios (OR) were generated using multinomial logistic regression. Results: Almost 57% of the women perceived HSD to be of high benefit. About 19%, 21%, and 60% of the women were in the PC/C, P/R and A/M, respectively. Low perceived benefit (OR=4.30, 95%CI: 2.30-8.05, P&lt;0.001), low health concern (OR=6.35, 95%CI: 2.53-15.93, P&lt;0.001), low education (OR=2.75, 95%CI: 1.39-5.44, P=0.004), and age &lt;35 years (OR=2.48, 95%CI: 1.02-6.07, P=0.046) predicted being in the PC/C stage. Low perceived benefit (OR=2.75, 95%CI: 1.63-4.63, P&lt;0.001), low health concern (OR=5.35, 95% CI: 2.40-11.92, P&lt;0.001), low level of education (OR=1.90, 95%CI: 1.05-3.42, P=0.033), and being poor (OR=2.90, 95%CI: 1.05-7.97, P=0.039) predicted being in the P/R stage. Being &lt;35 (OR=0.50, 95%CI: 0.28-0.87, P=0.014) and having low taste consideration (OR=0.29, 95%CI: 0.12-0.72, P=0.008) predicted being in the A/M stage. Conclusions: Readiness to adopt HSDs needs to be improved in Enugu, Nigeria. For this purpose, respective nutrition education interventions might be implemented regarding progress in HSDs.