Levels Of Household Wealth Research Articles

Spatial variation, 20-year trends, and determinants of the double burden of wasting and stunting among under-five children in Ethiopia: a geo-spatial and multivariate decomposition analysis (2000–2019)

Despite extensive efforts, malnutrition persists as a critical public health concern, particularly in developing nations like Ethiopia. Concurrent occurrence of wasting and stunting poses severe consequences. Analyzing trends and factors contributing to this double burden is vital for evaluating and enhancing existing nutritional programs. Additionally, understanding the spatial distribution of malnutrition is crucial for targeted resource allocation, expediting progress towards optimal child growth. A 20-year trend and spatial analysis was conducted among 27,138 weighted samples of under-five children using EDHS (2000–2019). The data extraction was conducted between October 1 and November 1, 2023. STATA 18, ArcGIS Pro, and Sat Scan 9.6 were used for analysis. A logit-based multivariate decomposition analysis was used to identify contributing factors for the change in the double burden of wasting and stunting in the past 20 years. The statistical significance was declared at a P-value < 0.05. The double burden of wasting and stunting had shown a decline from 8.42% in 2000 to 3.31% in 2019. There is a clustered distribution of wasting and stunting (Moran’s I = 0.0712, p-value = 0.0290). Significant clustering is detected in the Somali, Afar, and Tigray regions. Among the changes in the effect of the characteristics (coefficient), maternal education level [β = −0.0012, 95% CI −0.0021, −0.0006], wealth level [β = −0.0049, 95% CI −0.0223, −0.0014], family size [β = −0.0014, 95% CI −0.0132, −0.0009] and media access [β = −0.0027, 95% CI −0.0039, −0.0014] were found to be significant contributors to the reduction of the double burden of wasting and stunting over the past 20 years. Despite the significant progress observed in the past 20 years, the problem still requires urgent attention. Thus, improving maternal education and household wealth levels is crucial. Furthermore, enhancing access to and utilization of family planning services and media coverage will help alleviate the burden and end malnutrition. Additionally, deploying additional resources in hotspot areas is also recommended.

Association between internet exclusion and depressive symptoms among older adults: panel data analysis of five longitudinal cohort studies

Internet exclusion and depressive symptoms are prevalent phenomena among older adults; however, the association between internet exclusion and depressive symptoms remains limited. This study aims to investigate the association between internet exclusion and depressive symptoms among older adults from high-income countries (HICs) and low- and middle-income countries (LMICs). We conducted a comprehensive longitudinal, cross-cultural analysis, and the participants were adults aged 60 years and older from 32 countries participating in five nationally representative longitudinal cohort studies: the Health and Retirement Study (HRS), the English Longitudinal Study of Ageing (ELSA), the Survey of Health, Ageing and Retirement in Europe (SHARE), the China Health and Retirement Longitudinal Study (CHARLS), and the Mexican Health and Ageing Study (MHAS). Internet exclusion was defined as the self-reported absence from internet use. Depressive symptoms were evaluated using the Centre for Epidemiologic Studies of Depression scale (CES-D) or the Euro-Depression scale (Euro-D). These five cohorts, being heterogeneous, were respectively conducted with panel data analysis. Logistic regression, implemented within the generalized estimating equations framework, was used to examine the association between internet exclusion and the likelihood of experiencing depressive symptoms, adjusting for the causal-directed-acyclic-graph (DAG) minimal sufficient adjustment set (MSAS), including gender, age, education, labour force status, household wealth level, marital status, co-residence with children, residence status, cognitive impairment, and functional ability. Our study included a total of 129,847 older adults during the period from 2010 to 2020, with a median follow-up of 5 (2, 7) years. The pooled proportion of internet exclusion was 46.0% in HRS, 32.6% in ELSA, 54.8% in SHARE, 92.3% in CHARLS, and 65.3% in MHAS. Internet exclusion was significantly associated with depressive symptoms across all cohort studies: HRS (OR=1.13, 95% CI 1.07-1.20), ELSA (OR=1.22, 95% CI 1.11-1.34), SHARE (OR=1.55, 95% CI 1.47-1.62), CHARLS (OR=1.49, 95% CI 1.26-1.77), and MHAS (OR=1.48, 95% CI 1.39-1.58). Moreover, internet exclusion was found to be associated with all dimensions of depression in the SHARE, MHAS, and ELSA cohorts (except for sleep and felt sad) cohorts. A considerable proportion of older adults experienced internet exclusion, particularly those in LMICs. Internet exclusion among older adults, irrespective of their geographic location in HICs or LMICs, was associated with a higher likelihood of experiencing depressive symptoms, which demonstrated the importance of addressing barriers to internet access and promoting active participation in the internet society among older adults. National Key R&D Program of China (grant number 2022ZD0160704), the Scientific Research and Innovation Team of The First Affiliated Hospital of Zhengzhou University (grant number ZYCXTD2023005), the Collaborative Innovation Major Project of Zhengzhou (grant number 20XTZX08017), the Joint Project of Medical Science and Technology of Henan Province (grant number LHGJ20220428), and National Natural Science Foundation of China (grant number 82373341).

How did the introduction of the measles-containing vaccine second dose (MCV2) affect measles vaccine uptake? – evidence from Nigeria

ABSTRACT Nigeria has the highest burden of measles worldwide, as measles vaccine uptake remains low. Recently, the second dose of the measles-containing vaccine (MCV2) was introduced as part of the routine immunization (RI) program, and this study examined how it changed the uptake of the measles vaccine and the factors associated with vaccination behavior. The Nigeria Multiple Indicator Cluster Survey (MICS) 2021 was used to compare measles vaccination uptake as well as factors associated with vaccination uptake between children before MCV2 introduction (cohort 1) and after the introduction (cohort 2). The overall rate of measles vaccine uptake was higher among cohort 1 (64%–95%) than among cohort 2 (56%–92%) in all zones because of younger age among cohort 2. The dropout from the first to second measles vaccines was similar between the cohorts (around 24%). Higher maternal education levels and higher household wealth levels were both correlated with the vaccine uptake or both cohorts but a positive correlation between the dropout and mother’s education level was observed only among cohort 2, especially in the North West and South West zones. The positive correlation between the dropout and mother’s education level among cohort 2 indicates that the introduction of MCV2 as part of RI might have helped to narrow the disparity in measles vaccine uptake in North West and South West zones. Further study is required to investigate strategies employed to reduce the disparity in these zones to apply nationwide.

Impact of Institutionalisation of Births on Health Policies and Birth Registration in India.

Background: The Registration of Births and Deaths Act (RBD) of 1969 in India mandates continuous recording of vital events; however, after more than 50 years of its enactment, universality remains elusive. Birth registration, a fundamental right, is essential for demographic analysis and effective policy planning. Birth registration is closely linked to child development, access to healthcare, and other societal factors. Analysing its trends helps in designing targeted interventions and monitoring progress toward the Sustainable Development Goals (SDGs). Objectives: This paper aims to analyse the changes in birth registration across Indian states. This paper also examines the impact of institutionalization of births on registration and underscores its significance in policymaking. Methods: The study utilises data from the latest two rounds of National Family Health Survey (NFHS-4 & NFHS-5) to analyse birth registration trends in India. Multivariable logistic regression analysis was employed to examine the impact of place of delivery on birth registration. Findings: The comparison of NFHS-4 and NFHS-5 data demonstrates varying birth registration rates across Indian states, with notable progress in some regions and persistent challenges in others. Multivariable logistic regression analysis highlights the significant influence of place of delivery on registration likelihood. The interaction between wealth and place of delivery suggests a mitigating effect, indicating that increasing institutional births has a positive impact on birth registration, with this effect being more pronounced at different levels of household wealth. It highlights that wealthier households were more likely to register births due to the higher rate of institutional deliveries. Conclusion: India's journey towards universal birth registration under the SDGs presents progress and challenges. NFHS data shows improvements in birth registration, but disparities still persist. Socio-economic status, place of delivery, and maternal education have strong influences on birth registration. Institutional deliveries significantly increase registration likelihood, facilitated by programs like Janani Suraksha Yojana. Integrating birth registration with health services enhances health data accuracy and service delivery. By prioritising targeted interventions, addressing social barriers, and leveraging existing programs, India can ensure that every child's birth is registered, advancing towards a healthier, more equitable future.

Digital penetration and residents’ entrepreneurial decision

This paper selects survey data from the China Household Finance Survey (CHFS) for 2017, 2019, and 2021 to explore the impact of digital penetration on residents' entrepreneurship. It is found that digitization helps promote residents' entrepreneurship; there is heterogeneity in the impact of digital penetration on the probability of entrepreneurship among residents with different levels of household wealth, and the positive effect of Internet use on the probability of entrepreneurship increases with the level of wealth, but the positive effect of mobile payment use is more significant for entrepreneurship among residents with low to medium levels of wealth distribution.

Binge drinking and oral health-related quality of life in older adults: Socioeconomic position matters.

The objective of the study was to investigate whether the association between binge drinking and oral health-related quality of life (OHRQoL) differs by socioeconomic position (SEP) in Brazilian older adults. The adverse health effects of alcohol consumption disproportionately affect socioeconomically disadvantaged and older individuals. Moreover, measures of binge drinking may capture different domains of the association between alcohol misuse and health that might be independent of the traditional markers of volume or frequency of consumption. Evidence of the association between alcohol use and oral health outcomes has failed to consider binge drinking and possible effect modification by SEP. We conducted a secondary cross-sectional analysis using the baseline data from The Brazilian Longitudinal Study of Ageing (2015-2016). Effect Measure Modification analyses using multivariable Poisson regression models tested whether the association between past-month binge drinking and higher scores of the Oral Impacts on Daily Performance (OIDP) questionnaire differed in magnitude by level of household wealth and educational attainment, assessed using Relative Excess Risk due to Interaction (RERI) and simple slope test. The analytical sample comprised 8857 individuals. Participants who were from low-wealth households or with lower education and reported past-month binge drinking had 27% (95% CI: 1.16 to 1.39) and 28% (95% CI: 1.18 to 1.40) higher OIDP scores, respectively, than those not binge drinkers from higher SEP, and super-additive associations were detected (RERI for household wealth: 0.12; RERI for educational attainment: 0.14). Binge drinkers from low SEP have poorer OHRQoL. Public oral health initiatives aiming to combat binge drinking are likely to disproportionately benefit vulnerable groups.

Zero-Dose, Under-Immunized, and Dropout Children in Nigeria: The Trend and Its Contributing Factors over Time

This study analyzes the trend of prevalence of, and factors contributing to, children with incomplete vaccination status, namely zero-dose, under-immunized, and dropout children, over time from 2003 to 2018 in Nigeria, one of the countries with the highest number of children with incomplete vaccination. Nigeria Demographic and Health Survey data from 2003 to 2018 were analyzed to calculate the prevalence of children with incomplete vaccination status by geographical zone over time and to investigate the factors contributing to the change in the prevalence of such children over time based on the Blinder-Oaxaca decomposition analysis. The prevalence of children with incomplete vaccination status substantially decreased from 2003 to 2018 in most of zones in Nigeria. Rural areas and the northern zones had consistently higher prevalence of children with incomplete vaccination status than urban areas and the southern zones. It was identified that mothers' education and the household wealth level explained the reduction in the prevalence of zero-dose and under-immunized children, but the degree of contribution of each factor varied by zone and place of residence, i.e., urban or rural. Both the mother's education and household wealth level only weakly contributed to the reduction in the number of dropout children. Future studies should explore further how to improve the vaccination coverage in Nigeria over time. Examples of topics for future study include other contributing factors beyond education and wealth level, differential factors influencing the reduction in the number of children with incomplete vaccination status by area of residence (urban vs. rural), why the reduction in the number of dropout children is not explained by either education or wealth, and the significant contributors to the reduction in the number of such children.

Digital exclusion and functional dependence in older people: Findings from five longitudinal cohort studies.

Older people are more likely to be excluded from the digital world, and this has been linked to poor health outcomes. The extent and direction of the influence of digital exclusion on functional dependency is, however, not well understood. We aimed to investigate the association between digital exclusion and functional dependency among older adults from high-income countries (HICs) and low- and middle-income countries (LMICs). In this multicohort study, we pooled individual-level data from five longitudinal cohort studies that included nationally representative samples of older adults across 23 countries, including the Health and Retirement Study (HRS), the English Longitudinal Study of Aging (ELSA), the Survey of Health, Ageing and Retirement in Europe (SHARE), the China Health and Retirement Longitudinal Study (CHARLS), and the Mexican Health and Aging Study (MHAS). The digital exclusion was recorded as an absence from internet use by self-reported. We assessed basic activities of daily living (BADL) and instrumental activities of daily living (IADL), and we used interval-of-need methods to categorize the functional dependency. We applied generalized estimating equations models fitting Poisson model to investigate the association of digital exclusion with difficulties in BADL or IADL and functional dependency, adjusting for the causal-directed-acyclic-graph (DAG) minimal sufficient adjustment set (MSAS), including gender, age level, labour force status, education, household wealth level, marital status, and co-residence with children. We included 108,621 participants recruited between 2010 and 2018 with a median follow-up of 3 phrases. Digital exclusion in older adults varied across countries, ranging from 23.8% in Denmark (SHARE) to 96.9% in China (CHARLS). According to the crude model, digital exclusion was significantly associated with functional dependency. In the MSAS-adjusted model, those associations remained statistically significant: HRS (incidence rate ratio [IRR]=1.40, 95% confidence interval [CI] 1.34-1.48 for BADL; 1.71 [1.61-1.82] for IADL), ELSA (1.31[1.22-1.40] in BADL and 1.37 [1.28-1.46] in IADL), SHARE (1.69 [1.61-1.78] in BADL and 1.70 [1.63-1.78] in IADL), CHARLS (2.15 [1.73-2.67] in BADL and 2.59 [2.06-3.25] in IADL), and MHAS (1.15 [1.09-1.21] in BADL and 1.17 [1.09-1.25] in IADL). In the subgroup analyses, the associations were more pronounced in the oldest-old (aged≥80 years old). There is a substantial proportion of older adults who are excluded from the Internet, especially those in LMIC. Older people excluded from the Internet regardless of whether they live in HICs or LMICs are more likely to develop functional dependency. It should be made a priority to remove barriers to Internet access in order to assist older people in maintaining their independence and, consequently, to reduce the care burden associated with the ageing population worldwide. The National Natural Science Foundation of China (No. 71904004).

The burden of vaccine hesitancy for routine immunization in Yaounde-Cameroon: A cross-sectional study.

Immunization is the most cost-effective health intervention in the world yet, vaccination uptake is still low with less than 50% of children aged 12-23 months fully vaccinated in Cameroon by 2018. The objective of this study was to estimate the burden of vaccine hesitancy associated with routine vaccines in Yaounde-Cameroon. A two-stage cross-sectional cluster survey was conducted in Yaoundé in November 2021, targeting parents/guardians of children 0-59 months. Clusters were selected with probability proportionate to size (PPS) and household's selection done using a restricted sampling method. Data collection was done using an interviewer-administered questionnaire, "Core Closed Questions" and "Likert Scale Questions" proposed by the WHO Vaccine Hesitancy Technical Working Group in 2014. Vaccine hesitancy was analyzed as proportions of parent's/guardian's self-reported vaccine refusal or delay in vaccination with 95% confidence interval. This was stratified by household wealth level and tested using Chi-Square test to appreciate the effect of household wealth on vaccine hesitancy. A total of 529 participants were enrolled out of 708 visited, giving a non-response rate of 25%. In total, vaccine hesitancy was reported in 137(25.90[22.35-29.80] %), and oral polio vaccine(OPV) was the most affected vaccine with hesitancy of 10%. Vaccine hesitancy prevalence did not vary significantly across different households' wealth levels (p-value = 0.3786). However, in wealthy households' refusal of vaccines (14%) was less than in poorer households (20%). Lack of trust was reported as the leading cause of vaccine refusal (43%). Vaccine hesitancy prevalence in Yaounde is high and oral polio vaccine(OPV) was the most affected vaccine. The level of weath does not affect vaccine hesitancy and lack of trust was the leading cause of vaccine hesitancy related to routine immunization in Yaounde-Cameroon. We, recommend that the burden of vaccine hesitancy should be assessed at national scale and root causes investigated.

The prevalence of significant cognitive delay among 3- to 4-year-old children growing up in low- and middle-income countries: results from 126 nationally representative surveys undertaken in 73 countries.

We sought to (1) update estimates of the prevalence of significant cognitive delay (SCD) among nationally representative samples of young children overall, and in upper-middle, lower-middle and low-income countries; (2) investigate whether variation in prevalence between countries was systematically associated with national wealth and other country characteristics; (3) investigate the stability of prevalence estimates over time; (4) examine the correlation between SCD and 2019 Global Burden of Disease estimates on the prevalence of the impairment of developmental intellectual disability under 5years of age; and (5) investigate the extent to which risk of SCD within countries varies with child age and gender, maternal education and household wealth. Secondary analysis of data collected in 126 nationally representative Multiple Cluster Indicators Surveys (MICS) conducted under the supervision of UNICEF in 73 countries involving a total of 396596 3- to 4-year-old children. The overall prevalence of SCD was 9.7% (95% CI 8.6-10.9%). Between-country variation in prevalence was strongly related to national wealth, the Human Development Index, the Human Inequality-adjusted Development Index and the Multidimensional Poverty Index, but not income inequality. In the 46 countries in which more than one survey was available prevalence estimates were reasonably stable over time (r=0.80, P<0.001). There were strong independent associations between increased risk of cognitive delay and younger child age, lower levels of maternal education and lower levels of household wealth (but not male gender). There was only a weak association across countries between the estimated prevalence of SCD and Global Burden of Disease estimates of the under 5 prevalence of the impairment of developmental intellectual disability. UNICEF's MICS data are readily (and freely) available to researchers and provide a cost-effective opportunity for researchers who are concerned about better understanding the situation of young children growing up in the world's LMICs with a marked loss of developmental potential in areas of cognition and learning.

Changes in Inequality in Use of Maternal Health Care Services: Evidence from Skilled Birth Attendance in Mauritania for the Period 2007-2015.

Skilled birth attendance is critical to reduce infant and maternal mortality. Health development plans and strategies, especially in developing countries, consider equity in access to maternal health care services as a priority. This study aimed to measure and analyze the inequality in the use of skilled birth attendance services in Mauritania. The study identifies the inequality determinants and explores its changes over the period 2007–2015. The concentration curve, concentration index, decomposition of the concentration index, and Oaxaca-type decomposition technique were performed to measure socioeconomically-based inequalities in skilled birth attendance services utilization, and to identify the contribution of different determinants to such inequality as well as the changes in inequality overtime using data from Mauritania Multiple Indicator Cluster Surveys (MICS) 2007 and 2015. The concentration index for skilled birth attendance services use dropped from 0.6324 (p < 0.001) in 2007 to 0.5852 (p < 0.001) in 2015. Prenatal care, household wealth level, and rural−urban residence contributed most to socioeconomic inequality. The concentration index decomposition and the Oaxaca-type decomposition revealed that changes in prenatal care and rural−urban residence contributed positively to lower inequality, but household economic status had an opposite contribution. Clearly, the pro-rich inequality in skilled birth attendance is high in Mauritania, despite a slight decrease during the study period. Policy actions on eliminating geographical and socioeconomic inequalities should target increased access to skilled birth attendance. Multisectoral policy action is needed to improve social determinants of health and to remove health system bottlenecks. This will include the socioeconomic empowerment of women and girls, while enhancing the availability and affordability of reproductive and maternal health commodities. This policy action can be achieved through improving the availability of obstetric service providers in rural areas; ensuring better distribution and quality of health infrastructure, particularly health posts and health centers; and, ensuring user fees removal for equitable, efficient, and sustainable financial protection in line with the universal health coverage objectives.

Does the Two-Child Policy Affect the Consumption Upgrade of “Two-Child Families”: Based on CFPS Data from the Chinese Family Tracking Survey

Purpose &#8211; In the context of the continued low consumption rate of Chinese residents, the increasingly aged society in China, and the decline in the birth rate, the Chinese government has gradually liberalized the fertility policy. The twochild policy has undergone policy adjustments from “only child of both parties” in 2011 to “only child of one party” in 2014, and then to the “Universal” policy in 2016, which marked the complete end of the “one-child policy” implemented since the 1970s. The purpose of this paper is to assess the effect of the “two-child birth policy” on the consumption upgrading of urban households, and to explore the mechanism of the effect. Design/Methodology/Approach &#8211; Through the quasi-natural experiment of the “two-child policy”, empirical analysis is carried out using the panel data of the China Family Tracking Survey (CFPS) database from 2012-2018. In order to improve sample selection bias and endogenous problems as much as possible, double-difference (PSM-DID) methods based on propensity score matches were adopted to construct the experimental and control groups to empirically test the impact of the second-child policy. A robustness test was carried out through methods such as parallel trend tests and sample size reduction. Further heterogeneity analysis of the policy action mechanism was conducted using the triple difference method (DDD). Findings &#8211; (1) In general, the “two-child policy” has promoted the upgrading of household consumption levels and consumption structures. (2) Furthermore, research findings of a triple difference (DDD) model were that the effect of fertility policy between household consumption levels and consumption structure was different across target households with different levels of household wealth. That is, the higher the wealth level of the household, the more the fertility policy promoted an increase in household consumption and an upgrade of the consumption structure, but for education consumption expenditure, regardless of household wealth level, the fertility policy promoted a significant increase in household consumption expenditure and had a “crowding out effect” on other developmental hedonic consumption of the household, and the lower the wealth level, the more pronounced the crowding-out effect. Research Implications &#8211; This paper studies the consumption of urban residents from the perspective of the characteristics of family population structure. It uses Chinese empirical data to test the applicability of relevant consumption theories in China, and provides perfect unique sample data for the academic community. By exploring the mechanism of the impact of the fertility policy on the consumption level and structure of residents, it can provide a reference for evaluating past population and economic policies. However, it provides a theoretical basis and guidance for the formulation of population and economic policies in the future, and the implementation of supporting policies for the “Three-Child Policy”.

Assessing the overlap between immunisation and other essential health interventions in 92 low- and middle-income countries using household surveys: opportunities for expanding immunisation and primary health care.

BackgroundUnvaccinated children may live in households with limited access to other primary health care (PHC) services, and routine vaccination services may provide the opportunity to bring caregivers into contact with the health system. We aimed to investigate the overlap between not being vaccinated and failing to receive other PHC services in low- and middle-income countries (LMICs).MethodsUsing Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) data between 2010-2019 from 92 LMICs, we analysed six vaccination indicators based on the bacille Calmette-Guérin (BCG), polio, diphtheria-pertussis-tetanus (DPT) and measles vaccines and their overlap with four other PHC indicators - at least four antenatal care (ANC) visits, institutional delivery, careseeking for common childhood illnesses or symptoms and place for handwashing in the home - in 211,141 children aged 12-23 months. Analyses were stratified according to wealth quintiles and World Bank income levels.FindingsUnvaccinated children and their mothers were systematically less likely to receive the other PHC interventions. These associations were particularly marked for 4+ ANC visits and institutional delivery and modest for careseeking behaviour. Our stratified analyses confirm a systematic disadvantage of unvaccinated children and their families with respect to obtaining other health services in all levels of household wealth and country income.InterpretationWe suggested that lack of vaccination goes hand in hand with missing out on other health interventions. This represents an opportunity for integrated delivery strategies that may more efficiently reduce inequalities in health service coverage.FundingBill & Melinda Gates Foundation, Gavi, the Vaccine Alliance, The Wellcome Trust, Associação Brasileira de Saúde Coletiva and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior.

Trends and factors associated with the nutritional status of adolescent girls in Ghana: a secondary analysis of the 2003-2014 Ghana demographic and health survey (GDHS) data.

We examined the trends over time and the factors associated with malnutrition among adolescent girls in Ghana. Cross-sectional analysis from 3 nationwide Ghana Demographic and Health Surveys conducted in 2003 (n 983), 2008 (n 955) and 2014 (n 857). We used Cox proportional hazard models with sample weighting to model the prevalence ratio (PR) of malnutrition. Countrywide, covering rural and urban areas in Ghana. Non-pregnant adolescent girls aged 15-19 years. Compared with 2003, thinness declined marginally (PR 0·88 (95 % CI 0·45, 1·73)) in 2008 and in 2014 (PR 0·71 (95 % CI 0·38, 1·56)). Stunting declined marginally by 19 % in 2008 (PR 0·81 (95 % CI 0·59, 1·12)), flattening out in 2014 (PR 0·81 (95 % CI 0·57, 1·17)). We found an increasing trend of overweight/obesity with the PR peaking in 2014 (PR 1·39 (95 % CI 1·02, 1·88)) compared to 2003. The anaemia prevalence remained severe without a clear trend. A low level of education of the adolescent girl was positively associated with stunting. Increasing age was positively associated with stunting but inversely associated with thinness and anaemia. Girls who ever bore a child were more likely to be anaemic compared to those who never did. A lower level of household wealth and a unit increase in household size was negatively associated with overweight/obesity. Urban dwelling girls were less likely to be stunted. The stagnant burden of under-nutrition and rising over-nutrition emphasise the need for double-duty actions to tackle malnutrition in all its forms in Ghanaian adolescent girls.

Household\xa0food insecurity and coping strategies in Southern Ethiopia

BackgroundHunger and undernourishment are the main challenges of today’s world and 960 million people are hungry and undernourished. Food insecurity is an enduring, critical challenge in Ethiopia. Majority of the previous studies overlooked relevant determinant factors which affect the occurrence of food insecurity. This study aims to investigate household level food insecurity determinate factors and coping strategies used in the study area.MethodExplanatory and descriptive research was designed to assess household food insecurity and coping strategies in Analemmo district of southern Ethiopia. A multi-stage purposive sampling technique was used for the purpose of this study. Two hundred households were selected systematically following list of food insecure households. Econometric models were employed using binary logit model. Household calorie acquisition was calculated to categorize households into food secure and food insecurely status.ResultsThe survey result showed that 64% of the respondents were food insecure. Variables such as agro-ecology, age and education status, number of oxen, soil and water conservation, amount of credit, cultivated land size and receiving remittance were negatively but significantly (P < 0.05) affected households' food insecurity level. Female and young groups of the community were more food insecure as compared to others groups. The community was coping food shortage by relying on less preferred and less expensive food followed by participating in off-farm activities and borrowing food. Housesholds in the study area were utilizing less preferred foods to cope up food shortage and starvation.ConclusionEfforts of different developmental organizations should give due emphasis to household's wealth level, female-headed household and young and old-aged members of the community. Crop land production supported by modern agricultural technologies and information can reduce agricultural risks, and enhance productivity per unit land.

Digital Penetration，Inclusive Finance and Household Wealth Growth

With the deep integration of Internet technology and finance, digital finance has become an indispensable part of inclusive finance and an important driving force for the development of inclusive finance. How inclusive finance affects household wealth under the background of digital penetration has become a hot issue. Based on the advantages of digital finance, this paper compares the differences between traditional and digital inclusive finance, and discusses the mechanism and effect of digital inclusive finance in promoting household wealth.Based on the panel data of China Family Panel Studies（CFPS）, this paper finds that digital inclusive finance helps to increase the level of household wealth, and has greater inclusiveness and a stronger leverage effect than traditional finance. This conclusion is further confirmed by 2SLS test with “geographical distance” as the instrumental variable. Different business types of digital inclusive finance have different promotion effects. Monetary fund, electronic payment and other business types have obvious promotion effects on the overall household wealth. Insurance, credit, online investment and electronic credit also have certain positive effects on the overall wealth, but the impact is small. According to the results of heterogeneity test, the effect of digital inclusive finance on household wealth in the central and western regions is stronger than that in the eastern regions; the role of digital inclusive finance in promoting the increase of household wealth depends on the family’s education level and understanding ability, and has a stronger role in promoting the families with high education level and high understanding ability. The degree of digitalization has a significant negative impact on the overall household wealth, which may be related to the phenomenon of “digital exclusion” in digital inclusive finance. Digital exclusion may weaken the role of digital inclusive finance in promoting the growth of household wealth to a certain extent.The research shows that in order to play the positive role of digital inclusive finance in benefiting the real economy and promoting the growth of household wealth, government departments should promote the deep integration of digital finance and traditional finance, give full play to the respective advantages and characteristics of digital finance and traditional finance, and build a complementary and mutually reinforcing financial service system.This study expands the existing research in three aspects: First, based on the background of digital penetration into the financial field, it examines the mechanism and function of digital inclusive finance on household wealth. Second, it compares and tests the differences between digital inclusive finance and traditional inclusive finance in promoting household wealth. Third, it tries to use geographical distance as an instrumental variable to overcome endogeneity and carry out comprehensive heterogeneity analysis.

Dynamics of immobility: Capability conversion among aspiring migrants in Pakistan

AbstractWhat are the costs of attempting to migrate internationally for work but being deterred by unexpected changes in states’ policies? Building on recent insights into involuntary immobility, I examine immobility's financial consequences, including how these consequences vary across levels of household wealth. Drawing on an original panel survey of 70 aspiring Pakistani labour migrants and their heads of household, I find that poorer households more often expected to pay to migrate. They also lost the most in financing overseas employment attempts gone awry. I additionally use the findings to specify a dynamic of immobility: “capability conversion”, or the process by which migrants’ capability to migrate at one point in time crashes up against unexpected constraints, thereby affecting their future capability to migrate. Capability conversion helps explain how migratory attempts can lead individuals to becoming more “stuck” over time, and, more generally, helps develop the aspiration‐mobility framework for analysing (im)mobility.

Determinants of Processing Speed Trajectories among Middle Aged or Older Adults, and Their Association with Chronic Illnesses: The English Longitudinal Study of Aging

The aim of this study was to identify latent groups of similar trajectories in processing speed through aging, as well as factors that are associated with these trajectories. In the context of the Ageing Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) project, data from the English Longitudinal Study of Aging (ELSA) (n = 12099) were analyzed. Latent groups of similar trajectories in the processing scores as well as their predictors and covariates were investigated, using group-based trajectory models (GBTM). The coefficient estimates for potential group predictors correspond to parameters of multinomial logit functions that are integrated in the model. Potential predictors included sex, level of education, marital status, level of household wealth, level of physical activity, and history of smoking, while time-varying covariates included incidence of cardiovascular disease (CVD), diabetes mellitus, depressive symptoms, and sleep disturbances. Four trajectories were identified and named after their baseline scores and shapes: High (4.4%), Middle/Stable (31.5%), Low/Stable (44.5%), and Low Decline (19.6%). Female sex, higher levels of education, mild level of physical activity, having been married, and higher level of wealth were associated with a higher probability of belonging to any of the higher groups compared to the Low/Decline that was set as reference, while presence of CVD, diabetes mellitus, and depressive symptoms were associated with lower processing speed scores within most trajectories. All the aforementioned factors might be valid targets for interventions to reduce the burden of age-related cognitive impairment.

Determinants of unmet need for family planning in Gambia & Mozambique: implications for women\u2019s health

BackgroundIn low-middle-income countries, unmet need for family planning (FP) constitutes a major challenge for prevention of unintended pregnancies and associated health and psychological morbidities for women. The factors associated with unmet need for family planning have been studied for several countries in sub-Saharan Africa, but not much is known about the situation in Gambia and Mozambique. The purpose of this study was to perform a comparative analysis of the prevalence of unmet need for FP, and its sociodemographic correlates in Gambia and Mozambique to better inform FP policies and programs aimed at reducing associated negative health outcomes for women and their families.MethodsIn this analysis we used nationally representative data from Demographic and Health Surveys in Gambia (2013) and Mozambique (2011). Sample population were 23,978 women (n = 10,037 for Gambia and 13,745 for Mozambique) aged 15–49 years. Women who want to stop or delay childbearing but were not using any contraceptive method were considered to have unmet need for FP. Association between unmet need for FP and the explanatory variables was measured using binary logistic regression modelsResultsPrevalence of unmet need for FP was 17.86% and 20.79% for Gambia and Mozambique, respectively. Having employment in professional/technical/managerial position showed an inverse association with unmet need both in Gambia [OR = 0.843, 95% CI 0.730, 0.974] and Mozambique [OR = 0.886, 95% CI 0.786, 0.999]. Education and household wealth level did not show any significant association with unmet need. The only positive association was observed for rural [OR = 1.213, 95% CI 1.022, 1.441] women in the richer households in Gambia. Having access to electronic media [OR = 0.698, 95% CI 0.582, 0.835] showed a negative effect on having unmet need in Mozambique. Women from female headed households in Gambia [OR = 0.780, 95% CI 0.617, 0.986] and Mozambique [OR = 0.865, 95% CI 0.768, 0.973] had lower odds of unmet need for FP.ConclusionThe situation of unmet need for FP in Gambia and Mozambique was better than the Sub-Saharan African average (25%). Nonetheless, there is room for improvement in both countries. Significant assocations with lower unmet need for family planning and women’s occupational status (more education & higher skilled employment), access to mass media communication, and female-headed households provide possible areas for intervention for improved FP opportunities in the region.

Prevalence and determinants of unintended pregnancy in Ethiopia: A systematic review and meta-analysis of observational studies.

Unintended pregnancy has significant consequences for the health and welfare of women and children. Despite this, a number of studies with inconsistent findings were conducted to reduce unintended pregnancy in Ethiopia; unavailability of a nationwide study that determines the prevalence of unintended pregnancy and its determinants is an important research gap. Thus, this study was conducted to determine the overall prevalence of unintended pregnancy and its determinants in Ethiopia. We searched from Google Scholar, PubMed, Science Direct, Web of Science, CINAHL, and Cochrane Library databases for studies. Each of the original studies was assessed using a tool for the risk of bias of observational studies. The heterogeneity of studies was also assessed using I2 test statistics. Data were pooled and a random effect meta-analysis model was fitted to provide the overall prevalence of unintended pregnancy and its determinants in Ethiopia. In addition, the subgroup analyses were performed to investigate how the prevalence of unintended pregnancy varies across different groups of studies. Twenty-eight studies that satisfy the eligibility criteria were included. We found that the overall prevalence of unintended pregnancy in Ethiopia was 28% (95% CI: 26-31). The subgroup analyses showed that the highest prevalence of unintended pregnancy was observed from the Oromiya region (33.8%) followed by Southern Nations Nationalities and Peoples' region (30.6%) and the lowest was in Harar. In addition, the pooled prevalence of unintended pregnancy was 26.4% (20.8-32.4) and 30.0% (26.6-33.6) for community-based cross-sectional and institution-based cross-sectional studies respectively. The pooled analysis showed that not communicating with one's husband about family planning was more likely to lead to unintended pregnancy (OR: 3.56, 95%CI: 1.68-7.53). The pooled odds ratio also showed that unintended pregnancy is more likely among women who never use family planning methods (OR: 2.08, 95%CI: 1.18-3.69). Furthermore, the narrative review of this study showed that maternal education, age, and household wealth index are strongly associated with an unintended pregnancy. In this study, the prevalence of unintended pregnancy was high. Lack of spousal communication, never using family planning, maternal education, and household wealth level were significantly associated with an unintended pregnancy. This study implies the need to develop plans and policies to improve the awareness of contraceptive utilization and strengthen spousal communication related to pregnancy.