Impact Of Socioeconomic Factors Research Articles

Socioeconomic Factors Associated with ≥2-year Delayed Diagnosis of Neuromyelitis Optica Spectrum Disorder (NMOSD) in the United States.

The objective of this study is to explore the impact of socioeconomic factors on risk of ≥2-year delayed diagnosis of NMOSD. Consequences of delayed diagnosis in NMOSD could be as severe as complete blindness or quadriplegia. Female sex and African ancestry are risk factors for delayed diagnosis across many disease states in the US. Patients with NMOSD are disproportionately represented by women of African descent suggesting that there may be socioeconomic barriers to timely diagnosis. This retrospective cohort study of patients with NMOSD used a closed claims database linked with socioeconomic market research and American Community Survey data at the zip-9 level. Patients were included if they had at least 2 NMOSD claims ≥30 days apart between January 2018 and December 2021. Symptom onset was defined as the first claim of associated NMOSD symptoms up to 15 years prior to diagnosis. ≥2-year delayed diagnosis was defined as diagnosis at or after 2 years of symptom onset. The conceptual causal framework was illustrated with a directed acyclic graph. Multivariable regression models were used to estimate associations of patient characteristics and several socioeconomic variables with risk of ≥2-year delayed NMOSD diagnosis. In multivariable regression analysis, factors associated with ≥2-year delayed diagnosis were female sex (OR 1.44; 95%CI 1.07-1.95) and Managed Medicaid coverage (OR 1.45; 95%CI 1.11-1.89). Factors associated with diagnosis in <2 years included age≤45 (OR 1.43; 95%CI 1.06-1.94), moderate and severe comorbidity [(Moderate OR 1.62, 95%CI 1.13-2.33), (Severe OR 1.56; 95%CI 1.04-2.35)], and western US regions (OR 1.56; 95%CI 1.12-2.16). There was no impact of other socioeconomic factors on ≥2-year delayed diagnosis. However, patient-level data on race/ethnicity was not available. This study demonstrated that otherwise healthy, female, Managed Medicaid beneficiaries, age >45 years may be at highest risk for ≥2-year delayed diagnosis of NMOSD.

Analysis of the Combined Impact of Socio-Economic Factors on House Price Volatility in the Housing Market

As an important variable in China’s economic system, real estate price is a key point closely linked to the country’s economy and people’s livelihood. It is of great practical significance to study the impact of socio-economic factors in the housing market on China’s house prices and its transmission mechanism, so as to put forward corresponding policy recommendations for stabilizing house prices and preventing real estate market and financial risks. Taking China’s time series data from 2014 to 2023 as a sample, this paper empirically investigates the law of the relationship between socio-economic factors in the housing market and house price fluctuations by constructing a structural vector autoregressive model, and employs impulse response function and variance decomposition to analyze the relationship between the two dynamically. The study shows that the 15-period variance decomposition effect of itself and residents’ disposable income are the main influencing factors of house price fluctuation, and the degree of explanation of its fluctuation is 55.5% and 23.2% respectively. In a market economy, real estate prices fluctuate up and down around their value due to the law of value. Therefore, real estate prices cannot rise indefinitely, and the final result should be stabilized within a reasonable level.

The impact of socioeconomic factors and obesity on visual impairment among older adults in Poland.

Visual impairment is a significant public health concern, particularly among older adults in Poland. The aim of this study was to determine the impact of socioeconomic factors and medical condition on visual impairment among older adults in Poland. An analysis was conducted utilizing near visual acuity assessments with Snellen charts and surveys among 5987 participants aged 60 years and over from the nationwide PolSenior2 study. A univariable and multivariable logistic regression models were created to identify risk factors for visual impairment. In a multivariable regression analysis, the odds of visual impairments were 1.72 times higher among individuals aged 75 years and over compared to those aged 60-74 years. Furthermore, individuals with primary education had 1.66 times higher odds of visual impairment compared to those with higher education. Individuals engaged in manual/farming work in the past, those who were unemployed in the past and those engaged in other job in the past had 1.25, 1.42 and 1.26 times higher odds of visual impairment, respectively, compared to white collar workers. Additionally, multivariable logistic regression analysis also revealed that obesity is associated with a 0.85 times lower odds of visual impairments. Our study revealed that socioeconomic factors significanlty impact visual health. Visual impairment was most prevalent among older age groups (age 75 and above), individuals with lower education levels or no education, the unemployed, and those who previously worked in manual labor or farming jobs or other. Additionally, obesity was inversely associated with visual impairment.

Abstract A042: Patient poverty burden influences the molecular biology of ER+ breast cancer

Abstract Although the incidence of estrogen receptor positive (ER+) breast cancer is similar for Black and White women in the US, Black patients have significantly worse outcomes. Black women in the US have also have worse health care options, poorer educational opportunities, and face significantly higher rates of poverty burden. Collectively contributing to an overall lower socioeconomic status (SES) compared to White women. However, cancer health disparities research primarily exists in two forms: 1) The impact of socioeconomic factors on cancer outcomes, and 2) The molecular underpinnings associated with genetic ancestry on cancer biology. This siloing results in an incomplete picture of how systemic factors (i.e. racism, poverty burden) contribute to the biology of breast cancer in addition to, and along-with, ancestral genetics. Consequently, differences in the molecular biology between tumors from Black and White women remains a gap in knowledge in the field, because ancestral genetics cannot explain the breadth of disparities that patients face. Recent studies have found that Black cancer patients have a unique gene expression profile that may modulate treatment response. For instance, ER+ breast tumors in Black women have distinct signatures of defective DNA damage repair (DDR) that associate with more aggressive tumor growth. However, how factors of SES contribute to these differences in molecular biology and whether these differences alter treatment response remain unknown. One challenge to addressing these questions is that existing datasets significantly underrepresent Black women and are not sufficiently annotated to understand the complex interplay between molecular biology and factors of SES. Here, we present analysis of RNA expression datasets from 60 ER+ patient tumors (38 Black, 22 White), with corresponding SES and patient outcome annotations. Altogether, these data begin to define the complex interplay between factors of SES and changes in gene expression in addition to patient outcomes for women with ER+ breast cancer. Citation Format: Jerry T. DeWitt. Patient poverty burden influences the molecular biology of ER+ breast cancer [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A042.

The Impact of Socioeconomic Factors on HIV Prevalence and Treatment Accessibility in Nigeria: A Comprehensive Review

HIV/AIDS remained a major public health challenge in Nigeria, with approximately 1.9 million people living with HIV (PLHIV), making it one of the most affected countries globally. This comprehensive review explored the impact of socioeconomic factors on HIV prevalence and treatment accessibility in Nigeria, focusing on key determinants such as poverty, education, gender inequality, and geographic disparities. Poverty exacerbated the risk of HIV infection by limiting access to prevention resources and creating barriers to treatment, while educational disparities affect awareness and prevention behaviors. Gender inequality, particularly in patriarchal societies, increases women’s vulnerability to HIV due to limited control over sexual health decisions and economic dependence. Geographic disparities, especially between urban and rural areas, contributed to uneven HIV prevalence and treatment access, with rural regions often facing significant healthcare infrastructure challenges. Additionally, the strength of health system infrastructure and funding played a crucial role in shaping the effectiveness of HIV services, with underfunding and reliance on external donors posing significant risks to sustainability. The methodology used in this article involved a review and synthesis of existing literature and data on HIV/AIDS in Nigeria, emphasizing the socioeconomic determinants of the epidemic. Addressing these factors required targeted interventions, such as strengthening social protection programs, enhancing education, promoting gender equality, improving healthcare infrastructure, and ensuring sustainable funding. These efforts were essential for reducing HIV prevalence and improving treatment outcomes in Nigeria. Keywords: HIV/AIDS, Socioeconomic determinants, Nigeria, Healthcare infrastructure, Gender inequality.

The Impact of Socio-Economic Factors on Maternal Health in Rural Africa

Maternal health was a critical indicator of societal well-being, reflecting the quality of healthcare systems and socio-economic conditions. In rural Africa, maternal health outcomes were alarmingly poor, with high maternal mortality rates persisting despite global efforts. This review explored the impact of socio-economic factors on maternal health in rural Africa, focusing on economic barriers, educational attainment, gender inequality, access to healthcare services, and social support networks. Economic barriers such as poverty and healthcare costs significantly limit access to essential maternal care. Educational attainment influences health literacy and the utilization of maternal healthcare services, with higher education levels correlating with better health outcomes. Gender inequality and entrenched cultural norms restrict women’s autonomy and decision-making power, negatively affecting maternal health. Access to healthcare services in rural areas is severely constrained by geographic isolation, inadequate infrastructure, and resource limitations. Social support networks, including family, friends, community members, and traditional birth attendants, play a crucial role in maternal health by providing emotional, informational, and practical support. This review used a comprehensive analysis of existing literature to discuss these factors and propose solutions to improve maternal health outcomes in rural Africa. Strategies such as financial assistance programs, expanding educational opportunities, empowering women, improving healthcare infrastructure, and strengthening social support networks are essential for addressing these challenges. By implementing these targeted interventions, significant improvements in maternal health can be achieved, leading to healthier mothers and stronger communities in rural Africa. Keywords: Maternal Health, Socio-Economic Factors, Rural Africa, Gender Inequality, Healthcare Access.

Redefining at-risk patients undergoiong pancreaticoduodenectomy: Impact of socioeconomic factors including Area Deprivation Index and distance traveled

BackgroundThe Whipple procedure for pancreatic adenocarcinoma frequently is referred to surgeons at high-volume centers, which requires that patients travel long distances, potentially impacting patient outcomes. Furthermore, patients with pancreatic cancer from underserved areas often have poor outcomes. There are limited data on Whipple outcomes on the basis of both socioeconomic and distance traveled. MethodsThis retrospective cohort study examined patients who underwent the Whipple procedure for pancreatic adenocarcinoma at a tertiary care center from 2019 to 2021. Patients who lived in areas with an Area Deprivation Index national percentile of >50% and ≥100 miles away from the care center were labeled as “at-risk” patients. ResultsSeventy-eight patients were included, with 22 (28.2%) patients determined to be at risk. The preoperative characteristics were comparable between the patients in the at-risk and standard-risk groups. Postoperatively, patients in the at-risk group were more likely to require reoperation (13.6% vs 0%; P = .020) and less likely to undergo adjuvant chemotherapy (73.2% vs 50%; P = .034) than patients in the standard-risk group; pathologic staging and frequency of previous use of neoadjuvant chemotherapy were not significantly different between the groups. At-risk status did not influence overall survival or recurrence rate. ConclusionsThrough the integration of distance traveled and Area Deprivation Index, we have redefined the characterization of at-risk patients with pancreatic adenocarcinoma, who are at greater risk of undergoing reoperation and not receiving adjuvant chemotherapy. By addressing these intersecting challenges, providers can mitigate disparities and improve the care of these patients with pancreatic adenocarcinoma.

Zinc Deficiency and Risks of Toxoplasmosis-Related Miscarriage: Impacts of Socioeconomic Factors

Zinc Deficiency and Risks of Toxoplasmosis-Related Miscarriage: Impacts of Socioeconomic Factors

THE IMPACT OF SOCIOECONOMIC FACTORS ON NUTRITIONAL KNOWLEDGE AND DIETARY PRACTICES AMONG SCHOOL-GOING ADOLESCENTS

Objectives: This study investigates the impact of socioeconomic factors on nutritional knowledge and dietary practices among school-going adolescents in rural areas of Jodhpur, Rajasthan. The primary objectives were to assess the relationship between socioeconomic status and adolescents' nutritional knowledge and dietary practices, and to identify barriers to adopting healthy dietary practices in the context of socioeconomic disparities. Methods: A cross-sectional survey was conducted, encompassing data from 385 adolescents, with variables such as family income, parental education, and access to nutritional resources being analyzed. Results: The results revealed significant correlations between higher socioeconomic status and better nutritional knowledge and dietary practices. Adolescents from wealthier families and those with more educated parents demonstrated superior understanding and adherence to healthy dietary guidelines, while those from lower socioeconomic backgrounds exhibited gaps in knowledge and poorer dietary habits. Additionally, the study highlighted the presence of nutritional health issues, including both underweight and overweight adolescents, indicating a dual burden of malnutrition in the region. Conclusion: The conclusion emphasizes the need for targeted public health interventions that address the socioeconomic disparities influencing adolescent nutrition. Such interventions should include enhanced nutritional education, improved access to affordable nutritious foods, and culturally sensitive programs that respect local dietary practices while promoting balanced nutrition. The findings underscore the critical role of socioeconomic factors in shaping adolescents' nutritional behaviors and call for multi-faceted approaches to improve nutritional outcomes in rural communities. KEYWORDS: Nutrition knowledge, Dietary practices, Adolescent Nutrition, Public Health, Nutritional Education

Hepatitis B Prevalence and Referral Rates in Vulnerable Populations Undergoing Community-Based Screening-Results from the LIVE(RO)2 Program.

Background: Hepatitis B Virus (HBV) remains a major global health challenge, with significant morbidity and mortality associated with chronic infections. Methods: This study examines the epidemiology, screening, and risk factors associated with HBV in Romania, focusing on a comprehensive national screening program, LIVE(RO)2, involving 320,000 individuals (majority of them considered vulnerable population). A questionnaire was used to collect information on the potential risk factors for HBV transmission. Results: The overall prevalence rate of HBV chronic infection among all the participants tested was 1.67% (confidence interval: 1.63-1.72%), with significant differences (p = 0.0001) between participants from the main geographical regions of residence (North-East 1.89%, South 1.38%, South-East 2.06%, and South-West 1.54%). Male persons aged 30-49 or 60-69 years old, from the rural and Eastern parts of Romania and non-Romanian ethnia, with a low level of education, unvaccinated, not married, unemployed, with family members with hepatitis, with personal histories of blood or blood product transfusion, surgical interventions, tattooing, hospitalizations, imprisonment, haemodialysis, unsafe sexual contacts, or with sexual transmitted infectious diseases were risk factors associated with HBsAg seropositivity. Conclusions: Our findings highlight significant demographic and epidemiological patterns of reduced HBV prevalence even in vulnerable persons, as well as modified risk factors and the impact of socio-economic factors.

The impact of socioeconomic factors on long-term mortality associated with exposure to PM2.5: a systematic literature review and meta-analysis

The impact of socioeconomic factors on long-term mortality associated with exposure to PM2.5: a systematic literature review and meta-analysis

Retrospective Study of the Epidemiological-Clinical Characteristics of Burns Treated in a Hospital Emergency Service (2018-2022).

Burns are a common and severe medical emergency requiring immediate specialized care to minimize damage and prevent complications. Burn severity depends on depth, extent, and location, with more complex care needed for burns on critical areas or extensive burns. Nursing is essential in burn management, providing immediate care, adapting treatments, managing pain, preventing infections, and offering emotional support for recovery. The study aims to analyse the epidemiological and clinical characteristics of burns treated at the Hospital Emergency Department of the Hospital Complex of Cáceres (Spain) from January 2018 to December 2022. It looks at factors like gender, age, hospital stay duration, emergency type (paediatric or adult), main diagnosis, skin thickness, burn degree, affected body areas, percentage of body surface area burned, and treatment types. It also investigates how treatment varies by gender, age, skin thickness, and burn severity. The relevance of this research lies in the fact that periodic epidemiological studies are essential to monitor changes in diseases, evaluate the effectiveness of interventions, detect outbreaks quickly, update knowledge on risk factors, and guide health policy decisions. This ensures an adapted and effective response to the needs of the population. Retrospective, observational study that analysed burn cases treated at the Hospital Complex of Cáceres (Spain) 2018-2022. Inclusion criteria were based on ICD-10 codes for burns, excluding severe cases not treated in this service. Data were analysed using descriptive statistics, Student's t-tests, Chi-square tests, and ANOVA. 220 patients surveyed, with a mean age of 47 years and 60.9% male. Most burns (95.5%) affected the external body surface, with a mean hospital stay of 7.86 days. Medical treatment was provided to 75.5% of patients, and 24.5% required surgical intervention. Significant differences in treatment procedures were observed according to age, skin thickness, and burn degree. Older patients had more procedures and longer hospital stays. Excision and transfer procedures were more common in full-thickness and severe burns. The findings align with previous research on burn demographics and treatment approaches. Treatment differences by age and burn severity highlight the need for tailored interventions. The study underscores the importance of comprehensive burn management, including psychological support for improved long-term outcomes. Further research could explore the impact of socio-economic factors on burn incidence and treatment. This study was not registered.

[Translated article] Socioeconomic status, osteoporosis and fragility fractures

Low socioeconomic status (SES) is associated with a higher risk of fragility fractures, as well as higher mortality in the first-year post-fracture. The SES variables that have the greatest impact are educational level, income level, and cohabitation status. Significant disparities exist among racial and ethnic minorities in access to osteoporosis screening and treatment.In Spain, a higher risk of fractures has been described in people with a low-income level, residence in rural areas during childhood and low educational level. The civil war cohort effect is a significant risk factor for hip fracture. There is significant geographic variability in hip fracture care, although the possible impact of socioeconomic factors has not been analyzed. It would be desirable to act on socioeconomic inequalities to improve the prevention and treatment of osteoporotic fractures.

Study on Nutritional Status of the Adolescent Relationship with their Socio-Economic Status in Bagha, Rajshahi

Background: Adolescents' nutritional status is crucial to their overall health and development. Various socio-economic factors play significant roles in influencing this status, especially in rural areas. Objective: The study aimed to identify the factors contributing to adolescents' nutritional status and to examine the relationship between these factors and the adolescents' socio-economic characteristics in Bagha, Rajshahi. Method: Data were collected from 250 adolescents using structured interview schedules. Key variables studied included the adolescents' education, mothers' education, family income, food intake, and nutritional knowledge. Correlation and multiple linear regression analyses were conducted to evaluate the associations between these variables and the adolescents' BMI and nutritional status. Result: The study revealed that adolescents' BMI had significant positive correlations with their education, mothers' education, family income, food intake, and nutritional knowledge. An inverse correlation was found between nutritional status and disease information. Other factors, such as gender, religion, family size, fathers' education, and hygiene practices, showed positive but non-significant associations. Negative, non-significant correlations were observed with age, physical activity, transportation, leisure activities, and participation in nutrition programs. A substantial majority (89.6%) of respondents were inactive in calorie intake, with only 2.4% being active. Most adolescents (79.6%) were underweight, while 20% had normal weight. Most mothers (63.3%) and fathers (55%) had primary-level education. Multiple linear regression analysis indicated that annual family income, food intake, and nutritional awareness were positively correlated with nutritional status, whereas disease information had a significant negative correlation. Conclusions: The findings highlight the critical impact of socio-economic factors on adolescents' nutritional status. .......

The Impact of Social Deprivation on Anterior Urethral Stricture Recurrence After Urethroplasty - A Trauma and Urologic Reconstructive Network of Surgeons (TURNS) Analysis.

Several factors influence recurrence after urethral stricture repair. The impact of socioeconomic factors on stricture recurrence after urethroplasty is poorly understood. This study aims to assess the impact that social deprivation, an area-level measure of disadvantage, has on urethral stricture recurrence after urethroplasty. We performed a retrospective review of patients undergoing urethral reconstruction by surgeons participating in a collaborative research group. Home zip code was used to calculate Social Deprivation Indices (SDI; 0-100), which quantifies the level of disadvantage across several sociodemographic domains collected in the American Community Survey. Patients without zip code data were excluded from the analysis. The Cox Proportional Hazards model was used to study the association between SDI and the hazard of functional recurrence, adjusting for stricture characteristics as well as age and body mass index. Median age was 46.0 years with a median follow up of 367 days for the 1452 men included in the study. Patients in the fourth SDI quartile (worst social deprivation) were more likely to be active smokers with traumatic and infectious strictures compared to the first SDI quartile. Patients in the fourth SDI quartile had 1.64 times the unadjusted hazard of functional stricture recurrence vs patients in the first SDI quartile (95% CI 1.04-2.59). Compared to anastomotic ± excision, substitution only repair had 1.90 times the unadjusted hazard of recurrence. The adjusted hazard of recurrence was 1.08 per 10-point increase in SDI (95% CI 1.01-1.15, P = .027). Patient social deprivation identifies those at higher risk for functional recurrence after anterior urethral stricture repair, offering an opportunity for preoperative counseling and postoperative surveillance. Addressing these social determinants of health can potentially improve outcomes in reconstructive surgery.

Exploring patterns and insights in a comprehensive diabetes dataset

Diabetes, a pressing global health concern, imposes significant economic and healthcare burdens on millions worldwide. Understanding the multifaceted factors contributing to diabetes is pivotal for effective prevention strategies. In this study, we leverage a comprehensive dataset (952 instances, 17 predictor variables) and employ a multifaceted statistical approach to explore the intricate interplay among stress levels, blood pressure (BP), body mass index (BMI), age, sleep quality, and physical activity in relation to diabetes, with a focus on classification and predictive implications. Our research begins by establishing fundamental relationships between discrete variables using crosstabs and chi-square tests. We uncover close associations between stress levels and BP, heightened diabetes risk with increased BMI values, and the influence of age on sleep quality. Subsequent analysis, based on descriptive data, reveals a robust correlation between physical activity and stress levels, with the paradoxical observation that excessive exercise may increase stress levels. Factor analysis further elucidates the pivotal roles of sound sleep and regular exercise in diabetes prevention, supported by asymptotic significance levels below 0.05. To culminate our study, we construct a logistic regression model with an impressive 89.3% accuracy rate for predicting diabetes risk. Notably, age, family history of diabetes, and regular medication usage emerge as the most influential factors, with regular medication demonstrating significant potential for reducing diabetes risk. Our research underscores the intricate web of factors shaping individual health and offers valuable insights for a comprehensive understanding of health and well-being in the context of diabetes prevention. Moreover, it highlights the importance of considering multiple factors in health-related research. Future research could delve into the long-term effects of interventions targeting the identified risk factors, explore the impact of socio-economic factors on diabetes risk, and investigate the potential role of emerging technologies in personalized diabetes prevention strategies.

The Influence of Socio-economic Factors on Electric Vehicle Adoption in Uttar Pradesh

Using electric vehicles (EVs) is vital to the global plan to fight climate change and cut carbon emissions. In Uttar Pradesh, one of India's most populous and economically varied states, this study investigates the impact of socioeconomic factors on the adoption of electric vehicles. Using a mixed-methods approach that includes stakeholder interviews and surveys from various socioeconomic strata, the research highlights important factors such as infrastructure availability, government incentives, education levels, and income levels. The results show that growing EV use correlates with the income of EV owners and educational achievement, mainly because of improved access to resources and information. However, significant obstacles to widespread adoption include insufficient infrastructure for charging and the meagreness of government incentives. The study also emphasizes how important it is for governments to create infrastructure, run awareness programs, and offer incentives to encourage the use of electric vehicles. These findings are essential for stakeholders and policymakers who want to increase the use of electric vehicles in Uttar Pradesh and support the larger goals of environmental preservation and sustainable development.

Research on identification, classification, and policy development for urban shrinkage: A case study of Liaoning Province, China

Under the influence of economic globalization and the transformation of pillar industries, cities are facing phenomena such as slow economic growth and population outflow, which indicate urban shrinkage. However, the theoretical framework for this phenomenon remains incomplete, and measurement standards are inconsistent. Therefore, studying urban shrinkage is of significant importance. This paper analyzes the current status and causes of urban shrinkage in Liaoning Province, China, and proposes an accurate model for identifying shrinkage. It utilizes a two-step diagnostic method that incorporates both one-dimensional and multidimensional approaches to identify shrinking cities and applies systematic clustering methods to categorize urban population changes. By observing and analyzing the population and economic data of 30 cities over 12 years, this study assesses urban shrinkage from the perspectives of population change and multivariate indicators. It identifies five cities with significant shrinkage, categorized into mild, moderate, and severe levels. Based on multiple linear regression and grey relational analysis, the study examines the impact of socio-economic factors on population changes and offers corresponding development suggestions.

The impact of socioeconomic factors on water stress: insights from global analysis

ABSTRACT By utilizing a socioeconomic framework, this paper contributes to the water stress literature. Employing the instrumental variable quantile regression model on 81 countries from 2000 to 2019, our findings reveal financial development can alleviate high levels of water stress. Good governance consistently reduces water stress but human development exacerbates water stress, indicating a conflicting relationship between improving human development and reducing water stress. The moderating effect of good governance reveals that when combined with human development, it can effectively reduce water stress.

Healthcare and Disease Burden in Africa: The Impact of Socioeconomic Factors on Public Health, by Ilha Niohuru

Healthcare and Disease Burden in Africa: The Impact of Socioeconomic Factors on Public Health, by Ilha Niohuru