Child Health Inequalities Research Articles

The impact of psychosocial factors on breastfeeding duration in the BaBi cohort study, Germany

Abstract Background Breastfeeding is considered beneficial for both mother and child. In Germany, national guidelines recommend fully breastfeeding for at least 4 months, a goal reached by only 34% of mothers in 2012. The WHO’s recommendation of exclusively breastfeeding for six months was met by 19% only. Hardly modifiable factors such as socio-economic status and migration background have been associated with duration of breastfeeding but little is known about the impact of psychosocial factors such as personality traits and social support. We hypothesise that there are differences in the psychosocial profiles of mothers regarding the duration of breastfeeding. Methods We analyse baseline and follow-up data of the Bielefeld BaBi birth cohort (2013-16). They include detailed migration and socio-economic backgrounds, as well as three measures of psychological characteristics: the optimism scale, the Big Five inventory and the locus of control scales. We perform bivariate and multivariate analyses in order to identify psychosocial determinants of fully breastfeeding for four and six months. Results Out of 780 BaBi study participants, 548 fully breastfed for four months (70.3%), of which 279 continued until at least six months (35.8%). Logistic regression analyses show that fully breastfeeding for at least four or six months is independently associated with the intention to breastfeed and the attendance of antenatal class during this or previous pregnancies. Personality characteristics, social status and migration background show however no significant association with breastfeeding duration. Conclusions Our study results support the promotion of individuals’ breastfeeding intention and attendance to antenatal classes to increase breastfeeding duration. Since differences in breastfeeding practices have the potential to create inequalities in maternal and child health, more efforts are needed to intensify research on modifiable factors influencing breastfeeding duration. Key messages Neither psychosocial factors nor socioeconomic status were associated with breastfeeding duration. Two modifiable factors, breastfeeding intention and attending antenatal classes, were the main predictors of breastfeeding duration.

Examining the relationship between air pollution and health inequalities in children in England using multilevel modelling

Examining the relationship between air pollution and health inequalities in children in England using multilevel modelling

Driving Precision Policy Responses to Child Health and Developmental Inequities.

The growing evidence base on the extent of and opportunities to reduce inequities in children's health and development still lacks the specificity to inform clear policy decisions. A new phase of research is needed that builds on contemporary directions in precision medicine to develop precision policy making; with the aim to redress child inequities. This would include identifying effective interventions and their ideal time point(s), duration, and intensity to maximize impact. Drawing on existing data sources and innovations in epidemiology and biostatistics would be key. The economic and social gains that could be achieved from reducing child inequities are immense.

Equitable coverage? The roles of the private and public sectors in providing maternal, newborn and child health interventions in South Asia

IntroductionThe private sector accounts for an important share of health services available in South Asia. It is not known to what extent socioeconomic and urban–rural inequalities in maternal, newborn and...

Longitudinal analysis of health disparities in childhood

ObjectiveCombatting disparities in health outcomes among children is a major public health concern. This study focuses on two questions: (1) To what extent does socioeconomic status (SES) contribute to disparities...

Ex-ante Inequality of Opportunity in Child Malnutrition: New Evidence from Ten Developing Countries in Asia

This study explores the inequality of opportunity in child malnutrition in ten developing countries in Asia, where a high proportion of children still remain vulnerable to food insecurity. This study takes account of multidimensional aspects of household and parental socio-economic status, and partitions children into distinct types through a data-driven clustering method. This is followed by a comparison of the malnutrition rates between types. Next, we decompose the observed disparity into the factors that are associated with the between-type disparity in malnutrition rates through a non-linear decomposition method. The results indicate that in all 10 countries, significant between-type disparities are found. We find the largest difference in Pakistan as 21.7 percentage points and the smallest difference in Maldives as 5.9 percentage points. In five of the ten countries, the difference in household affluence explains the largest part of the observed between-type disparity. All the results suggest that priority should be given to protecting children from marginalised households in order to mitigate the inequality in child health.

Family income and exposure to norovirus in childhood: Findings from the UK Millennium Cohort Study.

Children from low income families are at greater risk of poorer health outcomes than their wealthier peers. Hospital admissions for children with gastroenteritis increase as deprivation increases. Noroviruses are responsible for 47–96% of outbreaks of acute paediatric gastroenteritis, and 5–36% of sporadic cases worldwide. However, evidence on the relationship between family income and childhood exposure to norovirus is still limited, with published studies pointing to conflicting results. This study explored the relationship between family income and early childhood exposure to norovirus in the United Kingdom using data from the Millennium Cohort Study linked to serological data. Exposure to norovirus was measured by the level of human norovirus-specific antibodies (titres) obtained from oral fluid samples collected from 5962 pre-school age UK children and tested for Norovirus-specific Immunoglobulin G (IgG). Multivariable linear and quantile regression analyses were conducted to investigate the extent to which family income was associated with child norovirus exposure, and to explore the potential mechanisms through which income might translate into norovirus exposure. Higher norovirus-specific IgG titres were associated with higher family income, but the relationship weakened after controlling for potential mediating factors, mainly increased opportunities for person-to-person contacts, such as formal childcare arrangements. This study provides novel evidence that can help inform and prioritise policy interventions (e.g. vaccination) and health promotion programmes to reduce child health inequalities in the area of gastrointestinal infections.

Using Hair Cortisol to Examine the Role of Stress in Children's Health Inequalities at 3 Years

ObjectiveChildren exposed to early adversity (eg, financial hardship, family violence, parent mental health difficulties) are at greater risk of poor health outcomes. Physiological stress is one mechanism thought to explain this pathway. We investigated associations between adversity and young children's health and whether child stress (measured using hair cortisol) mediated these associations. MethodsThis was a cross-sectional study of 3-year-old children whose mothers were recruited during pregnancy, through the right@home trial, for their experience of adversity. Using total counts of 9 sociodemographic and 9 psychosocial indicators of adversity, regression models examined relationships among adversity risk counts, child hair cortisol (potential mediator), and 5 health outcomes: externalizing and internalizing problems, physical and socioemotional wellbeing, and overweight/obesity. ResultsHair cortisol data were available for 297 out of 500 (59%) participating children. When examined separately, sociodemographic adversity risk was associated with higher externalizing problems, and psychosocial adversity risk was associated with higher externalizing problems and poorer physical/socioemotional wellbeing. When examined together in a single model, psychosocial (but not sociodemographic) adversity was associated with higher externalizing problems (unstandardized mean difference [β], 0.53; P = .002) and poorer physical wellbeing (β, 1.19; P = .009); higher hair cortisol was associated with higher externalizing problems (β, 0.76; P = .02). There was no evidence that stress (hair cortisol) mediated associations between adversity and health. ConclusionsIn 3-year-old children, we found no evidence that physiological stress (hair cortisol) mediated associations between adversity risk and children's health. Hair cortisol may be limited as a single measure of stress, or physiological stress may not be a mechanism for explaining the effects of adversity on these young children's health.

Analysing child linear growth trajectories among under-5 children in two Nairobi informal settlements.

We sought to identify factors associated with linear growth among under-5 children in two urban informal settlements in Nairobi. We used longitudinal data for the period 2007-2012 from under-5 children recruited in the two sites between birth and 23 months and followed up until they reached 5 years of age. We fitted a generalized linear model on height-for-age Z-scores using the generalized estimating equations method to model linear growth trajectories among under-5 children. Known for its flexibility, the model provides strong parameter estimates and accounts for correlated observations on the same child. Two urban informal settlements in Nairobi, Kenya.ParticipantsUnder-5 children (n 1917) and their mothers (n 1679). The findings show that child weight at birth, exclusive breast-feeding and immunization status were key determinants of linear growth among under-5 children. Additionally, maternal characteristics (mother's age, marital status) and household-level factors (socio-economic status, size of household) were significantly associated with child linear growth. There were biological differences in linear growth, as female children were more likely to grow faster than males. Finally, the model captured significant household-level effects to investigate further. Findings from the study point to the need to improve the targeting of child health programmes directed at the urban poor population in Nairobi. Specific modifiable determinants of child linear growth, particularly child weight at birth, exclusive breast-feeding, immunization status and mother's background characteristics, should be considered when designing interventions aiming at addressing child health inequities in these settings.

Trends and inequalities in maternal and child health in a Brazilian city: methodology and sociodemographic description of four population-based birth cohort studies, 1982-2015.

BackgroundFew low-middle-income countries have data from comparable birth cohort studies spanning over time. We report on the methods used by the Pelotas cohorts (1982, 1993, 2004 and 2015) and describe time trends in sociodemographic characteristics of the participant families.MethodsDuring the four study years, all maternity hospitals in the city were visited daily, and all urban women giving birth were enrolled. Data on socioeconomic and demographic characteristics were collected using standardized questionnaires, including data on maternal and paternal skin colour, age and schooling, maternal marital status, family income and household characteristics. The analyses included comparisons of time trends and of socioeconomic and ethnic group inequalities.ResultsDespite a near 50% increase in the city’s population between 1982 and 2015, the total number of births declined from 6011 to 4387. The proportion of mothers aged ≥35 years increased from 9.9% to 14.8%, and average maternal schooling from 6.5 [standard deviation (SD) 4.2] to 10.1 (SD 4.0) years. Treated water was available in 95.3% of households in 1982 and 99.3% in 2015. Three-quarters of the families had a refrigerator in 1982, compared with 98.3% in 2015. Absolute income-related inequalities in maternal schooling, household crowding, household appliances and access to treated water were markedly reduced between 1982 and 2015. Maternal skin colour was associated with inequalities in age at childbearing and schooling, as well as with household characteristics.ConclusionsDuring the 33-year period, there were positive changes in social and environmental determinants of health, including income, education, fertility and characteristics of the home environment. Socioeconomic inequality was also reduced.

The dynamics of the gradient between child's health and family income: Evidence from Canada

Children from low-income families are on average associated with poorer health. Using data on 8, 019 children from who participated in the first five cycles of the Canadian National Longitudinal Survey of Children and Youth (1994/95-2002/03), we find that the gradient of family income on children's health is statistically significant and becomes more pronounced as children age. This conclusion is consistent with some previous studies and the results are more robust in that the Health Utilities Index Mark 3 is used as an alternative measure of children's health, which is conventionally measured using ordinal self-rated health. We also observe that the strong gradient withstands some “third factor” explanations such as parental health and children's health at birth. However, regarding the potential causes of the strong and steepening gradient, contrary to the previous U.S. evidence that attributes part of the gradient to the protective effect of family income on the incidence and severity of children's health problems at birth and chronic conditions (Case et al., 2002), we find no evidence suggesting that children from low-income families suffer more from poor health at birth or recover more slowly from poor health at birth and that higher family income reduces the incidence of chronic conditions or buffers the adverse effects of chronic conditions. The contrast between Canadian and U.S. children may reflect the effects of universal health insurance in Canada. Furthermore, using local unemployment rates to instrument for family income, we find that family income has a statistically significant and economically meaningful causal effect on children's health and that OLS estimates may underestimate the positive impact of family income on children's health. Our findings suggest that universal health insurance may cushion the adverse effects of poor health at birth and chronic conditions but does not eliminate the strong income-related inequality in child health.

Effectiveness of home-based records on maternal, newborn and child health outcomes: A systematic review and meta-analysis.

Home-based records (HBRs) may improve the health of pregnant women, new mothers and their children, and support health care systems. We assessed the effectiveness of HBRs on maternal, newborn and child health reporting, care seeking and self-care practice, mortality, morbidity and women’s empowerment in low-, middle- and high-income countries. We conducted a systematic search in MEDLINE, EMBASE, CENTRAL, Health Systems Evidence, CINAHL, HTA database, NHS EED, and DARE from 1950 to 2017. We also searched the WHO, CDC, ECDC, JICA and UNAIDS. We included randomised controlled trials, prospective controlled trials, and cost-effectiveness studies. We used the Cochrane Risk of Bias tool to appraise studies. We extracted and analyzed data for outcomes including maternal, newborn and child health, and women’s empowerment. We synthesized and presented data using GRADE Evidence Profiles. We included 14 studies out of 16,419 identified articles. HBRs improved antenatal care and reduced likelihood of pregnancy complications; improved patient–provider communication and enhanced women’s feelings of control and empowerment; and improved rates of vaccination among children (OR: 2·39, 95% CI: 1.45–3·92) and mothers (OR 1·98 95% CI:1·29–3·04). A three-year follow-up shows that HBRs reduced risk of cognitive delay in children (p = 0.007). HBRs used during the life cycle of women and children in Indonesia showed benefits for continuity of care. There were no significant effects on healthy pregnancy behaviors such as smoking and consumption of alcohol during pregnancy. There were no statistically significant effects on newborn health outcomes. We did not identify any formal studies on cost or economic evaluation. HBRs show modest but important health effects for women and children. These effects with minimal-to-no harms, multiplied across a population, could play an important role in reducing health inequities in maternal, newborn, and child health.

Administration Frequencies of Hepatitis A and Hepatitis B Vaccines at Two Schools with Different Socioeconomic Status Before Admission to National Immunization Program

Amac: Hepatit A ve hepatit B asilarinin ulkemiz Genisletilmis Bagisiklama Programi’na girmeden once, sosyoekonomik duzeyleri farkli iki okulda, 7-15 yas arasi cocuklarda her iki etkene yonelik asilama oranlarinin ve seroprevelanslarin karsilastirilmasi amaclanmistir. Yontem: Calismamiz, 2003 yilinda, Istanbul Bakirkoy ilcesinde, sosyoekonomik duzeyi farkli iki okulda ogrenim goren 546 cocuk arasinda yapilmistir. Ebeveynlere calisma oncesi bilgilendirme toplantisi yapilmis, calismaya gonullu ebeveynlerin cocuklari calismaya dâhil edilmistir. Cocuklarin hepatit A ve hepatit B asilari uygulanma durumu, cocukta sarilik gecirme oykusu sorgulandi. Cocuklardan alinan venoz kanlardan Anti HAV IgG, HbsAg, Anti Hbs belirtecleri calisilmistir. Bulgular: Sosyoekonomik duzeyin daha yuksek oldugu okulda hepatit A ve hepatit B asisi ile asilanma oranlari ve bu etkenlerin seroprevalanslari istatistiksel anlamli olarak yuksek saptanmistir. Sonuc: Ulusal Asilama Programi’nda yer almayan asilarin uygulanmasi, sosyoekonomik duzeye gore farklilik gosterebilmektedir. Gunumuzde hepatit A ve hepatit B asilarinin Ulusal Bagisiklama Programi’nda yer almasi, cocuk sagliginda var olan bir sosyal esitsizligin kaldirilmasi acisindan onemli bir halk sagligi girisimidir.

Custody arrangements and social inequalities among children

The recent concentration of divorce and separation among the least advantaged, and the increase in shared physical custody of children raises the question of how such family developments affect social inequalities among children. Our paper contributes to this debate by examining the moderating role of parental socioeconomic background in the relationship between children’s health and well-being and child custody arrangements. From the Spanish ‘Health Behaviour in School-aged Children’ survey, we test the competing compensatory and floor effect hypotheses, distinguishing the separate effects of father’s and mother’s education and occupation on multiple children outcomes, such as psychological complaints and life satisfaction. Our results indicate that growing up in a “non-intact” family still has greater negative consequences for disadvantaged children, and that social inequalities in child health and well-being after separation persist in contemporary Spain.

Assessment of Inequalities in Coverage of Essential Reproductive, Maternal, Newborn, Child, and Adolescent Health Interventions in Kenya

Previous work has underscored subnational inequalities that could impede additional health gains in Kenya. To provide a comprehensive assessment of the burden, distribution, and change in inequalities in reproductive, maternal, newborn, child, and adolescent health (RMNCAH) interventions in Kenya from 2003 to 2014. This population-based cross-sectional study used data from the 2003, 2008, and 2014 Kenya Demographic and Health Surveys. The study included women of reproductive age (ages 15-49 years) and children younger than years, with national, regional, county, and subcounty level representation. Data analysis was conducted from April 2018 to November 2018. Socioeconomic position that was derived from asset indices and presented as wealth quintiles. Urban and rural residence and regions of Kenya were also considered. Absolute and relative measures of inequality in coverage of RMNCAH interventions. For this analysis, representative samples of 31 380 women of reproductive age and 29 743 children younger than 5 years from across Kenya were included. The RMNCAH interventions examined demonstrated pro-rich and bottom inequality patterns. The most inequitable interventions were skilled birth attendance, family planning needs satisfied, and 4 or more antenatal care visits, whereby the absolute difference in coverage between the wealthiest (quintile 5) and poorest quintiles (quintile 1) was 61.6% (95% CI, 60.1%-63.1%), 33.4% (95% CI, 31.9%-34.9%), and 31.0% (95% CI, 30.5%-31.6%), respectively. The most equitable intervention was early initiation of breastfeeding, with an absolute difference (quintile 5 minus quintile 1) of -7.9% (95% CI, -11.1% to -4.8%), although antenatal care (1 visit) and diphtheria-tetanus-pertussis immunization (3 doses) demonstrated the best combination of high coverage and low inequalities. Our geospatial analysis revealed significant socioeconomic disparities in the northern and eastern regions of Kenya that have translated to suboptimal intervention coverage. A significant gap remains for rural, disadvantaged populations. Coverage of RMNCAH interventions has improved over time, but wealth and geospatial inequalities in Kenya are persistent. Policy and programming efforts should place more emphasis on improving the accessibility of health facility-based interventions, which generally demonstrate poor coverage and high inequalities, and focus on integrated approaches to maternal health service delivery at the community level when access is poor. Scaling up of health services for the urban and, in particular, rural poor areas and those residing in Kenya's former north eastern province will contribute toward achievement of universal health coverage.

Persistent Inequalities in Reproductive, Maternal, Newborn, Child, and Adolescent Health in Kenya

Persistent Inequalities in Reproductive, Maternal, Newborn, Child, and Adolescent Health in Kenya

Childhood stunting in Thailand: when prolonged breastfeeding interacts with household poverty

BackgroundChildhood stunting, defined as the height-for-age standardized score lower than minus two, is one of the key indicators for assessing well-being and health of a child; and can be used for monitoring child health inequalities. Thailand has been successful in improving health and providing financial protection for its population. A better understanding of the determinants of stunting will help fill both knowledge and policy gaps which promote children’s health and well-being. This study assesses the factors contributing to stunting among Thai children aged less than five years.MethodsThis study obtained data from the Multiple Indicator Cluster Survey Round 4 (MICS4), conducted in Thailand in 2012. Data analysis consisted of three steps. First, descriptive statistics provided an overview of data. Second, a Chi-square test determined the association between each covariate and stunting. Finally, multivariable logistic regression assessed the likelihood of stunting from all independent variables. Interaction effects between breastfeeding and household economy were added in the multivariable logistic regression.ResultsIn the analysis without interaction effects, while the perceived size of children at birth as ‘small’ were positively associated with stunting, children in the well-off households were less likely to experience stunting. The analysis of the interactions between ‘duration of breastfeeding’ and ‘household’s economic level’ found that the odds of stunting in children who were breastfed longer than 12 months in the poorest household quintile were 1.8 fold (95% Confidence interval: 1.3–2.6) higher than the odds found in mothers from the same poorest quintiles, but without prolonged breastfeeding. However prolonged breastfeeding in most well-off households (those between the second quintile and the fifth wealth quintile) did not show a tendency towards stunting.ConclusionsChildhood stunting was significantly associated with several factors. Prolonged breastfeeding beyond 12 months when interacting with poor economic status of a household potentiated stunting. Children living in the least well-off households were more prone to stunting than others. We recommend that the MICS survey questionnaire be amended to capture details on quantity, quality and practices of supplementary feeding. Multi-sectoral nutrition policies targeting poor households are required to address stunting challenges.

4.N. Workshop: How can we reduce inequalities in child health? Perspectives from across Europe

4.N. Workshop: How can we reduce inequalities in child health? Perspectives from across Europe

How might improvements to maternal mental wellbeing reduce inequalities in child health in the UK? A simulation of hypothetical interventions using a causal mediation method

How might improvements to maternal mental wellbeing reduce inequalities in child health in the UK? A simulation of hypothetical interventions using a causal mediation method

How might improvements to maternal mental wellbeing reduce inequalities in child health in the UK? A simulation of hypothetical interventions using a causal mediation method

How might improvements to maternal mental wellbeing reduce inequalities in child health in the UK? A simulation of hypothetical interventions using a causal mediation method