Larger Household Size Research Articles

Willingness to renew national hospital insurance fund among voluntary scheme members in Kajiado County-Kenya

Objective: This study established determinants for readiness to renew the NHIF (national hospital Insurance fund) among informal sector national scheme members in Kenya for universal health coverage (UHC). Methods: This was a cross sectional survey on 394 purposively sampled national health insurance members in Kajiado County. Data was collected through questionnaires rated on a 5-point Likert scale. Binary logistic regression was used to establish the significant determinants associated with the willingness to renew the insurance covers. P-values of less than 0.05 were considered statistically significant. Results: Majority of the participants were male (n=266, 67.5%), over 36 years of age (n=330, 83.7%), married (n=200, 50.8%) and lived in large households of over 3 people (n=358, 90.9%). Overall, respondents showed high willingness to continue paying the insurance premiums and renew their insurance covers for health services (Median: 3.86, IQR 0.75). Controlling for all factors, married (AOR 15.6, 2.3-106.4), large household sizes with more than 3 people, low household income per month (less than KSh. 5000), awareness of NHIF fund services (AOR 13.2, 3.1-55.5), service provider factors (AOR 109, 14.8-803.8) and adverse selection on willingness to renew (AOR 0.043, 0.009-0.202) were significant determinants of willingness to renew the insurance cover (p<0.05). Conclusion: Individual factors - married, belonging to larger household, and lower income group, awareness of NHIF services and system/external factors - service provider’s factors and adverse selection on the other hand influenced willingness to renew insurance covers. There is need to increase the community’s awareness on the health insurance risk-benefits through member education and improve access to quality health services in the health facilities to enhance renewal of the NHIF covers by members.

The genetic landscape of autosomal dominant polycystic kidney disease in Kuwait.

Autosomal dominant polycystic kidney disease (ADPKD) is the most common renal monogenic disease, characterized by bilateral accumulation of renal fluid-filled cysts leading to progressive renal volume enlargement and gradual impairment of kidney function, often resulting in end-stage renal disease. Kuwait could provide valuable genetic insights about ADPKD, including intrafamilial phenotypic variation, given its large household size. This study aims to provide a comprehensive description of the pathogenic variants linked to ADPKD in the Kuwaiti population using multiple genetic analysis modalities and to describe and analyse the ADPKD phenotypic spectrum in terms of kidney function, kidney volume and renal survival. A total of 126 ADPKD patients from 11 multiplex families and 25 singletons were recruited into the study. A combination of targeted next-generation sequencing (tNGS), long-range polymerase chain reaction, Sanger sequencing and multiplex ligation-dependent probe amplification were utilized for genetic diagnosis. Clinical evaluation was conducted through renal function testing and ultrasonographic kidney volume analysis. We identified 29 ADPKD pathogenic mutations from 36 families achieving an overall molecular genetic diagnostic rate of 112/126 (88.9%), including 29/36 (80.6%) in families. A total of 28/36 (77.8%) families had pathogenic mutations in PKD1, of which 17/28 (60.7%) were truncating, and 1/36 (2.8%) had a pathogenic variant in the IFT140 gene. A total of 20/29 (69%) of the identified ADPKD mutations were novel and described for the first time, including a TSC2-PKD1 contiguous syndrome. Clinical analysis indicated that genetically unresolved ADPKD cases had no apparent association between kidney volume and age. We describe for the first time the genetic landscape of ADPKD in Kuwait. The observed genetic heterogeneity underlining ADPKD along with the wide phenotypic spectrum reveal the level of complexity in disease pathophysiology. ADPKD genetic testing could improve the care of patients through improved disease prognostication, guided treatment and genetic counselling. However, to fulfil the potential of genetic testing, it is important to overcome the hurdle of genetically unresolved ADPKD cases.

Differential Patterns by Area-Level Social Determinants of Health in Coronavirus Disease 2019 (COVID-19)-Related Mortality and Non-COVID-19 Mortality: A Population-Based Study of 11.8 Million People in Ontario, Canada.

Social determinants of health (SDOH) have been associated with coronavirus disease 2019 (COVID-19) outcomes. We examined patterns in COVID-19-related mortality by SDOH and compared these patterns to those for non-COVID-19 mortality. Residents of Ontario, Canada, aged ≥20 years were followed from 1 March 2020 to 2 March 2021. COVID-19-related death was defined as death within 30 days following or 7 days prior to a positive COVID-19 test. Area-level SDOH from the 2016 census included median household income; proportion with diploma or higher educational attainment; proportion essential workers, racially minoritized groups, recent immigrants, apartment buildings, and high-density housing; and average household size. We examined associations between SDOH and COVID-19-related mortality, and non-COVID-19 mortality using cause-specific hazard models. Of 11 810 255 individuals, we observed 3880 COVID-19-related deaths and 88 107 non-COVID-19 deaths. After accounting for demographics, baseline health, and other area-level SDOH, the following were associated with increased hazards of COVID-19-related death (hazard ratio [95% confidence interval]: lower income (1.30 [1.04-1.62]), lower educational attainment (1.27 [1.07-1.52]), higher proportions essential workers (1.28 [1.05-1.57]), racially minoritized groups (1.42 [1.08-1.87]), apartment buildings (1.25 [1.07-1.46]), and large vs medium household size (1.30 [1.12-1.50]). Areas with higher proportion racially minoritized groups were associated with a lower hazard of non-COVID-19 mortality (0.88 [0.84-0.92]). Area-level SDOH are associated with COVID-19-related mortality after accounting for demographic and clinical factors. COVID-19 has reversed patterns of lower non-COVID-19 mortality among racially minoritized groups. Pandemic responses should include strategies to address disproportionate risks and inequitable coverage of preventive interventions associated with SDOH.

SARS-CoV-2 seroprevalence and infection rate in Manila, Philippines prior to national vaccination program implementation: a repeated cross-sectional analysis

BackgroundSARS-CoV-2 seroepidemiological studies are used to guide public health decision making and to prepare for emerging infectious diseases. Disease occurrence estimates are limited in the Philippines, the country with the highest reported number of coronavirus disease-related deaths in the Western Pacific region. We aimed to estimate SARS-CoV-2 seroprevalence and infection rate among outpatient clinic attendees in Metro Manila prior to the implementation of the national coronavirus disease vaccination program.MethodsWe conducted repeated cross-sectional surveys at the animal bite clinic in San Lazaro Hospital, Manila, the Philippines across four periods, 3 months apart, between May 2020 and March 2021. Multivariable logistic regression was used to assess associations between different characteristics and infection status including seropositivity.ResultsIn total 615 participants were enrolled, ranging from 115 to 174 per period. Seroprevalence quadrupled between the first (11.3%) and second (46.8%) periods and plateaued thereafter (third—46.0%, fourth—44.6%). Among seropositive participants, total antibody concentration was comparable throughout the first to third periods but declined between the third and fourth periods. Infection prevalence was comparable across enrollment periods (range 2.9–9.5%). Post-secondary education [aOR 0.42 (95% CI 0.26, 0.67)] was protective, and frontline work [aOR 1.81 (95% CI 1.18, 2.80)] was associated with increased odds of seropositivity. Frontline work status [aOR 2.27 (95% CI 1.10, 4.75)] and large household size [aOR 2.45 (95% CI 1.18, 5.49)] were associated with increased odds of infection.ConclusionsThe quadrupling of seroprevalence over 3 months between the first and second enrollment periods coincided with the high burden of infection in Metro Manila in early 2020. Our findings suggest a limit to the rise and potential decline of population-level SARS-CoV-2 infection-induced immunity without introduction of vaccines. These results may add to our understanding of how immunity develops against emerging infectious diseases including coronaviruses.

Illuminating informal cross-border trade in processed small pelagic fish in West Africa

Trade in processed small pelagic fish and informal cross-border trade (ICBT) are linked to livelihood activities in West Africa. Although these fish products are being traded informally in West Africa, research on this topic is limited. This study builds on a multi-partner supported ‘FishTrade’ initiative in Africa to illuminate the volume and value of informal fish trade across the Ghana–Togo–Benin (GTB) borders, and the socio-demographic determinants supporting participation and profitability in this trade. We used a structured survey and focus group interviews to obtain data from women fish traders, who handle the entire fish trade in three major Ghanaian markets where ICBT activities are concentrated. Our results showed ICBT across these borders constitutes significant economic and livelihood potential, estimated at about 6000 MT in volume and US$14 million in market value per annum. Furthermore, socio-demographic factors, such as fish traders’ years of experience and membership in an unofficial market cooperative, positively influence participation and profitability, but access to market information negatively affects participation. However, geographical distance, large household size and access to micro-finance negatively affect ICBT profitability. Our findings illuminate that consumers’ purchasing power, fish taste and preference, ICBT’s economic opportunities and a shared heritage and connection significantly influence this form of trading along the GTB borders. We conclude that ICBT in these small pelagic processed fish represents untapped potential for local livelihood and highlight the need for further research on this topic.

Disaster-Induced Resettlements: the Resilience Of Flood-Affected Households In Dar Es Salaam, Tanzania

Floods are increasingly affecting cities around the world. As a result, displacement and resettlement of floodaffected households have become the norm in many parts of the world. While resettlement may be necessary to address flood vulnerabilities, including protecting the lives of those affected, empirical studies on the post-resettlement well-being of the resettled population are scarce. This paper presents empirical findings on the livelihood situation of flood-resettled households in Dar es Salaam. The results are based on key informant and household interviews and focus group discussions with resettled households. The findings show that the resettlement area’s location in the peri-urban of the city resulted in various challenges, including inaccessibility to basic facilities and high transportation costs, with households spending an average of TZS 2,000 (~US$1) to reach a public transportation facility, i.e., a bus stand. Resettled households also have lower income levels ranging from less than TZS 50,000 (12%) to between TZS 50,000 and TZS 500, 000 (75%). While weak social ties, a lack of trust among household members, and the social stress of loss of privacy were typical challenges among resettled households, vulnerable groups, particularly women and children, were exposed to increased vulnerability. The observed post-resettlement livelihood situation is influenced by the pre-resettlement conditions of the households, characterized by large household sizes ranging from 5 to 6 members (55%) to more than seven members (35%), low education levels (77%), and informal employment, largely petty trading (56%). The paper suggests that when resettling flood-affected households, the context-specific characteristics of the affected population, such as demographic and socio-economic characteristics, and their needs, be considered to improve post-resettlement livelihood sustainability.

Self-Reported Adherence to Antiretroviral Therapy (ART) Among Women Engaged in Commercial Sex Work in Southern Uganda.

We examined the correlates of self-reported adherence to antiretroviral therapy (ART) among women engaged in commercial sex work (WESW) in Uganda. We used baseline data from a longitudinal study, which recruited 542 WESW in Southern Uganda. We used nested regression models to determine the individual and family, and economic level correlates of self-reported adherence. Study findings show that older age (OR = 1.07, 95% CI = 1.013, 1.139), secondary education (OR = 2.01, 95% CI = 1.306, 3.084), large household size (OR = 1.08, 95% CI = 1.020, 1.136), high family cohesion (OR = 1.06, 95% CI = 1.052, 1.065), and high financial self-efficacy (OR = 1.07, 95% CI = 1.006, 1.130) were associated with good self-reported adherence to ART. Married women (OR=-0.39, 95% CI = 0.197, 0.774), depression (OR = 0.85, 95% CI = 0.744, 0.969), alcohol use (OR = 0.72, 95% CI = 0.548, 0.954), ever been arrested (OR = 0.58, 95% CI = 0.341, 0.997), and high household assets ownership (OR = 0.48, 95% CI = 0.313, 0.724) were associated with poor self-reported adherence to ART. Findings suggest a need to adopt a multi-level approach to address gaps in ART adherence among WESW.

Trends and associated factors of intergenerational obesity mother-child pairs in low-income households in Malaysia: Evidence from the National Health and Morbidity Survey.

The transmission in intergenerational overweight and obesity (OW/OB) from mothers to their offspring has been widely explored in numerous studies. This phenomenon of OW/OB is a greater concern globally in particular among low-income households. However, studies conducted to determine the factors associated with OW/OB among mother-child pairs in low-income families are very scarce especially in Malaysia. Therefore, this study aimed to determine the prevalence trend and associated factors of overweight mothers and children in low-income households using the National Health and Morbidity Survey data between the years 2006 to 2015. In each low-income household, mother and child were identified and grouped as mother-child pairs based on their body mass index categories. Multivariable logistic regression was conducted to determine the factors associated with overweight mother/overweight child pairs (OWM/OWC) in low-income households. The reference group determined in the analysis was normal weight mother/normal weight child pairs (NWM/NWC). Within a decade, the transmission of OWM/OWC mother-child pairs in the low-income households has increased by 9.0%, while the prevalence of NWM/NWC decreased by 6.9%. In low-income households, older mothers and children aged between 10 to 14 years were significantly associated with OWM/OWC, while a larger household size and being as Chinese were less likely to become OWM/OWC. In conclusion, intergenerational obesity in mother and their offspring is showing an alarming trend among the lowest socio-economic group in Malaysia.

Prevalence and determinants of asymptomatic Leishmania infection in HIV-infected individuals living within visceral leishmaniasis endemic areas of Bihar, India

People living with HIV (PLHIV) have an increased risk of developing visceral leishmaniasis (VL) and poor outcomes compared to HIV negative individuals. Here, we aim to establish the prevalence and determinants of asymptomatic Leishmania infection (ALI) in a cohort of PLHIV in Bihar, India. We hoped to evaluate optimal diagnostic algorithms to detect ALI in PLHIV. We conducted a cross-sectional survey of PLHIV ≥18 years of age with no history or current diagnosis of VL or post kala-azar dermal leishmaniasis (PKDL) at anti-retroviral therapy centres within VL endemic districts of Bihar. ALI was defined as a positive rK39 enzyme-linked immunosorbent assay (ELISA), rK39 rapid diagnostic test (RDT) and/or quantitative polymerase chain reaction (qPCR). Additionally, the urinary Leishmania antigen ELISA was evaluated. Determinants for ALI were established using logistic regression and agreement between diagnostic tests calculated using Cohen’s Kappa. A total of 1,296 PLHIV enrolled in HIV care, 694 (53.6%) of whom were female and a median age of 39 years (interquartile range 33–46), were included in the analysis. Baseline prevalence of ALI was 7.4% (n = 96). All 96 individuals were positive by rK39 ELISA, while 0.5% (n = 6) and 0.4% (n = 5) were positive by qPCR and rK39 RDT, respectively. Negligible or weak agreement was seen between assays. Independent risk factors for ALI were CD4 counts <100 (OR 3.1; 95% CI 1.2–7.6) and CD4 counts 100–199 (OR = 2.1;95% CI:1.1–4.0) compared to CD4 counts ≥300, and a household size ≥5 (OR = 1.9;95% CI:1.1–3.1). A total of 2.2% (n = 28) participants were positive by Leishmania antigen ELISA, detecting 20 additional participants to the asymptomatic cohort. Prevalence of ALI in PLHIV in VL endemic villages in Bihar was relatively high. Using the Leishmania antigen ELISA, prevalence increased to 9.0%. Patients with low CD4 counts and larger household size were found to have significantly higher risk of ALI.Trial Registration: Clinical Trial Registration CTRI/2017/03/008120.

A Systematic Investigation of American Vaccination Preference via Historical Data

While COVID-19 vaccines are generally available, not all people receive vaccines. To reach herd immunity, most of a population must be vaccinated. It is, thus, important to identify factors influencing people’s vaccination preferences, as knowledge of these preferences allows for governments and health programs to increase their vaccine coverage more effectively. Fortunately, vaccination data were collected by U.S. Census Bureau in partnership with the CDC via the Household Pulse Survey (HPS) for Americans. This study presents the first analysis of the 24 vaccination datasets collected by the HPS from January 2021 to May 2022 for 250 million respondents of different ages, genders, sexual orientations, races, education statuses, marital statuses, household sizes, household income levels, and resources used for spending needs, and with different reasons for not receiving or planning to receive a vaccine. Statistical analysis techniques, including an analysis of variance (ANOVA), Tukey multiple comparisons test, and hierarchical clustering (HC), were implemented to analyze the HPS vaccination data in the R language. It was found that sexual orientation, gender, age, and education had statistically significant influences on the vaccination rates. In particular, the gay/lesbian group showed a higher vaccination rate than the straight group; the transgender group had a lower vaccination rate than either the female or the male groups; older respondents showed greater preference for vaccination; respondents with higher education levels also preferred vaccination. As for the other factors that were not significant enough to influence vaccinations in the ANOVA, notable trends were found. Asian Americans had higher vaccination rates than other races; respondents from larger household sizes had a lower chance of getting vaccinated; the unmarried group showed the lowed vaccination rate in the marital category; the respondents depending on borrowed money from the Supplemental Nutrition Assistance Program (SNAP) showed a lower vaccination rate than people with regular incomes. Concerns regarding the side-effects and the safety of the vaccines were the two major reasons for vaccination hesitance at the beginning of the pandemic, while having no trust in the vaccines and no trust in the government became more common in the later stage of the pandemic. The findings in this study can be used by governments or organizations to improve their vaccination campaigns or methods of combating future pandemics.

Predictors of STD Screening From the Indigenist Stress-Coping Model Among Native Adults With Binge Substance Use.

ObjectiveThe American Indian/Alaska Native (AI/AN) population in the U.S. is thriving in spite of settler colonialist efforts of erasure. AI/AN people, however, continue to experience persistent health disparities including a disproportionate burden of substance use and sexually transmitted diseases/infections (STDs/STIs), as well as a disproportionate lack of public health STD screening services and STD prevention interventions grounded in AI/AN social contexts, experiences, and epistemologies. The present study explored how stressors and protective factors based on the Indigenist Stress Coping framework predict STD screening outcomes among Native adults.MethodsWe analyzed baseline self-report data from 254 Native adults ages 18–55 years with recent binge substance use who were enrolled in an evaluation of “EMPWR,” a two-session STD risk reduction program in a rural, reservation-based community in the U.S. Southwest. Logistic regression models with robust variance were used to estimate odds ratios of lifetime STD testing for the theoretical stressors and cultural buffers.ResultsA little over half the sample were males (52.5%, n = 136), with a mean age of 33.6 years (SD = 8.8). The majority (76.7%, n = 195) reported having ever been screened for STD in their life. Discrimination score were significantly associated with lifetime STD testing: The higher discrimination was associated with lower odds of STD testing in the fully adjusted model (aOR = 0.40, 95%CI: 0.18, 0.92). The effects of AI/AN-specific cultural buffer such as participation in traditional practices on STD testing outcomes was in the expected positive direction, even though the association was not statistically significant. Household size was significantly associated with STD screening: The higher the number of people lived together in the house, the higher the odds of STD testing in the fully adjusted model (aOR = 1.19, 95%CI: 1.04, 1.38).ConclusionOur findings suggest that STD prevention programs should take into consideration AI/AN-specific historical traumatic stressors such as lifetime discrimination encounters and how these interact to drive or discourage sexual health services at local clinics. In addition, larger household size may be a protective factor functioning as a form of social support, and the extended family's role should be taken into consideration. Future research should consider improvement in measurements of AI/AN enculturation constructs.

Perceived Effects of COVID-19 Pandemic on Food Security in Southeast Nigeria

The present study evaluated the perceived effects of the COVID-19 Pandemic on food security in Southeast Nigeria. A multi-stage random technique was used to select 209 households. Data for the study were collected with the aid of a structured questionnaire and were analyzed using descriptive statistics, z-test, food security model, and Tobit regression model. Results showed that the mean household size was 9.6 persons, which indicates a large household size. The percentage rate of food consumption of the households before the Pandemic was higher relative to the COVID-19 event. Again, exorbitant prices of food materials were noticed during the COVID-19 as compared to the period before the Pandemic. About 10.5% of the households met the minimum food requirements as proposed by World Health Organization (WHO), and Food and Agriculture Organization (FAO) as against the majority of 76.1%. The three dimensions of food security which include availability, accessibility, and utilization were interposed by a number of factors, such as artificial scarcity, and an increase in food prices. Furthermore, social distancing and lockdown imposition were COVID-19 determinants of the food security status of households in the Southeast Nigeria. About 24% of the households were food-secured compared to 76% that were insecured during the Pandemic. Robust and effective food and agricultural policy formulations and implementations were recommended in Southeast Nigeria.

Burden and risk factors for relapse following successful treatment of uncomplicated severe acute malnutrition in young children: Secondary analysis from a randomised trial in Niger.

This study aimed to quantify the burden of relapse following successful treatment for uncomplicated severe acute malnutrition (SAM) and to identify associated risk factors in rural Niger. We used data from 1490 children aged 6−59 months discharged as recovered from an outpatient nutritional programme for SAM and followed for up to 12 weeks after admission. Postdischarge SAM relapse was defined as weight‐for‐height Z‐score <−3, mid‐upper arm circumference (MUAC) <115 mm or bipedal oedema after having been discharged as recovered. Postdischarge hospitalisation was defined as admission to inpatient SAM treatment or hospitalisation for any cause after having been discharged as recovered. We used multivariate log‐binomial models to identify independent risk factors. After programmatic discharge, 114 (8%) children relapsed to SAM and 89 (6%) were hospitalised. Factors associated with SAM relapse were discharge during the lean season (relative risk [RR] = 1.80 [95% confidence interval [CI] = 1.22−2.67]) and larger household size (RR = 1.56 [95% CI = 1.01−2.41]), whereas older child age (RR = 0.94 [95% CI = 0.88−1.00]), higher child MUAC at discharge (RR = 0.93 [95% CI = 0.87−1.00]) and maternal literacy (RR = 0.54 [95% CI = 0.29−0.98]) were protective factors. Discharge during the lean season (RR = 2.27 [95% CI = 1.46−3.51]) was independently associated with postdischarge hospitalisation. Future nutritional programmes in the context of Niger may consider modification of anthropometric discharge criteria or the provision of additional home support or follow‐up during the lean season as potential interventions to prevent relapse. More research including postdischarge follow‐up is needed to better understand the sustainability of treatment outcomes after discharge and the type of intervention that may best sustain recovery over time. Clinical Trial Registration: ClinicalTrials.gov number, NCT01613547.

Temporal variation in individual social risk factors associated with testing positive for SARS-CoV-2 among veterans in the veterans health administration

PurposeMarginalized communities have been disproportionally impacted by SARS-CoV-2. How the associations between social determinants of health and the risk of SARS-CoV-2 infection shifted across time is unknown. In this evaluation, we examine individual-level social determinants of health as social risk factors for SARS-CoV-2 infection across the first 12 months of the pandemic among US Veterans.MethodsWe conducted a retrospective cohort analysis of 946,358 Veterans who sought testing or treatment for SARS-CoV-2 infection in U.S. Department of Veterans Affairs medical facilities. We estimated risk ratios for testing positive by social risk factors, adjusting for demographics, comorbidities, and time. Adjusted models were stratified by pandemic phase to assess temporal fluctuations in social risks.ResultsApproximately 19% of Veterans tested positive for SARS-CoV-2. Larger household size was a persistent risk factor and this association increased over time. Early in the pandemic, lower county-level population density was associated with lower SARS-CoV-2 infection risk, but between June 1 and August 31, 2020, this trend reversed.ConclusionsTemporal fluctuations in social risks associated with Veterans’ SARS-CoV-2 infection suggest the need for ongoing, real-time tracking as the social and medical environment continues to evolve.

What Factors Explain Postharvest Losses of Orange Fruit (Citrus sinensis) from Farm to Fork in the Tropics?

Demand for citrus fruit has increased over the years in Nigeria. However, post-harvest loss of tropical fruits is high in developing nations owing to poor handling and storage facilities along the supply chain. The study therefore assessed levels and correlates of postharvest losses of fresh oranges along the orange supply chain. Primary data collected from marketers and producers of orange were analysed using descriptive statistics and ordered logit. Orange farming was dominated by male (68.4%) while orange marketing was dominated by females. Most of the producers (63.16%) and wholesalers (65.38%) experienced postharvest loss of 6-10%, while 46.79% of the retailers experience a postharvest loss of less than 5%. Being a male farmer that harvested oranges in the afternoon increased the likelihood of postharvest losses among the farmers while having a large household size reduced it. However, education, smallholding marketing and use of storage facilities reduced the likelihood of postharvest loss among orange marketers. Postharvest training for farmers and marketers on fruit harvesting and storage methods will help to minimise postharvest loss from producers to retailers.

Patterns of human social contact and mask wearing in high-risk groups in China

BackgroundThe pandemic of coronavirus disease 2019 (COVID-19) has changed human behavior in areas such as contact patterns and mask-wearing frequency. Exploring human–human contact patterns and mask-wearing habits in high-risk groups is an essential step in fully understanding the transmission of respiratory infection-based diseases. This study had aims to quantify local human–human (H–H) contacts in high-risk groups in representative provinces of China and to explore the occupation-specific assortativity and heterogeneity of social contacts.MethodsDelivery workers, medical workers, preschoolers, and students from Qinghai, Shanghai, and Zhejiang were recruited to complete an online questionnaire that queried general information, logged contacts, and assessed the willingness to wear a mask in different settings. The “group contact” was defined as contact with a group at least 20 individuals. The numbers of contacts across different characteristics were assessed and age-specific contact matrices were established. A generalized additive mixed model was used to analyze the associations between the number of individual contacts and several characteristics. The factors influencing the frequency of mask wearing were evaluated with a logistic regression model.ResultsA total of 611,287 contacts were reported by 15,635 participants. The frequency of daily individual contacts averaged 3.14 (95% confidence interval: 3.13–3.15) people per day, while that of group contacts was 37.90 (95% CI: 37.20–38.70). Skin-to-skin contact and long-duration contact were more likely to occur at home or among family members. Contact matrices of students were the most assortative (all contacts q-index = 0.899, 95% CI: 0.894–0.904). Participants with larger household sizes reported having more contacts. Higher household income per capita was significantly associated with a greater number of contacts among preschoolers (P50,000–99,999 = 0.033) and students (P10,000–29,999 = 0.017). In each of the public places, the frequency of mask wearing was highest for delivery workers. For preschoolers and students with more contacts, the proportion of those who reported always wearing masks was lower (P < 0.05) in schools/workplaces and public transportation than preschoolers and students with fewer contacts.ConclusionsContact screening efforts should be concentrated in the home, school, and workplace after an outbreak of an epidemic, as more than 75% of all contacts, on average, will be found in such places. Efforts should be made to improve the mask-wearing rate and age-specific health promotion measures aimed at reducing transmission for the younger demographic. Age-stratified and occupation-specific social contact research in high-risk groups could help inform policy-making decisions during the post-relaxation period of the COVID-19 pandemic.Graphical

Food Security, Household Size and Anemia Status Among Malaysian Urban Poor Adolescents During the Pandemic

ObjectivesThe study aimed to determine the association between food security, household size, and anemia status among Malaysian urban poor adolescents during the pandemic. MethodsA cross-sectional study was carried out among 204 urban poor adolescents aged between 10–17 years in Kuala Lumpur, Malaysia between November 2021 to January 2022. Food insecurity status was assessed using the 18-item US Household Food Security Survey Module. Anthropometric assessments including weight and height were performed and body mass index (BMI) was calculated. WHO Anthro Plus was used to determine the height-for-age (HAZ) and BMI-for-age (BAZ). Haemoglobin concentration was measured using HemoCue®201+. ResultsMore than half (52.5%) of the adolescents were anemic of which 77.6% were present with mild anemia, especially among females (p < 0.001). Based on BAZ classification, 16.2%, 13.7% and 24.5% of adolescents were thin, overweight, and obese, respectively. Meanwhile, HAZ showed that 6.8% of adolescents were stunted. Majority of the adolescents experienced food insecurity (59.3%). Anaemic adolescents (–0.70 ± 1.04) had significantly lower HAZ than non-anaemic adolescents (–0.31 ± 1.27) (p = 0.016). A significant association was found between BAZ and anemia status (p = 0.004) in which anemic adolescents tended to be overweight than non-anemic adolescents. Significant positive correlations were found between height (r = 0.26), weight (r = 0.26), and BMI (r = 0.19) with haemoglobin levels of adolescents. The household size was significantly correlated with household food security (r = 0.15). Binary logistic regression analysis revealed that household size (OR = 1.26, p = 0.018) and female (OR = 4.64, p < 0.001) were likely to be anemic. No significant association was found between food security and anemia status. ConclusionsAnemia and food insecurity among urban poor adolescents is highly prevalent. These findings warrant effective measures needed to help eradicate anaemia problems, especially among females and large household size while addressing food insecurity among urban poor adolescents. Funding SourcesThis research was supported by Fundamental Research Grant Scheme under the Ministry of Education, Malaysia.

Household size, T regulatory cell development, and early allergic disease: a birth cohort study.

BackgroundChildren born to larger households have less allergic disease. T regulatory cell (Treg) development may be a relevant mechanism, but this has not been studied longitudinally.ObjectiveWe aim to (i) describe how prenatal and postnatal environmental factors are associated with Treg development and (ii) investigate whether serial Treg measures predict allergic outcomes at 1 year of age.MethodsA birth cohort (n = 1074) with information on prenatal and postnatal early life factors. Both naïve Treg (nTreg) and activated Treg (aTreg) cell populations (as a proportion of CD4+ T cells) were available in 463 infants at birth (cord blood), 600 at 6 months, and 675 at 12 months. 191 infants had serial measures. Measures of allergic status at 12 months were polysensitization (sensitization to 2 or more allergens), clinically proven food allergy, atopic eczema, and atopic wheeze.ResultsInfants born to larger households (3 or more residents) had higher longitudinal nTreg proportions over the first postnatal year with a mean difference (MD) of 0.67 (95% CI 0.30–1.04)%. Higher nTreg proportions at birth were associated with a reduced risk of infant allergic outcomes. Childcare attendance and breastfeeding were associated with higher longitudinal nTreg proportions (MD 0.48 (95% CI 0.08–0.80)%.ConclusionMultiple prenatal and postnatal microbial factors are associated with nTreg and aTreg development. Larger household size was associated with higher nTreg at birth which in turn was associated with reduced allergic sensitization and disease at 12 months of age.

Factors associated with the low birth weight of children under five years in North Center of Burkina Faso

Introduction. Low birth weight (LBW) is a major public health problem, in both developed and developing countries, due to its magnitude and strong association with infant morbidity and mortality. Aim. To estimate the prevalence of low birth weight and identify associated factors in children under five years old. Methods. This is a cross-sectional study carried out in 8 villages in the commune of Pissila in north-central Burkina Faso, involving 262 mother-child pairs. The factors associated with low birth weight were identified according to the odds ratio (OR) raw and the 95% confidence interval (95% CI) in the bivariate analysis and according to the adjusted OR in the multivariate analysis. Sociodemographic characteristics, reproductive history, previous morbidity and factors related to prenatal care were studied. Results. A total of 262 children with birth weights based on official documents were involved in this study. The proportion of low birth weight children was estimated at 10.7%. For maternal factors, we observed that the low level of education (adjusted OR=2.6), the fact of carrying out an itinerant activity (adjusted OR=3.4) and rural socialization (adjusted OR=0.3) were significantly associated with low birth weight. Additionally, maternal parity (adjusted OR=5.5) and large household size (adjusted OR=15.0) were also associated with low birth weight. Conclusion. These results confirm the conclusions of previous studies. Family planning, pre-conception intervention, financial empowerment of women and maternal education should be strengthened to reduce the incidence of low birth weight.

Intergenerational Transmission of Obesity from Mothers to Their Offspring: Trends and Associated Factors Derived from the Malaysian National Health and Morbidity Survey (NHMS).

Along with the increasing overweight and obesity trends among adults and children globally, numerous studies have suggested a strong association between maternal overweight and obesity among their offspring. We sought to report the prevalence and associated factors of intergenerational overweight and obesity among mother–child pairs in Malaysia from 2006 to 2015. Data were analysed from three waves of the Malaysian National Health and Morbidity Survey, a population-based cross-sectional study conducted in 2006, 2011 and 2015. A mother and the youngest child from each household formed ‘mother–child pairs’ and were grouped according to their body mass index categories. A multivariable logistic regression model was performed to determine the factors associated with overweight mother/overweight child pairs (OWM/OWC), with normal weight mother/normal weight child pairs (NWM/NWC) as the reference group. The prevalence of OWM/OWC increased from 15.3% to 21.7%, while the prevalence of NWM/NWC decreased from 28.4% to 23.8% between 2006 and 2015. Older maternal age and having primary and secondary education levels were positively associated with OWM/OWC. Conversely, older child age, Chinese ethnicity, large household size and low-income households were inversely associated with OWM/OWC. In conclusion, intergenerational weight gain is a worrisome trend in Malaysia. These findings may help in guiding priority setting for obesity prevention strategies in Malaysia.