Low Social Economic Status Research Articles

LYMPHATIC FILARIASIS DRUG TREATMENT POLICIES IN EASTERN INDONESIA: WHAT TARGET CHARACTERISTICS MATTER?

Background: Lymphatic filariasis (LF) drug treatment compliance remains a challenge in Eastern Indonesia. Aims: The study sought to determine which aspects of Eastern Indonesia's LF drug treatment compliance policies were most pertinent. Methods: The 2018 Indonesian Basic Health Survey data was employed. The analysis units were adults (≥ 15 years) who had received LF drug treatment. LF drug treatment compliance was analyzed based on respondent characteristics (age, gender, marital status, education, occupation, wealth and comorbidities) using binary logistic regression. Results: The proportion of adherence to LF treatment in Eastern Indonesia was 73.1%. Respondent characteristics that influenced LF treatment compliance were age group > 24 (aOR = 1.374, 95% CI: 1.305-1.447), female (aOR = 1.307, 95% CI: 1.263-1.353), all educated respondent status (aOR = 2.152, 95% CI: 2.043-2.268), and all employed respondents (aOR = 1.437, 95% CI: 1.365 - 1.512). Married respondents and those with all levels of wealth status were less likely to take LF drug treatment. Conclusion: Policy focus on improving LF treatment compliance among the younger male, the less educated, the unemployed, and those with lower social economic status. Keywords: compliance, Eastern Indonesia, lymphatic filariasis, public health

Intersectional collaboration and the development of prevention infrastructures: a qualitative study

PurposeInvesting in prevention could be of great benefit to public health. Especially for people with health risks, such as overweight, depressive symptoms, low social-economic status or people who experience loneliness or a sedentary lifestyle. In the Netherlands, different parties are responsible for financing and organising selective and indicated preventive interventions: the government, municipalities and health insurance companies. The aim of this study was two-fold: First, to describe the transition towards a sustainable prevention infrastructure. And second, to gain insight into barriers and facilitators associated with intersectoral collaboration regarding organising prevention for high-risk groups.Design/methodology/approachA longitudinal qualitative study was conducted among collaborative networks working together to build a prevention infrastructure. During a five-year study period, 86 semi-structured interviews were held. The COM-B model was used for data analysis.FindingsBarriers to intersectoral collaboration are: unknown (cost-)effectiveness, limited incentives to invest in collaboration, lack of clarity about responsibilities, differences in priorities and organisational culture between municipalities and health insurers. Facilitators are commitment, trust, sharing knowledge between parties, meeting regularly within the network and acknowledgement of mutual responsibilities. Also, national policy interventions targeted at the development of regional prevention infrastructures facilitated collaboration.Originality/valueThis study shows that collaboration regarding prevention is becoming increasingly common. It can be concluded that the transition towards a sustainable prevention infrastructure has started. The relationship between key stakeholders, like municipalities and health insurers, is generally stronger than it was five years ago. They have a better understanding of each other’s interests and expectations.

Big data study using health insurance claims to predict multidisciplinary low vision service uptake.

There is a lack of research from high-income countries with various health care and funding systems regarding barriers and facilitators in low vision services (LVS) access. Furthermore, very few studies on LVS provision have used claims data. This study aimed to investigate which patient characteristics predict receiving multidisciplinary LVS (MLVS) in the Netherlands, a high-income country, based on health care claims data. Data from a Dutch national health insurance claims database (2015 to 2018) of patients with eye diseases causing potentially severe visual impairment were retrieved. Patients received MLVS (n = 8766) and/or ophthalmic treatment in 2018 (reference, n = 565,496). MLVS is provided by professionals from various clinical backgrounds, including nonprofit low vision optometry. Patient characteristics (sociodemographic, clinical, contextual, general health care utilization) were assessed as potential predictors using a multivariable logistic regression model, which was internally validated with bootstrapping. Predictors for receiving MLVS included prescription of low vision aids (odds ratio [OR], 8.76; 95% confidence interval [CI], 7.99 to 9.61), having multiple ophthalmic diagnoses (OR, 3.49; 95% CI, 3.30 to 3.70), receiving occupational therapy (OR, 2.32; 95% CI, 2.15 to 2.51), mental comorbidity (OR, 1.17; 95% CI, 1.10 to 1.23), comorbid hearing disorder (OR, 1.98; 95% CI, 1.86 to 2.11), and receiving treatment in both a general hospital and a specialized ophthalmic center (OR, 1.23; 95% CI, 1.10 to 1.37), or by a general practitioner (OR, 1.23; 95% CI, 1.18 to 1.29). Characteristics associated with lower odds included older age (OR, 0.30; 95% CI, 0.28 to 0.32), having a low social economic status (OR, 0.91; 95% CI, 0.86 to 0.97), physical comorbidity (OR, 0.87; 95% CI, 0.82 to 0.92), and greater distance to an MLVS (OR, 0.95; 95% CI, 0.92 to 0.98). The area under the curve of the model was 0.75 (95% CI, 0.75 to 0.76; optimism = 0.0008). Various sociodemographic, clinical, and contextual patient characteristics, as well as factors related to patients' general health care utilization, were found to influence MLVS receipt as barriers or facilitators. Eye care practitioners should have attention for socioeconomically disadvantaged older patients when considering MLVS referral.

Constrained cooking energy choices in Tanzania: why urban dwellers cling on dirty even where clean energy alternatives are accessible?

PurposeThe purpose of this study is to examine households’ behavior towards dirty cooking energy utilisation in an environment where relatively higher accessibility to clean energy is noted. Although the low utilisation rate of clean energy can partly be attributed to utility gains anticipated in dirty energy mixes (DEMs) arising out of accessibility constraints, affordances and enablers, it is still unclear on the extend at which each of these contributes towards DEMs manifestation among the seemingly well-to-do households with higher levels of clean energy mixes (CEM) access. This study, therefore, hinges on scrutinising on this lower utilisation patterns despite a seemingly higher accessibility of CEMs, specifically liquified petroleum gases (LPG).Design/methodology/approachThe study is based on a household’s survey that was carried out in 2018, reaching a sample of 393 households using questionnaires in four wards of the Kigamboni district in Tanzania. Subsequent analyses were descriptive as well as inferential based on binary logistic regression analysis where utilisation of DEMs was predicted for both the high and low social economic status (SES) households by incorporating accessibility constraints, affordances and enablers.FindingsThe results show, first, if one assumes energy stacking is not an issue, as households become more constrained towards CEMs utilisation, they shift towards DEMs suggesting that the overall effect is a substitution, and second, the complementarity effect ultimately outweighs the substitution effect as households do not shift from DEMs to CEMs rather stack multiple energy. DEMs flourish in this case study area because those with high income are among those in the lowest SES, and some of those with the highest SES are from among the lowest income category, and all of them end up with more DEMs because shifting towards CEMs require income to complement SES.Practical implicationsPolicy-wise, removing hurdles in accessing CEMs such as LPG subsidy programme, gas stove provision to the poor, and enhanced LPG awareness will most likely benefits only those who do not stack energy in cooking while strategies targeting those at the lowest SES such as higher education attainment, empower women as a family decision maker, encourage co-occupancy to enlarge the household size and contain urban growth within certain perimeter will have a significant impact only if they raise both incomes and SES.Originality/valueDespite of the dominance of DEMs for cooking such as charcoal and firewood in Tanzania, CEMs such as LPG, have emerged as complements or alternatives in the household energy basket. The utilisation of such CEMs is, however, still very low despite the accessibility, cost, environmental and health advantages they offer. Accessibility is not the only factor fuelling CEMs; a complementarity must exist between SES and income for the positive transition towards CEMs to be realised.

A global comparative analysis of the criteria and equity considerations included in eighty-six national COVID-19 plans

Systematic priority setting (PS), based on explicit criteria, is thought to improve the quality and consistency of the PS decisions. Among the PS criteria, there is increased focus on the importance of equity considerations and vulnerable populations. This paper discusses the PS criteria that were included in the national COVID-19 pandemic plans, with specific focus on equity and on the vulnerable populations considered. Secondary synthesis of data, from a global comparative study that examined the degree to which the COVID-19 plans included PS, was conducted. Only 32 % of the plans identified explicit criteria. Severity of the disease and/or disease burden were the commonly mentioned criteria. With regards to equity considerations and prioritizing vulnerable populations, 22 countries identified people with co-morbidities others mentioned children, women etc. Low social-economic status and internally displaced population were not identified in any of the reviewed national plans. The limited inclusion of explicit criteria and equity considerations highlight a need for policy makers, in all contexts, to consider instituting and equipping PS institutions who can engage diverse stakeholders in identifying the relevant PS criteria during the post pandemic period. While vulnerability will vary with the type of health emergency- awareness of this and having mechanisms for identifying and prioritizing the most vulnerable will support equitable pandemic responses.

Implementing integrated care guidelines in asthma and COPD: It ain't easy!

ObjectiveTo evaluate the implementation of a guideline-based, integrated, standardised, personal approach in patients with Chronic Obstructive Pulmonary Disease (COPD) or Asthma in a real-life situation. MethodsPatients at the outpatient clinic of the department of pulmonary disease were included in a controlled cohort study, comparing the use of diagnostic items and ‘Personalised care plans' (PCPs) in patients with obstructive lung disease before (2013) and after (2015) implementation of a personalised diagnostic pathway. Results were compared with reference data (2016) from two control hospitals that used the same guidelines but did not implement this pathway. Results100 patients were selected for all three cohorts. After implementing the diagnostic pathway in 2015, 35 % of patients visited attended all pre-planned appointments, whereas 65 % of patients did not: they were diagnosed using usual care. Factors contributing to patients not attending the diagnostic care pathway were: the logistical complexity and intensity of the 2-day pathway, patients willingness to participate in a personalised pathway, and low social economic status or low literacy. After the implementation of the pathway, a significant improvement was seen in the number of PCPs (P < 0.001) and the number of diagnostic items registered recorded in the patients' electronic medical records (P < 0.001). ConclusionImplementing a standardised diagnostic pathway in a real-life population significantly improved the number of personalised care plans, demonstrating that the implementation of holistic care planning is feasible in this population. Nevertheless, the pathway needs further improvements to maximize the number of patients benefitting from it, including logistical streamlining, removing unnecessary diagnostic tools, and increasing the focus on low literacy. Additionally, we found that implementing existing guidelines in a real life context is complex. Therefore, it is required to prioritize the translation of current guidelines into every-day practice, before expanding existing guidelines and protocols.

Risk and protective factors for African American kinship caregiving: A scoping review

BackgroundAfrican American children are disproportionately placed in kinship care, specifically with kin caregivers who have pressing service needs given their relatively poor physical and mental health, and low economic status. Kinship caregivers often face challenges, however, they also show resilience when raising relative children. Although the literature has examined risk and protective factors that affect kinship caregiving, no scoping review has been conducted to summarize these factors as they relate to African American kinship caregivers. ObjectivesThis study aims to summarize the risk and protective factors that affect African American kinship caregiving. MethodsTwenty-six studies were identified from this scoping review. A data template was used to extract information on data/sample, research methods, and risk and protective factors. ResultsThis review found that the risk and protective factors in the identified studies can be summarized into four types: child, caregiver, relationship, and legal, cultural or social issues. Caregiver factors were examined from the perspective of physical and behavioral health, parenting, and resources. The most common risk factors were caregivers’ low social economic status or great financial need, and caregivers’ physical health. The most common protective factor was caregivers’ spirituality or religion. DiscussionThis review helps to better understand the risk and protective factors for African American kinship caregivers. Policies should be informed by African American kinship caregivers’ unique qualities to provide useful cultural solutions. Evidence based interventions should be developed and provided to African American kinship caregivers to improve their parenting abilities and to provide them with additional resources and supports. Implications for child welfare research are also presented.

Social housing as focus area for Nature-based Solutions to strengthen urban resilience and justice: Lessons from practice in the Netherlands

Social housing typically encompasses neighbourhoods with low social-economic status. Here, environmental problems like climate change and biodiversity loss have a higher impact than in other neighbourhoods. Applying Nature-based Solutions (NbS) may enhance the resilience of social housing neighbourhoods and as such make cities more just. In this article we explore to what extent NbS can be applied, given the physical, social and financial limitations that define Dutch social housing practice, and - by doing so – what NbS can contribute to environmental justice. Based upon several Living Lab experiences and dialogues with numerous housing corporations, ten NbS measures have been identified that likely will match with current practices in social housing. Implementing NbS contributes to all aspects of environmental justice, with distributional justice as the most straightforward one (more NbS means more environmental benefits). Procedural and recognitional justice were found to be of crucial importance to make greenspaces worthwhile for the residents. Our study draws attention to the fact that NbS knowledge is key but currently still insufficient, both within housing corporations as within the key partners (local authorities, landscaping firms). This means that there is a growing demand to increase NbS knowledge in the social housing sector. We finalize this article with recommendations on how to meet this demand.

Influence of Complementary Feeding Practices on Nutritional Status of Children Between 6 to 24 Months in Kisumu County, Kenya

Despite complementary feeding practices among mothers with children aged 6 – 24 months, death and disease infection rates are still escalating regardless of the nutritional status of children within that age gap. Complementary feeding practices plays a key role in providing the much-needed nutrients as it enhances successive development and general wellbeing of children, 6-24 months. A few research studies have been conducted in Kisumu County, more specifically, Kisumu County Referral Hospital on complementary feeding practices and nutritional status among children aged 6-24 months which is part of the critical window in the life of a child. The study assumed that most mothers with children between the age of 6-24 months within the Sub County attended Kisumu County Referral Hospital which was the area of study. The current study sought to establish the influence of complementary feeding practices and the nutritional status of children 6-24 months A sample selection of 79 participants was done through purposive sampling. Data was harvested through questionnaires. The study instruments were piloted and adjusted using participants who were not part of the sample. Analysis of data was done using descriptive statistics; mean and percentages. The study reveals that there are poor complementary feeding practices among mothers due to harmful cultural beliefs and low social-economic status. The study also report that malnourished children were 55% male and 45% female respectively. The study recommends that health aid programs should be more focused on homes with low economic background, counseling and sensitization to improve the mother’s knowledge on complementary feeding practices and nutritional status.

Effects of school connectedness on the relationship between child maltreatment and child aggressive behavior: A mediation analysis

BackgroundChildren growing up in a vulnerable and unstable family environment including child maltreatment, poor family functioning, and low social-economic status, are at higher risk of developing undesirable behavioral outcomes compared to peers in the general population. School life plays a critical role during the development of adolescents. ObjectiveThe purpose of this study is to examine the role of school connectedness in the relationship between child maltreatment and aggressive behavior. Participants and settingThis study employed the Fragile Family and Child Well-being Study – Year 15. The final analytic sample size is 2285 families. MethodsMediation analyses were conducted to evaluate the impact of CPS on child aggressive behavior mediated by school connectedness using OLS regression with robust standard errors. The bootstrap was used to estimate the standard error of the indirect effect. ResultsThe total effect of CPS contact on child aggressive behaviors was 0.14 (p < .001). The direct effect of CPS contact on child aggressive behavior was 0.13 (p < .001). The indirect effect, that school connectedness significantly mediated the relationship between CPS and child aggressive behavior, was tested and found statistically significant (Coef. = 0.01, p < .05). ConclusionsFindings of the mediation model suggest that interventions targeted at improving school connectedness among adolescents involved in the child welfare system may promote positive outcomes by reducing aggressive behaviors among youth growing in fragile families. On-going trainings are needed for schoolteachers and social workers to better engage adolescents with child maltreatment at school.

The Clinical and Social Economic Profile of Patients Diagnosed with COVID-19 at Likuni Mission Hospital, Malawi.

Background: The COVID-19 pandemic has caused devastating effects on the world since its discovery in the city of Wuhan in 2019. It has claimed millions of lives and has significantly affected the economies of the world. However, the characteristics of affected populations in poorest settings in Africa are not clearly known. Aims and Objectives: The study was undertaken to evaluate common clinical presentations of patients diagnosed with COVID-19, asses the socio-economic and demographic profiles and analyze the clinical course, and comorbidities of COVID-19 positive patients at Likuni mission hospital, central region of Malawi. Methods: This was a cross sectional study, however we looked at retrospective data from for all patients diagnosed from January 2021 to January 2022. Results: Patients were predominantly female (65%), less than 40 years, without any known comorbidity and had at least 3 symptoms before being diagnosed. The most common symptoms were fever, cough, chest pains, headache, shortness of breath, and general body weakness. A significantly higher population were from low social economic status (p&lt;0.05). Over 95% of the population suffered minor ailment and did not need hospitalization and advanced life support. All patients that required hospitalization were above the age of 60 and the results were statistically significant (p&lt;0.05). More than 90% of the cases were locally spread and did not have traceable positive contact. Conclusion: The diversity of clinical and epidemiological characteristic of patients diagnosed with COVID-19 across gender, socio-economic status, age group and occupation is extremely important. Our results provides an understanding of the characteristics of patients in a poor setting like Malawi and will inform policy makers at local hospitals and district levels including researchers and the ministry of health.

Disparities and resilience: analyzing online Health information provision, behaviors and needs of LBGTQ + elders during COVID-19

BackgroundPrior studies indicate that older members of LGBTQ+ communities have specific health provision and health information needs related to coping with COVID-19, its long-term effects, and the social and economic impact of the pandemic. This study addresses the issue of a lack of timely, complete, and high-quality data about this population’s healthcare and healthcare information needs and behaviors. Recognizing also that this is a diverse population made up of multiple communities and identities with different concerns and experiences, this research seeks to develop and refine a method that can provide additional nuanced data and insights that can support improved and more closely targeted health interventions and online information provision.MethodsWe use computational discourse analysis, which is based on NLP algorithms, to build and analyze a digital corpus of online search results containing rich, wide-ranging content such as quotes and anecdotes from older members of LGBTQ+ communities as well as practitioners, advice, and recommendations from policymakers and healthcare experts, and research outcomes. In our analysis, we develop and apply an innovative disparities and resilience (D&R) framework to identify external and internal perspectives and understand better disparities and resilience as they pertain to this population.ResultsResults of this initial study support previous research that LGBTQ+ elders experience aggravated health and related social-economic disparities in comparison to the general population of older people. We also find that LGBTQ+ elders leverage individual toughness and community closeness, and quickly adapt mentally and technologically, despite inadequate social infrastructure for sharing health information and elders’ often low social economic status. The methods used therefore are able to surface distinctive resilience in the face of distinctive disparities.ConclusionsOur study provides evidence that methodological innovation in gathering and analyzing digital data relating to overlooked, disparately affected, and socially and economically marginalized intersectional communities such as LGBTQ+ elders can result in increased external and self-knowledge of these populations. Specifically, it demonstrates the potential of computational discourse analysis to surface hidden and emerging issues and trends relating to a multi-faceted population that has important concerns about public exposure in highly timely and automated ways. It also points to the potential benefits of triangulating data gathered through this approach with data gathered through more traditional mechanisms such as surveys and interviews.Trial registrationNot Applicable.

Teachers ‘looking into a mirror’ - a journey through exposure to diverse perspectives

ABSTRACT This study examined the impact of a workshop for teachers entitled ‘Things are Not Always What They Seem’. The workshop’s aim was to raise awareness of teachers’ roles in heterogenic classrooms. The study’s primary assumption was the importance of increasing teachers’ awareness of their biases and the need to foster intercultural sensitivity. To do so, the workshop exposed 35 teachers to the perspectives of ‘other’ teachers and students including those deriving from the following defined categories: middle-class, advantaged, white teachers (MAW), and low social economic status, disadvantaged, and black (LDB) students. The research method was qualitative interpretive, based on the analysis of texts from the teachers’ workshop. The workshop included exposure to the MAW statements towards their students and LDB statements about their personal experience with racism. The teachers from the workshop read the quotes, searched for connections between them, and reflected about the texts. Findings indicate that the teachers’ responses to the offered quotes demonstrate intercultural sensitivity, as manifested through understanding their students’ points of view.

Analysis of Outpatient Adherence in 45,237 Patients Referred by an Emergency Department to Surgical Clinics.

IntroductionThis study examines referral patterns to surgical clinics from the emergency department and the impact of sociodemographic factors on adherence.MethodsPatients from 2017 to 2021 were identified who had a referral placed to surgical specialties from the ED. The primary outcome was the proportion of patients who had a referral to surgery placed during an ED visit but who showed up to surgery clinic visit within 60 days of referral placement. Univariate and multivariate analysis was performed.ResultsReferrals were made for 45,237 patients overall and 4130 for general surgery specifically. 44% showed up to general surgery clinic visit. In univariate and multivariate analysis, those who showed up to clinic were older, tended to be female, had a lower social economic status, had Medicaid or Medicare insurance and had more comorbidities compared to those who did not show up. Asians and Hispanics were more likely to show up to clinic compared to Whites.ConclusionsAssigning navigators in the ED to follow-up with patients who are younger and healthier, with private insurances who have existing PCPs to ensure they follow up as advised is a potential targeted intervention to improve clinic adherence.

Inflammatory bowel disease at a young age – implications for achieving upper secondary education

Abstract Background The incidence of inflammatory bowel disease (IBD) among children and adolescence is increasing worldwide. Having a chronic condition at a young age may affect educational achievement and later employment and self-support. The study aims to examine the impact of being diagnosed with IBD before 18 years of age on achieving an upper secondary education before 25 years of age. Methods Using the Danish National Patient Register (1980-2018) all patients (born 1970-1994) diagnosed with IBD at a young age (&amp;lt;18 years) were identified. The IBD-patients were matched on age and sex with 10 references without IBD at the index date (date of diagnosis of IBD). The outcome was achieving an upper secondary education using data from Danish Education Registers. The association between IBD diagnosis and achieving an upper secondary education was analyzed using Cox regression with robust variance estimation adjusting for parents’ highest educational level. Furthermore, stratified analyses were performed on parental socioeconomic status (education and income). Results We identified 3,178 patients with IBD: Crohn’s disease (CD) n = 1,344, Ulcerative colitis (UC) n = 1,834. Reference n = 28,220. The median age at diagnosis was 15.3 years (IQR: [13.0;16.9]). At the age of 25 74.0% (CI: 71.6-76.4) for CD, 75.8% (CI: 73.8-77.8) for UC, and 69.7% (CI: 69.2-70.3) for references had achieved an upper secondary education. The adjusted Hazard ratio (HR) of achieving an upper secondary education was 1.05 (CI: 1.00 -1.11) for CD and 1.09 (CI: 1.04 -1.15) for UC. When stratifying the IBD-patient with the lowest socioeconomic status performed better than their peers. Conclusions Being diagnosed with IBD before 18 years of age did not reduce the chance of achieving an upper secondary education. Patients with low socioeconomic status performed better than their peers, however the study gives no explanation of this. Key messages • Children diagnosed with IBD before 18 years of age had at least the same chance of achieving an upper secondary education compared to references. • IBD patients with low social economic status performed better than their peers.

New Smokers and Quitters Transitions in Smoking Status in a National Population

Background: Few studies have examined individual transitions in smoking status in national populations. Methods: A representative sample of 21,970 men and women aged 15-64 were questioned regarding current smoking status and smoking status of 12 months ago. Results: 1.6% of respondents had started to smoke and 1.6% had quit smoking. Becoming a smoker was significantly associated with younger age and lower social economic status (SES). Among women, many new smokers were between the age of 30 and 34, presumably due to relapse after pregnancy. High SES smokers quit at a younger age than lower SES groups. Conclusion: To reduce smoking prevalence in the Netherlands, more attention should be given to women aged 30-34 years and to people from the lower SES groups, especially those under the age of 45. JAFMC Bangladesh. Vol 18, No 1 (June) 2022: 90-93

Family fuctioning and health-related quality of life among adolescents of low socio-economic status.

Lower level of health-related quality of life has the potential to be experienced by adolescents with low socioeconomic status. This condition can hamper the productivity of adolescents who will enter their productive age. For this reason, it is important to strive the enhancement of health-related quality of life among adolescents with low socioeconomic status, especially by involving the family as adolescents’ microsystem. This research is important as an effort to collect empirical information that can be used in improving the health related quality of life in adolescents with low socio-economic status. We hypothesized that a functional family can help adolescents with low socioeconomic status achieve a better health-related quality of life. The purpose of this study was to determine whether the dimensions of family functioning simultaneously have significant contribution in the health-related quality of life among adolescents from low socioeconomic status background. One hundred and nine adolescents with low socioeconomic status who live in East Kalimantan province were involved as participants in this study. Convenience sampling technique was used to select participants. Self Report Family Inventory Version II (Beavers and Hampson) was used to measure dimensions of family functioning variable. KIDSCREEN 27 (Ravens-Sieberer) was used to measure health-related quality of life variable. The data in this study were analyzed by multiple regression test. The research findings showed that simultaneously dimensions of family functioning has positive and significant contribution to health-related quality of life as perceived by participants (F= 8,320; sig p= 0.000), with total contribution 28.8%. This is shows that family strength-based approach should be added in developing intervention to enhance health-related quality of life in adolescents with low socioeconomic status. Keywords : adolescence; family functioning; health related quality of life; low social economic status.

Risk factors for pneumococcal carriage in adults living with HIV on antiretroviral therapy in the infant pneumococcal vaccine era in Malawi.

Adults living with HIV (ALWHIV) on antiretroviral therapy (ART) are at high risk of pneumococcal carriage and disease. To help evaluate carriage risk in African ALWHIV at least 4 years after infant pneumococcal conjugate vaccination introduction in 2011, we assessed association between pneumococcal carriage and potential risk factors. Nasopharyngeal swabs were collected from adults aged 18-40 years attending an ART clinic during rolling, cross-sectional surveys in Blantyre, Malawi between 2015 and 2019. We fitted generalized additive models to estimate the risk of sex, social economic status (SES), living with a child less than 5 years, and ART duration on carriage. Of 2067 adults, median age was 33 years (range 28-37), 1427 (69.0%) were women, 1087 (61.4%) were in low-middle socioeconomic-status (SES), 910 (44.0%) were living with a child less than 5 years, and median ART duration was 3 years (range 0.004-17). We estimated 38.2 and 60.6% reductions in overall and vaccine-serotype carriage prevalence. Overall carriage was associated with low SES, living with a child less than 5 years and shorter duration on ART. By contrast, vaccine-type carriage was associated with living without a child less than 5 years and male sex. Despite temporal reductions in overall and vaccine-serotype carriage, there is evidence of incomplete vaccine-serotype indirect protection. A targeted-vaccination campaign should be considered for ALWHIV, along with other public health measures to further reduce vaccine-serotype carriage and therefore disease.

Comparing a ses-sensitive and an all-ses implementation strategy to improve participation rates of patients with a lower socioeconomic background in a web-based intervention for depressive complaints: a cluster randomised trial in primary care

BackgroundDepression is a major public health concern, which is most pronounced in population segments with a lower social-economic status (SES). E-health interventions for depressive complaints are proven to be effective, but their reach needs to be improved, especially among people with a lower socioeconomic status (SES). Implementing e-health interventions in the primary care setting with SES-sensitive guidance from General Practice nurses (GP nurses) may be a useful strategy to increase the reach of e-health in lower SES groups. We implemented an evidence-based online intervention that targets depressive complaints in primary care.MethodsA pragmatic cluster-randomised trial was conducted in two parallel groups where a SES sensitive (SES-sens) implementation strategy with additional face-to-face guidance by GP nurses was compared to an all-SES implementation strategy. The primary outcome was the percentage of lower SES participants in either condition. Participation was defined as completing at least 1 face-to-face session and 2 online exercises. Participation rates were evaluated using logistic mixed modelling.ResultsIn both conditions, the participation rates of lower SES participants were quite high, but were notably lower in the SES-sens implementation condition (44%) than in the all-SES implementation condition (58%). This unexpected outcome remained statistically significant even after adjusting for potential confounders between the conditions (Odds Ratio 0.43, 95%-CI 0.22 to 0.81). Less guidance was provided by the GP nurses in the SES-sens group, contrary to the implementation instructions.ConclusionsFrom a public health point of view, it is good news that a substantial number of primary care patients with a lower SES level used the implemented e-health intervention. It is also positive that an all-SES implementation strategy performed well, and even outperformed a SES-sensitive strategy. However, this was an unexpected finding, warranting further research into tailoring implementation strategies of e-health interventions towards specific target groups in the primary care setting.Trial registrationNetherlands Trial Register, identifier: NL6595, registered on 12 November 2017.

Inadequate Antenatal Care Visits and Risks of Infant Mortality in Rural District

Introduction: Infant Mortality Rate (IMR) in Indonesia has decreased over the last fifteen years, but still left behind from other South-East Asia countries. One of the efforts to reduce IMR is antenatal care. However, there are disparity of antenatal care coverage between rural and urban area.&#x0D; Objective: This study aimed to determine the effect of antenatal care on infant mortality in rural district in Indonesia.&#x0D; Methods: The quantitative study used cross-sectional secondary data from Indonesia Demographic Health Survey 2017 with a total sample of 7.551 most recent born infant in 2012-2017 from women with childbearing age who’s live in rural district. Logistic regression multivariate analysis was used to determine the effect of antenatal care and infant mortality.&#x0D; Results: The results show that antenatal care reduce risk of infant mortality. Infants whose mothers had 1-3 antenatal care visits (OR = 3; 95% CI = 1.6 – 5.3) and no antenatal care visits (OR = 3; 95% CI = 1.6 – 5.5) had higher odds compared to infants whose mother had 4 or more antenatal care visits after controlled by social-economic status, maternal occupation, parity, and tetanus immunization.&#x0D; Conclusions: Empowering community empowerment with the help of community health workers and midwives is needed to target women with low social economic status. Studies and regulations for pregnant and lactating women at work also needed to reduce infant mortality. Further research involving quality of antenatal care and more covariates variables might be carried out.&#x0D;