Lower Wealth Research Articles

DBT Skills Training Groups for School Personnel Working in High-Need Schools

The COVID-19 pandemic presented unprecedented challenges for school communities with long term impacts still unknown. School personnel working in high need, low wealth schools are uniquely at risk for pandemic-related stress given extensive changes to their work life and concerns regarding student trauma exposure. We delivered DBT skills training to 39 school personnel (89% female, mean years of experience was 18.49 [SD = 7.88]). Close to 20% of the sample reported moderate-to-severe anxiety, depression, and stress and substantial impact of COVID-19 on loved ones. Multilevel regressions indicated significant decreases in stress between the 1st-2nd sessions attended (p = .004), and the 3rd-6th sessions attended (p = .04). Sessions 7-8 were not associated with significant decreases in stress (p = .51). Study limitations, implications, and conclusions are discussed.

Understanding the longitudinal trends (2005-2018) and multilevel risk factors of complementary feeding in Guinea.

This study aimed to define complementary feeding trends in Guinea from 2005 to 2018 and complementary feeding risk factors at the individual, household, and community levels. Data from 2005 to 2018 demographic health surveys (DHS) and Multiple Indicator Cluster Surveys were used to describe complementary feeding trends in Guinea. The most recent DHS was used to examine complementary feeding risk factors at the individual, household, and community levels. Complementary feeding indicators including introduction to complementary foods (INTRO), minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD) were calculated based on the 2010 World Health Organisation guidance. Multivariate logistic regressions were used to identify significant risk factors (p < 0.05). Since 2005, there has been a marginal increase in MDD and MAD, but a decrease in INTRO and MMF. The 2018 DHS survey revealed various complementary feeding risk factors. At the individual level, travelling 1-60 min to get water was associated with decreased odds of meeting INTRO, while iron supplementation and maternal education were associated with increased odds of meeting MMF and MDD, respectively. Routine vitamin A supplementation, fever in the past 2 weeks, and low birth weight were associated with increased odds of meeting MAD. At the household level, being in a lower wealth quintile was associated with decreased odds of meeting MDD and MAD. National and subnational programmes and policies designed to improve infant and young child diets may consider tailored approaches that address the specific indicators and risk factors associated with poorer diets in this Guinean context.

On penalized goal-reaching probability minimization under borrowing and short-selling constraints

Abstract We consider a robust optimal investment–reinsurance problem to minimize the goal-reaching probability that the value of the wealth process reaches a low barrier before a high goal for an ambiguity-averse insurer. The insurer invests its surplus in a constrained financial market, where the proportion of borrowed amount to the current wealth level is no more than a given constant, and short-selling is prohibited. We assume that the insurer purchases per-claim reinsurance to transfer its risk exposure to a reinsurer whose premium is computed according to the mean–variance premium principle. Using the stochastic control approach based on the Hamilton–Jacobi–Bellman equation, we derive robust optimal investment–reinsurance strategies and the corresponding value functions. We conclude that the behavior of borrowing typically occurs with a lower wealth level. Finally, numerical examples are given to illustrate our results.

Change in the prevalence of anemia in children aged 6-59 months using the new World Health Organization 2024 criteria.

The World Health Organization (WHO) has published new hemoglobin cutoff points for defining anemia and its measurement. This change could impact the prevalence of anemia, particularly in countries with populations living in high-altitude areas. This study estimates the national prevalences of anemia in children aged 6-59 months using Centers for Disease Control and Prevention (CDC) 1989 and WHO 2024 criteria. Data from 406,106 children in 48 countries (45 Demographic and Health Surveys [DHS Program] and 3 Andean [Ecuador, Bolivia, and Peru]) were analyzed. The pooled prevalence of anemia was 61.4% according to the WHO 2024 criteria. Three countries showed changes in anemia prevalence, with shifts of 10 or more percentage points (Uganda, Rwanda, and Jordan). Across all the studied countries, the prevalence of anemia was higher at greater altitudes, rural areas, and children from households of low wealth quintiles, regardless of the criteria used. Moreover, changes in anemia prevalence were identified when stratified by altitude of residence, showing differences in the levels of public health significance across various political-administrative regions in Andean countries. Overall, these findings provide valuable insights into the epidemiology of anemia and highlight the need for continued surveillance and targeted interventions to effectively address this global health challenge.

Associations of serial negative income shock and all-cause mortality: a longitudinal study in China

IntroductionWith a precarious economic outlook and increasing income volatility in current times, understanding the association between negative income shock and health is crucial. However, few studies have examined such associations...

Level of eye healthcare utilisation and associated factors in Gamo and Gofa Zones, Southern Ethiopia: a community-based, cross-sectional study

ObjectiveAbout 90% of eye health problems are preventable or curable with existing cost-effective interventions. There is limited evidence on eye healthcare utilisation (ECU) and the factors influencing it in the...

The extent and burden of high multimorbidity on older adults in the US: a descriptive analysis of Medicare beneficiaries

BackgroundThe impact of multimorbidity (≥ 2 chronic diseases) on the well-being of older adults is substantial but variable. The burden of multimorbidity varies by the number and kinds of conditions, and timing of onset. The impact varies by age, race, ethnicity, socioeconomic status, and health indicators. Large scale longitudinal surveys linked to medical claims provide unique opportunities to characterize this variability.MethodsWe analyzed Medicare-linked Health and Retirement Study data for respondents 65 and older with 3 or more years of fee-for-service coverage (n = 17,199; 2000–2016). We applied standardized claims algorithms for operationalizing 21 chronic diseases. We compared multimorbidity levels, demographics, and outcomes at baseline and over time and escalation to high multimorbidity levels (≥ 5 conditions).ResultsAt baseline, 51.2% had no multimorbidity, 36.5% had multimorbidity, and 12.4% had high multimorbidity. Loss of function, cognitive decline, and higher healthcare utilization were up to ten times more prevalent in the high multimorbidity group. Greater rates of high multimorbidity were seen among non-Hispanic Black and Hispanic groups, those with lower wealth, younger birth cohorts, and adults with obesity. Rates of transition to high multimorbidity varied greatly and was highest among Hispanic and respondents with lower education.ConclusionsThe development and progression of multimorbidity in old age is influenced by many factors. Higher levels of multimorbidity are associated with sociodemographic characteristics, suggesting possible mitigation strategies.

Wasting and its associated factors among under-two years children in Ethiopia: a systematic review and meta-analysis

IntroductionGlobally, about 45 million under-five children have suffered from wasting where Asian and African countries have the major share of these wasted children. Despite wasting is affected all types of populations, the long and short term effect is more severe and sensitive in under-two aged children. Hence, this review was intended to assess pooled prevalence and associated factors of wasting among under-two children in Ethiopia.MethodsThe search was done using electronic data bases (Hinari, PubMed, Google scholar, Scopus) and research repositories from June 19–22/2023. The review included articles published between January 2013 and December 2023.The study included Cross-sectional/case control studies which report the prevalence and associated factors of wasting in under-two aged children. The quality of included studies was assessed using the Joanna Briggs Institute (JBI) quality assessment checklists for observational studies. The presence of heterogeneity between included studies was evaluated using Cochrane Q-test and the I2 statistics. Publication bias was checked through graphical and statistical test. Associated factors were estimated by random effect model using DerSimonian-Laird model weight.ResultsThe pooled prevalence of wasting among under-two children was 10.91% (95% CI: 8.97–12.85; I2 = 86.36%). Absence of maternal antenatal follow up (OR; 3.23: 95%CI: 1.20–5.26), no exclusive breast feeding until six months (OR; 5.30; 95%CI: 1.17–9.43), current illness of the child (OR; 2.58: 95%CI: 1.78–3.37), large family size (OR; 12.38; 95%CI: 1.37–26.13) and low wealth status of the households (OR; 3.91; 95%CI: 1. 54-8.36) were significant factors of wasting among under-two children.ConclusionsThis study disclosed that the pooled prevalence of wasting among under- two children were high in Ethiopia. Absence of maternal antenatal follow up, no exclusive breast feeding, low wealth status of the households, large family size and current illness of the child were significant factors of wasting. Strictly adherence of maternal antenatal follow up, counsel the parents to feed only breast milk until six months, limit the number of family size to the level of the household income and early treatment of the sick child were recommended. Furthermore, scale up the wealth status and living standard of the family can address the agenda of reducing and eradicating all forms of malnutrition. This review registered at PROSPERO with registration number CRD42023414914 (https://www.crd.york.ac.uk/prospero/#myprospero).

An Application of the Dagum Type III Model to Measure Household Net Wealth Inequality in Indonesia

Abstract This paper applies the Dagum Type III model to measure household net wealth inequality in Indonesia utilising data from the Indonesian Family Life Survey (IFLS) 1993–2014. The results are the distribution of household net wealth in Indonesia is right-skewed, with long-and sparse-hand tails that reflect a large proportion of households that have very low net wealth and a small proportion of households that have very high net wealth. Further, the inequality of household net wealth in Indonesia declined, as shown by the decrease in the Gini coefficient.

IDENTIFYING RISK FACTORS FOR STUNTING AMONG UNDER-FIVE INDONESIAN CHILDREN

The prevalence of child stunting in Indonesia in 2023 at the national level from 24.5% to 21.6%. Despite declining, the figure is still relatively high, as 28 out of 100 babies suffer from stunting. The study aims to predict stunting risk factors in children under the age of 5. They use bivariate and multivariate logistic regression to identify significant factors associated with stunting risk. Stunting prevalence in Batu Bara District of North Sumatra Province was 18.35% out of 28.716 children under 5 years of age (967 children very short and 3,944 young children). The study was conducted on 100 households with brief and concise children living in rural areas. The results of the study showed maternal education (OR 5.27; 95% CI 1.04-5.62); low maternal nutritional status during pregnancy (OR 2.57, 95% CI 1.22-5.89); formula milk delivery less than 6 months (OR 3.47; 95% CI 1.40-8.28); low birth weight of less than 2500 grams (OR 4.94; 95% CI 1.30-18.80); lack of access to drinkable water (or 3.14; 95% CI 1.29-7.65); low family wealth index (OR 0.13; 95% CI 0.05-0.32). Environmental and household factors have a significant relationship with stunting risk control. Multilateral efforts from the level of family empowerment, increasing the role of health services, and improving nutritional status are access to public health status.

Ethnic wealth inequality in England and Wales, 1858–2018

Using surnames from the universe of death and wealth-at-death records in England and Wales, from 1858 to 2018, I document the emergence of a modern ethnic wealth gradient. Historically, Non-British ethnicities have average wealth 2-5 times that of the English. However, this premium has decreased over the 20th century. By 1980, non-British ethnicities have no advantage over the British. However, this masks considerable heterogeneity within the non-British ethnicity group. Europeans typically die significantly richer than the English whereas the Pakistani and Swedish die significantly poorer. Some groups always have lower wealth. The Irish, have wealth around 50% of the average English throughout. Surprisingly, the most egalitarian measure of wealth is representation within the top 1%. Most ethnicities have an equal, or greater, representation in the top 1% than the English, 1980–1992. Despite large differences in average wealth between ethnicities, the vast majority of variation, 97.5% is between individuals.

Prevalence and factors associated with unmet need for menstrual hygiene management in six countries in Sub-Saharan Africa: A multilevel analysis

BackgroundMenstruation is a normal biological process experienced by more than 300 million women globally every day. Women require clean menstrual absorbents that can be changed as often as needed in a private and safe place with proper hygiene and disposal facilities. These needs must be met consistently throughout the duration of the menstrual cycle. Access to menstrual needs is crucial for women’s health, wellbeing, and dignity. This study assessed the prevalence and factors associated with unmet need for menstrual hygiene management (MHM) in Ethiopia, Kenya, Uganda, Burkina Faso, Ghana, and Niger.MethodsWe used data from the Performance Monitoring for Action (PMA) 2020 surveys. We defined the unmet need for MHM as the “lackof resources, facilities and supplies for MHM.” Sample characteristics were summarised using frequencies and percentages, while prevalence was summarised using proportions and their respective confidence intervals (CI). Factors associated with unmet need for MHM were assessed using multilevel logistic regression models.ResultsThe study included 18,048 women of reproductive age from the six countries. The prevalence of unmet need for MHM was highest in Burkina Faso (74.8%), followed by Ethiopia (69.9%), Uganda (65.2%), Niger (57.8%), Kenya (53.5%), and lowest in Ghana (34.2%). Unmet need for MHM was consistently higher among uneducated and multiparous women, those who reused MHM materials, practiced open defecation, and lived in rural areas across all six countries. The odds of unmet need for MHM were higher among younger women under 35 years, unmarried women, those with lower education levels, and those from poorer households. Similarly, the reuse of MHM materials, use of shared or non-improved toilet facilities, and open defecation increased the odds of unmet need for MHM. In contrast, the presence of handwashing facilities reduced the odds of unmet need for MHM.ConclusionMore than half of the women in five of the six countries have an unmet need for MHM, with significantly higher odds among younger women, those with low wealth status, the unmarried, and those with inadequate access to sanitary facilities. This study highlights the state of period poverty in Sub-Saharan Africa. Efforts to end period poverty should consider MHM needs as an integrated whole, as addressing each need in isolation is insufficient.

Prevalence and Correlates of Double and Triple Burden of Malnutrition Among Children and Adolescents in India: The Comprehensive National Nutrition Survey

BackgroundLimited information on the co-prevalence of undernutrition, micronutrient deficiencies, overnutrition, and abnormal levels of noncommunicable disease biomarkers at the same time in children and adolescents in India hinders efforts to comprehensively address their health. ObjectivesThis study aimed to examine the prevalence and correlates of double burden of malnutrition (DBM) and triple burden of malnutrition (TBM) among children and adolescents (5–19 y) to inform policies and programs. MethodsA total of 17,599 children (5–9 y) and 16,184 adolescents (10–19 y) with available biomarker data from the Comprehensive National Nutrition Survey were included. Malnutrition was defined based on either undernutrition based on anthropometry, overnutrition/abnormal metabolic markers, and anemia/micronutrient deficiency. DBM was defined as the coexistence of any 2 forms of malnutrition. DBM+ was defined as the coexistence of undernutrition and/or micronutrient deficiency along with overnutrition. TBM was defined as having the coexistence of all 3 forms of malnutrition. The prevalence of DBM, DBM+, and TBM was estimated accounting for probabilistic selection. We used mixed-effect binomial regression to determine correlates of DBM/TBM in children and adolescents separately. ResultsThe prevalence of DBM, DBM+, and TBM was 50.8%, 37.2%, and 14.4%, respectively, in children and 53.4%, 36.1%, and 12.7%, respectively, in adolescents. The prevalence of DBM+ was significantly higher in girls compared to in boys in the 5–9 y age group. In children, being in a disadvantaged caste group, having a lower wealth index, having inadequate diet diversity, having no maternal schooling, and having a recent history of acute illness were associated with DBM. In adolescents, being in a disadvantaged caste group, maternal occupation, and lower paternal age were correlated with DBM. A similar set of variables was associated with TBM in both age groups. ConclusionsThe prevalence of DBM and TBM is substantial in children and adolescents in India and varies across states. Socioeconomic factors and acute illness were the main correlates for DBM and TBM.

Can Social Health Insurance Improve Mental Health? An Analysis of Supplementary High-Cost Illness Insurance in China.

China introduced an innovative Supplementary High-Cost Illness Insurance (SHCII) program to enhance existing social health insurance by providing extra financial support for individuals facing catastrophic illnesses in 2015. The SHCII has notably increased access to healthcare and alleviated financial strain for economically disadvantaged individuals. However, there is a lack of information regarding the program's impact on the mental health of its beneficiaries. This study aims to assess the impact of SHCII on the mental well-being of middle-aged and older individuals. Using data from the China Health and Retirement Longitudinal Study (2011, 2013, 2015, and 2018), this study examined how SHCII affects mental health among middle-aged and older individuals in China using propensity score matching with the time-varying difference-in-differences method. We found that SHCII implementation can significantly reduce the Center for Epidemiologic Studies-Depression Scale scores of middle-aged and older individuals. This reduction was more pronounced among older individuals with poor self-rated health, chronic disease, and low household wealth when compared to their counterparts. The implementation of SHCII has had a significant and positive impact on mental health outcomes. We recommend that governments consider expanding the program to other areas within China, focusing especially on the most economically disadvantaged segments of the population.

Singlestick purchases: a comparative cross-country analysis in 10 African countries, Global Adult Tobacco Survey, 2012-21.

We utilized Global Adult Tobacco Survey data to examine singlestick purchases and related demographic characteristics in 10 African countries (Botswana, Cameroon, Ethiopia, Kenya, Nigeria, Mauritania, Senegal, South Africa, Uganda and Tanzania). Results show the weighted percentages and prevalence ratios with predicted marginal means to evaluate significant differences between groups (P < 0.05). The prevalence of singlestick purchases among the 10 African countries ranged from 48.4% in South Africa to 92.0% in Tanzania. Across countries, the incidence of singlestick purchases was higher in urban areas than rural areas in Kenya; among those aged 15-24 years versus those aged 45 years and older in Botswana, Ethiopia, Mauritania, Nigeria and South Africa; and among those aged 25-44 years versus those aged 45 years and older in Botswana, South Africa and Tanzania. The incidence in Botswana was higher among adults with no formal or primary education than among those with secondary or higher education. In South Africa, the incidence was higher among adults in the middle or lower wealth index than among those in the high or highest wealth index. The findings suggest opportunities for strengthening efforts to prevent singlestick purchases through effective legislation and enforcement in line with Article 16 of the World Health Organization Framework Convention on Tobacco Control.

Disabilities, shared capitalism, and wealth: evidence from health and retirement survey

ABSTRACT Does shared capitalism help to mitigate the economic effects of disability? Employee ownership and profit sharing are linked to higher incomes and wealth for workers, while disability is strongly linked to lower incomes, but there has been no prior research on their overlapping effects. Using household-level panel data from Health and Retirement Survey (HRS) restricted to households with at least one earner, we provide exploratory results on the relationships among disability, shared capitalism, and wealth. We find that: 1) disability households have lower mean and median wealth (one-third to one-half lower than non-disability households using the most comprehensive disability measure); 2) disability households are less likely to participate in shared capitalism (only three-fourths as likely as non-disability households using the most comprehensive disability measure); 3) shared capitalism is linked to a greater increase in wealth for disability households than for non-disability households, but disability wealth gaps remain even when shared capitalism is available. While we cannot make strong causal claims, these findings suggest that shared capitalism may play a positive role in wealth-building for people both with and without disabilities, and help to mitigate some of the economic disadvantages faced by people with disabilities.

Micronutrient deficiencies and the double burden of malnutrition in Vietnamese female adolescents: a national cross-sectional study in 2020

Vietnam is facing a double burden of malnutrition, with increasing prevalence of overweight coexisting with undernutrition (stunting and/or thinness) and micronutrient deficiencies (MNDs). Although malnutrition during female adolescence leads to poor health outcomes with potential intergenerational effects on offspring, no studies have comprehensively investigated MNDs and nutritional status among contemporary Vietnamese female adolescents. Data from 10- to 18-year-old female participants (n=1471) in the nationally-representative Vietnam General Nutrition Survey 2020 were analysed. Blood nutritional biomarkers, anthropometric measurements, and sociodemographic data were collected, and associations between nutrition status and MNDs were analysed; with anaemia, iron deficiency (ID), iron deficiency anaemia, low serum zinc, low serum retinol, and any MNDs as specified outcomes. Prevalence of overweight, stunting, and thinness was 27.2%, 14.3%, and 6.9%, respectively. Low serum zinc was common (39.8%), as was ID (13.4%). Bivariate analyses showed that older age (16-18 years old), ethnic minority status, lower wealth index, and inflammation were associated with MNDs. In adjusted logistic regressions, stunting was associated with increased odds ratio and [95% confidence intervals] of low serum retinol (8.92 [2.26, 35.15], p<0.01), as was thinness (12.25 [3.47, 43.33], p<0.01). Stunting was also associated with increased odds of having any MND (2.06 [1.31, 3.25], p<0.01). More female adolescents were overweight than undernourished in Vietnam in 2020. However, undernutrition, low serum zinc, and ID remain prevalent. Food systems approaches should be considered to stem the stark increase in the double burden of malnutrition in young people living in Vietnam. UK BBSRCBB/T008989/1.

Malaria community case management usage and quality of malaria care in a moderate Plasmodium falciparum burden region of Chadiza District, Zambia

BackgroundMalaria community case management (CCM) can improve timely access to healthcare, and CCM programmes in sub-Saharan Africa are expanding from serving children under 5 years (CU5) only to all ages. This report characterizes malaria case management in the setting of an age-expanded CCM programme in Chadiza District, Zambia.MethodsThirty-three households in each of 73 eligible communities were randomly selected to participate in a household survey preceding a trial of proactive CCM (NCT04839900). All household members were asked about fever in the prior two weeks and received a malaria rapid diagnostic test (RDT); those reporting fever were asked about healthcare received. Weighted population estimates were calculated and mixed effects regression was used to assess factors associated with malaria care seeking.ResultsAmong 11,030 (98.6%) participants with RDT results (2,357 households), parasite prevalence was 19.1% by RDT; school-aged children (SAC, 5–14 years) had the highest prevalence (28.8%). Prior fever was reported by 12.4% of CU5, 7.5% of SAC, and 7.2% of individuals ≥ 15 years. Among those with prior fever, 34.0% of CU5, 56.0% of SAC, and 22.6% of individuals ≥ 15 years had a positive survey RDT and 73.7% of CU5, 66.5% of SAC, and 56.3% of individuals ≥ 15 years reported seeking treatment; 76.7% across all ages visited a CHW as part of care. Nearly 90% (87.8%) of people who visited a CHW reported a blood test compared with 73.5% seen only at a health facility and/or pharmacy (p < 0.001). Reported malaria treatment was similar by provider, and 85.9% of those with a reported positive malaria test reported getting malaria treatment; 66.9% of the subset with prior fever and a positive survey RDT reported malaria treatment. Age under 5 years, monthly or more frequent CHW home visits, and greater wealth were associated with increased odds of receiving healthcare.ConclusionsChadiza District had high CHW coverage among individuals who sought care for fever. Further interventions are needed to increase the proportion of febrile individuals who receive healthcare. Strategies to decrease barriers to healthcare, such as CHW home visits, particularly targeting those of all ages in lower wealth strata, could maximize the benefits of CHW programmes.

Jim Crow and Black Economic Progress after Slavery

Abstract This article studies the long-run effects of slavery and restrictive Jim Crow institutions on Black Americans’ economic outcomes. We track individual-level census records of each Black family from 1850 to 1940 and extend our analysis to neighborhood-level outcomes in 2000 and surname-based outcomes in 2023. We show that Black families whose ancestors were enslaved until the Civil War have considerably lower education, income, and wealth than Black families whose ancestors were free before the Civil War. The disparities between the two groups have persisted substantially because most families enslaved until the Civil War lived in states with strict Jim Crow regimes after slavery ended. In a regression discontinuity design based on ancestors’ enslavement locations, we show that Jim Crow institutions sharply reduced Black families’ economic progress in the long run.

Changes in Household Wealth Over the Process of Widowhood Across European Countries.

Widowhood has been shown to decrease surviving spouses' economic well-being. However, previous research has focused mostly on income-related outcomes, and has been less attentive to the importance of wealth, the processual nature of spousal death, and cross-national variation. In this study, we assessed how total, housing, and nonhousing wealth changes over the process of widowhood across 11 European countries. Individual fixed-effects regressions and longitudinal data from the Survey of Health, Ageing and Retirement in Europe were used to estimate how household net total wealth, housing wealth, and nonhousing wealth changed 3 years prior and 6 or more years after spousal death relative to 4 or more years prior to widowhood in 11 European countries. In all countries, household net wealth stayed relatively constant across the widowhood process, except for Austria, the Czech Republic, and Poland, where wealth declines were observed especially in the years following death. However, we found declines in housing wealth over the widowhood process, including prior to spousal death, across most countries in our sample, particularly in Austria, France, Denmark, the Czech Republic, and Poland. Declines in housing wealth were generally not reflected by changes in nonhousing wealth but coincided with leaving homeownership and downsizing. Widowhood is associated with lower wealth, especially housing wealth, even in the years before spousal loss. Future research should focus on adjudicating the mechanisms behind country differences and exploring the implications of lost wealth following widowhood for surviving spouses' well-being and intergenerational transfers.