Lower Wealth Research Articles

Maternal physical, socioeconomic, and demographic characteristics and childbirth complications in rural lowland Nepal: Applying an evolutionary framework to understand the role of phenotypic plasticity.

Evolutionary perspectives on human childbirth have primarily focused on characteristics of our species in general, rather than variability within and between contemporary populations. We use an evolutionary framework to explore how physical and demographic characteristics of mothers shape the risks of childbirth complications in rural lowland Nepal, where childbearing typically commences in adolescence and chronic undernutrition is widespread, though maternal overweight is increasing in association with nutrition transition. We conducted secondary analyses of data from a cluster-randomized trial. Women aged 14-35 years were categorized by age, number of previous pregnancies, height, body mass index (BMI), husband's education, and household wealth. Multivariable logistic regression models tested whether these characteristics independently predicted risks of episiotomy and cesarean section (CS, n= 14 261), and obstructed labor (OL, n= 5185). Risks were greatest among first-time adolescent mothers, though associations with age varied by outcome. Independent of age and parity, short stature and high BMI increased risks of CS and OL, whereas associations were weaker for episiotomy. Male offspring had increased risk of CS and OL but not episiotomy. Wealth was not associated with OL, but lower wealth and lower husband's education were associated with lower likelihood of episiotomy and CS. At the individual level, the risk childbirth complications is shaped by trade-offs between fertility, growth, and survival. Some biological markers of disadvantage (early childbearing, short stature) increased the risk, whereas low socio-economic status was associated with lower risk, indicating reduced access to relevant facilities. Independent of these associations, maternal age showed complex effects.

Social determinants of chronic ill-health in contemporary South Africa: a social disadvantage approach

ABSTRACT In recent years South Africa has had to deal with the problem of multiple disease burdens. Non-communicable diseases (NCDs) are rising and emerging as the leading causes of death in the country. Existing empirical evidence suggests that different social conditions influence health outcomes in a population. In the present study, a social disadvantage approach was employed to examine demographic and socioeconomic gradients in self-reported diagnosed chronic conditions. Analyses were based on a sample of 45,913 adults aged 18 years and older drawn from the 2018 South African General Household Survey data, using multivariate regression techniques to assess the distribution and predictors of chronic ill- health in South Africa. The reported burden of chronic ill-health was 17.3%. Factors independently associated with the risk of NCDs included increasing age, population group, lower wealth index, lower education, urban residence and province of residence. The findings confirmed the existence of socioeconomic gradients as well as a gender gap in chronic ill-health, to the detriment of vulnerable sub-groups. Policy implications are discussed.

Wealth and wealth inequality in adult HIV prevalence

Background Studies investigating a correlation between economic status of household (wealth or income) and human immunodeficiency virus (HIV) prevalence have shown relationships ranging from insignificant to strong-positive. Using data from over 400,000 Demographic and Health Surveys (DHS) respondents in 29 African low- and middle-income countries receiving assistance from the US President’s Emergency Plan for AIDS Relief (PEPFAR), this study was conducted on HIV prevalence as it relates to wealth and wealth inequality. Methods Individual-level Demographic and Health Surveys (DHS) data was obtained for 2010-2016 from 29 PEPFAR recipient countries through the DHS data portal. These data link survey responses with the HIV test results from biomarker data. To adjust for sample selection bias in the observational data, an inverse probability reweighting (IPW) technique was used to create sample weights and estimate model parameters. Results After reweighting, the wealth effects on prevalence are smaller, often statistically insignificant or inconsistent, indicating that higher levels of wealth are not associated with higher HIV prevalence. Low wealth (being poor) is associated with a higher risk for some segments of the population. The growing interest in the literature of “wealth” as a driver of the maturing HIV epidemic may be an artifact of the longer survival of wealthy people in the DHS observational data. The extent of wealth inequality in the region of residence is consistently a positive driver of higher prevalence. In all three wealth categories (tertiles of high, medium, low), more wealth inequality in a region is consistently associated with a higher HIV prevalence, other things remaining the same. Conclusions The findings of the study suggest that supply-oriented policies (e.g. distribution of providers and programs) to integrate PEPFAR activities into country health systems targeted to areas where wealth inequality is high and where pockets of low-wealth populations are found would have the greatest impact.

Loneliness, Social Anxiety, and Depression During the SARS-CoV-2 Pandemic: A Global Longitudinal Study Examining Social Restrictions Severity and Demographic Differences

Background: Social restrictions and government-mandated lockdowns implemented worldwide to curb the SARS-CoV-2 virus disrupt our social interactions, behaviours, and routines. While many studies have examined how the pandemic has influenced feelings of loneliness and poor mental health, such as depression and anxiety, few have focused on social anxiety symptomatology. Methods: We collected data on loneliness, social anxiety, depression, and social restrictions severity across three timepoints in the first six months of the pandemic, in 2665 participants across 121 countries. We later restricted our analyses to Australia, United States, and United Kingdom (n = 1562) to code from reliable sources of objective social restriction data. Longitudinal data were analysed using a multivariate latent growth curve model. Findings: Loneliness reduced, depression remained unchanged, and social anxiety symptoms increased as social restrictions severity eased in the first six months of the SARS-CoV-2 pandemic. Consistent with previous research, specific demographic factors (e.g., younger age, unemployment, lower wealth, and living alone) all influenced loneliness, depression, and social anxiety at the onset of the pandemic. No demographic factors influenced changes in levels over time for loneliness or depression, but being younger and being unemployed influenced change in levels over time for social anxiety. Loneliness, social anxiety, and depressive symptoms were highly related, but the course of social anxiety symptoms differed from loneliness and depression- those higher in social anxiety at baseline also increased in social anxiety quicker over time. Interpretation: Social anxiety remains an overlooked mental health symptom in SARS-CoV-2 pandemic research. Frontline practitioners may see increased social anxiety and avoidance even as social restrictions ease. Service delivery providers should focus on vulnerable groups, including those aged 18 to 25 years, unemployed, and with lower wealth, during this public health crisis. Funding: None to declare. Declaration of Interest: None to declare. Ethical Approval: Ethics approval was granted by Swinburne University Human Research Ethics Committee.

Stochastic Earnings Growth and Equilibrium Wealth Distributions

The cross-section distribution of U.S. wealth is more skewed than the distribution of labor earnings. Stachurski and Toda (2019) explain how plain vanilla Bewley-Aiyagari-Huggett (BAH) models with infinitely lived agents can't generate that pattern because an equilibrium risk-free rate is lower than the time rate of preference and each person's wealth process is stationary. We provide two modifications of a BAH model that generate this pattern: (1) overlapping generations of agents who have low wealth at birth and pass through N life-stage transitions of stochastic lengths, and (2) labor-earnings processes that exhibit stochastic growth. With only a few parameters such a model can well approximate mappings from the Lorenz curve and Gini coefficient for cross-sections of labor earnings to their counterparts for cross sections of wealth. Three forces amplify inequality in wealth relative to inequality in labor-earnings: stochastic life-stage transitions; a precautionary savings motive for high wage earners that is especially strong after they receive positive permanent earnings shocks; and an energetic life-cycle saving motive for agents who have low wealth at birth. An equilibrium risk-free interest rate that exceeds a time preference rate fosters a fat-tailed wealth distribution. Institutional subscribers to the NBER working paper series, and residents of developing countries may download this paper without additional charge at www.nber.org.

Multiple Mainstreams

Multiple Mainstreams Carla Murphy (bio) Click for larger view View full resolution [End Page 24] I suppose I'm meant to care how "the left" talks about race and class. I fit the profile; I'm a black female journalist. My stories since the early 2000s have featured men and women made invisible or marginalized by society, sometimes by their own communities, and certainly by newsrooms. But as a news gatherer, I've always tinkered on the borderlands of mainstream and progressive journalism, the left's gathering space. I never fully committed. That's because early in my career I settled on an important distinction: it's not how you talk about class and race that matters; it's to and for whom. Audience determines how. Left conversations about race and class rarely center my folks as their audience: the precarious middle-class, working-class, and workingpoor residents of my Brooklyn street; recent immigrants; and native-born Americans like them. Left conversations seem unaware of the value of redistributing news media power such that non-whites and working people construct their own left conversations about race and class. This, to me, is the problem—not how the left's well-educated upper-middle class, unharmed and unbothered by journalism's poverty wages, talks about race and class. As a journalist I always conceived of my role as working for folks who are not in the room. I don't view the progressive or liberal journalist's pursuit of news about marginalized people as progress. From my view in the borderlands, the progressive mission should be to expand the production of news (about race, class, and gender) for these audiences. It should be to create multiple mainstreams strong enough to compete with the mainstream. Producing news about low-wealth people for a better-off, highly educated audience carries a high civic and socioeconomic cost for folks on the losing side of economic inequality and those of us driven to expand democratic participation. It never made sense to me to believe that a shooting in a New York City outer borough has gotten sunlight because a white guy in Greenwich, Connecticut, read about it in an issue of the New York Times. What [End Page 25] does informing him have to do with journalism fulfilling its public service for the people living in that outer borough? Where is their trusted mainstream for surfacing debate, sifting truth from misinformation, and building consensus? I come from city blocks that at one point seemed to be losing one member of every five households to Rikers and to prisons upstate. No mainstream outlet has ever covered that phenomenon commensurate to its effect on generations of families in the sending and receiving zip codes. The affected persons—black, brown, and white—aren't whom those outlets produce news for. Otherwise, we would see newsroom beats like "community health and safety," "justice," or "the prison economy"—instead of "crime." The way that mainstream news media covers healthcare, housing, and higher education, for example, is also shaped by the audience it values. These outlets don't consistently answer the practical, mundane, or even existential questions of people and communities that are low wealth, of color, or immigrant. They answer the white guy in Greenwich's questions. However those outlets talk about race and class, it's for him. They explain the world to him. They center him. They seek to expand his world. They seek to persuade and convince him. They engage and value him. They believe his civic participation matters more than that of the audiences I value. Meanwhile, the nation is browner in real life, and even browner on Gen Z's TV shows and social media. Right now, to paraphrase Ian Haney López, white people are trying to figure out what it means to be white in the United States. For low-wealth families the cost of upward mobility is prohibitive. Is our news system designed for now? It makes sense to me that the journalism industry should serve pluralities, or multiple mainstreams—not only the imagined white, suburban one penning in the black and brown inner-city. That's a throwback to when white...

The Long-Term Effects of Experienced Macroeconomic Shocks on Wealth

This paper examines the long-term effects of experienced macro-economic shocks – defined as multi-year peak-to-trough GDP declines of at least 10 percent – on the wealth distribution, portfolio allocation, and risk attitudes of older individuals in Europe. We show that individuals who have experienced more economic depression episodes have lower wealth in absolute terms, a lower probability to invest in risky assets, and display higher risk aversion. When analysing early investment decisions, we find that individuals hit by a depression substitute risky investments with investment in housing, and that these early choices shape wealth in the long-term.

Bullying Victimisation in Adolescence: Prevalence and Inequalities by Gender, Socioeconomic Status and Academic Performance Across 71 Countries

Background: Bullying victimisation is of global importance due to its long-term negative consequences. We examined the prevalence of victimisation and its inequalities in 15-year-olds across 71 countries, using data from the Programme for International Student Assessment 2018. Methods: Students reported frequencies of relational, physical, and verbal victimisation during the last 12 months, which were both analysed separately and combined into a total score. Prevalence of high victimisation (> a few times a month) was estimated, followed by mean differences by gender, wealth and academic performance quintiles in each country. Meta-analyses were used to pool and examine country differences. Findings: Of the 421,437 students included 30·4% experienced victimisation, yet this varied by country—from 9·3% (Korea) to 64·8% (Philippines). Verbal and relational victimisation were more frequent (21·4%, 20.9%, respectively) than physical victimisation (15·2%). On average, boys (vs girls +0·23SD, 95%CI: 0·22–0·24), students from the lowest wealth (vs highest +0·09SD, 0·08–0·10) and with lowest academic performance (vs highest +0·49SD, 0·48–0·50) were at higher risk of victimisation. However, there was substantial between-country heterogeneity in these associations (I2 =85%–98%). Similar results were observed for subtypes of victimisation—except relational victimisation, where gender inequalities were smaller. Interpretation: Globally, bullying victimisation was high, although the size, predominant subtype and strength of associations with risk factors varied substantially by country. This highlights the need to tackle bullying victimization globally—the cross-country differences observed suggest benefits may arise from identifying and learning from countries with low prevelance and/or inequality. Funding Information: Japan Foundation for Paediatric Research. Declaration of Interests: All authors declare no competing interests. Ethics Approval Statement: Approval for the collection of the data was obtained from the PISA Governing Board, composed of representatives of OECD Members and PISA Associates. In each participating country or economy, school staff, students and parents were informed of the nature of the assessment and its use and consent provided.

Marginal Propensities to Consume Before and After the Great Recession

Using a quasi maximum likelihood approach for a semi-structural model, we find highly precise and distinct estimates of consumption responses to idiosyncratic income shocks for different groups of households. Homeowners stratified by liquid wealth exhibit the most dispersion in their marginal propensities to consume. Time-varying estimates support strong patterns of heterogeneity by homeownership status and balance sheet liquidity, with economically and statistically significant increases in the sensitivity of transitory consumption for homeowners, especially those with lower liquid wealth, following the collapse in house prices with the Great Recession. These findings support consumption theories that include housing as an illiquid asset.

Go Big or Buy a Home: Student Debt, Career Choices and Wealth Accumulation

What is the impact of student loans on post baccalaureate choices? Using within-college variations in financial aid policies, we find that higher levels of debt induce a front loading of earnings, an underinvestment in human capital and an earlier entry into home ownership. We then estimate a life-cycle model using a representative panel of college graduates and analyze the mechanisms behind the interaction between student debt, career choices and housing. Our results indicate that lower net wealth generates a trade-off between career and housing choices for college graduates. Finally, we compare alternative policy proposals. Relative to the baseline 10-year fixed repayment plan, an income based repayment plan increases human capital accumulation and earnings growth, while postponing entry into home ownership. Importantly, linking repayments to income achieves outcomes that are close to what can be achieved by a more ambitious ”college for all” subsidy plan.

MultipleImpacts of Ethiopia’s Health Extension Programme on Adolescent Health and Wellbeing: a Quasi-Experimental Study 2002-2013

Background. Scalable interventions are needed to support adolescents thrive. Since 2003, the Ethiopian Government’s Health Extension Programme (HEP) has reached millions of households. We evaluated the relationship between household support from HEP and eleven indicators of adolescent health and wellbeing. Methods. We used Young Lives Ethiopia cohort data between 2002 and 2013. Outcomes were: not underweight, self-reported very good health, education enrolment, domestic tasks, paid work, fertility knowledge, sexually transmitted infection knowledge, no child marriage, no early pregnancy, literacy, and numeracy. We evaluated associations between household support from HEP at age 15 and study outcomes at age 19 using propensity score weighted regression, stratifying by sex, and adjusting for receipt of the Productive Safety Net Programme, and economic shocks. Adjusted probability differences (APDs) and adjusted mean differences (AMDs) were used to contrast exposure to HEP vs. no exposure. Findings. Of 775 adolescents with complete follow-up, 46% were female, with baseline mean age 7.87 years (SD: 0.29). Sixty-six percent of adolescents reported household support from HEP. Baseline predictors of support included lower household wealth, lower caregiver education, rural location, and residence in Tigray. Propensity score weighting yielded good balance. In boys, HEP was positively associated with education enrolment (APD: +17ppts, 95% CIs: +6ppts; +27ppts), and negatively associated with paid work (APD: -16ppts, 95% CIs: -27ppts; -4ppts). In girls, HEP was positively associated with fertility knowledge (APD: +14ppts, 95% CIs: 2ppts; 25ppts), no child marriage (APD: +19ppts, 95% CIs: +9ppts; +29ppts), no early pregnancy (APD: +18ppts, 95% CIs: +9ppts; +28ppts), education enrolment (APD: +23ppts, 95% CIs: +11ppts; +34ppts), literacy (AMD: +7ppts, 95% CIs: +2; +11), and numeracy (AMD: +10ppts, 95% CIs: +5; +14). Interpretation. Policies promoting HEP will substantially support multiple areas of adolescent health and wellbeing, and help their transition to adulthood.

Determinants of dietary diversity and its relationship with the nutritional status of pregnant women.

There is little information regarding factors that determine dietary diversity among pregnant women in Ghana. The present study, therefore, sought to assess the independent predictors of dietary diversity and its relationship with nutritional status of pregnant women in the Northern Region of Ghana. The present study was an analytical cross-sectional survey involving 423 pregnant women in different stages of gestation. The 24-h dietary recall method was used to assess minimum dietary diversity for women (MDD-W), and nutritional status was assessed using mid-upper arm circumference (MUAC) measurements. Binary logistic regression was performed to assess the association between maternal dietary diversity and maternal thinness and a P value of <0⋅05 was considered statistically significant. Of the 423 women, 79⋅9 % (95 % CI 76⋅1, 83⋅7) met the MDD-W and the prevalence of undernutrition among the pregnant women was 26⋅0 %. The analysis showed that women of low household wealth index were 48 % less likely (AOR 0⋅52, CI 0⋅31, 0⋅88) of meeting the MDD-W, whereas women from households of poor food insecurity were 88 % less likely (AOR 0⋅12, CI 0⋅05, 0⋅27) of achieving the MDD-W. Women of low household size were three times more likely of meeting the MDD-W (AOR 3⋅07, CI 1⋅13, 8⋅39). MDD-W was not associated with maternal underweight during pregnancy. In conclusion, the results of the present study showed that food insecurity and not low MDD-W, associated with mothers' thinness (underweight) during pregnancy in peri-urban setting of Northern Ghana.

Why Europe Looks so Much like China: Big Government and Low Income Inequalities

One view in the literature (Popov 2020) is that East Asian model is superior to other models in the Global South, at least in terms of catch-up development and possibly even in innovations beyond the technological frontier. Unlike economic models in Latin America and Sub-Sahara Africa, the East Asian model prioritizes community interests (e.g., that of work collective, neighborhood, nation-state, and all of humanity) over those of individuals with the possibility of limiting some human rights for the greater benefit of all. Crucial features of the East Asian economic model include relatively low income and wealth inequalities, strong state institutional capacity (as measured by the murder rate and share of the shadow economy). The origins of the East Asian economic model can be traced to different trajectories of the development of the Global South since the 16th century (Popov, 2009; 2014). This paper argues that European economic model and East Asian model have a lot in common. After controlling for the size of the country and the level of development, it turns out that government consumption as a share of GDP is relatively high in both models, whereas income inequalities are relatively low.

The Cross-Section of Household Preferences

This paper estimates the cross-sectional distribution of Epstein-Zin preference parameters in a large administrative panel of Swedish households. We consider life-cycle model of saving and portfolio choice that incorporates risky labor income, safe and risky financial assets inside and outside retirement accounts, and real estate. We study middle-aged stock-owning households grouped by education, industry of employment, and birth cohort as well as by their accumulated wealth and risky portfolio shares. We find some heterogeneity in risk aversion (a standard deviation of 0.47 around a mean of 5.24 and median of 5.30) and considerable heterogeneity in the time preference rate (standard deviation 6.0% around a mean of 6.2% and median of 4.1%) and elasticity of intertemporal substitution (standard deviation 0.96 around a mean of 0.99 and median of 0.42). Risk aversion and the EIS are almost cross-sectionally uncorrelated, in contrast with the strong negative correlation that we would find if households had power utility with heterogeneous risk aversion. The TPR is weakly negatively correlated with both the other parameters. We estimate lower risk aversion for households with riskier labor income and higher levels of education, and a higher TPR and lower EIS for households who enter our sample with low initial wealth. Institutional subscribers to the NBER working paper series, and residents of developing countries may download this paper without additional charge at www.nber.org.

Socioeconomic Determinants of Maternal HealthCare Utilisation in Zambia: 1997-2014.

This study aims at exploring the trends and socioeconomic inequalities in the use of maternal healthcare utilization between 1997 and 2014. Data were analyzed using descriptive and multivariate regression methods. Women in the higher wealth quintiles (Q4 and Q5) generally had higher prevalence of using health facility delivery and postnatal care services compared with those in the lower wealth quintiles (Q1 and Q2), whereas the prevalence of timely and adequate antenatal care visit was comparatively higher among those in the lower wealth quintiles. Findings indicated important sociodemographic inequalities in using maternal healthcare services, addressing which may help promote the utilization of these services.

Comparison of Growth in Children of 6 to 59 Months of Age According to Birth Order: Insights from the National Family Health Survey-4

Introduction: Undernutrition continues to be a major public health problem throughout the world. Higher birth order of the child contributes to higher chance of being undernutrition. But, the relationship between birth order and undernutrition has not been fully studied and understood, especially in India where the fertility rate was high. Aim: To understand the prevalence and determinants of undernutrition using National Family Health Survey-4 (NFHS-4) India. Materials and Methods: A national cross-sectional survey was conducted during January 2015 to December 2016. This study used information from a total weighted sample of 128859 children from India NFHS-4. Univariate and multivariate binary logistic regression were used to investigate the association of undernutrition with birth order, other child, maternal and socio-economic factors. Three models were constructed for the study, model 1 as univariate, model 2 adjusting with birth order and socio-economic predictors and model 3 adjusting with all the predictors included in the study. Results: Of the 128859 children, median Inter Quartile Range (IQR) age was 26 (16-41) months with female/male ratio was 1:1.2. The prevalence of stunting, underweight and wasting was 37.93% (95% Confidence Interval (CI) 37.67-38.20), 34.02% (95% CI 33.76-34.28) and 20.70% (95% CI 20.48-20.92), respectively. Model-1, 2 and 3 showed that the child's higher birth order was found to have higher odds of being stunted and underweight compared with first born children. Children with lower wealth quintiles, male, vaginal delivery had higher odds of being stunted, wasted and underweight in the model-3 adjusted analysis. Conclusion: This study indicates that higher birth order was a significant predictor of a child being stunted and underweight, as it is significant in all three models. However, further longitudinal studies are required to establish a cause-effect relationship between birth order and undernutrition and future interventions to prevent undernutrition should consider birth order as an important factor.

Incident hypertension in urban slums of central India: a prospective cohort study

BackgroundNumerous studies have highlighted the burden of hypertension by estimating its prevalence. However, information regarding quantum and characteristics of persons whose blood pressure converts to hypertension range from their previous...

The Barrier to Contraceptive Use among Multiparous Women in Indonesia.

Background:The lack of perception related to the risk of pregnancy and contraceptive use's side effects is the main reason for not using contraceptives.Objective:This study aimed to analyze barriers to contraceptive use among multiparous women in Indonesia.Methods:This study employed the 2017 Indonesia Demographic and Health Survey. The analysis unit was multiparous women aged 15–49 years old, and the sample was 25,543 women. The contraceptive use was the dependent variable, while the independent variables analyzed were residence, age, education, employment, wealth, and insurance. The study used a binary logistic regression to determine the barriers.Results:Women in urban areas were 1.100 times more likely not to use contraceptives than women in rural areas. All categories of age group are more likely to use contraception than the 45–49 age group. Multiparous women who had low education had a higher possibility of not using contraceptives. Unemployed multiparous women were 1.008 times more likely not to use contraceptives than employed multiparous women. In terms of wealth status, women with all wealth status tended not to use contraceptives than the richest.Conclusions:Multiparous women in Indonesia had five barriers to not using contraceptives. These included living in urban, being at younger ages, having no education, being unemployed, and having low wealth status.

Tuberculosis and HIV/AIDS-Attributed Mortalities and Associated Socioeconomic Demographic Factors in Papua New Guinea: Evidence From the Comprehensive Health and Epidemiological Surveillance System

Background: Tuberculosis (TB) and HIV/AIDS have been recently identified as the leading specific causes of deaths (COD) in Papua New Guinea (PNG). However, little is known about the socioeconomic demographic factors of mortalities attributed to these diseases. Objective: This study examines the socioeconomic and gender inequality in mortality attributed to TB and HIV/AIDS among the population by analyzing the associations of socioeconomic demographic factors of the deceased and CODs in the population in PNG to inform policy. Method: Mortality data from 926 verbal autopsy (VA) interviews were collected from the population living within the catchment areas of the Comprehensive Health and Epidemiological Surveillance System (CHESS), established in five provinces, including Central, Eastern Highlands, East New Britain, East Sepik, Madang and Port Moresby, the National Capital in the period 2018-2020, using the WHO 2016 VA tool. InterVA-5 cause of deaths (COD) diagnostic tool was used to assign possible CODs. Mortality data were linked with household socioeconomic data from CHESS database for analysis of socioeconomic factors associated with mortalities from TB and HIV/AIDS using multinomial logistic regression (MLR) models to provide estimates odds ratios (unadjusted and adjusted ORs) and 95% confidential intervals (CI). Result: TB and HIV/AIDS were the first and the third leading CODs, attributed to 9% and 8% of the total deaths recorded in the population. The prevalence of TB and HIV/AIDS co-morbidities was about 6% of all TB and HIV/AIDS-attributed deaths. Males were more likely to die from TB than females (aOR: 1.2; 95% CI: 0.62-1.83). The population aged 25-34 years had the highest proportion of deaths from TB (20% of deaths in this age group), and the risk of dying from TB in this age group was three folds more than those aged 75+ years (aOR: 2.7; 95% CI: 1.59-19.5). People from middle household wealth quintile had highest proportion of deaths from TB (15% of deaths in this population) and the risk of dying from TB in this quintile was doubled than the richest quintile (aOR: 2.14; 95% CI: 1.30-3.27). Rural population was more likely to die from TB than urban population. The risks of dying from TB were 50% higher in Central and Madang, but 50% lower in POM compared to East New Britain. HIV/AIDS-attributed deaths accounted for 11% of female deaths, compared to 5% of male deaths. Young population aged 25-34 years had the highest proportion of deaths attributed to HIV/AIDS (18%) and the risk of dying from HIV/AIDS in this population was twice higher than those aged 75+ years (aOR: 1.99; 95% CI: 0.77-20.3). HIV/AIDS-attributed deaths accounted for 5% of deaths among children aged 0-4 years. The highest proportion of HIV/AIDS mortality was found among the population from middle household wealth quintile (10% of deaths in this population), and this population was 85% more likely to die from HIV/AIDS than the richest quintile (aOR: 1.85; 95%CI: 0.91-3.21). About 9% of deaths in rural population was due to HIV/AIDS, compared to 6% in urban population. The proportion of people died from HIV/AIDS was highest in EHP (12%), followed by Madang (10%). The risks of dying from HIV/AIDS were higher in EHP and Madang than East New Britain (aOR: 1.3 [95% CI: 0.4-2.5] and aOR: 2.0 [95% CI: 0.8-3.6], respectively). Conclusion: TB and HIV/AIDS were the top leading causes of death in PNG population, and attributed to highest proportions of mortalities among the young people aged 24-35 years, are evidence of failed TB and HIV/AIDS programs. Death of children aged 0-4 years to HIV/AIDS suggested that the prevention of mother-to-child transmission was failed to protect newborns from HIV/AIDS. More targeted public health interventions are needed to reduce premature mortalities from TB and HIV/AIDS among the population in rural areas, particularly those are young females in Madang and EHP, and those are from households with low wealth status. Funding Information: The CHESS was operated with financial supported from the PNG Government through the Department of National Planning and Monitoring (PIP No. 02704). Declaration of Interests: No potential conflict of interest was reported by the authors. Ethics Approval Statement: The CHESS was granted ethics approvals from Institutional Review Board of PNG Institute of Medical Research (IRB’s Approval no. 18.05) and the Medical Research Advisory Committee of Papua New Guinea (MRAC’s Approval no. 18.06). These approvals covered all the data components under the CHESS, including the mortality data which were used in this manuscript. Informed consent was sought from self-identified close relatives of the deceased. They were informed about their right to withdraw from the study at any stage.

Factors Associated with Stunting Among Children Aged 24-59 Months in Food Secure and Insecure Households of Kuyu District, Northern Oromia, Ethiopia: &lt;i&gt;A Comparative Cross-Sectional Study&lt;/i&gt;

Background: Stunting is the most challenging and prevalent public health problems particularly in low socioeconomic settings. The major aim of this study was to assess and compare factors associated with stunting among children aged 24-59 months in food secure and insecure households of Kuyu district, North Shewa Zone, central Oromia. Methods: A comparative, cross-sectional study was done on 618 children (309 children from food secure and 309 from insecure households) between February and March 2019. Multiple stages sampling method was performed to select children from each kebele. Anthropometric data were taken and calculated using WHO Anthro v. 3.2.2. The data analysis was performed using SPSS version 20.0. Logistic regressions analysis was carried out in the statistical analysis. Results : The prevalence of stunting was 43.1% and 48.3% for children in food secure and insecure households, respectively. The multivariate analysis showed that low wealth status (AOR=7.44; 95% CI: 3.02, 18.46), a child who did not eat all food types (AOR=2.1; 95%CI: 1.12, 4.24) and low dietary diversity (AOR=8.3; 95%CI: 4.46, 15.5) were significantly linked with stunting in food-secure households. Whereas, in food, insecure households, poor dietary diversity (AOR=4.7; 95%CI: 2.5, 8.83), low wealth status (AOR=2.5; 95%CI: 1.1, 5.55) and child who did not eat breakfast (AOR=2.04; 95%CI: 1.1, 3.78) were predictors for children stunting. Conclusions: The prevalence of stunting among children under five years old was very high in the study area. Therefore, ensuring food security status using the Productive Safety Net Program (PSNP) in harmony with the participation of all responsible bodies should be intensified to overcome the problem of undernutrition in the study area. Funding: The Innovation and Technology Transfer Grant from Wollega University supported this work. Declaration of Interest: None to declare. Ethical Approval: The study was reviewed and approved by the Institutional Review Board (IRB) of the college of medicine and health sciences of Hawassa University.