Lower Wealth Research Articles

Prevalence of food insecurity and associated factors among households in Waliso town, Oromia, Ethiopia

BackgroundFood insecurity is the underlying cause of malnutrition. In addition, it is a condition where people lack consistent access to enough food for every person in a household to live an active and healthy life.Recently, urban food insecurity has been on the top agenda in Ethiopia, as households prone to food insecurity are rising because of various factors. Hence, we aimed to assess the prevalence of food insecurity and associated factors among households in Waliso town, Oromia, Ethiopia.MethodsA community-based cross-sectional study design was used from December 17, 2021, to January 16, 2022, among 397 randomly selected households in Waliso town. Study participants were selected using a simple random sampling technique. Data collection was performed using a structured questionnaire, and data were entered using Epi Info 7 and exported to SPSS version 20 software for analysis. To identify factors associated with household food insecurity, multivariable binary logistic regression analyses were done. An adjusted odds ratio along with a 95% confidence interval were estimated to measure the strength of the association. In this study, the level of statistical significance was declared at p < 0.05.ResultsThe prevalence of household food insecurity was 63.4%, 95% CI (58.60%, 68.20%). Factors associated with household food insecurity were family sizes 6 + [AOR = 3.06, 95% CI: (1.35, 6.94)], dependents 1–2 [AOR = 2.62, 95% CI: (1.35, 5.10)], dependents 3 + [AOR = 3.07, 95% CI: (1.38, 7.40)], unemployed [AOR = 6.86, 95% CI: (2.76, 17.04)], self-employed [AOR = 3.27, 95% CI: (1.50, 7.14)], wage laborers [AOR = 13.01, 95% CI: (4.93, 34.38)], low wealth index [AOR = 4.08, 95% CI: (2.18, 7.64)], and a medium wealth index [AOR = 2.08, 95% CI: (1.18, 3.69)].ConclusionNearly two in three households were food insecure in Waliso Town. Large family sizes, a high dependency ratio, unemployment, low wage employment, and a low wealth index were significantly associated with food insecurity. Hence, the implementation of actions to improve household income and livelihoods, minimize dependency rates, by strengthen the use of family planning and encourage urban agriculture is vital to alleviate household food insecurity problems in the town.

Factors associated with maternal health services utilization in Pakistan: Evidence from Pakistan maternal mortality survey, 2019.

This study investigates the factors associated with maternal health services utilization in Pakistan using two outcome indicators, ideal antenatal care (IANC), defined as the pregnant woman receiving all the essential services included in standard antenatal care, and skilled birth attendance (SBA). This study used the Pakistan Maternal Mortality Survey 2019 data. The study utilized binary logistic regression models to investigate the adjusted association between the outcome variables, separately for IANC and SBA, and the independent variables, education, wealth, parity, and residence. Wealth showed a positive association with utilization of IANC (adjusted odds ratio [AOR] = 11.48, 95% CI = 7.76, 16.99) and SBA (AOR = 4.37, 95% CI = 3.30,5. 80). Maternal age was associated only with IANC for women aged 35 or more years (AOR = 1.31, 95% CI = 1.06, 1.62). Increased likelihood of utilization of IANC and SBA services was also observed for women with formal education. Women who had 3-5 previous live births had higher odds of using IANC and SBA than women who had 1-2 or more than five previous live births. Urban residency was not correlated with either IANC or SBA. When compared to the wealthy and educated quintile, women in the lower wealth quintile and those without any formal education were less likely to utilize ANC and SBA services. A comprehensive and multipronged approach from the health and education sectors is needed to improve maternal health in Pakistan.

Treatment-seeking behaviour among 15–49-year-olds with self-reported heart disease, cancer, chronic respiratory disease, and diabetes: a national cross-sectional study in India

BackgroundEighty per cent of India´s non-communicable disease (NCD) mortality is due to four conditions: heart disease, cancer, chronic respiratory disease, and diabetes, which are primarily cause-amenable through treatment. Based on Andersen’s behavioural model of health services use, the current study aimed to identify the predisposing, enabling, and need factors associated with treatment-seeking status among people self-reporting the four main NCDs in India.MethodsCross-sectional study using secondary data. Usual residents aged 15–49 who self-reported cancer (n = 1 056), chronic respiratory disease (n = 10 534), diabetes (n = 13 501), and/or heart disease (n = 5 861) during the fifth National Family and Health Survey (NFHS-5), 2019–21, were included. Treatment-seeking status was modelled separately for each disease using survey-adjusted multivariable logistic regression.Results3.9% of India´s 15–49-year-old population self-reported ≥ 1 of the four main NCDs (0.1% cancer, 1.4% chronic respiratory disease, 2% diabetes, 0.8% heart disease). The percentage that had sought treatment for their condition(s) was 82%, 68%, 76%, and 74%, respectively. Greater age and having ≥ 1 of the NCDs were associated with greater odds of seeking disease-specific treatment. People in the middle or lower wealth quintiles had lower odds of seeking care than the wealthiest 20% for all conditions. Women with diabetes or chronic respiratory disease had greater odds of seeking disease-specific treatment than men. Muslims, the unmarried, and those with health insurance had greater odds of seeking cancer treatment than Hindus, the married, and the uninsured.ConclusionPredisposing, enabling, and need factors are associated with treatment-seeking status among people reporting the four major NCDs in India, suggesting that multiple processes inform the decision to seek disease-specific care among aware cases. Successfully encouraging and enabling as many people as possible who knowingly live with major NCDs to seek treatment is likely contingent on a multi-pronged approach to healthcare policy-making. The need to improve treatment uptake through accessible healthcare is further underscored by the fact that one-fifth (cancer) to one-third (chronic respiratory disease) of 15–49-year-olds reporting a major NCD have never sought treatment despite being aware of their condition.

Socioeconomic inequalities in physical, psychological, and cognitive multimorbidity in middle-aged and older adults in 33 countries: a cross-sectional study

Many physical, psychological, and cognitive disorders are highly clustered among populations with low socioeconomic status. However, the extent to which socioeconomic status is associated with different combinations of these disorders is unclear, particularly outside high-income countries. We aimed to evaluate these associations in 33 countries including high-income countries, upper-middle-income countries, and one lower-middle-income country. This cross-sectional multi-region study pooled individual-level data from seven studies on ageing between 2017 and 2020. Education and total household wealth were used to measure socioeconomic status. Physical disorder was defined as having one or more of the self-reported chronic conditions. Psychological and cognitive disorders were measured by study-specific instruments. The outcome included eight categories: no disorders, physical disorder, psychological disorder, cognitive disorder, and their four combinations. Multivariable-adjusted logistic regression models were used to estimate odds ratios (ORs) and 95% CIs for the associations of socioeconomic status with these outcomes separately for high-income countries, upper-middle-income countries, and the lower-middle-income country. Among 167 376 individuals aged 45 years and older, the prevalence of multimorbidity was 24·5% in high-income countries, 33·9% in upper-middle-income countries, and 8·1% in the lower-middle-income country (India). Lower levels of education, household wealth, and a combined socioeconomic status score were strongly associated with physical, psychological, and cognitive multimorbidity in high-income countries and upper-middle-income countries, with ORs (low vs high socioeconomic status) for physical-psychological-cognitive multimorbidity of 12·36 (95% CI 10·29-14·85; p<0·0001) in high-income countries and of 23·84 (18·85-30·14; p<0·0001) in upper-middle-income countries. The associations in the lower-middle-income country were mixed. Participants with both a low level of education and low household wealth had the highest odds of multimorbidity (eg, OR for physical-psychological-cognitive multimorbidity 21·21 [15·95-28·19; p<0·0001] in high-income countries, 37·07 [25·66-53·56; p<0·0001] in upper-middle-income countries, and 54·96 [7·66-394·38; p<0·0001] in the lower-middle-income country). In study populations from high-income countries, upper-middle-income countries, and the lower-middle-income country, the odds of multimorbidity, which included physical, psychological, and cognitive disorders, were more than ten times greater in individuals with low socioeconomic status. Equity-oriented policies and programmes that reduce social inequalities in multimorbidity are urgently needed to achieve Sustainable Development Goals. Zhejiang University, Fundamental Research Funds for the Central Universities, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Wellcome Trust, Medical Research Council, National Institute on Aging, and Academy of Finland. For the Chinese translation of the abstract see Supplementary Materials section.

Prevalence and predictors of acute respiratory infection among children under-five years in Tigray regional state, northern Ethiopia: a cross sectional study

BackgroundAcute respiratory infection is still one of the leading causes of child morbidity and mortality worldwide. Developing countries, especially in Sub-Saharan Africa including Ethiopia continue to share an overburden of this infection. Studies showed that different predictor factors were associated with the occurrence of childhood acute respiratory infection. Therefore, the main aim of this study was to assess the prevalence and associated predictor factors of acute respiratory infection among children under-five years in the Tigray Regional State, northern Ethiopia.MethodsA retrospective cross-sectional study design was done from January 18, 2016, to June 27, 2016. A total of 986 children under-five years were selected for this study. The logistic regression model analysis was employed to examine the predictor factors of childhood acute respiratory infection. Both bi-variable and multivariable data analysis was performed using STATA version 14.0.ResultsOverall, the study showed that the two weeks prevalence of acute respiratory infection among children under-five years was 16.10% [95%CI: 13.80–18.40]. According to the multivariable logistic regression model analysis, children aged (24–60) months (AOR: 0.59, 95%CI: 0.352–0.98), rich wealth index of households (AOR: 0.60, 95%CI: 0.378–0.959), diarrhea status of children (AOR: 3, 95%CI: 1.97–4.73), and mothers smoking cigarettes (AOR: 4, 95%CI: 1.15–16.50), were significant predictors of acute respiratory infection.ConclusionThe prevalence of ARI displays that Tigray regional state was experiencing a higher ARI rate than the national level. The current study identified the low wealth index of households, children aged (24–60 months), mothers smoking cigarettes, and diarrhea status of the children as crucial predictor factors for ARI. Interventions should be improved to these modifiable major predictor factors that significantly decrease the ARI problem among under-five children.

A Pilot Study on the Prevalence of Peripheral Arterial Disease in Kigali, Rwanda

Abstract Background Peripheral arterial disease (PAD) has significant morbidity including limb loss. The prevalence of PAD in low- and middle-income countries ranges from 3-25% though the global burden is accepted to be near 6%. The objective of this pilot study was to estimate the prevalence of PAD and associated risk factors in Kigali, Rwanda. Methods This is a multicenter, mixed-methods, cross-sectional study conducted at three health facilities in Kigali, Rwanda. Patients older than 40 years old presenting for non-emergent reasons at the clinics were eligible for participation in the study. An ankle-brachial index (ABI) was measured using the Unetixs Revo 1100/8 MHz probe for PAD screening. An ABI &amp;lt;/=0.9 was the value diagnostic for PAD, and &amp;gt;1.3 was used for an inconclusive ABI. A self-reported survey was collected to determine demographics and medical history, including smoking status and medication use. Results A total of 861 participants were included in this study with an overall PAD positivity rate of 3.14%. Additionally, 166 patients (19.3%) had inconclusive ABIs. Patients who screened positive for PAD were significantly more likely to be older (63 vs 56, p = 0.009), of lower wealth indexes (p = 0.016), and were more likely to be current or former smokers (13 (48.1%) vs 217 (32.5%), p = 0.041) (Table 1). Patients with inconclusive ABIs were significantly more likely to be male (70 (42%) vs 140 (21%), p = &amp;lt;0.001), more likely to have chronic kidney disease (4 (2.4%) vs 2 (0.3%), p = 0.016), and more likely to be positive for human immunodeficiency virus (HIV) (44 (27%) vs 127 (19%), p = 0.041). There were also lower rates of DM and HTN in the inconclusive group but no differences in the diagnostic group. Conclusions Our results revealed that the prevalence of PAD in Kigali, Rwanda, was similar to ranges quoted in the literature at 3.14%. Results hint that traditional risk factors such as DM and HTN may be less common amongst people with PAD in Rwanda. Key messages • The prevalence of peripheral artery disease (PAD) in Rwanda is similar to estimates in other LMICs. • Traditional risk factors such as diabetes and hypertension may play smaller roles in the etiology of peripheral artery disease (PAD) in Rwanda.

Residential status and household wealth disparities in modern contraceptives use among women in Ghana: a cross-sectional analysis

BackgroundModern contraceptive refers to “a product or medical procedure that interferes with reproduction from acts of sexual intercourse”. The aim of this study was to assess the relationship between residential status and wealth quintile, and modern contraceptive use among women in Ghana.MethodsWe examined residential status and wealth quintile on contraceptive use analysing the 2006, 2011 and 2018 Multiple Indicator Cluster Surveys datasets. A sample of 30,665 women in their reproductive ages (15–49 years) were enrolled in the surveys across Ghana. STATA version 13 was used to process and analyse the data. It examined socioeconomic and demographic characteristics, assessed modern contraceptive use prevalence among women, and used logistic regression models to determine predictors. The results were presented in odds ratio and adjusted odds ratio with 95% confidence intervals. All statistical tests were measured with p < 0.05.ResultsIn the three survey years, the highest prevalence of modern contraceptive usage was observed in 2011 (27.16%). The odds of using modern contraceptive increased by 19% in rural places (AOR = 1.19; 95% CI = 1.097–1.284) compared to urban places. The likelihood of women in second (AOR = 1.17; 95% CI = 1.065–1.289), middle (AOR = 1.24; 95% CI = 1.118–1.385), and fourth (AOR = 1.25; 95% CI = 1.113–1.403) wealth quintile using contraceptives increased compared to those of low wealth quintile. With the interactive terms, rural-second (AOR = 1.38; 95% CI = 1.042–1.830), rural-middle (AOR = 1.45; 95% CI = 1.084–1.933), rural-fourth (AOR = 1.52; 95% CI = 1.128–2.059), and rural-high (AOR = 1.42; 95% CI = 1.019–1.973) were more likely to use contraceptives compared to urban-low women. Despite lower odds, women of the age groups 20–24 (AOR = 2.33; 95% CI = 2.054–2.637), cohabitaing (AOR = 1.07; 95% CI = 0.981–1.173), secondary or higher education (AOR = 1.55; 95% CI = 1.385–1.736), Central (AOR = 1.48; 95% CI = 1.296–1.682) and Eastern (AOR = 1.48; 95% CI = 1.289–1.695) regions significantly predicted modern contraceptive use.ConclusionModern contraceptive use in Ghana is low. Women in rural-rich categories are more likely to use modern contraceptives. Background factors such as age, marital status, educational attainment, and previous child experiences predict modern contraceptive use. It is recommended for the intensification of contraceptive awareness and utilization for all reproductive age women, regardless of education, marriage, or wealth.

Temporal trends of food insecurity in Chad, 2016–2021

IntroductionConsidering persistently high levels of poverty and food insecurity in Chad, this study examines food insecurity trends from 2016 to 2021 and identifies risk factors for food insecurity in 2020 and 2021.MethodsData from six cross-sectional Enquête Nationale sur la Securité Alimentaire (ENSA) surveys from 2016 to 2021 collected in rural areas were used. The linear regressions for food consumption score (FCS), reduced coping strategy index (rCSI), and livelihood coping strategy index (LCSI) and logistic regressions for “poor food consumption” were used to estimate the annual rate of change. Risk factor analysis was conducted with demographic, socio-economic, and pandemic-related economic indicators in univariate models, and subsequent multivariate models were used to produce adjusted odds ratios.ResultsAt a national level, there was a gradual decrease in FCS (1.16 points per year), an increase in LCSI (0.11 points), and an increase in the proportion of households with poor food consumption from 18.5% to 25.3% (1.55 percentage point) during 2016–2021; a similar trend for FCS and LCSI for worsened food insecurity was observed in the Sudanian zone. There was no significant change in rCSI during that time at the national level, but there was a reduction in the Saharan zone and an increasing trend in the Sahélian zone. Risk factors for poor food consumption in 2020–2021 included lower wealth status, a single income source, an illiterate household head, and Sahelian zone residence. The only characteristic significantly associated with increased coping mechanism use in both years was having a disabled household head.DiscussionThe results provide evidence of worsening food security in Chad in the past 6 years, both nationally and including the agricultural Sudanian zone. Food insecurity was consistently the highest in the Sahelian zone. While some risk factors for poor food consumption and diet-related coping mechanism use were consistent between 2020 and 2021, there were differences among other risk factors, likely a reflection of the impacts of the COVID-19 pandemic. A strategic shift in humanitarian and development programming is required to mitigate the rise in food insecurity at the national and regional levels, with a particular emphasis on the Sahelian zone.

Anaemia and Its Determinants among Pregnant Women Attending for Accessing Antenatal Care in Dhaka, Bangladesh

Anaemia is a major cause of maternal mortality in low- and middle-income countries and Bangladesh. The primary objective of this study was to evaluate the prevalence of anemia and its contributing factors among pregnant women in Dhaka, Bangladesh. A total of 260 pregnant women were included in this study, recruited from two healthcare facilities in Dhaka. The primary outcome of interest was the presence or absence of anaemia (yes or no). The exposure variables encompassed various characteristics related to the women, their partners, and the community. To investigate the associations between the outcome and exposure variables, multivariate logistic regression techniques were employed. The findings revealed that two-thirds of the pregnant women in the study were anemic. Notable socio-demographic determinants of anaemia included women aged between 21 and 30 years, unemployment, residing in households with lower wealth, and not taking iron supplements during the current pregnancy. Additionally, a history of previous abortions was identified as a risk factor for anaemia during pregnancy. The prevalence of anaemia among pregnant women in Bangladesh is notably high. There is a pressing need for improvements in the provision of antenatal care and other healthcare services to address this issue effectively.

Geospatial patterns of progress towards UNAIDS ‘95-95-95’ targets and community vulnerability in Zambia: insights from population-based HIV impact assessments

IntroductionIn sub-Saharan Africa, HIV/AIDS remains a leading cause of death. The UNAIDS established the ‘95-95-95’ targets to improve HIV care continuum outcomes. Using geospatial data from the Zambia Population-based HIV...

Tax wedges, financial frictions and misallocation

We revisit the classical result that in a closed economy the incidence of corporate taxes on labor is approximately zero. We consider a rich general equilibrium framework, where agents differ in the level of their wealth as well as in their managerial and working ability. Potential entrepreneurs go through all the key decisions affected by corporate tax changes: the choice of (i) occupation, (ii) organizational form, (iii) investment, and (iv) financing structure. We allow both for the presence of financial frictions and the traditional tax advantage of debt over corporate equity, which jointly generate misallocation of capital and talent. In this environment we characterize the effects of increasing corporate taxes both analytically and for a calibrated version of the model. We show that this tax increase reallocates production from C corporations to pass-through businesses. Since, due to distorted prices, the latter have higher capital-labor ratios, this reallocation generates a reduction in labor productivity and wages. Furthermore, the corporate tax increase induces some C corporations to reorganize as pass-throughs, which implies more restricted access to external funds and thus a socially inefficient downsizing of production in these firms. Finally, the tax increase causes further misallocation of talent by inducing agents with low wealth relative to their managerial talent to switch from entrepreneurship to being workers, while the reverse happens for agents with higher wealth and lower managerial skills. Overall, we find that both labor and capital bear a large share of the corporate tax incidence, while entrepreneurs are net beneficiaries of the tax change.

Digital Economy Development and Corporate Bankruptcy Risk: Based on the Perspective of Institutional Isomorphism

ABSTRACT Digital economy development gives birth to new market norms and competition rules, which push digital transformation and further form the legitimacy isomorphism effect to decrease corporate bankruptcy risk. Using a sample of Chinese listed firms from 2011 to 2019, this study investigated how digital economy development influences corporate bankruptcy risk. We observe a negative relationship between digital economy development and bankruptcy risk. This negative relationship is more pronounced in firms when the degree of digital transformation, managerial incentive and internal supervision is expected to be high.Additionally, the risk effect of digital economy is more pronounced for firms with more media coverage, lower urban wealth, industry competition, and better government governance. Our study has implications for research on the microeconomic consequences of digital economy development and the factors influencing corporate bankruptcy risk, providing empirical evidence for bankruptcy risk management in the digital economy era.

Evaluating smoking cessation interventions in China's primary care facility networks for hypertensive patients aged 45 years and older: A retrospective cohort study.

In China's aging population, hypertension, aggravated by smoking, constitutes a substantial health concern. However, the effectiveness of the national public health interventions for smoking cessation under the Essential Public Health Services remains unverified. Our aim was to examine smoking prevalence, the proportion of individuals receiving smoking cessation advice, its impact on successful cessation among Chinese hypertensive patients aged ≥45 years, and to discern disparities in the coverage and efficacy of smoking cessation interventions between primary care facilities and hospitals. Employing a longitudinal cohort approach, we examined four waves (2011-2018) of the China Health and Retirement Longitudinal Study (CHARLS). We surveyed a nationally representative cohort of hypertensive individuals, accounting for smoking status, cessation advice, healthcare preferences, and 11 pertinent covariates. Among the 4269 hypertensive patients, smokers were predominantly male, aged <65 years, with lower education and lower wealth. Smoking prevalence decreased from 25.2% in 2011 to 21.1% in 2018. The incidence of physician-provided smoking cessation advice reached a peak of 60.3% in 2015, decreasing to 54.8% in 2018. Visitors to primary care facilities reported the highest rate of advice reception. While patients receiving advice exhibited a higher smoking prevalence, instrumental variable regression and subgroup analyses found no significant correlation between advice receipt and successful cessation. We observed a substantial smoking prevalence among older hypertensive Chinese individuals and limited effectiveness of existing cessation programs. This underscores the necessity for augmenting primary care and devising a comprehensive health policy for more successful smoking cessation interventions, particularly considering China's rapidly aging population.

Sociodemographic factors associated with concurrent stunting and wasting among children experiencing extreme poverty in the Philippines: A cross-sectional study.

Background: The coexistence of stunting and wasting in a child increases the risk of mortality and requires more intensive treatment and care. However, there is limited research on the burden of concurrent stunting and wasting among children and the socioeconomic factors that are correlated with having both conditions. Aim: To understand the prevalence and sociodemographic correlates of stunting, wasting, and concurrent stunting and wasting among a sample of children ages 6-144 months experiencing poverty in the Philippines. Methods: Cross-sectional data were drawn from nutrition screening and sociodemographic surveys conducted by International Care Ministries in 2018-2019. Descriptive statistics were calculated to determine the prevalence of stunting, wasting, and concurrent stunting and wasting. Multilevel logistic regression modelling was conducted to understand the sociodemographic factors that were associated with stunting and wasting. Results: Among the 3005 children in this sample, the prevalence of stunting, wasting, and concurrent stunting and wasting was 49.9%, 9.3%, and 4.6%, respectively. Children experiencing concurrent stunting and wasting lived in households in lower wealth index quintiles, had a household head with fewer years of education, and were more likely to experience food insecurity compared to children who were not stunted or wasted. The education of the household head, the number of household members, and the wealth of the household were correlated with stunting across age groups, while food insecurity was correlated with wasting among younger children. Conclusion: The presence of concurrent stunting and wasting among children provides the impetus to integrate both conditions into nutrition monitoring, prevention, and treatment interventions.

The combined effect of socioeconomic position and C-reactive protein for predicting incident cardiometabolic disease: Findings from a 14-year follow-up study of the English Longitudinal Study of Ageing (ELSA)

Cardiovascular disease and diabetes are leading causes of morbidity and mortality worldwide. Social inequalities in the distribution of these diseases across the population exist. The aim of the current study was to examine the additive effect of socioeconomic position and a known biological risk marker (C-reactive protein [CRP]) for future incident cardiometabolic disease. We used data from the English Longitudinal Study of Ageing (N = 5410). Tertiles of net financial wealth and CRP (>3 mg/L) were measured at wave 2 (2004/05) and disease incidence (coronary heart disease [CHD], stroke, diabetes/high blood glucose) was reported across the subsequent 14 years of follow-up (2006–2019). Individual diseases were modelled as well as cardiometabolic multimorbidity which was defined as 2 or more incident cardiometabolic disease diagnoses over follow-up. Participants were free from the disease of interest at baseline. Cox proportional hazard and logistic regression analyses were used controlling for sociodemographic, lifestyle and health-related covariates. After adjusting for all covariates, the combination of low wealth and elevated CRP was an independent predictor of incident diabetes/high blood glucose (Hazard Ratio (HR) = 2.14; 95% Confidence Interval (C.I.) = 1.49–3.07), CHD (HR = 2.48, 95% C.I. = 1.63–3.76), stroke (HR = 1.55; 95% C.I. = 1.18–2.04), relative to high wealth/low CRP. Low wealth and elevated CRP was also an independent predictor of incident cardiometabolic multimorbidity (Odds Ratio = 2.22, 95% C.I. = 1.16–4.28) in age and sex adjusted models. The presence of both low wealth and elevated CRP was implicated in the onset of CHD, stroke, diabetes/high blood glucose, and cardiometabolic multimorbidity up to 14 years later, reflecting the role of psychobiological processes in predicting disease burden. Our results reinforce calls for efforts to tackle structural inequalities to improve healthy ageing trajectories.

The association between wealth and sleep medication use in a nationally-representative sample of older Medicare beneficiaries.

Sleep disorders are common among older adults, leading to high prevalence of over-the-counter and prescription sleep medication use. Socioeconomically disadvantaged individuals have higher prevalence of sleep disorders. Frequent use of sleep medications can increase the risk of falls. Little is known about the association between wealth and sleep medication use in older adults. We conducted a cross-sectional analysis using a nationwide sample of 7603 Medicare beneficiaries (65+ years) from Round 1 (2011) of the National Health and Aging Trends Study. We measured self-reported wealth as the sum of assets (retirement savings, stocks/bonds, checking/savings accounts, business assets, and home value) minus liabilities (mortgage, credit card, and medical debt). Self-reported sleep medication use in the past month was categorized as frequent (5-7 nights/week), sometimes (1-4 nights/week), or never (0 night/week). We estimated differences in the prevalence of sleep medication use by quintiles of wealth using crude and adjusted binomial regression models. Individuals missing sleep medication information were excluded. Median wealth was $152 582 (IQR: $24 023-412 992). Sixteen percent reported frequent sleep medication use, 15% reported some use, and 70% reported no use. Frequent sleep medication use was more common in lower wealth quintiles (lowest: 20%, highest: 12%). Alternatively, some use was more common in higher wealth quintiles (lowest: 11%, highest: 18%). Results were similar after adjustment for demographic factors, anxiety, depression, and sleep disorders. In this study, less wealthy older adults had higher prevalence of frequent sleep medication use. This may lead to dependency or increased fall risk in this vulnerable population.

Cloth sharing with a scabies case considerably explains human scabies among children in a low socioeconomic rural community of Ethiopia

BackgroundIn 2020, scabies were integrated into the WHO roadmap for neglected tropical diseases, aimed at ending the negligence to realize the SDGs. Ethiopia has also introduced scabies as a notifiable disease in drought-prone localities since 2015. Many of the previous studies employed study designs that might be subject to bias. Moreover, there is no scientific evidence about scabies in this area. Hence, this study aimed to determine the prevalence and associated factors of scabies among children aged below 15 years in rural Ethiopia.MethodsA community-based cross-sectional study was carried out among 942 children in rural kebeles of Lay Gayent District from March through May 15, 2021. A two-stage sampling technique was applied. Data on sociodemographics, housing, water supply and sanitation, children’s personal hygiene, and caregivers’ knowledge about scabies were collected by a structured questionnaire. Data quality was maintained through pretesting, training of data collectors and supervisors, and supervision. An adjusted binary logistic regression was modelled to identify factors associated with scabies. The Hosmer–Lemeshow goodness-of-fit test was run to check the model fitness.ResultsThe prevalence of scabies was 21.5% (95% CI 19.0–24.3). Maternal illiteracy (adjusted odds ratio (AOR) = 1.61; 95% CI 1.07–2.43); low household wealth (AOR = 2.04; 95% CI 1.25–3.33); unimproved water source (AOR = 1.58; 95% CI 1.05–2.40); not cleaning a house daily (AOR = 2.43; 95% CI 1.63–3.62); not trimming nails (AOR = 2.21; 95% CI 1.50–3.25); cloth sharing with a scabies case (AOR = 11.77; 95% CI 6.94–19.97); and low caregiver knowledge about scabies (AOR = 2.44; 95% CI 1.64–3.63) were factors associated with scabies.ConclusionsScabies remains a significant public health issue among children aged below 15 years in the district. Maternal illiteracy, low household wealth, unimproved water source, not cleaning a house daily, not trimming nails, cloth sharing with a scabies case, and low caregiver knowledge about scabies were factors associated with scabies. Community-wide interventions with prime emphasis on improving maternal education and caregivers’ knowledge about scabies, upgrading household wealth, ensuring a safe water supply, providing healthy housing, and ensuring adequate personal hygiene are warranted.

Digital finance and financial literacy: Evidence from Chinese households

We measure financial literacy and study its impact on household use of digital finance using the 2015 and 2017 China Household Finance Survey. We find that financial literacy significantly boosts the use of digital finance, including mobile payments, online borrowing, and online financial products. This effect is more pronounced for online borrowing and online financial products than for mobile payments. This result suggests that the impact of financial literacy increases with the complexity of digital finance. Furthermore, financial literacy plays a more important role in promoting the use of digital financial services among disadvantaged groups, such as families with low income and wealth, the elderly, and residents in rural areas, compared with their counterparts.

Adult mortality trends in Matlab, Bangladesh: an analysis of cause-specific risks

ObjectiveWith socioeconomic development, improvement in preventing and curing infectious diseases, and increased exposure to non-communicable diseases (NCDs) risk factors (eg, overweight/obesity, sedentary lifestyle), the majority of adult deaths in Bangladesh...

Magnitude and Factors Associated with Teenage Pregnancy in Somaliland: Evidence from Somaliland Health and Demographic Survey, 2020.

Teenage pregnancy is estimated to be common in Somaliland. It is linked with adverse perinatal outcomes. However, no study has been conducted in the country on this subject. Therefore, this study intended to assess the magnitude and factors associated with teenage pregnancy in Somaliland. Data from the 2020 Somaliland Health and Demographic Survey (SLHDS); were used in the current analysis. A total sample of 3,786 women in reproductive age groups were involved as participants. The survey used a two-level cluster sampling design, which included initial selection of enumeration areas followed by selection of households. To identify associated factors, binary logistic regression analysis was applied. The magnitude of teenage pregnancy was 47.2% (95%CI: 45.5-48.9%). Being a nomadic resident (AOR: 1.26; 95%CI: 1.12-1.71), being in the lowest wealth quintiles (AOR: 1.34; 95%CI: 1.01-1.77), being in the Sanaag region (AOR: 1.95;95%CI: 1.54-2.46) and having lower educational attainment (AOR: 2.29; 95%CI: 1.08-4.83) were significantly associated with teenage pregnancy. Teenage pregnancy is highly prevalent in Somaliland and associated with a lower educational level, lower wealth quintiles and nomadic residence. Hence, governmental and non-governmental organizations should work on educating and financially empowering women by giving particular focus to nomadic people.