Lowest Wealth Quintile Research Articles

Factors explaining the dominion status of female sterilization in India over the past two decades (1992-2016): A multilevel study.

BackgroundFemale sterilization is a permanent method of contraception practiced widely in India. Though, the important evidences of behavior of contraceptives is widespread in the literature, relatively less research has been conducted that explores particularly female sterilization method and how its behavior has remained dominant over the past two decades. The present study aims to examine how the level of women’s socio-demographic and fertility related characteristics intersect to shape the behavior for the dominance of female sterilization.MethodsThis study was based on pooled data from 1992–93, 1998–99, 2005–06 and 2015–16 India’s DHS (NFHS) surveys. The outcome variable of the study was different types of contraceptive methods used. Multinomial logistic model has been applied to examine the relationship between the dependent variable and the explanatory variables. The software STATA version14 has been used for the entire analysis.ResultThe result of this study clearly demonstrates the evidence of continuing sterilization dominance in the India’s family planning program. The choice of different types of contraceptive methods is influenced by the longstanding heterogeneity of population associated with religion and the caste system. Reliance over female sterilization was observed in almost all parts of the country with southern India being the leading zone. Women in the lowest wealth quintile, uneducated, higher parity, and less exposed to media were more likely to use sterilization as a method of birth control.ConclusionThe study was successful in identifying the factors behind the excessive dependency on female sterilization and also highlights the weakness of family planning program to promote other useful modern methods over the past two decades.

Knowledge and Beliefs on Osteoporosis among African Postmenopausal Women in a Kenyan Semi-Rural County of Kiambu

BackgroundAssessing people’s knowledge and beliefs about osteoporosis is fundamental to the formulation of preventive strategies for this condition. To our knowledge, no randomized community survey has been conducted using Facts on Osteoporosis Quiz (FOOQ) and Osteoporosis Health Belief Scale (OHBS) exclusively in the postmenopausal women in Kenya. This study aimed to assess postmenopausal women’s knowledge and beliefs concerning osteoporosis in semirural Kiambu County, Kenya.MethodsA cross-sectional study involving face-to-face interviews with 254 African postmenopausal women was conducted between October 2017 and February 2018. The questionnaire explored the socio-demographic characteristics; FOOQ was used to evaluate the knowledge these women had about osteoporosis, while OHBS was used to assess their beliefs.ResultsThe mean age of the participants was 64.6±10.7 years. About 26.4% (67/254) of the participants had no formal education, while 3.1% (8/254) were in formal employment. About 54.3% (138/254) of the women were married, and 51.2% (130/254) were in the lowest and lower wealth quintile. FOOQ had a mean score of 8.6 (standard deviation±1.8; range, 0–17). OHBS revealed a low level of perceived susceptibility to osteoporosis. Perceived benefits of exercising and calcium intake as well as perceived seriousness of osteoporosis as a disease were at moderate levels. The level of health motivation was also moderate.ConclusionsThe women in this study demonstrated limited knowledge about osteoporosis. The low susceptibility score makes the prevention and treatment of osteoporosis in this population challenging. We recommend public health education for all postmenopausal women in this setting.

Geostatistical modeling of malaria prevalence among under-five children in Rwanda

BackgroundMalaria has continued to be a life-threatening disease among under-five children in sub-Saharan Africa. Recent data indicate rising cases in Rwanda after some years of decline. We aimed at estimating the spatial variations in malaria prevalence at a continuous spatial scale and to quantify locations where the prevalence exceeds the thresholds of 5% and 10% across the country. We also consider the effects of some socioeconomic and climate variables.MethodsUsing data from the 2014-2015 Rwanda Demographic and Health Survey, a geostatistical modeling technique based on stochastic partial differential equation approach was used to analyze the geospatial prevalence of malaria among under-five children in Rwanda. Bayesian inference was based on integrated nested Laplace approximation.ResultsThe results demonstrate the uneven spatial variation of malaria prevalence with some districts including Kayonza and Kirehe from Eastern province; Huye and Nyanza from Southern province; and Nyamasheke and Rusizi from Western province having higher chances of recording prevalence exceeding 5%. Malaria prevalence was found to increase with rising temperature but decreases with increasing volume for rainfall. The findings also revealed a significant association between malaria and demographic factors including place of residence, mother’s educational level, and child’s age and sex.ConclusionsPotential intervention programs that focus on individuals living in rural areas, lowest wealth quintile, and the locations with high risks should be reinforced. Variations in climatic factors particularly temperature and rainfall should be taken into account when formulating malaria intervention programs in Rwanda.

Household factors and under-five mortality in Bankass, Mali: results from a cross-sectional survey

BackgroundRural parts of Mali carry a disproportionate burden of the country’s high under-five mortality rate. A range of household factors are associated with poor under-five health in resource-limited settings. However, it is unknown which most influence the under-five mortality rate in rural Mali. We aimed to describe household factors associated with under-five mortality in Bankass, a remote region in central Mali.MethodsWe analysed baseline household survey data from a trial being conducted in Bankass. The survey was administered to households between December 2016 and January 2017. Under-five deaths in the five years prior to baseline were documented along with detailed information on household factors and women’s birth histories. Factors associated with under-five mortality were analysed using Cox regression.ResultsOur study population comprised of 17,408 under-five children from 8322 households. In the five years prior to baseline, the under-five mortality rate was 152.6 per 1000 live births (158.8 and 146.0 per 1000 live births for males and females, respectively). Living a greater distance from a primary health center was associated with a higher probability of under-five mortality for both males (adjusted hazard ratio [aHR] 1.53 for ≥10 km versus < 2 km, 95% confidence interval [CI] 1.25–1.88) and females (aHR 1.59 for ≥10 km versus < 2 km, 95% CI 1.27–1.99). Under-five male mortality was additionally associated with lower household wealth quintile (aHR 1.47 for poorest versus wealthiest, 95%CI 1.21–1.78), lower reading ability among women of reproductive age in the household (aHR 1.73 for cannot read versus can read, 95%CI 1.04–2.86), and living in a household with access to electricity (aHR 1.16 for access versus no access, 95%CI 1.00–1.34).ConclusionsU5 mortality is very high in Bankass and is associated with living a greater distance from healthcare and several other household factors that may be amenable to intervention or facilitate program targeting.

Vulnerability to HIV infection among adolescent girls and young women in Nigeria

ABSTRACT Adolescent girls and young women (AGYW) account for a disproportionate number of new HIV infections among young people living with HIV. This study identified factors associated with the vulnerability of AGYW to HIV infection in Nigeria. We conducted a cross-sectional survey of AGYW aged 15–24 years in three states (Akwa-Ibom, Kaduna, and Oyo) and the Federal Capital Territory (FCT) Abuja in Nigeria. We collected information on sociodemographic characteristics, risky sexual behaviors, practices, attitudes, perceptions of HIV, and related socio-cultural experiences from 4320 respondents. We identified twelve vulnerability factors and used a modified Delphi technique to assign relative weights to each. Composite vulnerability score was calculated by adding the weighted scores on all factors for each respondent and dichotomized using k-median analysis. Higher scores corresponded to higher vulnerability to acquiring HIV. More than 43% had a high vulnerability to HIV infection. Being older, of lower educational status, married, in a lower wealth quintile, and having low self-esteem were statistically significantly associated with being more vulnerable to acquiring HIV. Being knowledgeable about HIV prevention was protective but not statistically significant. We conclude that sociodemographic characteristics and self-esteem are important determinants of vulnerability to acquiring HIV among young women in Nigeria. Interventions targeted to reduce vulnerability to HIV among young women must address social-demographic and psychological risk factors.

Analysing the expenditure on childbearing: a community-based cross-sectional study in rural areas of Punjab (India)

BackgroundA vast array of literature has established that high maternity expenditure precludes women from accessing health services. Further, this maternity expenditure takes catastrophic form, forcing individuals or households to significantly lower their standard of living now or at some time in future. The present study analyses expenditure on childbearing in rural areas of one of the richest and top performer states on health parameters in India, namely Punjab along with examining the determinants of catastrophic expenditure. It also attempts to examine the implementation of Janani Shishu Suraksha Karyakaram (JSSK) which entitles pregnant women to free maternity services in public health facilities.MethodsA cross-sectional study was conducted in rural areas of Punjab involving 420 recently delivered women, who were questioned about their socio-economic attributes and expenditure incurred in the process of childbearing using face to face, semi-structured interviews. Employing logistic regression, an attempt has been made to understand the determinants of catastrophic maternity expenditure, i.e., expenditure exceeding 10% of annual household income.ResultsOf the 420 respondents surveyed, 96.7% reported bearing expenditure on childbearing, irrespective of the type of health facility used and 25% respondents spent catastrophically. On an average, respondents have spent US$62.87 on antenatal care, US$112.86 on delivery and US$6.55 on postnatal care. The results of multivariable analysis reveal that respondents belonging to general category (non reserve category), lower wealth quintiles and using private health facilities have higher odds of incurring catastrophic expenditure. At the same time, poor quality of care at government hospitals and inability of public health staff to provide timely treatment are the driving forces for utilizing private health facilities. Even in the presence of free maternity scheme at government hospitals, respondents on an average spent US$55.22 on availing maternity services.ConclusionThe study shows that risk of bearing catastrophic expenditure and being pushed down to abject poverty is higher for respondents who are already at the bottom of wealth quintiles. The policy imperative has to swing towards upgrading the creaky health infrastructure and addressing the issues of poor accountability and corruption at government hospitals, along with thwarting unregulated expansion of private health sector.

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.

Effective coverage of nutrition interventions across the continuum of care in Bangladesh: insights from nationwide cross-sectional household and health facility surveys

IntroductionImproving the impact of nutrition interventions requires adequate measurement of both reach and quality of interventions, but limited evidence exists on advancing coverage measurement. We adjusted contact-based coverage estimates, taking...

What explains the gender gap in wealth? Evidence from administrative data

This paper studies the gender gap in net wealth. We use administrative data on wealth that are linked to the Estonian Household Finance and Consumption Survey, which provides individual-level wealth data for all household types. The unconditional gender gap in mean wealth is 45%, but this sizeable gap in means originates mainly from the top tail of the distribution, where men have much more wealth than women, while the gender differences in wealth are statistically insignificant in most of the lower wealth quintiles. At the top of the distribution the differences in wealth can be explained by larger self-employment activity of men. Men have more business wealth than women do, and the gender wealth gap is the largest for this asset class. The gender wealth gaps across different household types are very heterogeneous. The unconditional gaps in wealth are strongly in favour of men throughout most of the wealth distribution for married couples. For single-member households, on the other hand, the raw gaps are in favour of women in the lower half of the wealth distribution. These raw gaps in opposite directions can mostly be explained by differences in the observed characteristics of men and women among married couples vs single people.

Is Volunteering an Equalizer? A Quasi-Experimental Study Using Propensity Score Analysis

Formal volunteering in later life has been extolled as beneficial for both physical and mental health. However, research points to potential selection bias, in that older adults with key advantages, such as higher wealth, are more likely to volunteer and reap its benefits. As such, we test two competing propositions: Volunteering may act as an equalizer if it benefits the health of the least wealthy the most, or it may further exacerbate disparities if it benefits the health of the wealthiest the most. To that end, we analyzed data from the 2012 and 2014 waves of the Health and Retirement Study (N≈15,000). First, we used relevant covariates (e.g., sociodemographic characteristics, informal volunteering, and health) in 2012 to predict volunteering in 2014, developing the propensity score weights from these results. We then performed several regression analyses to assess the influence of volunteering on self-reported health and depressive symptoms among the general population (ATE) and volunteers themselves (ATT), while comparing the findings for the highest and lowest wealth quintiles. We found that volunteering enhanced self-reported health and reduced depressive symptoms. Further, those in the highest quintile experienced significantly fewer depressive symptoms from volunteering while those in the lowest quintile did not, albeit with no significant differences between the two coefficients. The study enhances the nuanced understanding of volunteering and health while suggesting that unmeasured factors felt strongest among the least wealthy—such as financial distress, discrimination, or lack of organizational support—may attenuate the benefits of voluntary activity.

Later-Life Health Disparities in Nepal: Intersection of Gender and Socioeconomic Status

This study focuses on Nepal, a country still undergoing capitalist expansion, to examine intersectional effects of fundamental causes on later life health outcomes. Sandwiched between the republic of China and India, Nepal still has remnants of pre-capitalist social and economic formations. Despite growing focus on independent effects of SES and gender on health, the intersectional influences of such fundamental causes on later life health in Nepal has, however, been largely unexplored. Drawing from the World Health Survey (WHS) survey data (n=2,250 aged 50 years and older), we rely on negative binomial regression models to examine whether the effect of education and household wealth on chronic diseases and functional limitations differs between men and women. Findings indicate intersectional effects of gender, wealth, and education on health. Women do not incur health benefits from education and wealth. Statistically significant negative effect of education on functional limitations (OR=0.87, p<0.01) was documented only for men. Contrary to our theoretical expectations, we observed significantly higher count of chronic diseases among women (OR=1.13, p<0.01) with higher levels of education relative to lower educated women. Similarly, men in higher wealth quintiles reported significantly higher count of chronic diseases (OR=1.05, p<0.01) than their counterparts in lower wealth quintiles. Our study paves a way for future research on a range of structural mechanisms such as gendered labor market, patriarchal cultural expectations, and inequities in health care that could mediate intersectional effects of gender and education on later life health disparities in the Global South.

Basic maternal health care coverage among adolescents in 22 sub-Saharan African countries with high adolescent birth rate.

BackgroundIn the sub-Saharan Africa region, the adolescent birth rate is the highest in the world, estimated at 100.5 births per 1000 women aged 15 to 19 years, and 2.4 times greater than the global average. This analysis examines coverage levels and gaps in basic maternal health care for adolescent mothers living in this region.MethodsWe used data from national Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) conducted between 2010 and 2016 in 22 of the sub-Saharan African Countdown to 2030 priority countries with adolescent birth rates above 100 in 2016. We analyzed 11 indicators of coverage of key services provided during the pre-pregnancy, pregnancy, delivery and postnatal period. We described the coverage level among adolescent girls aged 15-19 and women aged 20-49 for basic indicators in the continuum of care. We conducted a multilevel random effect logistic regression to quantify the association between the receipt of basic package of maternal care and woman’s socio-demographic and socio-economic characteristics.ResultsThe median coverage of the basic package of maternal care among adolescents was extremely low, at 9.3%. Adolescent mothers who were in the highest household wealth quintile (odds ratio OR = 2.44, 95% confidence interval (CI) = 2.23-2.68), living in an urban area (OR = 1.25, 95% CI = 1.18-1.33) and having secondary education (OR = 1.61, 95% CI = 1.50-1.73) had greater odds of receiving the basic package of maternal health care as compared to those in the lowest wealth quintile, living in rural areas, and with no education respectively. Adolescent girls aged 15-17 and 18-19 had respectively 26% (OR = 0.74, 95% CI = 0.67-0.82) and 9% (OR = 0.91, 95% CI = 0.84-0.98) lower odds of receiving the basic package compared to women 20-49 years old. Child brides had 12% (OR = 0.88, 95% CI = 0.84-0.93) lower odds of receiving the basic package compared to women who were married after the age of 18.ConclusionCoverage of basic maternal health care for adolescent mothers is inadequate in the countries with the highest adolescent birth rates in the world. Addressing the reproductive and maternal health needs of adolescents in sub-Saharan Africa is of critical importance, especially given projections that this region will experience the highest increases in adolescent births in the coming decades.

Country compliance with WHO-recommended antenatal care guidelines: equity analysis of the 2015–2016 Demography and Health Survey in Myanmar

IntroductionEarly access to adequate antenatal care (ANC) from skilled providers is crucial for detecting and preventing obstetric complications of pregnancy. We aimed to assess factors associated with the utilisation of...

The Social Stratification of Availability, Affordability, and Consumption of Food in Families with Preschoolers in Addis Ababa; The EAT Addis Study in Ethiopia.

The aim of this study was to understand the quality of diet being consumed among families in Addis Ababa, and to what extent social stratification and perceptions of availability and affordability affect healthy food consumption. Data were collected from 5467 households in a face-to-face interview with mothers/caretakers and analyzed using mixed effect logistic regression models. All family food groups, except fish were perceived to be available by more than 90% of the participants. The food groups cereals/nuts/seeds, other vegetables, and legumes were considered highly affordable (80%) and were the most consumed (>75%). Households with the least educated mothers and those in the lowest wealth quintile had the lowest perception of affordability and also consumption. Consumption of foods rich in micronutrients and animal sources were significantly higher among households with higher perceived affordability, the highest wealth quintile, and with mothers who had better education. Households in Addis Ababa were generally seen to have a monotonous diet, despite the high perceived availability of different food groups within the food environment. There is a considerable difference in consumption of nutrient-rich foods across social strata, hence the cities food policies need to account for social differences in order to improve the nutritional status of the community.

What factors are associated with the increase of anemia in Ethiopian children aged 6 to 59\u2009months between 2011 and 2016?

BackgroundIn Ethiopia more than half of the children under 5 years are anemic and between 2011 and 2016 anemia in children under-5 increased by 28.7%. This study aimed to analyze this increase in anemia by socio-demographic characteristics.MethodThis study was a secondary analysis of the data from the Ethiopian Demographic Health Surveys (EDHS) for 2011 and 2016. The increase of anemia was calculated using percentage change. The chi-square test was used to determine the association between anemia and six predictor variables of age, sex, mother’s educational level, residence, wealth quintile and region. The strength of association was measured using Cramer’s V.ResultsAnemia increased in all age groups, both sexes, urban and rural residencies, across all wealth quintiles, all maternal education levels and all regions of Ethiopia except Benishangul Gumuz. The highest increase of anemia was seen among children born to mothers with above secondary education (65.8%), living in urban areas (40.1%), in the lowest wealth quintile (41.5%), and children from Tigray region (42.9%). Severe anemia increased in all age categories except in infants aged 9–11 months. Children of mothers with above secondary educational level had the highest increase of mild and moderate anemia. Severe anemia decreased in the second and middle wealth quintiles whereas it increased in the rest quintiles. Benishangul Gumuz is the only region where mild, moderate, and severe anemia decreased. Pearson’s chi-square (χ2) test showed that all the predictor variables except sex were significantly associated with anemia. Although highly significant (p < 0.001) using the chi-square test, Cramer’s V showed that residence (V = 0.052–0.066) and maternal education (V = 0.041–0.044) were only weakly associated with anemia.ConclusionAnemia in children under-5 continues to be a severe public health problem in Ethiopia. Benishangul Gumuz region is the only region that was able to reduce the prevalence of all forms of anemia under-5 between 2011 and 2016, consequently other regions of Ethiopia could learn from this experience. The high increase of anemia in children born to mothers with above secondary education and highest wealth quintiles points to poor dietary practices, therefore, community based nutrition education for mothers needs to be strengthened.

Equity lessons from a large scale private-sector healthcare intervention in Ghana and Kenya: Results for a multi-year qualitative study

Background: The poor fall sick more frequently than the wealthy, and are less likely to seek care when they do. Private provision in many Low- and Middle-Income Countries makes up half or more of all outpatient care, including among poor paitents. Understanding the preferences of poor patients which impel them to choose private providers, and how 3 rd party payment influences these preferences, is important for policy makers considering expansion of national health insurance financing to advance Universal Health Coverage. This paper reports on the results of a qualitative evaluation of the African Health Markets for Equity intiative (AHME), a multi-year initiative in Ghana and Kenya to increase options and improve quality for outpatient services, especially for the poor. Methods: Interviews with patients from private clinics were conducted annually between 2013 and 2018. Field staff recruited women for exit interviews as they were leaving these clinics. In the final round of data collection (2018), interviewers screened patients for wealth quintile and selected one third of the sample (approximately 10 patients per country) that fell into the two lowest wealth quintiles (Q1 and Q2). Transcripts were coded using Atlas.ti and coded for analysis using an inductive, thematic approach. Results: We found four primary drivers of patient preferences for private clinics: convenience; efficiency and predictability, perceived higher quality, and empowerment which was derived from greater choice in where to go. Conclusions: Our findings indicate that more options will lead to more opportunities for treatment, and decrease the percentage of those, mostly poor, who become ill and go without care of any kind. This should be considered as a priority by policy makers seeking to make the best use of existing national infrastructure and expertise to assure equal health for all. In this way, private providers offer an opportunity to advance national goals.

Equity lessons from a large scale private-sector healthcare intervention in Ghana and Kenya: Results for a multi-year qualitative study.

Background: The poor fall sick more frequently than the wealthy, and are less likely to seek care when they do. Private provision in many Low- and Middle-Income Countries makes up half or more of all outpatient care, including among poor paitents. Understanding the preferences of poor patients which impel them to choose private providers, and how 3 rd party payment influences these preferences, is important for policy makers considering expansion of national health insurance financing to advance Universal Health Coverage. This paper reports on the results of a qualitative evaluation of the African Health Markets for Equity intiative (AHME), a multi-year initiative in Ghana and Kenya to increase options and improve quality for outpatient services, especially for the poor. Methods: Interviews with patients from private clinics were conducted annually between 2013 and 2018. Field staff recruited women for exit interviews as they were leaving these clinics. In the final round of data collection (2018), interviewers screened patients for wealth quintile and selected one third of the sample (approximately 10 patients per country) that fell into the two lowest wealth quintiles (Q1 and Q2). Transcripts were coded using Atlas.ti and coded for analysis using an inductive, thematic approach. Results: We found four primary drivers of patient preferences for private clinics: convenience; efficiency and predictability, perceived higher quality, and empowerment which was derived from greater choice in where to go. Conclusions: Our findings indicate that more options will lead to more opportunities for treatment, and decrease the percentage of those, mostly poor, who become ill and go without care of any kind. This should be considered as a priority by policy makers seeking to make the best use of existing national infrastructure and expertise to assure equal health for all. In this way, private providers offer an opportunity to advance national goals.

Drivers of stunting reduction in Peru: a country case study

ABSTRACTBackgroundPeru reduced its under-5 child stunting prevalence notably from 31.3% in 2000 to 13.1% in 2016.ObjectivesWe aimed to study factors and key enablers of child stunting reduction in Peru from 2000–2016.MethodsDemographic and Health Surveys were used to conduct descriptive analyses [height-for-age z scores (HAZ) means and distributions, equity analysis, predicted child growth curves through polynomial regressions] and advanced regression analyses. An ecological (at department level) multilevel regression analysis was conducted to identify the major predictors of stunting decline from 2000 to 2016, and Oaxaca–Blinder decomposition was conducted to identify the relative contribution of each factor to child HAZ change. A systematic literature review, policy and program analysis, and interviews with relevant stakeholders were conducted to understand key drivers of stunting decline in Peru.ResultsThe distribution of HAZ scores showed a slight rightward shift from 2000 to 2007/2008, and a greater shift from 2007/2008 to 2016. Stunting reduction was higher in the lowest wealth quintile, in rural areas, and among children with the least educated mothers. Decomposing predicted changes showed that the most important factors were increased maternal BMI and maternal height, improved maternal and newborn health care, increased parental education, migration to urban areas, and reduced fertility. Key drivers included the advocacy role of civil society and political leadership around poverty and stunting reduction since the early 2000s. Key enablers included the economic growth and the consolidation of democracy since the early 2000s, and the acknowledgement that stunting reduction needs much more than food supplementation.ConclusionsPeru reduced child stunting owing to improved socioeconomic determinants, sustained implementation of out-of-health-sector and within-health-sector changes, and implementation of health interventions. These efforts were driven through a multisectoral approach, strong civil society advocacy, and keen political leadership. Peru's experience offers useful lessons on how to tackle the problem of stunting under differing scenarios, with the participation of multiple sectors.

Prevalence and Predictors of Adverse Childhood Experiences among Youths in Rural communities of Oyo State, South-west, Nigeria

Background: Adverse Childhood Experiences (ACEs) are traumatic events a child is exposed to early in life. It is a global problem that constitutes a public health concern. However, few studies have been conducted on ACEs in low- and middle-income countries (LMICs) like Nigeria. This study assessed the prevalence and predictors of ACEs among youths in rural communities in Oyo State, South-west, Nigeria.Methods: A cross-sectional survey was conducted among 575 youths selected by multistage sampling technique. A structured interviewer-administered questionnaire was used to obtain information on exposure to ACEs; abuse, neglect and household dysfunctions among respondents. Data were analyzed with SPSS version 21.0. Associations were explored with chi-square test and logistics regression analysis. Level of significance was set at 5%.Results: The mean age (SD) of respondents was 26.3 (4.9) years. Three hundred and forty-two (59.5%) respondents were males, 252 (43.8%) had secondary education and 276 (24.5%) were classified into the lowest wealth quintiles. Most respondents 529 (92%) reported they had experienced ACEs. Most prevalent ACEs were psychological neglect 247 (42.9%), physical neglect 236 (41.0%), psychological abuse 231 (40.2%) and household substance abuse 223 (38.8%). The predictors of experiencing ACEs were having a mother with primary education and below (AOR=2.61; CI=1.383.51) and being in the lowest wealth quintile (AOR=1.53 CI=1.24-2.87).Conclusion: Poor education and poverty contributed to the high occurrence of ACEs among youths in rural south-west. Strategic interventions by government/organizations to improve parental education and ameliorate poverty may be beneficial in reducing ACEs and ensure optimal child development.&#x0D; Keywords: Adverse childhood experiences; Predictors; Youths; Rural; Nigeria