Lower Wealth Research Articles

The prevalence, types, and risk factors of urinary incontinence among Bangladeshi women aged 15-49: A study based on a nationally representative survey.

To estimate the prevalence of urinary incontinence (UI), its subtypes, and the associated risk factors in women of reproductive age in Bangladesh. Data from the 2016 Bangladesh Maternal Mortality and Health Care Survey was analyzed in a nationally representative sample of 298 284 households that used a multistage sample selection procedure. Data on 183 560 ever-married women aged 15-49 years who had ever given birth were analyzed. Descriptive statistics was used to report the overall prevalence of any UI and its three subtypes: stress, urge, and mixed UI. The wealth index of each household was constructed using principal component analysis. Univariable and multivariable binary logistic regression analyses were conducted to identify the factors associated with each type of UI. The prevalence of any UI was 15.9% (95% confidence interval [CI]:15.7-16.1). Stress incontinence was the most prevalent UI (8.3%, 95% CI: 8.2-8.4), followed by mixed type (5.5%, 95% CI: 5.4-5.6), and urge incontinence (2.1%, 95% CI: 2.1-2.2). In multivariate logistic regression analysis, older age, no or less education, younger age at first birth, higher parity, lower wealth status, self-reported pelvic organ prolapse (POP), and being Muslim had a significant positive association with the presence of UI. About one in six women reported to have suffered from any type of UI in this study. Several common risk factors were found, which call for targeted policy and programmatic interventions.

Health-related behaviours and depression incidence amongst UK adults aged 50+: Evidence from the English Longitudinal Study of Ageing

Abstract Aim Physical activity (PA), and dietary fruit and vegetable intake, are important lifestyle variables that reduce risk of serious illness and mortality. Nevertheless, many older adults do not achieve government recommendations for these, which has adverse long-term impact on their health outcomes. Further, depression is common in those aged 50+, which impacts severely on quality of life and again raises risk of serious age-related disorders (e.g. Alzheimer’s disease). Here, we analyse data from the ELSA cohort study to provide up-to-date insights into the health-related behaviours and mental health status of UK adults aged 50–90. Subject and methods We used the most recent ELSA wave (Wave 10: 2021–2023). Regression models examined how sociodemographic factors influenced likelihood of meeting government PA and dietary fruit and vegetable recommendations. Then, we examined depression incidence and how PA/diet, as well as sociodemographic factors, are associated with depression. Results On PA guidance adherence, there were large disparities by wealth and education level. Higher age, current smoking, and low alcohol intake were also associated with lower adherence. Regarding dietary fruit and vegetable intake, increasing age, female sex, higher level of wealth and education, and non-smoking was associated with a higher likelihood of meeting guidelines. Depression was more common amongst females, those living alone, smokers, and those with lower wealth and education. Importantly, both PA and dietary adherence had significant beneficial effects on depression status. Conclusion This study provides crucial up-to-date insights, that can inform targeted interventions and public information campaigns to enhance the health of older adults; specifically, it points to the importance of promoting PA and dietary fruit and vegetable intake amongst lower wealth brackets.

Assessing the role of education level on climate change belief, concern and action: a multinational survey of healthcare professionals in nephrology.

Climate change poses a significant risk to kidney health, and countries with lower national wealth are more vulnerable. Yet, citizens from lower-income countries demonstrate less concern for climate change than those from higher-income countries. Education is a key covariate. To examine its role in explaining this perception gap, we obtained the perspectives of a highly educated cohort of healthcare professionals. This was a cross-sectional survey of healthcare professionals involved in kidney care. Responses were compared by the income level of the participant's country (per World Bank). Of the 849 healthcare professionals from 107 countries (63.4% from lower and middle-income countries) that participated, most believed climate change was happening (97.9%), displayed a high level of concern (73.3%), and took personal action to combat climate change (62.0%). While the proportion who believed in climate change did not vary by income level (high:98.1%, upper-middle:97.2%, lower-middle:97.8%, low:100%, p = 0.73), the proportion with a higher level of concern (high:80.7%, upper-middle:74.9%, lower-middle:67.5%, low:53.8%, p < 0.001), and who took climate action (high:76.2%, upper-middle:63.1%, lower-middle:51.2%, low:30.8%, p < 0.001) decreased by national wealth. Barriers to involvement in sustainable kidney care were lack of time (54.4%), knowledge (39.7%), and peer support (30.3%). Only 34.0% were aware of national mitigation plans and barriers related to finances, technologies, tools, methods, research, and evidence were perceived as greater obstacles in lower-income countries. Our results highlight that predictors and correlates of climate change risk perception vary across countries. Education alone is unlikely to increase individual and group engagement in climate change. A better understanding of these factors can inform strategies towards climate action in different settings.

Quality of antenatal care services in Afghanistan: findings from the national survey 2022–2023

BackgroundThe optimum use of antenatal care (ANC) services can reduce pregnancy-related complications and deaths. However, there is limited information on the quality of ANC services in Afghanistan. This study aimed to assess the quality of ANC services and examine the influence of sociodemographic factors on the quality of ANC services received by pregnant women in Afghanistan.MethodsThis study analyzed the data from the 2022–23 Afghanistan Multiple Indicators Cluster Survey (MICS), including 9,243 ever-married women aged 15–49 years who had given birth two years prior to the survey. ANC quality was classified as "good" if a woman had at least four ANC visits, initiated ANC during the first trimester, and received all four essential ANC services. Binary logistic regression was employed to examine the likelihood of receiving good-quality ANC across various sociodemographic variables.ResultsOnly 6.2% of women received good-quality ANC. Factors significantly associated with receiving good-quality ANC included woman’s secondary (AOR:1.87, 95%CI: 1.33–2.63) and higher education levels (AOR: 1.75, 95%CI: 1.01–3.03), household head’s higher education level (AOR:1.63, 95%CI: 1.11–2.40), and wealth status (1.71, 2.26, 1.92, and 1.97 higher odds of receiving good-quality ANC for 2nd, 3rd, 4th, and 5th as compared to 1st quintiles of wealth, respectively).ConclusionThe low utilization of good-quality ANC among women in Afghanistan, particularly among those at lower wealth status, with low education levels, underscores the need for targeted interventions to improve access and utilization of antenatal care services.

Mental health and help-seeking behaviors among Mozambican youth: insights from a post-pandemic National Survey Amidst Internal Conflict.

This study aimed to investigate the prevalence and sociodemographic determinants of major depressive disorder (MDD) and generalized anxiety disorder (GAD) among Mozambican youth aged 15-24 years, as well as their help-seeking behaviors. Data from 8,154 youth participants in the 2022-23 Mozambique Demographic Health Survey were analyzed. MDD and GAD were assessed using the PHQ-9 and GAD-7 scales, respectively. Univariate and multivariate logistic regression analyses were conducted to examine associations between sociodemographic factors and mental health outcomes and health-seeking behaviors. The prevalence of MDD and GAD among Mozambican youth was 7.5% for each condition. However, only 9.3% of those with either MDD or GAD sought help for their symptoms, primarily from family and friends. Females had significantly higher odds of experiencing both MDD and GAD but lower help-seeking behavior as compared to males. Unemployment, lower household wealth, and being single were associated with higher odds of both disorders and lower odds of help-seeking behaviors. Higher education increased the odds of GAD and help-seeking behaviors. Significant regional variations were observed, with conflict-affected regions including Cabo Delgado, Nampula, and Zambezia showing the highest prevalence of MDD and GAD. This study reveals substantial mental health challenges among Mozambican youth, with notable disparities across sociodemographic groups and regions. The low rates of help-seeking behavior underscore the need for targeted interventions to improve mental health awareness and access to services for socio-demographically vulnerable youth.

Wealth-based inequality in underweight among Scheduled Tribe women in India: a regional analysis

BackgroundDespite widespread undernutrition among tribal women, there is limited understanding of wealth-based disparities in underweight within this group and how these inequities have changed over time across different regions of India. This study aims to explore trends and patterns of wealth-based inequalities in underweight prevalence among Scheduled Tribe (ST) women across various regions of India.MethodsThe study analysed data from the fourth and fifth rounds of the National Family Health Survey, covering 113,549 and 121,326 non-pregnant ST women aged 15–49, respectively. Wealth-based inequality in underweight was assessed using the Erreygers normalized concentration index (ECI), while predicted probabilities of underweight, adjusted for relevant variables, were calculated using binary logistic regression.FindingsBetween 2015-16 and 2019-21, underweight prevalence among ST women in India decreased from 31.7 to 25.5%, with all regions showing declines. The northern region witnessed the largest drop (20.1–9.8%), followed by the western region (38.7–30.0%) and eastern-central region. The northeastern region that had consistently low underweight prevalence witnessed minimal change over the study period. Wealth inequality, as measured by the ECI, slightly decreased over the study period, from − 0.177 in 2015–16 to -0.134 in 2019–21. However, the reduction in ECI varied significantly across regions. The northern region experienced the most significant reduction in wealth inequality, with a decrease of -0.145 ECI points. In comparison, the western, southern, eastern-central regions exhibited more modest reductions of -0.036, -0.027, and − 0.028 ECI points, respectively. The northeastern region, characterized by initially lower levels of inequality, demonstrated no change in its ECI over the study period. The predicted probabilities from the pooled logistic regression analysis indicated a decline in inequality over the study period. This reduction was primarily driven by significant decreases in underweight prevalence among the poorer and poorest wealth quintiles. Notably, the northern, western, eastern-central, and southern regions experienced the most pronounced improvements in underweight prevalence among these lower wealth groups. Despite overall progress, wealth-based inequality in underweight persisted, especially in the western, southern, and eastern-central regions, where the 2019-21 ECI remained more than − 0.10.ConclusionDespite progress in reducing underweight among ST women in India, regional disparities and wealth-based inequality in underweight persist. Policies should focus on targeted, region-specific interventions that prioritize economically disadvantaged women, reduce inequality, and improve access to nutrition and healthcare, particularly in the western, southern, and eastern-central regions.

Geographic distribution and demographic factors associated with use of a long-acting reversible contraceptive (LARC) in Ethiopia.

Increasing access to and utilization of long-acting reversible contraceptives (LARC) can prevent unintended pregnancies and reduce unmet need for family planning in Ethiopia However, LARC uptake lags behind less effective contraceptive methods. This study aimed to analyze the geographical distribution and demographic factors associated to LARC uptake. The 2019 Performance Monitoring For Action Ethiopia (PMA Ethiopia) survey data was used. Spatial autocorrelation was examined using Global Moran's I and Local Indicators of Spatial Association (LISA). Bivariate Moran's I and bivariate LISA (BiLISA), Spatial lag, and spatial error regression analyses were performed to assess the spatial correlation and association between LARC uptake and demographic factors. LARC uptake was 8% among the study population, with Afar and Somali regions having the lowest uptake. There was a statistically significant positive spatial autocorrelation for LARC uptake (Moran's I= 0.308, p<0.001). Additionally, an inverse correlation was observed between LARC uptake and the percentage of Muslims, rural population, no formal education, and low wealth quantile. The spatial lag model indicated that zones with higher Muslim populations and those with higher percentages of population with no formal education had lower LARC uptake. To expand access to LARC, the Ethiopian government, policymakers, and non-governmental organizations might implement programs targeting low-uptake areas (Afar and Somali regions). Muslim religious leaders could play an important role in promoting acceptance of LARC among their members. Tailored health education programs should be developed for Muslim populations and those with no formal education to enhance awareness and acceptance of LARC.

Correlates of maternal health services utilization among adolescent mothers in Ghana: analysis of Ghana maternal health survey 2017

BackgroundThe prevalence of adolescent pregnancy is high in developing countries and poses a public health threat. This study aimed to assess the coverage and correlates of optimal ANC visits, early initiation of ANC visits, assisted delivery and health facility delivery among adolescent mothers.MethodsWe analysed data from the 2017 Ghana Maternal Health Survey (GMHS), using a sample of 567 (weighted) and 527 (unweighted) adolescent mothers with at least one live birth or stillbirth in the five (5) years preceding the survey.ResultsMost participants obtained four or more ANC visits, accessed health facility delivery and assisted delivery. Half (50%) of the participants initiated ANC visits in the first trimester. Less than half (39%) of the participants utilized all four maternal health services optimally. Utilization of maternal health services was associated with predisposing factors (age and parity) and enabling factors (wealth index, health insurance, permission to seek care). For instance, adolescent mothers aged 18–19 years (AOR = 1.65, 95% CI: 1.01–2.70) had increased odds of early initiation compared to those aged 15–17 years. Adolescent mothers who were uninsured (AOR = 0.30, 95% CI: 0.15–0.63) were less likely to obtain optimal ANC visits than insured mothers. Adolescent mothers in the middle wealth index (AOR = 1.97, 95% CI: 1.06–3.63) were about twice more likely to utilize all the four maternal health services compared to those in the lowest wealth index.ConclusionThis study has demonstrated that adolescent utilization of ANC visits, health facility delivery and skilled delivery were satisfactory. However, ANC initiation and optimal utilization of the recommended maternal health services were unsatisfactory. Utilization of the maternal health services was determined by predisposing factors such as age and parity as well as enabling factors including health insurance coverage, permission for treatment and wealth index.

More than a communication disorder: inequities in the financial toxicity of post-stroke aphasia

IntroductionAphasia, a communication disorder often resulting from stroke, can have profound impacts on both health outcomes and financial wellbeing. While the physical and cognitive consequences of stroke are well documented, the financial strain, or “financial toxicity,” associated with managing chronic conditions like aphasia remains underexplored. Furthermore, financial toxicity is not experienced equally across racial and ethnic groups, with disparities driven by socioeconomic factors, access to healthcare, and structural inequities. This study compares the financial toxicity of people with aphasia (PWA) to those with stroke alone, examining differences across racial and ethnic groups to highlight disparities in economic burden.MethodsThis study utilized data from the Medical Expenditure Panel Survey (MEPS) collected between 2018 and 2021 to examine the financial toxicity of PWA compared to those with stroke only. Financial toxicity was assessed using self-reported income and wealth data from the MEPS. Individual-level income and wealth values were calculated from the self-reported financial data to quantify the financial burden. Fixed effects regression models were employed to account for unobserved individual heterogeneity, controlling for time-invariant characteristics. Interaction terms were included in the models to capture the differential financial impacts of aphasia on Black and Hispanic individuals, compared to other racial and ethnic groups. The analysis examined both within-group and between-group differences in financial toxicity, highlighting potential racial and ethnic disparities among those affected by aphasia.ResultsApproximately 18.71% (N = 281) of respondents who reported having a stroke also had aphasia. After controlling for demographic, health, and household characteristics, PWA had 21% lower income and 7% lower wealth compared to stroke survivors without aphasia. Aphasia had a disparate impact on the income (−29%) and wealth (−24%) of Black stroke survivors. These findings were consistent across different model specifications, highlighting the robustness of the results indicating racial inequity in the financial toxicity of post-stroke aphasia.ConclusionThis study showed the financial impact of post-stroke aphasia and the disparate burden among Black PWA. The findings highlight the need to address the financial ramifications of post-stroke morbidities such as aphasia among vulnerable populations.

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

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

Prevalence of soil-transmitted helminths infection and associated risk factors among residents of Jigjiga town, Somali region, Eastern Ethiopia.

One of the tropical illnesses that is often overlooked is soil-transmitted helminths, or STHs. In tropical and subtropical nations, where poor sanitation and contaminated water sources are common, they mostly impact the most vulnerable populations. The aim of this study was to ascertain the prevalence of STHs and related risk factors among the people living in Jigjiga town, Somali region, Eastern Ethiopia. A community-based cross-sectional study was revealed from June 1 to July 21, 2023. Study participants were selected through a multistage sampling method, where households were randomly chosen from the kebeles. A semi-structured questionnaire and observational checklist were used to collect some of the data. A stool sample was collected from each participant, and a single Kato-Katz was performed to detect STHs. Bivariate and multivariate logistic regression analyses were performed, and statistical significance was declared at a level of p-value < 0.05 between the outcome and independent variables. There were 507 participants in this study, and 90.9% of them responded. STH prevalence was 11.4% overall (95% CI = 9.0, 14.0). With a prevalent parasite species, A. lumbricoides was 9.3%, T. trichiura was 2.8%, and hookworms were 0.2%. Of the overall positive cases, 93.1% are due to single parasite infections. Independent predictors of STHs included low wealth status (AOR = 3.10; 95% CI = 1.25, 7.75; p = 0.015), infrequent hand washing before meals (AOR = 3.19; 95% CI = 1.55, 6.57; p = 0.002), earthen floors (AOR = 2.32; 95% CI = 1.12, 4.79; p = 0.023), and no drinking water treatment habit (AOR = 5.07; 95% CI = 1.89, 13.57; p = 0.001). Jigjiga town had a low prevalence of STHs infections. Infrequent hand washing habits before meals, earthen floors, low wealth status, and no habit of treating drinking water were significant associated factors. Health education on handwashing, regular deworming, improved access to clean water and sanitation facilities to reduce the burden of STH effectively.

AGING SINGLE PARENTS: PSYCHOSOCIAL OUTCOMES AND WELL-BEING AMONG A MARGINALIZED POPULATION

Abstract Objective Over the last 50 years, single parents—in particular, single mothers—have received much popular and political attention. And yet, their aging experiences remain unresearched. This paper analyzes aging among single parents, including their sex/gender and racial/ethnic composition, as well as their psychosocial well-being, in a population-based aging study. Method Using Health and Retirement Study data (N = 38,785), we identify single parents as participants who were never married at baseline and have children (n = 680), 1.80% of participants with children. Multilevel regressions analyzed psychosocial outcomes: discrimination experiences, subjective social status, and social support. Results Odds of single parenthood increased for each subsequent birth cohort (OR = 1.89, p &amp;lt; 0.001). Women (□2 = 85.192, p &amp;lt; 0.001) and people of color (□2 = 802.32, p &amp;lt; 0.001) were more likely to be single parents, who also had lower education levels and wealth. Single parents were more likely to report discrimination due to race (OR: 1.522, p = 0.047), with single mothers of color more likely to report discrimination due to financial status (OR = 1.575, p = 0.049). Single parents received less positive social support and more negative support from their children; they were also more likely to experience depression, have lower self-rated health, and smaller social networks. Discussion Aging single parents are more likely to belong to already-marginalized groups, and face further and ongoing discrimination, known risk factors for adverse later-life health and well-being. These results indicate the need for greater attention to this marginalized group.

WEALTH DISPARITIES IN LATER LIFE: SENSE OF MEANING AND PURPOSE IN LIFE

Abstract This study examined the extent to which racial/ethnic, gender, and age disparities in wealth persist among U.S. older adults, focusing on housing wealth (non-liquid assets) and non-housing wealth (liquid assets), alongside income, and further evaluated whether sense of meaning and purpose in life mitigates these wealth disparities in later life. Data were from the Leave-Behind Questionnaire in the 2018 Health and Retirement Study (N=4,472). I estimated ordinary least squares regression models with interaction terms to evaluate moderation effects, adjusting for health and sociodemographic characteristics. Results showed that wealth disparities across race/ethnicity, gender, and age groups exist in older Americans. Non-Hispanic Black, non-Hispanic Asian/other races, and Hispanic older adults compared to non-Hispanic Whites, as well as women (vs. men), reported significantly lower wealth and income. The age groups of 65-79 and 80+ reported higher wealth than those aged 50-64. Multiple moderation analyses revealed evidence of racial/ethnic and age disparities in wealth, but not gender, were mitigated by sense of meaning and purpose in life. Specifically, non-housing wealth increased among non-Hispanic Asian/other and Hispanic older adults as their purpose in life increased. A notable increase in both housing and non-housing wealth, as well as income, was observed among those aged 50-64 as their purpose in life increased. Findings suggest the protective effect of sense of meaning and purpose in life in mitigating wealth disparities in later life. Through further research and interventions aimed at bolstering sense of meaning and purpose in life, there is potential to alleviate wealth disparities in later life.

A Study of the Impact of Population Aging on the Effectiveness of Household Financial Asset Allocation

Based on the perspective of population aging, this paper explores the impact of aging shocks on household financial asset allocation behavior, and constructs cross-period tracking panel data based on the 2015, 2017, and 2019 China Household Finance Survey (CHFS) data to empirically investigate the mechanism by which population aging affects different dimensions of household financial asset allocation behavior. The results of the study find that (1) population aging significantly inhibits household portfolio effectiveness; and this conclusion still holds after replacing variables and robustness testing of the model. (2) The mechanism analysis illustrates that population aging affects household financial asset allocation effectiveness through wealth constraints and health risk paths. (3) Heterogeneity analysis illustrates that there is urban-rural and wealth heterogeneity in the impact of population aging on financial asset allocation. The negative impact of population aging on financial asset allocation is more pronounced in rural households and in households with low wealth levels.

Healthcare utilization among people with disabilities in Iran: what predictors are associated with medical visits?

BackgroundEnsuring equitable access to healthcare services for individuals with disabilities poses a significant challenge for healthcare systems. This research aimed to explore the factors affecting medical visits among this population.MethodThis cross-sectional study in Iran involved data from 766 adults with disabilities aged 18 and older. Unadjusted and adjusted logistic regression analyses were used to calculate the odds ratios for medical visits.ResultsThe majority of participants were male (64.36%) and single (54.02%). In the adjusted model, participants with severe disabilities (OR: 1.901, p = 0.025) were more likely to utilize medical visits compared to those with less severe disabilities. Conversely, individuals in the second (OR: 0.420, p = 0.017), fourth (OR: 0.360, p = 0.004), and fifth (OR: 0.319, p = 0.001) wealth quintiles demonstrated a significantly lower likelihood of accessing medical visits in comparison to the reference group.ConclusionsThis study reveals critical disparities in healthcare access for individuals with disabilities in Iran. While individuals with severe disabilities demonstrate a higher likelihood of utilizing medical services, those in lower wealth quintiles face significant barriers to accessing care. These findings emphasize the urgent need for targeted interventions to enhance healthcare equity, ensuring that financial constraints do not hinder medical visits for this vulnerable population.

Cognition, function, and mood post-COVID-19: Comparative analysis using the health and retirement study.

Millions of Americans endure post-COVID conditions (PCC), yet research often lacks pre-illness measurements, relying primarily on follow-up assessments for analysis. The study aims to examine the prevalence of PCC, including cognitive impairment, functional limitation, and depressive symptoms, along with relevant risk factors, while controlling for individuals' pre-illness status measured in 2018. A cross-sectional retrospective study utilized the 2018 and 2020 Health and Retirement Study surveys. Sample included individuals with COVID-19 (n = 409; average age 64) and individuals without COVID-19 (n = 8689; average age 59). COVID-19 positive: Individuals with positive tests, physician diagnoses, emergency room visits, or hospitalizations for COVID-19 between 2019-2020. Cognition was assessed using immediate and delayed word-recall tests, serial seven subtractions, and backward counting. Functional status was measured using limitations in activities of daily living (ADLs) and instrumental ADLs. Depressive symptoms were measured using the modified Center for Epidemiology Studies Depression scale. Participants' perception of experiencing PCC was collected. Logistic regression and propensity score matching were employed for these analyses. Among 409 COVID-19-positive respondents (14% hospitalized), 24% exhibited new impairments after COVID-19 infection. Noteworthy increases in functional limitation (OR [95% CI]: 2.18 [0.95, 0.97], p < 0.001) and a marginal rise in cognitive impairment (1.79 [0.99, 3.32], p = 0.053) following COVID-19 infection were observed in comparison to their pre-COVID-19 baseline. Compared to 8689 non-COVID-19 cases, the 409 COVID-19 positives showed increased functional decline (1.78 [1.26, 2.51], p = 0.001) and depressive symptoms (1.41 [1.04, 1.91], p = 0.03). Factors associated with PCC included pre-existing impairments, lower education, female gender, prior hospitalization, higher comorbidity, lower wealth, and mild COVID-19. A notable number of respondents, especially older individuals with fewer pre-existing health conditions, experienced PCC without awareness. Compared to an individual's pre-illness baseline and uninfected individuals, being positive for COVID-19 raised the risk of functional limitation, depressive symptoms, and cognitive impairment. Additionally, addressing PCC through both subjective and objective approaches is essential to alleviate individual and societal burdens.

Individual, household, and community-level determinants of undernutrition among pregnant women in the northern zone of the Sidama region, Ethiopia: A multi-level modified Poisson regression analysis.

In Ethiopia, maternal undernutrition is a major public health concern. However, comprehensive evidence is lacking in the southern part of Ethiopia, specifically the household and community-level related determinants of undernutrition. Besides, the evidence about the prevalence and determinants of undernutrition is not yet documented in the current study setting. Thus, this study aimed to determine the prevalence of undernutrition and identify its determinants among pregnant women in Hawela Lida district of the Sidama region, Ethiopia. A community-based cross-sectional study was conducted on a sample of 515 pregnant women from June 1-25, 2024. A multi-stage sampling method was utilized to select eligible pregnant women. We collected data using a structured and pretested interviewer-administrated questionnaire and an anthropometric measurement. Data were collected using the Open Data Kit smart phone device and exported it to Stata version 17 for further processing and analysis. A multi-level mixed-effects modified Poisson regression analysis with robust variance was used to account for confounders and between and with cluster effects. The prevalence of undernutrition among pregnant women was 41.7% (95% CI: 37.3-45.6). The prevalence of undernutrition was associated with planned pregnancy (adjusted prevalence ratio [APR]: 0.80; 95% CI: 0.66-0.98), household food insecurity (APR: 1.64; 95% CI: 1.26-2.13), inadequate dietary diversity (APR: 1.79; 95% CI: 1.43-2.25), and women's poor knowledge of nutrition (APR: 1.68; 95% CI: 1.32-2.12) at individual levels. The identified determinants of undernutrition at the community level were low community literacy rates (APR: 4.62; 95% CI: 1.13-18.79) and low community wealth status (APR: 1.91; 95% CI: 1.10-3.31). Two in five pregnant women had an undernutrition problem in the study setting. Individual and community-level determinants contributed to the high prevalence of undernutrition. Thus, any prevention and control approaches to undernutrition should consider inter-sectorial collaboration to account for determinants at various levels. Besides, any program must emphasize the delivery of nutrition education about dietary diversity, particularly targeting pregnant mothers who have poor knowledge of nutrition and unplanned pregnancy at the individual level. Moreover, creating a small business reform for the community with low wealth status using agricultural extension workers must be considered.

Digital Exclusion and Depressive Symptoms among Older People: Findings from Five Aging Cohort Studies across 24 Countries.

Background: Digital exclusion is a global issue that disproportionately affects older individuals especially in low- and middle-income nations. However, there is a wide gap in current research regarding the impact of digital exclusion on the mental health of older adults in both high-income and low- and middle-income countries. Methods: We analyzed data from 5 longitudinal cohorts: the Health and Retirement Study (HRS), the English Longitudinal Study of Aging (ELSA), the Survey of Health, Ageing and Retirement in Europe (SHARE), the China Health and Retirement Longitudinal Study (CHARLS), and the Mexican Health and Aging Study (MHAS). These cohorts consisted of nationwide samples from 24 countries. Digital exclusion was defined as the self-reported lack of access to the internet. Depressive symptoms were assessed using comparable scales across all cohorts. We used generalized estimating equation models, fitting a Poisson model, to investigate the association between the digital exclusion and depressive symptoms. We adjusted for the causal directed acyclic graph (DAG) minimal sufficient adjustment set (MSAS), which includes gender, age, retirement status, education, household wealth, social activities, and weekly contact with their children. Results: During the study period (2010-2018), 122,242 participants underwent up to 5 rounds of follow-up. Digital exclusion varied greatly across countries, ranging from 21.1% in Denmark to 96.9% in China. The crude model revealed a significant association between digital exclusion and depressive symptoms. This association remained statistically significant in the MSAS-adjusted model across all cohorts: HRS [incidence rate ratio (IRR), 1.37; 95% confidence interval (CI), 1.28 to 1.47], ELSA (IRR, 1.32; 95% CI, 1.23 to 1.41), SHARE (IRR, 1.30; 95% CI, 1.27 to 1.33), CHARLS (IRR, 1.62; 95% CI, 1.38 to 1.91), and MHAS (IRR, 1.31; 95% CI, 1.26 to 1.37); all Ps < 0.001. Notably, this association was consistently stronger in individuals living in lower wealth quintile households across all 5 cohorts and among those who do not regularly interact with their children, except for ELSA. Conclusions: Digital exclusion is globally widespread among older adults. Older individuals who are digitally excluded are at a higher risk of developing depressive symptoms, particularly those with limited communication with their offspring and individuals living in lower wealth quintile households. Prioritizing the provision of internet access to older populations may help reduce the risks of depression symptoms, especially among vulnerable groups with limited familial support and with lower income.

Unbundling Social Security from the Payroll Tax

This Article emphasizes that social security funding has contributed significantly to the shift in tax burdens from high income and wealth to low and moderate income and wealth individuals. To preserve social security as a welfare program primarily for older individuals and to ameliorate the distributional inequity of funding social security across income and wealth levels, the Article proposes unbundling of the benefit side of social security from its longstanding payroll tax funding mechanism. The Article recommends substituting a budget allocation from general revenues for current payroll tax revenue. The substitution would be accompanied by revenue replacement through limitations on both social security benefits for higher income individuals and more general, high income centric tax expenditures while increasing income tax marginal rates moderately. Modifying social security benefits from their current overinclusive, entitlement structure for all to moderately needs-based entitlement possibly freed from the constraint of the current contribution requirement that makes social security underinclusive would help provide the older population an income to facilitate dignified aging.

Prevalence of Asymptomatic non-Falciparum and Falciparum Malaria in the 2014-15 Rwanda Demographic Health Survey.

Recent molecular surveillance suggests an unexpectedly high prevalence of non-falciparum malaria in Africa. Malaria control is also challenged by undetected asymptomatic P. falciparum malaria resulting in an undetectable reservoir for potential transmission. Context-specific surveillance of asymptomatic P. falciparum and non-falciparum species is needed to properly inform malaria control programs. We performed quantitative real time PCR for four malaria species in 4,595 primarily adult individuals in Rwanda using the 2014-2015 Demographic Health Survey. We assessed correlates of infection by species to explore attributes associated with each species. Asymptomatic P. ovale spp., P. malariae, and P. falciparum malaria infection had broad spatial distribution across Rwanda. P. vivax infection was rare. Overall infection prevalence was 23.6% (95%CI [21.7%, 26.0%]), with P. falciparum and non-falciparum at 17.6% [15.9%, 19.0%] and 8.3% [7.0%, 10.0%], respectively. Parasitemias tended to be low and mixed species infections were common, especially where malaria transmission and overall prevalence was the highest. P. falciparum infection was associated with lower wealth, rural residence and low elevation. Fewer factors were associated with non-falciparum malaria. Asymptomatic non-falciparum malaria and P. falciparum malaria are common and widely distributed across Rwanda in adults. Continued molecular monitoring of Plasmodium spp. is needed to strengthen malaria control.