Mean Monthly Household Income Research Articles

Knowledge, attitudes and practices regarding respirable silica exposure and personal protective equipment use among brick kiln workers in Nepal

ObjectivesBrick kiln workers in Nepal are a neglected population who are exposed to high respirable silica concentrations, and few use interventions to reduce exposure. We aimed to characterise the prevalence...

Economic Distress of Breast Cancer Patients Seeking Treatment at a Tertiary Cancer Center in Mumbai during COVID-19 Pandemic: A Cohort Study.

Background:Cancer treatment during nationwide lockdown due to the COVID-19 pandemic has posed several challenges in the delivery of cancer care and carries tremendous potential sequel of impoverishing the households. This study aims to examine the economic distress faced by breast cancer patients receiving treatment at Tata Memorial Center (TMC) Mumbai, India during the nationwide lockdown initiated in March 2020 following the outbreak of COVID-19. Methods:A total of 138 non-metastatic breast cancer patients who were accrued in this study at TMC before imposing of lockdown, and their treatment was impacted because of the COVID-19 outbreak, were interviewed. Telephonic interviews were conducted using a structured schedule which contained information on household and demographic characteristics of the patients, knowledge about COVID-19, their daily expenditure for treatment, difficulties faced during lockdown and how they met expenditures. Descriptive statistics and logistic regression were used in the analyses. Results:The average monthly expenditure of cancer patients had increased by 32% during the COVID-19 period while the mean monthly household income was reduced by a quarter. More than two-thirds of the patients had no income during the lockdown. More than half of the patients met their expenditure by borrowing money, 30% of the patients used their savings, 28% got charity and 25% used household income. About 81% of the patients had reported shortage of money, 32% reported shortage of food and 28% reported shortage of medicine. The distress financing was significantly higher among patients receiving treatment in Mumbai compared to those receiving treatment at their native cities (67% vs. 46%), patients under 40 years of age, illiterate, currently married, Muslim and staying at a rented house. Conclusion:The incremental expenditure coupled with reduced or no income due to the closure of economic activities in the country imposed severe financial stress on breast cancer patients.

Is Deep Learning Better than Machine Learning to Predict Benign Laryngeal Disorders?

It is important in otolaryngology to accurately understand the etiology of a laryngeal disorder, diagnose it early, and provide appropriate treatment accordingly. The objectives of this study were to develop models for predicting benign laryngeal mucosal disorders based on deep learning, naive Bayes model, generalized linear model, a Classification and Regression Tree (CART), and random forest using laryngeal mucosal disorder data obtained from a national survey and confirm the best classifier for predicting benign laryngeal mucosal disorders by comparing the prediction performance and runtime of the developed models. This study analyzed 626 subjects (313 people with a laryngeal disorder and 313 people without a laryngeal disorder). In this study, deep learning was the best model with the highest accuracy (0.84). However, the runtime of deep learning was 39min 41sec, which was a 10 times longer development time than CART (3min 7sec). This model confirmed that subjective voice problem recognition, pain and discomfort in the last two weeks, education level, occupation, mean monthly household income, high-risk drinker, and current smoker were major variables with high weight for the benign laryngeal mucosal disorders of Korean adults. Among them, subjective voice problem recognition was the most important factor with the highest weight. The results of this study implied that the prediction performance of deep learning could be better than that of machine learning for structured data, such as health behavior and demographic factors as well as video and image data.

Predicting the Swallow-Related Quality of Life of the Elderly Living in a Local Community Using Support Vector Machine.

Background and Objectives: This study developed a support vector machine (SVM) algorithm-based prediction model with considering influence factors associated with the swallowing quality-of-life as the predictor variables and provided baseline information for enhancing the swallowing quality of elderly people’s lives in the future. Methods and Material: This study sampled 142 elderly people equal to or older than 65 years old who were using a senior welfare center. The swallowing problem associated quality of life was defined by the swallowing quality-of-life (SWAL-QOL). In order to verify the predictive power of the model, this study compared the predictive power of the Gaussian function with that of a linear algorithm, polynomial algorithm, and a sigmoid algorithm. Results: A total of 33.9% of the subjects decreased in swallowing quality-of-life. The swallowing quality-of-life prediction model for the elderly, based on the SVM, showed both preventive factors and risk factors. Risk factors were denture use, experience of using aspiration in the past one month, being economically inactive, having a mean monthly household income <2 million KRW, being an elementary school graduate or below, female, 75 years old or older, living alone, requiring time for finishing one meal on average ≤15 min or ≥40 min, having depression, stress, and cognitive impairment. Conclusions: It is necessary to monitor the high-risk group constantly in order to maintain the swallowing quality-of-life in the elderly based on the prevention and risk factors associated with the swallowing quality-of-life derived from this prediction model.

Forest dependency, co-management and improvement of peoples’ livelihood capital: Evidence from Chunati Wildlife Sanctuary, Bangladesh

In order to reduce peoples’ dependency on forests, to improve their livelihoods, and to conserve forest resources a number of protected areas (PA) in Bangladesh has been brought under PA co-management. In this study, we examined the dependency of forest dependent communities (FDC) on forests, and the impacts of PA co-management on their livelihood capital drawing data from Chunati Wildlife Sanctuary (CWS), a pioneer PA of south-eastern Bangladesh. Data on forest dependency was collected through a participatory survey along 28 randomly selected forest trails and remote sensing (RS) analysis of betel leaf plots inside the CWS. To analyze the livelihood capital, we adopted a sustainable livelihood framework and interviewed randomly selected 843 FDC members, and 88 local people who were not involved in PA co-management as control. Remote sensing based vegetation indices were derived to evaluate the trends of vegetation condition in the CWS. Results show that 481 persons were entering into the CWS in a day to collect forest products having an estimated market value of about USD1,856. Even though the extent of cultivation had reduced but local people were still practicing betel leaf farming. The livelihood improvement activities under PA co-management had positive impacts, and livelihood capital indices of the FDC members were significantly higher than that of control group. Similar impact was also reflected in five livelihood capital, and notably the mean monthly household income (financial capital) of FDC members had increased by 53% in five years. The RS based vegetation indices indicate that overall forest condition was gradually improving from 2010 to 2015. In order to endure the livelihood of FDC members and to conserve the forests of CWS sustainably, we recommend further strengthening of human and social capital along with appropriate institutional support.

Developing A Model to Predict the Occurrence of the Cardio-Cerebrovascular Disease for the Korean Elderly using the Random Forests Algorithm

This study aimed to develop a model for predicting the cardio-cerebrovascular disease of the South Korean elderly using the random forests technique. This study analyzed 2,111 respondents (879 males and 1,232 females), who were age 60 or older, out of total 7,761 respondents, who completed the Seoul Welfare Panel Study. The result variable was defined as the cardio-cerebrovascular disease (e.g., hypertension, cerebral infarction, hyperlipidemia, cardiac infarction, and angina). As a result of developing a random forest-based model, the major determinants of the cardio-cerebrovascular diseases of the South Korean elderly were mean monthly household income, the highest level of education, subjective health condition, subjective friendship, subjective family relationship, smoking, regular exercise, age, marital status, gender, depression experience, economic activity, and high-risk drinking. Among them, mean monthly household income was the most important predictor of the cardio-cerebrovascular disease. Based on the developed prediction model, it is needed to develop a systematic program for preventing the cardio-cerebrovascular disease of the Korean elderly.

Out of Pocket Expenditures among Hypertensive Patients and their Households who Visit Public Hospitals in Addis Ababa, Ethiopia, 2016

Background: Hypertension like many chronic conditions require long term care, posing financial burden to the patients and their households. Even in countries with universal healthcare coverage, patients including those with chronic conditions can still incur substantial and increasing amounts of out-of-pocket expenditure (OOPE).However, the OOPE burden of hypertension has not been studied in the Ethiopian context. General objective: The objective of the study was to assess out of pocket expenditures among hypertensive patients and their households who visit public hospitals in Addis Ababa, Ethiopia, 2016. Methods: An institution based cross sectional study was conducted on 422 participants in public hospitals that provide care for hypertension in Addis Ababa city from September 01, 2016 to September 20, 2016. Structured questionnaires were used to collect the data. Then the data was entered and analyzed using the statistical package for social scientists version 20 (SPSS-20) and analyses were performed for household out of pocket expenditure that considered estimated direct and indirect out of pocket expenditure and household expenditure by using descriptive statistics. Results: The study covered 422 hypertensive patients and revealed that the total out pocket expenditure was estimated at median 5279.50 (mean 7194.00) birr/month, household expenditure (households food and non-food expenditure) was significant which estimated at median 5148.50 (mean 5003.29) birr/month. The direct cost of hypertensive patient was estimated at median 283 (mean 290.74) birr/month. Conclusion and recommendation: The average OOPE of hypertension to patients and their households were very high when compared with the mean monthly household income. Therefore further research ought to be done including economic consequence, catastrophic Health expenditure, impoverishments, coping mechanism and social resources of hypertension on patients and their households. Health Policymakers and health managers should prioritize the resources need for the hypertension prevention and control activities.

Socioeconomic status and organ damage in Mexican systemic lupus erythematosus women.

The objective of this cross-sectional study was to determine relationships between socioeconomic status and organ damage in Mexican systemic lupus erythematosus (SLE) patients. Demographic and clinical variables were assessed. Socioeconomic status was evaluated using the Graffar method and monthly household income. Lupus activity and organ damage were measured using the SLE disease activity scale, validated for the Mexican population (Mex-SLEDAI), and the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) scale. The 143 Mexican female SLE patients included (mean age 40.1 ± 8.9 years, mean disease duration 8.9 ± 6.3 years) had a mean monthly household income of $ 407.2 ± 326.5. According to the Graffar index, 18.9%, 52.5%, and 28.7% had high/medium-high, medium, and medium-low/low socioeconomic status, respectively. Organ damage was observed in 61 patients (42.7%). Patients with organ damage had lower monthly household incomes ($241.4 ± 152.4 vs. $354.8 ± 288.3) and were more frequently unemployed (57.3% vs. 35.3%; p = 0.01) than those without. Low monthly income was not associated with lupus activity or self-reported health status. In the adjusted multivariate analysis, low monthly income ( < $300) was associated with organ damage. In conclusion, low income may be associated with organ damage in Mexican SLE patients.

Prevalence of household-level food insecurity and its determinants in an urban resettlement colony in north India.

An adequate food intake, in terms of quantity and quality, is a key to healthy life. Malnutrition is the most serious consequence of food insecurity and has a multitude of health and economic implications. India has the world's largest population living in slums, and these have largely been underserved areas. The State of Food Insecurity in the World (2012) estimates that India is home to more than 217 million undernourished people. Various studies have been conducted to assess food insecurity at the global level; however, the literature is limited as far as India is concerned. The present study was conducted with the objective of documenting the prevalence of food insecurity at the household level and the factors determining its existence in an urban slum population of northern India. This cross-sectional study was conducted in an urban resettlement colony of South Delhi, India. A pre-designed, pre-tested, semi-structured questionnaire was used for collecting socioeconomic details and information regarding dietary practices. Food insecurity was assessed using Household Food Insecurity Access Scale (HFIAS). Logistic regression analysis was performed to determine the factors associated with food insecurity. A total of 250 women were interviewed through house-to-house survey. Majority of the households were having a nuclear family (61.6%), with mean family-size being 5.5 (SD +/- 2.5) and the mean monthly household income being INR 9,784 (SD +/- 631). Nearly half (53.3%) of the mean monthly household income was spent on food. The study found that a total of 77.2% households were food-insecure, with 49.2% households being mildly food-insecure, 18.8% of the households being moderately food-insecure, and 9.2% of the households being severely food-insecure. Higher education of the women handling food (OR 0.37, 95% CI 0.15-0.92; p < or = 0.03) and number of earning members in the household (OR 0.68, 95% CI 0.48-0.98; p < or = 0.04) were associated with lesser chance/odds of being food-insecure. The study demonstrated a high prevalence of food insecurity in the marginalized section of the urban society. The Government of India needs to adopt urgent measures to combat this problem.

The Impact of Psychotropic Drug Costs on the Brazilian Family Budget: An Analysis of the Family Budget Surveys of 2003 and 2009

ObjectiveTo estimate the cost of psychotropic drugs and its impact on the Brazilian family budget in 2003 and 2009 comparatively. MethodsThis study had a cross-sectional design. Data were obtained from the Family Budget Surveys conducted in 2003 and 2009, including interviews in 48,470 and 55,970 homes of all Brazilian regions, respectively. The main measures are prevalence of psychotropic drug acquisition, monetary and nonmonetary expenses with psychotropic drugs, total spending on drugs, spending on health, total household spending, and estimated mean monthly household income. All incomes and expenses from the 2003 survey were adjusted by inflation. ResultsThere was a reduction in the prevalence of psychotropic drug acquisition by Brazilian households from 13.0% in 2003 to 11.2% in 2009. The mean monthly household spending on psychotropic drugs, however, rose from R $54.38 in 2003 to R $78.73 in 2009. The percentage of spending on psychotropic drugs from the expenses with health increased 27%. ConclusionsThe increase in spending on psychotropic drugs can be due to a rise in their prices, the acquisition of more modern or more expensive drugs, or the increase in the number of drugs used. Proportionally, spending on psychotropic drugs grew more than did spending on health by Brazilian families.

Reaction to Ilesanmi O S et al. The managed hypertensive: the costs of blood pressure control in a Nigerian town.

We read with great interest the recently published article by Ilesanmi and colleagues in your journal [1]. The authors’ observation that patient’s mean monthly cost of treatment for hypertension was ₦1440±560 ($9.6±3.7), equivalent to 11% of their mean monthly household income was very interesting. It made an interesting piece to read that patient illness costs due to care seeking for hypertension are largely undocumented in Africa just like has been observed for infectious diseases like tuberculosis [2].

Catastrophic health expenses and impoverishment of households of patients with rheumatoid arthritis

BackgroundThe cost of certain diseases may lead to catastrophic expenses and impoverishment of households without full financial support by the state and other organizations. ObjectiveTo determine the socioeconomic impact of the rheumatoid arthritis (RA) cost in the context of catastrophic expenses and impoverishment. Patients and methodsThis is a cohort-nested cross-sectional multicenter study on the cost of RA in Mexican households with partial, full, or private health care coverage. Catastrophic expenses referred to health expenses totaling >30% of the total household income. Impoverishment defined those households that could not afford the Mexican basic food basket (BFB). ResultsWe included 262 patients with a mean monthly household income (US dollars) of $376 (0–18,890.63). In all, 50.8%, 35.5%, and 13.7% of the patients had partial, full, or private health care coverage, respectively. RA annual cost was $ 4653.0 per patient (65% direct cost, 35% indirect). RA cost caused catastrophic expenses in 46.9% of households, which in the logistic regression analysis were significantly associated with the type of health care coverage (OR 2.7, 95%CI 1.6–4.7) and disease duration (OR 1.024, 95%CI 1.002–1.046). Impoverishment occurred in 66.8% of households and was associated with catastrophic expenses (OR 3.6, 95%CI 1.04–14.1), high health assessment questionnaire scores (OR 4.84 95%CI 1.01–23.3), and low socioeconomic level (OR 4.66, 95%CI 1.37–15.87). ConclusionThe cost of RA in Mexican households, particularly those lacking full health coverage leads to catastrophic expenses and impoverishment. These findings could be the same in countries with fragmented health care systems.

Catastrophic health expenses and impoverishment of households of patients with rheumatoid arthritis

BackgroundThe cost of certain diseases may lead to catastrophic expenses and impoverishment of households without full financial support by the state and other organizations. ObjectiveTo determine the socioeconomic impact of the rheumatoid arthritis (RA) cost in the context of catastrophic expenses and impoverishment. Patients and methodsThis is a cohort-nested cross-sectional multicenter study on the cost of RA in Mexican households with partial, full, or private health care coverage. Catastrophic expenses referred to health expenses totaling >30% of the total household income. Impoverishment defined those households that could not afford the Mexican basic food basket (BFB). ResultsWe included 262 patients with a mean monthly household income (US dollars) of $376 (0–18,890.63). In all, 50.8%, 35.5%, and 13.7% of the patients had partial, full, or private health care coverage, respectively. RA annual cost was $ 4653.0 per patient (65% direct cost, 35% indirect). RA cost caused catastrophic expenses in 46.9% of households, which in the logistic regression analysis were significantly associated with the type of health care coverage (OR 2.7, 95%CI 1.6–4.7) and disease duration (OR 1.024, 95%CI 1.002–1.046). Impoverishment occurred in 66.8% of households and was associated with catastrophic expenses (OR 3.6, 95%CI 1.04–14.1), high health assessment questionnaire scores (OR 4.84 95%CI 1.01–23.3), and low socioeconomic level (OR 4.66, 95%CI 1.37–15.87). ConclusionThe cost of RA in Mexican households, particularly those lacking full health coverage leads to catastrophic expenses and impoverishment. These findings could be the same in countries with fragmented health care systems.

Child feeding practices, food habits, anthropometric indicators and cognitive performance among preschoolers in Peninsular Malaysia

This study aimed to determine the relationship between child feeding practices, food habits, and anthropometric indicators with cognitive performance of preschoolers aged 4–6years in Peninsular Malaysia (n=1933). Parents were interviewed on socio-demographic background, nutrition knowledge, child feeding practices and food habits. Height and weight of the preschoolers were measured; BMI-for-age, weight-for-age and height-for-age were determined. Cognitive performance was assessed using Raven’s Colored Progressive Matrices. The mean monthly household income was RM3610 and 59.6% of parents attained secondary education. Thirty-three percent of parents had good knowledge on nutrition, 39% satisfactory and 28% poor. For child feeding practices, perceived responsibility had the highest mean score (M=3.99, SD=0.72), while perceived child weight had the lowest (M=2.94, SD=0.38). The prevalence of possible risk of overweight, being overweight, and obesity were 3.9%, 7.9% and 8.1%, respectively, whereas the prevalence of underweight and stunting were 8.0% and 8.4%, respectively. Breakfast was the second most frequently skipped meal (16.8%) after dinner (18.1%). The mean cognitive score was 103.5 (SD=14.4). Height-for-age and consumption of dinner were found to contribute significantly towards cognitive performance after controlling for socio-demographic background and parent’s nutrition knowledge.

Out-of-pocket costs for facility-based maternity care in three African countries

OBJECTIVE To estimate out-of-pocket medical expenses to women and families for maternity care at all levels of the health system in Burkina Faso, Kenya and Tanzania. METHODS In a population-based survey in 2003, 6345 women who had given birth in the previous 24 months were interviewed about the costs incurred during childbirth. Three years later, in 2006, an additional 8302 women with recent deliveries were interviewed in the same districts to explore their maternity care-seeking experiences and associated costs. The majority of women interviewed reported paying out-of-pocket costs for facility-based deliveries. Out-of-pocket costs were highest in Kenya (a mean of US$18.4 for normal and complicated deliveries), where 98% of women who delivered in a health facility had to pay some fees. In Burkina Faso, 92% of women reported paying some fees (mean of US$7.9). Costs were lowest in Tanzania, where 91% of women reported paying some fees (mean of US$5.1). In all three countries, women in the poorest wealth quintile did not pay significantly less for maternity costs than the wealthiest women. Costs for complicated delivery were double those for normal delivery in Burkina Faso and Kenya, and represented more than 16% of mean monthly household income in Burkina Faso, and 35% in Kenya. In Tanzania and Burkina Faso most institutional births were at mid-level government health facilities (health centres or dispensaries). In contrast, in Kenya, 42% of births were at government hospitals, and 28% were at private or mission facilities, contributing to the overall higher costs in this country compared with Burkina Faso and Tanzania. However, among women delivering in government health facilities in Kenya, reported out-of-pocket costs were significantly lower in 2006 than in 2003, indicating that a 2004 national policy eliminating user fees at mid- and lower-level government health facilities was having some impact.

Resource utilization and costs in osteoporosis

Osteoporosis is characterized by low bone mass, deterioration of the microarchitecture of the bone tissue and increase susceptibility to fractures. Clinical manifestations are fractures and their complications. The most common fractures are hip,spine and wrist, although any bone is susceptible. To assess the resource utilization and the annual costs incurred by patients with postmenopausal osteoporosis One hundred consecutive patients were studied in the Universidade Federal de São Paulo. The inclusion criteria were: postmenopausal osteoporosis (WHO 1994) for at least one year b) at least one year attending the outpatient clinic, minimal comprehensive and speaking conditions. The socioeconomic and clinical characteristics, the resource utilization and costs in the last year were assessed using 2 questionnaires. The unitary costs were based in the Public Healthcare System Index (1998). The mean age was 66 years and the monthly family income was R$ 534.14 (US$ 456 - in 1998). There was a mean of 7 visits/patient/ year. 77% of the patients used calcium and 38% used estrogens. The mean total annual costs for osteoporosis treatment, considering societal perspective, were R$ 908.18 (US$ 776-in 1998) per patient per year. The costs related to osteoporosis treatment represented 11% of the mean monthly household income from the patients' perspective (R$ 534=US$ 456). As the population is ageing and the osteoporosis incidence is increasing, health policy should be implemented to rationally allocate the scarce resources available, based on economic analysis.