Multi-country Analysis Research Articles

Income and education disparities in childhood malnutrition: a multi-country decomposition analysis

IntroductionChildhood malnutrition is a complex issue with a range of contributing factors. The consequences of malnutrition are severe, particularly for children. This study aims to identify the factors contributing to inequality gaps in childhood malnutrition. Our study provides insights into modifiable elements to inform interventions targeted at distinct contexts and populations to improve child nutrition.MethodsThis study utilized data from the Demographic and Health Surveys (DHS) of 27 countries. First, the risk differences (RDs) between the prevalence of childhood malnutrition among the determinant variables, household income, and maternal education categories were calculated. The Blinder‒Oaxaca decomposition was subsequently used to determine the extent to which the difference in childhood malnutrition prevalence between low-income and high-income groups and maternal education levels results from the contributory effects of the explanatory variables: child and maternal individual-level compositional factors.ResultsWe examined data from 138,782 children in 27 countries from 2015 to 2020. The prevalence of childhood malnutrition (10.5%) varied across countries, ranging from 6.5% in Burundi to 29.5% in Timor Leste. On average, the prevalence of childhood malnutrition was 11.0% in low-income households and 10.7% among mothers without education. Some nations had pro-low-income (i.e., malnutrition concentrated among children from poor households) or pro-no-maternal education (i.e., malnutrition concentrated among children from mothers with no formal education) inequality in childhood malnutrition, but most did not. We found a complex interplay of compositional effects, such as the child’s age, maternal education, maternal health behavior, and place of residence, that influence the inequality in childhood malnutrition rates across 10 pro-low-income countries. In addition, we also found that a complex mix of compositional effects, such as the household wealth index, maternal health behavior, and maternal age, contribute to childhood malnutrition inequality between educated and uneducated mothers across the 7 pro-no maternal education countries.ConclusionThe prevalence of childhood malnutrition varies among low-income, high-income, and no maternal education-maternal education groups. This study highlights the need for a country-specific approach to addressing childhood malnutrition, with policies and interventions tailored to each country’s specific context.

How likely are Eastern European and central Asian countries to achieve global NCD targets: multi-country analysis

BackgroundIn Europe, mortality rates from noncommunicable diseases (NCDs) among persons 30–69 years of age (“NCD premature mortality rates”) have declined significantly, except in twelve countries of Eastern Europe and Central Asia, namely Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, Tajikistan, Turkmenistan, Ukraine and Uzbekistan. Data on long-term trends in NCD mortality in these countries are limited. We analyzed NCD premature mortality rates, identified change points in NCD mortality trends and forecasted how likely countries are to achieve the global NCD targets, stratified by gender and NCD type.MethodsWe used the 1990–2019 Global Burden of Disease database to analyze NCD trends and identified country-specific change points by using piecewise linear regression. We assessed the likelihood of achieving the global targets for reducing NCD premature mortality rates among persons 30–69 years of age from four NCDs: cancers, diabetes, cardiovascular and chronic respiratory diseases. The global NCD targets are 25% reduction in mortality from 2010 to 2025 (WHO 25X25 target) and 33%—from 2015 to 2030 (SDG 3.4.1). We applied the analysis to both genders and four NCDs.ResultsOnly Kazakhstan and Russia are likely to achieve the global NCD targets. For Kazakhstan, WHO 25X25 and SDG 3.4.1 global targets for mortality rates were 494.3 and 374.8 per 100,000 population respectively; the corresponding predicted values (PVs) were 360.6 [CI 260.1–461.1] and 245.1 [CI 113.4–376.8]. For Russia, WHO 25X25 and SDG 3.4.1 global targets were 560.5 and 442.8 per 100,000 population respectively; the corresponding PVs were 427.7 [CI 270.3–585.1] and 311.0 [CI 102.8–519.1]. Achieving NCD global targets is less likely for Kyrgyzstan, while it is unlikely for the rest of countries. Most countries had higher mortality rates and slower progress among men compared with women. The likelihood of achieving overall global NCD targets was mainly explained by reduction in cardiovascular mortality.ConclusionsIn most Eastern Europe and Central Asia countries, progress towards achieving NCD global targets is slow, or there’s a reverse trend. Further quantitative and qualitative research is needed to understand the underlying reasons. Separate indicators are needed to monitor trends for cancers, diabetes and chronic respiratory diseases.

Cross-context equivalence and agreement of healthy diet metrics for national and global monitoring: a multicountry analysis of cross-sectional quantitative 24-hour dietary intake studies

Cross-context equivalence and agreement of healthy diet metrics for national and global monitoring: a multicountry analysis of cross-sectional quantitative 24-hour dietary intake studies

Sustainable crowdfunding and cultural contexts: Evidence from a longitudinal multi-country analysis

Crowdfunding platforms are increasingly sensitive to sustainable practices. However, the connections between these platforms and sustainability remain under-researched. This study examines how the sustainability orientation of equity crowdfunding platforms influences their performance. Conducting a longitudinal analysis based on 573 platforms in 37 OECD countries over the 2008–2023 period, we document that social-oriented platforms outperform their counterparts. Platforms operating in countries with a more individualist and masculine culture gain less from their social orientation. We contribute to research and inform practitioners by showing that crowdfunding platforms benefit from engaging with sustainability issues and that cultural contexts matter for promoting sustainable crowdfunding.

63 - The relationship between use of digital food retail environments and associated sociodemographic characteristics: a multi-country analysis

63 - The relationship between use of digital food retail environments and associated sociodemographic characteristics: a multi-country analysis

Addressing diagnostic uncertainty and excellence in emergency care—from multicountry policy analysis to communication practice in Australian emergency departments: a multimethod study protocol

IntroductionCommunication failings may compromise the diagnostic process and pose a risk to quality of care and patient safety. With a focus on emergency care settings, this project aims to examine...

Climate finance spillovers and entrepreneurship in developing countries

AbstractResearch SummaryWe conduct a multicountry analysis and show that there is a strong and significant positive relationship between climate finance and entrepreneurship, even after controlling for conventional macroeconomic and institutional factors commonly reported in the literature. Specifically, a 10% increase in climate finance is linked with a 2% increase in entrepreneurial activity across most countries. There are important heterogeneities in this nexus as it relates to fossil fuel exporting countries—the main “losers” from a global move away from fossil fuels. We find that although fossil fuel exporting countries exhibit notably faster rates of entrepreneurship growth, the interaction with climate finance in these countries is negatively related to entrepreneurial activity. This finding holds across different types of climate finance—adaptation and mitigation—highlighting its robustness.Managerial SummaryIt is often suggested that more finance will lead to more entrepreneurship. We conduct a multicountry analysis and add nuance to this notion. We find that although there is a strong and significant positive relationship between climate finance and entrepreneurship in most countries, this is not always true for fossil fuel exporting countries. Fossil fuel exporting countries, despite experiencing faster entrepreneurial growth, exhibit a negative interaction between climate finance and entrepreneurship. For managerial practice, these results emphasize the importance of targeted strategies in deploying climate finance. Policymakers and investors should consider nuanced approaches that address the specific economic dependencies and regulatory environments of fossil fuel exporting countries.

Biomarker relationships with small bowel histopathology among malnourished children with environmental enteric dysfunction in a multicountry cohort study

BackgroundValidated biomarkers could catalyze environmental enteric dysfunction (EED) research. ObjectivesLeveraging an EED histology scoring system, this multicountry analysis examined biomarker associations with duodenal histology features among children with EED. We also examined differences in 2-h compared with 1-h urine collections in the lactulose rhamnose (LR) dual sugar test. MethodsThree cohorts of undernourished children unresponsive to nutrition intervention underwent esophagogastroduodenoscopy and duodenal biopsies. Histopathology scores were compared to fecal calprotectin (CAL), myeloperoxidase (MPO), neopterin (NEO), and urinary LR ratio and lactulose percentage recovery. Log-transformed biomarkers were used in linear regressions adjusted for age, center, and sample collection–biopsy time interval in multivariable models. ResultsData on >1 biomarker were available for 120 Bangladeshi (CAL, MPO, NEO, and LR), 63 Pakistani (MPO, NEO, and LR), and 63 Zambian children (CAL). Median age at endoscopy was similar (19 mo) across centers. Median sample collection prior to endoscopy was consistent with each center’s study design: 2 wk in Bangladesh (urine and stool) and Zambia (stool), and 6 (urine) and 11 (stool) mo in Pakistan. In multivariable models, intraepithelial lymphocytes were associated with CAL (exponentiated [exp.] coefficient: 1.19; 95% confidence interval [CI]: 1, 1.41), intramucosal Brunner’s glands with MPO (exp. coefficient: 1.33; 95% CI: 1.05, 1.69) and NEO (exp. coefficient: 1.37; 95% CI: 1.1, 1.7), and chronic inflammation with NEO (exp. coefficient: 1.61; 95% CI: 1.17, 2.17). Intraepithelial lymphocytes were associated with lactulose % recovery (exp. coefficient: 1.22; 95% CI: 1.05, 1.41). LR recovery was substantially lower in 1-h collections than in 2-h collections. ConclusionsFour commonly used markers of enteric dysfunction were associated with specific histologic features. One-hour urine collection may be insufficient to reflect small bowel permeability in LR testing. While acknowledging the challenges with obtaining relevant tissue, these findings form the basis for further EED biomarker validation research.

Measuring the frequency and determinants of COVID-19 prevention behaviours: a cross-sectional assessment of large-scale programmes in seven countries, late 2020

ObjectivesThis multicountry analysis aimed to assess the prevalence of key hygiene prevention behaviours and their determinants, associated with international non-governmental organisation (WaterAid) hygiene behaviour change programmes for COVID-19 prevention. The...

Temporal Change in the Effects of Particulate Matter on Mortality: A Multi-City Multi-Country Analysis from 143 Cities Across 26 Countries

Temporal Change in the Effects of Particulate Matter on Mortality: A Multi-City Multi-Country Analysis from 143 Cities Across 26 Countries

From disruption to recovery: a multi-country analysis of tourism and hospitality firms’ performance post-COVID-19

ABSTRACT This study employs a discontinuous growth model, a method that captures shifts in trends over time, to explore how the performance of tourism and hospitality firms has evolved from the pre-COVID to the post-COVID period. It uncovers two key insights. Firstly, a substantial decrease in tourism and hospitality firms’ financial and market performance was evident in 2020. For instance, their return on assets in 2020 was 348% lower than in 2019. Secondly, while there was no improvement in their financial performance in 2021, a noteworthy improvement in market performance was observed. In 2022, both financial and market performance exhibited significant recovery. Remarkably, the degree of recovery in market performance in 2021 and financial performance in 2022 mirrored their respective declines in 2020, indicating a restoration of tourism and hospitality firms’ performance to the pre-crisis level. However, this restoration was not observable among firms with low liquidity, little retained earnings, and high financial constraints, suggesting that such firms may take actions (such as cost-cutting) that can lead to a decline in their quality of services and customer experiences. Therefore, this study underscores the importance of government support to some tourism and hospitality firms even in the aftermath of the COVID-19 crisis.

The underlying signals of efficiency in European universities: a combined efficiency and machine learning approach

ABSTRACT This study explores the critical determinants of efficiency in European Higher Education Institutions (HEIs). The contemporary landscape presents a wide range of challenges and opportunities, necessitating unprecedented levels of efficiency. Our primary objective is to unravel the fundamental elements that drive the efficiency of European HEIs. To achieve this, we employ a novel methodological approach, integrating Data Envelopment Analysis (DEA) with a Machine Learning technique, specifically Feature Selection. This combination sheds new light on areas previously less explored in DEA, including the intricate interplay among variables. Our empirical investigation contributes to the academic discourse by presenting a comprehensive, multi-country analysis from a multifaceted viewpoint. We assess the efficiency levels of European universities, highlighting the influence of factors such as student fee funding, Ph.D. program intensity, and international mobility on achieving high efficiency scores. The findings of this study have some implications for policy-making, suggesting strategies to enhance the efficiency levels of HEIs.

Are We Getting Any Closer to Including Men and Boys in Sexual and Reproductive Health? A Multi-Country Policy Analysis on Guidance to Action in East and Southern Africa

There has been growing recognition of the need to address the sexual and reproductive health (SRH) needs of men and boys, including a need for more explicit guidance in domestic health policy and plans. This paper reports on a policy analysis, covering five East and Southern African countries, and discusses the extent and ways in which male clinical and non-clinical needs, and their roles in SRH are currently being reflected. It draws attention to the policy discourse, trends, and gaps in including men in the region as clients, partners and change agents to inform a way forward.

All-cause, cardiovascular, and respiratory mortality and wildfire-related ozone: a multicountry two-stage time series analysis

Wildfire activity is an important source of tropospheric ozone (O3) pollution. However, no study to date has systematically examined the associations of wildfire-related O3 exposure with mortality globally. We did a multicountry two-stage time series analysis. From the Multi-City Multi-Country (MCC) Collaborative Research Network, data on daily all-cause, cardiovascular, and respiratory deaths were obtained from 749 locations in 43 countries or areas, representing overlapping periods from Jan 1, 2000, to Dec 31, 2016. We estimated the daily concentration of wildfire-related O3 in study locations using a chemical transport model, and then calibrated and downscaled O3 estimates to a resolution of 0·25° × 0·25° (approximately 28 km2 at the equator). Using a random-effects meta-analysis, we examined the associations of short-term wildfire-related O3 exposure (lag period of 0-2 days) with daily mortality, first at the location level and then pooled at the country, regional, and global levels. Annual excess mortality fraction in each location attributable to wildfire-related O3 was calculated with pooled effect estimates and used to obtain excess mortality fractions at country, regional, and global levels. Between 2000 and 2016, the highest maximum daily wildfire-related O3 concentrations (≥30 μg/m3) were observed in locations in South America, central America, and southeastern Asia, and the country of South Africa. Across all locations, an increase of 1 μg/m3 in the mean daily concentration of wildfire-related O3 during lag 0-2 days was associated with increases of 0·55% (95% CI 0·29 to 0·80) in daily all-cause mortality, 0·44% (-0·10 to 0·99) in daily cardiovascular mortality, and 0·82% (0·18 to 1·47) in daily respiratory mortality. The associations of daily mortality rates with wildfire-related O3 exposure showed substantial geographical heterogeneity at the country and regional levels. Across all locations, estimated annual excess mortality fractions of 0·58% (95% CI 0·31 to 0·85; 31 606 deaths [95% CI 17 038 to 46 027]) for all-cause mortality, 0·41% (-0·10 to 0·91; 5249 [-1244 to 11 620]) for cardiovascular mortality, and 0·86% (0·18 to 1·51; 4657 [999 to 8206]) for respiratory mortality were attributable to short-term exposure to wildfire-related O3. In this study, we observed an increase in all-cause and respiratory mortality associated with short-term wildfire-related O3 exposure. Effective risk and smoke management strategies should be implemented to protect the public from the impacts of wildfires. Australian Research Council and the Australian National Health and Medical Research Council.

Extreme Temperatures and Stroke Mortality: Evidence From a Multi-Country Analysis.

Extreme temperatures contribute significantly to global mortality. While previous studies on temperature and stroke-specific outcomes presented conflicting results, these studies were predominantly limited to single-city or single-country analyses. Their findings are difficult to synthesize due to variations in methodologies and exposure definitions. Within the Multi-Country Multi-City Network, we built a new mortality database for ischemic and hemorrhagic stroke. Applying a unified analysis protocol, we conducted a multinational case-crossover study on the relationship between extreme temperatures and stroke. In the first stage, we fitted a conditional quasi-Poisson regression for daily mortality counts with distributed lag nonlinear models for temperature exposure separately for each city. In the second stage, the cumulative risk from each city was pooled using mixed-effect meta-analyses, accounting for clustering of cities with similar features. We compared temperature-stroke associations across country-level gross domestic product per capita. We computed excess deaths in each city that are attributable to the 2.5% hottest and coldest of days based on each city's temperature distribution. We collected data for a total of 3 443 969 ischemic strokes and 2 454 267 hemorrhagic stroke deaths from 522 cities in 25 countries. For every 1000 ischemic stroke deaths, we found that extreme cold and hot days contributed 9.1 (95% empirical CI, 8.6-9.4) and 2.2 (95% empirical CI, 1.9-2.4) excess deaths, respectively. For every 1000 hemorrhagic stroke deaths, extreme cold and hot days contributed 11.2 (95% empirical CI, 10.9-11.4) and 0.7 (95% empirical CI, 0.5-0.8) excess deaths, respectively. We found that countries with low gross domestic product per capita were at higher risk of heat-related hemorrhagic stroke mortality than countries with high gross domestic product per capita (P=0.02). Both extreme cold and hot temperatures are associated with an increased risk of dying from ischemic and hemorrhagic strokes. As climate change continues to exacerbate these extreme temperatures, interventional strategies are needed to mitigate impacts on stroke mortality, particularly in low-income countries.

The critical role of the health-care sector in promoting employment for women and migrants in the EU. A multicountry input-output analysis

A disproportionate concentration of women in low-pay and low-status sectors is a trend that has grown in significance with the globalization of production systems. For the health and social care sector, this has interesting socio-spatial implications, particularly in terms of immigration, the dimensions of which are worth investigating. This study employs the novel extended multiregional input-output FIGARO database to estimate the employment-generating capacity of the sector in the EU28, with a focus on the gender and geographic origin of its workers. The analysis takes into account both indirect and induced effects and considers both cross-country and cross-sectoral linkages. The findings identify the healthcare sector as a key source of employment for both national and immigrant women in more than half of EU countries. At the same time, this sector contributes to the earnings disadvantage experienced by women, which suggest that equality policies should consider the sectoral distribution of employment.

Audit report lag during the COVID-19 pandemic: A multi-country analysis

Audit report lag during the COVID-19 pandemic: A multi-country analysis

Measuring Subjective Well-being Capability: A Multi-Country Empirical Analysis in Europe

Measuring Subjective Well-being Capability: A Multi-Country Empirical Analysis in Europe

A multicountry analysis of local government financial vulnerability during the 2020 pandemic considering systemic factors

AbstractThe COVID‐19 pandemic cut across geographical, sectorial, and policy boundaries and imposed difficult health, economic, and social challenges. Among many learnings, after the 2007–2008 global financial crisis and the austerity period that followed it, the economic and health crises forged by the COVID‐19 pandemic in 2020 offer an important experience to make local governments (LGs) more financially resilient and ready to deal with similar shocks.This paper builds on a recent framework to investigate the impact of the first wave of the COVID‐19 pandemic on LG financial vulnerability looking at both contingent and systemic aspects. It addresses the need for a multicountry perspective on the effects of the pandemic and responds to calls to test existing models. Seven countries were chosen to represent different administrative contexts and traditions to understand what factors impact the local level in a time of crisis. Results demonstrate that not only contingent aspects but also systemic factors and the initial level of financial vulnerability influenced the responses to the pandemic, confirming findings about the importance of initial conditions and “path dependency” by previous studies.

A cross-country analysis of decision-making factors influencing tourists’ shift towards circular destinations in EU-27

The end of the pandemic introduced paradigmatic changes in several application domains - including the tourism and hospitality industry - and revealed territorial differences across the EU-27 area. Hence, the main aim of this paper is analyzing how travel habits, social, territorial and cultural factors led tourists to shift toward more sustainable practices and circular destinations after COVID-19, with a specific focus on the detection of regional clusters based on cross-country differences. The multi-country comparative analysis is centered on the measurement of sustainability-/circularity-related constructs and is grounded in a unique theoretical framework, integrating Value-Belief-Norm Theory, Information Adoption Model and Theory of Planned Behaviour. We examined 25,711 responses from the Flash-Eurobarometer-499 questionnaire (June 2022), using multi-group partial-least-square structural equation models (MG-PLS-SEM). Moreover, we assessed hidden heterogeneity across EU-27 countries through segmentation techniques like Finite Mixture (FIMIX-PLS) and Prediction-Oriented Segmentation (PLS-POS) in order to identify homogenous territorial clusters. Findings show that more sustainable travel habits have emerged after COVID-19, and new, sustainable and cultural factors now influence destination choices, while people look for more information when planning trips, emphasizing circular practices on destinations. Also, six regional clusters were identified across EU-27 countries, suggesting that managers and policy-makers should adopt ad hoc measures to respond to the circular shift in the tourism and hospitality industry, depending on territorial differences.