Multilevel Logistic Regression Models Research Articles

Factors affecting treatment decisions for endoscopically resected low- and high-risk malignant colorectal polyps in a screening setting

IntroductionThe European Guidelines for colorectal cancer screening of 2006 state that only high-risk endoscopically resected malignant colorectal polyps (MCPs), defined as poor/no differentiation or positive resection margins or lymphovascular invasion, require colonic resection. MethodsA multicentre series of 954 patients with screen-detected MCP (northern Italy, 2005–2016, age 50–69) was studied to identify (1) the factors affecting the choice of colonic resection, and (2) the factors associated with deviation from the European Guidelines for low- and high-risk patients. Data analysis was based on multilevel logistic regression models. ResultsFive hundred sixty-four (59.1 %) patients underwent colonic resection. The factors significantly associated with surgical referral included: distal and rectal versus proximal tumour site (inverse association); sessile and flat versus pedunculated morphology (direct association); tumour size (direct); moderate/poor versus good differentiation (direct); adenocarcinoma of not otherwise specified type versus adenocarcinoma with a residual adenoma component (direct); positive versus negative resection margins (direct); lymphovascular invasion (direct); and high-grade versus low-grade/absent tumour budding (direct). In low-risk MCPs, tumour budding encouraged strongly the decision for surgery. In high-risk MCPs, a distal/rectal tumour site encouraged the follow-up option. ConclusionThe identification of factors associated with treatment choices other than those currently recommended may help prioritise the clinical questions in the development of future guidelines.

Effect of arthroscopic partial meniscectomy on structural degeneration of the knee – A 5-year MRI-based follow-up of the placebo-surgery controlled FIDELITY (Finnish Degenerative Meniscus Lesion Study) trial

ObjectiveTo assess the 5-year effects of arthroscopic partial meniscectomy (APM) vs. placebo-surgery on the development of the structural changes of the knee by MRI. DesignThis multicentre, randomized, participant- and outcome-assessor-blinded, placebo-surgery-controlled trial was carried out in Finland. We randomized 146 adults, mean age 52 years (range 35 to 65) to undergo either APM or placebo surgery. The subjects had symptoms of degenerative medial meniscus tear, a tear verified in MRI and arthroscopy, and no advanced osteoarthritis at baseline. We compared the baseline and 5-year follow-up MRIs using MRI Osteoarthritis Knee Score (MOAKS) scoring to derive subregional data on cartilage damage, osteophytes and bone marrow lesions (BMLs). Progression of structural cartilage changes analysed per subregion was the main outcome, that of osteophytes and BMLs secondary outcomes. We analysed the progression with multilevel logistic regression model on subregion level data, adjusted for randomization stratification factors, and using robust standard errors. ResultsSixty-three (90%) subjects in the APM and 73 (96%) in the placebo-surgery group had MRI at both time points. The adjusted odds ratio (APM vs. placebo-surgery) was 1.31 (95% confidence interval 0.81, 1.94) for progression of cartilage damage, 2.86 (1.16, 6.21) for osteophytes, and 1.43 (0.84, 2.43) for BMLs. ConclusionsWe found a slightly greater risk for progression of osteophytes in the APM group compared to the placebo-surgery group at 5 years after surgery. Trial registrationClinicalTrials.gov (NCT01052233 and NCT00549172).

Examining the impact of daily discrimination on alcohol use among racially diverse, trauma-exposed sexually minoritized adults: A pilot study.

Identity-based stress and trauma are key drivers of alcohol use-related health inequities among minoritized people. Research on intersectional experiences of identity-based stress and alcohol use among trauma-exposed minoritized people is scant. This pilot study used a 30-day diary design to examine the effect of identity-based discrimination exposure on alcohol use in a racially diverse sample of trauma-exposed sexual minoritized (SM) adults (N = 47; 63.8% cisgender female; 65.2% Black, Indigenous, and People of Color [BIPOC]). Multilevel logistic regression models were used to evaluate whether days marked by any (vs. no) identity-based discrimination were concurrently or prospectively associated with increased likelihood of reporting a higher (vs. lower) level of drinking-and whether these associations differed by race/ethnicity. Discrimination was associated with increased likelihood of reporting a higher level of same-day drinking (B = 0.91, p = .03), but did not predict next-day drinking. BIPOC (vs. White) individuals were less likely to report a higher drinking level on or following nondiscrimination days (Bs = -2.18 to -1.52, ps ≤ .005), but more likely to do so on or following discrimination days (Bs = 1.13-1.60, ps ≤ .03). Results suggest that everyday discrimination may create insidious risk for coping-motivated alcohol use among SM BIPOC, a subgroup that otherwise exhibits resilience with respect to drinking. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Exclusive and dual use of electronic cigarettes among European youth in 32 countries with different regulatory landscapes

BackgroundThe Tobacco Products Directive (2014/40/EU) partially harmonised the regulation of electronic cigarettes (e-cigarettes) in Europe, but individual countries maintain jurisdiction over bans on use in public places, domestic advertising, taxation...

서울시 인구변화와 중고령기 수면건강 - 외국인 밀집정도와 지역사회 응집력의 상호작용을 중심으로

This study examines whether neighborhood demographic characteristics are associated with sleep health among Korean older adults and whether this association is moderated by neighborhood social cohesion. Data are drawn from the 2019 Seoul Survey Data (SSD) merged with various sources of contextual data to assess information on population loss, age structure and immigrant concentration at the Gu level (N=20,319). We defined poor sleep health as respondents reporting six hours or less of sleep (coded 1; otherwise 0) Results from multilevel logistic regression model indicated that older adults who live in neighborhoods with high levels of immigrant concentration are more likely to experience poor sleep health. However, this association was mitigated by neighborhood social cohesion, such that those who have high levels of neighborhood social cohesion appear to be less influenced by immigrant concentration. This study suggests that neighborhood social cohesion may play a buffering role in minimizing the negative influence of neighborhood immigrant concentration on sleep health among older adults in Korea. Social policy and intervention aimed at promoting social cohesion may help reduce further disparities in poor sleep health in later life.

Early neonatal mortality and determinants in Ethiopia: multilevel analysis of Ethiopian demographic and health survey, 2019

IntroductionDespite remarkable achievements in improving maternal and child health, early neonatal deaths still persist, with a sluggish decline in Ethiopia. As a pressing public health issue, it requires frequent and current studies to make appropriate interventions. Therefore, by using the most recent Ethiopian Mini Demographic Health Survey Data of 2019, we aimed to assess the magnitude and factors associated with early neonatal mortality in Ethiopia.MethodsSecondary data analysis was conducted based on the demographic and health survey data conducted in Ethiopia in 2019. A total weighted sample of 5,753 live births was included for this study. A multilevel logistic regression model was used to identify the determinants of early neonatal mortality. The adjusted odds ratio at 95% Cl was computed to assess the strength and significance of the association between explanatory and outcome variables. Factors with a p-value of < 0.05 are declared statistically significant.ResultsThe prevalence of early neonatal mortality in Ethiopia was 26.5 (95% Cl; 22.5–31.08) per 1000 live births. Maternal age 20–35 (AOR, 0.38; 95% Cl, 0.38–0.69), richer wealth index (AOR, 0.47; 95% Cl, 0.23–0.96), having no antenatal care visit (AOR, 1.86; 95% Cl, 1.05–3.30), first birth order (AOR, 3.41; 95% Cl, 1.54–7.56), multiple pregnancy (AOR, 18.5; 95% Cl 8.8–38.9), presence of less than two number of under-five children (AOR, 5.83; 95% Cl, 1.71–19.79) and Somali region (AOR, 3.49; 95% Cl, 1.70-12.52) were significantly associated with early neonatal mortality.ConclusionThis study showed that, in comparison to other developing nations, the nation had a higher rate of early newborn mortality. Thus, programmers and policymakers should adjust their designs and policies in accordance with the needs of newborns and children’s health. The Somali region, extreme maternal age, and ANC utilization among expectant moms should all be given special consideration.

State-Level LGBTQ + Policies and Experiences of Interpersonal Discrimination among Sexual and Gender Minority People

ObjectivesTo quantify the role of state-level lesbian, gay, bisexual, transgender, and queer (LGBTQ+)-related policies on experiences of discrimination in a population-representative sample of partnered individuals.MethodsAn adjusted multilevel random-intercept logistic regression model with individuals (level-1) nested within states (level-2) and a cross-level interaction term between gender/sexual identity and policy score was used to estimate the predicted probability of any experiences of discrimination for cisgender heterosexual, transgender and non-binary, and cisgender sexual minority respondents.ResultsExperiences of discrimination in the past month were more common amongst transgender and non-binary (90.2%) respondents compared to their cisgender sexual minority (74.0%) or cisgender heterosexual (73.2%) counterparts. When compared to cisgender heterosexual respondents, the interaction term was found to be statistically significant for only transgender and non-binary (OR = 0.93, 95% CI [0.88, 0.98]) but not cisgender sexual minority respondents (OR = 0.99, 95% CI [0.97, 1.01]). Indicating that as state policy environments became more protective the odds of experiencing discrimination decreased at a more substantial rate for transgender and non-binary respondents when compared to cisgender sexual minority or cisgender heterosexual respondents.ConclusionsTransgender and non-binary individuals experience more discrimination compared to their cisgender sexual minority or cisgender heterosexual counterparts. State-level LGBTQ + policy protections amplified the relationship between gender identity and experiences of discrimination.

Factors Associated with the Access and Use of Improved Latrine Facilities in Tanzania

Access to improved latrine facilities is a basic human right and fundamental to good health. Inadequate sanitation practices cause serious health problems especially transmission of diarrhea. The study aimed to determine associated factors with access to and use of improved latrine facilities in Tanzania. The data for this study was obtained from the 2022 Tanzania Demographic and Health Survey and Malaria Indicator Survey (2022 TDHS-MIS) by visiting https://www.dhsprogram.com. Data were analyzed using STATA Version 16, whereby a multilevel logistic regression model was chosen as the statistical approach. The study revealed that overall 67.76% of the households had access to improved latrines. The study revealed that head of households with higher education, rich 55+ years and with television had higher odds of using improved toilets compared to others. The study concludes that more than half of the households in Tanzania had access to an improved latrine which is not common in most developing countries, especially in sub-Saharan Africa, and thus can be used as a reference for learning. This implies the government and stakeholders’ interventions have brought positive changes. Hence, the need of policy enforcement in specific areas as well as government and stakeholders creating awareness campaigns to enable more households’ access to improved latrine in both rural and urban areas

Choice intention for the national volume-based procurement drug and its associated factors: a cross-sectional study on patients with late-life depression in China

BackgroundThe national volume-based procurement (NVBP) policy has significantly decreased prices and increased the accessibility of NVBP drugs. Nevertheless, issues such as heightened adverse reactions and suboptimal efficacy have arisen. Concerns regarding the quality of low-cost medications and the absence of long-term research have been widely recognized. This has led to caution among patients with late-life depression (LLD) due to their delicate health and the severity of their condition. This study evaluated the choice intention for NVBP drugs and associated factors in older patients with LLD.MethodsA weighted sample of 408 participants between December 2022 and March 2023 were included. Data were collected via face-to-face interviews and questionnaires. To identify significant associated factors of choice intention, a multilevel logistic regression model was employed.ResultsOver half (53.68%) of older patients with LLD intended to choose NVBP drugs. Associated factors included self-assessed poor economy, higher out-of-pocket expenses, monthly household income exceeding CNY 6000, absence of other non-communicable chronic diseases, ordinary registration, urban employee medical insurance, no requirements for brand-name drugs, adverse reactions after using NVBP drugs, and rejection of physicians’ recommendation for NVBP drugs. The interaction effect between the real economic condition and patients self-assessed economy significantly influences choice intention for NVBP drugs. Among 124 patients with self-assessed poor economy, 75 showed a higher intention to use NVBP drugs. In these patients, age, medical insurance reimbursement, and brand awareness were significantly associated with choice intention.ConclusionEconomic factors, physical conditions, medical needs, and physician recommendations significantly influenced the choice intention for NVBP drugs. The choice intention can be improved by strengthening physician-patient communication, increasing the scope and proportion of medical insurance reimbursement, improving substitution studies, and conducting post-marketing re-evaluations of NVBP drugs.

Parental Educational Homogamy and Children’s Tertiary Education in Europe

In this paper, we examine (1) whether parental educational homogamy is associated with children’s tertiary educational attainment in different European countries and (2) whether this association is moderated by families’ educational backgrounds. Using data from the European Social Survey and multilevel logistic regression models, we find that parental homogamy is important for children’s tertiary educational attainment. In particular, children of more highly educated homogamous parents are more likely to obtain a tertiary degree themselves. This parental homogamy association varies across countries. While the association is below the European average in Czechia, Austria, Hungary, Italy, Switzerland, and Germany, it is equal or close to average in Slovenia, Estonia, France, Poland, Ireland, Sweden, and Lithuania, and above average in Spain, Finland, the Netherlands, Portugal, the United Kingdom, Norway, and Belgium. Our findings suggest that parental educational constellations should be examined more closely in further education inequality research. * This article belongs to a special issue on “Changes in Educational Homogamy and Its Consequences”.

Domestic violence and associated factors among pregnant women in sub-Saharan African countries from the recent demographic and health survey data: a multilevel analysis.

Intimate partner violence (IPV) is a human rights violation that often involves violence against women, which appears to be the most prevalent type of abuse. IPV is a global public health issue with major human rights violations. Pregnant women's IPV needs special consideration because of the possible harm that might happen to mothers and their fetuses. The enormous global public health issue of IPV affects physical, mental, and sexual transgressions. Even though there were studies conducted on IPV among women, few studies were conducted among pregnant women in sub-Saharan African countries. Therefore, this study revealed IPV and associated factors among pregnant women from the recent Demographic and Health Survey (DHS) in sub-Saharan African countries. Multilevel logistic regression analysis used data from the recent sub-Saharan African countries DHS was carried out using this secondary data. For this study, pregnant women between the ages of 15 and 49 were included; the total sample size was 17,672. Multilevel logistic regression models were calibrated to determine the associated factors at the individual and community level with IPV, with a 95% CI and AOR. The prevalence of IPV among pregnant women in 23 sub-Saharan African countries was 41.94%, with a 95% CI of 40.82 to 43.06%. Poorer and poorest [AOR = 1.92; 95% CI: (1.01, 3.67)] and [AOR = 2.01; 95% CI:(1.02, 3.92)], partner alcohol drink [AOR = 3.37;95% CI:(2.21, 5.14)], and no partner education [AOR = 2.01;95% CI:(1.12, 3.63)] were statistically associated factors with IPV among pregnant women. The prevalence of IPV among pregnant women in sub-Saharan African countries was high (41.94%). Low economic status, partner drinking alcohol, and partner no education were the associated factors of IPV. This finding provides clues for policymakers and other organizations concerned about women.

Spatial distribution and determinants of exclusive breastfeeding practice among mothers of children under 24 months of age in Ethiopia: spatial and multilevel analysis

BackgroundBreast milk is the first, highly valuable, and solely natural food recommended for infants in their first six months of life, which is critical for children's overall growth and development. Evidence suggests that exclusive breastfeeding differs by geographic area in Ethiopia. However, little is known regarding the geographic distribution of exclusive breastfeeding practice. Hence, this study aimed to assess exclusive breastfeeding practice, its geographic variation and associated factors among Ethiopian mothers.MethodThe study used the 2019 Ethiopian mini demographic and health survey data. All living children born 0–23 months before the survey were included. Global Moran’s I statistics on Arc-GIS and Getis Ord Gi* statistics was used to visualize the spatial pattern and hotspot and cold spot areas, respectively. Kulldorff SaTScan was used to show purely significant spatial clusters. The associated factors were identified using a multilevel mixed-effects logistic regression model. Statistically significant factors were reported using the AOR with a 95% CI and a p-value of < 5%.ResultThe coverage of exclusive breastfeeding practice in Ethiopia was 56.05% (95% CI: 53.95%, 58.10%). The spatial pattern was non-random across the country’s regions. Somalia, Gambela, Benshangul Gumuz, Dire Dawa, and Harari regions had low clustering of exclusive breastfeeding practices, whereas Amhara, Eastern SNNPR, and Central and Northern Oromia regions had high clustering. Children born through caesarean delivery [AOR = 0.36; 95% CI: 0.21, 0.63], initiated breastfeeding within the first 1 h [AOR = 0.55; 95% CI: 0.34, 0.90], after 1–24 h of delivery [AOR = 0.36; 95% CI: 0.24, 0.54], after a day [AOR = 0.04; 95% CI: 0.02, 0.08], and women residing in the pastoralist region [AOR = 0.22; 95% CI: 0.12, 0.39] or city administrations [AOR = 0.49; 95% CI: 0.27, 0.89] had lower odds of exclusive breastfeeding practice.ConclusionExclusive breastfeeding practice in Ethiopia remained low. The practice had a spatial variation across the country. Caesarean section delivery, late breastfeeding initiation, and region were statistically significant variables. Therefore, promoting timely initiation of breastfeeding and improving the utilization of maternal health services and designing special intervention strategy for women residing in city administrations and pastoralist regions of the country may increase the coverage of exclusive breastfeeding practice.

Difficulty with mobility among the aged in Ghana: Evidence from Wave 2 of the World Health Organization's Study on Global Ageing and Adult Health.

Globally, the population is rapidly ageing, stemming from a recent decline in mortality, and an increase in life expectancy. About 727 million people globally were aged ≥65 in 2020, and 1 in 6 people will be ≥65 years by 2050. About 7% of Ghana's population was over 60 years in 2010, and projected to be 12% by 2050. However, the aged are confronted with degenerative conditions that translate into difficulty with mobility. The study was conducted to investigate the difficulty with mobility among the aged in Ghana. The study utilised a cross-sectional dataset of the 2014/2015 (wave 2) Study on Global Ageing and Adult Health and included 1,856 participants aged ≥50 years. The survey command was applied to adjust for sampling biases and the design of the study. At 5% alpha level, a chi-square test of independence was conducted to determine the association between dependent and independent variables. At 95% confidence interval and 5% alpha level, three-level multilevel logistic regression models were performed. The fixed-effects were presented in odds ratio and the random effects were presented using the Intra-Class Correlation. All analysis were performed using STATA statistical software version 16.0. Out of the 1,856 participants, 40.3% had difficulty with mobility. Additionally, age (80 and above) [AOR = 3.05, 95%CI = 1.78-5.22], self-reported poor/bad health status [AOR = 2.39, 95%CI = 1.35-4.23], having severe/extreme difficulty performing household activities [AOR = 25.12, 95%CI = 11.49-44.91], experienced severe/extreme bodily pains [AOR = 4.56, 95%CI = 2.16-9.64], severe/extreme sleep problems [AOR = 4.15, 95%CI = 1.68-10.29], and participants with difficulty with sight/vision [AOR = 1.56, 95%CI = 1.16-2.10] had higher odds of difficulty with mobility. The aged in Ghana had relatively higher prevalence (40.3%) of difficulty with mobility which is influenced by demographics, health status, and degeneration associated with ageing. This highlights the need to provide social support and strengthen social capital for the aged in Ghana, especially those with difficulty with vision, experiencing bodily pains and had poor health status. Additionally, the Government and stakeholders should provide assistive devices for the aged and geriatric care including recreational fields and care homes to address the health and physical needs of the aged in Ghana.

Longitudinal relationships between early-life homelessness and school-aged asthma and wheezing

BackgroundHomelessness is a disruptive life event with profound impacts on children’s health. It remains unclear, however, whether homelessness in early life has an enduring association with asthma and wheezing among...

Overnutrition and associated factors among women of reproductive age in Sub-Saharan Africa: A hierarchical analysis of 2019–2023 standard demographic and health survey data

ObjectivesOvernutrition, a leading cause of global mortality, has seen a significant rise in low- and middle-income countries, including sub-Saharan Africa. Despite emerging evidence linking overnutrition to non-communicable diseases, limited action has been taken to address this issue. While undernutrition studies have received more attention, research on overnutrition and women's health remains scarce in sub-Saharan Africa. Our study aims to assess the prevalence and associated factors of overnutrition among reproductive women in this region MethodsWe conducted a secondary analysis of 2019–2023 Demographic and Health Survey datasets in sub-Saharan Africa. Our study included a weighted sample of 65,161 women aged 15–49 y. Using a multilevel mixed-effects logistic regression model, we identified factors associated with overnutrition. The adjusted odds ratio, along with a 95% confidence interval and a significance level of p < 0.05, determined the statistical significance of the explanatory variables. ResultsThe pooled prevalence of overnutrition among women of reproductive age in sub-Saharan Africa was 34.79% (95% CI: 34.42–35.16). Specifically, the prevalence of overweight and obesity was 21.81% and 12.99%, respectively. Women's educational status, age, media use, household wealth, urbanization, community poverty, and country income level were significantly associated with higher odds of overnutrition. ConclusionsThe prevalence of overnutrition among women of reproductive age in sub-Saharan Africa is relatively high. Key factors associated with this issue include women's educational status, age, media utilization, household wealth, place of residence, community poverty level, and national income status. These multilevel determinants highlight the need for a comprehensive, evidence-based approach to address overnutrition in this population. Effective strategies should target individual behaviors while considering broader social, economic, and environmental contexts. Integrating overnutrition prevention into maternal and reproductive health services, as well as strengthening social protection measures, are recommended steps to tackle this growing challenge in sub-Saharan Africa.

Assessing the impact on quality of prediction and inference from balancing in multilevel logistic regression

The primary goal of this research is to examine the impact of balancing data on the prediction quality and inference in multilevel logistic regression models. Logistic regression is a valuable approach for modeling binary outcomes expected in health applications. The class imbalance problem, where one of the two outcome categories occurs much more often than the other, is common in healthcare data, such as when modeling the risk factors for rare diseases. The issue is particularly relevant for medical data that contains individual measurements and other data sources measured at a geographic region level, such as environmental risk factors. For this work, both prediction and model interpretation are of interest. A simulation model is proposed to test the impact of balancing strategies on the logistic multilevel model's parameter estimation, inference, and predictive performance. The simulated information emulates characteristics of a Gestational Diabetes Mellitus (GDM) dataset from Indiana's Medicaid program. Several datasets were simulated with varying levels of complexity, involving the balance of the outcome variable and predictors. These datasets exhibited high- or low-frequency occurrences in specific intersections of variables, often called ‘cells.’ The impact of the balancing strategies on prediction and inference was assessed using different techniques, such as the Equivalence (TOST) Test, power analysis, and predictive measures. To the best of our knowledge, this is the first research that explores the impact of using balanced samples on coefficient estimation and prediction measures when using logistic multilevel modeling, finding evidence about the benefits of using balanced samples in this context.

Idiosyncratic entrenchment: tracing change in constructional schematicity with nested random effects

Abstract Usage-based constructionist approaches see language as an inventory of constructions at different levels of schematicity learned from the input. If so, personal constructicons should vary as a function of usage. Repeated use and chunking/entrenchment of concrete instances should lead to reanalysis of their internal structure and change in the level of schematicity. This paper exploits the reduction probability of is in it is as a diagnostic of reanalysis in a 1.75-million-word diachronic corpus of a single blogger over 8 years. All instances of it is/it’s (n = 10,929) were annotated at the constructional and lexical levels. A multilevel logistic regression model showed significant fixed effects of constructional entropy and construction-to-word association on reduction probability. Importantly, there remained substantial variation across lexical types of constructions in the extent to which they associated or became associated with reduction over time, suggesting idiosyncratic entrenchment and potential reanalysis as a function of usage.

God and Group: The Religious Ecology of Hate Crimes Against Jews and Muslims in the United States

In the United States, hate crimes that are motivated by religious bias disproportionately impact minoritized religious groups. This study investigates religious ecological predictors of hate crimes against Jews and Muslims in the US, drawing on theories of religion and intergroup offending. Measures of areal religious composition and change are drawn from two waves of the US Religion Census. Multilevel logistic regression models predict incidence of anti-Jewish and anti-Muslim hate crimes across county-years (2010–2018), adjusting for law enforcement agency coverage, hate crime reporting, and social and political factors. Christian adherence and overall religious diversity are associated with lower incidence of anti-Jewish hate crime. Jewish and Muslim adherence are positively associated with anti-Jewish and anti-Muslim hate crime, respectively, and counties undergoing relatively large increases in Muslim adherence have heightened incidence of anti-Muslim hate crime. Implications for theory and policy, as well as opportunities for future research, are discussed.

Healthcare services access challenges and determinants among persons with disabilities in Bangladesh

Persons with disabilities in LMICs facing numerous challenges in accessing essential healthcare services. However, this understanding is lacking so far in LMICs and Bangladesh. This study aimed to explore the pattern and determinants of healthcare services access among persons with disabilities in Bangladesh. We analysed data from 4293 persons with disabilities extracted from the 2021 National Survey on Persons with Disabilities. The outcome variable was healthcare services access within three months of the survey, categorized as either “yes” or “no” based on perceived needs. Several individual, household, and community-level factors were considered as explanatory variables. We utilized a multilevel mixed-effect logistic regression model to explore the association of the outcome variable with explanatory variables. The analysis included stratification by age groups: 0–17 years and 18–95 years. One out of every four persons with disabilities in Bangladesh reported that they could not access healthcare services based on their needs within three months of the survey. The main reasons for not accessing services were healthcare costs (52.10%), followed by lack of family support (27.0%), and absence of healthcare facilities in their areas of residence (10.10%). Among those who did receive healthcare services, the majority reported accessing them from governmental hospitals (26.49%), followed by village practitioner (20.52%), and private healthcare centres (19.87%). There was a higher likelihood of accessing healthcare services among persons with disabilities residing in households with higher wealth quintiles and living in the Chattogram and Sylhet divisions. Unmarried or divorced/widowed/separated persons with disabilities reported lower likelihoods of accessing healthcare services. The findings of this study emphasize the need for policies and programs to ensure healthcare services for persons with disabilities in Bangladesh. This entails raising awareness about the importance of providing healthcare services for this demographic, as well as considering healthcare services as part of social safety net programs.

Prevalence and factors associated with anemia among HIV-infected women in sub-saharan Africa: a multilevel analysis of 18 countries

BackgroundDespite the intended 50% reduction in anemia in women of reproductive age, this tendency has only worsened. Even though iron deficiency is the most prevalent cause of anemia, anemia and chronic illnesses like HIV are closely associated; in fact, 48.6% of people living with HIV who were 15 years of age or older had anemia. However, the burden of anemia among HIV-positive women in sub-Saharan African (SSA) countries is not well documented. Therefore, the goal of our research was to investigate anemia and the factors that are linked to it in SSA women who had HIV infections.MethodsA cross-sectional study was conducted using demographic and health survey datasets from 18 SSA countries. A total of 7823 weighted samples were included. STATA version 16 software was used for analysis. A multilevel logistic regression model was fitted. An adjusted odds ratio with a 95% CI and a p-value < 0.05 was used to declare significantly associated factors.ResultThe overall prevalence of anemia was found to be 45.1% [95% CI: 43.97–46.18%]. Of those 5.05%, 37.97%, and 56.97% were severely, moderately, and mildly anemic, respectively. Education level of primary [AOR = 0.74, 95% CI: 0.62, 0.89], secondary [AOR = 0.81, 95% CI: 0.68, 0.98], and higher [AOR = 0.74, 95% CI: 0.55, 0.99], as well as current contraceptive use [AOR = 0.74, 95% CI: 0.63, 0.87] were negatively associated with anemia. While pregnancy [AOR = 1.51, 95% CI: 1.17, 1.94], breast feeding [AOR = 1.38, 95% CI: 1.17, 1.64], health insurance [AOR = 1.50, 95% CI: 1.25, 1.80], and menstruation within six weeks prior to data collection [AOR = 1.36, 95% CI: 1.20, 1.54] had a significant positive relation with anemia among HIV-infected women in SSA countries.ConclusionAnemia is a serious public health problem among HIV-infected women in SSA countries. Pregnancy, breast feeding, health insurance, and menstruation within six weeks prior to data collection were significant risk factors. On the other education and current contraceptive use were significant protective factors for anemia among HIV-infected women in SSA countries. Therefore, strategies aimed at early identification of anemia may lead to an improvement in the health of HIV-infected women.