Multiple Indicator Cluster Survey Data Research Articles

Child-level double burden of malnutrition in the MENA and LAC regions: Prevalence and social determinants.

Although the prevalence of obesity has rapidly increased in the low‐ and middle‐income countries of the Middle East and North Africa (MENA) and Latin America and the Caribbean (LAC) regions, child undernutrition remains a public‐health challenge. We examined region‐specific sociodemographic determinants of this double burden of malnutrition, specifically, the co‐occurrence of child stunting and overweight, using Demographic and Health Survey and Multiple Indicator Cluster Survey data (2003–2016) from 11 countries in the MENA (n = 118,585) and 13 countries in the LAC (n = 77,824) regions. We used multiple logistic regressions to model region‐specific associations of maternal education and household wealth with child nutritional outcomes (6–59 months). The prevalence of stunting, overweight, and their co‐occurrence was 24%, 10%, and 4.3% in children in the MENA region, respectively, and 19%, 5%, and 0.5% in children in the LAC region, respectively. In both regions, higher maternal education and household wealth were significantly associated with lower odds of stunting and higher odds of overweight. As compared with the poorest wealth quintiles, decreased odds of co‐occurring stunting and overweight were observed among children from the second, third, and fourth wealth quintiles in the LAC region. In the MENA region, this association was only statistically significant for the second wealth quintile. In both regions, double burden was not statistically significantly associated with maternal education. The social patterning of co‐occurring stunting and overweight in children varied across the two regions, indicating potential differences in the underlying aetiology of the double burden across regions and stages of the nutrition transition.

Child discipline in low- and middle-income countries: Socioeconomic disparities at the household- and country-level

BackgroundIn the past month, an estimated eight of ten children worldwide have experienced violent discipline. Understanding the economic and social contexts in which parents are more likely to use particular disciplinary practices is necessary to reduce violence against children. Critical examination of disciplinary practices and beliefs in cross-country analysis of low- and middle-income countries (LMICS) has been limited. ObjectiveTo estimate the association of country-level stressors and household-level economic stressors with disciplinary behaviors and beliefs. Participants and settingUsing Multiple Indicator Cluster Survey data between 2010 and 2013, 231,221 parents from 32 LMICS were included. MethodsThe prevalence of past-month nonviolent discipline, physical discipline, psychological aggression, belief in the utility of physical discipline, and incongruence of disciplinary practice and belief were estimated. Country-level prevalence was regressed on country-level stressors (economic burden, economic inequality, human security, and human development). Individual-level disciplinary practices and beliefs were regressed on household wealth. ResultsCountry-level stressors predicted psychological and physical discipline use and belief in the utility of physical discipline. Lower household wealth was associated with increased violent disciplinary practice and belief. Lower household wealth was associated with increased likelihood of using violent discipline, even when the caregiver did not believe in its utility (OR = 1.63 [1.34, 1.98]). ConclusionsDiscipline use and belief in LMICS should be understood within the context of salient societal and household stressors.Parental disciplinary beliefs and practices reflect complex interplay with broader social, political and economic contexts and should not be taken to be defined by monolithic views of culture.

Secular trends in the prevalence of female genital mutilation/cutting among girls: a systematic analysis

BackgroundCurrent evidence on the decline in the prevalence of female genital mutilation or cutting (FGM/C) has been lacking worldwide. This study analyses the prevalence estimates and secular trends in FGM/C...

Manifestations of socioeconomic status and its association with physical child punishment- Results from the Multi-Indicators Cluster Survey in Viet Nam, 2006-2014.

Physical child punishment is a critical public health problem that exhibits negative and long-lasting mental and physical health consequences. Yet, the predictors of physical punishment are understudied in developing countries, and disparities that exist between levels of economic status are not known well. The socioeconomic predictors of physical child punishment were investigated using three rounds of the Multiple Indicator Cluster Survey (MICS) results in a lower middle-income country, Viet Nam from 2006 to 2014. A total of 16,784 households that have answered the child punishment questionnaire from MICS data from 2006 to 2014 were included in the analysis. Descriptive statistics, univariate, and multivariate logistic regression analyses were conducted. A secular trend of disparity was investigated with and without the parents' normative values on physical punishment. Children in Viet Nam have been subject to some form of violent physical punishment by their parents or caregivers. About half of the children in the poorest households (44.7%) experienced physical child punishment while lesser percentage of children in the richer households experienced physical child punishment. Disparities existed across different wealth groups as the prevalence of physical child punishment decreased: the gap between the poorest and the richest group widened. Compared to the richest households, the poorest households were more likely to experience physical child punishment AOR 1.58 (95% CI 1.39-1.79). There is a decrease in the prevalence of physical punishment over the recent years in Viet Nam, socioeconomic disparities, in contrast, have increased, and the poorest children have a higher risk of experiencing physical child punishment. Such disparities should be considered in future research and intervention development.

Demand for family planning satisfied with modern methods among sexually active women in low- and middle-income countries: who is lagging behind?

BackgroundFamily planning is key for reducing unintended pregnancies and their health consequences and is also associated with improvements in economic outcomes. Our objective was to identify groups of sexually active women with extremely low demand for family planning satisfied with modern methods (mDFPS) in low- and middle-income countries, at national and subnational levels to inform the improvement and expansion of programmatic efforts to narrow the gaps in mDFPS coverage.MethodsAnalyses were based on Demographic and Health Survey and Multiple Indicator Cluster Survey data. The most recent surveys carried out since 2000 in 77 countries were included in the analysis. We estimated mDFPS among women aged 15–49 years. Subgroups with low coverage (mDFPS below 20%) were identified according to marital status, wealth, age, education, literacy, area of residence (urban or rural), geographic region and religion.ResultsOverall, only 52.9% of the women with a demand for family planning were using a modern contraceptive method, but coverage varied greatly. West & Central Africa showed the lowest coverage (32.9% mean mDFPS), whereas South Asia and Latin America & the Caribbean had the highest coverage (approximately 70% mean mDFPS). Some countries showed high reliance on traditional contraceptive methods, markedly those from Central and Eastern Europe, and the Commonwealth of Independent States (CEE & CIS). Albania, Azerbaijan, Benin, Chad and Congo Democratic Republic presented low mDFPS coverage (< 20%). The other countries had mDFPS above 20% at country-level, yet in many of these countries mDFPS coverage was low among women in the poorest wealth quintiles, in the youngest age groups, with little education and living in rural areas. Coverage according to marital status varied greatly: in Asia & Pacific and Latin America & the Caribbean mDFPS was higher among married women; the opposite was found in West & Central Africa and CEE & CIS countries.ConclusionsAlmost half of the women in need were not using an effective family planning method. Subgroups requiring special attention include women who are poor, uneducated/illiterate, young, and living in rural areas. Efforts to increase mDFPS must address not only the supply side but also tackle the need to change social norms that might inhibit uptake of contraception.

Routine immunization in Pakistan: comparison of multiple data sources and identification of factors associated with vaccination.

BackgroundWithin Pakistan, estimates of vaccination coverage with the pentavalent vaccine, oral polio vaccine (OPV) and measles vaccine (MV) in 2011 were reported to be 74%, 75% and 53%, respectively. These national estimates may mask regional variation. The reasons for this variation have not been explored.MethodsData from the Multiple Indicator Cluster Surveys (MICS) for Balochistan and Punjab (2010–2011) are analysed to examine factors associated with receiving three or more doses of the pentavalent vaccine and one or more MVs using regression modelling. Pentavalent and OPV estimates from the MICS were compared to vaccine dose histories from surveillance for acute flaccid paralysis (AFP; poliomyelitis) to ascertain agreement.ResultsAdjusted coverage of children 12–23 months of age were estimated to be 16.0%, 75.5% and 34.2% in Balochistan and 58.0%, 87.7% and 72.6% in Punjab for the pentavalent vaccine, OPV and MV, respectively. Maternal education, healthcare utilization and wealth were associated with receiving the pentavalent vaccine and the MV. There was a strong correlation of district estimates of vaccination coverage between AFP and MICS data, but AFP estimates of pentavalent coverage in Punjab were biased toward higher values.ConclusionsNational estimates mask variation and estimates from individual surveys should be considered alongside other estimates. The development of strategies targeted towards poorly educated parents within low-wealth quintiles that may not typically access healthcare could improve vaccination rates.

Subjective Well-Being and HIV Prevention: A Cross-Country Descriptive Study Using Multiple Indicator Cluster Survey Data

Subjective Well-Being and HIV Prevention: A Cross-Country Descriptive Study Using Multiple Indicator Cluster Survey Data

Community unit performance: factors associated with childhood diarrhea and appropriate treatment in Nyanza Province, Kenya

BackgroundThe government of Kenya launched its community health strategy in 2006 to improve certain aspects of its community health program. Under the strategy, community units (CUs) were established as level one of the Kenyan health system. A core member at this level is the community health worker (CHW). The objective of this study was to assess the relationship among the performance of the CUs, the prevalence of childhood diarrhea and appropriate treatment for it by controlling individual and community-level factors.MethodsThe main dataset used in this study was the 2011 Nyanza Province county-based Multiple Indicator Cluster Survey (MICS). In addition, based on the list of community units in Nyanza Province, Kenya, we identified the area’s CUs and their performance. MICS data and data on CUs were merged using sub-location names. There were 17 individual and two community-level independent variables in this study. Bivariate analysis and a multilevel logistic regression were performed.ResultsFactors significantly associated with a lower prevalence of diarrhea among children under five were the child’s increasing age, middle-aged household heads, children who received more attention, water treatment and rural versus urban area residence, while male children and highly performing CUs were significantly associated with a higher prevalence of diarrhea. In addition, middle wealth index, severity of diarrhea and middle- and high-CU performance were significantly associated with appropriate treatment for childhood diarrhea.ConclusionsAlthough this study found that children living in areas of high CU performance were more likely to have diarrhea, these areas would have been identified as being more at risk for diarrhea prevalence and other health concerns, prioritized for the establishment of a CU and allocated more resources to improve the performance of CUs. A higher CU performance was significantly associated with the appropriate treatment. It was suggested that CHWs could have a positive effect on the community, as demonstrated and promoted by appropriate health-seeking behavior and treatment for childhood diarrhea.

Positive parenting attitudes and practices in three transitional Eastern European countries: Bosnia and Herzegovina, Macedonia and Serbia.

To identify potential predictors of using only non-violent forms of discipline for children aged 2-14years and of being against physical punishment among Roma and non-Roma parents/caregivers in Eastern European countries with similar cultural-historical backgrounds. UNICEF Multiple Indicator Cluster Survey data collected in 2010-2011 in Bosnia and Herzegovina, Macedonia and Serbia (total of 9973 respondents) were analysed using multivariate logistic regression modelling with receiver operating characteristic analysis. Approximately 27% of the respondents practiced only non-violent child discipline. Roma children experienced only non-violent discipline less than half as often as their non-Roma counterparts. Household wealth index and child sex were significant predictors of positive parenting attitudes and practice. For Roma respondents, rural residence also contributed to being against physical punishment. Parents\caregivers from more affluent households are more likely than those who are less affluent to be against physical punishment of children and are more likely to practice only non-violent discipline. Evidence-based interventions are required to support existing positive forms of child rearing. These should target less affluent households from Roma settlements in the studied countries.

CONTEXT AND THE ADVANCEMENT OF A GLOBAL SCIENCE OF HUMAN DEVELOPMENT: A COMMENTARY.

United Nations agencies mandated to address the needs of children around the developing (Majority) world, routinely create large global data sets mostly for purposes of surveillance and strategic planning of development aid. UNICEF's Multiple Indicator Cluster Surveys (MICS) have produced one of the largest sources of internationally comparable data on women and children. This monograph creatively and elegantly harnesses MICS data on 41 low- and middle-income countries to shed light on risk and protective factors associated with growing up a boy or girl in the developing world. In this commentary, I assess the monograph's contribution to the progress that our field must make toward greater geo-ecological and cultural inclusiveness of its knowledge base. I do so in the context of scholarship that is increasingly and justifiably questioning the relevance of mainstream developmental science outside the Euro-American world. I conclude that notwithstanding the limitations inherent in the data set, Bornstein, Putnick, Lansford, Deater-Deckard, and Bradley have done our field a great service by moving us further on a trajectory toward a more global science.

Violence against children and education

In most countries around the world, children and adolescents spend more time in school than any other single location besides the family home. Whether or not children and adolescents are able to attend school, whether they are safe in school and whether they leave school with necessary learning and skills, are affected by their experiences of violence—at home, at school and in the community. Before children get to school, they are often exposed to violence at home. Analysis of the Multiple Indicator Cluster Surveys data from 28 countries shows that 43% of children aged 2–14 years in African countries, and 9% in ‘transitional’ states, have experienced severe physical violence from caregivers. 1 There are a host of negative health and social consequences associated with exposure to physical violence in childhood, especially during this early period. These include increased risk of depressive disorders and suicide attempts, 2 poor educational attainment 3 and increased risk of perpetrating or experiencing intimate partner violence in later relationships. 4, 5 Particularly for children who have also experienced violence at home, first experiences of the school environment are likely to be important in determining whether they are shunted down a trajectory towards later poor outcomes, including use of violence in their relationships, or if they are able to overcome negative exposures in their early childhood. Yet, school itself can also be a violent place. Levels of peer violence are high with 5–45% of boys and girls reporting bullying across 40 countries mainly in Europe. 6 Recent national surveys suggest that, at least in some settings, violence from school staff maybe animportant but overlooked contributor to the overall health burden associated with violence against children. More than 50% of men and women reported physical violence from teachers when they were aged 0–18 years in Tanzania, 7 and in Kenya more than 40% of 13–17 year olds reported being punched, kicked or whipped by a teacher in the past 12 months, versus 13–15% for parents. 8 For many adolescents, secondary school is a time and place where they will initiate their first romantic relationships. Unfortunately, recent analysis of Demographic and Health Survey data show that intimate partner violence also starts early—on average, first incidents of intimate partner violence among girls

Do ethnicity and polygyny contribute to justification of men beating women in Ghana?

ABSTRACTViolence against intimate partners threatens public health and social cohesion, and its prevalence could increase with an attitude of justification of such violence. The objective of this article was to use religion and ethnicity as proxies for culture to examine Ghanaian women’s acceptance of being beaten. We employed descriptive and binary logistic regression statistics applied to Multiple Indicator Cluster Survey data collected in 2011 in Ghana. With a weighted sample of 10,627 women, the findings revealed that more than half (59.83%, 95% confidence interval (CI) = 57.41%, 62.2%) of the respondents justified at least one form of intimate partner violence (IPV) or another and being a Mole-Dagbani (adjusted odds ratio [AOR] = 1.41; 95%; CI = 1.05, 1.90) and/or in a polygamous marriage/union (AOR = 1.22; 95% CI = 1.04, 1.420) were significant risk factors for justifying IPV. Activism in promoting IPV-free communities has to be group-specific to reach those in need of interventions.

Intrahousehold and Interhousehold Child Nutrition Inequality in Malawi

AbstractThis paper investigates whether child nutrition inequalities are attributable to differences between households or differences within households in Malawi. Child nutrition is measured using height‐for‐age z‐scores. The empirical analysis uses the 2006 Multiple Indicator Cluster Survey data. We find evidence of within household nutritional differences along gender, age and birth order lines in Malawi. The results for rural and urban areas as well as religious groups show that nutrition inequalities largely stem from differences within households. Both intrahousehold and interhousehold nutrition inequalities are unexplained by observable factors.

Measuring Coverage in MNCH: Challenges in Monitoring the Proportion of Young Children with Pneumonia Who Receive Antibiotic Treatment

Pneumonia remains a major cause of child death globally, and improving antibiotic treatment rates is a key control strategy. Progress in improving the global coverage of antibiotic treatment is monitored through large household surveys such as the Demographic and Health Surveys (DHS) and the Multiple Indicator Cluster Surveys (MICS), which estimate antibiotic treatment rates of pneumonia based on two-week recall of pneumonia by caregivers. However, these survey tools identify children with reported symptoms of pneumonia, and because the prevalence of pneumonia over a two-week period in community settings is low, the majority of these children do not have true pneumonia and so do not provide an accurate denominator of pneumonia cases for monitoring antibiotic treatment rates. In this review, we show that the performance of survey tools could be improved by increasing the survey recall period or by improving either overall discriminative power or specificity. However, even at a test specificity of 95% (and a test sensitivity of 80%), the proportion of children with reported symptoms of pneumonia who truly have pneumonia is only 22% (the positive predictive value of the survey tool). Thus, although DHS and MICS survey data on rates of care seeking for children with reported symptoms of pneumonia and other childhood illnesses remain valid and important, DHS and MICS data are not able to give valid estimates of antibiotic treatment rates in children with pneumonia.

Patterns of chloroquine use and resistance in sub-Saharan Africa: a systematic review of household survey and molecular data

BackgroundAs a result of widespread chloroquine and sulphadoxine-pyrimethamine (SP) resistance, 90% of sub-Saharan African countries had adopted policies of artemisinin-based combination therapy (ACT) for treatment of uncomplicated malaria by 2007. In Malawi, cessation of chloroquine use was followed by the re-emergence of chloroquine-susceptible malaria. It was expected that introduction of ACT would lead to a return in chloroquine susceptibility throughout Africa, but this has not yet widely occurred. This observation suggests that there is continuing use of ineffective anti-malarials in Africa and that persistent chloroquine-resistant malaria is due to ongoing drug pressure despite national policy changes.MethodsTo estimate drug use on a national level, 2006-2007 Demographic Health Survey and Multiple Indicator Cluster Survey data from 21 African countries were analysed. Resistance data were compiled by systematic review of the published literature on the prevalence of the Plasmodium falciparum chloroquine resistance transporter polymorphism at codon 76, which causes chloroquine resistance.ResultsChloroquine was the most common anti-malarial used according to surveys from 14 of 21 countries analysed, predominantly in West Africa. SP was most commonly reported in two of 21 countries. Among eight countries with longitudinal molecular resistance data, the four countries where the highest proportion of children treated for fever received chloroquine (Uganda, Burkina Faso, Guinea Bissau, and Mali) also showed no significant declines in the prevalence of chloroquine-resistant infections. The three countries with low or decreasing chloroquine use among children who reported fever treatment (Malawi, Kenya, and Tanzania) had statistically significant declines in the prevalence of chloroquine resistance.ConclusionsThis study demonstrates that in 2006-2007, chloroquine and SP continued to be used at high rates in many African countries. In countries reporting sustained chloroquine use, chloroquine-resistant malaria persists. In contrast, a low level of estimated chloroquine use is associated with a declining prevalence of chloroquine resistance.