Multiple Indicator Cluster Survey Research Articles

Counting who makes the grade: Updated estimates of the share of over-age for grade learners in sub-Saharan Africa using MICS6 data

Many education systems within sub-Saharan Africa are affected by the problem of over-aged learners. Children who are above the expected age for their grade experience poorer outcomes relative to other learners and it is therefore of interest to policymakers to accurately identify them for the purposes of informing effective remedial interventions. UNICEF’s sixth round of Multiple Indicator Cluster Survey’s [MICS6] are among the relatively few robust nationally representative data sources that can be used to calculate the share of over-age for grade learners within education systems. This paper identifies variability in the estimation method used to identify the same target over-age population (i.e. learners who are older than the official age for the grade they are currently attending) across MICS6 country reports in 14 countries in sub-Saharan Africa. Nine countries utilise a different method which captures only part of the desired target population. This approach fails to identify at least 50% of learners who are over-age for grade by two years in their primary education system and up to 57% of over-age for grade learners in lower secondary. Results are discussed in terms of their implications for supporting policymakers to plan and implement effective school-based education and health interventions, using Comprehensive Sexuality Education as an example.

Depressive symptoms, parenting attitude, and violent discipline among caregivers of left-behind children in rural China: a cross-sectional study

BackgroundThe situation of mental health and discipline behaviors of left-behind children’s caregivers were not optimistic in rural China. Caregivers’ depression might increase the risk of using violent discipline. However, the specific ways in which depressive symptoms impact violent discipline have rarely been explored in rural areas. This study aims to assess the prevalence of violent discipline among left-behind children under 6 years of age in rural China and explore the potential mechanisms of how caregivers’ depressive symptoms affect violent discipline.MethodsWe enrolled a total of 396 pairs of left-behind children and their caregivers in our study, which was conducted in 5 counties of Hebei, Henan, Jiangxi, Guizhou, and Sichuan provinces in China. The depressive symptoms of caregivers were measured by using Zung Self-rating Depression Scale (ZSDS) and violent discipline was assessed by the Child Discipline Module of Multiple Indicator Cluster Surveys (MICS). A self-designed questionnaire was utilized to measure caregiver’s parenting attitude. Based on the cross-sectional data, controlling for potential confounders, structural equation modeling (SEM) was used to assess the direct and indirect effects of the mediation models by applying the weighted least squares with mean and variance adjusted (WLSMV) estimate.ResultsThe prevalence of violent discipline, psychological aggression, and physical punishment was 72.7%, 59.3%, and 60.4% respectively of left-behind children under 6 years of age. According to the results of SEM, parenting attitude acted as a suppressor, suppressing the association between caregivers’ depressive symptoms and physical punishment/psychological aggression/violent discipline. The caregivers’ depressive symptoms positively influenced all the outcome variables by affecting parenting attitudes (p = 0.002, p = 0.013, p = 0.002).ConclusionsThe presence of depressive symptoms in caregivers increases the use of violent discipline through negative parenting attitudes. The mental health status of primary caregivers of left-behind children in rural China needed emphasis and improvement.

Effects of disability on adverse health outcomes and anthropometric deficits among under-five children in South Asian countries: evidence from multiple indicator cluster surveys

Children with disabilities face an increased risk of adverse health outcomes and poor anthropometric deficits, although the focus on them is limited in the South Asian context thus far and need newer and more evidence. This study investigates the effects of disability on adverse health outcomes and anthropometric deficits among 2-4 years aged children in South Asian countries. We analyzed data from 93,180 children aged 2-4 years across Bangladesh, Nepal, Pakistan, and Afghanistan using Multiple Indicator Cluster Surveys (2017-2023). Disability status was the primary exposure, and outcomes included adverse health outcome (acute respiratory infection, diarrhea, fever), anthropometric deficit (stunting, wasting, underweight), and healthcare service sources during adverse health events (care received from skilled healthcare personnel, care received from non-professional personnel, and care received from health facility workers other than skilled healthcare personnel). Using multilevel and multinomial logistic regression models, we examined associations between exposure and outcome variables, adjusting for covariates. We found average disability prevalence in South Asia was 8.7% (8.3-9.0; n=8072), varying from 3.4% (3.0-3.8; n=446) in Bangladesh to 12.3% (11.4-13.3; n=1259) in Afghanistan. Common health issues included fever (n=24,982, 26.8%, 26.2-27.4) and diarrhea (n=14,081, 15.1%, 14.7-15.6), while prevalent poor anthropometric deficits were stunting (n=39,766, 42.7%, 42.0-43.3) and underweight (n=22,390, 24.0%, 23.5-24.5). Children with disability had 1.30 (95% CI: 1.21-1.40) to 1.60 (95% CI: 1.47-1.75) times and 1.17 (95% CI: 1.05-1.29) to 1.39 (95% CI: 1.30-1.48) times higher likelihoods of adverse health outcomes and anthropometric deficits, respectively, with variations observed among countries and different disability types. Individuals with disability were 1.16 (95% CI: 1.00-1.35) to 1.26 (95% CI: 1.01-1.58) times more likely to receive healthcare services from skilled healthcare personnel compared to health facility workers other than skilled healthcare personnel. This study findings emphasizes the need for community-level awareness programs to improve anthropometric well-being and healthcare of the children with disability. This research did not receive any specific funds.

Unmet need for contraception among married women in the Kyrgyz Republic using the datasets from the 2006, 2014 and 2018 Multiple Indicator Cluster Survey: a cross-sectional study.

Since the beginning of the family program in 1998, the proportion of married women who used contraception has fluctuated. An unmet need for contraception among women in Kyrgyzstan drastically increased from 2006 (1.1%) to 2014 (19.1%), and remained unchanged until 2018 (19.0%). This study aims to re-investigate the prevalence of an unmet need for contraception from 2006 to 2018 in a comprehensive manner, and examine the factors associated with an unmet need for contraception among married women over the course of 12years in the Kyrgyz Republic. This is a cross-sectional study using secondary data that derived from the Multiple Indicator Cluster Survey (MICS). The study employed three datasets from the MICS 2006, 2014, and 2018. The study included a total of 9,229 women aged 15-49 who were married and fecund, and whose status of the met/unmet need for contraception could be identified. Logistic regression was employed to estimate the relationship of an unmet need for contraception with independent factors. A P value < 0.05 was set as statistically significant. The prevalence of an unmet need for contraception was 19.9% in 2006, 20.4% in 2014, and 22.5% in 2018. Across 12years, all reversible-contraceptive methods for women constantly declined. Although intrauterine devices were the prominent contraceptive method of usage among Kyrgyz women, the trend of usage drastically decreased over time. Factors associated with unmet need for contraception included women's age, area of residence, mother tongue of household head, age of husband, and number of children ever born. The unmet need for contraception among married Kyrgyz women slightly increased, and the trend of modern contraceptive usage declined from 2006 to 2018, particularly the use of pills, injections, and intra-uterine devices. Comprehensive sexual health education for young people and youth-friendly services should be promoted. An effective and reliable supply chain of contraceptive commodities should be prioritized and strengthened. Regular supportive supervision visits are essential to improve the knowledge and skills of healthcare providers to be able to provide intrauterine device service as a contraceptive choice for Kyrgyz women.

Prevalence, Pattern and Factors Associated with Developmental Delay amongst Under-5 Children in Nigeria: Evidence from Multiple Indicator Cluster Survey 2011-2017.

Children develop dynamically, and when a child fails to reach age-appropriate developmental milestones compared to their peers, it is considered a developmental delay. In developing nations like Nigeria, several demographics, socioeconomic, childcare and external factors may influence the highly individualised process. This study assessed the prevalence and pattern of developmental delay, across Nigeria's geopolitical zones including identified factors associated with developmental delay, providing insight for appropriate interventions to prevent disability in affected children. This was a secondary analysis of data from the Multiple Indicator Cluster Survey (MICS), which was carried out in rounds 4 (2011) and 5 (2016/2017). Every 5 years, the UNICEF-supported MICS cross-sectional household survey is carried out using the cluster sampling method. A semi-structured, questionnaire administered by the interviewer was used to obtain individual and household-level data. This study comprised a weighted sample of 17,373 under-5 children who had complete data from both survey rounds on characteristics deemed significant for the study. Data were analysed using SPSS version 23. Using the Chi-square test and multivariate binomial logistic regression, factors linked to developmental delay were identified, with 95% confidence intervals (CIs) provided and the significance level set at 5%. The mean age and sex distribution of the children surveyed in both rounds was comparable, with a male preponderance of 51.2% in round 4 and 50.4% in round 5. In both round 4 (51.2%) and round 5 (49.0%), the Northeast zone had the highest prevalence of overall developmental delay while the least prevalence was seen in the Southwest zone (20.3%) and the Southeast zone (14.7%) in round 4 and round 5, respectively. Across all the zones, delay in the literacy-numeracy domain of development was the most prevalent, with the highest (91.3% and 86.7%, respectively) in the Northeast zone during both rounds of the survey. Delay in the physical domain was, however, the least prevalent form of developmental delay across the zones, with the least in South South (20.6%) and Southeast (5.4%) in rounds 4 and 5. The odds of developmental delay were 1.5 and 1.7 times higher amongst children 4 years old than 3 years old in both rounds of the survey. The likelihood of having developmental delay was found to increase with the severity of stunting amongst the children during both rounds of the survey (odds ratio [OR] =1.5; 95% CI = 1.20-1.78 in round 4 and OR = 1.4; 95% CI = 1.16-1.58 in round 5). Children from the poorest wealth index had higher odds of developmental delay (OR = 5.8; 95% CI = 4.92-6.82 in round 4 and OR = 2.5; 95% CI = 1.99-3.10 in round 5). The prevalence of developmental delay is high across all zones; however, the burden varies amongst them. The age of the child, nutritional status and wealth index were indicators of developmental delay in Nigerian under-5 children. This underscores the need for surveillance and interventions focussed on improving child literacy, nutritional status and household standard of living across the zones.

Prevalence and risk factors associated with under-five years children diarrhea in Malawi: Application of survey logistic regression

BackgroundDiarrhea is a leading cause of illness and mortality among children under five, posing a significant public health challenge in Malawi. The current study assesses the prevalence and risk factors linked to diarrhea among under-five children in Malawi. MethodThe researcher used the Malawi Multiple Indicator Cluster Survey (MICS) 2019-20 as the dataset for this study. Due to the complex sampling design, survey logistic regression was used to accomplish the study objectives. The sample size was 15569 children who were aged under five. ResultsThe study found that the prevalence of diarrhea was 24.9%, with a higher percentage observed among children aged 12–23 months (38.5%) compared to other age groups. Additionally, children from the southern region had a higher prevalence of diarrhea at 27% compared to those from the northern region at 19.3%. Children from the poorest households also had a higher prevalence of diarrhea at 28.9% compared to those from the richest households at 22.6%. Furthermore, children with fever had a higher prevalence of diarrhea at 33.3% compared to those who did not have fever at 19.4%. ConclusionThe current study concluded that the prevalence of diarrhea was higher among children aged 12–23 months. Subsequently, policymakers should apply policies to reduce this high prevalence among this age group of children. In addition, the government needs special consideration in diarrhea control for children from the southern region because of the high prevalence of the disease compared to the other regions in Malawi. My study can help policymakers understand the scope and nature of the problem, which can notify the development of policies and programs intended to decrease the prevalence of risk factors and enhance child health outcomes.

Prevalence and determinants of continued breastfeeding beyond 6 months among Algerian women. Evidence for Multiple Indicators Cluster Surveys

Breastfeeding is considered the best nutrition for infants and plays a significant role in a child's growth and development. In this regard, the World Health Organization (WHO) strongly recommends exclusive breastfeeding for the first 6 months of life, as well as continued breastfeeding when safe and appropriate complementary foods are introduced, up to 2 years of age or beyond. Nonetheless, breastfeeding practices remain sub-optimal in many parts of the world. In this respect, many children have shown not to be breastfed up to 6 months of age or are not breastfed during their first hours of life or are weaned too early. This allows for the use of infant formula, which can be life threatening due to poor hygiene, storage conditions or inappropriate foods. Likewise, breastfeeding rates in the Middle East and North Africa (MENA) region are lower than the global average. In Algeria, the breastfeeding rate up to 6 months of age is among the lowest in the world according to previous Multiple Indicators Cluster Surveys (MICS) reports. In addition, by the end of the sixth month, the percentage of children exclusively breastfed is less than 3% and only 23% of children receive breast milk at 22-23 months. The median duration of breast-feeding is 12 weeks. However, the socio-demographic factors associated with this sub-optimal breastfeeding practice are not explored in these reports, as studies and research conducted in this context using other data are few and mostly conducted in limited geographical areas. This stands for a descriptive cross-sectional study of all children who were breastfed in the MICS database, carried out in 2019, 8 709 children, including 4 471 boys and 4 238 girls, registered in the database. To explore factors associated with the duration of breastfeeding, we only included weaned children to minimize bias related to children who were still breastfeeding. This allowed to analyze data from 3 761 children, including 1 930 boys (5.4%) and 1,831 girls (48.6%). Through using a logistic regression model, we could attain the assessment of the role of different socio-demographic, economic and geographical factors in the maintenance of breastfeeding beyond 6 months. The prevalence of breastfeeding is 81.1%; the rate of exclusive breastfeeding of children aged 0-6 months is 28.7%. The factors associated with breastfeeding beyond six months are area of residence, mother's occupational status and wealth quintile. In fact, rural area appears to be a factor favoring the continuation of breastfeeding beyond six months, compared with urban area (OR = 1.29; CI [1.032-1.369]). Mothers living in the Eastern Highlands geographic region appear to be 1.56 times more likely to maintain breastfeeding for more than six months compared to those living in the Southern region (OR = 1.56; CI [1.123 - 1.677]). Children of non-working mothers are almost 1.5 times more likely to be breastfed after 6 months than those of working mothers (OR = 1.489; CI [1.107 - 1.947]). Parents belonging to the "richest" wealth quintiles appear to increase the chance of continued breastfeeding after 6 months with a 1.24-fold increase compared to those belonging to the "poorest" quintile (OR = 1.24; CI [1.086 - 1.812]). Factors such as the child's gender, maternal education level, and functional difficulties do not appear to be determining factors for the continuation of breastfeeding after six months. The prevalence and factors associated with the initiation and continuation of breastfeeding vary from one country to another. Notwithstanding the numerous studies to better comprehend mothers' breastfeeding behaviour and various initiatives for promotion thereof, many countries have low rates. In consequence, the downward trend in breastfeeding is directly linked to advances in the production and marketing of industrial milks, the lack of information and awareness among mothers and the lack of training of health professionals. In this respect, it is highly recommended to encourage behavioural changes, to improve communication about the duration of breastfeeding, to increase the use of postnatal counselling and training of paramedical staff according to the recommendations with support for mothers.This study is of great interest in developing countries like Algeria, in order to adopt preventive interventions, and to organise communication and pre- and post-natal counselling in the breastfeeding project. Clearly, this study should be enhanced with supplementary qualitative studies concerning the factors contributing to early discontinuation of breastfeeding.

Sociodemographic factors underlying lifetime fertility among ever-married Swazi women.

Fertility rates remain high in certain subgroups of the population, and there is limited research about the sociodemographic factors influencing fertility, particularly in Eswatini where women are often considered minors. This study aims to investigate the changes in lifetime fertility, and the associations between sociodemographic factors and lifetime fertility among ever-married women. The study used secondary cross-sectional data from the 2010 and 2014 Eswatini Multiple Indicator Cluster Surveys (MICS), with a sample size of 2,295 and 2,351 women, respectively. The data was analysed using descriptive statistics and multivariable Poisson regression. The results showed that fertility rates decreased from 3.47 to 3.21 children between 2010 and 2014. The study found that child loss and age (25+ years) were significant factors associated with higher fertility, while delayed age at marriage and sexual debut (20+ years), at least secondary education, and being rich were strong predictors of lower fertility rates. The study recommends creating awareness about and strengthening laws to abolish early sexual debut and marriage. It also suggests empowering women through education, encouraging the use of contraceptives, and providing maternal and child health services in rural areas where fertility rates tend to be higher.

Functional difficulty among young children in Bangladesh: An analysis of nationally representative data.

Functional difficulty in children is a crucial public health problem still undervalued in developing countries. This study explored the socio-demographic factors and anthropometry associated with children's functional difficulty in Bangladesh. Data for 2-4-year-old children, obtained from Multiple Indicator Cluster Survey 2019, were used in this study. The mixed-effects logistic regression model was used to analyse the data. Children whose mothers had functional difficulty were found to be 2.75 times more likely to have functional difficulty than children whose mothers had no functional difficulty (95% CI 1.63-4.63). Male children were more likely to experience functional difficulty than female children (OR = 1.48). Furthermore, stunting was found to be significantly associated with functional difficulty (OR = 1.50). The study also revealed that division and mother's education, specifically, children with mothers having higher secondary + education, had significant association with the outcome variable. The findings provided a vital overview of child disability in a developing country.

Association Between Harsh Disciplinary Methods and Child Functioning in Children Aged 7-14 Years in Punjab, Pakistan.

Despite having adverse physical and mental health outcomes, harsh disciplinary methods are commonly practiced all over the world. This study aims to measure the harsh disciplinary actions taken by parents and their association with child functioning in children, aged 7 to 14 years in Punjab, Pakistan. This study is based on secondary data obtained from the United Nations Children's Fund (UNICEF's) Multiple Indicator Cluster Survey, conducted in the Punjab province from 2017 to 2018. Parents/caregivers of 19,721 children were included in the analysis. Questionnaire-based interviews were conducted, and the data collection form included sociodemographic information, questions on different "Methods of Child Discipline" and the "Child functioning module." The data was analyzed using STATA 15.0. Multiple logistic regression analysis was conducted to calculate the adjusted odds ratio and 95% CI exploring the association between harsh disciplinary methods and child functioning. More than 50% of children were exposed to severe physical, psychological, and emotional disciplinary methods. Exposure to severe physical aggression was associated with increased difficulty in learning (2.60 [1.27, 5.31]), remembering (2.83 [1.47, 5.44]), controlling behavior (1.63 [1.21, 2.18]), anxiety (1.98 [1.25, 3.13]), depression (2.57 [1.57, 4.22]) and making friends (1.94 [1.01, 3.79]). Whereas moderate physical aggression and psychological aggression were associated with (1.48 [1.19, 1.84]) and 1.5 times (1.20, 1.84) increase in difficulty in controlling behavior, respectively. Nonviolent actions were associated with protective odds for self-care (0.33 [0.17, 0.65]), communication (0.51 [0.27, 0.96]), learning (0.56 [0.33, 0.95]), remembering (0.62 [0.39, 0.90]), concentration (0.50 [0.31, 0.80]), anxiety (0.60 [0.46, 0.79]) and depression (0.67 [0.49, 0.92]). Severe disciplinary methods are detrimental to the child's personal care, mental, social, emotional, and psychological well-being, whereas nonviolent actions are associated with positive child functioning. In a third-world country such as Pakistan, this topic is widely undiscovered and understudied, thus emphasizing the need for awareness and education of parents and healthcare providers.

Examining the Utility of the Early Childhood Development Index (ECDI) among Children in the Nigeria Context.

An estimated 6 million children under the age of five in Nigeria (out of nearly 31 million) risk not reaching their full developmental potential. The dearth of context-relevant measures poses a challenge to the planning and implementation of effective interventions. This study assesses the utility of the Early Childhood Development Index (ECDI) in Nigeria. We used the Multiple Indicator Cluster Surveys to track progress among 3- to 4-year-old children (n = 11,073); 3-year-old, 51%; female, 49%. Using random calibration samples, the results from psychometric tests indicate that while over half of the children were on track in their development based on the ECDI, the instrument had low to average internal consistency and weak face validity, suggesting an inadequacy in capturing ECD information of value. At the outset of the launch of the new ECDI2030, the results of this study point to the need for continued discourse and advocacy for the use of culturally appropriate measures of child development, and a child-centered community engagement approach. This is essential in ensuring accountability and responsive interventions for the children served and their families.

A Sociodemographic Assessment of Infant Malnutrition in Rural Area, Bangladesh: Logistic Regression Approach

Abstract : This study investigates the association between socio-demographic factors and infant child (0-1 year) malnutrition defined by underweight, stunting and wasting, in rural areas, Bangladesh. Survey data, Multiple Indicator Cluster Survey (MICS) 2019 executed by UNICEF and Bangladesh Bureau of Statistics (BBS), is used in the study. The percentage of undernutrition is 17.08% for underweight out of 3571 sample, 18% for stunted out of 3504 sample, 9.8% for wasted out of 3470 sample with omitting missing value. Statistical methods, ANOVA, chi-square test and sampling weighted logistic regression model, are used to figure out impact of individual socio-demographic factors on child malnutrition. The variables gender, receiving prenatal care, delivery place, parents education, wealth index, child weight at birth, geographical division, and women age group at birth, are significantly associated with malnourished children (P-value: 1%, 5% or 10%). Odds of being malnutrition is lower among female children, educated parents and rich family. Prevalence of child underweight is higher among mother physical disability, childbirth weight. The undernutrition, stunting and wasting, are highly likely among the children of disabled mother. The presence of underweight and wasting is higher in Sylhet Division, lower in Mymenshingh Division respectively, while the prevalence of stunting is higher in Mymenshingh, Rajshahi, Rangpur and Sylhhet Division.

Factors associated with acute respiratory infection and healthcare-seeking behaviour among primary caregivers in Bangladesh: a study based on MICS 2019

IntroductionMore than 80% of deaths due to preventable and treatable causes among under 5 (U5) children occur in the sub-Saharan Africa and the South-Asia, pneumonia remains one of the most...

Unraveling birth weight determinants: Integrating machine learning, spatial analysis, and district-level mapping

Despite a decrease in the prevalence of low birth weight (LBW) over time, its ongoing significance as a public health concern in Bangladesh remains evident. Low birth weight is believed to be a contributing factor to infant mortality, prolonged health complications, and vulnerability to non-communicable diseases. This study utilizes nationally representative data from the Multiple Indicator Cluster Surveys (MICS) conducted in 2012-2013 and 2019 to explore factors associated with birth weight. Modeling birth weight data considers interactions among factors, clustering in data, and spatial correlation. District-level maps are generated to identify high-risk areas for LBW. The average birth weight has shown a modest increase, rising from 2.93 kg in 2012-2013 to 2.96 kg in 2019. The study employs a regression tree, a popular machine learning algorithm, to discern essential interactions among potential determinants of birth weight. Findings from various models, including fixed effect, mixed effect, and spatial dependence models, highlight the significance of factors such as maternal age, household head's education, antenatal care, and few data-driven interactions influencing birth weight. District-specific maps reveal lower average birth weights in the southwestern region and selected northern districts, persisting across the two survey periods. Accounting for hierarchical structure and spatial autocorrelation improves model performance, particularly when fitting the most recent round of survey data. The study aims to inform policy formulation and targeted interventions at the district level by utilizing a machine learning technique and regression models to identify vulnerable groups of children requiring heightened attention.

Assessing Child Health Disparities: Evidence from a Household-Based Health Index in Punjab, Pakistan

Around the world, undernutrition causes more than half of all deaths in children under 5 years of age. It also increases children's vulnerability to common diseases, impairs recovery, and stunts their physical and mental development. This paper investigates the state of child health and the assessment of health inequalities in children under 5 years, utilising Multiple Indicators Cluster Surveys across 36 districts in Punjab, Pakistan. We suggest a new household-based health index to identify health disparities and to help policymakers implement more successful domestic policies to offset inequalities. Additionally, this study estimates the health disparities for robustness checks applying the Palma ratio and Gini coefficient. The study's findings revealed that every second child in Punjab is malnourished and that 51% of children in Punjab had not received all of their recommended vaccinations. The results also show that health disparities in low-income districts are worse than in high-income districts. The findings further demonstrate that important contributors to health disparities include parental illiteracy, poverty, and political backwardness. This study recommends a multifaceted policy intervention to address child immunization, undernutrition, and infectious disease legislation, as well as income inequality, to reduce health disparities.

Disruptions in Educational Progress and Fertility Dynamics by Educational Level: Unraveling the Link between Education and Fertility Stalls in Sub‐Saharan Africa

AbstractStalls in fertility decline have been found in many sub‐Saharan African countries. Our objective is to unravel the relationship between education and stalled fertility by analyzing the extent to which fertility stalls reflect a lack of changes in the educational composition of the population or are related to reversals and halts in the fertility decline within educational groups. Using the Demographic and Health Surveys and Multiple Indicator Cluster Surveys, we first estimate total fertility rates by educational level and examine how they have varied over time, especially during periods of stagnation. Then, we use the Kitagawa decomposition method to analyze changes in country‐level fertility rates. We show that fertility stalls tend to be a collective experience with fertility stalls found among all educational groups in most countries that have experienced a fertility stall. In contrast, composition effects either have no or a limited impact on fertility stalls. However, slow educational progress made some countries more vulnerable to stalls.

Factors associated with rural-urban safe disposal of children stools in Ghana

IntroductionThe burden of children’s disease in many low-and middle-income countries is associated with poor sanitation, including unsafe disposal of children’s stool. Infants and toddler stools pose a greater public health risk than adults. Studies on stool disposal in Sub-Saharan Africa (SSA) and Ghana have focused on prevalence, patterns, and associated factors. Nevertheless, these studies have not focused on factors that independently influence rural and/or urban child stool disposal. This study, therefore, examines factors associated with safe child stool disposal in rural areas separately from urban areas towards Ghana’s readiness for ending open defaecation by 2030.MethodologyWe examined young children’s faecal disposal drawing on the sixth round of the nationally-representative Ghana Multiple Indicator Cluster Survey (MICS) conducted in 2017/18. This study was restricted to children under two years, yielding a sub-sample of 3,476. Responses of caregivers or mothers who disposed of children less than two years faecal matter, their characteristics in addition to the child’s age in months were analysed. A binary logistic regression was used to examine the factors associated with the safe disposal of young children’s stools.ResultsIn the aggregated data, only 22% of households, regardless of their residence, dispose of their young children less than two years stools safely. From the disaggregated data, the rural analysis shows that 26% of young children’s stools were safely disposed of, compared to 16% in the urban analysis. The urban analysis shows that the child’s age, sex and caregiver’s marital status were significantly associated with safe disposal of stools. On the other hand, child’s age, caregiver listening to radio and household access to improved toilet facilities were significant in the rural analysis.ConclusionThe safe practice of stool disposal was very low. The results of this study show that urgent and different policies and strategies are needed to address child stool disposal in urban residences compared to rural residences if we are to meet SDG targets of ending open defaecation.

Predicting and identifying factors associated with undernutrition among children under five years in Ghana using machine learning algorithms.

Undernutrition among children under the age of five is a major public health concern, especially in developing countries. This study aimed to use machine learning (ML) algorithms to predict undernutrition and identify its associated factors. Secondary data analysis of the 2017 Multiple Indicator Cluster Survey (MICS) was performed using R and Python. The main outcomes of interest were undernutrition (stunting: height-for-age (HAZ) < -2 SD; wasting: weight-for-height (WHZ) < -2 SD; and underweight: weight-for-age (WAZ) < -2 SD). Seven ML algorithms were trained and tested: linear discriminant analysis (LDA), logistic model, support vector machine (SVM), random forest (RF), least absolute shrinkage and selection operator (LASSO), ridge regression, and extreme gradient boosting (XGBoost). The ML models were evaluated using the accuracy, confusion matrix, and area under the curve (AUC) receiver operating characteristics (ROC). In total, 8564 children were included in the final analysis. The average age of the children was 926 days, and the majority were females. The weighted prevalence rates of stunting, wasting, and underweight were 17%, 7%, and 12%, respectively. The accuracies of all the ML models for wasting were (LDA: 84%; Logistic: 95%; SVM: 92%; RF: 94%; LASSO: 96%; Ridge: 84%, XGBoost: 98%), stunting (LDA: 86%; Logistic: 86%; SVM: 98%; RF: 88%; LASSO: 86%; Ridge: 86%, XGBoost: 98%), and for underweight were (LDA: 90%; Logistic: 92%; SVM: 98%; RF: 89%; LASSO: 92%; Ridge: 88%, XGBoost: 98%). The AUC values of the wasting models were (LDA: 99%; Logistic: 100%; SVM: 72%; RF: 94%; LASSO: 99%; Ridge: 59%, XGBoost: 100%), for stunting were (LDA: 89%; Logistic: 90%; SVM: 100%; RF: 92%; LASSO: 90%; Ridge: 89%, XGBoost: 100%), and for underweight were (LDA: 95%; Logistic: 96%; SVM: 100%; RF: 94%; LASSO: 96%; Ridge: 82%, XGBoost: 82%). Age, weight, length/height, sex, region of residence and ethnicity were important predictors of wasting, stunting and underweight. The XGBoost model was the best model for predicting wasting, stunting, and underweight. The findings showed that different ML algorithms could be useful for predicting undernutrition and identifying important predictors for targeted interventions among children under five years in Ghana.

Regional Disparities in Safe and Clean Environments in Uzbekistan: Analysis of 2021–2022 Uzbekistan Multiple Indicator Cluster Survey Data

Background: Water, sanitation, and hygiene (WASH) services and clean fuels are representative factors of a clean and safe residential environment. Uzbekistan faces environmental issues and ranks low among countries on the Environmental Performance Index. This study aimed to identify regional disparities and wealth inequalities in WASH services and clean fuels in Uzbekistan. Methods: We employed raw data from the 2021–2022 Uzbekistan Multiple Indicator Cluster Survey (MICS) and the WASH and clean fuels coverage were analyzed. For each of the variables with the lowest coverage within WASH services and clean fuels variables, we evaluated the disparities between urban and rural areas and calculated the concentration index (CI). Results: Among WASH services and clean fuels, basic handwashing and clean fuels for space heating demonstrated the lowest coverage. In most regions, urban areas had higher coverage of basic handwashing and clean fuels for space heating compared to rural areas. The CI of clean fuels for space heating was 0.2141 or higher in five areas. The CI was notably high in areas with low coverage of WASH services and clean fuel for space heating. Conclusions: Basic handwashing and clean fuels for space heating showed varied regional coverage patterns and wealth-related inequalities. The results of this study can provide evidence for policy formulation, particularly in addressing disparities.

Role of Households’ Wealth and Maternal Education in Early Child Development: A Case Study of Punjab, Pakistan

Children under the age of five are exposed to several hazards in developing countries, such as poverty, inadequate housing, and unstimulating home environments, which have an adverse influence on their cognitive and socio-emotional development. Since learning during adulthood is influenced by earlier developmental stages, these formative years are crucial in shaping a successful adult life. Therefore, the study intends to investigate what causes some children to perform worse than other children of the same age. It utilises data from the Multiple Indicator Cluster Survey (MICS) 2017-18 of 4,043 children from Punjab, Pakistan. Binary Logistic Regression was used for analysis and it demonstrated a positive relationship between early child development, wealth, maternal education, and home stimulating activities with all three measures of child development which include child identification of alphabets, reading at least four popular words, and recognition of numbers or shapes. The result of the study suggests that it is an urgent need of the hour to focus to women’s education and take steps to mitigate poverty in order to enable parents to provide their children with a better learning environment. JEL Classification Codes: I250, H75, P36, J13.