Multiple Indicator Cluster Survey Research Articles

Prevalence of asymptomatic malaria at the communal level in Burkina Faso: an application of the small area estimation approach

BackgroundIn malaria-endemic countries, asymptomatic carriers of plasmodium represent an important reservoir for malaria transmission. Estimating the burden at a fine scale and identifying areas at high risk of asymptomatic carriage are important to guide malaria control strategies. This study aimed to estimate the prevalence of asymptomatic carriage at the communal level in Burkina Faso, the smallest geographical entity from which a local development policy can be driven.MethodsThe data used in this study came from several open sources: the 2018 Multiple Indicator Cluster Survey on Malaria and the 2019 general census of the population data and environmental. The analysis involved a total of 5489 children under 5 from the malaria survey and 293,715 children under 5 from the census. The Elbers Langjouw and Langjouw (ELL) approach is used to estimate the prevalence. This approach consists of including data from several sources (mainly census and survey data) in a statistical model to obtain predictive indicators at a sub-geographical level, which are not measured in the population census. The method achieves this by finding correlations between common census variables and survey data.FindingsThe findings suggest that the spatial distribution of the prevalence of asymptomatic carriage is very heterogeneous across the communes. It varies from a minimum of 5.1% (95% CI 3.6–6.5) in the commune of Bobo-Dioulasso to a maximum of 41.4% (95% CI 33.5–49.4) in the commune of Djigoué. Of the 341 communes, 208 (61%) had prevalences above the national average of 20.3% (95% CI 18.8–21.2).ContributionsThis analysis provided commune-level estimates of the prevalence of asymptomatic carriage of plasmodium in Burkina Faso. The results of this analysis should help to improve planning of malaria control at the communal level in Burkina Faso.

Language of instruction policy in Nigeria: Assessing implementation and literacy achievement in a multilingual environment

In this study, I evaluate adherence to Nigeria's Language of Instruction (LOI) policy, which mandates that primary school students be taught in indigenous language. Using multivariate regression analysis and data from round 6 of the Multiple Indicator Cluster Survey (MICS6), I assessed disparities in adherence between school types (public and private schools) and location (urban/rural areas) and regions. The results reveal private schools exhibit lower implementation rates than public schools, while urban areas lag behind rural areas, and the southern region trails the north. This highlights the challenges of enforcing a uniform LOI policy in Nigeria's linguistically diverse setting. I also examine the relationship between LOI and literacy outcomes using regression and propensity score matching anaysis. Contrary to prevailing notion that teaching children in an indigenous language improves learning outcomes, my findings show that students taught in English outperformed their peers taught in indigenous languages. This departure from the norm underscores the need to reassess generalized conclusions derived from less lingustically diverse contexts, as they might not apply settings like Nigeria. It also calls for a nuanced understanding of how LOI influences learning outcomes in diverse contexts, emphasizing the importance of tailoring educational policies to local realities.

Measuring spatial inequalities in maternal and child mortalities in Pakistan: evidence from geographically weighted regression

BackgroundIn developing countries, the death probability of a child and mother is more significant than in developed countries; these inequalities in health outcomes are unfair. The present study encompasses a spatial analysis of maternal and child mortalities in Pakistan. The study aims to estimate the District Mortality Index (DMI), measure the inequality ratio and slope, and ascertain the spatial impact of numerous factors on DMI scores across Pakistani districts.MethodThis study used micro-level household datasets from multiple indicator cluster surveys (MICS) to estimate the DMI. To find out how different the DMI scores were, the inequality ratio and slope were used. This study further utilized spatial autocorrelation tests to determine the magnitude and location of the spatial dependence of the clusters with high and low mortality rates. The Geographically Weighted Regression (GWR) model was also applied to examine the spatial impact of socioeconomic, environmental, health, and housing attributes on DMI.ResultsThe inequality ratio for DMI showed that the upper decile districts are 16 times more prone to mortalities than districts in the lower decile, and the districts of Baluchistan depicted extreme spatial heterogeneity in terms of DMI. The findings of the Local Indicator of Spatial Association (LISA) and Moran's test confirmed spatial homogeneity in all mortalities among the districts in Pakistan. The H–H clusters of maternal mortality and DMI were in Baluchistan, and the H–H clusters of child mortality were seen in Punjab. The results of GWR showed that the wealth index quintile has a significant spatial impact on DMI; however, improved sanitation, handwashing practices, and antenatal care adversely influenced DMI scores.ConclusionThe findings reveal a significant disparity in DMI and spatial relationships among all mortalities in Pakistan's districts. Additionally, socioeconomic, environmental, health, and housing variables have an impact on DMI. Notably, spatial proximity among individuals who are at risk of death occurs in areas with elevated mortality rates. Policymakers may mitigate these mortalities by focusing on vulnerable zones and implementing measures such as raising public awareness, enhancing healthcare services, and improving access to clean drinking water and sanitation facilities.

Analyzing child health and water, sanitation, hygiene facilities in Punjab, Pakistan: A multilevel and spatial approach

AbstractThe health and well‐being of children can be achieved through access to clean water, proper sanitation, and hygiene practices. The current study investigates the effect of water, sanitation, and hygiene (WASH) on health outcomes using the multiple indicator cluster surveys (MICS) data. The household‐level and district‐level determinants of child health are analyzed using logistic regression models and multilevel logistic regression models. The results indicate that there are significant relationships between water availability, sanitation facilities, hygiene practices, and health outcomes. Access to clean water, an increase in sanitation facilities, and proper hygiene have a significant positive relationship with child health. Better access to clean water enhances children's well‐being. The level of parental education, household head dynamics, and WASH indicators at the district level also have a significant relationship with child health. The bivariate Local Moran's I analysis of child health and WASH facilities shows positive spatial autocorrelation (0.441). It also identifies the districts with significant high–high and low–low clustering patterns. This study contributes to achieving SDGs 3 and 6 to develop policies, programs, and future‐based solutions to promote the health and well‐being of children in Punjab and other similar areas.

Water, sanitation, and hygiene–specific risk factors of recent diarrheal episodes in children aged under 5 years: analysis of secondary data from the multiple indicator cluster survey (MICS 2019)

ObjectivesAccess to safe drinking water, sanitation, and hygiene, collectively called WASH, is a fundamental human right and a cornerstone of public health. However, inadequate WASH practices and environments significantly contribute to the global burden of diarrheal diseases, particularly, in children aged under 5 years. Inadequate WASH conditions are the primary drivers of various infectious diseases, including cholera, dysentery, hepatitis A, typhoid, and polio. MethodsWe conducted secondary data analysis using the 2019 Zimbabwe Multiple Indicator Cluster Survey to investigate the specific WASH risk factors associated with recent diarrheal episodes in children aged under 5 years. ResultsA total of 853 (14%) of 6092 children were reported to have experienced an episode of diarrhea in the last 2 weeks preceding the survey. Having insufficient water in the household was associated with 17.0% diarrhea episodes compared with 13.6% in those who did not face this problem. The availability of soap or detergents to wash hands was associated with a risk of diarrhea, with an odds ratio and 95% confidence interval of 1.19 (1.01-1.40), P = 0.033. The use of surface water, including rivers, dams, lakes, ponds, streams, canals, and irrigation channels, was associated with differences in diarrheal episodes, although this was of borderline significance, P = 0.082. Of the children who had a recent episode of diarrhea, 41.0% had their parents or caregivers seeking medical attention. ConclusionsThere is need for an improvement in safe water supply to households and an improvement in health education on the importance of using soap after using the toilet to avoid contamination of food and water.

Temporal trends of diarrheal diseases and associated treatment responses among children aged under five: Insight from the multiple Indicator Cluster surveys from 2006 to 2019

BackgroundDespite significant progress in its health sector, Bangladesh has a high burden of diarrheal mortality and morbidity in the South Asian region. Given recent major social and economic transitions in Bangladesh, it is important to examine how patterns of diarrhea and its treatment have evolved over the past few decades. The current study aims to assess the temporal changes in the frequency of diarrhea and identify the factors that influence whether affected children receive proper treatment. MethodsThe current study utilized data from three Bangladesh Multiple Indicator Cluster Surveys (MICS), 2006, 2012–13, and 2019, respectively. Binary logistic regressions were conducted, and the reported results included odds ratios (OR) and 95% confidence intervals (CIs). A p-value of <0.05 was considered statistically significant (α = 0.05). ResultsThe prevalence of diarrhea in Bangladesh declined from 7.05% in 2006 to 3.91% in 2012–13, but then increased to 8.78% in 2019. The proportion of children with diarrhea who received oral rehydration therapy (ORT) was 68.91%, 77.35%, and 70.59% respectively. Binary logistic regression indicated that older children (OR:0.54; CI:0.51–0.58), females (OR:0.92; CI:0.86–0.98), children from upper quintile families, and children from mothers having primary education (OR:0.9; CI:0.83–0.98) were less likely to suffer from diarrhea. However, the odds of receiving proper treatment with ORT were higher among older children (OR:1.45; CI:1.26–1.68), children from the rich and richest quintiles (OR:1.85; CI:1.47–2.32 and OR:1.7; CI:1.32–2.2 respectively). Also, it was the same for children from mothers with primary (OR:1.19; CI:1.01–1.41) and secondary or above education (OR:1.32; CI:1.12–1.56). ConclusionA targeted approach is needed to reduce diarrhea and promote the use of ORT. Maternal education can be an important intervention, and steps should be taken to reduce poverty. Future policies should consider strategies focusing on socioeconomic and environmental factors.

Women with disabilities' use of maternal care services in sub-Saharan Africa.

Quality maternal health care is central to the Sustainable Development Goals efforts to reduce maternal mortality, yet there remain limited quantitative data on maternal care inequities for women with disabilities in sub-Saharan Africa. This study aims to understand the differences in maternal care providers for women with and without disabilities. We used Multiple Indicator Cluster Surveys from 13 sub-Saharan African countries conducted between 2017-2020. We used logistic and multinomial logistic regression to examine the relationship between disability (Washington Group definition) and antenatal care attendance and the type of care provider for antenatal care, skilled birth attendance, and postnatal and postpartum checks. All analyses were adjusted for age, wealth, country, and location. The sample included 10 021 women, including 306 (3.1%) women with disabilities. There were small absolute and no relative differences in antenatal care attendance, qualified antenatal care provider, postnatal, and postpartum checks, for disabled and women without disabilities. Women with disabilities had some evidence of higher odds of having a doctor at their birth compared to women without disabilities (aOR = 1.52, 95% CI: 0.99-2.33). This study shows small absolute and no relative differences between women with and without disabilities for antenatal access and provider types for maternal care, though these findings are limited by a small sample and no data on care quality, acceptability, or outcomes. More research on care quality and outcomes is needed. This study is the first quantitative, multi-country study in sub-Saharan Africa to examine maternal care seeking patterns, demonstrating important data on maternal health indicators for women with disabilities.

Descriptive Overview of Adolescent Health Indicators in Humanitarian Settings: A Cross-Country Analysis

Purpose: An adolescent health information system is a relevantly new concept, especially in humanitarian settings. This article aims to map the available adolescent health indicators collected in selected humanitarian settings, identify the available data sources, and determine the alignment between these indicators and the draft list of priority indicators for adolescent health measurement recommended by the Global Action for the Measurement of Adolescent Health Advisory Group. Methods: We selected five countries experiencing humanitarian crises- Myanmar, Nigeria, Palestine, Ukraine, and Yemen. We identified the adolescent health indicators collected in each country using document analysis and a purposive sampling approach. We reviewed the primary population-based surveys used to gather adolescent health data and noted the most recent year each survey was conducted. The identified indicators were then categorized by measurement domains and specific areas of adolescent health.Results: The Multiple Indicator Cluster Survey and Demographic Health Survey were conducted in all five countries selected, but three out of five countries have not administered either within the last five years. Yemen and Palestine only included married women in their sample sizes, and no one younger than 15 was interviewed. Indicators most commonly assess reproductive health, tobacco use, and adolescent fertility. Limited data was found on younger adolescents, males, water, sanitation, hygiene, disability, and nutrition indicators. Discussion: Adolescent health information in humanitarian crises requires more frequent surveys, including all adolescent age groups, and unique data collection methodologies. The current surveys used to measure adolescent health indicators have limited ability to be inclusive to all adolescents. It is important to establish a list of priority indicators deemed essential in humanitarian settings and relevant ways to collect them.

Gender and child feeding practices in Belize- a trend analysis

The study aimed to determine the trend and gender differences in child feeding practices in Belize based on consecutive multiple indicator cluster surveys (MICS) using a retrospective quantitative study. The secondary analysis of the last consecutive MICS data from 2006, 2011 and 2015-16 was done using SPSS software version 23. Association between gender and feeding practices was determined by bivariate analysis using chi-square test and p value &lt; 0.05 was considered statistically significant. There was increased gender differentials in optimal feeding practices in children over the study period. The inequalities between male and female increased over the study period for most of the feeding practices except for exclusive breastfeeding where the gender inequality diminished. The exclusive breastfeeding rate among female children was higher than among male children in the three surveys but significant only in 2006 and 2011 surveys, p&lt;0.05. More female children were timely initiated on complementary feeding compared to male children in the three surveys and was found to be significant in 2006 and 2015 surveys, p&lt;0.05. Minimal meal frequency and minimal dietary diversity was higher among female than among male but there was no significant difference(p&gt;0.05). The study shows evidence of gender differential in feeding practices. There is need to improve gender sensitization in terms of feeding practices within the households; develop and implement culturally appropriate gender sensitive guidance and approaches on optimum infant and young child feeding practices in the country.

Effects of sanitation on child growth in Serbian Roma communities

Abstract Poor sanitation may be associated with growth faltering, but empirical evidence on the association between household sanitation infrastructure and child nutrition has been mixed. This article assessed whether sanitation infrastructure is associated with growth penalties for Roma children. Design This is a Roma nationally representative population-based study. Proxies of child nutritional outcomes included children’s height-for-age Z scores below two standard deviations from the median of WHO’s reference population. Multiple and logistic regressions estimated the association between the type of toilet usage, outcomes, and sociodemographic determinants. Setting Data were from UNICEF’s fifth and sixth Multiple Indicator Cluster Surveys for Serbian Roma settlements. Subjects Children aged 0–24 (n = 1,150) and 25–59 (n = 2,024) months born to women aged 15–48 years were included in this study. Results About 16% of children resided in households with no toilet service, and 23% of children were stunted. Roma children aged 25–59 months in households with no toilet service and in rural areas were more likely to be stunted and of significantly shorter stature than their counterparts. Children up to 24 months of age were not affected by the type of toilet, likely due to protective effects of breastfeeding. Child’s age, number of siblings, and birth spacing negatively influenced growth outcomes, while maternal age, birthweight above 2.5 kg, and being a female mitigated against poor growth outcomes. Conclusions The relationship between the type of toilet and growth outcomes among Roma children varied with age and area: having no toilet and living in rural areas were associated with compromised child growth for children aged 25–59 months. Maternal and child characteristics additionally accounted for children’s growth.

Is religious affiliation associated with parent disciplinary behavior in Suriname and Guyana

BackgroundAlthough limited, there is some evidence that certain physical punishments may vary by household religion. ObjectiveThis study aimed to determine whether parent disciplinary behavior varies by religious affiliation in two countries which have large, diverse religious groups. Participants and settingData from Multiple Indicator Cluster Surveys for Suriname (2018) and Guyana (2019–20), which contain nationally representative household samples, were used. The study was restricted to the three most prevalent religious groups: Christians, Hindus, and Muslims. MethodsAdult responses to a standardized survey that included questions about use of disciplinary behaviors in the household towards children (aged 1–14 years) were examined in relation to religious affiliation of the head-of-household and multiple covariates. ResultsOf the 3518 Suriname households, 62.4 %, 23.3 % and 14.3 % were Christians, Hindus, and Muslims, respectively. Compared to Christians, children in both Hindu and Muslim households had significantly lower odds of being hit with an object in adjusted logistic regression models. However, only Hindus had lower odds of being spanked and Muslims lower odds of exposure to a combined physical and non-physical practice, compared to Christians. Of the 2535 Guyana households, 69.5 %, 23.5 % and 7.0 % were Christians, Hindus, and Muslims, respectively. Children in Hindu, but not Muslim households, had significantly lower odds of being spanked, hit with an object, and exposed to a combine practice in adjusted models compared to Christians. ConclusionsPartial support was found for a potential influence of religion on some disciplinary behaviors. Further investigation is warranted to identify possible conditions and mechanisms.

PREDICTING UNDERNUTRITION RISK FACTORS USING MACHINE LEARNING TECHNIQUES IN NIGERIAN UNDER FIVE CHILDREN

Childhood undernutrition remains a critical global health challenge with far-reaching consequences. This study developed and compare predictive models for three key indicators of under-five child undernutrition in Nigeria: stunting, wasting, and underweight. By leveraging various machine learning (ML) algorithms, we identified the most significant socio-demographic determinants of these nutritional outcomes. The study utilizes data from the Nigerian Multiple Indicator Cluster Survey (MICS6) 2021, a comprehensive nationwide survey. Four ML algorithms were employed to predict the risk factors for the under-5 child nutritional status: k-nearest neighbors (KNN), random forest (RF), decision tree (DT), and logistic regression (LR). These models were evaluated and compared based on their predictive performance. The study encompasses households across Nigeria, providing a broad representation of the country's diverse population. Preliminary analysis reveals significant regional disparities in the prevalence of stunting, wasting, and underweight among Nigerian children. Among the four ML algorithms tested, the KNN model demonstrated superior predictive capability across all evaluation metrics, including accuracy (89.65%, 95.00%, 80.04%), precision (91.02%, 87.79%, 93.53), recall (99.98%, 100%, 100%), and F1-score (94.44%, 98.83%, 88.60%). This outperformance was consistent for all three undernutrition indicators. The KNN model, identified as the most effective predictor, highlighted several key determinants of childhood undernutrition. These factors varied somewhat across the three outcomes but commonly included: household wealth index, geopolitical zone, source of drinking water, child age, birth size, mother's education level, and residential area (urban/rural) among others. This study demonstrates the efficacy of machine learning approaches, particularly the KNN algorithm, in predicting and understanding the determinants of children undernutrition in Nigeria. The findings provide valuable insights for targeted interventions and policy formulation. These results can inform evidence-based decision-making and resource allocation in Nigeria's efforts to improve child nutrition and achieve related Sustainable Development Goals.

Inequality in Childhood Immunization Coverage: A Scoping Review of Data Sources, Analyses, and Reporting Methods.

Immunization through vaccines among children has contributed to improved childhood survival and health outcomes globally. However, vaccine coverage among children is unevenly distributed across settings and populations. The measurement of inequalities is essential for understanding gaps in vaccine coverage affecting certain sub-populations and monitoring progress towards achieving equity. Our study aimed to characterize the methods of reporting inequalities in childhood vaccine coverage, inclusive of the settings, data source types, analytical methods, and reporting modalities used to quantify and communicate inequality. We conducted a scoping review of publications in academic journals which included analyses of inequalities in vaccination among children. Literature searches were conducted in PubMed and Web of Science and included relevant articles published between 8 December 2013 and 7 December 2023. Overall, 242 publications were identified, including 204 assessing inequalities in a single country and 38 assessing inequalities across more than one country. We observed that analyses on inequalities in childhood vaccine coverage rely heavily on Demographic Health Survey (DHS) or Multiple Indicator Cluster Surveys (MICS) data (39.3%), and papers leveraging these data had increased in the last decade. Additionally, about half of the single-country studies were conducted in low- and middle-income countries. We found that few studies analyzed and reported inequalities using summary measures of health inequality and largely used the odds ratio resulting from logistic regression models for analyses. The most analyzed dimensions of inequality were economic status and maternal education, and the most common vaccine outcome indicator was full vaccination with the recommended vaccine schedule. However, the definition and construction of both dimensions of inequality and vaccine coverage measures varied across studies, and a variety of approaches were used to study inequalities in vaccine coverage across contexts. Overall, harmonizing methods for selecting and categorizing dimensions of inequalities as well as methods for analyzing and reporting inequalities can improve our ability to assess the magnitude and patterns of inequality in vaccine coverage and compare those inequalities across settings and time.

Which chronic diseases contribute the most to healthy life years lost in Algeria?

Chronic diseases contribute significantly to healthy years lost (HYLs). It is critical to investigate which are the most contributing diseases to enable enhancing health programs' effectiveness in improving health expectancy. This paper investigates disease-specific contributions to years lived with chronic diseases in Algeria and examines their recent evolution. We used morbidity data from the last three waves of the Multiple Indicator Cluster Surveys of 2006, 2012-13, and 2018-19. The studied chronic diseases included hypertension, cardiovascular diseases (CVDs), joint diseases, respiratory diseases, and diabetes. We calculated disease-specific contributions using the cause-deleted health expectancy approach. Then, we analyzed time changes and gender-based differences in contributions. The leading cause of HYLs in women is hypertension, followed by diabetes, joint diseases, CVDs, and respiratory diseases. The same ranking applies to men, with joint diseases coming last. The time evolution of relative disease-specific contributions shows an increase in CVDs for women and diabetes for both genders, against a decrease for the other diseases. To improve chronic disease-free life expectancy in Algeria, effective prevention programs must be implemented, with an emphasis on hypertension and diabetes. Further investigation into the risk factors affecting the prevalence and incidence of these diseases is also required.

Comparison of FGM prevalence among Nigerian women aged 15–49 years using two household surveys conducted before and after the COVID-19 pandemic

BackgroundDue to its economic burden and change of focus, there is no gainsaying of the potential impacts of the COVID-19 pandemic on the progress of several female genital mutilation (FGM) interventions across the various countries. However, the magnitude of the potential changes in likelihood and prevalence should be more accurately explored and quantified using a statistically robust comparative study. In this study, we examined the differences in the likelihood and prevalence of FGM among 15-49 years old women before and after the pandemic in Nigeria.MethodsWe used advanced Bayesian hierarchical models to analyse post-COVID-19 datasets provided by the Multiple Indicator Cluster Surveys (MICS 2021) and pre-COVID-19 data from the Demographic and Health Surveys (DHS 2018).ResultsResults indicated that although there was an overall decline in FGM prevalence nationally, heterogeneities exist at state level and at individual-/community-level characteristics. There was a 6.9% increase in prevalence among women who would like FGM to continue within the community. FGM prevalence increased by 18.9% in Nasarawa, while in Kaduna there was nearly 40% decrease.ConclusionsResults show that FGM is still a social norm issue in Nigeria and that it may have been exacerbated by the COVID-19 pandemic. The methods, data and outputs from this study would serve to provide accurate statistical evidence required by policymakers for complete eradication of FGM.

Antenatal Care Visits, Institutional Births, and Associated Risk Factors in Afghanistan: Insights from the Multiple Indicator Cluster Survey 2022-2023.

Insufficient use of antenatal care (ANC) services and institutional births services can elevate the maternal mortality risk in limited resource settings. Hence, the key objective of this study was to evaluate the potential association between the frequency of ANC visits and institutional birth services in Afghanistan, while also identifying other sociodemographic factors that may exert influence. Furthermore, we explored factors associated with the attendance of women at ANC visits during their pregnancy. We employed data from the most recent Multiple Indicator Cluster Survey conducted in Afghanistan in 2022 to 2023 with a total of 8096 women aged 15 to 49. A complex survey weight-adjusted logistic regression model was used to examine factors related to institutional births, and a multinomial logistic regression model was fitted to assess the relationships between sociodemographic factors and ANC visits, adjusting for survey weights, cluster effects, and strata. Approximately 40% of the sample (n = 3247) had undergone 4 or more ANC visits, and 74.4% (n = 6,022) had opted for institutional birth. Women's higher education was found to be associated with ANC visits. The area of residence, wealth index, education levels of women, ownership of mobile phones, number of children, and number of ANC visits were associated with institutional births. Compared with women with no or one ANC visit, those with more than 3 visits had 31% higher odds (adjusted odds ratio, 1.31; 95% CI, 1.10-1.57) of accessing institutional births. Our findings indicate a significant association between ANC visits and use of institutional birth care. These findings carry implications for advancing safe motherhood and childbirth by enhancing women's social status.

Prevalence of stunting and its correlates among children under 5 in Afghanistan: the potential impact of basic and full vaccination

BackgroundChild stunting is prevalent in low and middle-income countries (LMICs), but an information gap remains regarding its current prevalence, correlates, and the impact of vaccination against this condition in Afghanistan. This study aimed to determine the prevalence and correlates of moderate and severe stunting and the potential impact of basic and full vaccination among children under five in Afghanistan.MethodsThis is a secondary analysis of the 2022-23 Afghanistan Multiple Indicators Cluster Survey (MICS) including 32,989 children under 5. Descriptive statistics were employed to describe the distribution of independent variables and the prevalence of stunting across them. Chi-square analysis was used to examine the association between each independent variable with stunting. Multinomial logistic regression was used to examine the risk of stunting across different independent variables.ResultsA total of 32,989 children under 5 years old were included in this study. Of those 44.7% were stunted with 21.74% being severely stunted. Children aged 24–35 and 36–47 months faced the highest risk as compared to those aged 1–5 months. The prevalence was lower in female children and they were less likely to experience severe stunting. Stunting was more prevalent in rural areas, with children there 1.16 to 1.23 times more likely to be affected than urban counterparts. Lower wealth correlated with higher stunting. Younger maternal age at birth (≤ 18) correlated with increased stunting risks, particularly in severe cases. Parental education was inversely related to stunting; higher education levels in parents, especially fathers, were associated with lower stunting rates. Households with more than seven children showed a 25% and 44% higher risk of moderate and severe stunting, respectively, compared to families with 1–4 children. Improved sanitation, but not drinking water sources, was linked to reduced stunting in the adjusted model. Vaccination had a protective effect; in the adjusted analysis, basic and full vaccinations significantly lowered the risk of severe stunting by 46% and 41%, respectively.ConclusionIn this nationally representative study, the prevalence of stunting was substantial (44.7%) in Afghan children. Additionally, the findings emphasize the critical factors associated with child stunting and underscore the protective role of vaccination against this condition, which provides policymakers with directions for policy efforts and intervention strategies to reduce child stunting in Afghanistan.

Contraceptive use, unmet need, and demand satisfied for family planning across Cameroon: a subnational study including indirect effects of COVID-19 and armed conflict on projections

BackgroundCameroon is among countries that have made notable investments nationwide in line with the Family Planning 2030 initiative. This study examines the progress made across the 10 regions and 58 divisions of the country, including potential impairments following COVID-19 and armed conflict.MethodsIn this time-series analysis, parameters were sourced from 5 Demographic and Health Surveys and 3 Multiple Indicator Cluster Surveys conducted between 1991 and 2018. The Family Planning Estimation Tool (FPET) was used to estimate key family planning indicators among married women of reproductive age. Data from official country reports and FPET results were incorporated into Bayesian models to assess how projections (from 2020 to 2030) would vary given varying contractions (i.e., 0%, 5%, 10%, and 25% annually) to services coverage.ResultsNationally, modern contraceptive prevalence rate (mCPR) and demand satisfied with modern (contraceptive) methods reached 16.8% (95% credible interval 12.0 to 23.0) and 37.6% (28.7 to 47.0), respectively; and unmet need for modern methods decreased to 27.9% (22.9 to 33.7) in 2022. Notable improvements were observed in the East region and Boumba et Ngoko division, with annual mCPR trends of 2.1 percentage points (%p) (− 0.2 to 4.2) and 7.0%p (4.5 to 9.3) from 2015–2020; and 2030 projections of 58.7% (41.3 to 74.0) and 79.1% (65.0 to 89.0), respectively. The least performing in terms of demand satisfied with modern methods include Adamawa at the regional and Boyo at the divisional level, with 2030 projections of 45.5% (26.5 to 65.1) and 0.4% (0.2 to 0.8), respectively. The northern regions (Adamawa, Far North, and North) recorded the lowest levels of unmet need for modern methods. To achieve ≥ 75% demand satisfied with modern methods in 2030, an additional 1.4 (0.6 to 2.2) million modern contraceptive users are required. Given large reductions (− 25% annually) in services coverage post-COVID-19/armed conflict (2020 to 2030), the South region could experience the most significant contraction in projected mCPR, with a decrease of − 9.2%.ConclusionsFamily planning outcomes vary significantly across subnational territories of Cameroon. While the East region shows notable success, greater attention is needed in the northern regions. Strategies must be adaptive to address unprecedented emergencies that may disrupt access to services.

Child fostering and school attendance in West Africa over time

ABSTRACT Informal fostering arrangements can relieve pressure on parents and promote social mobility for children from poor households in sub-Saharan Africa. However, the motivation of host households to invest in fostered children would determine the extent of the benefits. This study uses Multiple Indicator Cluster Survey (MICS) data on children 6–12 years with both parents alive in five West African countries (Gambia, Ghana, Guinea-Bissau, Sierra Leone and Togo) to assess the relationship between foster status and school attendance in two time periods: 2005–2006 and 2017–2018. Multilevel logit regressions are used to estimate the likelihood of ever attending school. The results indicate that the likelihood of attending school for fostered children relative to non-fostered children was negative and statistically significant in 2017–2018 but was not different in 2005–2006. Further, the negative association between foster status and school attendance was larger for children in richer households in both time periods. These findings highlight the need for further research to provide insight into the dynamics of fostering children to higher socioeconomic status households.

The Construction of a Human Development Index at the Household Level and the Measurement of Human Development Disparities in Punjab (Pakistan)

ABSTRACT The key objectives of this research study are to construct a valid and reliable household-based Human Development Index (HDI) and to estimate human development disparities in 36 districts of Punjab (Pakistan) by analysing Multiple Indicator Cluster Survey microdata. The household-level HDI, a composite index, is constructed by applying the arithmetic mean of the household-level health, asset, and education indices. The district of Lahore, among all the 36 districts of Punjab, has the highest HDI score of 0.743, followed by districts Rawalpindi, Jhelum, and Gujrat. Four neighbouring districts from South Punjab: Rajanpur, Dera Ghazi Khan, Muzzaffar Gar, and Rahim Yaar Khan, have the lowest HDI scores of 0.492, 0508, 0.531, and 0.566, respectively. This paper has used the Palma-ratio and Gini-coefficient to estimate human development disparities in Punjab. The highest human development disparities are observed in the Rajanpur district with a Gini-coefficient of 0.38 and a Palma Ratio of 1.55. Both the Gini and Palma Ratio methods produce similar district rank orderings of inequality. This research recommends that additional efforts be made to uplift the districts with the lowest human development in Southern Punjab through local government restructuring and devolution of relevant powers, including the formation of a separate province.