National Household Survey Research Articles

Estimating the welfare effect of food price increase on households in Nigeria: Direct and substitution effect approach

Increases in food prices in Nigeria have raised huge concerns on the impact welfare of poor households who have substantial share of their spending on food. This study investigated the welfare effects (including the direct and substitution effects) of food price changes on households in Nigeria. The study employed time series data on food prices from 1991-2013 and household survey data obtained from the National household Survey (wave 2). We group household consumption expenditure on different food and non-food commodities into nine (9) namely; fish, meat, pulses, fruit & vegetable, fat & oil, beverages, wheat, rice, corn, and others. Welfare effect was analyzed by compensating variation. The results showed that a safety net program would net to transfer an amount equivalent to 0.76%, 0.26% and 1.02% of the total national consumption to fully compensate the poorest quintile in rural, urban and at the national level respectively. And also, in the richest losers’ quintile about 1.29% of the aggregate national consumption will be required by a safety net program to fully compensate them overall. The study concluded that food price changes related significantly with welfare status of the respondents as tested by CV model. Welfare gain was enjoyed mostly by urban household whose mean compensated variation was as high as 18% compared with 14% for rural household.

Lucky women in unlucky cohorts: Gender differences in the effects of initial labor market conditions in Latin America

This paper assesses gender differences in the effects of adverse conditions at labor-market entry in a developing region. Using harmonized microdata from national household surveys for 15 Latin American countries, we build a synthetic panel of cohorts that potentially transition from school to work and observe their labor market outcomes 10 years later. We find that men who faced higher unemployment rates at ages 18–20 suffer a negative effect on employment at ages 27–30. In contrast, women from those same unlucky cohorts have higher employment rates and earnings. Our results are consistent with women acting as secondary workers in downturns. We also find that initial labor market conditions correlate with the role played by women within the household and to perceptions about gender roles later in life. Such higher empowerment could be a result of increased female labor participation and at the same time might act as a mechanism underlying the persistence of the positive effects on female labor outcomes.

Routine Immunization Coverage and Immunization Card Retention in Pakistan: Results From a Cross-sectional National Survey.

Immunization is one of the most successful public health interventions available, saving millions of lives from death and disability each year. Therefore, improving immunization coverage is a high priority for the Government of Pakistan and essential to progress toward universal health coverage. This survey reports the national and provincial/regional coverage and determinants of fully, partially, and not-vaccinated children 12-23 months of age, antigen-wise coverage, percentage of home-based vaccination records (HBR) retention, and reasons for nonretention; dropout, timeliness, and prevalence of missed opportunities for simultaneous vaccination (MOSV). The survey was a descriptive cross-sectional national household survey carried out across Pakistan. The survey included 110,790 children 12-23 months old and their caregivers. A World Health Organization (WHO)-Expanded Program on Immunization (EPI) Survey questionnaire was adapted to collect information. Data were analyzed using the WHO Vaccination Coverage Quality Indicators (VCQI) software and Stata version 17. Nationally excluding Azad Jammu and Kashmir (AJK) and Gilgit Baltistan (GB), the coverage of fully vaccinated children was 76.5%. The likelihood of being fully vaccinated was higher among children of educated parents who belonged to higher wealth quintiles and resided in any province/region other than Balochistan. The main reasons for unimmunization were no faith in immunization, rumors about vaccines, and distance to the facility. About two-thirds (66.2%) of the children had their HBR available, and the main reasons for not having a card were never visiting a health facility and having no awareness about the importance of a card. Dropout was discernible for later doses of vaccines compared with earlier ones. Higher proportions of children received the last doses late by more than two months. Of the 218,002 vaccination visits documented on HBR in the provinces, MOSVs occurred in 17.6% of the visits. The immunization coverage rates provide a direction to strategize the progress to improve the vaccination rates in Pakistan. The country needs to outline the immediate and long-term actions to combat vaccine-preventable diseases, such as escalating integrated immunization campaigns and outreach activities, provision of mobility support, and deploying behavioral interventions as a cross-cutting strategy to improve awareness and reduce misconceptions.

Wealth distribution, income distribution, social class and education of household heads: Evidence from Thailand’s national household survey

Wealth distribution, income distribution, social class and education of household heads: Evidence from Thailand’s national household survey

Association between total available nutritional quality and food expenditure in Peruvian households, 2019-2020.

Evidence points to a direct relationship between nutritional quality and food expenditure. However, food expenditure is highly susceptible to changes, and nutritional quality of household food presents limited evidence. The aim of this study was to assess the relationship between nutritional quality available and total food expenditure in Peruvian households, and whether there were differences by area (urban and rural) and between years of the COVID-19 pandemic. For this, we used Peru's National Household Survey (ENAHO) from 2019 and 2020. We assessed total food expenditure in US dollars per day, whereas household nutritional quality available was assessed based on dietary diversity and compliance with the household calorie requirements, percentage of food expenditure, and potential confounders. We used the Student's t-test, analysis of variance (ANOVA), linear regression, and the Wald test to assess the interaction effect. Households with adequate total/partial nutritional quality available by area were found to spend, on average, USD 2.00 more in urban than in rural areas and, by year, they presented 7.1% more percentage of food expenditure in 2020 than in 2019. Despite associations existing between nutritional quality available and total food expenditure by year and study area, the effect modification was only present by study area. In multivariable model, households with adequate total/partial nutritional quality available consistently presented a lower total food expenditure by year, with a lower total food expenditure in urban areas. An inverse relationship was found between nutritional quality available and total food expenditure, in contrast to the direct relationship of studies assessing dietary cost and nutritional quality. Our results reflect the nutritional deficit in the food purchases of Peruvian households.

Trends in Socioeconomic Inequalities in Breast Cancer Incidence Among Women in Canada.

Breast cancer is the most common cancer among females in Canada. This study examines trends in socioeconomic inequalities in the incidence of breast cancer in Canada over time from 1992 to 2010. A census division level dataset was constructed using the Canadian Cancer Registry, Canadian Census of the Population and National Household Survey. A summary measure of the Concentration index (C), which captures inequality across socioeconomic groups, was used to measure income and education inequalities in breast cancer incidence over the 19-year period. The crude breast cancer incidence increased in Canada between 1992 and 2010. Age-standardized C values indicated no income or education inequalities in breast cancer incidence in the years from 1992 to 2004. However, the incidence was significantly concentrated among females in high income and highly educated neighbourhoods almost half the time in the 6 most recent years (2005-2010). The trend analysis indicated an increase in breast cancer incidence among females living in high income and highly educated neighbourhoods. Breast cancer incidence in Canada was associated with increased socioeconomic status in some more recent years. Our study findings provide previously unavailable empirical evidence to inform discussions on socioeconomic inequalities in breast incidence.

Prevalence and Correlates of Cardiovascular Health Status among Adults in Afghanistan: Results of a National Survey in 2018.

The aim of the study was to assess the prevalence and correlates of cardiovascular health (CVH) status among adults in Afghanistan. In a national cross-sectional household survey 3,447 adults completed CVH measurements in Afghanistan. Criteria for ideal CVH (ICVH) were physical activity, healthy diet, non-smoking, fasting blood glucose (<100 mg/dL), body mass index (<25 kg/m2), total cholesterol (<200 mg/dL), and blood pressure (<120/<80 mmHg). More than one-third (34.3%) of participants had 5-7 ICVH, 45.7% 3-4 ICVH, and 20% had 0-2 ICVH. In adjusted logistic regression analysis, secondary or more education (AOR: 1.80, 95% CI: 1.22-2.66) was positively associated, and older age (45-69 years) (AOR: 0.33, 95% CI: 0.26-0.42), and urban residence (AOR: 0.67, 95% CI: 0.51-0.88) were inversely associated with 5-7 ICVH. The prevalence of ICVH was low in Afghan adults. Population measures may be used to improve CVH targeting identified associated factors.

Abstract C076: Income and incidence of lung cancer in the capital of an upper-middle country

Abstract Background: Worlwide lung cancer is the leading cause of cancer related death. Research has revealed significant socioeconomic disparities in lung cancer; generally people from lower socio-economic status exhibit higher cancer incidence and poorer cancer survival. . Data on how socioeconomic disparities influence the incidence of lung cancer in Latin America is scarce. We evaluated the association of economic income with the incidence of lung cancer in Peru's capital city. Methods: This is a retrospective ecologic study with newly diagnosed lung cancer between two periods 2010-2012 and 2013-2015 reported in the Lima metropolitan Cancer Registry (Peru). The economic income was obtained from the National household survey conducted in 2012 and 2015, respectively.. To assess the statistical relationship between both variables, Pearson's correlation coefficient was performed. A p value &amp;lt; 0.05 was used to define significant association Results: Lima has 49 districts, including Callao. In the period 2010-2012, lung cancer incidence was 11.24 (median 10.36). La Punta and Carabayllo were the districts with highest and the lowest lung cancer incidences with 27.39 and 6.09, respectively. Regarding the economic income, the median was 230 dollars. La Punta (median 728.5) and Rimac (median 73.5) were the districts with the highest and lowest income, respectively. The Pearson`s correlation coefficient was 0.637 and the p value showed a significant association (p 0.0001) and the . In the analysis by sex, lung cancer incidence in women had no significant association with economic income (p 0.084) while lung cancer incidence in males was highly and positively and associated with economic income (p 0.0001; r 0.72). In the period 2013-2015, lung cancer incidence was 11.26 (median 11.21). Miraflores (26.53) and Ventanilla (5.01) were the districts with highest and the lowest incidences, respectively. The median economic income was 285.7 dollars. San Isidro was the district with the highest economic income (median 857) and Cineguilla (median 92.8) the one with the lowest one. The Pearson`s correlation coefficient was 0.501 and the p value showed a significant association (p 0.001). In the analysis by sex, lung cancer incidence in women had no a significant association with economic income (p 0.11) while lung cancer incidence in males exhibited a moderate positive association (p 0.03; r 0.471). Conclusion: In both periods, high economic income showed a positive association with lung cancer incidence. This finding was driven by lung cancer incidence in males as no a significant association was found in women. The reasons behind this finding need to be further studied. Citation Format: Katia Roque, Nanto Caparachin, Melanie Castro-Mollo, Marco Galvez-Nino, Rossana Ruiz, Ofelia Coanqui, Natalia Valdivieso, Mivael Hurtado de Mendoza, Edgar Amorin, Ebert Poquioma, Jose Cruzado, Luis Mas. Income and incidence of lung cancer in the capital of an upper-middle country [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C076.

Pensión 65 y acceso a los servicios de salud del adulto mayor: Perú 2019

The present research work had as objective: to analyze if the National Solidarity Assistance program: pension 65 allows to increase the probability of access of the elderly to health services; Taking into account the challenges of all the countries of the world and especially Peru, it is of vital importance to know if the country aims to comply with generating a state of total well-being for the elderly. We worked with a sample of 10,983 older adults who during 2019 reported discomfort, illness, relapse or accident, using the 2019 National Household Survey [ENAHO] and its respective modules as a source of information. The research was of a quantitative type of non-experimental cross-correlational-causal design, the logistic method was applied and =β_0+β_1×BeneficiaryP65+β_2×Rural+β_3×Woman+β_4×Age+β_5×Education+β_6×Employed+β_7× PoorNonExtreme+β_8×PoorExtreme, and the variables were: y= dummy variable that takes 1 when the older adult does not have access to health services due to not having sufficient economic resources, BeneficiaryP65, older adult according to area of residence, sex of the older adult, age , schooling, employment status and poverty status. &nbsp; When carrying out the respective analysis, an odds ratio of the constant 0.36422608 was obtained, predicting a low probability that older adults do not access health services due to lack of economic resources. The estimated odds ratios of the P65 Beneficiary, Age, and Education variables are less than one and significant, indicating the association of these variables with a greater probability of access to health services. The PoorExtreme and PoorNonExtreme coefficients are greater than one and significant, highlighting the relationship between poverty and less probability of access to health services, the odds ratio of the female variable is less than one and not significant, as is the employment status. . The estimated odds ratio of the Female variable is less than one and not significant, which suggests that there is not enough evidence to say that the female gender is associated with a lower or higher probability of access to health services. The estimated odds ratio of the Employed variable is greater than one, but not significant, which suggests that the fact of being employed is not related to the probability of access to health services. the estimated odds ratios of the P65 Beneficiary, Education, Extreme Poor and Non-Extreme Poor have a p-value less than 0.05, indicating that they are significant, an R^2 of 0.0281 was obtained.

Reduced rural residential emissions in the Northern China Plain from 2015 to 2021

China's rapid economic growth over the past few decades has been fueled by the fossil-fuel dominated energy system. In Northern China, coal and biomass are important fuel types for household cooking and heating. The use of coal and biomass not only contributes to CO2 emissions, but also worsens the ambient air quality and further causes adverse health outcomes. Since 2016, action plans have been implemented annually to promote the substitution of solid fuel use in the rural households of the Beijing-Tianjin-Hebei and surrounding region (“2 + 26” region). However, a comprehensive evaluation of the emission reductions by the control policies is still lacking. In this study, we built a rural residential emission inventory in the “2 + 26” region based on two-phase national household surveys in 2010 and 2015. We evaluated the air pollutant and CO2 reduction benefits of various control measures from 2015 to 2021 and discussed the opportunities for the synergistical control of air pollutant and CO2 emissions. We estimated that, in 2015, the coal and biomass fuel consumption from rural households in the “2 + 26” region was 28.7 Mt. and 30.6 Mt., respectively, which resulted in 93.8 Mt., 416.5kt, 402.5kt, 80.1kt, 268.0kt, and 6122.2kt of CO2, PM2.5, SO2, NOx, VOCs, and CO emissions. With the implementation of household solid fuel substitution policies, air pollutant emissions were estimated to decrease by 53– 74 % from 2015 to 2021, while the percentage reduction of CO2 was only 39 % due to additional emissions from the alternative clean energy sources. If biomass was treated as carbon-neutral fuel, the CO2 reducing potential was even lower. Building a clean and sustainable rural energy system is a multi-win option for China to achieve the “Beautiful China”, “Healthy China” and carbon-neutrality goals.

Social Factors Associated with Poverty in Households in Peru

The objective of the research was to identify the determinants of poverty at the household level in Peru in 2020. The research design was descriptive and correlational, with a type of non-experimental research and quantitative approach, and considered the logit econometric model; the sources of information used correspond to the National Household Survey of the National Institute of Statistics and Informatics, from which the variables that are considered determinants of poverty were extracted and managed. It was determined that the size of the household positively influences by 1.3%; the economic income of the head of household negatively influences by 0.000828%; the years of education of the head of household influences by 0.1%; homeownership influences by 0.9%; access to social programs of food and non-food aid influence by 0.9% and 0.6%, respectively; access to drinking water service, hygienic service and electric power service have a negative influence of 1.8%, 0.6% and 1.7%; all these factors are associated with the poverty of households in Peru. Therefore, the social determinants of poverty were household size, economic income, years of education, access to homeownership, access to a social food aid program, access to a social non-food aid program, access to drinking water services, access to hygienic services and access to electric power services.

The Proximity of Disaster Experiences and Financial Preparedness for Emergencies in the US.

This study investigated how the proximity of disaster experience was associated with financial preparedness for emergencies. The data used were from the 2018 National Household Survey, which was administered by the Federal Emergency Management Agency. The working sample included 4779 respondents. Logistic Regression showed that the likelihood of setting aside emergency funds tended to be the highest between 2-5 years after experiencing a disaster, which declined slightly but persisted even after 16 years. Recent disaster experience within 1 year did not show a significant impact, indicating a period of substantial needs. However, the proximity of disaster experience did not significantly affect the amount of money set aside. It is suspected that increased risk perception related to previous experiences of disasters is more relevant to the likelihood of preparing financially; whereas other capacity-related factors such as income and having a disability have more effect on the amount of money set aside.

SARS-CoV-2 antibody seroprevalence in Togo: a national cross-sectional household survey, May–June, 2021

BackgroundThe extent of SARS-CoV-2 circulation in African countries is still unclear. Seroprevalence studies are a common approach to epidemiological surveillance, allowing estimation of the proportion of people who have had contact with the virus. We aimed at estimating the seroprevalence of anti-SARS-CoV-2 antibodies and associated factors in Togo at the national level in 2021 according to age groups, gender, and place of residence (rural or urban).MethodsFrom 15 May to 31 June 2021, we conducted a nationally representative cross-sectional serological survey in 12 health districts (two districts per health region) in the > 5 years old population in Togo. The Wantai SARS-CoV-2 total antibody assay S protein receptor-binding domain-based ELISA (Wantai Biological Pharmacy Enterprise Co.; Beijing, China) was used to determine the presence of SARS-CoV-2 total antibodies in plasma. Crude and weighted seroprevalences (weighted by age, sex and place of residence) were calculated and then weighted seroprevalences were adjusted according to sensitivity and specificity of the ELISA test. Finally, logistic regression models were performed in order to describe factors associated.ResultsOf the 7593 participants, the overall weighted and adjusted seroprevalence of total anti-SARS-CoV-2 antibodies was 65.5% (95%CI: 64.3 -66.6). Urban dwellers, young adults (30–49 years) and vaccinated individuals were significantly more likely to be seropositive.ConclusionThe high seroprevalence we observed is consistent with observations across West Africa. Quantification of the level of immunity in the population is needed to know how close we are to herd immunity. In the meantime, vaccination against the COVID-19 remains necessary.

Social inequalities in utilization of a feminist telehealth abortion service in Brazil: A multilevel analysis.

The disruption caused by the COVID-19 pandemic on health services around the world boosted interest over telehealth models of care. In Brazil, where abortion is heavily restricted, abortion seekers have long relied on international telehealth services to access abortion pills. We conducted a cross-sectional multilevel study to assess the effect of individual and contextual social factors on utilization of one such service. For the individual-level, we analyzed data from the records of abortion seekers contacting this feminist international telehealth organization during 2019 (n = 25,920). Individual-level variables were age, race, education level and pregnancy length. Contextual-level units were states, for which we used data from the national Demographic Census and Household Surveys. Contextual-level variables were household income per capita, adjusted net school attendance rate, percentage of racialized women and income Gini Index. We fitted five multilevel Poisson Mixed-effects models with robust variance to estimate prevalence ratios (PR) of service utilization, which was defined as receiving abortion pills through the service. We found that only 8.2% of requesters got abortion pills through the service. Utilization was higher among women who were older, white, more educated and 5-8-weeks pregnant. Independently of this, service utilization was higher in states with higher income and education access, with lower proportions of racialized women, and located in the South, Southeast and Central-West regions. We concluded that while feminist telehealth abortion initiatives provide a life-saving service for some abortion seekers, they are not fully equipped to overcome entrenched social inequalities in their utilization, both at individual and contextual levels.

Has the treatment gap for opioid use disorder narrowed in the U.S.?: A yearly assessment from 2010 to 2019".

The United States overdose crisis continues unabated. Despite efforts to increase capacity for treating opioid use disorder (OUD) in the U.S., how actual treatment receipt compares to need remains unclear. In this cross-sectional study, we estimate progress in addressing the gap between OUD prevalence and OUD treatment receipt at the national and state levels from 2010 to 2019. We estimated past-year OUD prevalence rates based on the U.S. National Survey on Drug Use and Health (NSDUH), using adjustment methods that attempt to account for OUD underestimation in national household surveys. We used data from specialty substance use treatment records and outpatient pharmacy claims to estimate the gap between OUD prevalence and number of persons receiving medications for opioid use disorder (MOUD) during the past decade. Adjusted estimates suggest past-year OUD affected 7,631,804 individuals in the U.S. in (2,773 per 100,000 adults 12+), relative to only 1,023,959 individuals who received MOUD (365 per 100,000 adults 12+). This implies approximately 86.6% of individuals with OUD nationwide who may benefit from MOUD treatment do not receive it. MOUD receipt increased across states over the past decade, but most regions still experience wide gaps between OUD prevalence and MOUD receipt. Despite some progress in expanding access to MOUD, a substantial gap between OUD prevalence and treatment receipt highlights the critical need to increase access to evidence-based services.

The Impact of Extreme Temperature Shocks on the Health Status of the Elderly in China

With the accelerating process of climate change, long-term exposure to extreme temperatures could threaten individuals' physical health, especially for the vulnerable population. This paper aims to investigate the long-term effects of extreme temperature exposure on the health of the elderly in the context of climate change and aging. Different from most of the existing literature in environmental economics, we define the relative extreme temperature exposure based on the local temperature pattern. By combining a large national household survey and nationwide meteorologic historical data, this study provides empirical evidence that heat exposure days and cold exposure days during the past year both significantly affect the physical health of middle-aged and elderly groups, controlling for city, year, and individual fixed effects. The effect on individual physical health has certain seasonal characteristics and is heterogeneous across populations. Additionally, cooling and heating equipment are effective in alleviating the reverse impact of heat and cold exposure. The estimation is robust and consistent across a variety of temperature measurements and model modifications. Our findings provide evidence of the long-term and accumulative cost of extreme temperature to middle-aged and elderly human capital, contributing to helping the public to better understand the full impact of climate change.

A national household survey on HIV prevalence and clinical cascade among children aged ≤15 years in Kenya (2018).

We analyzed data from the 2018 Kenya Population-Based HIV Impact Assessment (KENPHIA), a cross-sectional, nationally representative survey, to estimate the burden and prevalence of pediatric HIV infection, identify associated factors, and describe the clinical cascade among children aged < 15 years in Kenya. Interviewers collected information from caregivers or guardians on child's demographics, HIV testing, and treatment history. Blood specimens were collected for HIV serology and if HIV-positive, the samples were tested for viral load and antiretrovirals (ARV). For participants <18 months TNA PCR is performed. We computed weighted proportions with 95% confidence intervals (CI), accounting for the complex survey design. We used bivariable and multivariable logistic regression to assess factors associated with HIV prevalence. Separate survey weights were developed for interview responses and for biomarker testing to account for the survey design and non-response. HIV burden was estimated by multiplying HIV prevalence by the national population projection by age for 2018. Of 9072 survey participants (< 15 years), 87% (7865) had blood drawn with valid HIV test results. KENPHIA identified 57 HIV-positive children, translating to an HIV prevalence of 0.7%, (95% CI: 0.4%-1.0%) and an estimated 138,900 (95% CI: 84,000-193,800) of HIV among children in Kenya. Specifically, children who were orphaned had about 2 times higher odds of HIV-infection compared to those not orphaned, adjusted Odds Ratio (aOR) 2.2 (95% CI:1.0-4.8). Additionally, children whose caregivers had no knowledge of their HIV status also had 2 times higher odds of HIV-infection compared to whose caregivers had knowledge of their HIV status, aOR 2.4 (95% CI: 1.1-5.4)". From the unconditional analysis; population level estimates, 78.9% of HIV-positive children had known HIV status (95% CI: 67.1%-90.2%), 73.6% (95% CI: 60.9%-86.2%) were receiving ART, and 49% (95% CI: 32.1%-66.7%) were virally suppressed. However, in the clinical cascade for HIV infected children, 92% (95% CI: 84.4%-100%) were receiving ART, and of these, 67.1% (95% CI: 45.1%-89.2%) were virally suppressed. The KENPHIA survey confirms a substantial HIV burden among children in Kenya, especially among orphans.

Consumption and labour income over the life cycle in Mali: A National Transfer Accounts approach

The paper analyses the consumption and production behaviour of the Mali’s population by age using the National Transfer Account approach and household surveys and macroeconomic data. It reveals that between the ages of 28 and 66, Malians generate a surplus of 1,620 billion XOF in 2017. This surplus covers only 46% of the social demand of those under 28 and over 66. Women are in deficit over their life cycle, in other words, their level of consumption remains higher than their level of labour income, given their late entry into the labour market. While women consume as much as men over part of the life cycle, they produce 22% of labour income. The results also show that in Mali the level of material well-being measured by consumption declines with age.

Geographic inequalities in health intervention coverage – mapping the composite coverage index in Peru using geospatial modelling

BackgroundThe composite coverage index (CCI) provides an integrated perspective towards universal health coverage in the context of reproductive, maternal, newborn and child health. Given the sample design of most household surveys does not provide coverage estimates below the first administrative level, approaches for achieving more granular estimates are needed. We used a model-based geostatistical approach to estimate the CCI at multiple resolutions in Peru.MethodsWe generated estimates for the eight indicators on which the CCI is based for the departments, provinces, and areas of 5 × 5 km of Peru using data from two national household surveys carried out in 2018 and 2019 plus geospatial covariates. Bayesian geostatistical models were fit using the INLA-SPDE approach. We assessed model fit using cross-validation at the survey cluster level and by comparing modelled and direct survey estimates at the department-level.ResultsCCI coverage in the provinces along the coast was consistently higher than in the remainder of the country. Jungle areas in the north and east presented the lowest coverage levels and the largest gaps between and within provinces. The greatest inequalities were found, unsurprisingly, in the largest provinces where populations are scattered in jungle territory and are difficult to reach.ConclusionsOur study highlighted provinces with high levels of inequality in CCI coverage indicating areas, mostly low-populated jungle areas, where more attention is needed. We also uncovered other areas, such as the border with Bolivia, where coverage is lower than the coastal provinces and should receive increased efforts. More generally, our results make the case for high-resolution estimates to unveil geographic inequities otherwise hidden by the usual levels of survey representativeness.

SARS-CoV-2 seroprevalence, cumulative infections, and immunity to symptomatic infection – A multistage national household survey and modelling study, Dominican Republic, June–October 2021

Population-level SARS-CoV-2 immunological protection is poorly understood but can guide vaccination and non-pharmaceutical intervention priorities. Our objective was to characterise cumulative infections and immunological protection in the Dominican Republic. Household members ≥5 years were enrolled in a three-stage national household cluster serosurvey in the Dominican Republic. We measured pan-immunoglobulin antibodies against the SARS-CoV-2 spike (anti-S) and nucleocapsid glycoproteins, and pseudovirus neutralising activity against the ancestral and B.1.617.2 (Delta) strains. Seroprevalence and cumulative prior infections were weighted and adjusted for assay performance and seroreversion. Binary classification machine learning methods and pseudovirus neutralising correlates of protection were used to estimate 50% and 80% protection against symptomatic infection. Between 30 Jun and 12 Oct 2021 we enrolled 6683 individuals from 3832 households. We estimate that 85.0% (CI 82.1-88.0) of the ≥5 years population had been immunologically exposed and 77.5% (CI 71.3-83) had been previously infected. Protective immunity sufficient to provide at least 50% protection against symptomatic SARS-CoV-2 infection was estimated in 78.1% (CI 74.3-82) and 66.3% (CI 62.8-70) of the population for the ancestral and Delta strains respectively. Younger (5-14 years, OR 0.47 [CI 0.36-0.61]) and older (≥75-years, 0.40 [CI 0.28-0.56]) age, working outdoors (0.53 [0.39-0.73]), smoking (0.66 [0.52-0.84]), urban setting (1.30 [1.14-1.49]), and three vs no vaccine doses (18.41 [10.69-35.04]) were associated with 50% protection against the ancestral strain. Cumulative infections substantially exceeded prior estimates and overall immunological exposure was high. After controlling for confounders, markedly lower immunological protection was observed to the ancestral and Delta strains across certain subgroups, findings that can guide public health interventions and may be generalisable to other settings and viral strains. This study was funded by the US CDC.