Poor Wealth Index Research Articles

Disparities in the Nutritional Status of Children (0–23 Months) in Kenya

Abstract Objectives To determine the social economic and rural/urban disparities in the nutritional status of children aged 0–23 months in Kenya. Methods This study utilized data from the most current Kenya Demographic and Health Survey (KDHS), a nationally representative cross-sectional study conducted in 2014. Data from children 0–23 months with complete information on weight, height, age and sex were used for analysis. Height for Age Z scores (HAZ), Weight for Age Z scores (WAZ), Weight for Height Z scores (WHZ), and BMI for Age Z scores (BAZ) were computed using WHO Anthroplus program to determine the nutritional status of the children. Chi square statistics were used to determine the relationship between wealth index, education status of mother, rural/urban residence, gender, and the nutritional status of the children. Significance was set at P < 0.05. Results Among all participating children aged 0–23 months (n = 7578), 22.7% were stunted (HAZ < −2), 10.7% were underweight (WAZ < −2), 6.2% were wasted (WHZ < −2), and 6.1% were either overweight or obese (BAZ > 2). Wasting, stunting, and underweight were significantly higher in children from rural areas, poorer wealth index and from mothers with no education. In contrast, children from urban areas, from richest wealth index category and from mothers with secondary or higher education were significantly more likely to be either overweight or obese. There were no gender differences in all the indicators of malnutrition. Stunting, wasting and underweight were also significantly higher in older children (6–23 months) as compared to the younger children (0–5 months). Conclusions Disparities exist in childhood malnutrition in Kenya with children from low social economic status and those living in rural areas experiencing higher rates of under-nutrition whereas those living in urban areas and those from higher social economic status experiencing higher rates of overweight and obesity. Current and new policies need to address these disparities to ensure that childhood malnutrition continues to improve in all sectors of the society. Funding Sources No funding source.

Timeliness of childhood vaccinations in Armenia, 2015–2016

BackgroundSuccessful control of vaccine preventable diseases not only requires high coverage but also requires that vaccines are administered in a timely manner. Prior studies have examined the timing of vaccinations in Armenia and found that although vaccination coverage is high, children are not receiving the vaccinations in a timely manner. This study aims to further elucidate the timing and associated factors of childhood vaccinations among children in Armenia in 2015–2016. MethodsData from the Armenia Demographic and Health Survey (ADHS) from 2015 to 2016 were used to examine the timing of WHO-recommended vaccinations during the first year of life of all living children under three years of age, which included a vaccine against tuberculosis (BCG), three doses of a diphtheria, pertussis and tetanus vaccine (DTP), three doses of a polio vaccine (Pol) and a measles-containing vaccine (MCV). The Kaplan-Meier method was used to assess age-appropriate receipt of vaccinations. Cox proportional hazards models with a shared gamma frailty to account for clustered sampling were used to determine factorsassociatedwith timely vaccinations. ResultsVaccination coverage was high ranging from 80.6% for the third dose of DTP to 98.4% for BCG, yet the proportion of children with delayed vaccinations increased with each dose in a series, with 51.9% and 48.5% having a delayed receipt of the third doses of DTP and Pol respectively. Factors associated with delayed vaccinations included female gender, certain regions of residence, previously delayed vaccinations, poorer wealth index and lower educational level of mother. There were no differences in timing of vaccinations between clusters. ConclusionsAlthough coverage was generally high, a high proportion of children under three in Armenia experienced delays in receiving the recommended vaccinations. Continued focus on adherence to the immunization schedule is necessary to ensure optimal coverage and protection for children in Armenia from vaccine preventable diseases.

Correlates of uptake of optimal doses of sulfadoxine-pyrimethamine for prevention of malaria during pregnancy in East-Central Uganda

BackgroundIn 2012, the World Health Organization recommended that pregnant women in malaria-endemic countries complete at least three (optimal) doses of intermittent preventive treatment (IPTp) using sulfadoxine-pyrimethamine (SP) to prevent malaria and related adverse events during pregnancy. Uganda adopted this recommendation, but uptake remains low in East-Central and information to explain this low uptake remains scanty. This analysis determined correlates of uptake of optimal doses of IPTp-SP in East-Central Uganda.MethodsThis was a secondary analysis of the 2016 Uganda Demographic Health Survey data on 579 women (15–49 years) who attended at least one antenatal care (ANC) visit and had a live birth within 2 years preceding the survey. Uptake of IPTp-SP was defined as optimal if a woman received at least three doses; partial if they received 1–2 doses or none if they received no dose. Multivariate analysis using multinomial logistic regression was used to determine correlates of IPTp-SP uptake.ResultsOverall, 22.3% of women received optimal doses of IPTp-SP, 48.2% partial and 29.5% none. Attending ANC at a lower-level health centre relative to a hospital was associated with reduced likelihood of receiving optimal doses of IPTp-SP. Belonging to other religious faiths relative to Catholic, belonging to a household in the middle relative to poorest wealth index, and age 30 and above years relative to 25–29 years were associated with higher likelihood of receiving optimal doses of IPTp-SP.ConclusionsIn East-Central Uganda, uptake of optimal doses of IPTp-SP is very low. Improving institutional delivery and household wealth, involving religious leaders in programmes to improve uptake of IPTp-SP, and strengthening IPTp-SP activities at lower level health centers may improve uptake of IPTp-SP in the East-Central Uganda.

Health Problem Related Smoking Behaviour Among Adult in Indonesia

Smoking behaviour is a problem that is often found in Indonesian society. The number of active smokers in Indonesia is increasing from year to year. Smoking can cause losses both in terms of socio-economic and health and even death. The aim this research is (1) to assess the prevalence of smoking cigarette among adult in Indonesia, and (2) to analizing relationship between health problem and smoking cigarette among adult in Indonesia. This is a cross-sectional study based on data extracted from the Indonesia Demographic and Health Survey, 2017. A household-based survey, implemented in a representative probability sample of more than 47963 households from urban and rural areas in Indonesia. This research was analytic correlational study with Cross sectional approach. The sample of reserach were 18023 adult aged between 15 and 44 years. Relationship between health problem and smoking cigarette among adult in Indonesia was assessed by bivariate methods. Based on the results of the study found that most smokers have ages, residing in rural areas, secondary level education background, have a very poor wealth index level. The research findings found there is a relationship between age (p=0,001), type of residence (p=0,005), type of education (p=0,000), type of wealth index (p=0,000), and health problem related smoking behavior. The findings indicate that there is a relationship between complaints of short / rapid breath (p=0,001), and dont have relationship with nasal disorders and the presence or absence of cough with smoking behavior.Â

Trends and Factors Associated with Healthcare Utilization for Childhood Diarrhea and Fever in Ethiopia: Further Analysis of the Demographic and Health Surveys from 2000 to 2016

Background Healthcare use for childhood illness reduces the risk of under-five deaths from common preventable diseases. However, rates of healthcare seeking for childhood diarrhea and fever remain low in most low- and middle-income countries including Ethiopia. This study aimed to assess the trends and factors for healthcare diarrhea and fever in Ethiopia from 2000 to 2016. Methods Analysis of healthcare use for diarrhea and fever trends was done using data from four Ethiopian Demographic Health Surveys. Descriptive statistics were used to report sample characteristics and healthcare use for diarrhea and fever trends, and chi-square tests were used to assess associations between independent variables and healthcare utilization in each survey. Binary logistic regression analysis was fitted to find the factors related to healthcare utilization for diarrhea and fever. All variables with odds ratio p values <0.05 were considered as significant determinants of the outcome. Results Healthcare seeking for diarrheal illness significantly increased from 13% (95% CI: 12.5–13.5) in 2000 to 44% (95% CI: 43.2–44.78) in 2016, while healthcare uses for fever significantly increased from 22% (95% CI: 16.7–27.3) in 2000 to 35% (95% CI: 34.3–35.7) in 2016. Factors of healthcare seeking for diarrhea in 2000–2016 were as follows: maternal age <30 years, urban residence, being a male child, nonexposure to mass media and not hearing information about oral rehydration, no desire to have more children, poor wealth index, and region. Meanwhile, factors for healthcare seeking for fever in 2000–2016 were as follows: a long distance from the nearest health facilities, first birth order, nonexposure to mass media, no desire to have more children, maternal age <30 years, urban residence, region, absence of antenatal and postnatal care utilization, poor wealth index, and being born from uneducated mothers (p values <0.05 were considered as significant determinants of the outcome. Conclusions Factors associated with healthcare utilization for diarrhea and fever differed between 2000 and 2016. Though Ethiopia has achieved a significant reduction in under-five mortality, it needs to accelerate the reduction through strengthening healthcare utilization for common childhood illness to avoid deaths from preventable diseases.

Factors affecting current khat chewing among male adults 15\u201359\u2009years in Ethiopia, 2016: a multi-level analysis from Ethiopian Demographic Health Survey

BackgroundRegular khat chewing causes gingivitis, tooth loss, gastric disorders, cardiac complications, male impotence, sleeplessness, and several mental health problems. Based on the Ethiopian Demographic and Health Survey (EDHS) 2016, 12% of women and 27% of men have reported having ever chewed khat. Even though khat addiction is a major public health problem, studies that consider both individual level and community level factors are limited. Therefore, this study aimed to determine the prevalence and factors affecting current khat chewing among male adults in Ethiopia.MethodsData from EDHS, a community-based cross-sectional study conducted from January 18, 2016, to June 27, 2016, was used. A multistage stratified cluster sampling technique was used to select participants. Both descriptive and analytical statistics were done. Bi-variable and multivariable multilevel logistic regression analyses were performed to determine factors affecting current khat chewing. Adjusted Odds ratio (AOR) with 95% Confidence Interval (CI) for variables with P-value < 0.05 was used as a measure of association.ResultA total of 12,595 male adults were included. The prevalence of current khat chewing was 23.61% (95% CI: 22.87, 24.36). Age 20–24 years; (AOR = 2.68, 95% CI: 2.02, 3.56), being uneducated (AOR = 1.62, 95% CI: 1.10, 2.39), professional/technical/managerial job (AOR = 3.59, 95% CI: 2.18, 5.91), Muslim religion (AOR = 18.30, 95% CI: 13.54, 24.74), poorest wealth index (AOR = 0.67, 95% CI: 0.51, 0.89), being divorced (AOR = 0.38, 95% CI: 0.21, 0.69), history of alcohol drinking in the last 30 days (AOR = 2.15, 95% CI: 1.69, 2.73), and history of cigarette smoking in the last 30 days (AOR = 14.92, 95% CI: 10.88, 20.47), and Amhara region (AOR = 0.07, 95% CI: 0.04, 0.14) were significantly associated with khat chewing.ConclusionKhat chewing remains high in Ethiopia with certain regional variations. The uneducated, older age, Alcohol and cigarette users, Muslims, and professional workers were at higher risk of khat chewing whereas the poorest wealth index and being divorced reduced its risk. Policymakers should consider a multi-faceted policy approach that accounts for regional variation and the identified risk factors to alleviate the problem.

Risk Factors Associated with Under-Five Stunting, Wasting, and Underweight Based on Ethiopian Demographic Health Survey Datasets in Tigray Region, Ethiopia.

Background Stunting, wasting, and underweight among children are major problems in most regions of Ethiopia, including the Tigray region. The main objective of this study was to assess the risk factors associated with stunting, wasting, and underweight of children in the Tigray region. Methods The information collected from 1077 children born 5 years before the survey was considered in the analysis. Multivariable binary logistic regression analysis was fitted to identify significant risk factors associated with stunting, wasting, and underweight. Results Male children and rural born were having a higher burden of both severe and moderate stunting, wasting, and underweight than females and urban born. Among male children, 27.6%, 4.10%, and 14.2% of them were stunted, wasted, and underweight, respectively. Protected drinking water (odds ratio (OR) = 0.68; 95% confidence interval (CI): (0.50, 0.92)) was associated with stunting. Maternal age at birth less than 20 years (OR = 0.66; 95% CI: (0.45, 0.97)) and being male (OR = 2.04; 95% CI: (1.13, 3.68)) were associated with high risk of underweight. No antenatal care follow-up (OR = 2.20; 95% CI: (1.04, 4.64)) was associated with wasting, while the poor wealth index, diarrhea, low weight at birth (<2.5 kg), lower age of a child, and 3 or more under-five children in a household were significantly associated with stunting, wasting, and underweight. Conclusions Being born in rural, being male, unprotected drinking water, smaller weight at birth, no antenatal follow-ups, diarrhea, and poor household wealth were factors associated with increased stunting, wasting, and underweight. Thus, interventions that focus on utilization of antenatal care services, improving household wealth, and improving access to protected drinking water were required by policymakers to decrease stunting, wasting, and underweight more rapidly.

Trends in the prevalence of overweight among Bangladeshi children aged 24-59 months (2004-2014) by sex and socioeconomic status.

While recent evidence suggests that the overall prevalence of overweight in young children in Bangladesh is low, little is known about variation in trends by sex, socioeconomic status, urbanicity, and region. We investigated the trends in overweight among children aged 24-59 months by these factors, using nationally representative samples from Bangladesh Demographic and Health Surveys (BDHS) between 2004 and 2014. Data from four BDHS surveys conducted between 2004 and 2014, with valid height and weight measurements of children, were included in this study (n = 15,648). BMI was calculated and the prevalence of overweight (including obesity) was reported using the International Obesity Taskforce (IOTF) classification system. To explore the association between socioeconomic status and childhood overweight, we used multivariable logistic regression. The overall prevalence of overweight among children aged 24-59 months increased from 1.60% (95% CI: 1.20-2.05%) in 2004 to 2.33% (95% CI: 1.82-2.76%) in 2014. Among girls, the overweight trend increased significantly (adjusted odds ratio (OR) comparing 2014 vs. 2004: 2.02 95% CI: 1.52-2.68), whereas among boys the trend remained steady. When compared with households with the poorest wealth index, households with richest wealth index had higher odds of childhood overweight among both boys (OR 2.39, 95% CI: 1.76-3.25) and girls (OR 1.86, 95% CI: 1.35-2.55). Higher household education level was also associated with childhood overweight. Subgroup analyses showed that relative inequalities by these factors increased between 2004 and 2014 when adjusted for potential confounders. There is a rising trend in overweight prevalence exclusively among girls aged 24-59 months in Bangladesh. Childhood overweight is associated with higher household education and wealth index, and the relative disparity by these factors appears to be increasing over time. These unmet inequalities should be considered while developing national public health programs and strategies.

The Association of Women\u2019s Empowerment with Stillbirths in Nepal

IntroductionGlobally, 2.6 million stillbirths occur each year. Empowering women can improve their overall reproductive health and help reduce stillbirths. Women empowerment has been defined as women’s ability to make choices in economic decision-making, household and health care decision-making. In this paper, we aimed to evaluate if women’s empowerment is associated with stillbirths.MethodsData from 2016 Nepal Demographic Health Surveys (NDHS) were analysed to evaluate the association between women’s empowerment and stillbirths. Equiplots were generated to assess the distribution of stillbirths by wealth quintile, place of residence and level of maternal education using data from NHDS 1996, 2001, 2006, 2011 and 2016 data. For the association of women empowerment factors and stillbirths, univariate and multivariate analyses were conducted.ResultsA total of 88 stillbirths were reported during the survey. Univariate analysis showed age of mother, education of mother, age of husband, wealth index, head of household, decision on healthcare and decision on household purchases had significant association with stillbirths (p < 0.05). In multivariate analysis, only maternal age 35 years and above was significant (aOR 2.42; 1.22–4.80). Education of mother (aOR 1.48; 0.94–2.33), age of husband (aOR 1.54; 0.86–2.76), household head (aOR 1.51; 0.88–2.59), poor wealth index (aOR 1.62; 0.98–2.68), middle wealth index (aOR 1.37; 0.76–2.47), decision making for healthcare (aOR 1.36; 0.84–2.21) and household purchases (aOR 1.01; 0.61–1.66) had no any significant association with stillbirths.ConclusionsThere are various factors linked with stillbirths. It is important to track stillbirths to improve health outcomes of mothers and newborn. Further studies are necessary to analyse women empowerment factors to understand the linkages between empowerment and stillbirths.

Spatial evaluation of prevalence, pattern and predictors of cervical cancer screening in India

ObjectiveTo investigate the social determinants of cervical cancer screening and report the locations vulnerable to poor utilization of cervical cancer screening services. Study designAn ecological study with the data derived from fourth round of the National Family Health Survey conducted in India in the period 2015–2016. MethodsThe study focused on the percentage of women who have never undergone cervical cancer screening across 639 districts in India. Moran's I statistic was used to investigate the overall clustering of location. The Getis-Ord Gi* statistic was used for the detection of significant local clusters. Spatial error, spatial lag, spatial Durbin and spatial Durbin error models were compared, and the model with best fit was reported. ArcGIS, GeoDa and R software were used for the analysis. ResultsThe existence of spatial autocorrelation (Moran's I = 0.61) necessitates the consideration of spatial component while studying the screening data. A significant clustering of districts with poor screening has been observed in the North-Central and North-Eastern regions of India. The geographic arrangement of the percentage of women who have undergone cervical cancer screening was associated with the percentage of women with poor wealth index (P < 0.001), not using a modern method of contraception (P < 0.001), residing in rural areas (P = 0.033) and never heard of sexually transmitted infection (P = 0.014). The range of percentage of women getting cervix screened for cancer was 0.5–68.4%, presenting the heterogeneity among the population elements. ConclusionA higher risk of poor cervical cancer screening is observed in the districts where most of the women have poor wealth index, reside in urban area, have never heard of sexually transmitted infection and do not use a modern method of contraception.

Correlates of stunting among under-five children in Bangladesh: a multilevel approach

BackgroundChild malnutrition still remains a major cause of childhood morbidity and mortality in Bangladesh. This study aims to determine the prevalence and identify the associated risk factors of child malnutrition in Bangladesh using multilevel logistic regression model on data from the Bangladesh Demographic and Health Survey (BDHS), 2014.MethodsA total sample of 6965 children aged 0–59 months was extracted from BDHS 2014. We performed descriptive analysis and multilevel generalized linear regression analysis with clustered data structure.ResultsOur findings show that among children the prevalence of moderate and severe values was respectively: 25 and 12% for stunting; 11 and 3.1% for wasting; 25 and 7.9% for underweight. The probability of stunting increased with age, with highest rate among children aged 36–47 months, which was significantly higher than children aged less than 6 months (OR = 6.71, 95% CI = 4.46, 10.10). Female children are found to be 11% less likely to be stunted than male children (OR = 0.89, 95% CI = 0.78, 1.02). Children with birth interval less than 24 months were significantly more likely to be stunted than children of first birth by 36% (OR = 1.36, 95% CI = 1.11, 1.67). Mothers with a normal BMI were 16% less likely to have children with stunting compared to mothers who are underweight (OR = 0.84, 95% CI = 0.76, 0.93). Other factors which were associated with a higher risk of stunting included parents with lower educational levels, children from the poorest wealth index, and mothers aged less than 20 years as first birth.ConclusionGovernment and non-government organization should generate effective program to aware women of reproductive age about adverse effect of short birth interval, and to aware parents about standard height and weight according to age and gender of children. Overall, necessary steps may be taken to make people educated and to reduce household wealth inequality to improve nutritional status of children.

Home childbirth among young mothers aged 15–24 years in Nigeria: a national population-based cross-sectional study

ObjectiveTo estimate the prevalence and identify factors associated with home childbirth (delivery) among young mothers aged 15–24 years in Nigeria.DesignA secondary analysis of cross-sectional data from the 2013 Nigeria Demographic...

Gender differences in hypertension awareness, antihypertensive use and blood pressure control in Nepalese adults: findings from a nationwide cross-sectional survey.

The objective of this cross-sectional study was to determine the gender differences in hypertension awareness, antihypertensive use and blood pressure (BP) control among the adult Nepalese population (≥18 years) using data from the nationally representative Nepal Demographic and Health Survey 2016. A weighted sample of 13,393 adults (5620 males and 7773 females) was included in the final analysis. After conducting descriptive analyses with the selective explanatory variable, multivariable logistic regression analysis was performed to assess the association between the outcome variable and the explanatory variables. The strength of the association was expressed in adjusted odds with 95% confidence intervals. A higher proportion of women had their BP checked (87.7% females vs 73.0% males, p<0.001) and were aware of their raised BP (43.9% females vs 37.1% males, p<0.001) compared with men. Although female hypertensive individuals had a higher prevalence of antihypertensive medication use than their male counterparts (50.1% females vs 47.5% males), a higher proportion of male hypertensive participants had their BP controlled (49.2% females vs 53.5% males). Women with the poorest wealth index had a lower prevalence of antihypertensive use than their male counterparts. The odds of having their own BP measured increased with age among men but decreased with age among women. The household wealth index was positively associated with the odds of BP measurement, awareness of own BP and antihypertensive use. This study revealed that although women had a higher prevalence of hypertension awareness and antihypertensive medication use, the practice did not translate into better BP control. Inequality in antihypertensive medication use was observed among the poorest wealth quintiles. Public health programmes in Nepal should focus on reducing these inequalities. Further research is needed to learn why females have poorer control of BP, despite having higher antihypertensive medication use.

Prevalence and associated factors of safe and improved infant and young children stool disposal in Ethiopia: evidence from demographic and health survey

BackgroundInfant and young children stools are often considered innocuous, and are not disposed of safely despite having a higher pathogen load than adult feces. In Ethiopia, sanitary management of young children’s stool is often overlooked and transmission of fecal-oral diseases is still a significant health burden. The study, therefore, describes the prevalence and associated factors of safe and improved child stool disposal.MethodsData from the fourth round of the Ethiopian Health and Demographic Survey (EDHS) conducted in 2016 was used for this analysis. Descriptive statistics were computed. Bivariate and multivariable logistic regression analyses were performed to identify factors associated with safe and improved child stool disposal.ResultsThe prevalence of safe and improved child stool disposal in Ethiopia was 36.9% (95%CI: 33.4–40.5%) and 5.3% (95%CI: 4.3–6.5%) respectively. There was regional variation in the prevalence of safe and improved child stool disposal. The odds of safe stool disposal among households with richest wealth index had 4.54 (AOR: 4.54; 95%CI: 2.89–7.12), richer 3.64 (AOR: 3.64; 95%CI: 2.46–5.38), middle 3.26 (AOR: 2.26; 95%CI: 2.27–4.68), and poorer 1.93 (AOR: 1.93; 95%CI: 1.39–2.68) times higher odds of practicing safe child stool disposal than households with poorest wealth index. Similarly, households found in richest, richer, middle, and poorer wealth index had also (AOR: 20.23; 95%CI: 8.59–47.66), (AOR: 12.53; 95%CI: 5.59–28.10) (AOR: 4.91; 95%CI: 1.92–12.55), and (AOR: 4.50; 95%CI: 2.06–9.84) higher odds of practicing improved child stool disposal than households from poorest wealth index respectively. The odds of safe child stool disposal were higher among households whose children age between 6 and 11 months (AOR: 1.57; 95%CI: 1.17–2.09), 12–17 months (AOR: 1.39; 95%CI: 1.00–1.95), and 18–23 months (AOR: 1.43; 95%CI: 1.03–1.99) than households whose children age between 0 and 5 months. The odds of safe child stool disposal were 1.31 (AOR: 1.31; 95%CI: 1.00–1.72) and 1.44 (AOR: 1.44; 95%CI: 1.04–2.01) times higher among mothers whose age between 25 and 34 and greater than 34 years compared to mothers whose age between 15 and 24 years, respectively. In addition, children’s stools are more likely to be disposed of safely in urban households than in rural households (AOR: 3.12; 95%CI: 1.86–5.22). The present study also revealed households with access to improved sanitation facilities fail to use them for disposal of child stool (AOR: 0.99; 95% CI: 0.67–1.45).ConclusionsThe prevalence of safe and improved child stool disposal in Ethiopia was found to be very low. Household socio-demographic and economic determinate were the key factors associated with child stool disposal. Appropriate strategic interventions to ensure safe and improved child stool disposal in Ethiopia is necessary. In addition, integrating child stool management into the existing sanitation interventions programs should be strongly recommended.

Health Predictors of Pain in Elderly-A Serbian Population-Based Study.

Objectives: The aim of our study was to evaluate the association of health factors with the presence and different degrees of pain in elderly above 65 years of life. Methods: The population-based study included 3540 individuals above 65 years of age of life from twofold stratified household sample representative for Serbia, during 2013 (the average age 73.9 ± 6.3 years; average Body Mass Index was 26.7 ± 4.4, females 56.8%, living with partner 55.5%, with primary education 55.3%, with poor wealth index 55.8% and from rural settings 46.2%). As health predictors of pain, we analyzed further health parameters: self-perceived general health, long-lasting health problems, diagnosed pulmonary disease, cardiovascular disease, musculoskeletal disease, diabetes, hyperlipidemia, hypertension and other chronic diseases. Pain domain of SF-36 version 2.0 was used for pain assessment. Results: Significant health predictors of pain were: self-perceived general health (OR 2.28), where bad perception of self-perceived general health in our study had greater risk of pain with higher degree of severity; long-lasting health problems (OR 1.60), where elderly with long-lasting health problems had almost twice the risk of moderate degree of pain, and above twice the risk for severe degree of pain; pulmonary disease (OR 1.38); musculoskeletal disease (OR 2.98) and other chronic diseases (OR 1.71). The presence of musculoskeletal disease increases the risk for pain, even more than double in severe versus mild degrees of pain. Conclusion: Bad self-perceived general health, long-lasting health problems, pulmonary, musculoskeletal diseases, cardiovascular disease and other chronic disease were significant health-related predictors of various degrees of pain in elderly.

Factors associated with skilled attendants at birth among married adolescent girls in Nigeria: evidence from the Multiple Indicator Cluster Survey, 2016/2017

This study examines the factors associated with skilled birth attendants at delivery among married adolescent girls in Nigeria. The study was a secondary data analysis of the fifth round of the Multiple Indicator Cluster Survey conducted between September 2016 and January 2017. Married adolescent girls aged 15-19 y who had live births in the last 2 y preceding the survey were included in the analysis. We performed univariate and multivariate logistic regression analyses with a skilled birth attendant (doctor, nurse or midwife) at delivery as the outcome variable and sociodemographic, male partner- and maternal health-related factors as explanatory variables. Of the 789 married adolescent girls, 387 (27% [95% CI=22.8-30.7]) had a skilled birth attendant at delivery. In the adjusted model, adolescent girls who were aged ≥18 y (ref: <18 y), primiparous (ref: multiparous), had antenatal care (ANC) provided by skilled healthcare providers (ref: no ANC), belonged to at least the poor and middle wealth index quintiles (ref: poorest), and resided in the south west zone (ref: north central), independently had a significantly higher likelihood of having a skilled birth attendant at delivery. Interventions that will reduce pregnancy in younger adolescent girls, poverty, and increase ANC provided by skilled attendants, are likely to improve deliveries assisted by skilled birth attendants among married adolescent girls in Nigeria.

A Longitudinal Study of Changes in Cognition Among Older Thais: Studying From the Kanchanaburi Demographic Surveillance System.

Objectives: To examine the impacts of changes in social determinants of health (SDH) toward changes in cognition. Methods: Longitudinal data came from the Kanchanaburi Demographic Surveillance System (KDSS) collected in 2007 and 2011. Cognitive impairment was measured by category fluency and delayed recall. Generalized estimating equation (GEE) was used to investigate changes in cognition by taking SDH and other variables including age, gender, marital status, education, and depression into the model. Results: GEE revealed longitudinal effects of wealth index and working status against cognition. Older Thais living with richest wealth index (odds ratio [OR] = 0.54; 95% confidence interval [CI] = 0.31-0.94) and still being employed (OR = 0.65; 95% CI = 0.47-0.89) were less likely to have cognitive impairment. Discussion: Poorer wealth index and being unemployed were served as a risk factor for cognitive impairment over time. Increasing age was still the major risk for cognitive impairment.

The Prevalence of Intimate Partner Violence, Associated Risk Factors, and Other Moderating Effects: Findings From the Kenya National Health Demographic Survey.

Intimate partner violence (IPV) is not only a fundamental violation of human rights but also a major public health problem. IPV is the most predominant form of violence committed by men against women. Therefore, our study sought to determine the prevalence of IPV and other moderating factors associated with IPV among these women. This study utilized data from the 2014 Kenya Demographic and Health Survey (KDHS), a nationally representative household-based survey that utilizes a two-stage sampling design. Data was weighted and analyzed using Stata 12 for Windows. A total of 3,028 women were interviewed for the analysis. A majority of the women were aged between 20 and 29 years (1,305; 43.1%), with a greater proportion married (2,329; 76.9%) and identified as Protestant (2,181; 72.1%). On adjusted analysis, factors associated with experiencing IPV included women who: were aged between 40 and 49 years belonging to religions other than Catholic, Protestant, or practiced no religion, resided in urban areas, were currently working, had a poor Wealth Index, were not sexually assertive, had one sexual partner other than their husband/spouse, received money, gifts, or favors in return for sex, had no knowledge on HIV, had husbands/partners aged above 50 years, experienced an early sexual debut of less than 18 years and felt that their partners were justified in beating them. Gender-based violence is complex and multifaceted affecting individuals, families, and society at large and should be addressed from different spectrums of intervention. There is a need for interventions that reduce and prevent IPV through empowering women, creating jobs to accumulate wealth, creating a conducive environment within workplaces for those employed, educating women, and empowering school-aged children to avert IPV.

Underlying determinants of maternal mortality in a rural South African population with high HIV prevalence (2000-2014): A population-based cohort analysis.

IntroductionMaternal mortality is one of the significant health indicators of any country and it’s a frequent subject in many global heath discussions. Even though the global trends have shown a decrease on maternal mortality, many countries in sub-Saharan Africa failed to achieve the MDG 5 target in 2015.There is no specific single solution for reducing maternal mortality but there is unanimity that a reliable health system with skilled personal is vital for addressing maternal mortality. This study therefore seeks to identify the risk factors for maternal mortality in typical rural sub-Saharan African countries.MethodA longitudinal population based cohort study was conducted using data from 2000–2014 in Africa Health Research Institute (AHRI).The Cox regression method was used to assess the influence of selected risk factors using the Mosley-Chen model on maternal mortality. A total of 20701 women aged 15–49 years were included in the study.ResultsThe study found 212 maternal deaths from 32,620 live births with a maternal mortality ratio (MMR) of 650 per 100,000 live births. The main causes of death were Communicable diseases (38.2%), Aids and TB (31%) and Unknown causes (11.8%). An increased risk of death was identified on, poor wealth index (HR 3.92[1.01, 15.3]), period of death 2000–2006(HR32.1 [3.79, 71.5]) and number of deliveries (6.76[2.70, 16.9]) were associated with a high risk of maternal mortality after adjusting for other independent variables included in the study.ConclusionSocio-economic status, number of deliveries and period of death were found to be associated with maternal death in rural South Africa.

Trends and factors associated with pregnancies among adolescent women in Nepal: Pooled analysis of Nepal Demographic and Health Surveys (2006, 2011 and 2016).

IntroductionAdolescent pregnancy is a significant cost to mother, newborn, and their family and society. Despite the enormous health and social impact of adolescent pregnancy, there is a dearth of nationally representative studies on factors associated with adolescent pregnancies in Nepal. Therefore, this study aimed to examine trends and factors associated with adolescent pregnancies in Nepal, using pooled data of three nationally representative demographic surveys.MethodsData for this study was derived from the recent three consecutive (2006, 2011 and 2016) Nepal Demographic and Health Surveys (NDHS). A total of 7,788 adolescent women aged 15–19 years included in the analysis. Trends and multivariable logistic regression analysis was performed to examine the factors associated with adolescent pregnancy.ResultsOver the study period (2006–2016), the rate of adolescent pregnancy was 173 [95% Confidence Interval (CI): 159, 188] per 1000 women aged 15–19 years. Adolescent pregnancy was significantly higher among woman with middle household wealth index [adjusted Odds Ratio (aOR) 2.19, 95% confidence interval CI 1.65, 2.91] or poor household wealth index (aOR 2.37, 95% CI 1.76, 3.21). Similarly, Dalit (aOR 1.87, 95% CI 1.50, 2.34) or Madhesi (aOR 1.67, 95% CI 1.32, 2.11); and unemployed (aOR 1.28, 95% CI 1.09, 1.50) women had higher odds of adolescent pregnancies. In contrast, adolescent pregnancy was significantly lower among educated women (aOR 0.60, 95% CI 0.48, 0.74), and women with access to media exposure to public health issues (aOR 0.75, 95% CI 0.64, 0.88).ConclusionsAccess to the media exposure on public health issues can be the effective efforts to reduce adolescent pregnancy. Women who have low maternal education, low wealth index, unemployed, and ethnic groups such as Dalits, and Madeshi needs to be targeted while designing and implementing policies and programs.