Poorest Quintile Research Articles

Vaccination dropout and wealth related inequality among children aged 12-35 months in remote and underserved settings of Ethiopia: a cross-sectional evaluation survey.

Vaccination is one of the most cost-effective public health interventions that prevents millions of deaths. Although immunization coverage is increasing globally, many children in low- and middle-income countries drop out of the vaccination continuum. This study aimed at determining vaccination dropout rates and predictors in children aged 12-35 months in remote and underserved areas of Ethiopia. This study was part of a cross-sectional evaluation survey that was conducted in 2022 in Ethiopia. The study settings include pastoralist, developing & newly established regions, conflict affected areas, urban slums, internally displaced populations and refugees. A sample of 3,646 children aged 12-35 months were selected using a cluster sampling approach. Vaccination dropout was estimated as the proportion of children who did not get the subsequent vaccine among those who received the first vaccine. A generalized estimating equation was used to assess determinants of the dropout rate and findings were presented using an adjusted odds ratio with 95% confidence interval. Concentration curve and index were used to estimate wealth related inequality of vaccination dropout. A total of 3,646 caregivers of children participated in the study with a response rate of 97.7%. The BCG to Penta-3 (52.5%), BCG to MCV-2 (57.4%), and Penta-1 to Penta-3 (43.9%) dropouts were all high. The highest Penta-1 to Penta-3 dropout rate was found in developing regions (60.1%) and the lowest was in urban slums (11.2%). Caregivers who were working outside their homes [AOR (95% CI) = 3.67 (1.24-10.86)], who had no postnatal care follow-up visits [AOR (95%CI) = 1.66 (1.15-2.39)], who did not receive a service from a skilled birth attendant [AOR (95%CI) = 1.64 (1.21-2.27)], who were older than 45 years [AOR (95% CI) = 12.49 (3.87-40.33)], and who were less gender empowered [AOR (95%CI) = 1.63 (1.24-2.15)] had increased odds of Penta-1 to Penta-3 dropout. The odds of dropout for children from poor caregivers was nearly two times higher compared to their wealthy counterparts [AOR (95%CI) = 1.87 (1.38-2.52)]. Vaccination dropout estimates were high among children residing in remote and underserved settings. Poor wealth quintile, advanced maternal age, low women empowerment, and limited utilization of maternity care services contributed to vaccination dropout.

Investigating the Distributional Effect of the UK Carbon Price Floor

This paper empirically investigates the distributional effects of the UK carbon price floor (CPF) on households’ electricity expenditure. I employ the difference-in-differences model to analyse the impact of the carbon price floor on vertical inequality. The main result finds that households in the poorest quintile are most impacted by the electricity price increase. I further explore the heterogenous effect on households within the bottom quintile by considering various household characteristics. This paper contributes to the existing literature on carbon pricing policies, in particular their impact on inequality both across income groups and within households in the poorest quintile.

Composite indexes of anthropometric failure in children under 5 years of age in Argentina: Comparative analysis among regions: 2019-2020.

Composite Index of Anthropometric Failure (CIAF) and Extended CIAF (ECIAF) allow for the identification of simultaneous presence of two or more types of malnutrition. The objective of this study was to analyze anthropometric failure in Argentinean children under 5 years old, taking into consideration regional and socioeconomic perspectives. Data from the National Survey of Children and Adolescents MICS 2019-2020 were used, which included 5473 children under 5 years old of both sexes residing in the six regions of Argentina. CIAF and ECIAF excludes children not in anthropometric failure (group A) and was calculated from a percentage of children included in malnutrition categories B: wasting only; C: wasting and underweight; D: wasting, stunting, and underweight; E: stunting and underweight; F: stunting only; Y: underweight only; G: only weight excess; and H: stunting and weight excess. The data were analyzed according to region and wealth quintile. In children aged 0-2.99 years, CIAF was 12.5% and ECIAF was 27.7%, with boys being more affected. In children aged 3-4.99 years, the rates were 9.7% and 22.3%, respectively, with girls showing a higher prevalence. The highest ECIAF was recorded in the Patagonia region (31.3%), while the highest ECIAF was observed in the poorest quintile. The presence of double burden of malnutrition has been observed across all regions and household income levels. Additionally, overweight has shown a higher intensity in economically prosperous regions and households, while stunting has been more prevalent in economically disadvantaged areas.

Financial hardship associated with catastrophic out-of-pocket spending tied to primary care services in low- and lower-middle-income countries: findings from a modeling study

BackgroundFinancial risk protection (FRP) is a key component of universal health coverage (UHC): all individuals must be able to obtain the health services they need without experiencing financial hardship. In many low-income and lower-middle-income countries, however, the health system fails to provide sufficient protection against high out-of-pocket (OOP) spending on health services. In 2018, OOP health spending comprised approximately 40% of current health expenditures in low-income and lower-middle-income countries.MethodsWe model the household risk of catastrophic health expenditures (CHE), conditional on having a given disease or condition—defined as OOP health spending that exceeds a threshold percentage (10, 25, or 40%) of annual income—for 29 health services across 13 disease categories (e.g., diarrheal diseases, cardiovascular diseases) in 34 low-income and lower-middle-income countries. Health services were included in the analysis if delivered at the primary care level and part of the Disease Control Priorities, 3rd edition “highest priority package.” Data were compiled from several publicly available sources, including national health accounts, household surveys, and the published literature. A risk of CHE, conditional on having disease, was modeled as depending on usage, captured through utilization indicators; affordability, captured via the level of public financing and OOP health service unit costs; and income.ResultsAcross all countries, diseases, and health services, the risk of CHE (conditional on having a disease) would be concentrated among poorer quintiles (6.8% risk in quintile 1 vs. 1.3% in quintile 5 using a 10% CHE threshold). The risk of CHE would be higher for a few disease areas, including cardiovascular disease and mental/behavioral disorders (7.8% and 9.8% using a 10% CHE threshold), while lower risks of CHE were observed for lower cost services.ConclusionsInsufficient FRP stands as a major barrier to achieving UHC, and risk of CHE is a major problem for health systems in low-income and lower-middle-income countries. Beyond its threat to the financial stability of households, CHE may also lead to worse health outcomes, especially among the poorest for whom both ill health and financial risk are most severe. Modeling the risk of CHE associated with specific disease areas and services can help policymakers set progressive health sector priorities. Decision-makers could explicitly include FRP as a criterion for consideration when assessing the health interventions for inclusion in national essential benefit packages.

Exploring health insurance and knowledge of the ovulatory cycle: evidence from Demographic and Health Surveys of 29 countries in Sub-Saharan Africa

BackgroundUnplanned pregnancy continues to be a major public health concern in Sub-Saharan Africa (SSA). Understanding the ovulatory cycle can help women avoid unplanned pregnancy. Though a wide range of factors for ovulatory cycle knowledge in SSA countries has not been well assessed, the influence of health insurance on ovulatory cycle knowledge is largely unknown. As a result, we set out to investigate the relationship between health insurance enrollment and knowledge of the ovulatory cycle among women of childbearing age. This study aims to investigate the relationship between health insurance enrollment and knowledge of the ovulatory cycle among women of childbearing age in sub-Saharan Africa (SSA).MethodsDemographic and Health Surveys (DHSs) data from 29 SSA countries were analyzed. The association between health insurance and ovulatory cycle knowledge was investigated using bivariate and multivariate multilevel logistic regression models among 372,692 women of reproductive age (15–49). The findings were presented as adjusted odds ratios (AOR) with 95% confidence intervals (CI). A p-value of 0.05 was considered statistically significant.ResultsThe pooled result shows that the prevalence of knowledge of ovulatory cycle in the studied 29 SSA countries was 25.5% (95% CI; 24.4%-26.6%). Findings suggest higher odds of ovulatory cycle knowledge among women covered by health insurance (AOR = 1.27, 95% CI; 1.02–1.57), with higher education (higher-AOR = 2.83, 95% CI; 1.95–4.09), from the richest wealth quintile (richest-AOR = 1.39, 95% CI; 1.04–1.87), and from female headed households (AOR = 1.16, 95% CI; 1.01–1.33) compared to women who had no formal education, were from the poorest wealth quintile and belonged to male headed households, respectively. We found lower odds of ovulatory cycle knowledge among women who had 2–4 parity history (AOR = 0.80, 95% CI; 0.65–0.99) compared to those with history of one parity.ConclusionsThe findings indicate that the knowledge of the ovulatory cycle is lacking in SSA. Improving health insurance enrollment should be considered to increase ovulatory cycle knowledge as an approach to reduce the region's unplanned pregnancy rate. Strategies for improving opportunities that contribute to women’s empowerment and autonomy as well as sexual and reproductive health approaches targeting women who are in poorest quintiles, not formally educated, belonging to male headed households, and having high parity should be considered.

Spatial spillover impact of determinants on child mortality in Pakistan: evidence from Spatial Durbin Model

BackgroundChild mortality is a major challenge to public health in Pakistan and other developing countries. Reduction of the child mortality rate would improve public health and enhance human well-being and prosperity. This study recognizes the spatial clusters of child mortality across districts of Pakistan and identifies the direct and spatial spillover effects of determinants on the Child Mortality Rate (CMR).MethodData of the multiple indicators cluster survey (MICS) conducted by the United Nations International Children’s Emergency Fund (UNICEF) was used to study the CMR. We used spatial univariate autocorrelation to test the spatial dependence between contiguous districts concerning CMR. We also applied the Spatial Durbin Model (SDM) to measure the spatial spillover effects of factors on CMR.ResultsThe study results showed 31% significant spatial association across the districts and identified a cluster of hot spots characterized by the high-high CMR in the districts of Punjab province. The empirical analysis of the SDM confirmed that the direct and spatial spillover effect of the poorest wealth quintile and MPI vulnerability on CMR is positive whereas access to postnatal care to the newly born child and improved drinking water has negatively (directly and indirectly) determined the CMR in Pakistan.ConclusionThe instant results concluded that spatial dependence and significant spatial spillover effects concerning CMR exist across districts. Prioritization of the hot spot districts characterized by higher CMR can significantly reduce the CMR with improvement in financial statuses of households from the poorest quintile and MPI vulnerability as well as improvement in accessibility to postnatal care services and safe drinking water.

Considering equity andcost-effectiveness inassessing a parenting intervention to promote early childhood development inrural Vietnam.

Considering equity in early childhood development (ECD) is important to ensure healthy development for every child. Equity-informative cost-effectiveness analysis can further guide decision makers to maximize outcomes with limited resources while promoting equity. This cost-effectiveness study aimed to examine the equity impacts of a multicomponent ECD intervention in rural Vietnam. We estimated the cost-effectiveness of the intervention with a 30-month time horizon from the service provider and household perspectives with equity considerations. Data were from a cluster-randomized controlled trial comparing the intervention with the local standard of care. The incremental cost-effectiveness ratios (ICERs) per child cognitive development score gained were estimated by household wealth quintile and maternal education level, adjusted for cluster effects and baseline characteristics such as maternal parity and age. A 3% discount rate was applied to costs, and non-parametric cluster bootstrapping was used to examine uncertainty around ICERs. Children in the intervention had higher cognitive development scores than those in the control arm across all subgroups. Based on intervention recurrent cost, the ICER per cognitive development score gained was lower in children from the poorest quintile (-US$6) compared to those from the richest quintile (US$16). Similarly, the ICER per cognitive development score gained was lower in children whose mothers had the lowest education level (-US$0.02) than those with mothers who had the highest education level (US$7). Even though our findings should be interpreted with caution due to the insufficient study power, the findings suggest that the intervention could promote equity while improving child cognitive development with greater cost-effectiveness in disadvantaged groups.

How equitable is utilization of maternal health services in Uganda? Implications for achieving universal health coverage

BackgroundMaternal and neonatal mortality in Uganda remain persistently high. While utilisation of maternal health services has been shown to reduce the risk of maternal death, little is known about the inequalities in utilisation of maternal health services in Uganda. This study examined the inequalities in utilisation of maternal health services between 2006 and 2016 to draw implications for achieving universal health coverage.MethodsWe used the Uganda Demographic Health Survey 2006, 2011 and 2016 to analyse inequalities in utilisation of antenatal care (ANC4+), skilled birth attendance (SBA), postnatal care (PNC) and a package of maternal health services. Equity ratios, concentration curves, concentration indices and regression analysis were used in the estimations.ResultsInequalities in utilization of single and a package of maternal health services reduced between 2005 and 2016, but remained pro-rich. Inequalities in utilisation of package of maternal health services were greater than for a single service. Women from the richest quintile were 4 times more likely to receive a package of care compared to the poorest women, but were just 1.5 times more likely to receive ANC4 + than those in the poorest quintile. In 2006 women in urban areas were 2.6 times more likely to receive a package of all three maternal health services than their rural counterpart and they had a relative advantage of 23.4% to utilize skilled birth delivery than the poorest women. Each additional year of schooling and living in urban areas was associated with 1.2 and 1.6% point increase in utilisation of a package of care respectively. Wealth, education and living in urban areas were positively associated with utilisation of all maternal healthcare.ConclusionDeclining inequalities in utilisation of maternal healthcare reflect a move towards achieving universal health coverage in Uganda. Pro-rich, education and urban-biased inequalities, imply the need for targeted interventions for the poor, less educated and rural women. Targeted voucher schemes, free distribution of birth kits for poorer and rural women, community-level mobilization to improve uptake of postnatal care, and promoting women’s education and incomes are feasible interventions to improve utilisation of maternal health services and equity.

Socio-economic and cultural factors associated with the utilization of maternal healthcare services in Togo: a cross-sectional study

BackgroundProper utilization of maternal healthcare services plays a major role on pregnancy and birth outcomes. In sub-Saharan Africa, maternal and child mortality remains a major public health concern, especially in least developed countries such as Togo. In this study, we aimed to analyze factors associated with use of maternal health services among Togolese women aged 15–49 years.MethodsThis study used data from third round of nationally representative Demographic and Health Survey conducted in Togo in 2013. Analysis included 4,631 women aged 15–49 years. Outcome variables were timely first antenatal care (ANC) visits, adequate ANC4 + visits, and health facility delivery. Data were analyzed using Stata version 16.ResultsOverall, proportion of maternal healthcare utilization was 27.53% for timely first ANC visits, 59.99% for adequate ANC visits, and 75.66% for health facility delivery. Our multivariable analysis showed significant differences among women in highest wealth quintile, especially in rural areas with increasing odds of timely first ANC visits (Odds ratio (OR) = 3.46, 95% CI = 2.32,5.16), attending adequate ANC visits (OR = 2.19, 95% CI = 1.48,3.24), and delivering in health facilities (OR = 8.53, 95% CI = 4.06, 17.92) compared to those in the poorest quintile. Also, women with higher education had increased odds of timely first ANC visits (OR = 1.37, 95% CI = 1.11,1.69), and attending adequate ANC visits (OR = 1.73, 95% CI = 1.42,2.12) compared to those with no formal education. However, having higher parity and indigenous beliefs especially in rural areas decreased odds of using healthcare services.ConclusionsFindings from this study showed that socio-economic inequality and socio-cultural barriers influenced the use of maternal healthcare services in Togo. There is therefore a need to improve accessibility and the utilization of maternal healthcare services through women’s economic empowerment and education to reduce the barriers.

An analysis of the effect of fiscal expenditure on the income distribution of Chilean households

This study analyzes the effect of government spending on income distribution in Chile for 2016 using a multiplier model with the Social Accounting Matrix. The results indicate that increasing fiscal expenditure has a regressive effect on the income share of households in the richest quintile and widens the income gap between the two poorest quintiles and the third and fourth quintiles. When the effect of fiscal expenditure is measured by its nominal impact, households with the highest income receive approximately ten times more income than those with the lowest income. Thus, the regressivity of the income share of the richest households conceals an unequal distribution of the nominal income generated by the fiscal expenditure. Using counterfactual simulations, we suggested that fiscal expenditures could become more equalitarian through policies affecting the distribution of labor payments.

Wealth and poverty in mining Africa: migration, settlement and occupational change in Tanzania during the global mineral boom, 2002–2012

ABSTRACT This article interrogates place, process and people’s quest for enhanced welfare during the 2002–2012 global mineral price boom in northwest Tanzania. Mass in-migration of miners, traders and service providers generated diversified residential settlements. Processes of occupational change and urbanization, catalyzed by acquisition of employment, land, housing and other possessions at six contrasting mining locations were compared from a geo-social perspective. Our surveyed gold and diamond mining sites represented different manifestations of the mining trajectory namely: (1) artisanal rushes, (2) mature artisanal and (3) industrial mining. The article investigates who benefitted locationally and who lost in residents’ scrambles to gain improved living standards. Survey data on 216 household heads’ occupations, educational backgrounds, consumption and investments were collected, followed by construction of a household welfare index, revealing modest welfare improvements relative to rural consumption norms for the majority of interviewed resident households. However, in line with Picketty’s theoretical insights, extreme material inequality surfaced on the welfare spectrum between the outlier affluent and poor quintile groups. Those with higher educational attainment enjoyed superior welfare and occupational status, coalescing towards middle class formation. At the opposite end, single female-headed households stood out as extremely disadvantaged, handicapped by high child dependency ratios and occupational immobility.

Patterns in the prevalence and wealth-based inequality of cervical cancer screening in India

BackgroundCervical cancer is the second leading cause of deaths due to cancer among women in India. This study assesses the prevalence of cervical cancer screening among women in the 30 to 49 years age-group and its relation to demographic, social and economic factors. The equity in the prevalence of screening is studied with respect to the women’s household wealth.MethodsData from the fifth National Family Health Survey are analyzed. The adjusted odds ratio is used to assess the prevalence of screening. The Concentration Index (CIX) and the Slope Index of Inequality (SII) are analyzed to assess the inequality.ResultsThe average national prevalence of cervical cancer screening is found to be 1.97% (95% C.I, 1.8–2.1), ranging from 0.2% in West Bengal and Assam to 10.1% in Tamil Nadu. Screening is significantly more prevalent among the following demographics: educated, higher age group, Christian, scheduled caste, Government health insurance coverage, and high household wealth. Significantly lower prevalence is found among Muslim women, women from scheduled tribes, general category castes, non-Government health insurance coverage, high parity, and those who use oral contraceptive pills and tobacco. Marital status, place of residence, age at first sexual activity, and IUD usage are not significant influencers. At the national level, CIX (0.22 (95% C.I, 0.20–0.24)) and SII (0.018 (95% C.I, 0.015–0.020)) indicate significantly higher prevalence of screening among women from the wealthier quintiles. Significantly higher screening prevalence among wealthier quintiles in the North-East (0.1), West (0.21) and Southern (0.05) regions and among the poor quintiles in the Central (-0.05) region. Equiplot analysis shows a “top inequality pattern” in the North, North-East and Eastern regions, with overall low performance where the rich alone manage to avail screening. The Southern region exhibits an overall progress in screening prevalence with the exception of the poorest quintile, which is left behind. Pro-poor inequality exists in the Central region, with significantly higher prevalence of screening among poor.ConclusionThe prevalence of cervical cancer screening is very low (2%) in India. Cervical cancer screening is substantially higher among women with education and Government Health insurance coverage. Wealth-based inequality exists in the prevalence of cervical cancer screening and the prevalence is concentrated among the women from wealthier quintiles.

Does reducing out-of-pocket costs for children’s surgical care protect families from poverty in Somaliland? A cross-sectional, national, economic evaluation modelling study

ObjectivesAn estimated 1.7 billion children around the world do not have access to safe, affordable and timely surgical care, with the financing through out-of-pocket (OOP) expenses being one of the...

A Study on Income Inequality and Nutritional Status of Children in Rural Areas of Jammu and Kashmir: Evidence from Jammu District, India

Children nutritional status is a powerful indicator of nutrition security and well-being of individual and reflects the nutritional and poverty situation of household. Good nutritional status of children under five years of age is very crucial for the foundation of a healthy life. This study is a small attempt to highlight the extent of malnutrition in rural areas of Jammu district on the basis of households’ economic status. It empirically investigates the relationship between income inequality and nutritional status of children under age of five years of age (stunting) in the rural areas of Jammu district of Jammu and Kashmir. To determine the prevalence of undernutrition among different income groups of rural households, the study uses the data of a primary household survey. In order to measure the level of undernutrition (stunting), gender-specific anthropometric z-scores for height-for-age are calculated by using new child growth standards which are developed by the World Health Organisation (WHO). The study finds that children from households in the poorest quintile have significantly higher odds of stunting compared to those in the highest income quintile. The study revealed a negative association between income and the prevalence of stunting in the study area. It means the proportion of stunted children under five years of age decreases as the level of income increases among rural households. The study suggests that the government can help improve the nutritional status of children by taking important policy initiatives that addresses income inequality and poverty in rural areas.

Effects of public financing of essential maternal and child health interventions across wealth quintiles in Nigeria: an extended cost-effectiveness analysis

Maternal and newborn mortality rates in Nigeria are among the highest globally, and large socioeconomic inequalities exist in access to maternal, newborn, and child health (MNCH) services in the country. Inequalities also exist in catastrophic health expenditure among households in Nigeria. We aimed to estimate the health and financial risk protection benefits across different wealth groups in Nigeria if a policy of public financing of MNCH interventions were to be introduced. We did an extended cost-effectiveness analysis to estimate the health and financial risk protection benefits, across different household wealth quintiles, of a public-financing policy that assumes zero out-of-pocket costs to patients at the point of care for 18 essential MNCH services. We projected health outcomes (deaths in children aged <5 years [under-5 deaths] and maternal deaths) and private expenditure averted using the Lives Saved Tool with data extracted from national surveys. We modelled three scenarios: 1) coverage expansion at a rate equal to the trend observed between 2013 and 2018 (status quo); 2) annual coverage expansion by 5% compared with the status quo (uniform scale-up scenario); and 3) annual coverage expansion by 10%, 8%, 6%, 4%, and 2% compared with the status quo from the poorest to the wealthiest quintiles, respectively (pro-poor scale-up scenario). Our analysis shows that, if an additional 5% increase in coverage was provided for all wealth quintiles between 2019 and 2030, this uniform scale-up policy would prevent more than 0·11 million maternal deaths and 1·05 million under-5 deaths, avert US$1·8 billion in private expenditure, and avert 3266 cases of catastrophic health expenditure. The incremental cost effectiveness ratio would be $44 per life-year gained, which is highly cost-effective when compared with the gross domestic product per capita of Nigeria for 2018 ($2028). The policy would prevent a higher number of under-5 deaths and catastrophic health expenditure cases in poorer quintiles, but would prevent more maternal deaths and private expenditure in wealthier quintiles. If poorer populations experienced a greater increase in service coverage (ie, the pro-poor scale-up scenario), more maternal and under-5 deaths would be prevented in the poorer quintiles and more private expenditure would be averted than would be under previous scenarios. Public financing of essential MNCH interventions in Nigeria would provide substantial health and financial risk protection benefits to Nigerian households. These benefits would accrue preferentially to the poorest quintiles and would contribute towards reduction of health and socioeconomic inequalities in Nigeria. The distribution would be more pro-poor if public financing of MNCH interventions could target poor households. WHO Partnership for Maternal, Newborn, and Child Health.

Sleep and physical activity patterns among Tanzanian, South African, and Côte d’Ivoire primary schoolchildren. Findings from the KaziAfya study

Introduction Sleep and physical activity habits during childhood are influenced by developmental, cultural and environmental factors. Poor sleep is associated with lower immune function, physical activity levels, and psychological functioning, thus contributing to a vicious cycle of increased vulnerability during this developmental period. Regular physical activity, in turn, is associated with better sleep, improved immune function, and higher psychological well-being. There is, however, a lack of research on sleep and physical activity patterns in Sub-Saharan Africa, especially among children from marginalized areas. Therefore, the present study has two objectives: First, it aims to fill a gap in the literature by reporting sleep and physical activity patterns among primary schoolchildren aged 6-12 years from Tanzania (Ifakara: N = 845), South Africa (Gqeberha: N = 1,287), and Côte d’Ivoire (Taabo: N = 1,027). Second, to investigate the relationship between habitual physical activity (7-day actigraphy) and sleep (parental and self-reported). Methods Thousand three-hundred and twenty children aged 5-12 years from each country were recruited. Sleep. Parents were asked to complete a few sleep-related questions regarding their child`s bed- and rise times. To assess sleep quality, children completed questions from the Pittsburgh Sleep Quality Index (Buysse et al., 1989). To screen for sleep disturbances, children also answered three items of the Insomnia Severity Index (Morin et al., 2011), addressing difficulty falling asleep, staying asleep and waking up too early in the morning. Physical Activity. Objective physical activity was assessed with an accelerometry (Actigraph wGT3x-BT, Shalimar, FL, USA) worn around the hip. The device was worn for 7 consecutive days to assess a full weekly period, with a sampling epoch of 15 sec (Rowlands, 2007). Time per day spent in MPA (&gt;3 MET [metabolic equivalents of task]) and VPA (&gt;6 MET) is determined based on the raw accelerometry counts and the ActiLife computer software, with cut-off values derived from Freedson et al. (1998). The ActiGraph accelerometrys have been validated with children (Crouter et al., 2013; Hänggi et al., 2013). Results Children assessed in Côte d’Ivoire and Tanzania showed higher levels of daily physical activity (MVPA) than those assessed in South Africa. Yet, mean group levels still exceeded the recommended amount of 60 min MVPA/day. Across all three countries, boys generally had higher MVPA levels than their female peers, and children from the poorest wealth quintile were also more active than their peers from the least poor quintile. Composite sleep health was significantly different between countries, with the highest scores reported in Tanzania, followed by Côte d’Ivoire and South Africa. After controlling for sex, it was found that MVPA significantly predicted composite sleep health among children in Tanzania (ß = 5.83, p = .002) and Côte d’Ivoire (ß = 3.41, p = .072), but not in South Africa (ß = 0.67, p &gt; .05). Discussion/Conclusion Adequate sleep and physical activity is crucial for children’s physical and mental development. Most of our understanding of the relationship between daily physical activity and sleep patterns is based on research conducted in Western high income countries. Currently, little is known about this association in children from Sub-Saharan African, specifically primary schoolchildren living in marginalized areas in Tanzania, South Africa, and Côte d’Ivoire. Results will reveal whether research from high-income countries is generalizable to low- or middle-income countries, and inform health policy makers on points for prevention and intervention in school-based settings.

Associations between infant and young child feeding (IYCF) practice and attitudes toward intimate partner violence (IPV) in Timor-Leste

BackgroundBoth the proportions of malnutrition among children and women’s justifying partner’s intimate partner violence (IPV) are high in Timor-Leste. However, no study has looked at the associations between acceptable infant and young child feeding (IYCF) and women’s attitudes toward IPV, as a women’s empowerment index. In light of the lack of evidence described above, the study objective was to examine associations between IYCF practice and attitudes toward IPV in Timor-Leste and other women’s characteristics.MethodsA secondary analysis of children’s records from the Demographic and Health Survey Timor-Leste 2016 was conducted using a cross-sectional design. Univariable and multivariable analyses were performed to investigate associations between acceptable IYCF and women’s agreement that men are justified in beating their wives for five specific reasons and socio-economic factors.ResultsThe day before the survey, 33.4% of mothers gave their child at least the minimum dietary diversity and 46.4% at least the minimum meal frequency; and 15.0% practiced acceptable IYCF. Among all respondents, 17.5% did not agree that all five specific reasons for beating are justified. The adjusted odds ratio (aOR) of acceptable IYCF for mothers who did not agree was 1.51 (95% confidence interval [CI] 1.09–2.09) compared to those who agreed. The aOR of acceptable IYCF for mothers who worked outside the home was 1.48 (95% CI 1.16–1.96) compared to those who did not. Compared to mothers in the poorest quintile, the aORs of acceptable IYCF among those in the poorer, middle, richer, and richest quintiles were 1.33 (95% CI 0.83–2.21), 1.90 (95% CI 1.15–3.14), 2.01 (95% CI 1.17–3,45), and 2.99 (95% CI 1.63–5.50) respectively. Compared to children aged 6–11 months, the aORs of acceptable IYCF for children aged 12–17 months and 18–23 months were 2.14 (95% CI 1.54–2.97) and 1.63 (95% CI 1.14–2.34), respectively.ConclusionsAcceptable IYCF was associated with mothers’ attitudes toward wife-beating, wealth quintile, and mother’s work. Factors that we found associated with IYCF were all related to women’s empowerment. It implies that women’s empowerment is a key to improving mothers’ childcare. Merely promoting a specific childcare practice may not be enough for better child health.

Women empowerment indices and utilization of health facilities during childbirth: evidence from the 2019 Sierra Leone demographic health survey

BackgroundWomen empowerment is recognized as a potential enabling factor to the utilization of health facilities during childbirth. However, the association between women empowerment and utilization of health facilities is poorly studied, especially in counties with high maternal mortality. Therefore, we investigated the association between women empowerment indices and the utilization of health facilities during childbirth in Sierra Leone.MethodsWe analyzed secondary data from the 2019 Sierra Leone Demographic and Health Survey (SLDHS). We included 5,997 married women who had given birth in the five years before the survey, and had been sampled for the women empowerment questionnaire. The study employed the gender roles framework developed by the Harvard Institute for International Development in the selection and classification of women empowerment indices, which include influencing, resource and decision-making factors. We conducted logistic regression analyses using SPSS version 25.0 complex samples package to determine the association between women empowerment indices and utilization of health facilities.ResultsThe overall prevalence of health facility utilization during childbirth was 84.1% (5,042/5,997): 95% CI: 83.6 to 85.4. Among the influencer domain variables, women from the southern (aOR = 2.25, 95% CI: 1.34–3.78), northern (aOR = 1.69,95% CI: 1.01–2.82) and eastern regions (aOR = 3.71, 95% CI: 2.03–6.77) had higher odds of health facility utilization compared to women in the western region, while women in polygamous marriages (aOR = 0.82, 95% CI: 0.69–0.98) had lower odds of utilizing health facilities compared to their counterparts in monogamous marriages. Furthermore, women who had their first birth when they were less than 18 years, had higher odds of utilizing health facilities (aOR = 1.22, 95% CI: 1.02–1.45) compared to those who were 18 years and above. Among the resource domain variables, women with post-primary education (aOR = 1.58, 95% CI: 1.21–2.06) had higher odds of utilizing health facilities compared to their counterparts with no education and women who belonged to the richest wealth quintile (aOR = 2.42, 95% CI: 1.31–4.46) had higher odds of utilizing health facilities compared to their counterparts belonging in the poorest quintile. None of the variables in the decision making domain was significantly associated with health facility utilization.ConclusionThese findings emphasize that, successful implementation of health facility utilization interventions should prioritize women empowerment with more pragmatic efforts. Policies and programme should aim at all women with more focus on those having lower education (primary and below), belonging to the poorest wealth quintile, give birth before reaching18 years and in polygamous marriages.

There is no capitalist conspiracy and the rich are not all‐powerful

There is no capitalist conspiracy and the rich are not all‐powerful

Escherichia coli Contamination of Water for Human Consumption and Its Associated Factors in Peru: A Cross-Sectional Study.

The objective of the study was to determine the factors associated with the presence of Escherichia coli contamination in water supplies for human consumption in Peru. A secondary analysis of the Food and Nutrition Surveillance by Life Stages survey (VIANEV) of 2017-2018 was performed. The presence of E. coli contamination in the water samples for human consumption of the households evaluated was defined as a dependent variable. A supply was considered contaminated when there was at least 1 colony-forming unit of E. coli in 100 mL of water for human consumption. Data from 886 participants were analyzed. It was found that 25.2% of household water supply sources for human consumption had E. coli at the time of sampling. Water reservoirs such as buckets or other containers (adjusted prevalence ratio [aPR]: 1.15; 95% confidence interval [CI]: 1.18-1.93), households belonging to a poor wealth quintile (aPR: 1.82; 95% CI: 1.01-3.25), residing in a rural area (aPR: 1.36; 95% CI: 1.01-1.83), and having a low human development index (aPR: 2.12; 95% CI: 1.15-3.91) were more likely to contain E. coli in water supplies for human consumption. However, households with chlorine concentrations of 0.5 mg/L or more in water (aPR: 0.20; 95% CI: 0.11-0.33) and with household members with a higher education (aPR: 0.67; 95% CI: 0.45-0.99) were less likely to contain E. coli in drinking-water supplies. From 2017 to 2018, one in four Peruvians had contamination by E. coli in the water supply to their homes, which was associated with sociodemographic factors, management, and water treatment.