Poorest Quintile Research Articles

Ethnic diversity and mortality in northwestern Burkina Faso: a cohort analysis from 2000 to 2012

Abstract Background Ethnic diversity has been a topic of contention across the globe, contrasted with economic development, social security, and political stability. The link between health and ethnic diversity is not yet well established. This study aims to explore the association between ethnic diversity and all-cause mortality. Methods We used data from the Nouna Health & Demographic Surveillance System (HDSS) collected between 2000 and 2012. To derive Standardized Mortality Ratios (SMR), the observed number of deaths for each village was compared to the expected deaths based on the whole HDSS accounting for sex, age, rainy season, calendar year, and village. SMR were calculated on a village level for ethnic diversity (using the Simpson Index), geographical region, wealth, distance to Healthcare Facility (HCF), and religious diversity (Simpson Index). Also, we modeled SMR with a multilevel random intercept Poisson model considering individual ethnic and religious groups in addition to the above-mentioned village-level information. Results Village wealth (poorest quintile: SMR 1.07; 95% CI: 1.02-1.13, richest quintile: SMR 0.85; 95% CI: 0.82-0.88), distance to HCF (within the village: SMR 0.88; 95% CI: 0.85-0.91, further than 5km: SMR 1.13; 95% CI: 1.10-1.16), and village geographical region showed significant associations with overall mortality. Villages in the high ethnic diversity tertile had a lowered SMR (0.86; 95% CI: 0.84-0.89) compared to the overall HDSS, while those with low diversity yielded an elevated SMR (1.13; 95% CI: 1.09-1.17). The multivariable model including all co-variables confirmed the association. Conclusions This study shows a link between ethnic diversity and health. Historically established ethnic diversity in rural areas of Burkina Faso is associated with lower all-cause mortality. A lack of standardization exists in defining and measuring ethnic diversity. More research is needed to understand this relation and to establish it in different settings. Key messages Ethnic diversity is potentially linked to health. Further studies in different settings are needed to fully understand the relation between ethnic diversity and health.

Prevalence of antibodies against SARS-CoV-2 according to socioeconomic and ethnic status in a nationwide Brazilian surveyPrevalência de anticorpos contra o SARS-CoV-2 de acordo com o status socioeconômico e étnico em uma pesquisa nacional no Brasil

RESUMENObjetivos.Investigar las desigualdades socioeconómicas y entre distintos grupos étnicos en la prevalencia de anticuerpos contra el SARS-CoV-2 en las 27 unidades federativas de Brasil.Métodos.En este estudio transversal, se realizaron tres encuestas de hogares los días 14-21 de mayo, 4-7 de junio y 21-24 de junio de 2020 en 133 áreas urbanas brasileñas. Se utilizó un muestreo de etapas múltiples para seleccionar 250 individuos en cada ciudad a fin de someterlos a una prueba rápida de anticuerpos. Los sujetos respondieron un cuestionario sobre los bienes del hogar, la escolaridad y el color de la piel y etnia (autodeclarado utilizando la clasificación brasileña estándar de cinco categorías: blanco, negro, pardo, asiático o indígena). Se utilizó el análisis de los componentes principales de los bienes para clasificar el estatus socioeconómico en cinco quintiles de riqueza. Se empleó la regresión de Poisson para los análisis.Resultados.Se analizaron 25 025 sujetos en la primera encuesta, 31 165 en la segunda y 33 207 en la tercera, que mostraron una prevalencia de resultados positivos de 1,4%, 2,4% y 2,9%; respectivamente. Los individuos del quintil más pobre tuvieron 2,16 veces más probabilidades de presentar un resultado positivo (intervalo de confianza del 95%: 1,86-2,51) que los del quintil más rico, y los que tenían 12 o más años de escolaridad tuvieron una prevalencia menor que los sujetos con menos educación. Las personas indígenas presentaron una prevalencia 4,71 (IC95%: 3,65-6,08) veces mayor que las blancas, al igual que las de piel negra o parda. El ajuste por región del país redujo los índices de prevalencia según la riqueza, la educación y el origen étnico, pero los resultados siguieron siendo estadísticamente significativos.Conclusiones.La prevalencia de anticuerpos contra el SARS-CoV-2 en Brasil muestra gradientes relacionados con la posición socioeconómica y la etnia muy pronunciados, con menor riesgo en las personas blancas, educadas y ricas.

The Relevance Of Shura In Promoting Shared Prosperity In Developed And Developing Countries: ICIS 2021

The issue of greater inequalities and social exclusion reckoned to be the result of economic growth led the World Bank to set the new goal, to end extreme poverty and promote shared prosperity. Interestingly, the approach of the contemporary solution is largely in consonance with the maqasid or objectives of the Shari’ah. Islam is a universal religion and addresses the entire mankind not the believers alone. It is, therefore, no surprise that people irrespective of faith do often think along Islamic lines. The term shura has generally accepted by Muslims scholars as that which most closely approximates the notion of democracy. This study analyzed the impact of the shura as one elements of governance from Islamic perspective on poverty, by adopting a cross-country approach. Specifically, the study examined the impact of Shura on the poorest quintiles of the population by evaluating the relationship between the factors and the changes in the per capita income of the poor of the developed and developing countries. This study applied panel regression to examine the significance of the shura as one component of the governance from Islamic perspective towards the shared prosperity of the developed and developing countries. It is found that equality of participation, effective participation and representation are the significant factors in promoting shared prosperity. It is hoped that this study will serve as an effective mechanism for poverty eradication in the respective countries.

Cycle-network expansion plan in Oslo: Modeling cost-effectiveness analysis and health equity impact.

Physical inactivity is the leading cause of non-communicable diseases, and further research on the cost-effectiveness of interventions that target inactivity is warranted. Socioeconomic status is vital in this process. We aim to evaluate the cost-effectiveness of a cycle-network expansion plan in Oslo compared to the status quo by income quintiles. We applied a Markov model using a public payer perspective. Health outcomes were measured by quality-adjusted life years (QALYs) gained from the prevention of coronary heart disease, stroke, type 2 diabetes, and cancer. We measured equity impact by the concentration index and social welfare using the achievement index. We conducted sensitivity analyses. The intervention was generally more costly and more effective than the status quo. Incremental cost per QALY falls with income quintile, ranging from $10,098 in the richest quintile to $23,053 per QALY gained in the poorest quintile. The base-case intervention increased health inequality. However, a scenario targeting low-income quintiles reduced inequality and increased social welfare. In conclusion, the cycle-network expansion is likely to be cost-effective, but with equity concerns. If decision makers care about health inequalities, the disadvantaged groups could be targeted to produce more equitable and socially desirable outcomes instead of a uniform intervention across income quintiles.

Spatial patterns and inequalities in skilled birth attendance and caesarean delivery in sub-Saharan Africa

BackgroundImproved access to and quality obstetric care in health facilities reduces maternal and neonatal morbidity and mortality. We examined spatial patterns, within-country wealth-related inequalities and predictors of inequality in skilled...

Association between socioeconomic status and fertility among adolescents aged 15 to 19: an analysis of the 2013/2014 Zambia Demographic Health Survey (ZDHS)

BackgroundAdolescents face significant barriers to access and utilization of sexual and reproductive health services in many low-income settings, which in turn may be associated with adverse consequences such as early pregnancy, sexually transmitted infections, unsafe abortion and mortality. There is evidence suggesting that limited access to sexual and reproductive health information and services among adolescents contributes to these outcomes. We aimed to find out the factors that affect the fertility of adolescents aged 15 to 19 years in Zambia and to identify possible drivers of adolescents’ fertility.MethodsSecondary analysis of the ZDHS 2013/14 data was carried out to find out the factors that affect the fertility rate of adolescents aged 15 to 19 years using multivariate logistic regression (n = 3666).ResultsOverall, 23.1% of adolescents had given birth at least once in the 5 years leading to the survey (n = 3666, 99.4% response), and 49.8% were rural-based while 50.2% were urban-based. The median number of schooling was 8 years (IQR 6–10). About 52% of the adolescents were in the poorer, poor and medium wealth quintiles while the other 48% were in the rich and richer quintiles. Factors found to affect fertility include residence, wealth status, educational attainment, marriage and abortion. An urban-based adolescent with a lower socioeconomic status was 2.4 times more likely to give birth compared to rural-based poorer adolescents (aOR = 2.4, 95% CI: 1.5, 3.7, p < 0.001). Although odds of giving birth were much higher among rural-based married adolescents (aOR = 8.0, 95% CI: 5.4, 11.9, p < 0.001) compared to urban married adolescents (aOR = 5.5, 95% CI: 8.3, 16.0, p < 0.001), and these relationships both statistically significant, higher educational attainment (aOR = 0.7, 95% CI: 0.6, 0.8 p < 0.001) and abortion (aOR = 0.3, 95% CI: 0.1, 0.8, p = 0.020) reduced these odds, particularly for rural-based adolescents.ConclusionDespite response aimed at reducing adolescent fertility, low wealth status, low educational attainment and early marriage remain significant drivers of adolescent fertility in Zambia. There is a need to address sexual and reproductive health needs of urban-based adolescents with a lower socioeconomic status.

Distributional health and financial consequences of increased cigarette tax in Iran: extended cost-effectiveness analysis

BackgroundTo assess the potential impact of a tax-induced cigarette price increase on financial and health outcomes by different socioeconomic groups.MethodsIn a modeled condition using pooled cross-section data from Household Income and Expenditure Survey (2002–2017) and Iran 2019 population data, a methodology of an extended cost effectiveness analysis (ECEA) was applied to model the impact on cigarette consumption of hypothetically increased cigarette tax. The methodology was employed to evaluate: [1] health benefits (premature deaths averted); [2] health expenditures regarding smoking-related disease treatment averted; [3] additional tax revenues raised; [4] change in household expenditures on cigarettes; and [5] financial risk protection among male Iranian smokers in a time span of 60 years following a one-time increase in cigarette price of 75%. The Stata version 15.1 (StataCorp., College Station, TX, USA) was used to perform the relevant analysis and estimate regression models.ResultsA 75% increase in cigarettes price through taxation would reduce the number of smokers by more than half a million, 11% of them in the poorest quintile; save about 1.9 million years of life (11% of which would be gained in the lowest quintile compared to 20% in the highest one); eliminate a total of US$196.4 million of health expenditures (9% of which would benefit the bottom quintile). Such a policy could raise the additional annual tax revenues by roughly US$ 1 billion, where the top two quintiles bear around 46% of the total tax burden. We estimated that the tax increase would avert an estimated 56,287 cases of catastrophic expenditure that wholly concentrated among the bottom two expenditure quintiles.ConclusionIncreasing cigarette tax can provide health and financial benefits, and would be pro-poor in terms of health gains, Out-of-Pocket (OOP) savings, and financial risk protection against smoking-related diseases.

Socio-economic predictors of adolescent marriage and maternity in West and Central Africa between 1986 and 2017.

BackgroundEarly marriage and maternity prevalence rates among adolescent girls remain alarmingly high in West and Central Africa (WCA). This study aims to explore the associations between socio-economic factors and the prevalence of early marriage and maternity, thus contributing to the identification of girls at risk of early pregnancy or marriage.MethodsWe pooled data from national representative surveys (1986 – 2017) for 23 countries in WCA to examine associations between wealth, educational attainment, religious affiliation, and place of residence with adolescent marriage and maternity. We decomposed the wealth and education gradients for individual countries, while controlling for common characteristics of the local environment via the use of primary sampling unit fixed-effects. The pooled sample provides information on 262 721 girls (age 15-19 years). Survey weights and population share weights were used in the estimations.ResultsThe prevalence of adolescent maternity and marriage exhibited a wealth and education gradient. Prevalence of marriage in the poorest wealth quintile was 41.1% (95% confidence interval (CI) = 38.8%-43.5%) and 10.5% (95% CI = 9.5%-11.6%) in the richest. For maternity it was 38.3% (95% CI = 36.4%-40.3%) in the poorest quintile and 12.7% (95% CI = 11.5%-13.9%) in the richest. Marriage/maternity is three/two times more likely to occur among girls with incomplete primary or no formal education than in those with at least primary. Maternity and marriage among adolescents exhibit a geographical pattern and differences between religious groups. Adolescent marriage prevalence was 34.4% (95% CI = 32.9%-35.8%) in rural areas compared to 13.3% (95% CI = 12.3%-14.2%) in urban areas. Adolescent maternity prevalence was 32.8% (95% CI = 31.7%-33.9%) in rural compared to 16.3% (95% CI = 15.3%-17.3%) in urban areas. Finally, the prevalence of adolescent marriage was substantially higher among Muslims compared to all other religious groups.ConclusionsOur results highlight the disparities in the prevalence of adolescent marriage and maternity and confirm the existence of wealth and education gradients. These findings can help to improve targeting of vulnerable adolescents and to identify areas for policy implementation.

SDG3-related inequalities in women’s, children’s and adolescents’ health: an SDG monitoring baseline for Latin America and the Caribbean using national cross-sectional surveys

ObjectivesLatin America and the Caribbean (LAC) countries have made important progress towards achieving the Sustainable Development Goal (SDG) targets related to health (SDG3) at the national level. However, vast within-country...

Effects of minimum unit pricing for alcohol in South Africa across different drinker groups and wealth quintiles: a modelling study

ObjectivesTo quantify the potential impact of minimum unit pricing (MUP) for alcohol on alcohol consumption, spending and health in South Africa. We provide these estimates disaggregated by different drinker groups...

Public Social Spending and Poverty in Tanzania: A Benefit Incidence Analysis

Research on poverty in relation to public spending has never been as vigorous as it is now. Public spending has along-run effect in reducing the likelihood of being poor. This study estimated the benefit incidence analysis, progressivity of benefit and marginal benefit incidence of public spending on selected social utilities in Tanzania using the household budget surveys of 2000/01 and 2007. Benefit incidence and progressivity of benefit were estimated using the distributive analysis stata package procedure. The result of the analyses shows that public spending on social utilities in Tanzania is not pro-poor. The marginal benefit incidence analysis shows that the poorest quintile can only benefit more than the richest quintile from extra spending on the social utility in which the current accessibility is high. This is mostly the case of primary education as estimated in this study. Finally, from the findings of this study we recommend more efforts by the government to make public spending in Tanzania pro-poor to accelerate the speed at which the poor benefit more from increases in access to social utilities. One of the major ways in which the government can make public spending pro-poor is spending on the sectors that benefit more the poor people such as on social infrastructure (health and education), and on agriculture.&#x0D; JEL Classification: D21

Determinants of household catastrophic costs for drug sensitive tuberculosis patients in Kenya

BackgroundDespite free diagnosis and treatment for tuberculosis (TB), the costs during treatment impose a significant financial burden on patients and their households. The study sought to identify the determinants for catastrophic costs among patients with drug-sensitive TB (DSTB) and their households in Kenya.MethodsThe data was collected during the 2017 Kenya national patient cost survey from a nationally representative sample (n = 1071). Treatment related costs and productivity losses were estimated. Total costs exceeding 20% of household income were defined as catastrophic and used as the outcome. Multivariable Poisson regression analysis was performed to measure the association between selected individual, household and disease characteristics and occurrence of catastrophic costs. A deterministic sensitivity analysis was carried using different thresholds and the significant predictors were explored.ResultsThe proportion of catastrophic costs among DSTB patients was 27% (n = 294). Patients with catastrophic costs had higher median productivity losses, 39 h [interquartile range (IQR): 20–104], and total median costs of USD 567 (IQR: 299–1144). The incidence of catastrophic costs had a dose response with household expenditure. The poorest quintile was 6.2 times [95% confidence intervals (CI): 4.0–9.7] more likely to incur catastrophic costs compared to the richest. The prevalence of catastrophic costs decreased with increasing household expenditure quintiles (proportion of catastrophic costs: 59.7%, 32.9%, 23.6%, 15.9%, and 9.5%) from the lowest quintile (Q1) to the highest quintile (Q5). Other determinants included hospitalization: prevalence ratio (PR) = 2.8 (95% CI: 1.8–4.5) and delayed treatment: PR = 1.5 (95% CI: 1.3–1.7). Protective factors included receiving care at a public health facility: PR = 0.8 (95% CI: 0.6–1.0), and a higher body mass index (BMI): PR = 0.97 (95% CI: 0.96–0.98). Pre TB expenditure, hospitalization and BMI were significant predictors in all sensitivity analysis scenarios.ConclusionsThere are significant inequities in the occurrence of catastrophic costs. Social protection interventions in addition to existing medical and public health interventions are important to implement for patients most at risk of incurring catastrophic costs.Graphic abstract

Modeling spatial determinates of teenage pregnancy in Ethiopia; geographically weighted regression

BackgroundIn developing countries, 20,000 under 18 children give birth every day. In Ethiopia, teenage pregnancy is high with Afar and Somalia regions having the largest share. Even though teenage pregnancy has bad maternal and child health consequences, to date there is limited evidence on its spatial distribution and driving factors. Therefore, this study is aimed to assess the spatial distribution and spatial determinates of teenage pregnancy in Ethiopia.MethodsA secondary data analysis was conducted using 2016 EDHS data. A total weighted sample of 3381 teenagers was included. The spatial clustering of teenage pregnancy was priorly explored by using hotspot analysis and spatial scanning statistics to indicate geographical risk areas of teenage pregnancy. Besides spatial modeling was conducted by applying Ordinary least squares regression and geographically weighted regression to determine factors explaining the geographic variation of teenage pregnancy.ResultBased on the findings of exploratory analysis the high-risk areas of teenage pregnancy were observed in the Somali, Afar, Oromia, and Hareri regions. Women with primary education, being in the household with a poorer wealth quintile using none of the contraceptive methods and using traditional contraceptive methods were significant spatial determinates of the spatial variation of teenage pregnancy in Ethiopia.Conclusiongeographic areas where a high proportion of women didn’t use any type of contraceptive methods, use traditional contraceptive methods, and from households with poor wealth quintile had increased risk of teenage pregnancy. Whereas, those areas with a higher proportion of women with secondary education had a decreased risk of teenage pregnancy. The detailed maps of hotspots of teenage pregnancy and its predictors had supreme importance to policymakers for the design and implementation of adolescent targeted programs.

Determinants of trends in reported antibiotic use among sick children under five years of age across low-income and middle-income countries in 2005–17: A systematic analysis of user characteristics based on 132 national surveys from 73 countries

ObjectivesThis study aimed to analyze any reported antibiotic use for children aged <5 years with fever, diarrhea or cough with fast or difficult breathing (outcome) from low-income and middle-income countries (LMICs) during 2005–2017 by user characteristics: rural/urban residence, maternal education, household wealth, and healthcare source visited. MethodsBased on 132 demographic and health surveys and multiple indicator cluster surveys from 73 LMICs, the outcome by user characteristics for all country-years was estimated using a hierarchical Bayesian linear regression model. ResultsAcross LMICs during 2005–2017, the greatest relative increases in the outcome occurred in rural areas, poorest quintiles and least educated populations, particularly in low-income countries and South-East Asia. In low-income countries, rural areas had a 72% relative increase from 17.8% (Uncertainty Interval (UI): 5.2%–44.9%) in 2005 to 30.6% (11.7%–62.1%) in 2017, compared to a 29% relative increase in urban areas from 27.1% (8.7%–58.2%) in 2005 to 34.9% (13.3%–67.3%) in 2017. Despite these increases, the outcome was consistently highest in urban areas, wealthiest quintiles, and populations with the highest maternal education. ConclusionThese estimates suggest that the increasing reported antibiotic use for sick children aged <5 years in LMICs during 2005–2017 was driven by gains among groups often underserved by formal health services.

Providing universal access to modern contraceptive methods: An extended cost-effectiveness analysis of meeting the demand for modern contraception in Ethiopia

Despite recent advances in access to and use of modern contraception in Ethiopia, further improvement is needed, particularly among poorer women. This extended cost-effectiveness analysis investigated the health outcomes, their distribution, and financial risk protection associated with meeting the demand for modern contraception for all Ethiopian women. We developed five Markov models with wealth quintile–specific input data to investigate the effects of meeting this demand and followed a hypothetical cohort of 1,252,000 women through their reproductive lives from ages 15–49 years. The health outcomes are reported in quality-adjusted life years (QALYs) gained and in intermediate health outcomes, such as the total number of induced abortions, unintended pregnancies, and pregnancy-related deaths averted. The economic effect of meeting the demand for modern contraception was assessed by estimating the financial risk protection benefits in terms of averted out-of-pocket payments and the reduction in the number of cases of catastrophic health expenditure by quintile. Meeting the demand for modern contraception was deemed highly cost effective, with an incremental cost-effectiveness ratio of $96.60/QALY gained per woman. A total of 676,300 QALYs were gained, and approximately 1,900,000 unintended pregnancies, 250,000 induced abortions, and 9000 pregnancy-related deaths were averted over the 35-year period. Most of these gains were achieved among low-income groups. When the demand for modern contraception was met, almost 40,000 cases of catastrophic health expenditure were averted in the poorest quintile. The total governmental cost was higher in all quintiles when the demand for modern contraception was met compared to the baseline scenario, with the largest percentage increase in governmental spending in the poorest quintiles. Meeting the demand for modern contraception fulfills the priority-setting criteria established by the Ethiopian Ministry of Health and makes the Ethiopian health care system more equitable.

Care-Seeking for Fever for Children Under the Age of Five Before and After the Free Healthcare Initiative in Burkina Faso: Evidence from Three Population-Based Surveys.

BackgroundIn 2016, a free healthcare policy (FHP) was implemented in Burkina Faso for children under the age of five. In our study, we aimed to determine the prevalence of care-seeking for a fever in children under the age of five before and after the implementation of the FHP and to analyze the determinants of not seeking care under the FHP.MethodsThe data of three nationally representative surveys were used to evaluate the trends of the prevalence of care-seeking. We performed a modified Poisson regression using a generalized estimating equation to determine the factors associated with not seeking care.ResultsThe prevalence for care seeking increased from 57.5% (95% CI, 54.2–60.8) in 2014 to 72.3% (95% CI, 68.1–76.2) in 2017. Children from the poor quintile were less likely to seek care when compared to children from the poorest quintile (prevalence ratio (PR) = 0.7 (95% CI, 0.5–0.9)). Caregivers who did not have messages regarding malaria in the past six months were more likely not to seek care (PR = 0.8 (95% CI, 0.7–0.9)). Caregivers of children aged 36–59 months were more likely not to seek care compared to those aged <12 months (PR = 1.6 (95% CI, 1.2–2.1)). Children from the Boucle du Mouhoun region (PR = 1.9 (95% CI, 1.2–3.2)) and the Centre-Est region (PR = 1.9 (95% CI, 1.2–3.0)) were more likely not to seek care compared to children from the Sud Ouest region.ConclusionOur study showed an increase in the prevalence of care-seeking after the implementation of the FHP. Even if this is encouraging, these findings highlight the critical importance of non-financial barriers to care-seeking. Maintaining FHP and tackling the barriers should be considered by policy makers to increase care-seeking.

Geographical variation and factors associated with unsafe child stool disposal in Ethiopia: A spatial and multilevel analysis

Unsafe disposal of children's stool makes children susceptible to fecal-oral diseases and children remain vulnerable till the stools of all children are disposed of safely. There is a paucity of data on spatial distribution and factors associated with unsafe child stool disposal in Ethiopia. Previous estimates, however, do not include information regarding individual and community-level factors associated with unsafe child stool disposal. Hence, the current study aimed (i) to explore the spatial distribution and (ii) to identify factors associated with unsafe child stool disposal in Ethiopia. A secondary data analysis was conducted using the recent 2016 Ethiopian demographic and health survey data. A total of 4145 children aged 0-23 months with their mother were included in this analysis. The Getis-Ord spatial statistical tool was used to identify high and low hotspots areas of unsafe child stool disposal. The Bernoulli model was applied using Kilduff SaTScan version 9.6 software to identify significant spatial clusters. A multilevel multivariable logistic regression model was fitted to identify factors associated with unsafe child stool disposal. Unsafe child stool disposal was spatially clustered in Ethiopia (Moran's Index = 0.211, p-value< 0.0001), and significant spatial SaTScan clusters of areas with a high rate of unsafe child stool disposal were detected. The most likely primary SaTScan cluster was detected in Tigray, Amhara, Afar (north), and Benishangul-Gumuz (north) regions (LLR: 41.62, p<0.0001). Unsafe child stool disposal is more prevalent among households that had unimproved toilet facility (AOR = 1.54, 95%CI: 1.17-2.02) and those with high community poorer level (AOR: 1.74, 95%CI: 1.23-2.46). Higher prevalence of unsafe child stool disposal was also found in households with poor wealth quintiles. Children belong to agrarian regions (AOR: 0.62, 95%CI 0.42-0.91), children 6-11 months of age (AOR: 0.65, 95%CI: 0.52-0.83), 12-17 months of age (AOR: 0.68, 95%CI: 0.54-0.86), and 18-23 months of age (AOR: 0.58, 95%CI: 0.45-0.75) had lower odds of unsafe child stool disposal. Unsafe child stool disposal was spatially clustered. Higher odds of unsafe child stool disposal were found in households with high community poverty level, poor, unimproved toilet facility, and with the youngest children. Hence, the health authorities could tailor effective child stool management programs to mitigate the inequalities identified in this study. It is also better to consider child stool management intervention in existing sanitation activities considering the identified factors.

Progress in Reducing Inequalities in Reproductive, Maternal, Newborn and Child Health Services in Nepal.

Equity has emerged as a cross-cutting theme in the health sector, and countries across the world are striving to ensure that all people have access to the health services they need without undue financial hardship and educational, social, cultural and geographical barriers. In this context, this analysis has attempted to analyse Nepal's progress in reducing inequalities in reproductive, maternal, newborn and child health services based on economic status and place of residence. In this analysis, we have used data available from the web version of the Health Equity Assessment Toolkit, a data visualisation tool developed by the World Health Organisation. We have analysed the inequalities in terms of a composite coverage index which combines eight reproductive, maternal, newborn and child health interventions along the continuum of care. Composite coverage of reproductive, maternal, newborn and child health services was 43% in 2001 which increased to 65% in 2016. The absolute difference in composite coverage of the services between the lowest and highest wealth quintiles decreased from 28-percentage points in 2001 to 8-percentage points in 2016. The difference in service coverage between the urban and rural settings reduced from 21-percentage points to six percentage points in the period. Among the eight various services, births attended by skilled birth attendants is the indicator with the highest scope for improvement. Conclusions: Inequalities based on wealth quintiles and residence places have narrowed from 2001 to 2016. Additional efforts in expanding skilled birth attendants and antenatal care service coverage among the poorest quintile and rural residents could further improve the coverage of the indicators at the national level and narrow down the inequalities.

Role of husband\u2019s attitude towards the usage of contraceptives for unmet need of family planning among married women of reproductive age in Pakistan

BackgroundFamily planning services deliver a wide range of benefits to the well-being of females and the community. It can curtail the risk of maternal and neonatal mortality through the reduction in abortions and pregnancies. The government of Pakistan has been struggling to convince people about the usefulness of family planning programs. However, different factors related to social norms, values, and culture are important to determine the success of these programs. One such factor is the patriarchal structure of Pakistani society where most of the household decisions are made by men. The objective of this research is to examine the role of the husband’s attitude towards the usage of contraceptives for the unmet need of family planning (UMNFP) among married women of reproductive age (MWRA) in Pakistan.MethodThe dataset of Pakistan Demographic and Health Survey 2017–18 is utilized to examine the role of the husband’s attitude towards the usage of contraceptives in UMNFP among MWRA in Pakistan.ResultsThe UMNFP was considerably lower among MWRA between 40 years and above compared to women 15–19 years. The odds of UMNFP were higher among women and men who were educated up to the primary level compared to those with no education. Odds of UMNFP were higher among women from the poor wealth quintile compared to the poorest wealth quintile; similarly, it was significantly lower among women who were from the richer and the richest wealth quintile compared to the poorest wealth quintile. The odds of UMNFP were lower among women who were employed compared to those who were not employed. Lastly, the odds of UMNFP were higher among women whose husbands opposed to using contraceptives, who perceived that there was a religious prohibition for such use and when a decision on the contraception use was solely made by the husband.ConclusionsHusband’s attitude towards the usage of contraceptives is an important predictor of UMNFP. Liaising with the community and religious leaders to persuade people particularly men about the usefulness of family planning programs and encouraging men to understand their women’s say in using contraceptives should be encouraged.

Uncontrolled hypertension among tobacco-users: women of prime childbearing age at risk in India

BackgroundUncontrolled hypertension and tobacco use are two major public health issues that have implications for reproductive outcomes. This paper examines the association between tobacco-use status and uncontrolled hypertension among prime childbearing age (20–35) women in India.MethodsWe used the India National Family Health Survey (NFHS-4) 2015–2016 to obtain data on hypertension status and tobacco use for 356,853 women aged 20–35. We estimated multivariate logistic regressions to obtain the adjusted odds ratio for tobacco users in favor of having uncontrolled hypertension. We examined the adjusted odds at different wealth index quintiles, at different educational attainment, and at different level of nutritional status measured by body mass index.ResultsWe found that the odds of having uncontrolled hypertension for the tobacco user women in India was 1.1 (95% CI: 1.01–1.19) times that of tobacco non-users at prime childbearing age. The odds were higher for tobacco-users at the poorest quintile (1.27, 95% CI: 1.14–1.42) and with no education (1.22, 95% CI: 1.10–1.34). The odds were also higher for tobacco-users who were overweight (1.88, 95% CI: 1.57–2.29) or obese (2.82, 95% CI: 1.88–4.24).ConclusionsOur findings highlight the disproportionate dual risk of uncontrolled hypertension and tobacco use among lower-income women of prime childbearing age, identifying an opportunity for coordinated tobacco control and hypertension prevention initiatives to ensure better health of reproductive-age women in India.