Provincial Variations Research Articles

Provincial variations in catastrophic health expenditure and medical impoverishment in China: a nationwide population-based study

Financial protection, as a key dimension of Universal Health Coverage (UHC), has been under increasing attention in recent years. A series of studies have examined the nationwide extent of catastrophic health expenditure (CHE) and medical impoverishment (MI) in China. However, disparities in financial protection at the province level have rarely been studied. The aim of this study was to investigate provincial variations in financial protection as well as its inequality across provinces. Using data from the 2017 China Household Finance Survey (CHFS), this study estimated the incidence and intensity of CHE and MI for 28 Chinese provinces. Ordinary least square (OLS) estimation, using robust standard errors, was used to explore the factors associated with financial protection at the province level. Moreover, this study examined the urban-rural differences in financial protection within each province, and calculated the concentration index of CHE and MI indicators for each province using household income per capita. The study revealed large provincial variations in financial protection within the nation. The nationwide CHE incidence was 11.0% (95% CI: 10.7%, 11.3%), ranging from 6.3% (95% CI: 5.0%, 7.6%) in Beijing to 16.0% (95% CI: 14.0%, 18.0%) in Heilongjiang; the national MI incidence was 2.0% (95% CI: 1.8%, 2.1%), ranging from 0.03% (95% CI: 0.00%, 0.06%) in Shanghai to 4.6% (95% CI: 3.3%, 5.9%) in Anhui province. We also found similar patterns for provincial variations in intensity of CHE and MI. Moreover, substantial provincial variations in income-related inequality and urban-rural gap existed across provinces. Eastern developed provinces in general had much lower inequality within them, compared with central and western provinces. Despite the great advances towards UHC in China, substantial provincial variations exist in financial protection across provinces. Policymakers should pay special attention to low-income households in central and western provinces. Provision of better financial protection for these vulnerable groups will be key to achieving UHC in China. This research was supported by the National Natural Science Foundation of China (Grant Number: 72074049)and the Shanghai Pujiang Program (2020PJC013).

Pharmacy location and medical need: regional evidence from Canada

BackgroundPharmacists in Canada are assuming an increasingly important role in the provision of primary care services. This raises questions about access to pharmacy services among those with medical care needs. While there is evidence on proximity of residents of Ontario and Nova Scotia to community pharmacies, there is little evidence for the rest of Canada. I thus measured the availability of pharmacist services, both the number of community pharmacies and their hours of operation, at both the provincial and sub-provincial level in Canada. Next, I measured associations of indicators of medical need and the availability of pharmacist services across sub-provincial units.MethodsI collected data, for each Forward Sortation Area (FSA), on medical need, measured using the fraction of residents aged 65 + and median household income, and pharmacist service availability (the number of community pharmacies and their hours of operation, divided by the FSA population). Linear regression methods were used to assess associations of FSA-level service availability and medical need.ResultsThere are between 2.0 and 3.3 community pharmacies per 10,000 population, depending on the province. There are also provincial variations in the number of hours that pharmacies are open. Quebec pharmacies were open a median of 75 h a week. In Manitoba, pharmacies were open a median of 53 h a week. The per capita number of pharmacies and their total hours of operation at the FSA level tend to be higher in less affluent regions and in which the share of residents is aged 65 or older. Provincial differences in pharmacy availability were still evident after controlling for medical need.ConclusionCommunity pharmacies in Canada tend to locate where indicators of health needs are greatest. The impact on patient health outcomes of these pharmacy locational patterns remains an area for future research.

Contextual factors and spatial trends of childhood malnutrition in Zambia.

Understanding the national burden and epidemiological profile of childhood malnutrition is central to achieving both national and global health priorities. However, national estimates of malnutrition often conceal large geographical disparities. This study examined the prevalence of childhood malnutrition across provinces in Zambia, changes over time, and identified factors associated with the changes. We analyzed data from the 2013/4 and 2018 Zambia demographic and health surveys (ZDHS) to examine the spatial heterogeneity and mesoscale correlates of the dual burden of malnutrition in children in Zambia. Maps illustrating the provincial variation of childhood malnutrition were constructed. Socio-demographic and clinical factors associated with childhood malnutrition in 2013 and 2018 were assessed independently using a multivariate logistic model. Between 2013/4 and 2018, the average prevalence of stunting decreased from 40.1% (95% CI: 39.2-40.9) to 34.6% (95% CI:33.6-35.5), wasting decreased from 6.0% (95% CI: 5.6-6.5) to 4.2% (95% CI: 3.8-4.7), underweight decreased from 14.8% (95% CI: 14.1-15.4) to 11.8% (95% CI: 11.2-12.5) and overweight decreased from 5.7% (95% CI: 5.3-6.2) to 5.2% (95% CI: 4.8-5.7). High variability in the prevalence of childhood malnutrition across the provinces were observed. Specifically, stunting and underweight in Northern and Luapula provinces were observed in 2013/14, whereas Lusaka province had a higher degree of variability over the two survey periods. The study points to key sub-populations at greater risk and provinces where malnutrition was prevalent in Zambia. Overall, these results have important implications for nutrition policy and program efforts to reduce the double burden of malnutrition in Zambia.

Provincial variations and entrepreneurialism in the development of China’s Distant Water Fisheries (2011–2020)

This study rescales the current state-centric understanding of the development of China’s distant water fishing (DWF) and explores the instrumental role of Chinese provinces in actualizing and shaping this development. The rapid growth of China’s DWF during 2011–2020 can be attributed primarily to five subnational provinces and actors. As a case study, this article shows that the Fujian provincial government proactively carved out development space for boosting its DWF industry, despite Beijing’s growing efforts to tighten central control out of concern over environmental externalities. Central–Local relations remain a critical perspective for those who seek to understand the challenges faced by China’s central government as it tries to rein in the rapid expansion of the country’s DWF activities.

Provincial and Territorial Variation in Barriers in Accessing Healthcare for Children and Youth With Mental and Neurodevelopmental Health Concerns in Canada.

Provincial and Territorial Variation in Barriers in Accessing Healthcare for Children and Youth With Mental and Neurodevelopmental Health Concerns in Canada.

Bayesian Spatial Modeling of Diabetes and Hypertension: Results from the South Africa General Household Survey

Determining spatial links between disease risk and socio-demographic characteristics is vital in disease management and policymaking. However, data are subject to complexities caused by heterogeneity across host classes and space epidemic processes. This study aims to implement a spatially varying coefficient (SVC) model to account for non-stationarity in the effect of covariates. Using the South Africa general household survey, we study the provincial variation of people living with diabetes and hypertension risk through the SVC model. The people living with diabetes and hypertension risk are modeled using a logistic model that includes spatially unstructured and spatially structured random effects. Spatial smoothness priors for the spatially structured component are employed in modeling, namely, a Gaussian Markov random field (GMRF), a second-order random walk (RW2), and a conditional autoregressive (CAR) model. The SVC model is used to relax the stationarity assumption in which non-linear effects of age are captured through the RW2 and allow the mean effect to vary spatially using a CAR model. Results highlight a non-linear relationship between age and people living with diabetes and hypertension. The SVC models outperform the stationary models. The results suggest significant provincial differences, and the maps provided can guide policymakers in carefully exploiting the available resources for more cost-effective interventions.

Progress towards the UNAIDS 95-95-95 targets among pregnant women in South Africa: Results from the 2017 and 2019 national Antenatal HIV Sentinel Surveys.

ObjectivesThe UNAIDS 95-95-95 global targets for epidemic control aim to ensure by 2030 that 95% of HIV-positive people know their HIV status, 95% of people diagnosed with HIV receive sustained antiretroviral therapy (ART), and 95% of people on ART have viral suppression. While data on the first and second 95 targets are routinely reported nationally, data on the third 95 target are not available for pregnant women in South Africa. The lack of data on the third 95 target limits the inclusion of low viral suppression as one of the contributing factors in MTCT root cause analyses. This study assessed progress towards the 95-95-95 targets among pregnant women between the ages of 15–49 years attending public health facilities in South Africa.MethodData were obtained from two consecutive national cross-sectional antenatal HIV sentinel surveys conducted between 1 October and 15 November in both 2017 and 2019. In each survey, data on age, knowledge of HIV status, ART initiation, and geographical location (province) were extracted from medical records. A blood specimen was collected from each woman and tested for HIV. Viral load tests were performed on HIV-positive specimens. Descriptive and multiple logistic regression analyses were performed to examine association between province and viral suppression (defined as viral load <50 copies/mL) using the combined dataset (i.e., both 2017 and 2019 data combined). All analyses considered the survey design.ResultsOf 10 065 and 11 321 HIV-positive women included in the 2017 and 2019 surveys, respectively, 96.0% (95% confidence interval (CI): 95.6–96.4%) and 97.6% (95% CI: 97.3–97.8%) knew their HIV-positive status; 86.6% (95% CI: 85.9–87.3%) and 96.0% (95% CI: 95.6–96.4%) of those who knew their HIV status were receiving ART; while 64.2% (95% CI: 63.2–65.2%) and 66.0% (95% CI: 65.1–66.8%) of those receiving ART were virally suppressed. Achievement of the third 95 target significantly varied by province ranging from 33.9–72.6% in 2017 and 43.4–77.3% in 2019. Knowledge of HIV-positive status, ART initiation, and viral suppression increased in both 15–24 and 25–49 year age groups between 2017 and 2019. In a multivariable analysis adjusting for survey year, gravidity, and education, the odds of viral suppression significantly varied by province (except KwaZulu-Natal and Western Cape, other provinces were less likely to attain viral suppression compared to Gauteng), age (adjusted odds ratio (AOR) for 15–24 years vs 25–49 years: 0.7, 95% CI: 0.6–0.8), and timing of ART initiation (AOR for ART initiation during pregnancy vs before pregnancy: 0.4, 95% CI: 0.5–0.6).ConclusionAlthough in 2019 the first and second 95 targets were achieved among pregnant women, meeting the third 95 target remains a challenge. This study highlighted the importance of promoting early ART initiation and the need to target young women in efforts to improve progress towards the third 95 target. Additionally, the provincial variation in viral suppression could be further investigated in future studies to identify and address the root causes underlying these differences.

Culture-confirmed neonatal bloodstream infections and meningitis in South Africa, 2014–19: a cross-sectional study

SummaryBackgroundFew population-level estimates of invasive neonatal infections have been reported from sub-Saharan Africa. We estimated the national incidence risk, aetiology, and pathogen antimicrobial susceptibility for culture-confirmed neonatal bloodstream infections and meningitis in South Africa.MethodsWe conducted a cross-sectional study of neonates (<28 days of life) admitted to neonatal or paediatric wards of 256 public sector health facilities in South Africa during 2014–19. Diagnostic pathology records from Jan 1, 2014, to Dec 31, 2019, were extracted from a national pathology data warehouse. A case was defined as a neonate with at least one positive blood or cerebrospinal fluid culture during a 14-day period. Incidence risk was calculated using annual numbers of registered livebirths. Among the causative pathogens identified, we calculated the proportion of cases attributed to each of them, as well as the rates of antibiotic susceptibility of Gram-positive and Gram-negative bacteria.FindingsAmong 43 438 records of positive cultures, there were 37 631 incident cases of neonatal infection with at least one pathogen isolated. The overall incidence risk of culture-confirmed infections was 6·0 per 1000 livebirths (95% CI 6·0–6·1). The incidence risk of late-onset sepsis (days 3–27 of life) was 4·9 per 1000 livebirths (4·9–5·0) and that of early-onset sepsis (days 0–2 of life) was 1·1 per 1000 livebirths (1·1–1·1); risk ratio 4·4 (95% CI 4·3–4·5). The cause of infection differed by syndrome, timing of infection onset, facility, and province, although Klebsiella pneumoniae (26%), Acinetobacter baumannii (13%), and Staphylococcus aureus (12%) were the dominant pathogens overall. Gram-negative bacteria had declining susceptibility to most antibiotics over the study period.InterpretationWe found a high incidence risk of late-onset sepsis with provincial variations, predominance of K pneumoniae, and declining antibiotic susceptibility among Gram-negative bacteria. This national surveillance in an upper-middle-income country provides a baseline burden of neonatal infections against which the impact of future clinical and public health interventions can be measured.FundingBill & Melinda Gates Foundation.

THU295 - Hepatitis C prevalence and elimination in Pakistan; a bottom-up approach accounting for provincial variation

THU295 - Hepatitis C prevalence and elimination in Pakistan; a bottom-up approach accounting for provincial variation

A subnational affordability assessment of nutritious foods for complementary feeding in Kenya.

Complementary feeding among children aged 6-23 months is a key determinant of micronutrient deficiencies and childhood stunting, the burdens of which remain high in Kenya. This study examines the affordability of complementary foods to increase young children's nutrient consumption across eight provinces in Kenya. We combined data from household surveys, food composition tables and published sources to estimate the cost of portion sizes that could meet half of the children's daily iron, vitamin A, calcium, zinc, folate, vitamin B12 and protein requirements from complementary feeding. These costs were compared to current household food expenditures. The selection of foods and price and expenditure data were stratified by province. Our analysis indicates that vitamin A, vitamin B12 and folate are affordable to most households in Kenya via liver, beans and in some provinces, orange-fleshed fruits and vegetables, avocado and small dried fish. Calcium, animal-source protein, zinc and iron were less affordable and there was more provincial variation. In some provinces, small dried fish were an affordable source of calcium, protein and zinc. In others (North Eastern, Central, Eastern, parts of Rift Valley and Coast), small dried fish were not commonly consumed and other foods were less affordable. Future research should consider interventions aimed at reducing prices, increasing availability and changing behaviours related to these foods. Solutions such as supplementation and fortification may be needed for iron and zinc in some locations. Food affordability presented the greatest barriers in North Eastern province, which had lower dietary diversity and may require additional targeted interventions.

Growing more Rice with less water: the System of Rice Intensification and water productivity in Vietnam*

We study the effects of a large‐scale System of Rice Intensification (SRI) program on the water productivity of rice in Vietnam by exploiting provincial and time variations in SRI uptake and irrigation water supply over the period 2000–2012. Our findings document that the world's second‐largest rice exporter could produce 4 million tonnes more rice with the same water supply in the reasonably achievable case of 20 per cent SRI uptake across its provinces. In addition, we find that SRI also increases the output of other crops, due at least partly to its possible water savings and soil nutrition preservation in rice production. Moreover, we show that SRI is more likely to be adopted in provinces with a stronger quality of provincial institutions and a weaker agricultural capital base. Numerous selectivity and randomisation tests affirm that the water productivity effect of SRI is robust to selection in SRI uptake at the province and district levels and addressing potential unobservable and omitted variable problems.

A short overview of stone-inscriptions using the humanistic capitalis typeface

This essay is looking over the use of Humanist capitalis letter types in the first Renaissance period in the Hungarian Kingdom. In the case of stone inscriptions, the Humanist capitalis letter remained the most characteristic type from 1467 till the historical epoch-marking year of 1541. Its provincial variations appeared in the country at the beginning of the 16th century and became widely accepted till the 20th century. The excessive use of ligatures and enclaves became more marked after 1500 and they were fashionable till 1541. The type called early Humanist capitalis can be observed on a seal of King Matthias from 1472. Its general usage can be dated to the first decades of the 16th century.

Nexus between financial development, FDI, industrial structure change and innovation in the post-financial crisis era: Evidence from China

China began to strive for innovation-driven economic growth by encouraging technological progress since the recent world financial crisis. Further, Chinese economy exhibited several different features since the crisis. Its financial credits surged. Meanwhile, it began to adjust its industrial structures. In order to test the effect of these policies, this paper investigates whether financial development, FDI and industrial structure changes affect innovation in this new era. The results find that provincial variation in innovation performance enlarged during this period. Further, financial development significantly improves innovation. However, FDI hampers innovation. Lastly, industrial structure adjustment promotes innovation. The paper suggests that China improve the technological skills of local firms and its human capital and introduce high-quality and efficient foreign direct investment to achieve an innovation-driven economic growth.

Provincial variations in not having a regular medical doctor and having unmet healthcare needs among Canadians.

Despite spending 11.0% of the total gross domestic product, the quality of healthcare services in Canada has received mixed reviews. We first separately examined provincial variations in not having a regular medical doctor and having unmet healthcare needs among Canadians. Second, we evaluated provincial variations in the impact of not having a regular medical doctor on having unmet healthcare needs among Canadians. We applied logistic regressions using data from the 2014 and 2017-2018 Canadian Community Health Surveys (CCHS). The total sample size for this study was 120,345 individuals aged 12years and older: 61,240 from the 2014 CCHS and 59,105 from the 2017-2018 CCHS. We found significant provincial variations in not having a regular medical doctor and having unmet healthcare needs among Canadians. People in Quebec and the Territories were more likely not to have a regular medical doctor than their peers in Alberta. People in Quebec and the Territories were also more likely to have unmet healthcare needs than their counterparts in Alberta. Not having a regular medical doctor impacted whether Canadians reported having unmet healthcare needs to varying degrees across provinces. Findings from this study may contribute to designing province-specific policy interventions and inform efforts that seek to address barriers to having a regular medical doctor and reducing unmet healthcare needs among Canadians.

Provincial variations in radiotherapy utilization as a measure of access: A pan-Canadian study

Background and purposeAccess to radiotherapy (RT) is a key component of a cancer control strategy. However, radiotherapy utilization (RTU) rates fall short of desired benchmarks in certain Canadian provinces. We aimed to describe provincial variations in RTU across Canada. Materials and methodsWe calculated radiotherapy utilization ratios (RTUR) for each Canadian province from 2016 (RT case counts divided by incidence counts), by cancer type (all cancers, lung, breast, rectal, prostate) and treatment intent (curative, palliative) where data were available. Data were extracted from each provincial RT data repository, cancer registry and/or RT department. We compared RTURs descriptively across provinces and to Ontario benchmarks, and calculated an estimated national RTUR. In provinces with capacity for data linkage, RTURs were compared to a linked (patient-specific) method of calculating utilization, by linking each incident case to whether RT was received within 1 year of diagnosis (RTU-1 yr). ResultsExcluding three provinces that included re-treatments, all-cancer RTURs ranged from 0.31 in Manitoba to 0.40 in Nova Scotia. The national all-cancer RTUR was 0.35, which was comparable to Ontario benchmarks (0.34). Larger variations were seen by cancer type, with an absolute difference in RTURs of 28% for lung cancers, 27% for breast cancers, 21% for rectal cancers, and 18% for prostate cancers. RTURs for nearly all provinces were below established Ontario benchmarks for each cancer type, except prostate cancer. RTURs over-estimated RTU-1 yr by at most 5%, except for prostate cancers where they over-estimated RTU-1 yr by up to 15%. ConclusionsRTU varies by province in Canada, and most notably by cancer subsite. More granular data at the regional level and by healthcare facility is required to further tailor strategies aimed at improving RT access. RTURs also serve as a reasonable surrogate for linked RTU, and both methods can contribute meaningfully to measure RTU depending on the context and data availability.

Policy Forum: Implementing the Chippewas of Georgina Island First Nation Property Tax System—Opportunities, Challenges, and Lessons Learned

In 2018, the Chippewas of Georgina Island First Nation (GIFN) implemented a First Nation property tax system under the First Nations Fiscal Management Act (FMA)—one of the earliest First Nations in Ontario to do so. Implementation of a property tax system gave GIFN an opportunity to improve funding for and expand local services, and provide a more equitable sharing of local service costs between cottagers leasing First Nation land and the First Nation. Key challenges encountered when implementing the property tax system were building consensus around the need for a tax system, building an appropriate administrative infrastructure, carrying out property assessments, and professionals lacking knowledge of First Nation property tax. These challenges, however, presented opportunities to create a knowledge base around property taxation within GIFN, among cottage leaseholders, and in the wider community. Key lessons learned were (1) start as soon as possible; (2) First Nations Tax Commission support and standards are important; (3) staff training is important; (4) communicate early and often; (5) hold open houses; (6) local services are more than garbage collection; (7) property taxes do not harm lease rates or cottage sales; (8) educate lawyers, real estate agents, and other professionals; (9) startup costs were significant; (10) coordinate laws and standards with provincial variations; (11) modernize systems; and (12) utilize other parts of the FMA.

87 Validation of a Costing Algorithm in the Neonatal Intensive Care Unit and Identification of Cost Drivers for Neonates

Abstract Primary Subject area Neonatal-Perinatal Medicine Background Neonatal Intensive Care Units (NICUs) account for over 35% of pediatric in-hospital clinical costs, thus implying that a better understanding of care expenditures within these units is the first step for improving efficiency of care. The Canadian Neonatal Network (CNN) algorithm is the first to provide case-specific costs based on resource usage among preterm infants born &amp;lt; 37 weeks but has not yet been validated for other populations in the NICU. Objectives To validate the CNN costing algorithm in six case-mix categories with real-time costs obtained from hospital-specific financial software (CPSS) in a tertiary-level NICU and assess the variations in proportion of cost centers across case-mixes. Design/Methods A retrospective cohort study of all patients admitted within 24h of birth to a Level 3 medico-surgical NICU 2016-2019. Patient demographics, clinical information and CNN predicted costs were obtained from the CNN database. Real-time costs were obtained from the hospital financial software (CPSS). Total and daily costs were compared between sources using Pearson correlation coefficient (r) and paired Student’s t-test. Costs were adjusted to account for inter-institutional and -provincial price variations using the Cost of Standard Hospitalization Stay from the Canadian Institute for Health Information. Proportions of each cost center across the different case-mix categories were compared using Chi-square analyses. Results Among the 1795 live infants admitted into the NICU, 167 (9.3%) were &amp;lt; 29 weeks gestational age (GA), 193 (11%) were 29-32 weeks GA, 457 (25.5%) were 33-36 weeks GA, 144 (8%) had major congenital anomalies, 179 (10%) were term infants diagnosed with Hypoxic-Ischemic Encephalopathy (HIE) and 672 (37%) were term infants with no HIE or major congenital anomalies. Median NICU costs varied according to each case-mix from $10,025 for term infants without HIE or congenital anomaly to $180,145 for infants born &amp;lt; 29 weeks (Figure 1). Despite high variation in total NICU costs, there were small variations in median daily costs (range: $1,312-$1,941). Overall, the CNN algorithm strongly correlated with CPSS total costs across all 6 case-mix categories (r range 0.90-1.00, p-value &amp;lt; 0 .01) (Figure 2). We report a consistent strong predictive performance of the algorithm in 5/8 pre-specified cost centers among preterm infants (r range 0.77-0.99, p-value &amp;lt; 0 .01). Unit producing personnel (nurses and physicians) consistently comprised the largest proportion of total costs (64-78%) for all case-mix categories. Conclusion The CNN algorithm accurately predicts NICU total costs for six case-mix categories. Costs per day were comparable across different case-mix categories, and unit producing personnel represented the highest proportion of costs suggesting that reductions in length of stay would be the most efficient method to reduce NICU costs.

Upgrading Big Brother: Local Strategic Adaptation in China\u2019s Security Industry

What are the circumstances under which latecomer firms can develop indigenous innovative capacity and compete globally? China’s construction of a vast domestic security apparatus has contributed to it becoming the world’s largest supplier and consumer of video surveillance products and services. It has also produced several globally competitive companies, including those engaged in digital surveillance. Although security equipment producers initially emerged in Guangdong province, China’s leading technology companies are concentrated in Zhejiang province. This comparative study is motivated by the puzzle of why Guangdong, which has a larger security equipment industry with more local investment and earlier introduction of foreign technology, has lagged behind Zhejiang in technological upgrading. We trace this provincial variation to the policy choices of local state bureaucracies and the business strategies of local enterprises. While macro-level variables such as market demand and establishing national industry standards are important for industrial development, this study demonstrates the critical role of local technocrats and entrepreneurs in facilitating technological innovation in a rapidly evolving surveillance regime. Our analysis also reveals how latecomers to a technology-intensive industry were able to adapt their products strategically to meet the technical demands of a major segment of the domestic market, China’s public security sector.

Mapping the Burden of Hypertension in South Africa: A Comparative Analysis of the National 2012 SANHANES and the 2016 Demographic and Health Survey.

This study investigates the provincial variation in hypertension prevalence in South Africa in 2012 and 2016, adjusting for individual level demographic, behavioural and socio-economic variables, while allowing for spatial autocorrelation and adjusting simultaneously for the hierarchical data structure and risk factors. Data were analysed from participants aged ≥15 years from the South African National Health and Nutrition Examination Survey (SANHANES) 2012 and the South African Demographic and Health Survey (DHS) 2016. Hypertension was defined as blood pressure ≥ 140/90 mmHg or self-reported health professional diagnosis or on antihypertensive medication. Bayesian geo-additive regression modelling investigated the association of various socio-economic factors on the prevalence of hypertension across South Africa’s nine provinces while controlling for the latent effects of geographical location. Hypertension prevalence was 38.4% in the SANHANES in 2012 and 48.2% in the DHS in 2016. The risk of hypertension was significantly high in KwaZulu-Natal and Mpumalanga in the 2016 DHS, despite being previously nonsignificant in the SANHANES 2012. In both survey years, hypertension was significantly higher among males, the coloured population group, urban participants and those with self-reported high blood cholesterol. The odds of hypertension increased non-linearly with age, body mass index (BMI), waist circumference. The findings can inform decision making regarding the allocation of public resources to the most affected areas of the population.

Climato-Economic Origins of Variations in Uniqueness of Nickname on Sina Weibo.

In the world of social media, people are free to choose names based on their preferences, which may potentially reflect certain levels of uniqueness. In this study, we have attempted to explore the possibility of applying the ecological theory of individualism/collectivism in the context of social media. We, thus, examined provincial variations in the uniqueness of nicknames among more than 13 million Sina Weibo users. Initially, the nickname uniqueness indicator was set at the provincial level. It was found that the uniqueness of nicknames was the highest in provinces with temperate climates, for example Guangdong, and the lowest in provinces with demanding climate, such as Ningxia. Regression analysis results partially supported that inhabitants in provinces with temperate climate were more likely to use unique nicknames on social media compared to those from harsh climate. This finding is significant in terms of ecology.