Household Socioeconomic Status Research Articles

Patterns and determinants of tobacco purchase behaviors among male cigarette smokers in Vietnam: A latent class analysis.

Understanding smokers' purchasing patterns can aid in customizing tobacco control initiatives aimed at reducing the tobacco smoking prevalence. Therefore, this study identified cigarette purchase behavior among Vietnamese male smokers and associated demographic and consumption factors. We analyzed a secondary dataset of male current tobacco smokers (n=3983) who participated in the Vietnam Global Adult Tobacco Survey in 2015. We applied the latent class analysis (LCA) to identify the classes of purchase behavior among cigarette smokers (n=1241). Multinomial logistic regression was performed to identify demographics (education level, ethnicity, partnership status, and household socioeconomic status) and cigarette consumption variables (smoking years and heavy smoking status) related to purchase behavior classes. The results are reported as an adjusted relative risk ratio (ARRR). The LCA identified four cigarette purchase behaviors classes: Class 1 (price-insensitive and purchased international brand: 44.4%), Class 2 (price-sensitive and purchased domestic brand: 27.6%), Class 3 (price-sensitive and purchased cigarettes in a street vendor: 18.6%), and Class 4: price-sensitive and purchased loose/carton cigarette: 9.4%). The poorer economic groups were more likely to belong to the three price-sensitive classes. Heavy smokers and those who had smoked for a longer period were more likely to belong to Class 3 (ARRR=2.33; 95% CI: 1.51-3.58 and ARRR=1.02; 95% CI: 1.001-1.05, respectively) and Class 4 (ARRR=2.94; 95% CI: 1.71-5.06 and ARRR=1.05; 95% CI: 1.02-1.08, respectively). Varied purchasing behaviors among male cigarette smokers, influenced by divergent price sensitivities and economic backgrounds, underscore the need for comprehensive tobacco control. Future efforts should include targeted policy interventions, behavior modification, and reshaping social norms.

The Prevalence and Epidemiological Features of Ischaemic Heart Disease in Sri Lanka.

There is limited evidence on the prevalence of ischaemic heart disease (IHD) and its association with risk factors and socioeconomic status (SES) in low- and middle-income countries (LMICs). Given the relatively high levels of access to healthcare in Sri Lanka, the association of IHD with SES may be different from that observed in other LMICs. To estimate the prevalence of IHD in Sri Lanka, determine its associated risk factors and its association with SES. We analysed data from 6,513 adults aged ≥18 years examined in the 2018/19 Sri Lanka Health and Ageing Study. We used the Rose angina questionnaire to classify participants as having angina (Angina+) and used self-report or medical records to identify participants with a history of IHD (History+). The association of Angina+ and History+ with age, ethnicity, sector of residence, education level, household SES wealth quintile, area SES wealth quintile, hypertension, diabetes, smoking, total cholesterol, cholesterol-to-HDL ratio, waist-to-hip ratio and body mass index were analysed in unadjusted and adjusted models. Additional analyses were performed to investigate sensitivity to correction for missing data and to benchmark estimates against evidence from other studies. We estimated prevalence of History+ of 3.9% (95% CI 3.3%-4.4%) and Angina+ of 3.0% (95% CI 2.4%-3.5%) in adults aged 18 years and over. The prevalence of Angina+ was higher in women than men (3.9% vs. 1.9%, p < 0.001) whilst prevalence of History+ was lower (3.8% vs. 4.0%, p = 0.8), which may suggest a higher rate of undiagnosed IHD in women. A history of IHD was strongly associated with age, hypertension and diabetes status even after adjusting for sociodemographic factors. Though the prevalence of History+ was higher in the most developed area SES tertile and urban areas, History+ was also associated with less education but not household SES, consistent with patterns emerging from other LMICs.

The Intersection of a Child's Demographics and Household Socioeconomic Status in the Multimorbidity of Malaria, Anaemia, and Malnutrition among Children Aged 6-59 Months in Nigeria.

Multimorbidity of malaria, anemia, and malnutrition (MAMM) is a condition in which an individual has two or more of these health conditions, and is becoming an emergent public health concern in sub-Saharan African countries. The independent associations of a child's demographic variables and household socioeconomic (HSE) disparities with a child's health outcomes have been established in the literature. However, the effects of the intersection of these factors on MAMM, while accounting for other covariates, have not been studied. Therefore, this study aimed to determine how children's sex, age, and household socioeconomic status interact to explain the variations in MAMM among children aged 6-59 months in Nigeria. Data from the 2018 Nigeria Demographic and Health Survey and the 2018 National Human Development Report (NHDR) were used. This study included weighted samples of 10,184 children aged 6-59 months in Nigeria. A three-level multilevel mixed effect ordinal logistic regression model was used, such that individual characteristics at level 1 were nested in communities at level 2 and nested in states at level 3. Subsequently, predictive probability charts and average adjusted probability tables were used to interpret the intersectional effects. Five models were created in this scenario. Model 1 is the interaction between the child's sex and household wealth status; model 2 is the interaction between the child's sex and age; model 3 is the interaction between the child's age and household wealth status; model 4 has the three two-way interactions of the child's sex, age, and household wealth status; and model 5 includes model 4 and the three-way interactions between a child's sex, age, and household wealth quintiles; while accounting for other covariates in each of the models. The prevalence of children with a 'none of the three diseases' outcome was 17.3% (1767/10,184), while 34.4% (3499/10,184) had 'only one of the diseases', and 48.3% (4918/10,184) had 'two or more' MAMMs. However, in the multivariate analyses, model 3 was the best fit compared with other models, so the two-way interaction effects of a child's age and household wealth status are significant predictors in the model. Children aged 36-47 months living in the poorest households had a probability of 0.11, 0.18, and 0.32 of existing with MAMM above the probability of children of the same age who live in the middle class, more prosperous, and richest households, respectively, while all other covariates were held constant. Thus, the variation in the prevalence of MAMM in children of different ages differs depending on the household wealth quintile. In other words, in older children, the variations in MAMM become more evident between the richer and the poorer household quintiles. Therefore, it is recommended that policies that are geared toward economic redistribution will help bridge the disparities observed in the prevalence of multiple diseases among children aged 6-59 months in Nigeria.

Malawi Epidemiology and Intervention Research Unit Non-Communicable Disease Survey data, 2013-2017

Here we describe a dataset from a cross-sectional survey carried out by the Malawi Epidemiology and Intervention Research Unit, to describe the burden and determinants of hypertension, diabetes and lipid disorders in rural and urban Malawi. Data were collected between May 2013 and April 2017 through face-to-face data capture in participant’s homes in the Karonga district in northern Malawi (n=13,904) and Area 25 in the capital Lilongwe in the central region (n=16,660). Data collected included sections on demographic data, marital status and spouse information, household socio-economic status, smoking, indoor smoke exposure, alcohol use, diets, physical activity, pregnancy, medical history and family medical history. All blood samples were tested for glucose, lipids, electrolytes and full blood count. Data are available to researchers on reasonable request.

How did we protect children against COVID-19 in Iran? Prevalence of COVID-19 and vaccination in the socio-economic context of COVID-19 epidemic.

The COVID-19 pandemic posed significant risks to children worldwide. This study aimed to assess the COVID-19 protection status of children and explored the relationship between household socio-economic status and COVID-19 morbidity and preventive measures, including vaccination and mask-wearing, in two cities in Iran. A population-based cross-sectional study was conducted from July to October 2022 among 7 to 18-year-old children and their families in Tehran and Karaj. A total of 3,022 samples were selected using stratified multistage cluster sampling. Data were collected through interviews with children and adults, using questionnaires and was analyzed with Stata software version 14. The analysis focused on 2,878 children with a median age of 12. Over half (54%) reported that the pandemic negatively affected their family's financial status, with 45% describing its impact on children's needs as negative or very negative. Just under 50% of respondents consistently wore masks during the study period, and around 54% had received at least one dose of the COVID-19 vaccine. Reasons for not getting vaccinated included concerns about side effects, ineligibility for the target age group, and overcrowding at vaccination sites. The odds of not getting vaccinated were significantly lower for children aged 15-18, with boys more likely to refuse vaccination than girls. The financial impact of the pandemic in Iran affected families' ability to meet their children's needs. Moreover, low vaccination acceptance rates increased children's vulnerability to health problems and contributed to COVID-19 infections. Efforts should be made to increase vaccination acceptance, particularly among immigrant populations.

Associations of prenatal stress with 5-year-old children's executive function in a low socioeconomic status population.

Prenatal stress has a significant, but small, negative effect on children's executive function (EF) in middle and high socioeconomic status (SES) households. Importantly, rates and severity of prenatal stress are higher and protective factors are reduced in lower SES households, suggesting prenatal stress may be particularly detrimental for children's EF in this population. This study examined whether prenatal stress was linked to 5-year-old's EF in a predominantly low SES sample and child sex moderated this association, as males may be more vulnerable to adverse prenatal experiences. Participants were 132 mother-child dyads drawn from a prospective prenatal cohort. Mothers reported on their depression symptoms, trait anxiety, perceived stress, everyday discrimination, and sleep quality at enrollment and once each trimester, to form a composite prenatal stress measure. Children's EF was assessed at age 5 years using the parent-report Behavior Rating Inventory of Executive Function - Preschool (BRIEF-P) Global Executive Composite subscale and neuropsychological tasks completed by the children. Mixed models revealed higher prenatal stress was associated with lower BRIEF-P scores, indicating better EF, for females only. Higher prenatal stress was associated with lower performance on neuropsychological EF measures for both males and females. Results add to the limited evidence about prenatal stress effects on children's EF in low SES households.

Drivers of Urban Agriculture and their Influence on the Socio-Economic Status of the Urban Farmers in Uganda, A Case Study of Kampala and Mbarara Cities

The study analyzed the influence of forms and drivers of urban Agriculture on the socio-economic status of the farmers in Kampala and Mbarara Cities. The specific objective of the study was to examine the influence drivers of urban agriculture on the socio-economic status of farmers. The study adopted a cross-sectional research design using multiple data collection methods. A multistage cluster sampling technique involving simple random sampling to get both primary and secondary sampling units, snowball to get target respondents and purposive sampling for key informants and focus group members was used. Data were collected using social survey questionnaires for households, focus group discussions checklist (FGDs), key informant interview guides and observations, from a sample of 384 respondents. The study found a strong association between drivers of UA and the socioeconomic status of the urban farmers in Kampala and Mbarara Cities. Household socio-economic status has substantially correlated with the drivers of the urban farmers and out of 9 items considered only 5 was significant which include access to capital (x2 = 1.175, p&lt; 0.047), access to agriculture extension services (x2 = 3.634, p&lt; 0.026), access to financial grants (x2 = 5.190, p&lt;0.001), access to markets (x2 = 6.993, p&lt; 0.001), value addition(x2 = 3.718, p&lt;0.014). The study confirmed a significant relationship between drivers of urban agriculture and the socio-economic status of urban farmers. Urban agriculture drivers like access to capital and financial grants, nature of market access and value addition had a significant influence on household socio-economic status.

Multivariate mixed-effects ordinal logistic regression models with difference-in-differences estimator of the impact of WORTH Yetu on household hunger and socioeconomic status among OVC caregivers in Tanzania.

Although most of the livelihood programmes target women, those that involve women and men have been evaluated as though men and women were a single homogenous population, with a mere inclusion of gender as an explanatory variable. This study evaluated the impact of WORTH Yetu (an economic empowerment intervention to improve livelihood outcomes) on household hunger, and household socioeconomic status (SES) among caregivers (both women and men) of orphaned and vulnerable children (OVC) in Tanzania. The study hypothesized that women and men respond to livelihood interventions differently, hence a need for gender-disaggregated impact evaluation of such interventions. This is a secondary analysis of longitudinal data, involving caregivers' baseline (2016-2019) and follow-up (2019-2020) data from the USAID Kizazi Kipya project in 25 regions of Tanzania. Two dependent variables (ie, outcomes) were assessed; household hunger which was measured using the Household Hunger Scale (HHS), and Socioeconomic Status (SES) using the Principal Component Analysis (PCA). WORTH Yetu, a livelihood intervention implemented by the USAID Kizazi Kipya project was the main independent variable whose impact on the two outcomes was evaluated using multivariate analysis with a multilevel mixed-effects, ordinal logistic regression model with difference-in-differences (DiD) estimator for impact estimation. The analysis was based on 497,293 observations from 249,655 caregivers of OVC at baseline, and 247,638 of them at the follow-up survey. In both surveys, 70% were women and 30% were men. Their mean age was 49.3 (±14.5) years at baseline and 52.7 (±14.8) years at the follow-up survey. Caregivers' membership in WORTH Yetu was 10.1% at the follow-up. After adjusting for important confounders there was a significant decline in the severity of household hunger by 46.4% among WORTH Yetu members at the follow-up compared to the situation at the baseline (adjusted Odds Ratio (aOR) = 0.536, 95% Confidence Interval (CI) [0.521, 0.553]). The decline was 45.7% among women (aOR = 0.543 [0.524, 0.563]) and 47.5% among men (aOR = 0.525 [0.497, 0.556]). Regarding SES, WORTH Yetu members were 15.9% more likely to be in higher wealth quintiles at the follow-up compared to the situation at the baseline (aOR = 1.159 [1.128, 1.190]). This impact was 20.8% among women (aOR = 1.208 [1.170, 1.247]) and 4.6% among men (aOR = 1.046 [0.995, 1.101]). WORTH Yetu was associated with a significant reduction in household hunger, and a significant increase in household SES among OVC caregivers in Tanzania within an average follow-up period of 1.6 years. The estimated impacts differed significantly by gender, suggesting that women and men responded to the WORTH Yetu intervention differently. This implied that the design, delivery, and evaluation of such programmes should happen in a gender responsive manner, recognising that women and men are not the same with respect to the programmes.

Binge drinking associated with mean temperature: a cross-sectional study among Mexican adults living in cities

BackgroundThe association between environmental temperature and alcohol consumption has not been widely explored despite the potential that increasing temperatures could promote the consumption of alcoholic beverages and the alcohol-related burden of disease. We aimed to explore the association between temperature and binge drinking in Mexican adults from urban cities, overall, and by alcoholic beverage type.MethodsData on 10,552 adults ≥ 18 years was obtained from the 2016 National Survey on Drug, Alcohol, and Tobacco Consumption. The mean annual temperature at the municipality was obtained from the Mexican National Weather Service using monthly temperatures from 2015 to 2016. We analyzed binge drinking for all alcoholic beverages in the last year and by type of alcohol as beer, liquor, wine, and coolers. Associations between mean temperature over the past year and binge drinking over the past year among current drinkers were estimated using multilevel Poisson models with robust standard errors adjusted for age, sex, education level, marital status, and household socioeconomic status, with a fixed effect by region.ResultsWe observed a non-significant increase in the prevalence of binge drinking for every difference of 1 °C between municipalities of the same region. By alcohol type, a 1 °C increase in mean annual temperature across municipalities of the same region increased the prevalence of beer binge drinking in the past year by 0.9% (PR = 1.009, 95%CI 1.005, 1.013) among beer consumers and the prevalence of coolers’ binge drinking by 3.0% (PR = 1.030, 95%CI 1.003, 1.057) in coolers consumers. We observed non-significant results for liquor binge drinking (PR = 1.047, 95%CI 0.994, 1.102) and wine binge drinking (PR = 1.047, 95% 0.944, 1.161).ConclusionPeople living in municipalities with higher temperatures reported a higher beer binge drinking in Mexican cities. This could account for 196,000 cases of beer binge drinking in 2016. The context of each country needs to be considered when generalizing these findings, and they need to be further explored with longitudinal data as there might be implications for climate change. If our findings are confirmed given the forecasted rising temperatures, we could expect an increase in binge drinking and therefore, in the alcohol burden of disease.

Low birth weight, household socio-economic status, water and sanitation are associated with stunting and wasting among children aged 6-23 months: Results from a national survey in Ghana.

Stunting and wasting are key public health problems in Ghana that are significantly linked with mortality and morbidity risk among children. However, information on their associated factors using nationally representative data is scanty in Ghana. This study investigated the influence of Infant and Young Child Feeding (IYCF) indicators, socio-demographic and economic related factors, and water and sanitation on stunting and wasting, using nationally representative data in Ghana. This is a secondary data analysis of the most recent (2017/2018) Ghana Multi-Indicator Cluster Survey (MICS) datasets. The multi-indicator cluster survey is a national cross-sectional household survey with rich data on women of reproductive age and children under the age of five. The survey used a two-stage sampling method in the selection of respondents and a computer-assisted personal interviewing technique to administer structured questionnaires from October 2017 to January 2018. The present study involved 2529 mother-child pairs, with their children aged 6 to 23 months. We used the Complex Sample procedures in SPSS, adjusting for clustering and stratification effects. In a bivariate logistic regression, variables with P-values ≤ 0.05 were included in a backward multivariate logistic regression to identify the significant factors associated with stunting and wasting. The mean age of children was 14.32 ± 0.14 months, with slightly more being males (50.4%). About 12% and 16% of the children were wasted and stunted, respectively. There were 39.4%, 25.9%, and 13.7% of children who, respectively, satisfied the minimum meal frequency (MMF), minimum dietary diversity (MDD), and minimum acceptable diet (MAD). None of the IYCF indicators was significantly associated with stunting or wasting in the multivariate analysis but low socio-economic status, low birth weight, being a male child and unimproved toilet facilities were significantly associated with both wasting and stunting. Our findings suggest that aside from the pre-natal period, in certain contexts, household factors such as low socio-economic status and poor water and sanitation, may be stronger predictors of undernutrition. A combination of nutrition-specific and nutrition-sensitive interventions including the pre-natal period to simultaneously address the multiple determinants of undernutrition need strengthening.

Stratification of Urban Health Centers of Khorramabad Based on Socioeconomic Status of Households Using Factor Analysis and Cluster Analysis

Background: In numerous studies in the field of medical sciences, researchers use health centers as a frame for stratified sampling. Since socioeconomic variables play a major role in health outcomes, the present study aimed to classify urban health centers of Khorramabad in terms of the socioeconomic status of households using factor and cluster analysis. Materials and Methods: In this cross-sectional study, the statistical population included all urban areas of Khorramabad based on the population and housing census conducted by the Statistical Center of Iran. Firstly, the scatter maps of urban areas and health centers were adopted together. Thereafter, socioeconomic indexes of urban areas were calculated in seven fields, and exploratory factor analysis was used to reduce dimensions. Finally, the similar health centers in terms of factor scores were allocated to the same clusters by k-means cluster analysis using SPSS software (version 26) and were displayed on city maps using Arc GIS software. Results: Three factors identified in factor analysis explained about 73.3% of the total variance of socioeconomic indexes. Based on cluster analysis, 11 health centers were located in cluster 1 (related to lower educational attainment, poorer housing amenities, and higher rate of homelessness and divorce), 16 centers were located in cluster 2 (related to higher studying persons rate, lower marriage rate in women, lower unemployment rate, and higher residence in apartment flats) and 10 health centers were located in cluster 3 (related to higher academic graduates, more profitable jobs, and better housing amenities). Conclusion: The results of this research can be used in health studies in urban areas of Khorramabad as a basis for performing stratified sampling. Furthermore, it is recommended that authorities adopt more effective planning to improve deprived areas in cluster one.

Regional Variation in the Prevalence of Undernutrition and its Correlates Among Under Five-Year Children in North India.

Undernutrition is an important public health problem affecting one-third of under five-year-old children in India. To assess the nutritional status of under five-year-old children along with child feeding practices. We adopted a systematic sampling procedure to carry out this community-based, cross-sectional study in all the districts of Haryana. Data was collected on socioeconomic and demographic particulars along with anthropometric measurements. Analysis was done using SPSS Windows 23. The overall prevalence of stunting, underweight, and wasting was 34%, 27.5%, and 11%, while that of severe undernutrition was 11%, 8%, and 3%, respectively. The odds of underweight were significantly higher among children of the Muslim religion, children of scheduled caste, children of illiterate mothers, lower per capita income, HHs without electricity, landless HHs, low birth weight, no ANC care, and those early ages at complementary feeding. Stunting was significantly higher among children whose mothers were illiterate, children whose fathers were laborers, among landless HHs, with no separate kitchen and lower birth weight, while wasting was higher among children of Muslim religion, children of scheduled caste, with no sanitary latrine facility, low-birth-weight children and early initiation of complementary feeding. Undernutrition is observed to be associated with religion, community, education of mother, per capita income, land holding status, birth weight, and age at complementary feeding. Thus, improving maternal nutrition can improve birth weight, improving maternal knowledge about child feeding, and the household's socio-economic status may improve the nutritional status of children.

Social inequality in the association between life transitions into adulthood and depressed mood: a 27-year longitudinal study.

Few studies have considered the life-course development of depressive symptoms in relation to life transitions in early-adulthood and whether these might affect depressive trajectories differently depending on specific indicators of parental socioeconomic status (SES). In the present work, we explore these questions using the adolescent pathway model as a guiding framework to test socially differential exposure, tracking and vulnerability of the effects of life transitions on depressed mood across different socioeconomic backgrounds. Latent growth modeling was used to estimate the associations between indicators of parental SES (parental education and household income) and depressed mood from age 13 to 40 with life transitions (leaving the parental home, leaving the educational system, beginning cohabitation, attaining employment) as pathways between the two. Our analyses were based on a 27-year longitudinal dataset (n = 1242) of a Norwegian cohort with 10 time points in total. To make socioeconomic comparisons, three groups (low, mid, and high) were made for parental education and income respectively. Depressed mood decreased from age 13 to 40. The low and high parental education groups showed a stable difference in depressed mood during early adolescence, which decreased in young adulthood and then increased slightly in mid-adulthood. The low household income group showed higher depressed mood across young adulthood compared to the medium and higher household income groups. For life transitions, leaving the parental home and beginning cohabitation was associated with an added downturn of the trajectory of depressed mood when adjusting for other transitions. However, adolescents with high parental education showed a relatively stronger decrease in depressed mood when leaving the parental home. Similarly, adolescents with a high household income showed a relatively stronger decrease in depressed mood when leaving the educational system. Depressed mood decreased over time and developed differently depending on parental education and household income. Life transitions were generally associated with reductions in depressed mood across time, but lower SES youths were not found to be more socially vulnerable these effects.

Correlates of early child development among children with stunting: A cross-sectional study in Uganda.

Many children in low- and middle-income countries are not attaining their developmental potential. Stunting is associated with poor child development, but it is not known which correlates of stunting are impairing child development. We explored potential socioeconomic, nutritional, clinical, and household correlates of early child development among 12-59-month-old children with stunting in a cross-sectional study in Uganda. Development was assessed using the Malawi Development Assessment Tool (MDAT) across four domains of gross and fine motor, language, and social skills. Linear regression analysis was used to assess correlates of development in the four domains and total MDAT score. Of 750 children included, the median [interquartile range] age was 30 [23-41] months, 55% of the children resided in rural settings with 21% from female-headed households and 47% of mothers had no schooling. The mean ± standard deviation height-for-age z-score (HAZ) was -3.02 ± 0.74, 40% of the children had a positive malaria test and 65% were anaemic (haemoglobin < 110 g/L). One-third had children's books at home, majority (96%) used household objects to play with and most of them (70%) used toys as pretence items like those to mimic cooking. After age, sex, and site adjustments, HAZ (0.24, 95% confidence interval [CI]: 0.14-0.33) and head circumference (0.07, 95%CI: 0.02-0.12) were positive correlates of total MDAT score, whereas weight-for-height z-score (WHZ) was not. Current breastfeeding was associated with 0.41 (95%CI: 0.17-0.65) lower total MDAT score. Children from households with a single income earner had 0.22 (95%CI: 0.06-0.37) lower total MDAT score. Furthermore, severe food insecurity, inflammation and positive malaria test were associated with lower scores for motor development. All family care indicator subscales (FCIs) positively correlated with the total MDAT score and this association was independent of household's socioeconomic status. In conclusion, stunting degree, head circumference, number of household income earners and stimulation by improved FCIs correlate with early child development among stunted children. The negative association with prolonged breastfeeding is likely due to reverse causality. Identified correlates may inform initiatives to support children with stunting attain their development potential.

Socioeconomic shocks, social protection and household food security amidst COVID-19 pandemic in Africa's largest economy.

Africa has been known to experience series of problems among which are poverty, food insecurity, lack of access to energy, lack of infrastructure among others. These problems were exacerbated by the COVID-19 pandemic, which has had a severe impact on the socioeconomic status of households in Africa. This paper examines the relationship between socioeconomic shocks, social protection, and household food security during the pandemic in Nigeria, the Africa's largest economy. Using the World Bank's COVID-19 national longitudinal baseline phone survey (2020) for the analysis and applied the multinomial logit regression, the study finds that socioeconomic shocks resulting from the pandemic have led to an increased level of food insecurity. Social protection programmes have played a crucial role in mitigating the impact of these shocks on households. However, the study also highlights the need for more targeted and effective social protection policies to ensure that vulnerable households are adequately protected from the adverse effects of the pandemic. The findings of this study have important implications for policymakers and stakeholders in Africa's largest economy, as they seek to address the challenges posed by the pandemic and promote household food security for the actualisation the United Nations (UN) Sustainable Development Goal (SDG) of food and nutrition security (SDG2). The study, therefore, recommends that efforts be made to preserve food supply chains by mitigating the pandemic's effect on food systems, increasing food production, and looking forward beyond the pandemic by building resilient food systems with the use of social protection interventions.

Snakebite prevalence and risk factors in a nomadic population in Samburu County, Kenya: A community-based survey.

Snakebite is an important public health concern, especially in tropical areas, but the true burden remains unclear due to sub-optimal reporting and over-reliance on health facility-based data. A community-based cross-sectional survey was conducted in Samburu County, Kenya from December 2019 to March 2020. Geospatial techniques were used to create a sampling frame of all households in Samburu County and a multistage cluster sampling strategy to select households and recruit study participants. Five year prevalence and mortality rates were estimated, the characteristics and circumstances of snakebite were described, and multilevel logistic regression models were built to identify independent risk factors for snakebite. We recruited 3,610 individuals living in 875 households from 30 clusters. The 5-year prevalence of snakebite was 2.2% (95% CI 1.4%-3.4%), and the 5-year mortality rate was 138 (95% CI 44-322) deaths per 100,000 inhabitants, resulting in an estimated 1,406 snakebites and 88 deaths from snakebites per year in Samburu County. Snakebite incidents often occurred at night between 9pm and 6 am (44%, n = 36), and the participants were mostly walking/playing outdoors (51%, n = 41) or sleeping (32%, n = 27) when they were bitten. Lower household socioeconomic status and smaller numbers of people per house were significant independent risk factors. Samburu County has a high snakebite burden and the most victims are bitten while sleeping or walking outdoors at night. Snakebite prevention and health promotion programs in Samburu County, and other endemic regions, need to be contextualised and consider the geographic, seasonal, and temporal specificities found in our study. Our findings also have implications for health care delivery, especially identification of the need for night-time staffing with expertise in snakebite management and antivenom availability to better manage patients and thereby improve outcomes.

Multilevel negative binomial analysis of factors associated with numbers of antenatal care contacts in low and middle income countries: Findings from 59 nationally representative datasets.

Antenatal care (ANC) is one of the recommended interventions to reduce stillbirth, maternal, neonatal, and child mortality through early identification and management of pregnancy complications or pre-existing conditions. Although increasing number of ANC is a key priority of the 2016 WHO recommendations, ANC uptake in Low and Middle Income Countries (LMICs) is insufficient. Therefore, this study aimed to investigate factors associated with the number of ANC contacts in LMICs. Data for the study were drawn from 59 recent Demographic and Health Surveys (DHS) conducted in LMICS. We included a total sample of 520,377 mothers who gave birth in the five years preceding the survey. A multilevel negative binomial regression model was applied to identify factors that may affect number of ANC. Adjusted incidence rate ratios (AIRR) with 95% Confidence Interval (CI) were reported to show association. This study found that mothers and their partner with higher educational attainment, mothers aged >35 years, mothers who had decision making autonomy, mothers from female headed household, mothers from richer and richest household, mothers exposed to media, and residing in urban areas had significantly more ANC contacts. However, number of ANC contacts were significantly lower among mothers who initiated ANC after 12 weeks of gestation and perceived healthcare access to be a big problem. Our results suggest that individual, household, and community-level factors were associated with number of ANC contacts among pregnant mothers in LMICs. Hence, local and international policymakers, and programmers should focus on improving community awareness about maternal health care services through mass media and outreach programs with especial emphasis on women's and their partners educational attainment, rural mothers, women's empowerment, and household socioeconomic status.

How do household living conditions and gender-related decision-making influence child stunting in Rwanda? A population-based study.

Child stunting (chronic undernutrition) is a major public health concern in low- and middle-income countries. In Rwanda, an estimated 33% of children are affected. This study investigated the household living conditions and the impact of gender-related decision-making on child stunting. The findings contribute to ongoing discussion on this critical public health issue. In December 2021, a population-based cross-sectional study was conducted in Rwanda's Northern Province; 601 women with children aged 1-36 months were included. Stunting was assessed using low height-for-age criteria. The Multidimensional Poverty Index (MPI) was used to determine household socioeconomic status. Researcher-designed questionnaires evaluated gender-related factors such as social support and household decision-making. Multivariable logistic regression analysis identified risk factor patterns. Six hundred and one children were included in the study; 27.1% (n = 163) were diagnosed as stunted; there was a higher prevalence of stunting in boys (60.1%) than girls (39.9%; p<0.001). The MPI was 0.265 with no significant difference between households with stunted children (MPI, 0.263; 95% confidence interval [CI], 0.216-0.310) and non-stunted children (MPI, 0.265; 95% CI, 0.237-0.293). Most households reported a lack of adequate housing (78.9%), electricity (63.0%), good water sources (58.7%), and proper toilets (57.1%). Male-headed households dominated (92% vs. 8.0%; p = 0.018), and women often shared decision-making with their partners. However, 26.4% of women reported forced sexual intercourse within marriage (Odds Ratio [OR] 1.81; 95% CI, 1.15-2.85). Lack of support during illness ([OR], 1.93; 95% CI, 1.13-3.28) and absence of personal guidance (OR, 2.44; 95% CI, 1.41-4.26) were significantly associated with child stunting. Poverty contributes to child stunting in the Northern Province of Rwanda. Limited social support and women's lack of decision-making power in the household increase stunting rates. Interventions should empower women and address the broader social and economic context to promote both women's and children's health.

Temporal Trends in Tobacco Smoking Prevalence During the Period 2010-2020 in Vietnam: A Repeated Cross-Sectional Study.

Objectives: This study used repeated cross-sectional data from three national surveys in Vietnam to determine tobacco smoking prevalence from 2010 to 2020 and disparities among demographic and socioeconomic groups. Methods: Tobacco smoking temporal trends were estimated for individuals aged 15 and over and stratified by demographic and socioeconomic status (SES). Prevalence estimates used survey weights and 95% confidence intervals. Logistic regression models adjusted for survey sample characteristics across time were used to examine trends. Results: Tobacco smoking prevalence dropped from 23.8% in 2010 to 22.5% in 2015 and 20.8% in 2020. The adjusted OR for 2015 compared to 2010 was 0.87, and for 2020 compared to 2010 was 0.69. Smoking decreased less for employed individuals than unemployed individuals in 2020 compared to 2010. Smoking was higher in the lower SES group in all 3years. Higher-SES households have seen a decade-long drop in tobacco use. Conclusion: This prevalence remained constant in lower SES households. This highlights the need for targeted interventions to address the specific challenges faced by lower-SES smokers and emphasizes the importance of further research to inform effective policies.

Place of Residence Is Associated with Dietary Intake and BMI-SDS in Children and Adolescents: Findings from the DONALD Cohort Study.

We aimed to determine whether place of residence in the German urban food environment is associated with habitual dietary intake (energy, macronutrients, and food groups) and body mass index (standard deviation score of BMI and BMI-SDS). Our hypothesis was that place of residence may explain some variation in dietary intake and nutritional outcomes. For the cross-sectional analyses of DONALD study data, we grouped participants according to their geocoded residence in the north or south of Dortmund. We applied robust multi-level mixed effects regression models using residence as a predictor and (1) BMI-SDS or (2) dietary data (daily intake of energy (kcal), macronutrients (energy percentage), or food groups (g/1000 kcal)) as the outcome. Models were adjusted for age, sex, and household socio-economic status. An analysis was carried out on 1267 anthropometric measurements collected annually from 360 participants aged 6-18 years (935 3-day weighed dietary records from 292 participants) between 2014 and 2019. In the fully adjusted models, residence in the south was associated with a lower BMI-SDS (β = -0.42, p = 0.02), lower intake of sugar-sweetened beverages (β = -47.00, p = 0.04), and higher intake of vegetables (β = 11.13, p = 0.04). Findings suggest that the place of residence, beyond individuals' socio-economic statuses, may be a contributing factor to dietary quality.