Stratified Cluster Sampling Approach Research Articles

Prevalence of overweight/obesity, and associated factors among adolescents aged 12 ∼ 15 in Shandong Province, China: A cross-sectional study

Overweight/obesity among adolescents in Shandong Province, China, has been rising, posing significant public health challenge. Comprehensive investigation is needed to develop effective interventions. Following the Strengthening the Reporting of Observational Studies in Epidemiology guidelines, a stratified random cluster sampling approach was used from September to October 2023 across 17 cities in Shandong Province. The study included 165 middle schools, surveying 99,638 students aged 12 ∼ 15. After applying exclusion criteria, 97,356 students (97.71% effective rate) completed anthropometric measurements and questionnaires. Overweight/obesity were assessed based on national and international standards. Univariable chi-square test and multivariable logistic regression were used to analyze factors influencing overweight/obesity. In 2023, the overweight/obesity rate among 12 ∼ 15-year-olds in Shandong was 19.75%. Significant factors included sex, age, residence, family income, parental weight status and activity, mother’s gestational diabetes history, birth weight, physical activity, sleep, screen time, homework, and diet. Girls, older adolescents, and those with physically active parents or who themselves engaged in over 1.5 hours of daily physical activity had lower odds of being overweight/obese. Adequate sleep and frequent consumption of vegetable and fruit were also protective. Higher odds were associated with urban residence, high family income, overweight/obese parents, maternal gestational diabetes, high birth weight, excessive screen time, extensive homework, and frequent fast food consumption. Overweight/obesity in Shandong adolescents is influenced by multiple determinants. Holistic interventions addressing genetic, behavioral, and environmental factors are essential for promoting healthier lifestyles and reducing the prevalence in this demographic.

A national survey of iodine nutrition in children aged 3-6 years in China and its relationship with children's physical growth.

Iodine, an essential trace element for the human body, plays a pivotal role in sustaining health. Malnutrition has emerged as a pressing public health concern, posing a significant threat to human well-being. Iodine deficiency poses a substantial threat to the development of children, potentially leading to neurological developmental disorders and mental retardation. Conversely, excessive iodine intake can result in structural and functional abnormalities in the thyroid gland. In this study, we selected children aged 3-6 years through a stratified cluster sampling approach in six regions across China to explore the correlation between iodine nutrition and their physical growth. A total of 5920 preschool children participated in this study, with a median urinary iodine concentration (UIC) of 177.33 [107.06, 269.92] μg/L. Among these children, 250 (4.2%) exhibited stunting, 180 (3.0%) were underweight, 198 (3.3%) experienced wasting, 787 (3.3%) were overweight and 414 (7.0%) were classified as obese. The multivariate linear regression revealed that UIC exhibited a positive correlation with body mass index z-Score (BMIZ) in overweight children (β = 0.038; 95% CI: 0.001, 0.075). In normally growing children, the associations between UIC and height-for-age z-score, weight-for-age z-score and BMIZ displayed nonlinear patterns. Our findings suggest that iodine nutrition is adequate for Chinese children aged 3-6 years. Furthermore, iodine nutrition is intricately linked to the growth and development of these children. Consequently, it is imperative to implement decisive measures to prevent both iodine deficiency and excess.

The Impact of Urban Migration on the Mental Well-Being of Young Women: Analyzing the Roles of Neighborhood Safety and Subjective Socioeconomic Status in Shaping Resilience against Life Stressors

This study evaluates the impact of urban migration on the mental health of young women, focusing specifically on how objective life stressors, perceived neighborhood safety, and subjective socioeconomic status influence depression. Depression is the main outcome measure in this research, serving as a critical indicator of mental health in the context of urban migration. Utilizing a stratified cluster sampling approach, we collect data from 2138 young female migrants in Bao’an District, Shenzhen, employing the Life Stress Scale, Patient Health Questionnaire-9 items, Perceived Neighborhood Safety Scale, and Subjective Social Economic Status Scale to assess the corresponding constructs. Our findings highlight that life stressors directly contribute to increased depression levels among young female migrants, with perceived neighborhood safety significantly mediating this relationship. Furthermore, subjective socioeconomic status moderates the impact of life stressors on perceived neighborhood safety, underlining the intricate dynamics between objective life stressors and the social-environmental context in shaping mental health outcomes. This research underscores the importance of creating supportive and inclusive social environments to mitigate the adverse psychological effects of life stressors on young female migrants, thereby contributing to discussions on sustainability and social welfare.

Who is missed in a community-based survey: Assessment and implications of biases due to incomplete sampling frame in a community-based serosurvey, Choma and Ndola Districts, Zambia, 2022.

Community-based serological studies are increasingly relied upon to measure disease burden, identify population immunity gaps, and guide control and elimination strategies; however, there is little understanding of the potential for and impact of sampling biases on outcomes of interest. As part of efforts to quantify measles immunity gaps in Zambia, a community-based serological survey using stratified multi-stage cluster sampling approach was conducted in Ndola and Choma districts in May-June 2022, enrolling 1245 individuals. We carried out a follow-up study among individuals missed from the sampling frame of the serosurvey in July-August 2022, enrolling 672 individuals. We assessed the potential for and impact of biases in the community-based serosurvey by i) estimating differences in characteristics of households and individuals included and excluded (77% vs 23% of households) from the sampling frame of the serosurvey and ii) evaluating the magnitude these differences make on healthcare-seeking behavior, vaccination coverage, and measles seroprevalence. We found that missed households were 20% smaller and 25% less likely to have children. Missed individuals resided in less wealthy households, had different distributions of sex and occupation, and were more likely to seek care at health facilities. Despite these differences, simulating a survey in which missed households were included in the sampling frame resulted in less than a 5% estimated bias in these outcomes. Although community-based studies are upheld as the gold standard study design in assessing immunity gaps and underlying community health characteristics, these findings underscore the fact that sampling biases can impact the results of even well-conducted community-based surveys. Results from these studies should be interpreted in the context of the study methodology and challenges faced during implementation, which include shortcomings in establishing accurate and up-to-date sampling frames. Failure to account for these shortcomings may result in biased estimates and detrimental effects on decision-making.

Relationship between home literacy environment and emotional regulation in children: the mediating effect of the parent-child relationship

To study the impact of the home literacy environment on children's emotional regulation skills and the mediating role of the parent-child relationship between them. A stratified cluster sampling approach was employed to select 1 626 preschool children from five kindergartens in Nanjing. Questionnaires were used to collect detailed information on the home literacy environment, children's emotional regulation skills, and the parent-child relationship. A mediation model was established using the Process program in SPSS macro, and the significance of the mediation effect was tested using the Bootstrap method. The findings revealed a positive correlation between the home literacy environment and children's emotional regulation skills (r=0.217, P<0.001), as well as parent-child intimacy (r=0.065, P<0.01). Conversely, a negative correlation was found between the home literacy environment and parent-child conflict (r=-0.129, P<0.001). Additionally, parent-child conflict demonstrated a negative correlation with children's emotional regulation skills (r=-0.443, P<0.001), while parent-child intimacy exhibited a positive correlation (r=0.247, P<0.001). The home literacy environment exerted a significant direct effect on children's emotional regulation skills (β=0.162, P<0.001), and the mediating effect of the parent-child relationship accounted for 25.54% of the total effect. The home literacy environment significantly influences children's emotional regulation skills, with the parent-child relationship partially mediating this relationship.

The combined effect of pit and fissure sealant application and oral health education on oral health status of children aged 6–9 years: a 12-month follow-up study in Northeast China

BackgroundChildren aged 6–9 years are vulnerable to dental caries due to age-related limitations and a lack of adequate knowledge regarding oral health and hygiene practices. This study aimed to establish a cohort of children aged between 6 and 9 years and conducted a 12-month follow-up to examine the combined effect of pit and fissure sealant (PFS) application and oral health education on their oral health status.MethodsA cohort study with 12-month follow-up was conducted in Liaoning province, China. A multi-stage stratified cluster sampling approach was employed in the study. The enrolled 6- to 9-year-old children were all from the selected primary schools, who had resided in the designated area for at least 6 months. Children who were unable to cooperate with the examiner or without informed consent from their guardians were excluded. Experienced dental professionals examined the oral health status of primary school children aged 6–9 years. All children and their guardians were mandated to complete a questionnaire (qualitative data) at the beginning of the study. In the experiment group, children underwent PFS application and chairside oral health education. Clinical examinations and questionnaire surveys were repeated at the 12-month follow-up. The chi-square test and binary logistic regression were conducted to investigate the potential risk factors associated with dental caries prevalence (dependent variable). Independent variables were items from the questionnaire (such as living place, parents’ education level and children’ birth weight). The significant variables identified in the chi-square tests were subsequently included in the binary logistic regression analysis.ResultsA total of 4,085 children aged 6–9 years were included in the study, with 1805 participants assigned to the experiment group and 2280 to the control group. At baseline, the caries rates of the experimental and control group were 77.95% and 80.35%, respectively without any statistically significant differences. However, at the 12-month follow-up, the caries rate in the experimental group (83.65%) was significantly lower than that in the control group (86.62%) (P < 0.05). The results from the binary logistic regression analysis indicated that parents with a college degree and children in the experimental group exhibited lower caries rates. Conversely, higher caries rates were associated with the consumption of sweet beverages and foods more than once a day and a lack of knowledge regarding the causes of caries (P < 0.05).ConclusionsIn Liaoning, China, children aged 6 to 9 years exhibited a high prevalence of dental caries. Several factors, including the parent’s education level, the frequency of consuming sweet beverages and foods, and the children’s understanding of the cause of caries, significantly affected the caries prevalence rates. The implementation of PFS application and oral health education effectively reduce the caries rate among the surveyed children.

The effectiveness of combined approaches towards improving utilisation of adolescent sexual and reproductive health services in Kenya: a quasi-experimental evaluation

Adolescent sexual and reproductive health (ASRH) services are key to improving the health of adolescents. This study aimed to establish the effectiveness of an intervention that combined activities in health facilities and communities in Kenya to increase utilisation of ASRH services. A quasi-experimental evaluation design was used to assess the effectiveness of the intervention. Using a stratified cluster sampling approach, two cross-sectional household surveys targeting girls aged 15–19 were conducted at baseline (September 2019) and endline (December 2020) in intervention and comparison. We combined the difference-in-difference approach to analyse the net change in outcomes between intervention and comparison arms of the study at baseline and endline and coarsened exact matching for variables that were significantly different to address the imbalance. There were a total of 1011 participants in the intervention arm and 880 in the comparison arm. Descriptive results showed a net increase of 12.7% in intervention sites in the knowledge of misconceptions about sex, pregnancy, and contraception, compared to 10.4% in the control site. In the multivariate regression analysis, two outcomes remained significant: decreases in adolescents’ discomfort when seeking ASRH services because of either fear of parents (aPR = 0.58, 95% CI = 0.42–0.79, P = 0.001) or a lack of support from their partner (aPR = 0.25, 95% CI = 0.08–0.82, P = 0.023). The intervention combining a facility and community approach was not effective in increasing the use of ASRH information and services. Possible reasons for this are explored.

Prevalence, severity, and risk factors of allergic rhinitis among schoolchildren in Saudi Arabia: A national cross-sectional study, 2019

BackgroundAllergic rhinitis is a significant public health concern worldwide, affecting both developed and developing countries, with prevalence rates ranging between 10% and 30% in adults and over 40% in children. However, there are limited studies on allergic rhinitis prevalence in Saudi Arabia. ObjectiveTo explore allergic rhinitis among schoolchildren in Saudi Arabia in terms of prevalence, severity, and risk factors. MethodsThis study was conducted between March and April 2019, covering 20 regions. The study employed a multistage, stratified cluster sampling approach and selected 137 primary and 140 intermediate schools. The research utilized the methodology and questionnaires recommended by the Global Asthma Network (GAN). Data analysis was carried out using IBM SPSS Statistics (Version 23). ResultsThe completed questionnaires in the analysis comprised 3614 children aged 6–7 years old and 4068 adolescents aged 13–14 years old. The study found that 5.6% of children and 14.0% of adolescents reported current rhinoconjunctivitis, with 0.5% of children and 1.3% of adolescents experiencing severe symptoms. Several risk factors were significantly associated with rhinoconjunctivitis. In children 6–7 years old, eating cooked vegetables was inversely associated with rhinoconjunctivitis, while prematurity, wheezing in infancy, and a history of pneumonia were positively associated with the condition. In adolescents, vigorous physical activity, current exposure to cats, and frequent use of paracetamol were found to be the main risk factors associated with rhinoconjunctivitis, while high consumption of pulses and eggs was found to have a protective effect. ConclusionIn Saudi Arabia, the prevalence of rhinoconjunctivitis in children is lower than average globally, but among adolescents, it is within the global average range. However, the prevalence of severe rhinoconjunctivitis among adolescents is twice the global average. Further research is required to examine regional differences, track trends over time, and explore risk factors that contribute to allergic rhinitis.

Uptake and determinants of childhood vaccination status among children aged 0–12 months in three West African countries

BackgroundVaccination has long been recognized as one of the most effective ways to reduce child mortality. It has played a significant role, particularly for children, and is considered a major achievement and relevant in preventing childhood diseases worldwide. This study looks at the uptake and determinants of childhood vaccination status among children under the age of one year, for Gambia, Sierra Leon, and Liberia.MethodData from 2019 to 20 Demographic and Health Survey (DHS) data from Gambia, Sierra Leone, and Liberia were pooled for the analysis used in this study. Data were obtained from a total weighted sample of 5,368 children aged 0–12 months through a stratified two-stage cluster sampling approach. A multivariable logistic regression model was used to assess the predictors of childhood vaccination uptake at 95% confidence interval (CIs) with computed adjusted odds ratios (aORs).ResultsThe weighted sample pooled prevalence of full vaccination among children under 12 months of age was 15.1% for males and 15.0% for females. After controlling for confounders in the regression model, factors that were found to be associated with vaccination status include children whose mothers attended postnatal care (PNC) visits had higher odds of being fully vaccinated (aOR = 1.23, 95% CI = 1.03–1.46), while children whose fathers had primary education (aOR = 0.67, 95% CI = 0.48–0.96), children whose households never watched TV (aOR = 0.68, 95% CI = 0.56–0.82) and children whose mothers attended 1–3 antenatal care (ANC) visits (aOR = 0.59, 95% CI = 0.45–0.79) had lower odds of being fully vaccinated.ConclusionChildhood vaccination uptake was low among children under 12 months of age in these countries. Hence, there is a need to promote the uptake of vaccination across these three West African countries especially among rural dwellers.

Association between sleep-wake schedules and myopia among Chinese school-aged children and adolescents: a cross-sectional study

BackgroundThis study aimed to investigate the relationship between sleep-wake schedules and self-reported myopia in the pediatric population.MethodsIn this cross-sectional study in 2019, school-aged children and adolescents in the Baoan District of Shenzhen City were sampled using a stratified cluster sampling approach. Sleep-wake schedules of children were determined by a self-administered questionnaire. The age that participants first reported using myopia correction glasses or contact lenses was used to identify those with myopia. Pearson χ2 test was used to examine differences in myopia prevalence among participants with different characteristics. Multivariate logistic regression, adjusted for potential confounding variables, was applied to examine the relationship between sleep-wake schedule and risk of self-reported myopia, and a stratification analysis by school grade was also performed.ResultsA total of 30,188 students were recruited. In this study, the overall prevalence of myopia was 49.8%, with prevalence rates of 25.6%, 62.4%, and 75.7% for primary, junior high, and senior high school students, respectively. Students with irregular sleep-wake times reported a higher prevalence of myopia than those with regular sleep-wake times. Nighttime sleep duration of < 7 hours/day (h/d) (OR = 1.27, 95%CI: 1.17–1.38), no daytime nap (OR = 1.10, 95%CI: 1.03–1.18), irregular weekday bedtime (OR = 1.11, 95%CI: 1.05–1.17), irregular weekday wake time (OR = 1.21, 95%CI: 1.12–1.30), weekend bedtime delayed > = 1 h/d (OR = 1.20, 95%CI: 1.11–1.29, P < 0.001), weekend wake time delayed > = 1 h/d (OR = 1.11, 95%CI: 1.03–1.19), irregular sleep-wake time on weekdays (OR = 1.13, 95%CI: 1.07–1.19), and social jetlag > = 1 h (OR = 1.08, 95%CI: 1.03–1.14) were likely to be associated with increased risks of self-reported myopia after adjusting age, sex, grade, parental education level, family income, parental myopia, academic record, and academic workload. When stratified by school grade, we observed that nighttime sleep duration < 7 h/d, no daytime naps, and irregular sleep-wake time on weekdays were significantly associated with self-reported myopia in primary school students.ConclusionInsufficient sleep and irregular sleep-wake schedules can increase the risk of self-reported myopia in children and adolescents.

The influence of parental awareness of the "Chinese double reduction" policy on junior high school students' extracurricular physical exercise.

In this study, we aimed to explore the relationship between parental cognitive awareness (criticality, disruption and novelty cognition) of DBR, educational anxiety, and attitudes toward students' physical exercise and students' extracurricular physical exercise so as to construct and verify a conditional process model. We adopted a stratified random cluster sampling approach and conducted a nationwide questionnaire survey with 2,700 junior high school students and their parents across 9 provinces, municipalities and autonomous regions. Parents generally had a certain degree of cognitive awareness of DBR. Criticality cognition and disruption cognition had a significant positive impact on junior high school students' extracurricular physical exercise (β = 0.24, p < 0.01; β = 0.04, p < 0.05), but the effect of novelty cognition was not significant (β = -0.04, p = 0.06). Parents' educational anxiety played a significant mediating role in parents' cognition of DBR and students' extracurricular physical exercise (criticality cognition: β = 0.10, 95% CI: 0.03-0.06; disruption cognition: β = 0.37, 95% CI: 0.31-0.42). Parents' attitude toward students' exercise also played a significant positive moderating effect in the mediation model (criticality cognition: β = 0.014, 95% CI: 0.002-0.031; disruption cognition: β = 0.010, 95% CI: 0.007-0.013). Parents' novelty, disruption, and criticality cognition of DBR have different effects on parents' education anxiety and students' extracurricular physical exercise, in which parental educational anxiety mediates the influence of DBR cognition on students' extracurricular physical exercise, while attitudes toward students' extracurricular physical exercise positively moderates the mediating effect.

Health impacting behaviour & morbidity: Implications for adolescent & youth health programmes in India.

In Himachal Pradesh (HP), a comprehensive health survey was conducted to assess the prevalent health affecting habits and issues among young individuals aged 10 to 24 yr. The study was aimed to evaluate key factors such as nutrition, substance use (including tobacco and alcohol), mental health concerns such as anxiety and depression, sexual behaviours and personal hygiene, as well as incidents of violence and injury (including road traffic and other injuries). A cross-sectional survey was conducted in HP on 2895 individuals aged between 10 and 24 yr. The survey encompassed four districts, namely Shimla, Kinnaur, Kangra, and Sirmaur, and 12 blocks (three in each district). To ensure a representative sample, a stratified multistage cluster sampling approach was used. Districts and blocks were selected purposively so as to represent the diverse sociodemographic and cultural characteristics of this region. Within each block, thirty clusters were chosen using a probability proportional to size method. Clusters were defined as villages in rural areas and wards in urban areas. The World Health Organization 30 × 7 cluster technique was employed to identify households and individuals for the study. Underweight (44.39%), risk of cell phone addiction (19.62%), feeling anxious (15.54%), unintentional injuries (14.72%) and violence (8.19%) were the top five health impacting problems among young people in HP. The leading health impacting problems identified are preventable and/or modifiable factors affecting the overall health and development of young people in HP. These need to be addressed as priority health problems for interventions with a focus on maintaining positive health through integrated approaches including care provision, risk reduction and health promotion related to these health impacting behaviours. Such interventions are likely to yield better results towards the overall health and development of young people in HP.

Magnitude and associated factors of intimate partner violence among youth women in Ethiopia: multilevel analysis based on 2016 Ethiopian Demographic and Health Survey

BackgroundThe period of youth is important for the foundation of healthy and stable relationships, women’s health and well-being. Youth women face a higher risk of experiencing violence than older women. Intimate partner violence (IPV) against youth women is a significant public health concern. Despite paramount negative health consequences of IPV for the survivor, as per our knowledge, research study on IPV and associated factors among youth women in Ethiopia is scarce. Therefore, this study aimed to assess the magnitude and associated factors of IPV among youth women in Ethiopia.MethodsThe data was accessed from 2016 Ethiopia demographic and health survey (EDHS) which was a cross sectional population based household survey. It was also conducted using a multi-stage stratified random cluster sampling approach. The data were cleaned, weighted, and analyzed using STATA Version 14 software. The total weighted sample of 1077 youth women were used in this study. Multilevel logistic regression modeling was used to determine factors associated with IPV among youth women. Adjusted odds ratio (AOR) with 95% confidence interval (CI) and p value < 0.05 were used to declare the significant variables.ResultsAmong the total participants, 30.27% (95% CI 27.59, 33.09) of youth women experienced IPV. Individual level variables such as: Being widowed/divorced/separated (AOR = 2.28; 95% CI 1.33, 3.91), having a partner who drinks alcohol (AOR = 5.76; 95% CI 3.42, 9.69), witnessing inter-parental violence during childhood (AOR = 3.45; 95% CI 2.21, 5.37), being afraid of partners (AOR = 7.09; 95% CI 4.30, 11.68), and from community level variables, youth women residing in communities with a low proportion of educated youth women (AOR = 0.31; 95% CI 0.13, 0.78) were significantly associated with having experience of IPV.ConclusionThe magnitude of intimate partner violence among youth women in Ethiopia was relatively high as compared to the global estimate of IPV. Individual and community level variables such as currently widowed/divorced/separated women, having a partner who drinks alcohol, witnessing inter-parental violence, being afraid of partner, and women from a low proportion of community level youth women's education were significantly associated with intimate partner violence. To decrease this public health problem, it is better to strengthen legislation on the purchase and sale of alcohol, provide legal protection for separated/divorced women, establish effective legal response services for IPV, promote gender equality, and provide psychological support for those who witnessed inter-parental violence during childhood to reduce IPV.

Correlates of Physical Activity Among Adults in Botswana: Sociodemographic Factors, Health Status, and Body Image.

Growing evidence of lower physical activity (PA), higher sedentary behavior, and prevalence of overweight and obesity in African countries calls for more research on PA behavior and its various correlates in this context. This study examined the proportion of adults meeting World Health Organization PA guidelines from 3 urban regions of Botswana, as well as the relationship among sociodemographic factors, body image, and participation in moderate to vigorous PA. Using a 2-stage stratified cluster sampling approach, cross-sectional data were collected from 699 participants (females = 66%; M = 32.60y; SD = 11.96). Overall, 45.8% of participants met World Health Organization PA guidelines. Censored regression analyses indicated that females (B = -221.573, P &lt; .001), and individuals from middle- (B = -331.913, P &lt; .001), and high-income (B = -165.185, P = .036) households spent significantly less minutes in moderate to vigorous PA per week. Evaluative (B = -333.200, P &lt; .001) and affective (B = -158.753, P = .038) components of body image were associated with significantly less minutes spent in moderate to vigorous PA per week. A systematic approach to PA promotion that targets females, middle- to high-income groups, and individuals experiencing body image concerns is needed.

Unravelling patterns of forest carbon stock along a wide elevational gradient in the Himalaya: Implications for climate change mitigation

In an era of climate change, quantifying forest biomass and carbon stock along elevational gradients in mountainous areas assumes immediate relevance for carbon budgeting and forest management. Here, we carried out extensive field studies to quantify the tree biomass and carbon stock of major forest types along a wide elevational gradient (350–3450 m) in Jammu and Kashmir, a region located in the northwestern Himalaya. We adopted a stratified random cluster sampling approach to generate ground-based data on structural variables (diameter at breast height-DBH, stem height, basal area, stem density, species richness), and quantified biomass and carbon stock volume using allometric equations in 12 major forest types in the region. We found a significant difference in all the tree structural variables among the forest types. Our results show a significantly positive correlation between DBH and height, but a significantly negative correlation of stem density with DBH and height. We observed a higher basal area in the forest types between 1750 and 3350 m elevation, with the highest value (104.4 ± 29.0) found in Fir forest. We also found higher stem density values at mid- and high-elevations in comparison to low-elevation, but the trend was inconsistent. To evaluate the influence of elevation on the structural attributes, we fitted a Linear Regression Model (LM) for each variable, followed by F-test. We observed a significant effect (p < 0.008) of elevation on all the forest tree structural variables, species richness, biomass and carbon stock. All these variables, except species richness, showed a positive relationship with elevation. We found the highest aboveground-, belowground-, total biomass, and carbon stock in the forest types at high elevation above 1750 m. The most significant tree species in terms of biomass and carbon stock contribution was Abies pindrow, followed by Cedrus deodara and Pinus roxburghii, thus making them suitable tree species for forest conservation and restoration in this Himalayan region. Principal component analysis of anthropogenic disturbances revealed the fire mostly associated with the forest types dominated by P. roxburghii, stem cutting with those dominated by C. deodara, P. wallichiana and A. pindrow, and grazing with the high-elevation forest types. Overall, our study unravels the patterns of forest carbon stock along a wide elevational gradient in this Himalayan region, with immediate implications for climate change mitigation policy and practice in mountainous landscapes.

Pooled prevalence and contextual determinants of contraceptive utilization among reproductive-age women in The Gambia: Evidence from 2013 – 2020 Demographic Health Surveys

Background: Family planning (FP) methods have been found as an efficient approach of reducing fertility and are therefore widely supported in order to decrease population growth, particularly in poor nations. Promoting contraception availability among women (15 – 49) age has also been shown to be an efficient public health strategy for improving maternal and newborn health outcomes. This paper aimed at exploring the pooled prevalence of contraceptive uptake and its contextual determinants among women of childbearing age in The Gambia. Methods: The Gambia Demographic and Health Survey (GDHS) in both 2013 and 2019-20 was used for this study. Data were obtained from a pooled 22,098 women aged 15-49 (10,233 for 2013 and 11,865 for 2019-20) through a stratified two-stage cluster sampling approach. Percentages and chi-square tests were used and variables with p-value &lt;0.05 were included into the model. A multivariable logistic regression model was used to assess the predictors of contraceptive usage at 95% confidence interval (CIs) with computed adjusted odds ratios (aORs). All the study data were analyzed using Stata version 15. Results: The weighted pooled prevalence of modern contraceptive utilization in The Gambia was 10.1%. Younger age, compared with women aged 25-29; 30-34; 35-39; 40-44; primary education (aOR=1.25, 95% CI=1.05-1.49); secondary education (aOR=1.57, 95% CI= 1.32-1.85); Higher education (aOR=1.90, 95% CI=1.34-12.69); living in urban areas (aOR=1.49, 95% CI= 1.25-1.79); parity 2-4 (aOR=1.21, 95% CI= 1.01-1.47); told about FP at health facility (aOR=2.97, 95% CI= 2.61-3.38), and no desire for many children (aOR=1.96, 95% CI= 1.62-2.37) were more like to use modern contraceptives among Gambian women. Conclusion: The programme certainly needs to consider improvements in the quality of care being offered to acceptors. Government agencies should target these programs and campaigns on regional FP demands and provide suitable culturally sensitive and regionally adaptive services to the communities' contexts. The programme should intensify its efforts in rural and urban settings to improve accessibility to and availability of FP services.

Colorectal cancer screening knowledge and uptake in lebanon: a national survey

ObjectiveThe main aim of this national survey was to identify the levels of colorectal cancer screening knowledge and uptake in Lebanon. MethodsA total of 1200 participants were enrolled in this cross-sectional household survey targeting the Lebanese population aged 50 years and above. The sample was recruited using a two-stage stratified cluster sampling approach. ResultsOf the total sample, 38.3% knew about any screening test for colorectal cancer but only 7.5% had ever used any. Thirty-nine percent of the participants rated their risk of getting colorectal cancer as very low or low, and only 53.5% were confident in their ability to undertake a screening test. Almost all participants agreed that medical advice and test reimbursement would encourage them to do a screening test. At the multivariate analysis level, hearing of an awareness campaign in the last two years showed the strongest association with the knowledge of a colorectal cancer screening test with an estimated ORadj = 5.12 (95%CI: 3.67 – 7.15). Other factors that were significantly associated with this knowledge variable included: a family history of colorectal cancer, a personal history of colorectal illness, having a health coverage, and knowledge of colorectal cancer signs and symptoms. DiscussionThis national study highlights an alarming lack of uptake and low levels of knowledge of colorectal cancer screening tests even though it is among the most prevalent cancers in Lebanon and its prevalence has been continuously increasing in the past years. The evidence suggests that people who had an experience with colorectal cancer diagnostic tests, either personally or through a family member, and those who have heard of an awareness campaign about colorectal cancer in the last two years are more likely to know its screening tests. ConclusionColorectal cancer screening knowledge and uptake in Lebanon are limited and justify the need for public health interventions. This study gives evidence that awareness campaigns, coupled with the involvement of medical providers and the reimbursement of screening test fees, would alleviate the burden of colorectal cancer in Lebanon.

Prevalence and Determinants of Acute Respiratory Infections among Children under Five Years in Rural Settings of The Gambia: Evidence from a National Survey

Background: Acute respiratory infections (ARIs) generally describe a group of infections caused by a range of organisms whose site of action includes the nostrils, through the pharynx to the alveoli. ARIs are reportedly key contributing factors to childhood morbidities and deaths, with a higher impact on children less than the age of five years. This paper aimed at exploring the prevalence of ARIs and their contextual determinants among children less than 60 months of age in the rural settings of the Gambia. Method: The Gambia Demographic and Health Survey (GDHS) in 2019-20 was used for this study. Data were obtained from 1364 rural women aged 15-49 with children less than 60 months through a stratified two-stage cluster sampling approach. Percentages and chi-square tests were used and variables with p-value &lt;0.15 were included in the model. A multivariable logistic regression model was used to assess the predictors of acute respiratory infection at 95% confidence interval (CIs) with computed adjusted odds ratios (aORs). All the study data were analyzed using Stata version 17. Results: The weighted prevalence of ARIs among children under 60 months of age in the rural Gambia was 37.1% with 95% CI (34.5% - 39.6%). The magnitude of ARI was higher among children 25-60 months age group (38.6%), male children (38.9%) unvaccinated children (42.9%), and those whose fathers and mothers were not working at 60.5% and 38.7%, respectively. In the adjusted model, children whose mother had primary education [aOR=0.65, 95% CI= 0.46-0.91], currently non-breastfed children [aOR=1.40, 95% CI= 1.09-1.79] and those whose father were not working [aOR=2.65, 95% CI= 1.47-4.17] were found to be associated with ARIs among children less than 60 months in The Gambia. Conclusion: The prevalence of ARI was moderately high across children under 5 years of age in rural Gambia, low mother’s educational levels, and unemployed fathers. The program must consider improvements in the quality of care provided to children in both primary, secondary and tertiary healthcare levels in rural settings. Partner support and adapting community-based supporting systems on child health strategies should be strengthened especially in rural settings.

Household Solid Fuel Use and Associated Factors in Ethiopia: A Multilevel Analysis of Data From 2016 Ethiopian Demographic and Health Survey.

Solid fuels are types of fuel that comprise coal, biomass, charcoal, wood, or straw and are used for cooking, heating, lighting, boiling water, and generating revenue at home. Globally, 3 billion of the world’s poorest people continue to rely on inefficient solid fuels, which produce health-damaging contaminants. In Ethiopia, more than 90% of households rely on wood as their primary source of energy. The actual and potential determinants of solid fuel use have not been fully identified, particularly at the national level in Ethiopia. Therefore, this study aimed to determine the magnitude of solid fuel use and its associated factors in Ethiopia. We used the Ethiopian Demographic and Health Survey (EDHS), which was conducted in 2016. The data was conducted using a 2-stage stratified cluster sampling approach. A total of 16 650 weighted samples were taken. Multilevel logistic regression models were fitted to identify factors associated with solid fuel use, and a cluster-level random intercept was introduced in the mixed model. An adjusted odds ratio with a 95% confidence level was reported to show the strength of the association and its significance. The goodness of fit of the model was checked using proportional change deviance (PCV). The magnitude of solid fuel use among households in Ethiopia was 94.03% (95% CI = 93.66, 94.37). Household heads completed in primary school (AOR, 3.09, 95% CI = 2.44, 3.91), outdoor cooking places (AOR, 4.13, 95% CI = 2.96, 5.76), and small peripheral regions (AOR, 14.44, 95% CI = 6.12, 34.04) were all significantly associated with solid fuel use. The intra-cluster correlation coefficient (ICC) showed that about 81% of the variations in the use of solid fuel were attributed to the difference at the 643 cluster level, but the remaining 19% were attributed to individual household factors. The PCV was 90%, which showed that the variation in solid fuel use among study households was explained by factors at both the individual and community levels. The deviation test of the fourth model had the lowest value (3528) and was chosen as the best-fitted model. Due to different influencing factors, the use of solid fuel is still high in Ethiopia. Promoting access to education and raising awareness toward solid fuel impact is very important.

Prevalence and associated factors for malnutrition among children under 6 years of age in Hunan province

Objective: To analyze the prevalence and associated factors of malnutrition among children under 6 years of age in Hunan province. Methods: This study was a cross-sectional study. A combination of multistage stratified cluster sampling and systematic sampling approach was used to recruit 10 442 children aged 0-71 months from 144 communities (villages) across 48 streets(towns) in 24 districts(counties) from Hunan province between August and November 2019. Data concerning the children and their mothers, caregivers, and family conditions was collected using unified questionnaire, with the lengths/heights and weights of the children being measured using unified instruments. The length/height for age, weight for age, weight for length/height, and body mass index for age Z scores were calculated and used to evaluate the prevalence of children's stunting, underweight, and wasting. The chi-square test was used to compare the prevalence of malnutrition among children with different characteristics. The multivariate Logistic regression model was used to conduct multivariate analysis for childrens' malnutrition. Results: The prevalence of protein-energy malnutrition (PEM) among children under 6 years of age was 6.8% (710/10 442), and the prevalence of stunting, underweight, and wasting were 3.1% (328/10 442), 2.7% (280/10 442), and 3.3% (343/10 442), respectively. Rural areas (OR=1.60), older age of children (compared with children of 0-11 months, the OR for 12-23, 24-35, 36-47, 48-59, and 60-71 months were 1.42, 1.75, 1.55, 1.70, and 1.88, respectively), low birth weight (OR=2.72), caregivers of minority ethnicity (OR=1.95), and large family size (OR=1.25) were risk factors for children's PEM. Rural areas and low birth weight were risk factors for stunting in children (OR=2.13 and 3.28). Rural areas, low birth weight, caregivers of minority ethnicity, and large family size were risk factors for underweight in children (OR=2.57, 3.34, 1.86, and 1.32). Rural areas (OR=1.43), older age of children (compared with children of 0-11 months, the OR for 24-35, 36-47, 48-59, and 60-71 months were 1.63, 1.80, 1.84 and 2.17, respectively), low birth weight (OR=2.36), caregivers of minority ethnicity (OR=2.88), and large family size (OR=1.42) were risk factors for children's wasting. Higher education level of caregivers was a common protective factor for PEM, stunting, and underweight (OR=0.85, 0.76, and 0.82). Conclusions: The prevalence of stunting, underweight, and wasting among children under 6 years of age in Hunan province were all at a low level. Nevertheless, the urban-rural differences still existed, with these prevalence being affected by children age, birth weight, ethnicity of caregivers, education level, and family size.