Two-stage Cluster Sampling Research Articles

Spatial heterogeneity and predictors of stunting among under five children in Mozambique: a geographically weighted regression

IntroductionChildhood stunting, a major public health concern in many developing countries, is associated with impaired physical and cognitive development, increased risk of infectious diseases, and long-term adverse health and economic consequences. Mozambique is among the countries with the highest stunting rates in sub-Saharan Africa. This study aims to examine the spatial variation and identify the predictors of stunting among children under the age of five years in Mozambique.MethodsWe utilized children’s recode data and geographic coordinates extracted from the 2022–23 Mozambique Demographic and Health Survey dataset. A stratified two-stage cluster sampling approach was employed. The study included a total weighted sample of 3,910 children under the age of five years. A geographically weighted regression was used to identify predictors of stunting.ResultsThe prevalence of stunting among children under the age of five in Mozambique was 31.26% (95% CI: 29.88 to 32.65%). The Nampula (46.00%), Cabo Delgado (43.79%), Manica (40.88%), Zambezia (38.27%), Niassa (35.52%), and Tete (34.85%) regions of Mozambique were identified as hotspot areas of stunting. Several factors were significantly associated with the spatial heterogeneity in stunting, where household wealth index (poor and middle categories) and Mother’s age (15–19 years) were positively associated with higher occurrence of stunting, while having an employed mother and being a child under 2 years of age were negatively associated with stunting occurrence.ConclusionThe spatial heterogeneity in stunting patterns highlighted by this analysis suggests that a one-size-fits-all approach to address child undernutrition in Mozambique may not be effective. Instead, tailored, location-specific strategies that account for the predictors of stunting are necessary to effectively combat this persistent public health challenge. Policymakers and program implementers should prioritize the hotspot regions for targeted interventions, while also maintaining and strengthening the factors contributing to the lower stunting prevalence in the cold spot areas.

Prevalence and associated factors of loneliness among in-school adolescents in three South Asian countries

Objective: We aimed to determine the prevalence and factors associated with loneliness among adolescent students in three South Asian countries. Methods: We used data from the latest Global School-Based Health Survey of Afghanistan, Bangladesh, and Pakistan. A two-stage cluster sampling design was used to collect the cross-sectional survey data. Data from 8 089 in-school adolescents were analysed using STATA 14.0. Results: Among all the participants, the prevalence of loneliness was 14.9%. The prevalence of loneliness was significantly higher in females (19.7%), Afghan adolescents (35.5%), participants having anxiety-induced sleep disturbance (51.4%), often experiencing bullying (28.9%), feeling hungry often or always (23.9%), suffering parental emotional neglect (21.2%), and spending ≥ 8 hours/day leisure time (35.8%), than their counterparts. The final adjusted model of multiple logistic regression showed that females (OR = 1.36, 95% CI: 1.02 –1.80), having no close friends (OR = 2.00, 95% CI: 1.30 – 3.10), having an anxiety-induced sleep disturbance (OR = 5.25, 95% CI: 3.75 – 7.34), being bullied 1 to 2 days in the past month (OR = 2.13, 95% CI: 1.60 – 2.84), being physically attacked 2 or more times in the past year (OR = 1.69, 95% CI: 1.26 – 2.26), suffering parental emotional neglect (OR = 1.67, 95% CI: 1.18–2.34), and current tobacco user (OR = 2.70, 95% CI: 1.39 – 5.25) had significantly higher odds of having loneliness. Conclusion: We found a higher prevalence of loneliness and identified several risk factors among in-school adolescents in three South Asian countries. To reduce loneliness among in-school adolescents, target-oriented interventions, such as peer, parental, and counselling support, are needed at schools.

Does Education Make Local Elected Officials Perform Better?—A Case of Gram Panchayats in India

In India, in keeping with constitutional provisions, some states have started prescribing educational qualification criteria for candidates contesting elections to Panchayati Raj system of local self-government bodies. This study attempts to analyse whether educational qualifications indeed enable a local elected official (LEO) perform better. The study was conducted in Uttarakhand state of India. Two-stage cluster (probability) sampling was used. Data for the study were collected from 128 gram panchayats in four blocks of the state, selected randomly using the two-stage cluster sampling method. Results showed that educational background has a significant impact on the LEO’s performance, with secondary education having the largest impact followed by tertiary education.

Readiness for Organizational Change of Employee in Merger Situation (study in a State-owned enterprise Bank)

Readiness for organizational change plays an important role in the change process. It shapes behavior that supports organizational change and makes employees strive harder to implement change. This study uses a descriptive quantitative method to describe the level of readiness for organizational change of employees at a State-owned enterprise Bank undergoing a merger process. 480 respondents were involved in this study, obtained through the two-stage cluster sampling technique. The study results showed that most respondents were in the high readiness for organizational change category, namely 69%, in the medium category 30.06%, and in the low category 0.4%. While the highest dimension is in managerial support (mean = 5.54) and the lowest is in personal valance (mean = 4.72). In addition, it was found that there were differences in the level of readiness for organizational change in several demographic factors, such as actors, such as sex, age, work location, job level, and education.

Assessment of satisfaction of using socially marketed health consumables at government settings among beneficiaries in a rural area of Hooghly District, West Bengal

ABSTRACT Introduction: India is committed to achieving universal health care for all by 2030. The objective of social marketing is to promote public health and its goal is to improve health for all, but there are some challenges like irregular availability, quality issue, inadequacy of marketing causes under- utilization of the government supplied health consumables. Objectives: Present study aims to find out the usage pattern and assess the perceived satisfaction level of beneficiaries of using various socially marketed health consumables at government settings and explore the perception of healthcare personnel regarding barriers to its usage in a rural area of India. Materials and Methods: A community-based, Mixed-Methods study (Convergent parallel design) was done in the service area of the Rural Health Unit and Training Centre (RHU&TC), Singur of Hooghly district, West Bengal, between January 2023 and December 2023, where the quantitative component was carried out by face-to-face interview among 150 beneficiary household respondents selected by two-stage cluster sampling; and qualitative component was done by 4 Key informant interviews (KII) among healthcare personnel (medical officer, public health nurse, pharmacist). Statistical data were analyzed by descriptive statistics using SPSS 16 version and Microsoft Excel for the quantitative part, and thematic analysis was done for the qualitative part. Institutional Ethics Committee clearance was obtained. Results: Ever use of government-supplied contraceptives like Chhaya (Ormeloxifene), Antara (Injectable contraceptive), emergency contraceptive pills, and intrauterine contraceptive devices (IUCD) was done by only 15.3%, 10.7%, 7.3%, 32% of eligible beneficiary households, respectively. The major reasons cited for irregular use were unawareness of availability of the products (Chhaya = 76.3%, Antara = 64.9%, EC pills = 46.7%), poor faith regarding quality (Male condom = 40%, Generic medicines = 70%), inadequate promotion (IUCD = 53.9%). The majority of users of male condoms (90%), IFA tablets (52.9%), ORS (51.1%), and generic medicines (55.7%) were not satisfied after using those products. Key informant interviews among healthcare personnel revealed avoidance of using modern contraceptive methods and frequent unavailability of some socially marketed health consumables were the predominant causes of reduced uptake of those products by beneficiaries. Conclusions: Proper social marketing strategies, adequate promotion, regular awareness campaigns, and tailored training of field healthcare workers are required to improve the acceptability, availability, and marketing of these health consumables.

Prevalence and severity of periodontal disease in the host community and Rohingya refugees living in camps in Bangladesh.

To assess the prevalence and severity of periodontal disease of the Rohingya refugees and host community in Bangladesh. An unpublished pilot was conducted for the sample size calculation. Two-stage cluster sampling method was used to select 50 participants from refugee camps and 50 from the host community. Structured questionnaire and periodontal examination were completed. Composite measures of periodontal disease were based on the World Workshop (WW) and Centers for Disease Control and Prevention-American Academy of Periodontology. Linear regression models, for clinical attachment level and periodontal pocket depth (PPD) and ordered logistic regression models, for composite measures, were fitted to test the association of periodontal measures and refugee status. Compared to the host community, a smaller percentage of refugees reported good oral health-related behaviours. Refugees exhibited lower levels of bleeding on probing but higher PPD, hence a higher proportion had severe stages of periodontitis. As per the WW, prevalence of periodontal disease was 88% and 100% in the host and refugee groups, respectively. In the unadjusted models, refugees were three times more likely to have severe stages of periodontitis; this association was attenuated when adjusted for confounders (sociodemographic variables and oral health-related behaviours). Prevalence of periodontitis was high both in the host community and refugees. The refugees exhibited a more severe disease profile. The oral health of both groups is under-researched impacting the response of the health system. Large-scale research systematically exploring the oral health of both groups will inform the design and delivery of community-based interventions.

Biocultural determinants of overweight-obesity among adult women experiencing the nutritional transition in the Democratic Republic of Congo.

The African Great Lakes region is experiencing rapid urbanization, which is leading to a nutritional transition and its related chronic diseases. Similar to other Great Lakes countries, the nutritional transition in the Democratic Republic of Congo (DRC) is reflected by increased non-communicable diseases, including morbid obesity. The 2014 Demographic Health Survey (DHS) revealed a rising incidence of overweight among women, ranging from 10% in 2001 to 16% in 2014. Furthermore, over 20% of individuals in several provinces of the DRC are classified as overweight-obese. This study aimed to investigate the prevalence as well as the main biocultural determinants of overweight-obesity among adult women in the DRC. In a cross-sectional survey, including a representative sample of adult Congolese women living in the South Kivu province, participants were randomly recruited using a two-stage cluster sampling technique after an initial urban-rural stratification. The estimation of the was based on previous results from DHS. Thus, a total of 495 individuals were selected, including 325 urban and 170 rural subjects. Data were collected from households by dietitians who were specifically trained for this survey. In this study population, the prevalence of overweight-obesity was 33.6%, with 7.1% classified as obese. The prevalence of obesity was significantly higher among urban people, while all subjects with obesity were from the older age group (>35 years). Using binomial logistic regressions, it was observed that overweight-obesity had a significant positive correlation with the duration of urban residence, namely, Migrants' status: "New residents" 4.6 [1.9-11.7] p < 0.003, "Long term residents" 8.7 [3.5-21.5] p < 0.001; Socio-economic status (SES): "High" 2.4 [1.1-5.3] p < 0.03, and Stoutness valorization: "Yes" 6.1 [3.4-10.9] p < 0.001. In a pathway analysis conducted based on a structural equation model (SEM), we discovered that urban residence and SES were associated with an increase in overweight-obesity, with a positive correlation with processed food consumption and a negative correlation with physical activity. Age was associated with an increase in overweight-obesity through a negative association with physical activity, whereas stoutness valorization directly increased overweight-obesity. In order to properly guide public health policies, public authorities in the DRC should consider the main findings of this original study, which identify how socio-demographic and socio-ecological factors contribute jointly to the rising prevalence of overweight-obesity in the country.

Seroprevalence of Hepatitis C in Ethiopia: First National Study Based on the 2016 Ethiopian Demographic and Health Survey.

Hepatitis C virus (HCV) is hypothesised to be a public health problem in Ethiopia, and systematic review evidence suggested 1%-3% seroprevalence. We aimed to estimate the seroprevalence of HCV overall and across regions of Ethiopia. We estimated HCV seroprevalence using the 2016 Ethiopian Demographic and Health Survey (EDHS-2016). EDHS-2016 is a nationwide household survey conducted using two-stage cluster sampling methods. We tested all 26,753 samples from participating adult women (15-49 years) and men (15-59 years) using HCV Enzyme Immunoassay. Descriptive analyses were performed based on the Guide to Demographic Health Survey statistics. We applied sample weighting to derive representative estimates. Of the total tested, more than half (54.40%) were aged 15-29 years and 51.59% were women. Overall HCV seroprevalence was 0.18% (95% Confidence Interval: 0.10-0.32). Higher seroprevalences were found in Afar (0.92%) and South Nations Nationality Peoples Region (0.43%); people living with HIV (PLWH) (0.62%); the poorest wealth index (0.35%); people having multiple lifetime sexual partners (0.31%); and widowed/divorced individuals (0.30%). In stratified analyses by sex and residency, we found higher seroprevalences in non-Christian and non-Muslim males (1.98%) and rural population (1.00%), male PLWH (1.67%), rural PLWH (1.45%), widowed/divorced males (0.97%), and in all groups from the Afar region: males (1.30%), females (0.61%), urban (1.07%), and rural (0.86%). HCV seroprevalence among the general population in Ethiopia is much lower than from previous estimates. General population screening is unlikely to be cost-effective, and so screening programs targeted to people at greater risk of HCV will be required.

Mapping the prevalence and covariates associated with home delivery in Bangladesh: A multilevel regression analysis.

Bangladesh has made an intense effort to improve maternal healthcare facilities including facility delivery, but the number of home deliveries is still very high. Therefore, this study aims to find out district-wise prevalence and determine the individual and community-level predictors of home delivery among women in Bangladesh. Data were derived from the Multiple Indicator Cluster Survey (MICS) 2019, a nationwide cross-sectional survey in Bangladesh. A final sample of 9,166 (weighted) women who gave birth in the two years preceding the survey were included in this study. Considering the two-stage cluster sampling strategy adopted by MICS, we used multilevel (2-level) logistic regression analysis to find out the correlates of home delivery. The overall weighted prevalence of home delivery was 46.41% (95% confidence interval [CI]: 45.39-47.43). The highest prevalence was observed in Bandarban district (84.58%), while the lowest was found in Meherpur district (6.95%). The intercept-only regression model demonstrates that the likelihood of women from various clusters having home delivery varied significantly (variance: 1.47, standard error [SE]: 0.117), indicating the applicability of multilevel regression modeling. The multilevel regression analysis showed that women with higher education, wealth status and ANC visit, and those aged >18 years at first marriage/union were associated with lower odds of delivering child at home compared to their counterparts. While women from age group of 35-49 years, whose last pregnancy was unintended were more likely to deliver child at home. In addition, those respondents belonging to a community that had higher wealth status, women's education level, and exposure to media showed lower odds of having delivery at home. The finding indicates that delivery at home is still high in Bangladesh. Targeted interventions to reduce home delivery are urgently needed in Bangladesh to tackle adversities during deliveries and save mothers from the consequences.

High immunity and low mortality after Omicron and mass event in Cameroon despite low vaccination.

Little is known about the evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunity in African communities. We evaluated changes in anti-SARS-CoV-2 antibodies, mortality and vaccination status in Cameroon between August 2021 and September 2022 to begin describing the evolution of the pandemic in Africa. The study was conducted across Cameroon's 10 regional capitals, between 2021 and 2022 as the country hosted a mass gathering. We conducted a cross-sectional population-based survey in 2022, including SARS-CoV-2 seroprevalence testing and retrospective mortality estimation using two-stage cluster sampling. We estimated and compared seroprevalence and crude mortality rates (CMR) to a survey conducted in 2021 using the same methodology. We performed serologic testing on 8400 individuals and collected mortality data from 22 314 individuals. Approximately 5% in each survey reported SARS-CoV-2-vaccination. Rapid diagnostic test-based seroprevalence increased from 11.2% (95% confidence interval [CI]: 10-12.5) to 59.8% (95% CI: 58.3-61.2) between 2021 and 2022, despite no increase in the proportion vaccinated. The CMR decreased from 0.17 to 0.06 deaths per 10 000 persons per day between 2021 and 2022. In 2022, no deaths were reportedly attributable to COVID-19 as compared to 17 deaths in 2021. Over a 12-month period encompassing two waves of omicron variant SARS-CoV-2 and a mass gathering, SARS-CoV-2 seropositivity in Cameroon approached 60%, and deaths declined despite low vaccination coverage. This study challenges the assumption that high immunisation coverage is the sole determinant of epidemic control in the African context and encourages policymakers to increasingly rely on local research when designing response strategies for more effective outbreak management.

Do Boys Empathize Less than Girls? Exploring the Links Among Empathy, Gender and Sexist Attitudes in Adolescents.

(1) Background: Intimate partner violence (IPV) remains a pervasive issue, particularly among adolescents. Its prevalence is still high despite intervention efforts, especially for younger generations. Empathy and sexism are factors linked with IPV that have shown gender differences. This study focuses on how gender moderates the association of empathy and sexist attitudes among adolescents in Spain; (2) Methods: A two-stage stratified cluster sampling method for collecting data from 516 adolescents (219 boys, 297 girls) aged 12-18 years was used. Participants completed the Ambivalent Sexism Inventory and the Interpersonal Reactivity Index. Hierarchical multiple regression analyzed the moderating role of gender in the relation between empathy and ambivalent sexism; (3) Results: Boys exhibited higher sexism levels than girls. Perspective taking negatively predicted hostile sexism. Empathic concern positively predicted hostile and benevolent sexism. Significant gender-specific patterns emerged: more empathic concern was linked with increased hostile sexism in boys; higher perspective taking was linked with increased benevolent sexism in boys, but was lower in girls; (4) Conclusions: There is a complex interplay among empathy, gender, and sexism, suggesting that IPV prevention programs should be tailored differently for boys and girls by considering broader socio-political contexts, addressing traditional gender norms, and promoting gender equality.

Spatiotemporal patterns and factors contributing to neonatal mortality in Ethiopia: Data from EDHS 2000 to 2019.

Although Ethiopia has substantial improvements in various health indicators such as maternal and child mortality, the burden of neonatal mortality remains high. Between 2016 and 2019, neonatal mortality increased from 29 deaths per 1,000 live births to 33 deaths per 1,000 live births. This study aimed to explore the spatial patterns and factors contributing to neonatal mortality in Ethiopia. Data from the Ethiopian Demographic and Health Surveys (EDHS) for the years 2000, 2005, 2011, 2016, and 2019 were analyzed. The EDHS sampling design uses a two-stage cluster sampling technique, considering census enumeration areas as primary sampling units and households as secondary sampling units. We used the Spatial Scan analysis in SaTScan and Getis-Ord Gi* statistic in Geographic Information System (GIS), to analyse the spatiotemporal patterns of neonatal mortality. Maternal, newborn and health service-related factors contributing to neonatal mortality were also analyzed using a multilevel logistic regression model. Adjusted Odds Rios (AOR) with corresponding 95% CI were presented as a measure of association and a P-value of 0.05 was used to declare statistical significance. During the initial three consecutive surveys, there was a consistent pattern of hot spot clusters in the Amhara and Benshangul Gumuz regions, along with certain parts of the Oromia region. However, in later surveys, these clusters shifted to the eastern parts of the country, notably including the Somali region. Early initiation of breast feeding was associated with reduced chances of neonatal death (Adjusted Odds Ratio [AOR]) = 0.27; 95% Confidence Interval [CI]: 0.23, 0.32). Neonates born at home (AOR = 1.46; 95% CI: 1.16, 1.82) and male babies had a higher likelihood of mortality during the neonatal period compared to their counterparts (AOR = 1.36; 95% CI: 1.24, 1.51). The odds of neonatal mortality increased with the number of children a mother had ever given birth to (AOR = 1.36; 95% CI: 1.24, 1.51). In contrast, longer birth intervals were associated with a reduced risk of neonatal mortality (AOR = 0.76; 95% CI: 0.68, 0.83). The central southern, central-western, north-western, and northern parts of Ethiopia had most of the neonatal death clusters in the first three rounds of DHS while eastern Ethiopia had the highest neonatal mortality clusters in the latest two surveys. Our results underscore the importance for policymakers and health administrators to reassess intervention approaches and reallocate resources to regions identified as hot spots for neonatal mortality. Enhancing the initiation of breastfeeding within the first hour of birth would improve newborn survival rates. Special attention and care need to be given to babies born of smaller sizes.

Exploring the determinants of fertility rates in Ethiopia: a decomposition analysis using count regression models with a focus on urban and rural residence, based on the 2019 Ethiopian demographic health survey

IntroductionFertility refers to the biological capacity to reproduce and have children. It is a key aspect of reproductive health influenced by various factors. Therefore, this study aims to explore the determinants of fertility rates based on urban and rural settings in Ethiopia.MethodA stratified two-stage cluster sampling approach was used, employing data from the 2019 Ethiopian Mini Demographic and Health Survey (https://dhsprogram.com). The study comprised 8,885 women aged 15 to 49 years. The study employed Stata 17, and the data was described using descriptive statistics. Associations were examined using decomposition analysis and negative binomial regression. The Incidence Rate Ratio and p-value were used to determine the statistical significance of the variables examined.ResultsThe negative binomial regression found that factors such as maternal age (IRR, 1.08, P-value,0.00), living in rural (IRR,1.09, P-value,0.00), being Muslim (IRR,1.13, P-value,0.00), being from other religious groups (IRR,1.16, P-value,0.00), having six up to nine household members (IRR,1.24, P-value,0.00), having greater than nine household member(IRR,1.14, P-value,0.04), having one child under five year (IRR,1.35, P-value,0.00), having two children under five year (IRR,1.77, P-value,0.00), and having more than two under five years (IRR,1.99, P-value,0.00), being currently pregnant (IRR,1.08, P-value,0.00), use of contraceptive(IRR,1.13, P-value,0.00) are positively associated with bearing more children. On the other hand, completing primary education (IRR,0.84, P-value,0.00), secondary education (IRR,0.61, P-value,0.00), being from the richest household (IRR = 0.94, P-value,0.00), and being single/divorced and widowed (IRR,0.49, P-value,0.00) are negatively associated with having more children because their IRR is less than one. The decomposition analysis also demonstrated that marital status has a stronger negative correlation with fertility in rural compared to urban settings. Additionally, the number of children under five exerts a greater influence on fertility in urban areas.Conclusionthe study found significant rural-urban differences in the factors shaping fertility in Ethiopia. While demographics like maternal age, education, and wealth influenced fertility in both settings, the relationships varied in nature and magnitude. To address this, Policymakers should develop targeted fertility programs that address the unique needs and challenges faced by rural and urban populations.

Feature Contributions and Predictive Accuracy in Modeling Adolescent Daytime Sleepiness Using Machine Learning: The MeLiSA Study.

Background: Excessive daytime sleepiness (EDS) among adolescents poses significant risks to academic performance, mental health, and overall well-being. This study examines the prevalence and risk factors of EDS in adolescents in Bangladesh and utilizes machine learning approaches to predict the risk of EDS. Methods: A cross-sectional study was conducted among 1496 adolescents using a structured questionnaire. Data were collected through a two-stage stratified cluster sampling method. Chi-square tests and logistic regression analyses were performed using SPSS. Machine learning models, including Categorical Boosting (CatBoost), Extreme Gradient Boosting (XGBoost), Support Vector Machine (SVM), Random Forest (RF), K-Nearest Neighbors (KNN), and Gradient Boosting Machine (GBM), were employed to identify and predict EDS risk factors using Python and Google Colab. Results: The prevalence of EDS in the cohort was 11.6%. SHAP values from the CatBoost model identified self-rated health status, gender, and depression as the most significant predictors of EDS. Among the models, GBM achieved the highest accuracy (90.15%) and precision (88.81%), while CatBoost had comparable accuracy (89.48%) and the lowest log loss (0.25). ROC-AUC analysis showed that CatBoost and GBM performed robustly in distinguishing between EDS and non-EDS cases, with AUC scores of 0.86. Both models demonstrated the superior predictive performance for EDS compared to others. Conclusions: The study emphasizes the role of health and demographic factors in predicting EDS among adolescents in Bangladesh. Machine learning techniques offer valuable insights into the relative contribution of these factors, and can guide targeted interventions. Future research should include longitudinal and interventional studies in diverse settings to improve generalizability and develop effective strategies for managing EDS among adolescents.

Association Between Quality of Life and Drug Adherence Among Patients With Diabetes in India.

Diabetes represents a significant global health concern. Effective diabetes management necessitates substantial behavioral and psychological modifications, including regular glucose monitoring, dietary adjustments, and medication adherence. However, treatment adherence remains suboptimal, particularly in developing countries, leading to poor glycaemic control, increased healthcare costs, and diminished quality of life (QoL). Common factors influencing medication nonadherence include lack of medication knowledge, age, education of patients, polypharmacy, duration of disease, cost of therapy, complexity of dosing regime, and the presence of comorbidities. So, the study aims to assess the adherence status to antidiabetic medication and its association with QoL among diabetes patients in the Anand district of Gujarat state. A study was carried out in Anand district, Gujarat, from 2023 to 2024, focusing on community-based cross-sectional research. In the eight blocks of Anand district, a two-stage cluster sampling method was utilized, with one village or town randomly chosen from each taluka, and 25 diabetes patients interviewed per area. Data collection involved visiting 200 participants' houses, starting with a randomly selected house and continuing until the target was met. The interviews, conducted in the local language, lasted around 45 minutes and utilized a pre-validated and pretested questionnaire. The questionnaire covered demographic details, disease characteristics, and medication adherence using the semi-structured scale from Adherence to Refills and Medications Scale (ARMS-D), as well as the assessment of QoL using the WHOQoL-BREF questionnaire. Descriptive and inferential statistics were used for data analysis. Sociodemographic attributes were presented in terms of percentages (%) and frequencies (N). The means and standard deviation (SD) of health-related QoL and adherence to anti-diabetic medication were reported. Multiple linear regression analysis was used to assess the impact of adherence to antidiabetic medication within each QoL area after adjusting for a few sociodemographic variables. P values below 0.05 were considered statistically significant. The study included predominantly older participants (58.1 years) with 53.5% being male. Most participants (65.5%) had diabetes for more than 5 years, 60.0% had comorbidities, and 29.0% experienced complications. Nonadherence to treatment was observed in 37.0% of patients. The study found that factors like age, education, occupation, family history of diabetes, smoking, alcohol consumption, exercise habits, and medication adherence significantly influenced the QoL in diabetic patients, with medication adherence showing the strongest positive association with all QoL domains. This study shows a high percentage of nonadherence to antidiabetic medications. Poor adherence had significantly lower mean scores across all domains of QoL. Community-based educational programs targeting older and less-educated individuals should promote regular physical activity. Developing strategies to improve medication adherence and ensuring affordable access to essential medications, along with prioritizing enhancements in the QoL through psychosocial support and lifestyle counseling are imperative for diabetic patients.

Determinants of Willingness to Pay for Community-Based Health Insurance in Ethiopia: National Household Survey

The existing evidence on households' participation in Ethiopia's community-based health insurance (CBHI) scheme is limited, lacks representativeness, and lacks disaggregation. Thus, this study aims to assess households' willingness to pay (WTP) for CBHI membership and identify the factors that influence their decision to enroll. From February to May 2020, a nationwide cross-sectional household survey was conducted involving CBHI member and non-member households. The primary theories that informed this study were utility theory, social capital theory, and the health belief model. Sample included 5,976 households from 166 EAs—118 in CBHI regions and 48 in non-CBHI regions. A two-stage stratified cluster sampling used to select enumeration areas (EAs) and households from within these areas. The maximum amount of money at which participants responded "yes" in the bidding game exercise was used to measure WTP. Data were analyzed using STATA Version 16. Household expenditure was adjusted for key factors. Analyses explored WTP for CBHI by region, membership, and livelihood, with WTP based on mean maximum values. Linear regression identified influencing factors. The findings reveal that 30.9% of participants were active CBHI members. The average WTP increased with each additional family member, both in rural (AMD = 9.3 [6.8, 11.9]) and urban areas (AMD = 7.2 [1.0, 13.4]). In urban areas, WTP was also positively associated with the ability to pay (ATP) for CBHI (AMD = 64.1 [6.3, 121.8]). Male respondents and those who were literate in urban areas had higher mean WTP values of AMD = 39.8 [13.1, 66.4] and AMD = 56.8 [26.1, 87.4], respectively. Additionally, holding leadership positions in health and women's development initiatives positively influenced WTP. The study found that 30.9% of participants were active CBHI members. WTP for CBHI was higher among larger families. In urban areas, WTP was positively associated with the ability to pay (ATP) for CBHI, particularly among male and literate respondents. Community leadership roles in health and women's development also positively influenced WTP. To improve the CBHI scheme, adjustments should be made to premiums based on households' ability to pay. Community engagement should be strengthened, service quality enhanced, regional disparities addressed, and performance regularly monitored.

Sri Lanka Child Growth Cohort (SLCGC): a population-based study on growth faltering of children

PurposeThis paper aims to describe the study design and baseline characteristics of the Sri Lanka Child Growth Cohort (SLCGC), which was established to assess the timing, pattern and determinants of...

Drivers of COVID-19 Vaccination among Eligible Adults in Abuja, Nigeria: A Mixed-Methods Study Using the WHO Behavioral and Social Drivers of Vaccination Framework.

Despite the availability of COVID-19 vaccines, Nigeria still faces significant COVID-19 vaccine hesitancy, with only 60.7% of the eligible population fully vaccinated as of 20 March 2023. Our study, part of a community-based effort to improve knowledge and uptake of the COVID-19 vaccine in the Gwagwalada Area Council of Abuja, the Federal Capital Territory (FCT) of Nigeria, utilized the WHO's Behavioral and Social Drivers (BeSDs)-of-vaccination framework to examine the drivers of COVID-19 vaccination among eligible adults. This was a mixed-method study with focus group discussions (FGDs) and in-depth interviews (IDIs) involving 40 purposively sampled participants. We triangulate qualitative findings with data from a household survey of 1512 eligible adults identified using a two-stage systematic cluster sampling approach. All data were collected from the 1-18 November 2022. The household survey showed 46% COVID-19 vaccine uptake, with Pearson chi-square and Fisher's exact test showing significant associations between vaccine uptake and gender, religion, and education. Multivariate logistic regression showed that confidence in vaccine safety, knowing vaccination sites and family/friends' endorsement of COVID-19 vaccination were the strongest items associated with vaccine uptake in the thinking-and-feeling, practical-issue, and social-process domains, respectively. Multiple items measuring these domains aligned with BeSD priority question, demonstrating the robustness of the pared-down framework. Qualitative data corroborated these findings. To address vaccine hesitancy and increase uptake, community-driven approaches to improve trust in vaccine safety and benefits and promote positive vaccination norms are needed. In addition, service delivery strategies to make vaccination services easily accessible and identifiable should be developed and tailored to community needs.

Examining Instructional Approaches to Foster Soft Skills among Information Technology Undergraduates in Nairobi Metropolitan Area, Kenya

Abstract: This study examines the pedagogical methods meant to improve soft skill acquisition and development in information technology undergraduates in the Nairobi Metropolitan Area. Utilizing a sequential mixed-methods design, the research adopted a two-stage cluster sampling where 10 universities were selected from a total of 31 within the region, representing 5 private and 5 public institutions. Thereafter, 1,143 undergraduate IT students were randomly sampled from an overall population of 3,814 enrolled students, while professors and IT technicians were purposively selected for qualitative interviews. Quantitative data in this respect were collected by using semi-structured questionnaires, capturing the points of view of stakeholders on perceived improvement in soft skills. Although the modern-day job markets require graduates with soft and non-cognitive skills, employers have nonetheless complained about the lack of such competencies among university graduates concerning aspects such as communication, teamwork, problem-solving, and leadership. This study was based on Vygotsky's social constructivism theory and investigated the development of soft skills among students taking a Bachelor of Information Technology at selected universities within the Nairobi Metropolitan Area. The results have indicated that modern learning methods support the development and acquisition of soft skills aptly. The programs for soft-skill are adequate and frequent training which impacts performance in other disciplines. Signs were proving that there was significant enhancement regarding interpersonal and cognitive competencies of the students as a result of collaborative projects, problem-solving in real life, and reflective practices. It also stresses that educational institutions need to orient themselves more toward interactive and practical teaching methods to better prepare IT graduates for the challenges of a modern workforce.

Knowledge And Utilization Of Market-Oriented Agricultural Extension Service Among Farmers In Oyo State, Nigeria

Market-oriented agricultural extension services (MOAES) are pivotal in transforming subsistence farming into a profitable and sustainable venture, thereby reducing rural poverty. This study investigates the knowledge and utilization of market-oriented agricultural extension services among farmers in Oyo State, Nigeria. The study employs a two-stage cluster sampling technique to select 106 farmers from four agricultural zones in Oyo State. Data was collected through structured questionnaires and interview schedules on knowledge, accessibility, utilization, and satisfaction with MOAES provided. The public extension (61.6%) was the primary provider of market-oriented agricultural extension services, with low knowledge and satisfaction. Utilization of the services on types of crops to grow, food safety standards, and sourcing of farm inputs were moderate. Overall utilization of MOAES by 55.7% of the farmers was low. Constraints were poor linkage (x̅=1.90), limited access to credit for input purchases (x̅=1.84), and inadequate price information for various inputs (x̅=1.68). Significant relationships existed between farmers sex (X2=3.259), marital status (X2=0.186), educational level of MOAES (X2=8.055). Strengthening the capacity of extension agents and focusing on value addition are recommended.