Urban-rural Residence Research Articles

Health benefits from risk information of air pollution in China

Risk-related information regarding air pollution can help people understand the risk involved and take preventive measures to reduce health loss. However, the health benefits through these protective behaviors and the health threat of information inequality have not been systematically measured. This article reports the health gains and losses caused by the interaction of “air pollution—air pollution information—human”, and studies the heterogeneity and impact of this interaction. Based on field investigations and transfer learning algorism, this study compiled the first nationwide city-level risk-related information (ERI) response parameter set in China. Then, we developed a Information-Behavioral Equivalent PM2.5 Exposure Model (I-BEPEM) model to project the health benefits caused by the impact of environmental risk-related information on residents’ protective behaviors under different scenarios. The protective behavior led by air pollution risk information reduces 5.7% PM2.5-related premature deaths per year. With a 1% increase in regional ERI reception, PM2.5-related premature mortality decreases by 0.1% on average; If the level of information perception and behavioral protection in all cities is the same as that in Beijing, PM2.5-related premature deaths will decrease by 6.9% annually in China. Further, changing the air quality standard issued by China to the American standard can reduce the overall PM2.5-related premature deaths by 9.9%. Meanwhile, compared with men, other age groups and rural residents, women, older persons, and urban residents are more likely to conceive risk information and adopt protective behaviors to reduce the risk of premature death from air pollution. Air pollution risk information can significantly reduce people's health loss. Changing the real-time air quality monitoring information indicator standard to a more stringent level can quickly and effectively enhance this effect. However, the uneven distribution of this information in regions and populations has resulted in the inequality of health gains and losses.

Rural–urban and socio-demographic differentials in perceived health state among aging population in Ghana

BackgroundThe variations in health between rural and urban population have become an increasingly significant public health concern in developing countries including Ghana where urbanization is occurring. Whereas urbanization results in improved access to healthcare services, the concomitant negative consequences of urbanization coupled with unfavorable compositional and contextual attributes can affect the health of populations. The study sought to examine the effect of rural–urban residence and selected socio-demographic factors on perceived health state among aging population by employing a nationally representative data collected by the WHO from 2014 to 2015.MethodsThe data were derived from the WHO Study on Aging wave 2 released in 2019. A total of 4511 individuals, made up of 1018 adults between 18 and 49 years and 3493 respondents within the ages of 50 years and above, were involved in this study. The study examined the Spearman’s rho correlations between perceived health, rural–urban residence, age, sex, marital status, ever schooled, current work state, religion, and regional location. Subsequently, the study employed a multivariable ordinal logistic regression model to test the effect of the selected biosocial and contextual variables on perceived health state.ResultsThe selected socio-demographic variables significantly correlated with health state, except for rural–urban residence. However, the predictive ability of rural–urban residence and the socio-demographic variables on perceived health state were strongly ascertained. It was observed that age, sex, rural–urban residence, and current state of work among aging populations were significant predictors of perceived health state as demonstrated by odds ratios and significant p values. The contextual factor of regional location was the most significant variable that increases the perceived health state of respondents in the study.ConclusionsContinues engagement in work-related activities, an individual’s age within the aging continuum and regional location coupled with its environmental and ecological attributes, may significantly influence the development of positive perception toward health state, which forms a vital constituent of an individual health seeking behavior.

Socioeconomic inequalities in dental visits among high school students in Chile, years 2013 and 2017.

To analyze prevalence changes in dental visits and socioeconomic inequalities among high school students in Chile, years 2013 and 2017. Analysis of nationally representative data from 2013 and 2017 waves of the Chilean National Socioeconomic Characterization Survey (CASEN). In a sample of high school students aged 14 to 20 years old (n=12699 in 2013; n=11122 in 2017) we investigated prevalence of dental visits in the last 3 months, by urban-rural residence, sex, type of health insurance, type of school, income level and benefit of dental care at school. For inequality analysis we estimated prevalence ratio of dental visits in the last 3 months according to study variables. There was a significant increase in the prevalence of dental visits in the last 3 months and the receipt of dental care at school between years 2013 and 2017. The highest prevalence of dental visits in the last 3 months was found among students living in urban residence, women, with private insurance, in the highest income level, that attended private schools. Inequalities persist but the gap associated with type of residence, health insurance and between the lowest income quintiles decreased over the years. The Comprehensive Dental Care for senior year high school students, a public policy that began in 2015 in Chile, could have aided the gap reduction and the increase in visits to the dentist in the last 3 months in this group.

The rural–urban poverty gap in England after the 2008 financial crisis: exploring the effects of budgetary cuts and welfare reforms

ABSTRACT A rural–urban poverty gap exists in most countries around the world, and this paper employs a novel approach to explain this difference, using logistic regression to examine the effects of rural–urban residence type, individual socio-economic and demographic characteristics, and changes in government policies on the likelihood of being poor in England. Unusually, rural areas in England have lower poverty rates than urban areas, so the direction of the typical rural–urban poverty gap is reversed, but the method employed here would be applicable in either direction. We disaggregate micro-data from the Understanding Society Survey (USS) into three residence types (predominantly rural; significantly rural and predominantly urban), and combine these USS data with information on changes in councils’ spending power, in service spending and in per capita income lost from cuts to welfare benefits since 2010. The results demonstrate that rural residence provides a buffer against poverty in England, a so-called ‘rural advantage effect’, but this is reduced or becomes non-significant after controlling for individual socio-economic and demographic characteristics and changes in government policies. Furthermore, working-age poverty has increased more rapidly in rural areas than urban between 2010 and 2018. Our analysis also reveals how national policies have differential spatial impacts on local populations according to their diverse characteristics.

Utilization and factors associated with health facility delivery among women of reproductive age in rural Ethiopia: Mixed effect logistic regression analysis.

Worldwide over 800 women lose their life each day from complication in pregnancy and child birth. Health facility delivery is one of the key strategies for reducing maternal mortality and for ensuring safe birth. Inequity by urban-rural residence is one of the most pronounced challenges in maternal health service coverage with women living in rural areas at a greater disadvantage than other women. This study aims to assess the magnitude and factors affecting the utilization of health facility delivery for the most recent live birth among women of reproductive age in rural Ethiopia. This is a cross-sectional study based on a data from Ethiopian Mini Demographic and Health Survey 2019 dataset with a total weighted sample of 2900 women of reproductive age group in rural Ethiopia. Data cleaning, coding and labeling were done using STATA version 14 software. Multilevel mixed effect logistic regression model was employed to identify associated factors. Only 44% of reproductive-age women in rural Ethiopia gave their most recent live birth in health institutions. In the multivariable multilevel binary logistic regression analysis; educational status, wealth index, attending 4+ANC, and had ANC from skilled provider were found to be statistically significant factors associated with health facility delivery. In a rural part of Ethiopia, the prevalence of institutional delivery is low. Especial emphasis should be given for mothers with no formal education, and poor household wealth index, Furthermore, implementing public health programs that target to enable women to have more frequent Antenatal Care follow-up from skilled providers may increase the number of health facility deliveries.

Determinants of cervical cancer screening among women living with HIV in Zimbabwe.

In sub-Saharan Africa (SSA), cervical cancer (CC) is the second leading cause of cancer-related deaths, with human immunodeficiency virus (HIV) seropositive women being particularly vulnerable. Despite the benefits of early CC screening in reducing HIV-related CC deaths, CC screening uptake remains limited, with wide disparities in access across SSA. As part of a larger study, this paper examines the determinants of CC screening among HIV-seropositive women of reproductive age (15-49 years) in Zimbabwe. Using the 2015 Zimbabwe Demographic and Health Survey, we conducted multilevel analyses of CC screening among 1490 HIV-seropositive women, nested in 400 clusters. Our findings revealed that, even though 74% of HIV-seropositive women knew about CC, only 17.6% of them reported ever screening for it. Women who held misconceptions about HIV (OR = 0.47, p = 0.01) were less likely to screen for CC compared to those with accurate knowledge about HIV and CC. HIV-seropositive women with secondary or higher education were more likely to screen (OR = 1.39, p = 0.04) for CC compared to those with a primary or lower level of education. Age was positively associated with screening for CC. Furthermore, locational factors, including province and rural-urban residence, were associated with CC screening. Based on these findings, we call for integrated care and management of HIV and non-communicable diseases in Southern Africa, specifically, Zimbabwe due to the legacy of HIV in the region.

Urban-rural differences in hypertension prevalence, blood pressure control, and systolic blood pressure levels.

Higher rates of cardiovascular events have been observed among rural residents compared with urban. Hypertension and lack of blood pressure (BP) control are risk factors for cardiovascular events. We compared the prevalence of hypertension and controlled BP, and the distribution of systolic blood pressure (SBP), by urban-rural residence. Participants from the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study, a prospective cohort of Black and White adults aged ≥45 years, were categorized as either urban, large rural, or small-isolated rural, by using the Rural-Urban Commuting Area (RUCA) categorization B system. Oucomes were hypertension prevalence (BP ≥ 140/90 mmHg or antihypertensive use), BP control (BP < 140/90 among participants on antihypertensive medication), and the distribution of SBP. Counfounders were age, race, sex, antihypertensive medication use, and US Census Bureau division. The analysis included 26,133 participants (80.3% urban, 11.6% large-rural, 8.2% small-isolated rural). The unadjusted prevalence of hypertension was not different between groups. However, after adjustment, the odds of hypertension was higher among participants in the large rural group (odds ratio [OR] 1.17; 95% confidence interval [CI], 1.08-1.27) and small-isolated rural group (OR 1.19; 95% CI, 1.08-1.30), compared with the urban group. There was no evidence of an adjusted difference in BP control for those taking antihypertensive medications. Adjusted differences in SBP were greater for both rural groups, compared with urban, at the higher percentiles of SBP. Rural residence was associated with a higher adjusted odds of hypertension and higher SBP.

Perceived Neighborhood Conditions, Psychosocial Factors, and Sleep Problems Among Urban and Rural Older Adults in China.

To examine the associations between perceived neighborhood conditions and older Chinese adults' sleep problems, and whether these associations are mediated by psychosocial factors and moderated by urban-rural residence. Data were from the World Health Organization Study on global Ageing and Adult Health. We used OLS, binary, and multinomial logistic regression analyses. Karlson-Holm-Breen decomposition method was used to test mediation effects. Positively perceived neighborhood social cohesion was associated with fewer insomnia symptoms and decreased odds of poor sleep quality, sleepiness, lethargy, and short sleep duration. Positively perceived neighborhood safety was related to decreased risks of poor sleep quality and sleepiness. Depression and perceived control partially mediated the effects of perceived neighborhood on sleep. Furthermore, the protective effects of neighborhood cohesion against sleep problems were more pronounced among older urban adults than their rural counterparts. Interventions that make neighborhoods safer and more integrated will improve late-life sleep health.

Neighborhood Socioeconomic Status, Green Space, and Walkability and Risk for Falls Among Postmenopausal Women: The Women's Health Initiative.

This study estimated associations between neighborhood socioeconomic status (NSES), walkability, green space, and incident falls among postmenopausal women and evaluated modifiers of these associations, including study arm, race and ethnicity, baseline household income, baseline walking, age at enrollment, baseline low physical functioning, baseline fall history, climate region, and urban-rural residence. The Women's Health Initiative recruited a national sample of postmenopausal women (50-79years) across 40 U.S. clinical centers and conducted yearly assessments from 1993 to 2005 (n=161,808). Women reporting a history of hip fracture or walking limitations were excluded, yielding a final sample of 157,583 participants. Falling was reported annually. NSES (income/wealth, education, occupation), walkability (population density, diversity of land cover, nearby high-traffic roadways), and green space (exposure to vegetation) were calculated annually and categorized into tertiles (low, intermediate, high). Generalized estimating equations assessed longitudinal relationships. NSES was associated with falling before adjustment (high vs. low, odds ratio,1.01; 95% confidence interval, 1.00-1.01). Walkability was significantly associated with falls after adjustment (high vs. low, odds ratio,0.99; 95% confidence interval, 0.98-0.99). Green space was not associated with falling before or after adjustment. Study arm, race and ethnicity, household income, age, low physical functioning, fall history, and climate region modified the relationship between NSES and falling. Race and ethnicity, age, fall history, and climate region modified relationships between walkability and green space and falling. Our results did not show strong associations of NSES, walkability, or green space with falling. Future research should incorporate granular environmental measures that may directly relate to physical activity and outdoor engagement.

Ethnic Disparities in Early-Onset Gastric Cancer Persist across Rural-Urban Geographies.

The incidence of noncardia gastric cancer is increasing in adults ages less than 50 years old. Early-onset gastric cancer (EOGC) is characterized by ethnic disparities occurring more in Hispanic persons than non-Hispanic persons. It is unknown whether rural-urban disparities exist in EOGC and if this intersects with ethnic disparities. We utilized the Surveillance Epidemiology and End Results 17 Census Tract-level Socioeconomic Status and Rurality Database from 2006 to 2018 to calculate incidence rates and incidence rate ratios of EOGC among Hispanic and non-Hispanic persons by census tract rural-urban location, age, gender, persistent poverty, and stage of disease. We used the Tiwari Method to estimate incidence rate ratios with 95% confidence intervals (CI). Hispanic persons had higher incidence rates of EOGC compared with non-Hispanic persons in both rural [incident rate ratios (IRR), 2.12; 95% confidence interval (CI), 1.64-2.73] and urban census tracts (IRR, 2.03; 95% CI, 1.91-2.16). Similar findings were seen when comparing Hispanic to non-Hispanic persons in rural and urban census tracts by age, stage of disease, and persistent poverty. Higher incidence rates of EOGC among Hispanic persons persist across rural-urban locations. Further research is needed to understand the etiology of this elevated risk in young Hispanics and interventions that may help to modify their outcome. While other cancers have ethnic disparities which may differ by rural-urban location, the ethnic disparity in EOGC among Hispanic and non-Hispanic persons does not differ by rural-urban residence.

Relationship between social support and 7-year trajectories of cognitive decline: results from the China Health and Retirement Longitudinal Study

BackgroundSocial support is associated with cognitive function at an older age, but how distinct dimensions of social support affect trajectories of cognitive decline in older Chinese adults remains unclear.MethodsUsing longitudinal...

Age differences in Allostatic Load among adults in the United States by rural-urban residence

•Rural residence is associated with allostatic load levels by age groups.•Allostatic load is higher among rural adults with the exception of the oldest age group.•Evidence of a rural-urban convergence in allostatic load levels among oldest old.•These rural disadvantages remained strong even when accounting for covariates.•The study of allostatic load can improve our understanding of rural disparities.

Sociodemographic inequalities in mortality from drowning in the Baltic countries and Finland in 2000–2015: a register-based study

BackgroundDrowning is an important public health problem. Some evidence suggests that the risk of drowning is not distributed evenly across the general population. However, there has been comparatively little research on inequalities in drowning mortality. To address this deficit, this study examined trends and sociodemographic inequalities in mortality from unintentional drowning in the Baltic countries and Finland in 2000–2015.MethodsData for Estonia, Latvia and Lithuania came from longitudinal mortality follow-up studies of population censuses in 2000/2001 and 2011, while corresponding data for Finland were obtained from the longitudinal register-based population data file of Statistics Finland. Deaths from drowning (ICD-10 codes W65–W74) were obtained from national mortality registries. Information was also obtained on socioeconomic status (educational level) and urban-rural residence. Age-standardised mortality rates (ASMRs) per 100 000 person years and mortality rate ratios were calculated for adults aged 30–74 years old. Poisson regression analysis was performed to assess the independent effects of sex, urban-rural residence and education on drowning mortality.ResultsDrowning ASMRs were significantly higher in the Baltic countries than in Finland but declined by nearly 30% in all countries across the study period. There were large inequalities by sex, urban-rural residence and educational level in all countries during 2000–2015. Men, rural residents and low educated individuals had substantially higher drowning ASMRs compared to their counterparts. Absolute and relative inequalities were significantly larger in the Baltic countries than in Finland. Absolute inequalities in drowning mortality declined in all countries across the study period except between urban and rural residents in Finland. Changes in relative inequalities were more variable during 2000–2015.ConclusionDespite a sharp reduction in deaths from drowning in the Baltic countries and Finland in 2000–2015, drowning mortality was still high in these countries at the end of the study period with a substantially larger risk of death seen among men, rural residents and low educated individuals. A concerted effort to prevent drowning mortality among those most at risk may reduce drownings considerably in the general population.

How to effectively communicate about greenhouse gas emissions with different populations

A critical aspect of climate policy is effective communication about greenhouse gas emissions (GHG-E) themselves. However, since attitudes towards climate change vary by different segments of the population, different methods of communication about GHG-E may be necessary. This study investigates different responses to GHG-E information by population and how to best communicate such information with them. Eight framing techniques following goal framing theory and moral foundations theory were developed, and a discrete choice experiment was applied to determine willingness to pay (WTP) for CO2 emissions reductions. Six segmentation analyses for people’s WTP for emissions under different framing techniques were carried out for culture, region, urban-rural residence, political leaning, attitudes and beliefs towards climate change, and income. Based on the data of 2015 respondents from six provinces of Canada, the strength of GHG information influence was tested according to different respondent segmentations. The results show that in most cases, an emoticon framing has the strongest influence, though two exceptions exist: With respect to political orientation, nearly all framings were ineffective for those on the extremes, and for those on the right (not extreme) the current label has the largest impact; With respect to climate change motivation, color framing works best for those unsure how to reduce emissions, while the current label works for those uninterested in reducing their emissions. Surprisingly, “tree” framing was most effective among those who report not being concerned about climate change. The results help policy and decision-makers improve the likelihood of climate-friendly choices being made.

Rural-urban residence and sequelae of hypertensive disorders of pregnancy in the first year postpartum, 2007 - 2019.

To estimate the association between rural residence and sequelae of hypertensive disorders of pregnancy (HDP) in the first year postpartum. We used the Maine Health Data Organization's All Payer Claims Data to identify women with HDP who delivered during 2007-2019 and did not have chronic hypertension or pre-pregnancy cardiac conditions (n=8882). We used Cox proportional hazards modeling to estimate rural-urban hazard ratios (HR) and 95% confidence intervals (CI), adjusting for HDP subtype, age, insurance, nulliparity, and co-morbidities. Results were stratified by HDP subtype and timing of acute care visits. Risk of at least one emergency room or inpatient visit related to hypertension or cardiovascular conditions in the first year postpartum and receipt of outpatient antihypertensive medications from 4days to 1year postpartum, separately. Overall, risk of at least one acute care visit in the first year postpartum was not different between rural vs urban women (4.2% vs 4.2%; adjusted HR 0.98; 95% CI 0.79,1.21), and outpatient receipt of antihypertensive medication was not different (12.9% vs 12.8%; adjusted HR 0.99; 95% CI 0.87, 1.12). However, stratified analyses suggested some differences (e.g. preeclampsia with severe features: acute care visit adjusted HR 1.54; 95% CI 0.95, 2.49). Rural and urban women do not differ in the risks of these common HDP sequelae, though rural women may have increased risk by HDP subtype or timing of acute care visit. Future research should investigate postpartum interventions for reducing HDP sequelae in rural and urban women.

Assessing the combined effect of household cooking fuel and urbanicity on acute respiratory symptoms among under-five years in sub-Saharan Africa

BackgroundThis study sought to investigate the association between urbanicity (rural-urban residency), the use of solid biomass cooking fuels and the risk of Acute Respiratory Infections (ARIs) among children under the age of 5 in sub-Saharan Africa (SSA). MethodsCross-sectional data from the most recent surveys of the Demographic and Health Survey Program conducted in 31 sub-Saharan African countries were pooled for the analysis. The outcome variables, cough and rapid short breath were derived from questions that asked mothers if their children under the age of 5 suffered from cough and short rapid breath in the past two weeks preceding the survey. To examine the associations, multivariable negative log-log regression models were fitted for each outcome variable. ResultsHigher odds ratios of cough occurred among children in urban households that use unclean cooking fuel (aOR = 1.05 95% CI = 1.01, 1.08). However, lower odds ratios were observed for rural children in homes that use clean cooking fuel (aOR = 0.93 95% CI = 0.87, 0.99) relative to children in urban homes using clean cooking fuel. We also found higher odds ratios of short rapid breaths among children in rural households that use unclean cooking fuel compared with urban residents using clean cooking fuel (aOR = 1.12 95% CI = 1.08, 1.17). ConclusionUrbanicity and the use of solid biomass fuel for cooking were associated with an increased risk of symptoms of ARIs among children under five years in SSA. Thus, policymakers and stakeholders need to design and implement strategies that minimize children’s exposure to pollutants from solid biomass cooking fuel. Such interventions could reduce the burden of respiratory illnesses in SSA and contribute to the realization of Sustainable Development Goal 3.9, which aims at reducing the number of diseases and deaths attributable to hazardous chemicals and pollution of air, water and soil.

Analysis of the status of social frailty in Chinese older adults with cardiovascular and cerebrovascular diseases: a national cross-sectional study.

Social frailty is one type of frailty. Physical frailty with cardiovascular and cerebrovascular diseases (CCVD) have been studied a lot, but less research on social frailty. To study the prevalence, related risk factors and regional differences of social frailty with CCVD in Chinese older adults. SSAPUR was a national cross-sectional survey. Participants aged 60 years or older were recruited in August 2015. Demographic data and information regarding family, health and medical conditions, living environment conditions, social participation, spiritual and cultural life, and health condition were obtained. Social frailty was assessed in five areas (HALFE Social Frailty Index) including inability to help others, limited social participation, loneliness, financial difficulty, and living alone. The prevalence of CCVD with social frailty, related risk factors and regional differences in CCVD with social frailty were studied. A total of 222,179 participants were enrolled. 28.4% of them had CCVD history. The prevalence of social frailty in the CCVD group was 16.03%. In CCVD participants, compared with the group without social frailty, there were significant differences in gender, age, urban-rural distribution, ethnicity, marital status, and education levels in the social frailty group. Significant differences were also found in physical exercise participation, health status, cataract, hypertension, diabetes mellitus, hospitalization within 1 year, self-assessed health status, crutch or wheelchair usage, urinary and fecal incontinence, need for care from others, fall history, housing satisfaction, and self-assessed happiness in the social frailty group. Women with CCVD had a higher prevalence of social frailty than men. By age in CCVD with social frailty, the highest prevalence was found in participants 75-79 years old. The prevalence of CCVD was significant difference between social frailty in urban and rural group. The prevalence of social frailty with CCVD was significantly different in different regions. The highest prevalence was 20.4% in southwest area, and the lowest prevalence was 12.5% in northeast with area. The prevalence of social frailty among the CCVD older adults is high. Factors such as gender, age, region, urban-rural residence, and the state of the disease may be associated with social frailty.

Impact of the COVID-19 pandemic on cancer patients in western Pennsylvania: rural–urban disparities

Disparities in cancer care persist between patients living in rural versus urban areas. The COVID-19 pandemic may have impacted concerns related to care and personal health differently in rural cancer patients. Using survey data collected from cancer patients in western Pennsylvania, we examined pandemic-related distress, concerns related to cancer care, impact on personal health, and the extent to which these differed by urban-rural residence. Patients filled out an initial survey in August-December 2020; a second survey was completed in March 2021. The following patient concerns related to the pandemic were evaluated: threat of COVID-19 to their health, pandemic-related distress, perceptions of cancer care, and vaccine hesitancy. Multivariable logistic regression models were used to examine relationships between these outcomes and urban-rural residence as well as patient-related factors, including anxiety symptoms and social support. The study sample included 1,980 patients, 17% resided in rural areas. COVID-19 represented a major or catastrophic threat to personal health for 39.7% of rural and 49.0% of urban patients (p = 0.0017). Patients with high general anxiety were 10-times more likely to experience pandemic-related distress (p < 0.001). In the follow-up survey (n = 983), vaccine hesitancy was twice as prevalent among rural patients compared to urban (p = 0.012). The extent to which perceptions of the threat of COVD-19 to personal health and vaccine hesitancy exacerbates rural-urban disparities in cancer care and prognosis warrants further study. Cancer patients may be vulnerable to heightened anxiety and distress triggered by the pandemic.

Covid-19-induced Shocks, Access to Basic Needs and Coping Strategies.

We examine the association between the Covid-19 pandemic and and access to basic needs, and how households respond using various coping strategies in the context of Nigeria. We use data from the Covid-19 National Longitudinal Phone Surveys (Covid-19 NLPS-2020) conducted during the Covid-19 lockdown. Our findings reveal that the Covid-19 pandemic is associated with households' exposure to shocks such as illness or injury, disruption of farming, job losses, non-farm business closure, and increase in price of food items and farming inputs. These negative shocks have severe consequences on access to basic needs of households, and the outcomes are heterogeneous across gender of household head and rural-urban residence. Households adopt a number of coping strategies, both formal and informal to mitigate the effects of the shocks on access to basic needs. The findings of this paper lend credence to the growing evidence on need to support households exposed to negative shocks and the role of formal coping mechanisms for households in developing countries.

Socioeconomic and urban-rural inequalities in the population-level double burden of child malnutrition in the East and Southern African Region.

Socioeconomic and urban-rural inequalities in the population-level double burden of child malnutrition threatens global nutrition targets 2025, especially in East and Southern Africa. We aimed to quantify these inequalities from nationally representative household surveys in the East and Southern African region. 13 Demographic and Health Surveys between 2006 and 2018 including 72,231 children under five years old were studied. Prevalence of stunting, wasting and overweight (including obesity) were disaggregated by wealth quintiles, maternal education categories and urban-rural residence for visual inspection of inequalities. The slope index of inequality (SII) and the relative index of inequality (RII) were estimated for each country. Regional estimates of child malnutrition prevalence and socioeconomic and urban-rural inequalities were generated from pooling country-specific estimates using random-effects meta-analyses. Regional stunting and wasting prevalence were higher among children living in the poorest households, with mothers with the lowest educational level and in rural areas. In contrast, regional overweight (including obesity) prevalence was higher among children living in the richest households, with mothers with the highest educational level and urban areas. This study indicates pro-poor inequalities are present in child undernutrition and pro-rich inequalities are present in child overweight including obesity. These findings re-emphasise the need for an integrated approach to tackling the population-level double burden of child malnutrition in the region. Policy makers must target specific populations that are vulnerable to child malnutrition, to avoid further widening of socioeconomic and urban-rural inequalities.