Wealth Status Research Articles

Climate change adaptation and land tenure: exploring pastoral adaptation strategies under communal and private land ownership in Kenya

ABSTRACT Climate change adaptation is critically important for communities in the Global South, especially for those depending on climate-sensitive resources for their livelihoods, such as pastoralist communities. Land is a key asset for the ability of such communities to adapt. However, our understanding of the ways in which pastoral adaptation strategies develop under different land tenure systems – and how such strategies shape local land tenure systems – remains limited. This article conceptualises the relationship between local climate change adaptation strategies and land tenure and examines how adaptation strategies develop under communal and private tenure systems in southern Kenya. The article draws on primary data from a household survey (n = 160) and in-depth qualitative interviews in Kajiado County, Kenya, where Maasai pastoralists are adapting under both communal and private land tenure systems. We find that adaptation strategies vary with the different land tenure systems and we show how the tenure systems shape and are shaped by local adaptation strategies. We further find that wealth and social status influence the ability of households to benefit from and influence land tenure systems. The article contributes to our knowledge on autonomous local climate change adaption by adding insights on the role of land tenure as an important contextual factor. It further highlights the role of pastoralists’ agency as they develop their adaptation strategies and adjust livelihoods beyond livestock and mobility, and how this interacts with communal and private land tenure.

Rural-urban disparities in full antenatal care utilization among women in Ethiopia: A further analysis of Mini-EDHS, 2019.

Full antenatal care utilization is a key intervention that creates the opportunity to provide all the necessary health services during pregnancy that aims to reduce maternal and newborn morbidity and mortality. However, there is still a gap in utilizing this service between rural and urban women. So, this study aimed to identify the sources of variations in full antenatal care utilization between the rural and urban areas of Ethiopia. The study used the data on a nationwide representative sample of the Mini- Demographic and Health Survey (DHS) of Ethiopia. The data were collected from March 21, 2019, to June 28, 2019, in all regions of Ethiopia. Two stage cluster sampling techniques were used to select the study participants. This study included about 3,927 (weighted samples) of women aged from 15 to 49 years. A multivariate decomposition analysis technique was performed to observe the rural-urban disparities in full antenatal care utilization explained by residence difference in components of endowments and coefficients. The prevalence of full antenatal care utilization was 43.25% (95% CI: 41.7%, 44.8%). The difference in the prevalence of full antenatal care utilization between rural and urban women was (rural prevalence was 27.73%, while in urban areas it was 15.52%). These results showed a statistically significant full antenatal care utilization gap in rural urban resident women (-0.21807, 95% CI:(-0.27397, -0.16217)). The majority of the gap was explained by the covariate distribution, which accounted for 76.84%, and the rest, 23.16%, was due to the effect of covariate differences. Educational status, wealth status, religion, region, birth order, and parity differences between urban and rural women explain most of the full antenatal care utilization disparities. There is a significant full antenatal care utilization disparity between rural and urban women in Ethiopia. This variation in the rural-urban full antenatal care utilization was explained by differences in characteristics (endowment). So to decrease this gap, emphasis should be given to resource distribution targeting rural households, improvement of maternal education and creating a platform to access information about the service and its relevance.

Intraminority Gay Community Stress and Coping Responses Among Gay and Bisexual Men in Taiwan

ABSTRACT A proportion of gay and bisexual men (GBM) experience worse mental health when they encounter stress from problems within the gay community. This qualitative study examined the dominant standards held in the gay community in Taiwan, the intraminority-community stress experienced by GBM, and the strategies that GBM adopt to cope with such stress. Data from open and in-depth interviews with 26 GBM were subject to reflexive thematic analysis. The results found that appearance, sexual satisfaction, wealth and social status, being a member of gay groups, and youth were valued in the gay community in Taiwan. These standards resulted in a variety of stress responses, including concerns about not fitting in, diminished self-confidence, feelings of frustration due to unattainable standards and challenges in interpersonal relationships. The strategies adopted to cope with such stress involved acceptance and adherence, passive acceptance, rational thinking and critique, mental resilience, mutual support, and efforts to question and challenge norms. Our findings can provide mental health professionals with key insights into the intraminority gay community stress and coping responses in GBM.

The Collector Hypothesis : Who Benefits More from Art, the Artist or the Collector?

Human fascination with art has deep evolutionary roots, yet its role remains a puzzle for evolutionary theory. Although its widespread presence across cultures suggests a potential adaptive function, determining its evolutionary origins requires more comprehensive evidence beyond mere universality or assumed survival benefits. This paper introduces and tests the Collector Hypothesis, which suggests that artworks serve as indicators of collectors' surplus wealth and social status, offering greater benefits to collectors than to artists in mating and reproductive contexts. Our study among Indigenous Papuan communities provides preliminary support for the Collector Hypothesis, indicating that, compared to artists, collectors are perceived as having higher social status and greater attractiveness to women. These findings provide unique insights into Papuan communities and contribute to the ongoing discussion about art's adaptive significance of art by suggesting that artistic capacities may benefit not only creators but also those who accumulate and display art. Further research in diverse cultural contexts is needed for a comprehensive understanding of this interplay.

Early childhood development and its associated factors among children aged 36–59 months in Afghanistan: evidence from the national survey 2022–2023

BackgroundUnderstanding the status of early childhood development (ECD) and its associated factors could serve as the basis for future policy efforts and interventions. Therefore, this study aimed to determine the status of ECD and its associated factors among children aged 36–59 months in Afghanistan.MethodsWe used data from the Afghanistan Multiple Indicator Cluster Survey 2022–2023 (MICS) to assess ECD status. The outcome variable was a binary measure, indicating whether a child was developmentally on track or not. To explore the associations between ECD status and various explanatory variables, we applied binary logistic regression models, presenting both univariate and multivariate analyses.ResultsAmong the 13,866 children aged 36 to 59 months included in the analysis, 29.95% (95% CI: 29.19-30.72%) were found to be developmentally on track. The likelihood of being developmentally on track was higher in children whose mothers had secondary [adjusted odds ratio (AOR) 1.36 (95%CI 1.04–1.77)] and higher education [1.73 (1.08–2.76)], in children whose fathers had primary [1.32 (1.05–1.67)], secondary [1.40 (1.10–1.79) and higher education [1.60 (1.21–2.11)], and in children belonging to the higher household wealth status [1.46 (1.18–1.82)]. On the other hand, the likelihood of being developmentally on track was lower in children aged 48–59 months [0.35 (0.30–0.40)], in children living in rural areas [0.77 (0.62–0.96)], in children with stunting [0.77 (0.61–0.96)], and in underweight children [0.61 (0.52–0.72)].ConclusionOur findings indicate that 29.95% of children aged 36–59 months in Afghanistan are developmentally on track. Positive associations were found between ECD and higher parental education and household wealth status. However, living in rural areas, underweight and stunted growth were negatively associated with ECD. To improve early childhood development programs in Afghanistan, targeted interventions are needed to address the factors identified in this study.

Information communication technologies and intimate partner violence among women in sub-Saharan African countries

Intimate partner violence is widespread in sub-Saharan Africa with women the usual victims. Efforts to address intimate partner violence (IPV) include interventions with information communication technologies (ICT) that are being used to raise awareness and promote the empowerment of women. Thus, there is a need to examine the relationship between ICT ownership and IPV among women in sub-Saharan Africa. We conducted a cross-sectional study of four countries in sub-Saharan Africa using the Demographic and Health Survey data. Ownership of ICT was the main predictor variable that was measured by ownership of a radio, television, mobile phones, and access to the Internet. The outcome variable was IPV, which was measured in two forms: physical and sexual violence. A multivariable analysis using binary logistic regression was used to examine the association between ownership of ICT devices and intimate partner violence (IPV) among women. In Zambia and Mali, women who own ICT devices were significantly less likely to experience sexual violence than those who did not own ICT devices. Predictors such as age, place of residence, education, wealth status, employment status, number of children and age at first marriage were significantly associated with experiences of IPV, even though the strength of this relationship varied across countries and types of IPV. Access to ICT should be promoted among women because ICT can raise awareness and offer women a platform for receiving social support and advice about coping with intimate partner violence.

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.

Predictors of anxiety among women of reproductive age in Nepal: a comprehensive nationwide analysis.

Anxiety poses a significant challenge for women of reproductive age globally, often leading to other mental health issues. However, research on anxiety prevalence among this demographic, particularly in Nepal, remains scarce. This study aims to fill this gap by identifying demographic, biological, and behavioral predictors of anxiety among reproductive-aged women in Nepal. Using data from the nationally representative Nepal Demographic and Health Survey 2022, this study employed the Generalized Anxiety Disorder (GAD-7) scale to assess anxiety prevalence. Descriptive and inferential statistics, including one-way ANOVA and stepwise multiple regression, were utilized for identifying the potential predictors of anxiety. This study found that 22.2% of reproductive-aged women in Nepal experience moderate to severe anxiety. The stepwise multiple regression revealed seven most influential factors, with depression (mild, moderate, severe) being the most influential predictor of anxiety, explaining 51.8% of the variance (R square change = 0.518; Sig. =<0.001). Self-reported health status (R square change = 0.010; Sig.=<0.001), experienced emotional violence (R square change = 0.007; Sig.=<0.001), and pregnancy termination (R square change = 0.002; Sig.=0.001) accounted for 1.0%, 0.7%, and 0.2% of the variance in anxiety, respectively. Other significant predictors of anxiety included husband's alcohol consumption, genital discharge, and household wealth status. Anxiety is substantially prevalent among reproductive-aged women in Nepal, with sociodemographic factors playing a crucial role. Further research is needed to develop targeted socioeconomic, and behavioral interventions aimed at addressing anxiety and its broader impact on daily life, thereby ensuring the mental well-being of women of reproductive age.

Suicidal behaviour, depression and generalized anxiety and associated factors among female and male adolescents in Mozambique in 2022–23

BackgroundThe purpose of the study was to assess the prevalence and associated factors of major depressive disorder (MDD), generalized anxiety disorder (GAD), and past 12-month suicidal behaviour (PSB) among adolescents in Mozambique.MethodsData from 3,109 females (aged 15–19 years) and 1,439 males (aged 15–19 years) that participated in the 2022-23 Mozambique Demographic and health Survey were analysed. MDD was assessed with the PHQ-9 and GAD with the GAD-7.ResultsResults indicate that among girls the prevalence of PSB was 4.3% (attempt 1.0%, plan 1.9% and/or ideation 3.6%) and among boys 2.5% (attempt 0.3%, plan 0.7% and/or ideation 2.4%). Among girls and boys, the prevalence of MDD (≥ 8 scores) was 15.5% and 3.7%, respectively, and the prevalence of GAD (≥ 5 scores) was 25.0% and 10.3%, respectively. In adjusted logistic regression analysis, among girls, GAD was positively and solid fuel use was negatively associated with PSB, while among boys MDD and urban residence were positively associated with PSB. Among female adolescents, currently being pregnant and “big problem to get money for medical treatment” increased the odds of MDD. While among male adolescents, urban residence, having a genital sore or ulcer, has living children, and early sexual debut were positively associated with MDD. Urban residence, current alcohol use, and early sexual debut were positively associated with GAD in male adolescents, while poorer wealth status, being pregnant, and having a “big problem to get money for medical treatment” were positively associated with GAD in female adolescents.ConclusionAbout 3% of participants had PSB, among girls one in five had MDD or GAD and among boys more than 5% had MDD or GAD. Public health interventions can be guided by several associated factors that have been identified.

Prevalence of anemia and its associated factors among under-five children living in Arba Minch Health and Demographic Surveillance System Sites (HDSS), Southern Ethiopia.

Childhood anemia affects around half of under five children and has impacts on physical, mental, and social development, both in the short and long term. The objective of the study was to determine the prevalence of anemia and its associated factors among under-five children living in Arba Minch Health and Demographic Surveillance System Sites (HDSS). A community-based cross-sectional study was conducted among randomly selected under-five children with their caregivers living in Arba Minch HDSS from June to August 2023. The questionnaire was developed to assess sociodemographic, nutrition, healthcare, and environmental characteristics. Hemoglobin concentration was adjusted for altitude of the village. Anemia was defined as the hemoglobin concentration below 11 g/dL. It was further categorized as mild (between 10-10.9 g/dL), moderate (7-9.9 g/dL), and severe (less than 7 g/dL). The analysis of factors associated with anemia was assessed by using logistic regression and significance was determined at p-value <0.05. A total of 332 under-five children with a mean (SD) age of 33(15) months participated. The overall prevalence of anemia among under-five children was 35.3% (95% CI: 30.4, 40.7). The magnitude of mild, moderate, and severe anemia was 12.4% (95%CI: 9.2, 16.4), 22.1% (95%CI: 17.9, 26.9), and 0.9% (95%CI: 0.3, 2.8), respectively. Anemia had a negative association with the advancing age of the children (0.95, 95%CI: 0.93, 0.97) and improvement in the family wealth score (0.86, 95%CI: 0.75, 0.99). Nearly one-third of the under-five children were anemic and childhood anemia is a moderate public health problem in the study area. The magnitude of anemia was negatively associated with the advance in child age and with the increase in the wealth status of the household. It is important to provide due attention to reduce the magnitude of anemia specifically for the youngest children and for those children from poor households.

Comparative Analysis of Factors Influencing Optimal and Timely Antenatal Care Uptake in Kenya, South Africa, and Nigeria: A Cross-Section Study

Background Adequate antenatal care (ANC) visits and early timing are crucial for maternal and foetal health. However, many pregnant women in Kenya, South Africa, and Nigeria delay ANC initiation and fail to meet recommended visit numbers. This study aimed to identify factors associated with timely ANC initiation and achieving optimal number of ANC visits in these countries. Methods A cross-sectional analysis with data from the most recent Demographic Health Survey (DHS) datasets for Kenya (2022), Nigeria (2018) and South Africa (2016) were used. The study included 35,219 women aged 15–49 who had given birth within the previous two years. The women's sociodemographic and maternal health care-seeking characteristics were summarised using descriptive statistics. Multiple logistic regression was used to identify associations between explanatory variables, the timing of the first ANC visit, and the frequency of ANC visits. Results Optimal ANC visits (≥4 visits) were 67.2% in Kenya, South Africa (75.5%), and Nigeria (56.9%). Early timing of first ANC visits (≤3 months) was 30.2% in Kenya, 47.3% in South Africa and 18.3% in Nigeria. Factors associated with adequate ANC visits were maternal age, wealth status, and caesarean section, while parity and household size reduced the odds of optimal ANC visits. Maternal age, caesarean section, wealth status, and others were associated with increased odds of early timing of ANC visits. Parity, male-headed households, employed women and women who had a challenge with treatment costs had reduced the odds of timely ANC uptake. Conclusion More than half of the participants had optimal ANC visits, while less than half initiated ANC early. Tailored interventions addressing specific social, cultural, and economic contexts are crucial to improving early ANC visits and the frequency of ANC visits. Mixed methods research could provide in-depth insights into barriers and facilitators of ANC uptake, informing the design of targeted interventions.

New Evidence for Prehistoric Textile Production and Social Complexity on the Southeastern Tibetan Plateau, Southwestern China

ABSTRACT This paper presents new discoveries of textile tools and fabric remains from the Yanyuan Basin, offering insights into textile production and social complexity on the southeastern Tibetan Plateau from the late 4th to the late 1st millennium b.c. The findings from the Yanyuan Basin, along with those from other parts of the region, indicate that spindle whorls have been used by individuals with diverse cultural traditions and of different social status since the Neolithic period. In the Bronze Age, clay whorls generally came from small and medium burials, likely associated with spinning workers. However, bronze textile tools were commonly found in large burials from the late Bronze Age, during which significant social stratification took place, and they were likely symbols of the wealth and high social status of the occupants. This study proposes that textile production changed from a household activity to a socially organized activity over time.

What factors influence women's empowerment in Ethiopia? A multilevel analysis of Ethiopia's demographic and health survey data.

Women's empowerment has been a global priority, as countries can achieve significant growth and economic development by empowering women. Understanding the individual and community-level factors that influence women's empowerment is crucial for policymakers to develop effective policies and to improve women's empowerment. A community-based cross-sectional survey was conducted in 11 administrative regions of Ethiopia. The analysis included a weighted sample of 7,108 married women of reproductive age (15-49 years) from the 2,016 Ethiopian Demographic and Health Survey (EDHS). A multilevel mixed-effect binary logistic regression analysis was used to examine the individual and community-level factors associated with women's empowerment. In the final model, significant variables were identified using a p-value of <0.05 and an adjusted odds ratio (AOR) with a 95% confidence interval (CI). The overall magnitude of women's empowerment was 23.7% (95% CI: 22.7-24.7). Only 30.9% of women reported participating in household decision-making, and 32.5% disagreed with all the reasons justifying wife-beating. At individual-level, factors positively associated with women's empowerment included secondary (AOR: 2.72 (1.77-4.23), and higher (AOR: 3.65 (1.81-7.34) education. However, belonging to the Muslim religion was negatively associated with women's empowerment (AOR: 0.63 (0.47-0.85). At the community level, wealthy communities were positively associated with women's empowerment (AOR: 1.60 (1.05-2.44). Conversely, residing in rural areas (AOR: 0.49 (0.29-0.83), and living in the Afar (AOR: 0.35 (0.17-0.70), Amhara (AOR: 0.45 (0.26-0.79), Oromia (AOR: 0.43 (0.26-0.73), South Nation Nationalities, and Peoples (SNNP) (AOR: 0.42 (0.24-0.75), and Gambella (AOR: 0.36 (0.20-0.66) regional states were negatively associated with women's empowerment. The overall magnitude of women's empowerment in this study was low. Factors that positively influenced empowerment included attending secondary and higher education, as well as residing in communities with higher wealth status. On the other hand, being Muslim, residing in rural areas, and living in the Afar, Amhara, Oromia, SNNPR, Gambella, and Tigray regions were negatively associated with women's empowerment. As a result, the government of Ethiopia needs to design community-based women's empowerment strategies and involve women in income-generation activities that improve their participation in household decision-making to empower them.

Rural-urban differentials in undernutrition among women in India: Evidence from a decomposition approach.

Background: Global healthcare and nutrition policies have not eliminated the pressing public health issue of undernutrition, which remains a paramount public health concern in countries like India, coinciding with overweight and obesity, in the form of dual burden of malnutrition. Aim: This study delves into the rural-urban differential in undernutrition among reproductive-aged women in India for targeted policy interventions and to achieve universal health coverage. Methods: Data from the recent iteration of the National Family Health Survey (NFHS-5; 2019-21) were utilized to examine the factors influencing rural-urban differentials in women's undernutrition. A set of logistic regression and Fairlie's decomposition analysis are employed to identify the associated covariates and understand the factors driving these differentials. Results: The analysis reveals that rural women are significantly more vulnerable to undernutrition compared to urban counterparts, with factors such as education, wealth status, age, and dietary diversity playing key roles. The decomposition analysis of the rural-urban gap revealed that the variables considered in the study accounted for approximately 75% of the disparity. The difference in household wealth between rural and urban areas contributed about 63% of the explained gap, followed by educational status (16%), age group (11%), dietary diversity (8%), religion (5%), and media exposure (4%). Conclusion: The findings underscore the importance of targeted interventions addressing socio-economic inequalities to mitigate undernutrition among women in India. Enhancing access to education, improving economic opportunities, promoting dietary diversity, and challenging cultural norms are crucial steps towards achieving equitable nutritional outcomes and reducing the existing rural-urban disparity.

Regional disparities and socio-demographic factors associated with eight or more antenatal care visits in Ghana

BackgroundAntenatal care is vital for maternal health and wellbeing, with the World Health Organization recommending a minimum of eight visits during pregnancy. In this study, we examined the regional disparities and factors associated with eight or more antenatal care visits in Ghana.MethodsWe performed a cross-sectional analysis of data from the 2022 Ghana Demographic and Health Survey. Our study comprised 3,893 women of reproductive age with birth history in the last two years before the survey. Regional disparities in the proportion of eight or more antenatal care visits were visualised using a spatial map. A mixed-effect multilevel binary logistic regression analysis was conducted to determine the factors associated with eight or more antenatal care visits using a four-modeled approach. The results were presented as adjusted odds ratios (aOR) with a 95% confidence interval (CI).ResultsThe prevalence of eight or more antenatal care visits in Ghana was 38.4% [95% CI = 36.0–41.0]. The regions with the highest prevalence were Eastern, Greater Accra, Western, and Volta. Those with the lowest prevalence were Northern, North East, Savannah, and Oti. The odds of eight or more antenatal care visits were lower among women aged 40–49 [aOR = 0.42, 95% CI = 0.18–0.96], women with four or more children [aOR = 0.57, 95% CI = 0.36–0.93], women who wanted pregnancy later [aOR = 0.63, 95% CI = 0.46–0.85], and women in five regions: Western North [aOR = 0.43, 95% CI = 0.19–0.94], Bono [aOR = 0.33, 95% CI = 0.14–0.76], Northern [aOR = 0.29, 95% CI = 0.13–0.66], Savannah [aOR = 0.30, 95% CI = 0.14–0.65] and North East [aOR = 0.33, 95% CI = 0.14–0.75]. Women in the richer [aOR = 1.99, 95% CI = 1.19–3.33] and richest [aOR = 4.82, 95% CI = 2.45–9.51] wealth index showed a higher likelihood of completing eight or more antenatal care visits relative to women in the poorest wealth index.ConclusionA significant proportion of women in Ghana fall short of the recommended eight or more antenatal care visits. Age, parity, desired pregnancy timing, wealth status, and region of residence are associated with the number of antenatal care visits. Women in five regions (Bono, Northern, North East, Savannah, and Western North) are significantly less likely to have eight or more antenatal care visits than those in the Western region. The government and policymakers should design programs to address the needs of older women, those with high parity, and women who want to delay pregnancy. Increased healthcare resources, educational campaigns, and addressing regional barriers to antenatal care access are crucial. Promoting public health initiatives to emphasise the importance of completing the recommended number of antenatal care visits for a healthy pregnancy is essential.

Enhance physical, mental and academic wellbeing of pupils in Germany through digital health literacy

Abstract Background Digital health literacy (DHL) involves the ability to find, understand, appraise, and apply health information from digital sources. It serves as the foundation for informed decision-making about one’s health and well-being using digital technology and online health information sources and services. Despite its significance, the role of DHL in relation to schoolchildren’s wellbeing remains underexplored. Therefore, this study aims to investigate how schoolchildren’s DHL influences their physical, mental, and academic well-being. Methods The cross-sectional survey comprised a representative sample of N = 1448 school-aged children (9-18 years) living in Germany. DHL was assessed via a translated and adapted version of the DHL instrument. The assessment of physical, mental, and academic well-being relied on the KINDL questionnaire. Linear regression analyses were conducted, with the scale score of physical, mental, and academic well-being serving as dependent variables and DHL as predictor. Additionally, potential confounding variables such as sex, age, migration background, subjective family wealth, chronic illness, and subjective health status were included in the analyses. Results All three regression models were significant (physical: F(9,1325) = 34.99, p &amp;lt; .001; R2 = 0.19; mental: F(9,1320) = 27.43, p &amp;lt; .001; R2 = 0.16; academic: F(9,1336) = 15.19, p &amp;lt; .001; R2 = 0.09). DHL significantly predicted physical (B=.08, p=.01), mental (B=.17, p&amp;lt;.001), and academic (B=.21, p&amp;lt;.001) wellbeing. Conclusions This study provides the first evidence of the predictive power of DHL for schoolchildren’s physical, mental, and academic well-being. It emphasizes the importance of promoting DHL in schoolchildren to empower them to find, understand, appraise, and apply digital health information effectively. Key messages • Digital health literacy significantly predicts schoolchildren’s physical, mental, and academic well-being. • Promoting digital health literacy can empower schoolchildren to make informed decisions about their well-being.

An assessment of adequate quality antenatal care and its determinants in India

BackgroundAntenatal care (ANC) is an important component in the continuum of care. Providing adequate quality ANC is necessary to prevent maternal and newborn mortality. The coverage of ANC has increased significantly in the last decade in India, but a mere increase in coverage is insufficient if the issue of quality is not simultaneously addressed. This study examines the change in each component of quality ANC between 2015-16 and 2019-21, highlights the factors associated with adequate quality ANC, and observes the state- and district-level distribution of adequate quality ANC during 2019-21.MethodsThis study is based on data from the two most recent rounds of the National Family Health Survey (NFHS), the Indian equivalent of the Demographic and Health Surveys (DHS). These rounds were conducted in 2015-16 and 2019-21 in selected households of India with a total of 190,797 and 176,843 sampled births, respectively. The dependent variable was quality antenatal care, a composite variable consisting of skilled healthcare providers, timeliness, sufficiency, and appropriateness of content. The independent variables were mother’s age, education, wealth quintile, birth order, mass media exposure, health insurance coverage, relationship with the head of household, facility exposure, intended pregnancy, history of adverse pregnancy outcomes, and other socio-demographic variables. Change in each component and dimension of quality antenatal care was assessed using data from both rounds of the survey. A multivariate multinomial logistic regression analysis was employed to identify the determinants of adequate quality ANC using the NFHS-5 data.ResultsThe findings revealed that 32 per cent of mothers received adequate quality antenatal care in 2019–2021, an increase of only 9% points compared to the 2015-16 period. Two significant barriers to achieving adequate quality antenatal care, in terms of appropriateness of content, were the provision of Iron and Folic Acid (IFA) tablets and counselling. The highest utilisation of adequate quality antenatal care was observed in the southern states. The utilisation of quality ANC increased with an increase in women’s education and wealth status; and was more prevalent among those with health insurance coverage and exposure to mass media.ConclusionDespite some improvements in the coverage of antenatal care, the quality of antenatal care continues to be very low and needs urgent attention. Achieving quality antenatal care in both content and experience requires addressing service gaps and developing better measures to capture and improve women’s care experiences.

Utilisation and associated socio-demographic factors related to the maternal continuum of care in sub-Saharan Africa: A systematic review and meta-analysis.

Maternal continuum of care (MCC) is the utilisation of maternal health care services, including 4+ antenatal care (ANC) visits, skilled birth attendants (SBAs), and postnatal care (PNC). This systematic review and meta-analysis assessed the pooled proportion of MCC utilisation among women in sub-Saharan Africa (SSA) and its association with selected sociodemographic factors. We identified keywords and MeSH terms related to the condition (MCC), the context (SSA), and population (women with history of childbirth) to search for published or unpublished observational studies. We used the Joanna Briggs Institute tool to extract data and the Newcastle Ottawa Scale for quality assessment. Meta-analysis was used to compute pooled estimates (MCC utilisation and odds ratio (OR) associates) with 95% confidence intervals (CI) using Stata 17. Of 45 402 studies identified, we included 23 involving 320 353 women. The pooled estimate of MCC utilisation across SSA was 18.72% (95% CI = 14.51, 22.93), showing a significant increase (P < 0.05) from 2015 to 2022. Southern Africa had the highest MCC utilisation (38%; 95% CI = 36.59, 39.41), while East Africa had the lowest (17.5%; 95% CI = 12.22, 22.75). Maternal continuum of care utilisation was associated with maternal age 25-34 years (pooled odds ratio (POR) = 1.27), urban residence (POR = 2.69), richer/richest wealth status (POR = 1.68), as well as higher level of education and employment (POR = 1.32). MCC utilisation in SSA remains low, with significant variation across the sub-regions and sociodemographic strata. Context-specific interventions targeting identified factors are essential to enhance MCC utilisation in SSA. PROSPERO: CRD42021272708.

Polygyny, Infant, and Child Mortality in Pakistan: Moderating Effect of Household Wealth Status.

The United Nations report in 2021 ranks Pakistan 21st among countries with the highest infant and child mortality rate in the world. It is the fifth most populous country in the world with a growth rate of 2% annually. Therefore, understanding child mortality is crucial to reducing the child mortality burden. The research utilized two waves of the Pakistan Demographic and Health Survey (PDHS), 2012-13 and 2017-18. The data are analyzed using logistic regression with interaction effects of household wealth status and propensity score matching techniques. The study reveals a positive link between polygyny and infant and child mortality. The odd ratios higher than "1" indicate increased mortality risk for infants and children belonging to polygynous families taking monogamous families as a reference category. Mortality risk is higher among children (OR 1.50 CI 0.18-12.63) as compared with infants (OR 1.28 CI 0.37-4.45). The main effect of household shows a negative association with infant and child mortality while after interacting with polygyny it turns out to be positive. The mortality risks increase with increasing wealth status. It can be translated as a positive link between household wealth status, and infant and child mortality in the context of polygyny. Infants and children belonging to polygynous families experience increased mortality risk as compared with monogamous families. The household wealth status may not help improve child mortality.

Knowledge towards health impacts of climate change among Amhara Sayint community, Northeastern Ethiopia

Purpose This study aims to assess the knowledge of Amhara Sayint district community in Northeastern Ethiopia towards the health impacts of climate change. Design/methodology/approach A community-based cross-sectional study was conducted from 20 July to 5 September 2022, involving 605 randomly selected households in Amhara Sayint district, Northeastern Ethiopia. Data were collected through face-to-face interviews using a pilot-tested and content-validated questionnaire administered via Kobo Collect survey tool. The data were then exported to STATA for management and analysis. A proportional odds approach of ordinal logistic regression model was fitted with a 95% confidence level to identify factors associated with the community’s knowledge towards the health impacts of climate change. Findings Of the total respondents, 3.47% (95% confidence interval [CI]: 2.1, 5.3) and 42.98% (95% CI: 38.9, 47) had inadequate and medium levels of knowledge towards the health impacts of climate change, respectively. Proportional odds model analysis result indicated that gender (female) (adjusted odds ratio [AOR] = 1.49; 95% CI: 1.053, 2.13), wealth status (poorest) (AOR = 1.97; 95% CI: 1.01, 3.83), educational status (unable to read and write) (AOR = 4.13; 95% CI: 1.25, 13.68) and participation status in environmental protection activities (not) (AOR = 1.78; 95% CI: 1.17, 2.71) were factors that significantly associated with inadequate and medium levels of knowledge towards the health impacts of climate change. Research limitations/implications The result of this research is not supported by qualitative methods. Practical implications Residents of the study area know the climate is changing; however, they lack adequate knowledge towards the health impacts of climate change. Social implications Significant number of people have inadequate level of knowledge about health impacts of climate change so relevant health education is needed. Originality/value This research is original in its focus on assessing public knowledge about the health impacts of climate change in the Amhara Sayint district, northeastern Ethiopia, a perspective often overlooked in existing studies. Its findings are crucial for guiding future research and developing targeted public health strategies and educational initiatives.