Barriers and enabling structural forces affecting access to antiretroviral therapy in Nigeria.

BACKGROUND: Access to antiretroviral therapy (ART) helps to improve quality of life and reduces the spread of HIV. However, while a lot of studies focus on supply factors, such as resources for the purchase of antiretroviral drugs, demand and structural forces are not given much emphasis. In this paper it is argued that structural forces shape the way people access antiretroviral therapy in Nigeria. METHODS: A Grounded Theory methodology was undertaken in the research. Semi structured qualitative interviews were administered to select people living with HIV/AIDS in Nigeria. This was facilitated by the Network of People Living with HIV/AIDS in Nigeria (NEPWHAN) to understand their perspectives with regard to barriers and enablers to ART access in Nigeria. Thirty persons living with HIV/AIDS were interviewed and recorded. The interview recordings were transcribed and coded using a constructionist epistemological approach. This was triangulated with results of preliminary and secondary literature review analysis. RESULTS: In this research, the participants discussed structural forces (barriers and enablers) that influenced how they accessed ART. These included economic factors such as poverty that enabled transactional sex. Unequal gender relations and perceptions influenced how they accessed ART. The participants' belief in 'God' and religious activities such as 'prayer' and the use of 'traditional medicine' had an impact on how and when they accessed ART. Political activity at the international, national, and local levels influenced access to ART as well as resources. The individual's familial, social, and organisational connections also influenced their ease of accessing ART. CONCLUSIONS: This study identifies structural forces that affect access to antiretroviral therapy and provides recommendations on how they can be harnessed to enable improved access to ART and consequently improved health.

Spatiotemporal heterogeneity and long-term impact of meteorological, environmental, and socio-economic factors on scrub typhus in China from 2006 to 2018.

BACKGROUND: Large-scale outbreaks of scrub typhus combined with its emergence in new areas as a vector-borne rickettsiosis highlight the ongoing neglect of this disease. This study aims to explore the long-term changes and regional leading factors of scrub typhus in China, with the goal of providing valuable insights for disease prevention and control. METHODS: This study utilized a Bayesian space-time hierarchical model (BSTHM) to examine the spatiotemporal heterogeneity of scrub typhus and analyze the relationship between environmental factors and scrub typhus in southern and northern China from 2006 to 2018. Additionally, a GeoDetector model was employed to assess the predominant influences of geographical and socioeconomic factors in both regions. RESULTS: Scrub typhus exhibits a seasonal pattern, typically occurring during the summer and autumn months (June to November), with a peak in October. Geographically, the high-risk regions, or hot spots, are concentrated in the south, while the low-risk regions, or cold spots, are located in the north. Moreover, the distribution of scrub typhus is influenced by environment and socio-economic factors. In the north and south, the dominant factors are the monthly normalized vegetation index (NDVI) and temperature. An increase in NDVI per interquartile range (IQR) leads to a 7.580% decrease in scrub typhus risk in northern China, and a 19.180% increase in the southern. Similarly, of 1 IQR increase in temperature reduces the risk of scrub typhus by 10.720% in the north but increases it by 15.800% in the south. In terms of geographical and socio-economic factors, illiteracy rate and altitude are the key determinants in the respective areas, with q-values of 0.844 and 0.882. CONCLUSIONS: These results indicated that appropriate climate, environment, and social conditions would increase the risk of scrub typhus. This study provided helpful suggestions and a basis for reasonably allocating resources and controlling the occurrence of scrub typhus.

Demographic and socio-economic factors affecting bed net ownership, usage, and malaria transmission among adult patients seeking healthcare in two Ghanaian urban cities.

BACKGROUND: The most cost-effective malaria prevention and control strategy is the use of a bed net. However, several factors affect the ownership and usage of bed nets among the adult population. Hence, this study aimed to examine socio-demographic factors affecting bed net ownership, usage and malaria transmission among adult patients seeking healthcare in two Ghanaian urban cities. METHODS: This hospital-based cross-sectional study was conducted, between January and September 2021, at Bremang Seventh-Day Adventist Hospital, Suame Municipal, Ashanti Region and Sunyani Municipal Hospital, Sunyani, Bono Region, Ghana. Structured questionnaires were administered to a total of 550 participants to ascertain their ownership and usage of the bed nets. Afterwards, finger prick blood samples were collected for malaria microscopy. Crude and adjusted prevalence ratios (PR) and their respective 95% CIs were calculated, using Poisson regression with robust standard errors, to show associated variables in bivariate and multivariate analyses respectively. R software (version 4.1.1) was used to perform all statistical analyses. RESULTS: About 53.3% (n = 293) of participants owned at least one-bed net but only 21.5% (n = 118) slept under it the previous night. Those married were 2.0 (95% CI: 1.6 - 2.5) and 2.4 (95% CI: 1.6 - 3.5) times more likely to own and use a bed net respectively than those who never married. Also, pregnant women were 1.3 (95% CI: 1.1 - 1.6) and 1.8 (95% CI: 1.3 - 2.5) times more likely to own and use a bed net respectively than non-pregnant. Even though income levels were not associated with bed net ownership and usage, students were 0.4 (95% CI: 0.2 - 0.6) and 0.2 (95% CI: 0.1 - 0.5) times less likely to own and use bed net respectively compared to formally employed persons. The overall malaria prevalence rate was 7.8%. Malaria-negative patients were 1.6 (95% CI: 1.2 - 2.0) and 2.4 (95% CI: 1.4 - 4.1) times more likely to own and use bed nets respectively than malaria positive. Patients with tertiary education recorded the lowest malaria prevalence (3.5%, n = 4). None of those with a monthly income > $300 recorded a case of malaria. On the contrary, majority 83%, n/N = 25/30) of the malaria-positive patients earned ≤ $150. CONCLUSION: The National Malaria Control Program should conduct comprehensive mapping of all urban population segments before launching mass bed net distribution campaigns, taking into account demographic and socioeconomic factors to enhance bed net utilization and reduce malaria prevalence.

Socio-demographic and economic factors associated with the consumption of processed foods in South Africa - Evidence from Demographic and Health Survey VII.

OBJECTIVE: The primary objective of this study was to examine the socio-demographic and economic factors associated with the consumption of processed foods in South Africa. STUDY DESIGN: This is an empirical study where secondary data analysis was performed from the South African Demographic and Health Survey VII. METHODS: A nationally representative sample of 10,336 participants (aged ≥15 years) was included in the analysis. Using regression models, we studied the association between socio-demographic and economic predictors and the intake of processed foods. RESULTS: The regression models found that the odds of consumption of any type of processed foods were significantly high in all South African provinces but specifically higher in urban settings, those with any level of education, and young adults. The odds of processed meat consumption were significantly higher among the coloured population, while that of fried food, fast food, and salty snacks was significant in the white population. The odds of consumption increased irrespective of marital status and were higher among males, specifically among those in the poorer and poorest wealth quintiles. CONCLUSION: These findings warrant advocacy and action for healthy food choices in the population. The role of industry, ethnic vulnerability, and gender stereotypes in food preparation are areas that need priority attention.

Estimating the effect of socio-economic factors on infant mortality rates in Latin America between 2000 and 2019: a panel data analysis.

OBJECTIVES: Infant mortality is a crucial indicator of socio-economic development, reflecting the conditions in which children are born and raised. Despite notable reductions in Latin America, infant mortality rates remain relatively high compared to other regions worldwide. By understanding the socio-economic factors that influence infant mortality, we not only uncover immediate causes of infant deaths but also shed light on broader socio-economic and healthcare disparities contributing to the burden of disease. This study analyzes the impact of socio-economic factors on infant mortality rates in Latin America from 2000 to 2019, estimating the speed and magnitude of the response of infant mortality rates to changes in specific socio-economic factors. STUDY DESIGN: Longitudinal panel study. METHODS: Panel data regression models were used to examine the influence of specific socio-economic factors on infant mortality rates in Latin America. Additionally, impulse response functions estimated by local projections were used to estimate the speed and magnitude of the impact of socio-economic factors on infant mortality rates. RESULTS: The results highlight the importance of factors such as healthcare expenditure, female literacy, public expenditures on education, maternal mortality, physician density, total fertility rate, and tuberculosis incidence as significant determinants of infant mortality rates in the region. CONCLUSION: This study adds to the existing literature by offering empirical evidence on the association between these socio-economic factors and infant mortality in Latin America. It also provides a foundation for future research that investigates specific cases within Latin America and examines the variations of these socio-economic factors within those countries.

Socio-economic factors and medical conditions affecting regular stomach cancer screening in Korea: a retrospective longitudinal study using national public health data for 11 years.

OBJECTIVE: This study aimed to explore socio-economic factors and medical conditions that affect regular stomach cancer (SC) screening among Korean adults. STUDY DESIGN: This was a retrospective observational study. METHODS: Study subjects were 5545 adults aged ≥40 years who participated in the 2007-2012 Korean National Health and Nutrition Examination Survey and were followed up to year 2017 based on data linking to the Korean National Health Insurance Service and Korean Health Insurance Review and Assessment. Socio-economic factors included sex, age, residential area, education, occupation, marital status, disability, public and private health insurance, service through local public health organizations, history of cancer except for SC, and family history of SC. Medical factors included six gastric lesions with the possibility of facilitating SC screening, including benign gastric neoplasm, chronic atrophic gastritis, gastric polyp, Helicobacter pylori infection, intestinal metaplasia, and peptic ulcers. The outcome was adherence to SC screening, which was divided into non-adherence, irregular adherence, and regular adherence. RESULTS: After adjusting for the effects of socio-economic factors, multivariate ordinal logistic regression revealed that participants with a history of four types of gastric lesions were more likely to regularly participate in SC screening: chronic atrophic gastritis (odds ratio [OR] 1.567; 95% confidence interval [CI] = 1.276-1.923), gastric polyps (OR 1.565; 95% CI = 1.223-2.003), H. pylori infection (OR 1.637; 95% CI = 1.338-2.003), and peptic ulcer (OR 2.226; 95% CI 1.750-2.831). CONCLUSIONS: To improve participation in SC screening, it is necessary to implement personalized strategies for individuals at risk for gastric cancer in addition to population-based strategies for vulnerable groups.

Changes in Health Care Workers' Economic Outcomes Following Medicaid Expansion.

Importance: The extent to which changes in health sector finances impact economic outcomes among health care workers, especially lower-income workers, is not well known. Objective: To assess the association between state adoption of the Affordable Care Act's Medicaid expansion-which led to substantial improvements in health care organization finances-and health care workers' annual incomes and benefits, and whether these associations varied across low- and high-wage occupations. Design, Setting, and Participants: Difference-in-differences analysis to assess differential changes in health care workers' economic outcomes before and after Medicaid expansion among workers in 30 states that expanded Medicaid relative to workers in 16 states that did not, by examining US individuals aged 18 through 65 years employed in the health care industry surveyed in the 2010-2019 American Community Surveys. Exposure: Time-varying state-level adoption of Medicaid expansion. Main Outcomes and Measures: Primary outcome was annual earned income; secondary outcomes included receipt of employer-sponsored health insurance, Medicaid, and Supplemental Nutrition Assistance Program benefits. Results: The sample included 1 322 263 health care workers from 2010-2019. Health care workers in expansion states were similar to those in nonexpansion states in age, sex, and educational attainment, but those in expansion states were less likely to identify as non-Hispanic Black. Medicaid expansion was associated with a 2.16% increase in annual incomes (95% CI, 0.66%-3.65%; P = .005). This effect was driven by significant increases in annual incomes among the top 2 highest-earning quintiles (ß coefficient, 2.91%-3.72%), which includes registered nurses, physicians, and executives. Health care workers in lower-earning quintiles did not experience any significant changes. Medicaid expansion was associated with a 3.15 percentage point increase in the likelihood that a health care worker received Medicaid benefits (95% CI, 2.46 to 3.84; P < .001), with the largest increases among the 2 lowest-earning quintiles, which includes health aides, orderlies, and sanitation workers. There were significant decreases in employer-sponsored health insurance and increases in SNAP following Medicaid expansion. Conclusion and Relevance: Medicaid expansion was associated with increases in compensation for health care workers, but only among the highest earners. These findings suggest that improvements in health care sector finances may increase economic inequality among health care workers, with implications for worker health and well-being.

Commentary: Determining Economic Factors That Matter to People With Intellectual and Developmental Disabilities and Their Caregivers: A Process Framework.

BACKGROUND: The 2020-2029 strategic plan for the Patient-Centered Outcomes Research Trust Fund calls for addressing data infrastructure gaps that are critical for studying issues around intellectual and developmental disabilities (I/DD). Specifically, the plan calls for data collection on economic factors that affect person-centered approaches to health care decision-making. Among people with I/DD and their caregivers, such economic factors may include financial costs of care, decreased opportunities for leisure and recreation, income losses associated with caregiving, and foregone opportunities for skill acquisition or other human capital investments. OBJECTIVE: This commentary supports responsiveness to the Patient-Centered OutcomesResearch Trust Fund (PCORTF) calls by conceptualizing and operationalizing a framework for identifying preferences on economic factors that are relevant to people with I/DD and their caregivers. MAIN ARGUMENTS: The framework outlined in this commentary addresses barriers to data collection that hinder measure development in the study of I/DD. This work is significant and timely given the continued movement to integrate and maintain people with I/DD within communities and recent methodological advances for eliciting preferences among people with I/DD. RELEVANCE TO THE SPECIAL ISSUE: Readers will be introduced to a framework for building data capacity in the study of economic outcomes among a population that is a high research priority for federal funding agencies. This commentary aims to be useful to researchers in planning, developing, and initiating projects in this area.

An observational, sequential analysis of the relationship between local economic distress and inequities in health outcomes, clinical care, health behaviors, and social determinants of health.

BACKGROUND: Socioeconomic status has long been associated with population health and health outcomes. While ameliorating social determinants of health may improve health, identifying and targeting areas where feasible interventions are most needed would help improve health equity. We sought to identify inequities in health and social determinants of health (SDOH) associated with local economic distress at the county-level. METHODS: For 3,131 counties in the 50 US states and Washington, DC (wherein approximately 325,711,203 people lived in 2019), we conducted a retrospective analysis of county-level data collected from County Health Rankings in two periods (centering around 2015 and 2019). We used ANOVA to compare thirty-three measures across five health and SDOH domains (Health Outcomes, Clinical Care, Health Behaviors, Physical Environment, and Social and Economic Factors) that were available in both periods, changes in measures between periods, and ratios of measures for the least to most prosperous counties across county-level prosperity quintiles, based on the Economic Innovation Group's 2015-2019 Distressed Community Index Scores. RESULTS: With seven exceptions, in both periods, we found a worsening of values with each progression from more to less prosperous counties, with least prosperous counties having the worst values (ANOVA p < 0.001 for all measures). Between 2015 and 2019, all except six measures progressively worsened when comparing higher to lower prosperity quintiles, and gaps between the least and most prosperous counties generally widened. CONCLUSIONS: In the late 2010s, the least prosperous US counties overwhelmingly had worse values in measures of Health Outcomes, Clinical Care, Health Behaviors, the Physical Environment, and Social and Economic Factors than more prosperous counties. Between 2015 and 2019, for most measures, inequities between the least and most prosperous counties widened. Our findings suggest that local economic prosperity may serve as a proxy for health and SDOH status of the community. Policymakers and leaders in public and private sectors might use long-term, targeted economic stimuli in low prosperity counties to generate local, community health benefits for vulnerable populations. Doing so could sustainably improve health; not doing so will continue to generate poor health outcomes and ever-widening economic disparities.

Factors affecting ability of TB patients to follow treatment guidelines - applying a capability approach.

BACKGROUND: Negotiating anti-Tuberculosis treatment is a complicated process comprising daily consumption of multiple medications at stipulated times and dosages, as well as periodic follow-ups and investigations, may not be uniform for all Tuberculosis (TB) patients and some may perform better than others. In this context, we conducted a study in Thiruvananthapuram district, Kerala to ascertain the ability of those suffering from TB to follow treatment guidelines. METHODS: This study used an embedded mixed methods design. We collected cross-sectional data from 135 drug sensitive pulmonary TB patients aged 18 years or above in Thiruvananthapuram, Kerala using a structured questionnaire to get the proportion of patients following all treatment guidelines. We also did eight in-depth interviews (four men and four women) from within the survey sample. The in-depth interviews were inductively analysed for getting deeper insights about reasons for the choices people made regarding the treatment guidelines. Written informed consent was taken from all participants and the study was implemented after the necessary programmatic and ethical clearances. RESULTS: Of the 105 men and 30 women studied, uninterrupted daily drug consumption was reported by 80 persons (59.3%, 95% Confidence Intervals (CI) 50.8-67.2%). Overall, 38 (28.2%, 95% CI 21.3%-36.3%) persons were able to follow all seven aspects of advised guidelines. Living in an extended/ joint family (Adjusted Odds ratio (AOR) 2.6, 95% CI 1.1-6.0), approximate monthly household expenditure of over rupees 13,500 (AOR 2.9, 95% CI 1.3-6.7) and no perceived delay in seeking initial care (AOR 3.2, 95% CI 1.2-8.7) were significantly associated with following all aspects of treatment guidelines. In-depth interviews revealed reflective treatment related behaviours were influenced by bodily experiences, moral perceptions, social construct of TB, programmatic factors and substance use. Sometimes behaviours were non-reflective also. Programmatic stress was on individual agency for changing behaviour but capability and opportunity for these were influenced social aspects like stigma, gender roles and poverty. CONCLUSION: TB patients live amidst a syndemic of biomedical and social problems. These problems influence the capabilities and opportunities of such TB patients to follow treatment guidelines. Interventions should balance focus on individual agency and social abd economic factors.

Enhancing linkage to HIV care in the "Universal Test and Treat" era: Barriers and enablers to HIV care among adults in a high HIV burdened district in KwaZulu-Natal, South Africa.

Ending AIDS by 2030 would depend on how successful health systems are in linking people living with HIV (PLHIV) into care. The World Health Organization recommended the 'Universal Test and Treat' (UTT) strategy - initiating all individuals testing positive on antiretroviral therapy (ART) irrespective of their CD4 count and clinical staging. This study aimed to explore the enablers and barriers to linkage to HIV care among adults with a new HIV diagnosis in a high-HIV prevalent rural district in South Africa. A qualitative study was undertaken to explore patients' perceptions of enablers and barriers of linkage-to-care, using a life-story narration and dialogue approach. In-depth interviews were conducted with 38 HIV-positive participants sampled from a cohort of 1194 HIV-positive patients recruited from December 2017 to June 2018. Participants were selected based on whether they had been linked to care or not within 3 months of positive HIV diagnosis. Interviews were thematically analysed using a general inductive approach. Of the 38 participants, 22 (58%) linked to care within three months of HIV-positive diagnosis. Factors that facilitated or inhibited linkage-to-care were found at individual, family, community, as well as health systems levels. Enablers included a positive HIV testing experience, and assistance from the fieldwork team. Support from family, and friends, as well as prior community-based education about HIV and ART were also noted. Individual factors such as acceptance of HIV status, previous exposure to PLHIV, and fear of HIV progressing, were identified. Barriers to linkage included, denial of HIV status, dislike of taking pills, and preference for alternative medicine. Negative experiences with counselling and health systems inefficiency were also noted as barriers. Perceived stigma and socio-economic factors, such as lack of food or money to visit the clinic were other barriers. Community-based and health system-level interventions would need to focus on clinic readiness in providing patients with necessary and effective health services such as proper and adequate counselling. This could increase the number of patients who link to care. Finally, interventions to improve linkage-to-care should consider a holistic approach, including training healthcare providers, community outreach and the provision of psychological, social, and financial support.

Indonesia youth population norms for EQ-5D-Y-3 L, EQ-5D-Y-5 L and the PedsQL generic core scale: lower health related quality of life relates to high economic status and stress.

BACKGROUND: The availability of population norms from generic health-related quality of life (HRQoL) instruments can support the interpretation of health outcomes. This study aimed to provide Indonesian youth population norms for the generic HRQoL measures: EQ-5D-Y-3 L, EQ-5D-Y-5 L, and the PedsQL Generic Core Scales. In addition the opportunity arising from the generation of a large representative sample was taken to explore the relationships between HRQoL, health, and socio-economic factors. METHODS: A representative sample of 1103 Indonesian children (aged 8-16 years) completed EQ-5D-Y-3 L, EQ-5D-Y-5 L, the PedsQL Generic Core Scales, and questions related to demographic data and self-reported health status. A stratified quota sampling design was used to represent Indonesian children in terms of residence, age, gender, and geographical area. Family expenses per capita per month were retrieved from parents to determine a child's economic status. RESULTS: The total sample was representative of the Indonesian youth general population. The proportions of participants who reported problems were 43.35% (EQ-5D-Y-3 L), 44.10% (EQ-5D-Y-5 L), and 94.93% (PedsQL Generic), with 31.7% of children reporting health complaints. Older children (13-16 years) reported more problems than younger children (8-12 years). Children living in urban areas reported more problems than children living in rural areas. The lowest value health state reported was '12332' (valued at 0.54), and the minimum EQ VAS score was 60.00. Moderate correlations were found between EQ-5D-Y-3 L values to EQ VAS scores and to PedsQL Total Score. Hierarchical regression analysis showed that females, older age, and having health complaints contributed to a lower level of HRQoL as measured by EQ-5D-Y-3 L values, EQ VAS, and PedsQL Total Score. Remarkably, children with high economic status had lower EQ VAS and PedsQL Total Scores. Among symptoms, 'having stress' had the largest influence with respect to lower EQ-5D-Y-3L values, EQ VAS, and PedsQL Total Score. CONCLUSIONS: Population norms for children's HRQoL as measured by EQ-5D-Y-3 L, EQ-5D-Y-5 L, and the PedsQL Generic Scales are now available for Indonesia. Age, gender, economic status, and health complaints were related to children's HRQoL. These results provide a basis for health studies and health policy for the youth population of Indonesia.

Socio-economic factors, mood, primary care utilization, and quality of life as predictors of intervention cessation and chronic stress in a type 2 diabetes prevention intervention (PREVIEW Study).

BACKGROUND: Sedentary lifestyle and unhealthy diet combined with overweight are risk factors for type 2 diabetes (T2D). Lifestyle interventions with weight-loss are effective in T2D-prevention, but unsuccessful completion and chronic stress may hinder efficacy. Determinants of chronic stress and premature cessation at the start of the 3-year PREVIEW study were examined. METHODS: Baseline Quality of Life (QoL), social support, primary care utilization, and mood were examined as predictors of intervention cessation and chronic stress for participants aged 25 to 70 with prediabetes (n = 2,220). Moderating effects of sex and socio-economic status (SES) and independence of predictor variables of BMI were tested. RESULTS: Participants with children, women, and higher SES quitted intervention earlier than those without children, lower SES, and men. Lower QoL, lack of family support, and primary care utilization were associated with cessation. Lower QoL and higher mood disturbances were associated with chronic stress. Predictor variables were independent (p ≤ .001) from BMI, but moderated by sex and SES. CONCLUSIONS: Policy-based strategy in public health should consider how preventive interventions may better accommodate different individual states and life situations, which could influence intervention completion. Intervention designs should enable in-built flexibility in delivery enabling response to individual needs. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01777893.

The impact of geo-political socio-economic factors on vaccine dissemination trends: a case-study on COVID-19 vaccination strategies.

BACKGROUND: The world in recent years has seen a pandemic of global scale. To counter the widespread loss of life and severe repercussions, researchers developed vaccinations at a fast pace to immunize the population. While the vaccines were developed and tested through extensive human trials, historically vaccines have been known to evoke mixed sentiments among the generic demographics. In the proposed study, we aim to reveal the impact of political and socio-economic factors on SARS-Cov-2 vaccination trends observed in two hundred and seventeen countries spread across the six continents. METHODS: The study had hypothesized that the citizens who have lower trust in their government would be less inclined towards vaccination programs. To test this hypothesis, vaccination trends of nations under authoritarian rule were compared against democratic nations. Further, the study was synthesized with Cov-2 vaccination data which was sourced from Our World Data repository, which was sampled among 217 countries spread across the 6 continents. The study was analyzed with exploratory data analysis and proposed with relevance and impacting factor that was considered for vaccine dissemination in comparison with the literacy rate of the nations. Another impacting factor the study focused on for the vaccination dissemination trends was the health expenses of different nations. The study has been synthesized on political and socio-economic factors where the features were ardently study in retrospect of varied socio- economic features which may include country wise literacy rate, overall GDP rate, further we substantiated the work to address the political factors which are discussed as the country status of democratic or having other status. RESULTS: The comparison of trends showed that dissemination of SARS-Cov-2 vaccines had been comparable between the two-opposing types of governance. The major impact factor behind the wide acceptance of the SARS-Cov-2 vaccine was the expenditure done by a country on healthcare. These nations used a large number of vaccines to administer to their population and the trends showed positive growth. The overall percentage of vaccine utilized by countries in quantitative terms are Pfizer/BioNTech (17.55%), Sputnik V (7.08%), Sinovac (6.98%), Sinopharm/Beijing (10.04%), Oxford/AstraZeneca (19.56%), CanSino (2.85%), Moderna (12.05%), Covaxin (3.28%), JohnsonandJohnson (10.89%), Sputnik Light (3.07%), Novavax (3.49%). While the nations with the lowest healthcare expenses failed to keep up with the demand and depended on vaccines donated by other countries to protect their population. CONCLUSIONS: The analysis revealed strong indicators that the nations which spend more on healthcare were the ones that had the best SARS-Cov-2 vaccination rollout. To further support decision-making in the future, countries should address the trust and sentiment of their citizens towards vaccination. For this, expenses need to be made to develop and promote vaccines and project them as positive health tools.

Ethnic differences in multimorbidity after accounting for social-economic factors, findings from The Health Survey for England.

BACKGROUND: Social-economic factors and health behaviours may be driving variation in ethnic health inequalities in multimorbidity including among distinct ethnic groups. METHODS: Using the cross-sectional nationally representative Health Surveys for England 2011-18 (N = 54 438, aged 16+), we performed multivariable logistic regression on the odds of having general multimorbidity (≥2 longstanding conditions) by ethnicity [British White (reference group), White Irish, Other White, Indian, Pakistani, Bangladeshi, Chinese, African, Caribbean, White mixed, Other Mixed], adjusting for age, sex, education, area deprivation, obesity, smoking status and survey year. This was repeated for cardiovascular multimorbidity (N = 37 148, aged 40+: having ≥2 of the following: self-reported diabetes, hypertension, heart attack or stroke) and multiple cardiometabolic risk biomarkers (HbA1c ≥6.5%, raised blood pressure, total cholesterol ≥5mmol/L). RESULTS: Twenty percent of adults had general multimorbidity. In fully adjusted models, compared with the White British majority, Other White [odds ratio (OR) = 0.63; 95% confidence interval (CI) 0.53-0.74], Chinese (OR = 0.58, 95% CI 0.36-0.93) and African adults (OR = 0.54, 95% CI 0.42-0.69), had lower odds of general multimorbidity. Among adults aged 40+, Pakistani (OR = 1.27, 95% CI 0.97-1.66; P = 0.080) and Bangladeshi (OR = 1.75, 95% CI 1.16-2.65) had increased odds, and African adults had decreased odds (OR = 0.63, 95% CI 0.47-0.83) of general multimorbidity. Risk of cardiovascular multimorbidity was higher among Indian (OR = 3.31, 95% CI 2.56-4.28), Pakistani (OR = 3.48, 95% CI 2.52-4.80), Bangladeshi (OR = 3.67, 95% CI 1.98-6.78), African (OR = 1.61, 95% CI 1.05-2.47), Caribbean (OR = 2.18, 95% CI 1.59-2.99) and White mixed (OR = 1.98, 95% CI 1.14-3.44) adults. Indian adults were also at risk of having multiple cardiometabolic risk biomarkers. CONCLUSION: Ethnic inequalities in multimorbidity are independent of social-economic factors. Ethnic minority groups are particularly at risk of cardiovascular multimorbidity, which may be exacerbated by poorer management of cardiometabolic risk requiring further investigation.

The application of spatial analysis to understanding the association between area-level socio-economic factors and suicide: a systematic review.

BACKGROUND: Little is known about what impact the use of different spatial methodological approaches may have on understanding the relationship between area-level socio-economic factors and suicide. METHODS: In this systematic review, we searched PubMed, Embase, CINAHL and PsycInfo for original empirical studies examining the relationship between socio-economic factors and suicide with a spatial lens, published up to January 22, 2022. Data on applied spatial methods, indicators of socio-economic factors, and risk of suicide related to socio-economic factors were extracted. The protocol for this systematic review was registered with PROSPERO (CRD42021251387). RESULTS: A systematic search yielded 6290 potentially relevant results; 58 studies met the inclusion criteria for review. Of the 58 included studies, more than half of the studies (n = 34; 58.6%) used methods that accounted for spatial effects in analyses of the association between socio-economic factors and suicide or examined spatial autocorrelation, while 24 (41.4%) studies applied univariate and multivariate models without considering spatial effects. Bayesian hierarchical models and spatial regression models were commonly used approaches to correct for spatial effects. The risk of suicide relating to socio-economic factors varied greatly by local areas and between studies using various socio-economic indicators. Areas with higher deprivation, higher unemployment, lower income, and lower education level were more likely to have higher suicide risk. There was no significant difference in results between studies using conventional versus spatial statistic methods. CONCLUSION: An increasing number of studies have applied spatial methods, including Bayesian spatial models and spatial regression models, to explore the relationship between area-level socio-economic factors and suicide. This review of spatial studies provided further evidence that area-level socio-economic factors are generally inversely associated with suicide risk, with or without accounting for spatial autocorrelation.

First Nations music as a determinant of health in Australia and Vanuatu: political and economic determinants.

This article reports on findings that indicate how First Nations musical activities function as cultural determinants of health. Drawing on early findings from a 3-year Australian Research Council funded project titled The Remedy Project: First Nations Music as a Determinant of Health, we detail Australian and Ni Vanuatu First Nations musicians' reported outcomes of musical activity using a First Nations cultural determinants of health framework. The broader findings indicate that our respondents see musical activity as actively shaping all known domains of cultural health determinants, and some surrounding political and social determinants. However, this paper focusses specifically on the political and economic determinants that emerged in analysis as the most dominant subthemes. We argue that this study provides strong impetus for continued investigation and reconceptualization of the place of music in cultural health determinant models.

This article looks at how making and performing music, recording music and listening to music helps the health of First Nations peoples in Australia and Ni Vanuatu. Music is an important part of the lives of First Nations peoples from these places and so research was done to try to understand why it is meaningful. Music can be used as an outlet for personal feelings, and can also be a way that groups of people can express common concerns. First Nations musicians talked about how music makes them feel, and how music is used to strengthen relationships between people, and between people and their culture. Musicians also talked about how music helps them express their political and economic goals. The findings backed up existing First Nations' models of health that say that health for First Nations People's needs to be thought about in a holistic way. The findings also showed that the relationship between music and health needs to be studied more so that we can better understand how it helps maintain links with the past, gives a guide for the present and opens options for the future.

Farm management and economic factors associated with bulk tank total bacterial count in Holstein dairy herds in Iran.

The objectives of this research were (1) to study different factors affecting milk total bacterial count (TBC) and (2) to estimate the economic value associated with TBC in Holstein dairy herds in Iran. The relationships between bulk tank TBC and farm management and economic factors were examined on 56 randomly selected intensive dairy farms. Herd management factors associated with bulk tank TBC were determined using mixed linear models. The median bulk tank TBC for the sample herds was 299 (range 81-1185) × 103 cfu/ml. The average economic premium opportunity from bulk tank TBC was US$ 1.32 per ton of milk ranging from US$ 0.02 per ton of milk for herds applying wet tissue procedures as teat cleaning material and washing the water troughs three times per day to US$ 5.20 per ton of milk for herds with dirty barns. Results showed that the following management factors were associated with low TBC and high economic value: frequency of cleaning water troughs, teat cleaning material, the frequency of milk delivery to the processor, bedding material, herd size, education level of workers, udder washing material, material of milking parlor wall, frequency of disinfection of the calving area, presence of veterinarian, water quality control, having a hospital pen and barn hygiene. In conclusion, our findings highlight the need to pay more attention to farm management issues, particularly farm hygiene practices to reduce milk TBC and so reduce the economic burden of TBC in dairy herds in Iran.

Nonlinear effects of socio-economic factors on urban haze in China: Evidence from spatial econometric smooth transition autoregressive regression approach.

In recent years, China has achieved numerous economic miracles but it has also been plagued by severe air pollution. The frequent hazy weather has severely restricted China's sustainable development. To investigate the nonlinear threshold effect of socio-economic factors on urban haze in China, this study constructs a spatial econometric Smooth Transition Autoregressive Regression (STAR) model based on the STIRPAT theory by using the remote sensing inversion PM2.5 data of 223 prefecture-level and above cities in China mainland during 2004-2016. In this study, the ARAR-STAR model is estimated by quasi-maximum likelihood estimation, and the accuracy of parameter estimation is verified by Monte Carlo simulation, which proves that the ARAR-STAR model constructed in this study is robust. It is concluded that: there is a complex spatial nonlinear relationship between socio-economic factors such as economic development level, population density, advanced industrial structure, energy consumption, opening-up, and haze pollution. The effect of socio-economic factors on haze emission reduction under the spatial influence has complex heterogeneity with the smooth transition between high and low regimes with economic development. The ARAR-STAR model constructed in this paper, which has both individual fixed effects and time fixed effects, expands the form of existing spatial panel nonlinear models and enriches and implements the application of spatial panel smooth transfer threshold models in the environmental field. Not only can it provide policy recommendations for China to achieve "coordinated efficiency in pollution reduction and carbon reduction" as soon as possible, but it also contributes to China's plan to address global climate change and promote global sustainable development.

Influence of households' socio-economic factors on maternal and under-five survival in Nigeria: Implication for the sustainable development goal 3.

The objective of this study was to examine the influence of household socio-economic factors on maternal mortality and under-five survival in Nigeria. Consequently, data from 2005 to 2021 were collected from the World Development Indicators, and fully modified least squares and canonical cointegrating regression were utilised to implement the study. The results showed that for every 100,000 live births, at least 1097 mothers die in Nigeria. GDP per capita showed a positive but insignificant impact on maternal mortality, while adjusted net national income had a significant negative relationship with maternal mortality. Broad money supply reduced under-five survival in Nigeria, while social inclusion causes a reduction in under-5 mortality with 32 deaths per 1,000 live births in Nigeria. Hence, to reduce the high rate of maternal mortality in Nigeria, policy and programmes that will be socially inclusive for women and children should be implemented in the country.

L'objectif de cette étude était d'examiner l'influence des facteurs socio-économiques des ménages sur la mortalité maternelle et la survie des moins de cinq ans au Nigeria. Par conséquent, les données de 2005 à 2021 ont été collectées à partir des indicateurs de développement dans le monde, et les moindres carrés entièrement modifiés et la régression canonique de cointégration ont été utilisés pour mettre en oeuvre l'étude. Les résultats ont montré que pour 100 000 naissances vivantes, au moins 1 097 mères meurent au Nigeria. Le PIB par habitant a montré un impact positif mais insignifiant sur la mortalité maternelle, tandis que le revenu national net ajusté avait une relation négative significative avec la mortalité maternelle. Une masse monétaire importante a réduit la survie des moins de cinq ans au Nigeria, tandis que l'inclusion sociale entraîne une réduction de la mortalité des moins de cinq ans avec 32 décès pour 1 000 naissances vivantes au Nigeria. Par conséquent, pour réduire le taux élevé de mortalité maternelle au Nigeria, des politiques et des programmes socialement inclusifs pour les femmes et les enfants doivent être mis en oeuvre dans le pays.