Mind the gap: what explains the rural-nonrural inequality in diarrhoea among under-five children in low and medium-income countries? A decomposition analysis.

BACKGROUND: Diarrhoea poses serious health problems among under-five children (U5C) in Low-and Medium-Income Countries (LMIC) with a higher prevalence in rural areas. A gap exists in knowledge on factors driving rural-non-rural inequalities in diarrhoea development among U5C in LMIC. This study investigates the magnitude of rural-non-rural inequalities in diarrhoea and the roles of individual-level and neighbourhood-level factors in explaining these inequalities. METHODS: Data of 796,150 U5C, from 63,378 neighbourhoods across 57 LMIC from the most recent Demographic and Health Survey (2010-2018) was analysed. The outcome variable was the recent experience of diarrhoea while independent variables consist of the individual- and neighbourhood-level factors. Data were analysed using multivariable Fairlie decomposition at p < 0.05 in Stata Version 16 while visualization was implemented in R Statistical Package. RESULTS: Two-thirds (68.0%) of the children are from rural areas. The overall prevalence of diarrhoea was 14.2, 14.6% vs 13.4% among rural and non-rural children respectively (p < 0.001). From the analysis, the following 20 countries showed a statistically significant pro-rural inequalities with higher odds of diarrhoea in rural areas than in nonrural areas at 5% alpha level: Albania (OR = 1.769; p = 0.001), Benin (OR = 1.209; p = 0.002), Burundi (OR = 1.399; p < 0.001), Cambodia (OR = 1.201; p < 0.031), Cameroon (OR = 1.377; p < 0.001), Comoros (OR = 1.266; p = 0.029), Egypt (OR = 1.331; p < 0.001), Honduras (OR = 1.127; p = 0.027), India (OR = 1.059; p < 0.001), Indonesia (OR = 1.219; p < 0.001), Liberia (OR = 1.158; p = 0.017), Mali (OR = 1.240; p = 0.001), Myanmar (OR = 1.422; p = 0.004), Namibia (OR = 1.451; p < 0.001), Nigeria (OR = 1.492; p < 0.001), Rwanda (OR = 1.261; p = 0.010), South Africa (OR = 1.420; p = 0.002), Togo (OR = 1.729; p < 0.001), Uganda (OR = 1.214; p < 0.001), and Yemen (OR = 1.249; p < 0.001); and pro-non-rural inequalities in 9 countries. Variations exist in factors associated with pro-rural inequalities across the 20 countries. Overall main contributors to pro-rural inequality were neighbourhood socioeconomic status, household wealth status, media access, toilet types, maternal age and education. CONCLUSIONS: The gaps in the odds of diarrhoea among rural children than nonrural children were explained by individual-level and neighbourhood-level factors. Sustainable intervention measures that are tailored to country-specific needs could offer a better approach to closing rural-non-rural gaps in having diarrhoea among U5C in LMIC.

Environmental sustainability and prevention of heavy metal pollution of some geo-materials within a city in southwestern Nigeria.

Increased anthropogenic activities may cause the release of potentially hazardous metals into the environment. This is a major public health concern. The study was aimed at accessing ways by which pollution can be prevented with enhanced environmental sustainability in Ibadan, Southwestern, Nigeria. Geo-materials (groundwater, soil and stream sediment) were collected, analyzed for heavy metals using inductively coupled plasma-mass spectrometry. Results of acidity (pH), electrical conductivity (EC), total dissolved solid (TDS) and heavy metals (Zn, As, and Cd) obtained in water were compared with WHO permissible limits. All parameters were found within WHO permissible limits except TDS (624.35 mg/L). Risk index showed dangerous to extremely dangerous. High TDS can be attributed to weathering while high Cd, Zn and Pb in stream sediment and soil are due to anthropogenic effect. Provision of adequate disposal facilities should be created by private and government agencies and the use of it must be enforced.

Perceptions on the use of insecticide treated nets in parts of the Imo River Basin, Nigeria: implications for preventing malaria in pregnancy.

This study aimed at assessing perceptions on use of ITNs in parts of the Imo River Basin, Nigeria and its implications in preventing malaria in pregnancy. Data was collected using focus group discussions, key informant interviews and structured questionnaires. Results showed high awareness on the benefits of ITNs. Factors affecting use of ITNs included its high cost, perceptions of chemicals used to treat them as having dangerous effects on pregnancy, low utilization of antenatal care, husband's lack of interest in malaria prevention and perceptions that adolescent girls are at low risk of getting malaria. The implications of these findings include demystifying the negative perceptions on the chemicals used for net treatment and subsidizing the cost of ITNs to increase access. These findings provide important lessons for malaria programmes that aim at increasing access to ITNs by pregnant women in developing countries.

Repellency and larvicidal activities of Azadirachta indica seed oil on Anopheles gambiae in Nigeria.

Despite the recent decline in the global prevalence of malaria, the disease continues to be one of the major causes of morbidity and mortality among pregnant women and under-five children in Nigeria. The adoption of an integrated approach to malaria control including the use of bio-insecticide will further reduce the burden of malaria. This study determined the repellency and bio-insecticidal effects of Azadirachta indica oil on Anopheles gambiae in Ibadan, Nigeria. The study was experimental in design. Oil was extracted from the ground seed kernel of Azadirachta indica plants using N-hexane as a solvent. Larvicidal tests were carried out on 600 third and fourth instar stages of Anopheles gambiae using an aliquot of extracted oil emulsified with a surfactant (Tween 80) at concentrations ranging from 100 to 500 ppm. Mortality was recorded every 24 h for five days. Repellency tests were carried out by exposing Guinea pigs that were previously treated with the oil mixed with paraffin at 10-40%v/v concentrations, to 70 adult female Anopheles gambiae in netted cages. Data were analysed using descriptive statistics and ANOVA. The oil yield accounted for 40.0% weight of the ground seed kernel. The larvicidal effect was significant across the concentration of the emulsified Azadirachta oil ranging from 91.6-100.0%, compared to the control experiment ranging from 5-15% (LC50 and LC90: -1666.86 ppm and -2880.94 ppm respectively). A 100.0% larval mortality of Anopheles gambiae was recorded within three days at 500 ppm. All the concentrations of the oil solution also caused 100% inhibition of pupae formation. The repellent effect of adult Anopheles was significant (p < 0.05) across the concentrations but with varying degrees of protection. The highest repellent effect was observed at 40.0% (v/v). The possibility of using Azadirachta indica as bio-insecticide against Anopheles gambiae was established in this study.