Estimation of household smoke-exposure risk using Demographic and Health Survey (DHS) data.

We introduce Stata and R codes to estimate the household smoke-exposure risk (SER) variable using cooking fuel- and cooking place-related information obtained from country-level demographic and health survey (DHS) data. Two categories of cooking fuels (smoke-producing and non-smoke producing fuels) and two categories of cooking places (indoor and outdoor) are used to estimate the household SER. Finally, household SER is classified into four levels of risk: high (cooking indoor using smoke-producing fuels), medium (cooking outdoor using smoke-producing fuels), low (cooking indoor using non-smoke-producing fuels), and very low (cooking outdoor using non-smoke-producing fuels). An example of a household SER calculation using the DHS data and codes is provided for clarification. The available DHS data of over 90 countries contain both cooking fuel- and cooking place-related information, so the method of estimating household SER would be the same for these countries.•Household-level cooking fuel and cooking place data can be used to estimate household SER.•This paper illustrates an estimation technique for household smoke-exposure risk (SER) using demographic and health survey (DHS) data.•This method can be used to estimate household SER data for any country on the DHS country list.

Household Smoke-Exposure Risks Associated with Cooking Fuels and Cooking Places in Tanzania: A Cross-Sectional Analysis of Demographic and Health Survey Data.

Household smoke-exposure risk (SER) can be defined through the assessment of cooking fuels (smoke and no smoke-producing) and cooking places (indoor and outdoor) related information, which represent different levels of household air pollution. This study aimed to explore the prevalence and geographical variations in smoke-exposure risks (SERs) associated with indoor and outdoor cooking practices and use of smoke-producing and non-smoke-producing cooking fuels in Tanzania. We further investigated the social and spatial features associated with household SERs. We defined an indicator variable, the household SER, using country-level, cross-sectional data on cooking fuels and cooking places obtained from the 2015-2016 Tanzania Demographic and Health Survey and then estimated zone-level average SERs. We used an ordered logistic regression model to assess the social and spatial characteristics associated with household SER. We identified 76.4% of the 12,425 households that practiced indoor cooking using smoke-producing fuels as having a high SER. High-level SER was more prevalent in the Central, Southern highland, and Southwest highland zones. Overall, wealthier households, female-headed households, and households with higher education attainments were more likely to be categorized as households with very low SER. Meanwhile, households headed by older individuals and with larger family sizes were less likely to be in the very low SER category. The prevalence of high SER is a major public health concern in Tanzania. Improved cooking stoves and cleaner fuels should be adopted simultaneously to minimize the adverse effects associated with household SER.

Mental model-based repeated multifaceted (MRM) intervention design: a conceptual framework for improving preventive health behaviors and outcomes.

OBJECTIVE: Field interventions employed to improve preventive health behaviors and outcomes generally use well-established approaches; however, recent studies have reported that health education and promotional interventions have little to no impact on health behaviors, especially in low- and middle-income countries. We aimed to develop a conceptual framework to improve intervention designs that would internalize these concerns and limitations. RESULTS: We identified three major experimental design- and implementation-related concerns associated with mental models, including the balance between the treatment and control groups, the treatment group's willingness to adopt suggested behaviors, and the type, length, frequency, intensity, and sequence of treatments. To minimize the influence of these aspects of an experimental design, we proposed a mental model-based repeated multifaceted (MRM) intervention design framework, which represents a supportive intervention design for the improvement of health education and promotional programs. The framework offers a step-by-step method that can be used for experimental and treatment design and outcome analysis, and that addresses potential implementation challenges.

Relationships Among Toilet Sharing, Water Source Locations, and Handwashing Places Without Observed Soap: A Cross-Sectional Study of the Richest Households in Bangladesh.

BACKGROUND: A high percentage of the richest households in Bangladesh lack soap at their handwashing places, a problem that is typically considered to be one of the poor. OBJECTIVE: We investigated toilet sharing practices, locations of water sources, and relevant sociodemographic factors associated with the observed handwashing places that lack soap in the richest (ninth wealth decile) households in Bangladesh. METHODS: We used data from the 2017-18 Bangladesh Demographic and Health Survey (BDHS). Logistic regression technique was used to investigate how toilet sharing practices, water source locations, and different sociodemographic factors were associated with observed handwashing places without soap. RESULTS: We found that 25.8% of the richest households were observed to have no soap at their handwashing places. Of these households, those that shared their toilets with another household were 4.6 times (95% CI 3.15-6.60) more likely to observe handwashing places without soap as compared with those that did not share their toilets. Further, the richest households were 4.2 times (95% CI 2.38-7.33) more likely to observe handwashing places without soap if they collected water from their own yard or plot, and 7.1 times (95% CI 3.61-13.97) more likely to observe handwashing places without soap if they collected water from elsewhere in comparison to the reference group that collected water from their own dwelling. CONCLUSION: Sharing toilet with other households and location of main water source are associated with handwashing places without observed soap in the richest households in Bangladesh. These results can inform discussions of water availability and soap-handwashing-related policy and program development.

Officially Confirmed COVID-19 and Unreported COVID-19-Like Illness Death Counts: An Assessment of Reporting Discrepancy in Bangladesh.

Reporting discrepancies between officially confirmed COVID-19 death counts and unreported COVID-19-like illness (CLI) death counts have been evident across the world, including Bangladesh. Publicly available data were used to explore the differences between confirmed COVID-19 death counts and deaths with possible COVID-19 symptoms between March 2, 2020 and August 22, 2020. Unreported CLI death counts totaled more than half of the confirmed COVID-19 death counts during the study period. However, the reporting authority did not consider CLI deaths, which might produce incomplete and unreliable COVID-19 data and respective mortality rates. All deaths with possible COVID-19 symptoms need to be included in provisional death counts to better estimate the COVID-19 mortality rate and to develop data-driven COVID-19 response strategies. An urgent initiative is needed to prepare a comprehensive guideline for reporting COVID-19 deaths.