Evaluating the Predictive Accuracy of Socioeconomic Metrics on Heart Failure Risk and Outcomes in Maryland.

Introduction Annually, a significant number of Americans are hospitalized due to heart failure (HF), marking it as an important contributor to morbidity and mortality. It also poses a substantial financial burden and leads to considerable losses in productivity. Socioeconomic disparities may intensify the risk of hospital admissions following HF and worsen patient outcomes.  Objective This study investigates the predictive accuracy of different socioeconomic metrics on the risk and outcomes of HF in Maryland.  Methodology To evaluate the predictive accuracy of various socioeconomic metrics on the risk of HF, we utilized data from the Maryland State Inpatient Database. Our retrospective analysis covered hospital admissions for HF from 2016 to 2020, correlating these with poverty indicators derived from U.S. Census data at the zip code level with socioeconomic metrics like race/ethnicity, insurance, household median income, and neighborhood distress (Distressed Communities Index (DCI)). Multivariate logistic regression models adjusted for confounders and isolated the impact of socioeconomic factors.  Result During the study period, a total of 389,220 cases of HF were reported in the Maryland State Inpatient Database (SID). The majority of these patients were White individuals (56.8%) and female (51.1%), with a median age of 73 years (interquartile range (IQR) 62-82 years). The in-hospital mortality rate was 5.1%, while rates of atrial fibrillation, cardiac arrest, and prolonged hospital stay were 34.4%, 0.3%, and 48.4%, respectively. The studied socioeconomic metrics showed varying predictive power for the risk of HF-related admissions and selected outcomes, with the highest predictive accuracy for neighborhood distress on the risk of HF (AUC = 0.53, 95% CI 0.530-0.532), atrial fibrillation (AUC = 0.479, 95% CI 0.477-0.480), cardiac arrest (AUC = 0.511, 95% CI 0.498-0.525), prolonged hospital stays (AUC = 0.531, 95% CI 0.530-0.532), and mortality (AUC = 0.499, 95% CI 0.496-0.502).  Conclusions The Distressed Communities Index demonstrates significant predictive power for assessing the risk of hospital admissions following HF and outcomes among individuals with HF, exceeding factors like insurance, race/ethnicity, and household median income.

The concentration of hemoglobin is associated with the dietary iron availability, food insecurity and the use of oral contraceptives among women in socially vulnerable areas of a capital city in northeastern Brazil.

This study aimed to assess hemoglobin concentration and its association with oral contraceptive (OC) use, food insecurity (FI) and dietary iron availability (DIA) in adult women of reproductive age (20-44 years). This is a population-based cross-sectional study that analysed 505 women living in favelas and urban communities in a capital city in northeastern Brazil. Hemoglobin concentration was determined using capillary blood samples. FI and DIA were assessed using the Brazilian Food Insecurity Scale and the 24-h food recall, respectively. Association analysis was carried out using logistic regression. A directed acyclic graph (DAG) was designed to illustrate the causal paths between hemoglobin concentration and DIA. A significance level of 5 % was adopted. Low hemoglobin concentrations (11·2 g/dl: (1·79)) and a high prevalence of anaemia (64·0 %) were observed; 28·7 % used OC (28·7 %) and 76·4 % were in FI. An average energetic intake of 1495 kcal/d (482·0) and 0·46 mg/d (0·27) of DIA were also observed. In the DAG-guided multivariable analysis, it was observed that hemoglobin concentrations ≥ 12 mg/dl were directly associated with higher DIA (OR: 1·67; 95 % CI (1. 08, 2·59)) and OC use (OR: 1·67; 95 % CI (1·10, 2·55)) and inversely associated with mild FI (OR: 0·60; 95 % CI (0·37, 0·96)) or severe FI (OR: 0·37; 95 % CI: (0·18, 0·76)). Women taking OC and with a higher DIA were less likely to have low hemoglobin concentrations, while those in the context of FI were in the opposite situation.

Structural injustice, marginality, and neurolaw: a normative comparative and theoretical approach.

In this paper, we introduce a perspective based on a comparative viewpoint on the Colombian Penal Code and a theoretical approach to neurolaw and criminal responsibility in contexts of marginality and extreme poverty. We present a further response to the debate on how structural injustice impacts criminal responsibility. By offering a comparative and theoretical insight, this paper enriches the debate and provides an understanding of how legal systems might address these issues. The paper then suggests that other legislations can follow the rule of Article 56 of the Colombian Penal Code, which reduces punishment in circumstances of marginality, ignorance, or extreme poverty. Utilizing neuroscience findings, we briefly highlight the interplay between structural injustice and neurobiological vulnerabilities, emphasizing the complexity of the role of incarceration and criminal law in marginalized populations. We invite scholars to consider debates on alternatives to criminal law, the reduction of prison use and mass incarceration, as well as further remarks on the problem of free will. In this paper, we seek to bridge the gap between neuroscientific insights and socio-legal ethics to foster a more equitable and humane system of justice.

Balancing nutrition and budgets: Socio-ecological impacts on nutritional environments of families with low incomes.

BACKGROUND: Research on childhood nutritional environments, which are predictive of a variety of child and family health and wellbeing outcomes, has primarily focused on parenting behaviors and the home food environment. However, broader social and community factors play an important role in shaping nutritional environments during early childhood. Food security is a key example that is closely linked to nutrition-related health disparities, which can arise from constrained financial resources and material deprivations. Understanding parent and caregiver lived experiences related to social and community components of family nutritional environments in the context of economic constraints could help to support multi-level nutritional practices that are optimal for healthy child development. METHOD: Semi-structured in-depth interviews were conducted using a narrative approach with parents (n = 21) of pre-school aged children living near or below the poverty line. Participants were recruited from social and community service sites pertinent to maternal and child health in Philadelphia where health disparities are highly concentrated. Analysis was conducted using MAX QDA analytic software following a systematic approach for thematic analysis in narrative research. RESULTS: Three themes describe the feeding and eating environments in the home and community context: 1) Food Procurement and Meal Planning; 2) Family Togetherness; 3) Creativity, Variety, and Flexibility. Creative decision making and food procurement strategies responsive to child preferences were balanced by shopping to save and visiting multiple stores for the best foods and savings. Logistical (e.g., transportation, childcare) and emotional supports facilitated food shopping habits and routines, while lack of trusted childcare, reliable transportation, and social support barriers challenged feeding and eating decisions. CONCLUSION: Strategies for improving cost and time-efficiencies could help support health-promoting nutritional environments of families with food insecurity. Building social and community capacity and facilitating connections to practical supports that include trustworthy childcare and peer support may be particularly important for this population.

Health, economic and social impacts of the Brazilian cash transfer program on the lives of its beneficiaries: a scoping review.

BACKGROUND: The Bolsa Família cash transfer Program (BFP) aims to break the poverty cycle by providing a minimum income to poor families conditioned on their investment in human capital (such as, education and health) and currently is the largest Program in the world in terms of the number of beneficiaries. Because there is a scarcity of reviews grouping studies on the impacts of the BFP, the objective of this scoping review was to identify and describe studies which evaluate the impact of the BFP on poverty, health, education, and other related outcomes. METHODS: We searched for quantitative, qualitative, and mixed-method articles that assessed the impact of the BFP on any aspect of the beneficiaries' lives between 2003 and March 2021. We included quantitative articles that used experimental, quasi-experimental or pre and post comparison designs. We excluded articles that analyzed impacts on political outcomes. There was no age restriction for the participants. The search was done in seven electronic databases. RESULTS: One thousand five hundred forty-six papers were identified and 94 fulfilled the inclusion criteria. Poverty and health outcomes were the most common outcomes studied. We found consistent evidence of the positive impact of the BFP on poverty reduction, as well as employment outcomes. We also found positive impacts in relation to mortality rates for children and adults, school dropout and school attendance among children and adolescents, and violence related outcomes such as homicide, suicide, crime, and hospitalization. However, we also found some evidence that BFP increased intimate partner violence and gender stereotypes among women and no evidence of impact on teenage pregnancy. CONCLUSIONS: Overall, the studies included found that BFP showed positive impacts on most poverty, health and education outcomes. More studies are needed to confirm some results, especially about violence and stereotype against women as there were few evaluations on these outcomes.

Risk of Severe Early Childhood Caries over Time in Low-Income Preschoolers.

INTRODUCTION: Early childhood caries (ECC), and the progression to severe ECC (S-ECC), is a serious oral health issue, leading to acute pain, sepsis, tooth loss, and compromised quality of life. Although the association between sociodemographic factors and ECC has been widely discussed, it remains unclear whether the same association exists between inequality and S-ECC. OBJECTIVES: To investigate the impact of low income on the oral health of preschool children and explore any additional risk factors for developing ECC and S-ECC during follow-up. METHODS: The study used Taipei Child Development Screening Program data from 2014 to 2019. It included children aged 3 to 5 y who had more than 2 oral exams and completed baseline oral health questionnaires. Low-income children were matched 1:4 with controls by age and gender. Evaluation of ECC and S-ECC used the dmft index during follow-up exams. Generalized estimating equations (GEEs) assessed the impact of household income on ECC and S-ECC risk over time. RESULTS: Of the 895 participants, 179 were from low-income households. We revealed a significantly higher risk of developing S-ECC (adjusted odds ratio [aOR] 1.99; 95% confidence interval [CI] 1.25-3.17) in children from low-income households, with no significantly increased of risk of developing ECC. Children who consumed sugary beverages >4 times per week showed elevated risks of developing both ECC (aOR 1.77; 95% CI 1.07-2.94) and S-ECC (aOR 1.89; 95% CI 1.13-3.17). Protective factors included children with mothers with a college education (S-ECC: aOR 0.50; 95% CI 0.32-0.79). CONCLUSION: Children from low-income households have a significant risk of developing S-ECC compared with children from non-low-income households during follow-up. Factors contributing to this risk include lower maternal education, poor maternal oral health, and increased consumption of sugar-sweetened beverages. Policymakers should develop health measures to reduce the prevalence of ECC and S-ECC in children from low-income households whose mothers have lower educational levels and poor oral health. KNOWLEDGE TRANSFER STATEMENT: The results of this study highlight the significant S-ECC risk among preschool children from low-income households in Taipei, with other risk factors including higher consumption of sugar-sweetened beverages, lower maternal education, and poor maternal oral health. Policymakers can use our findings to develop targeted policy and behavioral interventions to reduce S-ECC in vulnerable populations.

What is the Role of Minimum Wages in Addressing Precarious Employment in the Informal and Formal Sectors? Findings from a Systematic Review.

This article presents synthesized evidence from 16 studies examining initiatives with potential to mitigate workers' exposure to precarious employment through the adoption of minimum wage policies. All studies were set in low-income countries and focused on both formal and informal workers. A systematic review of evaluated initiatives addressing precarious employment identified the evidence. We consider minimum wage policies as initiatives that could address precarious employment because of the central role of minimum wages in establishing employment terms for workers in precarious situations. We include initiatives aimed at formal and informal workers, given that precarious employment can exist in both sectors, that these workers share concerns regarding income and would benefit from minimum wage policies. The findings imply that minimum wage policies could increase precariously employed workers' financial compensation, although with some differences and with little or no effect on employment security. It is not feasible to extend these conclusions beyond low-income economies due to differences with high-income economies in how the mechanisms through which minimum wage policies could impact worker compensation and employment security. However, they should serve as a reminder for high-income economies, many of which experience expanding informal sectors, about the need for related research and policy.

The nexus between poverty and maternal healthcare utilization with a focus on antenatal care visits and choice of place of birth in Somaliland.

Introduction: Poverty poses a significant barrier to accessing healthcare globally, particularly in relation to antenatal care (ANC) visits and the use of childbirth facilities, both of which are crucial for women's health and fetal well-being. In Somaliland, only 47% of pregnant women attend healthcare facilities for ANC, with a mere 33% receiving care from skilled birth attendants. Despite this, no previous studies have examined the relationship between poverty and maternal healthcare utilization in Somaliland. This study aims to investigate the effect of poverty on maternal healthcare utilization with focus on ANC visits and the choice of place of birth in Somaliland. Method: Utilizing data from the 2020 Somaliland Demographic Health Survey, a cross-sectional study design was employed, analyzing a nationally representative sample. The sample size used in this study was 3,183 women of reproductive age. Descriptive analysis, negative binomial regression, and multinomial logistic regression were conducted using Stata version 18.0. Diagnostic tests, including Chi-square - 2log likelihood statistic, Akaike Information Criterion, and Bayesian Information Criterion, were employed to evaluate model fit. Results: Poverty, as indicated by wealth quintile, was associated with reduced ANC visits (adjusted incidence rate ratio (aIRR) = 0.884, 95% CI: 0.791-0.987) among women in poorer households compared to those in richer households. Women in Togdheer, Sool, and Sanaag regions had lower ANC visit rates compared to Maroodi Jeex region (aIRR = 0.803, 95% CI: 0.687-0.939; aIRR = 0.710, 95% CI: 0.601-0.839; aIRR = 0.654, 95% CI: 0.558-0.768, respectively). Women from poorer households had lower probabilities of opting for public health facilities (adjusted relative risk ratio (aRRR) = 0.457, 95% CI: 0.352-0.593) and private health facilities (aRRR = 0.195, 95% CI: 0.111-0.341) over home births compared to women in richer households. Women in Togdheer, Sool, and Sanaag regions had lower probabilities of choosing public (aRRR range: 0.331-0.175) and private (aRRR range: 0.350-0.084) health facilities for delivery over home births compared to women in Maroodi Jeex region. Conclusion: Poverty significantly impedes maternal healthcare utilization, contributing to lower ANC attendance and preference for home births over public or private health facility births. Addressing these disparities requires initiatives to eliminate financial barriers, such as user fees, and enhance equitable access through community-based health insurance and improved healthcare infrastructure.

Does Adulthood Socioeconomic Status Predict Subsequent Telomere Length in Racially and Ethnically Diverse Women?

Background: Telomere length is a critical biomarker of cellular aging and overall health. While childhood socioeconomic status (SES) indicators such as education and poverty can have long-lasting effects on biological aging, research has shown contradictory results regarding the impact of adulthood SES on future telomere length, particularly in racially and ethnically diverse individuals. This study investigates the effects of baseline adulthood SES indicators such as education and poverty on telomere length nine years later in women, using data from the Future of Families and Child Wellbeing Study (FFCWS). Methods: We analyzed data from the FFCWS, a longitudinal cohort study. The sample included baseline adulthood SES and follow-up telomere length measure of women (n = 2,421) with varying socioeconomic conditions. Telomere length was measured from saliva samples nine years after the baseline measure of adulthood SES. Education, poverty, and marital status at baseline were assessed. Multivariate linear regression models were used to examine the association between adulthood SES indicators at baseline and future telomere length, controlling for potential confounders. Results: From the total 2,421 women, 675 were Latino White, 1,158 were non-Latino Black, and 588 were non-Latino White. Our findings indicate that for non-Latino White women poverty at certain level, and childbirth weight, and for non-Latino Black maternal age were predictors of telomere lengths nine years later. Conclusion: Poverty at a specific level, maternal age and childbirth weight serve as predictors of telomere lengths nine years later in some women. These findings underscore the importance of socioeconomic factors and early-life influences in understanding telomere dynamics and aging processes among women from varied racial and ethnic backgrounds.

Global burden of viral infectious diseases of poverty based on Global Burden of Diseases Study 2021.

BACKGROUND: Viral infectious diseases of poverty (vIDPs) remain a significant global health challenge. Despite their profound impact, the burden of these diseases is not comprehensively quantified. This study aims to analyze the global burden of six major vIDPs, including coronavirus disease 2019 (COVID-19), HIV/AIDS, acute hepatitis, dengue, rabies, and Ebola virus disease (EVD), using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 (GBD 2021). METHODS: Following the GBD 2021 framework, we analyzed the incidence, mortality, and disability-adjusted life years (DALYs) of the six vIDPs across 204 countries and territories from 1990 to 2021. We examined the association between the Socio-Demographic Index (SDI) and the burden of vIDPs. All estimates were reported as numbers and rates per 100,000 population, calculated using the Bayesian statistical model employed by GBD 2021, with 95% uncertainty intervals (UI). RESULTS: In 2021, vIDPs caused approximately 8.7 million deaths and 259.2 million DALYs, accounting for 12.8% and 9.0% of the global all-cause totals, respectively. Globally, the burden of vIDPs varied significantly: COVID-19 caused around 7.9 million (95% UI: 7.5, 8.4) deaths and 212.0 million (95% UI 197.9, 234.7) DALYs in 2021. Acute hepatitis had the second-highest age-standardized incidence rate, with 3411.5 (95% UI: 3201.8, 3631.3) per 100,000 population, while HIV/AIDS had a high age-standardized prevalence rate, with 483.1 (95% UI: 459.0, 511.4) per 100,000 population. Dengue incidence cases rose from 26.5 million (95% UI: 3.9, 51.9) in 1990 to 59.0 million (95% UI: 15.5, 106.9) in 2021. Rabies, although reduced in prevalence, continued to pose a significant mortality risk. EVD had the lowest overall burden but significant outbreak impacts. Age-standardized DALY rates for vIDPs were significantly negatively correlated with SDI: acute hepatitis (r = -0.8, P < 0.0001), rabies (r = -0.7, P < 0.0001), HIV/AIDS (r = -0.6, P < 0.0001), COVID-19 (r = -0.5, P < 0.0001), dengue (r = -0.4, P < 0.0001), and EVD (r = -0.2, P < 0.005). CONCLUSIONS: VIDPs pose major public health challenges worldwide, with significant regional, age, and gender disparities. The results underscore the need for targeted interventions and international cooperation to mitigate the burden of these diseases. Policymakers can use these findings to implement cost-effective interventions and improve health outcomes, particularly in regions with high or increasing burdens.

Revisiting a decade of inequality in healthcare financial burden in Cambodia, 2009-19: trends, determinants and decomposition.

BACKGROUND: Out-of-pocket healthcare expenditure (OOPHE) without adequate social protection often translates to inequitable financial burden and utilization of services. Recent publications highlighted Cambodia's progress towards Universal Health Coverage (UHC) with reduced incidence of catastrophic health expenditure (CHE) and improvements in its distribution. However, departing from standard CHE measurement methods suggests a different storyline on trends and inequality in the country. OBJECTIVE: This study revisits the distribution and impact of OOPHE and its financial burden from 2009-19, employing alternative socio-economic and economic shock metrics. It also identifies determinants of the financial burden and evaluates inequality-contributing and -mitigating factors from 2014-19, including coping mechanisms, free healthcare, and OOPHE financing sources. METHODS: Data from the Cambodian Socio-Economic Surveys of 2009, 2014, and 2019 were utilized. An alternative measure to CHE is proposed: Excessive financial burden (EFB). A household was considered under EFB when its OOPHE surpassed 10% or 25% of total consumption, excluding healthcare costs. A polychoric wealth index was used to rank households and measure EFB inequality using the Erreygers Concentration Index. Inequality shifts from 2014-19 were decomposed using the Recentered Influence Function regression followed by the Oaxaca-Blinder method. Determinants of financial burden levels were assessed through zero-inflated ordered logit regression. RESULTS: Between 2009-19, EFB incidence increased from 10.95% to 17.92% at the 10% threshold, and from 4.41% to 7.29% at the 25% threshold. EFB was systematically concentrated among the poorest households, with inequality sharply rising over time, and nearly a quarter of the poorest households facing EFB at the 10% threshold. The main determinants of financial burden were geographic location, household size, age and education of household head, social health protection coverage, disease prevalence, hospitalization, and coping strategies. Urbanization, biased disease burdens, and preventive care were key in explaining the evolution of inequality. CONCLUSION: More efforts are needed to expand social protection, but monitoring those through standard measures such as CHE has masked inequality and the burden of the poor. The financial burden across the population has risen and become more unequal over the past decade despite expansion and improvements in social health protection schemes. Health Equity funds have, to some extent, mitigated inequality over time. However, their slow expansion and the reduced reliance on coping strategies to finance OOPHE could not outbalance inequality.

Does younger children's social health insurance alleviate household impoverishment due to illness?

BACKGROUND: The ambitious expansion of social health insurance in China has played a crucial role in preventing and alleviating poverty caused by illness. However, there is no government-sponsored health insurance program specifically for younger children and inequities are more pronounced in healthcare utilization, medical expenditure, and satisfaction in some households with severely ill children. This study assessed the effectiveness of child health insurance in terms of alleviating poverty caused by illness. METHODS: Data were collected from two rounds of follow-up surveys using the China Family Panel Studies 2016 and 2018 child questionnaires to investigate the relationship between child health insurance and household medical impoverishment (MI). Impoverishing health expenditure (IHE) and catastrophic health expenditure (CHE) were measured to quantify "poverty due to illness" in terms of absolute and relative poverty, respectively. Propensity score matching with the difference-in-differences (PSM-DID) method, robustness tests, and heterogeneity analysis were conducted to address endogeneity issues. RESULTS: Social health insurance for children significantly reduced household impoverishment due to illness. Under the shock of illness, the incidences of IHE and CHE were significantly lower in households with insured children. The poverty alleviation mechanism transmitted by children enrolled in social health insurance was primarily driven by hospitalization reimbursements and the proportion of out-of-pocket medical payments among the total medical expenditure for children. CONCLUSIONS: Children's possession of social health insurance significantly reduced the likelihood of household poverty due to illness. The poverty-reducing effect of social medical insurance is most significant in rural areas, low-income families, no-left-behind children, and infants. Targeted poverty alleviation strategies for marginalized groups and areas would ensure the equity and efficiency of health system reforms, contributing to the goal of universal health insurance coverage in China.

Poverty Dynamics and Caries Status in Young Adolescents.

OBJECTIVES: To investigate whether timing, accumulation and trajectories of poverty are associated with dental caries in young adolescents. METHODS: The study was conducted within the Generation R Study, which is an ongoing population-based prospective cohort study conducted in Rotterdam, the Netherlands. This study included 2653 children. Information about household income and number of children and adults living in a household at six time points from pregnancy to 13 years old was retrieved from parental questionnaires to construct the poverty variable. Dental caries was assessed with the decayed, missing and filled teeth index through intraoral photographs at the age of 13 years. Sociodemographic and oral health-related characteristics were included as possible confounders. The association between poverty and dental caries was analysed on the basis of the three lifecourse theories, that is, critical period, cumulative risk and social mobility model. For the latter, we used latent class growth analysis (LCGA) to identify poverty trajectories over time. Next, the associations were studied with Hurdle Negative Binomial Models. RESULTS: Poverty at birth and intermittent poverty up to the age of 13 were significantly associated with dental caries at 13 years of age (OR 1.41, 95% CI 1.01-1.99; OR 1.36, 95% CI 1.01-1.83 respectively) and with an increased mean number of decayed teeth by 34% (95% CI 1.02-1.76; 95% CI 1.05-1.71, respectively). LCGA showed four trajectories for the probabilities of poverty. All trajectories were significantly associated with dental caries at 13 years of age, with the 'downward mobility' trajectory showing the strongest association with dental caries (OR 1.55, 95% CI 1.05-2.29) and an increasing mean number of decayed teeth by 58% (95% CI 1.18-2.12) than the 'stable absent' trajectory. CONCLUSION: Poverty at birth, intermittent poverty and downward poverty trajectory were associated with higher odds and higher mean number of decayed teeth at 13 years of age. The three lifecourse models influenced dental caries status during adolescence, hence strategies and policies targeted to improve socioeconomic conditions on deprived children should be implemented.

Prevalence and neighbourhood determinants of early sexual debut and multiple sexual partnerships among young people in Rwanda, Ghana and South Africa.

BACKGROUND: The consequences of engaging in risky sexual behaviours (RSB) can lead to HIV infection, sexually transmitted diseases and unintended pregnancy. The relationship between neighbourhood characteristics and youth involvement in RSB such as early sexual debut and multiple sexual partnerships has been of great concern to government, researchers and policymakers. However, there are very few empirical studies using demographic and health surveys to unpack the nature of this relationship in Rwanda, Ghana and South Africa. The objective of this study was to estimate the prevalence and determinants of early sexual debut and condom use, and to explore the neighbourhood factors associated with early sexual debut and condom use in Rwanda, Ghana and South Africa. METHODS: This was a cross-sectional study using the most recent Demographic and Health Survey Data (DHS 2014-2016) from Ghana, Rwanda and South Africa to investigate the relationship between neighbourhood characteristics and risky sexual behaviour among the youth. RESULTS: The prevalence of risky sexual behaviour in the three countries ranges from 56% (South Africa), 30% (Ghana) and 12% (Rwanda). Male youth in the 20-to-24-year-old category had increased odds of engaging in multiple sexual partnerships for the three countries (AOR 4.58; 95% CI 3.40-6.16), Rwanda (AOR 2.72; 95% CI 2.04-3.68) and South Africa (AOR 4.56; 95% CI 3.33-6.24). Meanwhile, at the community level, community education significantly increased the odds of age sexual debut among female adolescents by 50% (South Africa), and 46% (Ghana), while in Rwanda, this factor had decreased odds with higher community education. CONCLUSION: To lower the incidence of risky sexual behaviour in the community, programmes aimed at appropriate policy options must be intensified. The implications of these findings is helpful for a developmental approach aimed at reaching Africa's long-term development goal of eliminating STIs among young people.

Who counts in poverty research?

Mainstream poverty analysis currently renders certain people and degrees of privation more socially legible than others across high-income countries. This article examines how these hierarchies carry through to and corrupt wider social scientific analysis, inscribing differential value to actors and phenomena in ways that undermine social understanding and explanation. First, conventional approaches to poverty analysis and measurement obscure the de facto prevalence of deep poverty, as well as those most subject to its violence. Second, a growing number of hyper-marginalised groups are missing from population income surveys, undermining the accuracy of (deep) poverty estimates and public understanding of both its determinants and dynamics. Third, the inferential and external validity of income surveys is significantly diminished by problems surrounding data quality and coverage. Attempts to address this have principally focused on improving data quality, but as demonstrated in this article, these strategies exacerbate poor representation of the lowest-income groups in distributional analysis. Much more than merely technical or pragmatic, these are theoretical and normative judgements about who counts in welfare policy and politics. Overall, I demonstrate how current data practices occlude some the most violent forms of denigration and exploitation that structure advanced marginality, particularly the gendered, racialised, bordering and ableist practices underpinning state-citizen dynamics. Focusing principally on the UK context, I argue that the epistemic erasure committed features in and systematises a policy blindness to deep poverty for some of the most marginalised social groups making it harder to evidence its effects and address its causes across high-income countries.

Examining multidimensional health poverty and determining factors among rural women of childbearing age in ningxia, china.

BACKGROUND: The multidimensional health poverty afflicting rural women of reproductive age bears profound implications for the sustainable development of families, societies, and healthy villages. Elucidating vulnerable groups at risk of multidimensional health poverty and delineating its determinants can inform refinements and implementation of health-poverty alleviation policies. METHODS: Based on the 2022 "Health Status and Health Service Utilization" survey data in rural Ningxia, China, this study analyzes the dimension of health status, capacity for health service utilization, health expenditure and security using the A-F dual-threshold method, logit model, and probit model. It comprehensively evaluates multidimensional health poverty and analyzes its determining factors among rural women of childbearing age. RESULTS: With k set at 0.3, the health multidimensional poverty index, incidence, and intensity among rural women of reproductive age were 0.021, 0.053, and 0.392, respectively. Chronic illness, capacity for free gynecological examination utilization, health examination utilization, and borrowing due to illness contributed significantly to multidimensional health poverty. Risk factors for multidimensional health poverty among rural women of childbearing age include age, unemployment, family size, and lack of sanitary toilets. Protective factors include being married, educational level, non-farm or student occupation, receiving government support, separate housing and kitchen, owning a television and computer. CONCLUSIONS: Even with the elimination of absolute poverty, the multidimensional health poverty situation among rural women remains important from a gender perspective. It is recommended to strengthen economic assistance and health service support for these groups, improve the level of rural health services from a gender perspective, and enhance housing structure and sanitation toilet usage in rural areas. Efforts should be made to narrow the digital divide in rural areas and promote digital health education. Pre-interventions on multidimensional health poverty can provide new pathways for the development, empowerment, and well-being of rural women of childbearing age.

NOVA FOOD ACQUISITION AND CONSUMPTION AMONG RURAL AND URBAN HOUSEHOLDS IN SOUTH AFRICA AND GHANA.

OBJECTIVE: This study aims to determine differences in food consumption by the NOVA food categories in South Africa and Ghana and how they relate to poverty and food supply systems. DESIGN: This study used a cross-sectional design to assess household food acquisition and lived poverty index. SETTING: The study was conducted in Khayelitsha and Mount Frere, urban and rural communities in South Africa, respectively, and Ahodwo and Ejuratia, urban and rural communities in Ghana, respectively. PARTICIPANT: An adult in charge of or knowledgeable about household food acquisition and consumption was selected to participate in the study. RESULTS: A total of 1299 households participated in the study. Supermarkets were a prominent source of ultra-processed foods for households in South Africa, while informal outlets were an important source of ultra-processed foods in Ghana. Consumption of unprocessed foods was higher among South African households (58.2%) than Ghanaian households (41.8%). In South Africa, deprivation was associated with increased odds of infrequent consumption of both unprocessed foods (OR 3.431 p<0.001) and ultra-processed foods (OR 2.656 p<0.001) compared to non-deprivation. In Ghana, no significant associations were observed between household deprivation and consumption of the NOVA food classes. CONCLUSION: Different food supply systems and poverty are associated with household acquisition of the different NOVA food classes. Policies should be geared towards formal shops in South Africa and informal shops in Ghana to reduce the consumption of key obesogenic foods.

Beyond the illness: a qualitative exploration of the burden of caring for people with tuberculosis on caregivers and their households in South Africa.

Tuberculosis (TB) affects not only the person sick with TB but also their households. Our study aimed for a deeper understanding of the multiplicative impact of TB on households, and more specifically on caregivers of people with TB, as well as factors that influence the burden on caregivers in South Africa. We conducted an exploratory qualitative study focusing on the lived experiences of people providing care to a family member sick with TB. The study found that the burden of caregiving is significant and falls disproportionally on women and poorer households whose resilience has already been compromised by pre-existing multiple stressors and demands, contributing to health inequities and gender inequalities. Having to care for a household member sick with TB imposed an additional strain causing further health, financial and social problems, leaving the household in a worse-off position, and at a higher risk of continued ill health and further poverty. Social support was found to mediate the burden, however, was lacking for many as kinship bonds are weakened by high levels of poverty and unemployment. Support to households is recommended to ensure recovery of the person with TB and their household post-TB illness, and prevent further ill health and poverty.