Socioeconomic inequalities in child growth failure in Ethiopia: findings from the 2000 and 2016 Demographic and Health Surveys.

OBJECTIVE: Socioeconomic inequalities in child growth failure (CGF) remain one of the main challenges in Ethiopia. This study examined socioeconomic inequalities in CGF and determinants that contributed to these inequalities in Ethiopia. METHODS: The Ethiopia Demographic and Health Surveys 2000 and 2016 data were used in this study. A pooled unweighted sample of the two surveys yielded 21514 mother-child pairs (10873 in 2000 and 10641 in 2016). We assessed socioeconomic inequalities in CGF indicators using the concentration curve and concentration index (CI). We then decomposed the CI to identify percentage contribution of each determinant to inequalities. RESULTS: Socioeconomic inequalities in CGF have increased in Ethiopia between 2000 and 2016. The CI increased from -0.072 and -0.139 for stunting, -0.088 and -0.131 for underweight and -0.015 and -0.050 for wasting between 2000 and 2016, respectively. Factors that mainly contributed to inequalities in stunting included geographical region (49.43%), number of antenatal care visits (31.40%) and child age in months (22.20%) in 2000. While in 2016, inequality in stunting was contributed mainly by wealth quintile (46.16%) and geographical region (-13.70%). The main contributors to inequality in underweight were geographical regions (82.21%) and wealth quintile (27.21%) in 2000, while in 2016, wealth quintile (29.18%), handwashing (18.59%) and access to improved water facilities (-17.55%) were the main contributors. Inequality in wasting was mainly contributed to by maternal body mass index (-66.07%), wealth quintile (-45.68%), geographical region (36.88%) and paternal education (33.55%) in 2000, while in 2016, wealth quintile (52.87%) and urban areas of residence (-17.81%) were the main driving factors. CONCLUSIONS: This study identified substantial socioeconomic inequalities in CGF, and factors that relatively contributed to the disparities. A plausible approach to tackling rising disparities may involve developing interventions on the identified predictors and prioritising actions for the most socioeconomically disadvantaged groups.

Trends in child growth failure among children under five years of age in Ethiopia: Evidence from the 2000 to 2016 Demographic and Health Surveys.

INTRODUCTION: In a majority of low- and middle-income countries (LMICs), levels of child growth failure (CGF) have steadily declined since 2000. However, some countries show a different trend. Despite continued investment from the government of Ethiopia as well as donors, CGF levels are still high in Ethiopia. This study aimed to assess trends in CGF and associated sociodemographic, economic and water, sanitation, and hygiene (WASH) factors from 2000 to 2016 in Ethiopia. METHODS: Data were taken from four rounds of the Ethiopia Demographic and Health Survey (EDHS). Children aged between 0 to 59 months were included. CGF indicators were categorised based on height-for-age z-score (HAZ) < -2 Standard deviation (SD), weight-for-age z-score (WAZ) < -2 SD and weight-for-height z-score (WHZ) < -2 SD. CGF trends were estimated for predicted probabilities and odds ratios (ORs) between 2000 and 2016. RESULTS: A total sample size of 31978 for HAZ, 32045 for WAZ and 32246 for WHZ were included in the current study. Stunting decreased from an adjusted odds ratio (AOR) = 0.77 (95% CI: 0.67 to 0.88) in 2005 to an AOR = 0.45 (95% CI: 0.39 to 0.53) in 2016 compared with the year 2000. Compared with data in 2000, underweight decreased from an AOR of 0.70 (95% CI: 0.61 to 0.80) in 2005 to an AOR of 0.43 (95% CI: 0.36 to 0.50) in 2016. Wasting declined from an AOR of 0.91 (95% CI: 0.75 to 1.10) in 2005 to an AOR of 0.76 (95% CI: 0.61 to 0.94) in 2016, compared with data in 2000. CONCLUSIONS: Between 2000 to 2016, there was a decline in CGF levels albeit the levels are still relatively high compared with the World Health Organization (WHO) cut-off levels for public health concern. Observed rates of change varied across sociodemographic, economic and WASH factors which suggest that interventions tailored towards addressing the imbalances across those factors are required.

Examining the pathways for young people with drug and alcohol dependence: a mixed-method design to examine the role of a treatment programme.

INTRODUCTION: Young people with drug and alcohol problems are likely to have poorer health and other psychosocial outcomes than other young people. Residential treatment programmes have been shown to lead to improved health and related outcomes for young people in the short term. There is very little robust research showing longer term outcomes or benefits of such programmes. This paper describes an innovative protocol to examine the longer term outcomes and experiences of young people referred to a residential life management and treatment programme in Australia designed to address alcohol and drug issues in a holistic manner. METHODS AND ANALYSIS: This is a mixed-methods study that will retrospectively and prospectively examine young people's pathways into and out of a residential life management programme. The study involves 3 components: (1) retrospective data linkage of programme data to health and criminal justice administrative data sets, (2) prospective cohort (using existing programme baseline data and a follow-up survey) and (3) qualitative in-depth interviews with a subsample of the prospective cohort. The study will compare findings among young people who are referred and (a) stay 30 days or more in the programme (including those who go on to continuing care and those who do not); (b) start, but stay fewer than 30 days in the programme; (c) are assessed, but do not start the programme. ETHICS AND DISSEMINATION: Ethics approval has been sought from several ethics committees including a university ethics committee, state health departments and an Aboriginal-specific ethics committee. The results of the study will be published in peer-reviewed journals, presented at research conferences, disseminated via a report for the general public and through Facebook communications. The study will inform the field more broadly about the value of different methods in evaluating programmes and examining the pathways and trajectories of vulnerable young people.

Factors distinguishing employed from unemployed people in the Positive Health Study.

OBJECTIVE: To identify predictors of unemployment among Australian people living with HIV/AIDS. DESIGN: A longitudinal cohort of Australian men living with HIV/AIDS. METHODS: Participants were separated into two groups, currently working versus currently unemployed. The two groups were compared on a range of factors related to physical health, mental health and sociodemographic variables. Each family of variables was reduced to a set of best predictors, and multivariate log binomial regression was used to identify the predictors of unemployment. RESULTS: Unemployment was more likely among those who experienced HIV/AIDS-related illness, scored higher on the Kessler scale of psychological distress and were older. There was a lower likelihood of unemployment among those who had better self-rated health, had been living with HIV/AIDS for a shorter period and who had a tertiary education. CONCLUSION: These findings indicate that unemployment among people living with HIV/AIDS is best understood within a combined social and medical context. Interventions that acknowledge the differences in age and education that contribute to unemployment would improve employment prospects among people living with HIV/AIDS.

Risk behaviour among Aboriginal and Torres Strait Islander gay men: comparisons with other gay men in Australia.

OBJECTIVES: To determine any differences in HIV-risk and drug-use behaviour among Aboriginal and Torres Strait Islander gay men and other gay men in Australia. METHODS: The Gay Community Periodic Survey is a repeated cross-sectional prevalence study of the sexual and drug use behaviours of Australian gay men conducted since 1996. Responses from Aboriginal and Torres Strait Islander (ATSI) gay men were compared with those from non-ATSI gay men for the years 2000-2004. RESULTS: Of 34 708 responses collected in major Australian cities over a 6-year period, 1208 identified as Aboriginal or Torres Strait Islander. There was little difference between ATSI and non-ATSI men in the reported prevalence of HIV, though ATSI gay men were more likely than non-ATSI gay men to engage in unprotected anal intercourse with casual partners and to inject illicit drugs but were more likely to have been recently tested for HIV CONCLUSIONS: These ATSI gay men were at increased risk of HIV and other blood-borne viruses, though this may be due to differences in socio-economic status as much as cultural background. These findings indicate the continued need for targeted sexual and injecting-drug-use health interventions among this population.