ABSTRACT
OBJECTIVE: To examine knowledge of menstruation, HIV and STIs other than HIV across eight sites in SSA to develop effective programmatic interventions enabling adolescents to achieve positive SRH as their transition to adulthood. METHODS: We combine data from eight Health and Demographic Surveillance Sites across sub-Saharan Africa, from an adolescent-specific survey that included 7116 males and females age 10-19 years old. We provide pooled and site-specific estimates from multiple analytic models examining the how year-specific age, school attendance and work correlate with knowledge of menstruation, HIV knowledge and knowledge of sexually transmitted infections (STIs) other than HIV. RESULTS: Many adolescents lack knowledge of menstruation (37.3%, 95% CI 31.8, 43.1 do not know of menstruation) and STIs other than HIV (55.9%, 95% CI 50.4, 61.3 do not know of other STIs). In multivariate analysis, older age, being in school and wealth are significant positive correlates of STI knowledge. Older adolescent age, female sex and being in school are significant positive correlates of knowledge of menstruation. Knowledge of HIV is high (89.7%, 95% CI 8.3, 12.7 know of HIV) and relatively similar across adolescent age, sex, wealth and school and work attendance. CONCLUSION: Knowledge of HIV is widespread across adolescents in these communities in sub-Saharan Africa, but knowledge of other dimensions of sexual and reproductive health - menstruation and other STIs in this study - is lacking especially for early adolescents (10- to 14-year olds). The dissemination of more comprehensive sexual and reproductive health information is needed within these and similar communities in SSA to help adolescents gain insight on how to make their own decisions towards positive adolescent sexual and reproductive health and protect them from risks.
OBJECTIF: Examiner les connaissances sur la menstruation, le VIH et les IST autres que le VIH dans huit sites d'Afrique subsaharienne (ASS) afin d'élaborer des programmes d'interventions efficaces permettant aux adolescents d'obtenir une santé sexuelle et reproductive (SSR) positive lorsqu'ils passent à l'âge adulte. MÉTHODES: Nous combinons ici les données de huit sites de Surveillance Démographique et de Santé en Afrique subsaharienne, à partir d'une enquête spécifique réalisée auprès d'adolescents et comprenant 7.116 hommes et femmes âgés de 10 à 19 ans. Nous fournissons des estimations poolées et spécifiques à chaque site à partir de plusieurs modèles analytiques examinant la corrélation entre l'âge, la fréquentation scolaire et le travail, avec les connaissances sur la menstruation, sur le VIH et sur les IST autres que le VIH. RÉSULTATS: Beaucoup d'adolescents manquaient de connaissance sur les menstruations (37,3% ; IC95%: 31,8-43,1 ne connaissaient pas les menstruations) et les IST autres que le VIH (55,9% ; IC95%: 50,4-61,3 ne connaissent pas d'autres IST). Dans l'analyse multivariée, l'âge plus avancé, la fréquentation scolaire et la richesse sont des corrélats positifs significatifs des connaissances sur les IST. L'âge adolescent plus avancé, le sexe féminin et le fait d'être à l'école sont des corrélats positifs significatifs pour les connaissances sur la menstruation. Les connaissances sur le VIH sont élevées (89,7%, IC95%: 8,3-12,7 sont au courant du VIH) et relativement similaires selon les âges des adolescents, le sexe, la richesse et la fréquentation scolaire et le travail. CONCLUSION: Les connaissances sur le VIH semblent être répandues parmi les adolescents de ces communautés en Afrique subsaharienne, mais les connaissances sur les autres aspects de la santé sexuelle et reproductive - menstruations et autres IST dans cette étude - semblent faire défaut, en particulier chez les jeunes adolescents (âgés de 10 à 14 ans). La dissémination de telles informations plus complètes est nécessaire au sein de ces communautés et de communautés similaires en ASS afin d'aider les adolescents à comprendre comment prendre leurs propres décisions en matière de santé sexuelle et reproductive et de les protéger contre les risques.
Subject(s)
Health Knowledge, Attitudes, Practice , Reproductive Health/statistics & numerical data , Sexual Health/statistics & numerical data , Adolescent , Adolescent Health , Africa South of the Sahara/epidemiology , Age Factors , Child , Female , HIV Infections/epidemiology , Humans , Interviews as Topic , Male , Menstruation/physiology , Sexually Transmitted Diseases/epidemiology , Socioeconomic Factors , Young AdultABSTRACT
Policy Points: Improvements in reproductive health lead to improvements in women's economic empowerment. Contraceptive use improves women's agency, education, and labor force participation; higher maternal age at first birth (reducing adolescent childbearing) increases the likelihood of school completion and participation in the formal labor market; and having fewer children increases labor market participation. Reproductive health is not just a benefit to a woman's individual rights, but her gateway for breaking free from her poverty trap and improving the welfare of herself, her children, and her household. CONTEXT: Women's access to employment, business opportunities, and financial resources is critical to achieving the United Nations Sustainable Development Goals over the next 15 years. With increased attention to women's economic empowerment among donors and policymakers across the globe, this moment is a pivotal one in which to review the current state of the research on this topic. METHODS: We reviewed the Population and Poverty (PopPov) Research Initiative results from the past 10 years with attention to the causal link between reproductive health improvements and women's economic empowerment, in addition to seminal research that informed our understanding of the link. FINDINGS: Our review of PopPov findings revealed that improvements in reproductive health do lead to improvements in women's economic empowerment; expanding contraceptive use improves women's agency, education, and labor force participation; higher maternal age at first birth (reducing adolescent childbearing) increases the likelihood of school completion and participation in the formal labor market; and having fewer children increases labor force participation. CONCLUSIONS: Gaps remain in measuring women's work and in the full exploration of women's economic empowerment. More research is needed regarding the long-term impact of reproductive health improvements on women's economic empowerment, as some studies have shown that at times unintended negative consequences occur after early positive improvements.
Subject(s)
Employment/economics , Employment/statistics & numerical data , Poverty/economics , Power, Psychological , Reproductive Health/economics , Reproductive Health/statistics & numerical data , Women's Rights/economics , Adult , Developing Countries , Female , Humans , Middle Aged , Poverty/statistics & numerical data , Socioeconomic Factors , Women's Rights/statistics & numerical data , Young AdultABSTRACT
OBJECTIVES: The full impact of a maternal death includes consequences faced by orphaned children. This analysis adds evidence to a literature on the magnitude of the association between a woman's death during or shortly after childbirth, and survival outcomes for her children. METHODS: The Ifakara and Rufiji Health and Demographic Surveillance Sites in rural Tanzania conduct longitudinal, frequent data collection of key demographic events at the household level. Using a subset of the data from these sites (1996-2012), this survival analysis compared outcomes for children who experienced a maternal death (42 and 365 days definitions) during or near birth to those children whose mothers survived. RESULTS: There were 111 maternal deaths (or 229 late maternal deaths) during the study period, and 46.28 % of the index children also subsequently died (40.73 % of children in the late maternal death group) before their tenth birthday-a much higher prevalence of child mortality than in the population of children whose mothers survived (7.88 %, p value <0.001). Children orphaned by early maternal deaths had a 51.54 % chance of surviving to their first birthday, compared to a 94.42 % probability for children of surviving mothers. A significant, but lesser, child survival effect was also found for paternal deaths in this study period. CONCLUSIONS: The death of a mother compromises the survival of index children. Reducing maternal mortality through improved health care-especially provision of high-quality skilled birth attendance, emergency obstetric services and neonatal care-will also help save children's lives.
Subject(s)
Child Mortality , Infant Mortality , Maternal Death/statistics & numerical data , Maternal Mortality , Rural Population/statistics & numerical data , Adult , Child , Child, Orphaned , Cohort Studies , Female , Humans , Infant , Maternal Age , Pregnancy , Socioeconomic Factors , Survival Analysis , Tanzania/epidemiologyABSTRACT
BACKGROUND: Maternal mortality remains the leading cause of death and disability for reproductive-age women in resource-poor countries. The impact of a mother's death on child outcomes is likely severe but has not been well quantified. This analysis examines survival outcomes for children whose mothers die during or shortly after childbirth in Butajira, Ethiopia. METHODS: This study uses data from the Butajira Health and Demographic Surveillance System (HDSS) site. Child outcomes were assessed using statistical tests to compare survival trajectories and age-specific mortality rates for children who did and did not experience a maternal death. The analyses leveraged the advantages of a large, long-term longitudinal dataset with a high frequency of data collection; but used a strict date-based method to code maternal deaths (as occurring within 42 or 365 days of childbirth), which may be subject to misclassification or recall bias. RESULTS: Between 1987 and 2011, there were 18189 live births to 5119 mothers; and 73 mothers of 78 children died within the first year of their child's life, with 45% of these (n=30) classified as maternal deaths due to women dying within 42 days of childbirth. Among the maternal deaths, 81% of these infants also died. Children who experienced a maternal death within 42 days of their birth faced 46 times greater risk of dying within one month when compared to babies whose mothers survived (95% confidence interval 25.84-81.92; or adjusted ratio, 57.24 with confidence interval 25.31-129.49). CONCLUSIONS: When a woman in this study population experienced a maternal death, her infant was much more likely to die than to survive--and the survival trajectory of these children is far worse than those of mothers who do not die postpartum. This highlights the importance of investigating how clinical care and socio-economic support programs can better address the needs of orphans, both throughout the intra- and post-partum periods as well as over the life course.
Subject(s)
Infant Mortality , Maternal Death/statistics & numerical data , Maternal Mortality , Adolescent , Adult , Child , Ethiopia/epidemiology , Female , Humans , Infant , Kaplan-Meier Estimate , Longitudinal Studies , Male , Maternal Age , Socioeconomic Factors , Young AdultABSTRACT
Understanding the dynamics of social risk factors in the occurrence of adolescent motherhood is vital in designing more appropriate prevention initiatives in low-income and middle-income countries (LMICs). We aimed this study to examine the transition of social risk factors and their association with adolescent motherhood in LMICs since the initiation of the MDGs. We analysed 119967 adolescent girls (15-19 years) from 40-nationally representative Demographic Health Surveys in 20 LMICs that had at least two surveys: a survey in 1996-2003(baseline, near MDGs started) and another in 2014-2018(endline). Adolescent motherhood (having a live birth or being pregnant before age 20) was the outcome of interest, whereas social risk factors including household wealth, girls' level of education, and area of residence were the exposures. The association between adolescent motherhood and the social risk factors, as well as changes in the strength of the association over time were observed using multilevel logistic regression analysis. On an average, the proportion of adolescent mothers without education decreased by -15·61% (95% CI: -16·84, -14·38), whereas the poorest adolescent mother increased by 5·87% (95% CI: 4·74, 7·00). The national prevalence of adolescent motherhood remained unchanged or increased in 55·00% (11/20) of the studied countries. Comparing baseline to endline, the overall adjusted odds ratio (AOR) of adolescent motherhood increased for both poorest (AOR = 1·42, 95% CI: 1·28, 1·59) and rural residences (AOR = 1·09, 95% CI: 1·01, 1·17), and decreased, but not statistically significant for the low level of education (AOR = 0·92, 95% CI: 0·84, 1·01 for no education). Our study concludes that social risk factors of the adolescent mother had shifted in different directions during MDGs and SDGs eras, and adolescent mothers remained more disadvantaged than non-mothers in LMICs. Efforts need to be enhanced to improve adolescent girls' education. Intervention should be prioritised in disadvantaged communities to delay adolescent first birth and prevent adolescent motherhood in LMICs.
ABSTRACT
BACKGROUND: Documenting trends and inequalities in the prevalence of adolescent motherhood across low-income and middle-income countries (LMICs) is important to support the adolescent sexual and reproductive health target in the UN Sustainable Development Goals (SDGs). We aimed to examine time trends and sociodemographic inequalities in the prevalence of adolescent motherhood in LMICs. METHODS: We analysed data from 747â137 young women (aged 15-19 years) from 74 LMICs, using 254 nationally representative Demographic and Health Surveys done between 1990 and 2018. We estimated the population-weighted prevalence of adolescent motherhood among women aged aged 15-19 years (defined as having had a livebirth or being pregnant at the time of the survey). Trends in the prevalence were calculated at the national level using the average annual rate of change (AARC) in a subset of 61 countries with at least two surveys from different timepoints during the study period. Sociodemographic inequalities (eg, wealth quintile, level of education, and rural or urban residence) in adolescent motherhood were described using the normalised concentration index. FINDINGS: The highest prevalence of adolescent motherhood was observed in sub-Saharan African countries, for example it was 36·00% (95% CI 33·98-38·08) in Mali (which had recent survey data; 2018). Examining AARC, countries such as Nigeria (AARC -1·35%; 1990-2018) and India (-4·62%; 1992-2015) experienced a steady decline in the prevalence of adolescent motherhood during the study period. However, several high-burden countries experienced little change in prevalence over time (-0·60%; Bangladesh, 1993-2014), and 16 countries, such as Cambodia (2·42%; 2000-14) and Philippines (1·59%; 1993-2017), had an increase in the prevalence of adolescent motherhood over time. Sociodemographic inequalities in the prevalence of adolescent motherhood persist in most countries in this study. INTERPRETATION: Many of the countries in this study experienced either a slow rate of reduction or an increase in the prevalence of adolescent motherhood during the study period, and sociodemographic inequalities within countries persist. These results indicate that efforts to reduce adolescent motherhood and the associated health burden need to be improved within many LMICs. These findings can assist policy makers to target the rollout of interventions on the basis of observed geographic and sociodemographic inequalities to reduce adolescent motherhood among the disadvantaged, and accelerate progress towards adolescent sexual and reproductive health targets in the UN SDGs. FUNDING: None.
Subject(s)
Pregnancy in Adolescence/statistics & numerical data , Adolescent , Adolescent Health Services , Developing Countries , Female , Healthcare Disparities , Humans , Population Surveillance , Pregnancy , Prenatal Care , Prevalence , Socioeconomic Factors , Surveys and Questionnaires , Young AdultSubject(s)
Infant Mortality , Obesity/complications , Pregnancy Complications , Female , Humans , PregnancyABSTRACT
INTRODUCTION: The first 1000 days of life is a period of great potential and vulnerability. In particular, physical growth of children can be affected by the lack of access to basic needs as well as psychosocial factors, such as maternal depression. The objectives of the present study are to: (1) quantify the burden of childhood stunting in low/middle-income countries attributable to psychosocial risk factors; and (2) estimate the related lifetime economic costs. METHODS: A comparative risk assessment analysis was performed with data from 137 low/middle-income countries throughout Asia, Latin America and the Caribbean, North Africa and the Middle East, and sub-Saharan Africa. The proportion of stunting prevalence, defined as <-2 SDs from the median height for age according to the WHO Child Growth Standards, and the number of cases attributable to low maternal education, intimate partner violence (IPV), maternal depression and orphanhood were calculated. The joint effect of psychosocial risk factors on stunting was estimated. The economic impact, as reflected in the total future income losses per birth cohort, was examined. RESULTS: Approximately 7.2 million cases of stunting in low/middle-income countries were attributable to psychosocial factors. The leading risk factor was maternal depression with 3.2 million cases attributable. Maternal depression also demonstrated the greatest economic cost at $14.5 billion, followed by low maternal education ($10.0 billion) and IPV ($8.5 billion). The joint cost of these risk factors was $29.3 billion per birth cohort. CONCLUSION: The cost of neglecting these psychosocial risk factors is significant. Improving access to formal secondary school education for girls may offset the risk of maternal depression, IPV and orphanhood. Focusing on maternal depression may play a key role in reducing the burden of stunting. Overall, addressing psychosocial factors among perinatal women can have a significant impact on child growth and well-being in the developing world.
ABSTRACT
In this paper, we examine the inequality in the dynamics of the total fertility rate within 21 sub-Saharan African countries by wealth quintiles. We also examine the associated inequality within each country in the proximate determinants of fertility-marriage, contraception, and breastfeeding. Applying Bongaarts' proximate determinants of fertility framework, for 14/21 countries we analyze, we find that those in the richest wealth quintiles have had a more rapid decline in fertility rates than those in the poorest wealth quintiles. The rapid decline for those in the richest wealth quintiles is attributable to delayed marriage and modest increases in contraceptive use. Although the poorest lag in fertility decline, postpartum abstinence and breastfeeding are the most important factors for them for fertility regulation. Further encouraging maternal health programs that focus on natural methods of fertility regulation will work in favor of the poorest in sub-Saharan Africa in moving through the demographic transition.
Subject(s)
Birth Rate , Socioeconomic Factors , Africa South of the Sahara , Birth Rate/trends , Breast Feeding , Contraception Behavior , Developing Countries , Family Planning Services , Female , Fertility , Humans , Infant, Newborn , Male , Marriage , Maternal Health Services , Poverty , PregnancySubject(s)
Body Mass Index , Global Health , Overweight/epidemiology , Adult , Female , Humans , Income , Socioeconomic FactorsABSTRACT
BACKGROUND: An estimated 151 million children worldwide have lost one or both parents (UNICEF). Although a considerable literature has documented the impact of parental loss on children's emotional development, to date there are mixed findings regarding the potential effect of orphanhood on children's physical growth. The aim of the study is to examine the association between orphanhood (maternal, paternal or both) on childhood stunting status, accounting for living arrangement. METHODS: We combine nationally representative data from 84 Demographic Health Surveys for 49 low-income and middle-income countries (LMICs). Data from 222â 690 children aged 0-23â months were included in the analytical sample. We show pooled estimates from multiple analysis models, as well as models examining the role of the surviving parent's residence and household structure. RESULTS: In fully adjusted models, maternal orphans were found to have an increased risk of stunting (RR 1.3, 95% CI 1.2 to 1.4) compared to children with two living parents. The stratified models demonstrated that the greatest risk was observed for maternal orphans whose surviving fathers did not live with the child (RR 1.4, 95% CI 1.3 to 1.6). CONCLUSIONS: Early orphanhood constitutes a major risk for children's physical development in LMICs. However, the results suggest that the adverse effects of a parental loss can be mitigated if appropriate support is provided, indicating the potential benefits of the surviving parents staying with their children. The benefits of targeted social policies aimed at single fathers and grandparents supporting orphans may be significant.
Subject(s)
Caregivers , Child, Orphaned , Growth Disorders , Family Characteristics , Female , Humans , Infant , Infant, Newborn , Male , PovertyABSTRACT
OBJECTIVE: Objectives are to examine the shift away from undernutrition towards overnutrition for low to medium income countries (LMIC) and investigate the potential determinants of this shift using the nationally representative survey data. DESIGN AND SUBJECTS: We analysed cross-sectional, representative samples of 540,290 women aged 20-49 years drawn from the Demographic and Health Surveys (DHS) at two time points in 36 LMIC. The ratio of overweight-to-underweight at earliest and latest survey was calculated for each country to illustrate the relative magnitude of the shifting of underweight to overweight. Potential determinants of underweight (BMI < 18.5) and overweight (BMI ≥ 25) were examined. RESULTS: In the latest DHS compared to the earliest DHS (mean duration 10 years), the prevalence of underweight significantly declined for one in two countries and the prevalence of overweight significantly increased for 80% of the listed countries. The annual increase of overweight was two folds higher than annual decline of underweight (6.4% vs. 3.3%). Although higher socio-demographic factors were associated with shifting of underweight towards overweight, over time, the risk of the highly educated, wealthy, and urban women being overweight was weakening. CONCLUSIONS: Findings of this study suggest that among women of child-bearing age there was a large shift away from undernutrition to overnutrition for most of the LMIC. Overtime, the contribution of higher education, wealth and urbanisation to being overweight was decreasing in the LMIC.
Subject(s)
Developing Countries/statistics & numerical data , Overweight/epidemiology , Thinness/epidemiology , Adult , Body Mass Index , Cross-Sectional Studies , Female , Health Surveys , Humans , Nutritional Physiological Phenomena , Pregnancy , Social Class , Socioeconomic FactorsABSTRACT
BACKGROUND: An unresolved debate in demography concerns the causal sequence between the supply of contraception and the demand for smaller families in fertility decline. Through a mixed-methods approach, we explored the effect of a sudden increase in access to legal abortion on subsequent fertility decline when Ghana's criminal code was amended in 1985. METHODS: Using Ghana Demographic and Health Surveys, we constructed a panel of women aged 15-34 years and undertook a spline regression analysis to examine the effect of legal changes in 1985 and fertility decline controlling for social determinants of fertility. In addition, we conducted 17 key informant interviews (KIIs) to understand the reasons for the legal change and competing explanations for fertility decline. RESULTS: Multivariate results indicated that the timing of the liberalization of the abortion law coincided with the onset of Ghana's fertility decline. The KIIs indicated that the reasons for the liberalization of reproductive health laws were in response to famine and physician advocacy. CONCLUSIONS: While the timing of the abortion law liberalization coincided with the fertility decline in Ghana, we are unable to decouple the effect of the legal change from the effects of a severe famine that affected the region at the same time. Further research on documented and undocumented abortion in Ghana should be conducted to validate the contribution of legal abortion to fertility decline.
Subject(s)
Abortion, Legal/legislation & jurisprudence , Contraceptive Agents/supply & distribution , Fertility , Reproductive Health/legislation & jurisprudence , Adolescent , Adult , Contraception/methods , Data Collection , Family Planning Services , Female , Ghana , Health Services Accessibility , Health Surveys , Humans , Regression Analysis , Starvation/epidemiology , Young AdultABSTRACT
The extent to which body mass index (BMI) varies between small areas or neighborhoods in low- to middle-income countries (LMICs) remains unknown. Further, whether such variation is reflective of characteristics of individuals living in these neighborhoods is also not clear. We estimated the extent to which there is variation in BMI is attributable to neighborhoods in 57 LMICs. The data were from non-pregnant women of reproductive age (20-49 y) participating in Demographic and Health Surveys conducted in 57 countries between 1994 and 2008. Body mass index (BMI, weight [in kg] divided by height squared [in m(2)]) was used to assess weight status. Height and weight were measured objectively by trained field investigators. Age, household wealth, education were included as individual covariates and place of residence (urban or rural) as a neighborhood-level covariate. We conducted a multilevel analysis of 451,321 women (aged 20-49 y) from 32,814 neighborhoods and 57 countries. We used linear and multinomial models to partition the variation in BMI (in kg/m(2)), underweight (BMI <18.5 kg/m(2)) and overweight (BMI ≥25.0 kg/m(2)) at the level of neighborhoods and countries. We also explored the heterogeneity in neighborhood variation by socioeconomic status (SES). Of the total variation in BMI 17.6% was attributable to countries (Standard Deviation [SD] 2.0, 95% credible interval [CI] 1.7, 2.4) and 10.6% (SD 1.56, 95% CI 1.54, 1.58) was attributable to neighborhoods in age-adjusted models. Adjusting for individual- and neighborhood-level covariates reduced the SD attributable to countries and neighborhoods to 1.9, and 1.17, respectively. Between-country variation was 13.4% (SD 0.75, 95% CI 0.62-0.90) for underweight and 18.9% (SD 0.92, 95% CI 0.76-1.10) for overweight, and between-neighborhood variation was 7.7% (SD 0.57, 95% CI 0.55-0.58) for underweight and 7.1% (SD 0.56, 95% CI 0.55-0.58) for overweight in the fully-adjusted multinomial model. In country-specific models, the neighborhood variation in BMI ranged from 0.4 SD in Central African Republic to 2.7 SD in Sierra Leone in fully-adjusted models. Our results demonstrate a considerable range in neighborhood variation in BMI. In countries with greater neighborhood variation it is possible that BMI is being influenced by local conditions more than others with lesser neighborhood variation.
Subject(s)
Body Mass Index , Developing Countries/statistics & numerical data , Overweight/epidemiology , Residence Characteristics/statistics & numerical data , Adult , Female , Global Health , Health Surveys , Humans , Middle Aged , Socioeconomic Factors , Sociology, Medical , Thinness/epidemiologyABSTRACT
Demographic and Health Surveys (DHS) are comparable nationally representative household surveys that have been conducted in more than 85 countries worldwide since 1984. The DHS were initially designed to expand on demographic, fertility and family planning data collected in the World Fertility Surveys and Contraceptive Prevalence Surveys, and continue to provide an important resource for the monitoring of vital statistics and population health indicators in low- and middle-income countries. The DHS collect a wide range of objective and self-reported data with a strong focus on indicators of fertility, reproductive health, maternal and child health, mortality, nutrition and self-reported health behaviours among adults. Key advantages of the DHS include high response rates, national coverage, high quality interviewer training, standardized data collection procedures across countries and consistent content over time, allowing comparability across populations cross-sectionally and over time. Data from DHS facilitate epidemiological research focused on monitoring of prevalence, trends and inequalities. A variety of robust observational data analysis methods have been used, including cross-sectional designs, repeated cross-sectional designs, spatial and multilevel analyses, intra-household designs and cross-comparative analyses. In this profile, we present an overview of the DHS along with an introduction to the potential scope for these data in contributing to the field of micro- and macro-epidemiology. DHS datasets are available for researchers through MEASURE DHS at www.measuredhs.com.
Subject(s)
Demography/methods , Demography/statistics & numerical data , Global Health , Health Surveys/methods , Health Surveys/statistics & numerical data , Adolescent , Adult , Child , Child Welfare/statistics & numerical data , Child, Preschool , Data Collection/methods , Data Collection/statistics & numerical data , Databases, Factual/statistics & numerical data , Developing Countries/statistics & numerical data , Female , Health Status Disparities , Humans , Infant , Infant, Newborn , Male , Middle Aged , Reproductive Health/statistics & numerical data , Socioeconomic Factors , Young AdultABSTRACT
BACKGROUND: Adult height is a useful biological measure of long term population health and well being. We examined the cohort differences and socioeconomic patterning in adult height in low- to middle-income countries. METHODS/FINDINGS: We analyzed cross-sectional, representative samples of 364,538 women aged 25-49 years drawn from 54 Demographic and Health Surveys (DHS) conducted between 1994 and 2008. Linear multilevel regression models included year of birth, household wealth, education, and area of residence, and accounted for clustering by primary sampling units and countries. Attained height was measured using an adjustable measuring board. A yearly change in birth cohorts starting with those born in 1945 was associated with a 0.0138 cm (95% CI 0.0107, 0.0169) increase in height. Increases in heights in more recent birth year cohorts were largely concentrated in women from the richer wealth quintiles. 35 of the 54 countries experienced a decline (14) or stagnation (21) in height. The decline in heights was largely concentrated among the poorest wealth quintiles. There was a strong positive association between height and household wealth; those in two richest quintiles of household wealth were 1.988 cm (95% CI 1.886, 2.090) and 1.018 cm (95% CI 0.916, 1.120) taller, compared to those in the poorest wealth quintile. The strength of the association between wealth and height was positive (0.05 to 1.16) in 96% (52/54) countries. CONCLUSIONS: Socioeconomic inequalities in height remain persistent. Height has stagnated or declined over the last decades in low- to middle-income countries, particularly in Africa, suggesting worsening nutritional and environmental circumstances during childhood.
Subject(s)
Body Height , Developed Countries , Developing Countries , Social Class , Cohort Studies , Data Collection , Female , Humans , Sample SizeABSTRACT
OBJECTIVE: To examine the association between maternal age at first birth and infant mortality, stunting, underweight, wasting, diarrhoea and anaemia in children in low- and middle-income countries. DESIGN: Cross-sectional analysis of nationally representative household samples. A modified Poisson regression model is used to estimate unadjusted and adjusted RR ratios. SETTING: Low- and middle-income countries. POPULATION: First births to women aged 12-35 where this birth occurred 12-60 months prior to interview. The sample for analysing infant mortality is comprised of 176,583 children in 55 low- and middle-income countries across 118 Demographic and Health Surveys conducted between 1990 and 2008. MAIN OUTCOME MEASURES: Infant mortality in children under 12 months and stunting, underweight, wasting, diarrhoea and anaemia in children under 5 years. RESULTS: The investigation reveals two salient findings. First, in the sample of women who had their first birth between the ages of 12 and 35, the risk of poor child health outcome is lowest for women who have their first birth between the ages of 27 and 29. Second, the results indicate that both biological and social mechanisms play a role in explaining why children of young mothers have poorer outcomes. CONCLUSIONS: The first-born children of adolescent mothers are the most vulnerable to infant mortality and poor child health outcomes. Additionally, first time mothers up to the age of 27 have a higher risk of having a child who has stunting, diarrhoea and moderate or severe anaemia. Maternal and child health programs should take account of this increased risk even for mothers in their early 20s. Increasing the age at first birth in developing countries may have large benefits in terms of child health.
ABSTRACT
BACKGROUND: Low- to middle-income countries (LMICs) are believed to be characterized by the coexistence of underweight and overweight. It has also been posited that such coexistence is appearing among the low socioeconomic status (SES) groups. METHODS: We conducted a cross-sectional analysis of nationally representative samples of 451,321 women aged 20-49 years drawn from 57 Demographic and Health Surveys conducted between 1994 and 2008. Body Mass Index (BMI in kg/m²), was used to define underweight and overweight following conventional cut-points. Covariates included age, household wealth, education, and residence. We estimated multinomial multilevel models to assess the extent to which underweight (BMI<18.5 kg/m²) and overweight (BM I≥ 25.0 kg/m²) correlate at the country-level, and at the neighborhood-level within each country. RESULTS: In age-adjusted models, there was a strong negative correlation between likelihood of being underweight and overweight at country- (râ=â-0.79, p<0.001), and at the neighborhood-level within countries (râ=â-0.51, P<0.001). Negative correlations ranging from -0.11 to -0.90 were observed in 46 of the 57 countries at the neighborhood-level and 29/57 were statistically significant (p ≤ 0.05). Similar negative correlations were observed in analyses restricted to low SES groups. Finally, the negative correlations across countries, and within-countries, appeared to be stable over time in a sub-set of 36 countries. CONCLUSION: The explicitly negative correlations between prevalence of underweight and overweight at the country-level and at neighborhood-level suggest that the hypothesized coexistence of underweight and overweight has not yet occurred in a substantial manner in a majority of LMICs.
Subject(s)
Malnutrition/epidemiology , Adult , Body Mass Index , Cross-Sectional Studies , Female , Humans , Middle Aged , Overweight/epidemiology , Residence Characteristics , Socioeconomic Factors , Thinness/epidemiology , Young AdultABSTRACT
BACKGROUND: Recent studies have shown a strong positive association between individual BMI (in kg/m(2)) or overweight prevalence and socioeconomic status (SES) in low- and middle-income countries (LMICs). However, it is not clear whether this association is weakening or reversing over time. OBJECTIVE: With the use of nationally representative data collected at 2 time points in 37 LMICs, we compared the associations of SES with BMI and of SES with overweight between the earlier surveys and the later surveys. DESIGN: We conducted a cross-sectional analysis of nationally representative samples of 547,056 ever-married nonpregnant women aged 15-49 y: 208,570 women in the earlier round of surveys conducted between 1991 and 2003 and 338,486 women in the later round conducted between 1998 and 2008. We used linear and modified Poisson analyses with a country fixed effect to obtain a pooled estimate and a country-stratified analysis for country-specific estimates. RESULTS: In adjusted models, BMI was 2.32 units higher (95% CI: 2.23, 2.41 units) among women in the wealthiest quintile compared with women in the poorest quintile in the earlier surveys and was 3.00 units higher (95% CI: 2.92, 3.07 units) in the later surveys. The association between BMI and wealth was positive in 37 countries in the earlier round of surveys and in 36 countries in the later round. Patterns were similar for overweight prevalence. CONCLUSION: The association between SES and BMI or overweight is positive in most LMICs and has not weakened over time. It appears that the burden of overweight is consistently greater among wealthier populations within LMICs.