Neighbourhood effect and inequality in access to essential health services among mother-child paired samples: a decomposition analysis of data from 58 low- and middle-income countries.

INTRODUCTION: Neighbourhood effect on health outcomes is well established, but little is known about its effect on access to essential health services (EHS). Therefore, this study aimed to assess the contributing factors to access to EHS in slum versus non-slum settings. METHODOLOGY: The most recent data from 58 Demographic and Health Surveys (DHS) conducted between 2011 and 2018 were used, including a total of 157,000 pairs of currently married women aged 15-49 and their children aged 12-23 months. We used meta-analysis techniques to examine the inequality gaps in suboptimal access to EHS between mother-children pairs living in slums and non-slums. Blinder-Oaxaca decomposition technique was used to identify the factors contributing to the inequality gaps in each low- and middle-income country (LMIC) included. RESULT: The percentage of mother-child pairs living in slums ranged from 0.5% in Egypt to 63.7% in Congo. Meta-analysis of proportions for the pooled sample revealed that 31.2% [27.1, 35.5] of slum residents and 20.0% [15.3, 25.2] among non-slum residents had suboptimal access to EHS. We observed significant pro-slum inequalities in suboptimal access to EHS in 28 of the 52 LMICs with sufficient data. Of the 34 African countries included, 16 showed statistically significant pro-slum inequality in suboptimal access to EHS, with the highest in Egypt and Mali (2.64 [0.84-4.44] and 1.76 [1.65, 1.87] respectively). Findings from the decomposition analysis showed that, on average, household wealth, neighbourhood education level, access to media, and neighbourhood-level illiteracy contributed mostly to slum & non-slum inequality gaps in suboptimal access to EHS. CONCLUSION: The study showed evidence of inequality in access to EHS due to neighbourhood effects in 26 LMICs. This evidence suggests that increased focus on the urban poor might be a important for increasing access to EHS and achieving the universal health coverage (UHC) goals.

Age heaping among adults in Nigeria: evidence from the Nigeria Demographic and Health Surveys 2003-2013.

Age, as a variable, represents a critical basis for demographic classification; thus, its misrepresentations or misreporting alter the accuracy of demographic estimates. This paper examines the extent and pattern of age heaping in the age data for adults, collected in the Nigerian Demographic Health Survey (NDHS). The study used the NDHS data for 2003, 2008, and 2013 to compute a Whipple's and Meyers' blended index for each survey year, by gender, geopolitical zones, states and place of residence. The analysis shows that age heaping was higher than the acceptable levels in all three data sets. The Whipple's index puts the rate of age heaping in the 2003 dataset at 271.3, whilst the rates declined slightly in the 2008 and 2013 datasets to reach 204.2 and 202.5 respectively. Similarly, the Myers' blended index portrayed that age heaping in the 2003 data was highest at 47.0 while the subsequent years were lower at 38.60 and 38.66, respectively. Digits ending in 0 and 5 were mostly reported in all three surveys and higher rates of age heaping were observed among males, the uneducated and rural dwellers. Age heaping was prominent in all three surveys, thus affecting the data quality gathered at these surveys. Thus, future studies should assess the extent to which age misreporting could bias the estimate of fertility rate.

Use, characteristics and influence of lay consultation networks on treatment-seeking decisions in slums of Nigeria: a cross-sectional survey.

OBJECTIVES: To describe the use, characteristics and influence of lay consultants on treatment-seeking decisions of adults in slums of Nigeria. DESIGN: Cross-sectional survey using a pre-piloted questionnaire. SETTINGS: Two slum communities in Ibadan city, Nigeria. PARTICIPANTS: 480 adults within the working age group (18-64). RESULTS: Most respondents (400/480, 83.7%) spoke to at least one lay consultant during their last illness/health concern. In total, 683 lay consultants were contacted; all from personal networks such as family and friends. No respondent listed online network members or platforms. About nine in 10 persons spoke to a lay consultant about an illness/health concern without intending to seek any particular support. However, almost all (680/683, 97%) lay consultants who were contacted provided some form of support. Marital status (OR=1.92, 95% CI: 1.10 to 3.33) and perceiving that an illness or health concern had some effects on their daily activities (OR=3.25, 95% CI: 1.94 to 5.46) had a significant independent association with speaking to at least one lay consultant. Age had a significant independent association with having lay consultation networks comprising non-family members only (OR=0.95, 95% CI: 0.92 to 0.99) or mixed networks (family and non-family members) (OR=0.97, 95% CI: 0.95 to 0.99), rather than family-only networks. Network characteristics influenced individual treatment decisions as participants who contacted networks comprising non-family members only (OR=0.23, 95% CI: 0.08 to 0.67) and dispersed networks (combination of household, neighbourhood and distant network members) (OR=2.04, 95% CI: 1.02 to 4.09) were significantly more likely to use informal than formal healthcare, while controlling for individual characteristics. CONCLUSIONS: Health programmes in urban slums should consider engaging community members so, when consulted within their networks, they are able to deliver reliable information about health and treatment-seeking.

Systematic review of educational interventions to improve the menstrual health of young adolescent girls.

OBJECTIVES: To systematically review interventions that include an element of menstrual education delivered to young adolescent girls. DESIGN: This was a systematic review and meta-analysis. Selected articles were quality assessed using the Mixed Methods Appraisal Tool quality appraisal checklist. A meta-analysis was conducted on a subset of articles, and the effect size of the intervention was calculated using Cohen's d. A logic model was constructed to frame the effect of menstrual education interventions on menstrual health. SETTING: Papers reporting on interventions in high-income and low-income and middle-income countries were sought. INFORMATION SOURCES: Seven electronic databases were searched for English-language entries that were published between January 2014 and May 2020. PARTICIPANTS: The interventions were aimed at younger adolescent girls aged 10-14 years old. INTERVENTIONS: The interventions were designed to improve the menstrual health of the recipients, by addressing one or more elements of menstrual knowledge, attitude or practices (KAP). ELIGIBILITY CRITERIA: Interventions that had not been evaluated were excluded. PRIMARY AND SECONDARY OUTCOMES: The most common type of output was a difference in knowledge or skill score ascertained from a pre and post test. Some studies measured additional outcomes, such as attitude or confidence. RESULTS: Twenty-four eligible studies were identified. The number of participants varied from 1 to 2564. All studies reported improvements in menstrual KAP. The meta-analysis indicates that larger effect sizes were attained by those that encouraged discussion than those that distributed pamphlets. CONCLUSIONS: Education interventions are effective in increasing the menstrual knowledge of young adolescent girls and skills training improves competency to manage menstruation more hygienically and comfortably. Interactive interventions are more motivating than didactic or written. Sharing concerns gives girls confidence and helps them to gain agency on the path to menstrual health. TRIAL REGISTRATION NUMBER: For this review, a protocol was not prepared or registered.

Systematic review of lay consultation in symptoms and illness experiences in informal urban settlements of low-income and middle-income countries.

OBJECTIVES: Lay consultation is the process of discussing a symptom or an illness with lay social network members. This can have positive or negative consequences on health-seeking behaviours. Understanding how consultation with lay social networks works in informal urban settlements of low-income and middle-income countries (LMICs) is important to enable health and policy-makers to maximise its potential to aid healthcare delivery and minimise its negative impacts. This study explored the composition, content and consequences of lay consultation in informal urban settlements of LMICs. DESIGN: Mixed-method systematic review. DATA SOURCES: Six key public health and social science databases, Google Scholar and reference lists of included studies were searched for potential articles. ELIGIBILITY CRITERIA: Papers that described discussions with lay informal social network members during symptoms or illness experiences. DATA ANALYSIS AND SYNTHESIS: Quality assessment was done using the Mixed Methods Appraisal Tool. Data were analysed and synthesised using a stepwise thematic synthesis approach involving two steps: identifying themes within individual studies and synthesising themes across studies. RESULTS: 13 studies were included in the synthesis. Across the studies, three main categories of networks consulted during illness: kin, non-kin associates and significant community groups. Of these, kin networks were the most commonly consulted. The content of lay consultations were: asking for suggestions, negotiating care-seeking decisions, seeking resources and non-disclosure due to personal or social reasons. Lay consultations positively and negatively impacted access to formal healthcare and adherence to medical advice. CONCLUSION: Lay consultation is mainly sought from social networks in immediate environments in informal urban settlements of LMICs. Policy-makers and practitioners need to utilise these networks as mediators of healthcare-seeking behaviours. PROSPERO REGISTRATION NUMBER: CRD42020205196.