COVID-19 vaccine intercountry distribution inequality and its underlying factors: a combined concentration index analysis and multiple linear regression analysis.

Introduction: Inequitable access to COVID-19 vaccines among countries is a pressing global health issue. Factors such as economic power, political power, political stability, and health system strength contribute to disparities in vaccine distribution. This study aims to assess the inequality in vaccine distribution among countries based on these factors and identify their relationship with COVID-19 vaccine distribution. Methods: A Concentration Index (CI) analysis was conducted to evaluate inequalities in the distribution of COVID-19 vaccines among countries based on four separate variables: GDP per capita, political stability (PS), World Power Index (WPI), and Universal Health Coverage (UHC). Additionally, Multiple Linear Regression (MLR) analysis was employed to explore the relationship between vaccine distribution and these independent variables. Two vaccine distribution variables were utilized for result reliability. Results: The analysis revealed significant inequalities in COVID-19 vaccine distribution according to the countries' GDP/capita, PS, WPI, and UHC. However, the multiple linear regression analysis showed that there is no significant relationship between COVID-19 vaccine distribution and the countries' GDP/capita and that UHC is the most influential factor impacting COVID-19 vaccine distribution and accessibility. Discussion: The findings underscore the complex interplay between economic, political, and health system factors in shaping vaccine distribution patterns. To improve the accessibility to vaccines in future pandemics, Global Health Governance (GHG) and countries should consider working on three areas; enhance political stabilities in countries, separate the political power from decision-making at the global level and most importantly support countries to achieve UHC.

Screening and determinant of suspected developmental delays among Egyptian preschool-aged children: a cross-sectional national community-based study.

BACKGROUND: Early childhood life is critical for optimal development and is the foundation of future well-being. Genetic, sociocultural, and environmental factors are important determinants of child development. AIM: The objectives were to screen for suspected developmental delays (DDs) among Egyptian preschool children, and to explore the determinants of these delays based on sociodemographic, epidemiological, maternal, and child perinatal risk factors. METHODS: A national Egyptian cross-sectional developmental screening of a representative sample of preschool children (21,316 children) aged 12 to 71 months. The Revised Denver Prescreening Developmental Questionnaire (R-PDQ) followed by the Denver Developmental Screening Test, 2nd edition (DDST) was used. RESULTS: Each screened child manifested at least one of six developmental categories. Either typical development, gross motor delay (GM), fine motor adaptive delay (FMA), Language delay (L), Personal-social delay (PS), or multiple DDs. The prevalence of preschool children with at least one DD was 6.4%, while 4.5% had multiple DDs. Developmental language delay was the most prevalent, affecting 4.2% of children. The least affected domain was GM (1.9% of children). Boys were more likely to have DD than girls. Children in urban communities were more likely to have at least one DD than those in rural areas (OR = 1.28, 95%CI: 1.14-1.42), and children of middle social class than of low or high social class (OR = 1.49, 95%CI: 1.30-1.70 & OR = 1.40, 95%CI: 1.23-1.59 respectively). The strong perinatal predictors for at least one DD were children with a history of postnatal convulsions (OR = 2.68, 95%CI: 1.97-3.64), low birth weight (OR = 2.06, 95%CI: 1.69-2.52), or history of postnatal cyanosis (OR = 1.77, 95%CI: 1.26-2.49) and mothers had any health problem during pregnancy (OR = 1.73, 95%CI: 1.44-2.07). Higher paternal and maternal education decreased the odds of having any DD by 43% (OR = 0.57, 95% CI: 0.47-0.68) and 31% (OR = 0.69, 95%CI: 0.58-0.82) respectively. CONCLUSION: This study demonstrates a considerable attempt to assess the types and the prevalence of DD among preschool children in Egypt. Perinatal factors are among the most common determinants of DD in preschool children and the majority could be preventable risk factors.

Prevalence and risk factors of disabilities among Egyptian preschool children: a community-based population study.

BACKGROUND: Child disability has significant implications on their well-being and healthcare systems. AIM: This survey aimed to assess the magnitude of seven types of disability among Egyptian children aged 1 < 6 years and their socio-demographic, epidemiological, and perinatal predictors. METHODS: A national population-based cross-sectional household survey targeting 21,316 children from eight governorates was conducted. The screening questionnaire was derived from the WHO ten-question survey tool validated for identifying seven disability categories. RESULTS: The percentage of children with at least one disability was 8.1% as follows: speech/communication (4.4%), Mobility/physical (2.5%), Seizures (2.2%), Comprehension (1.7%), Intellectual impairment (1.4%), Visual (0.3%) and Hearing (0.2%). Age was not found to affect the odds of disability except for visual disability (significantly increased with age (AOR = 1.4, 95% CI:1.1-1.7). Male sex also increased the odds of all disabilities except visual, hearing, and seizures. Convulsions after birth significantly increased the odds of disability as follows: hearing (AOR = 8.1, 95% CI: 2.2-30.5), intellectual impairment (AOR = 4.2, 95% CI: 2.5-6.9), and mobility/physical (AOR = 3.4, 95% CI: 2.3-5.0). Preterm delivery and being kept in an incubator for more than two days after birth increased the odds for visual disability (AOR = 3.7, 95% CI: 1.1-12.1 & AOR = 3.7, 95% CI: 1.7-7.9 respectively). Cyanosis increased the odds of seizures (AOR = 4.7, 95% CI: 2.2-10.3). Low birth weight also increased the odds for all disability domains except for visual and hearing. Maternal health problems during pregnancy increased the odds for all types of disability except hearing and seizures. Higher paternal education decreased the odds for all disabilities by at least 30% except for vision and hearing. CONCLUSION: The study found a high prevalence of disability among Egyptian children aged 1-6 years. It identified a number of modifiable risk factors for disability. The practice of early screening for disability is encouraged to provide early interventions when needed.

National screening for developmental delays and their determinants among Egyptian school age children: A step towards implementing life skills programs.

AIM: This study aimed to estimate the national prevalence of developmental delays (DDs) and their determinants among Egyptian children aged 6 to 12 years. Such estimation is a prerequisite step toward the application of Life Skill Education (LSE) programs that will potentiate children's future capabilities. METHODS: Vineland Adaptive Behavior Scales" was used as a reliable and diagnostic test for DDs screening during this national cross sectional study. Gross motor (GM), fine motor (FM), daily living skills, communication, and socialization skills were assessed. The multivariate logistic regression analysis was used to identify factors associated with DDs. The Adjusted Odds Ratio (AOR) with a 95% Confidence Interval was estimated to indicate the strength of association. A p-value of <0.05 was used to declare statistical significance. RESULTS: Out of the 20324 surveyed school-aged children, 7.4% were found to have at least one delay. Communication deficits were the most common (6.4%) followed by delay in daily living skills (2.0%). The final model of logistic regression had a good fit for seven variables out of the sociodemographic, epidemiological characteristics, maternal and perinatal problems that were associated with a higher likelihood of at least one DD: Children suffering from any convulsions (AOR = 4.32; 95% CI: 3.18-5.88), male gender (AOR = 1.86; 95% CI: 1.65-2.09), birth weight less than 2.5 kg (AOR = 1.77; 95% CI: 1.40-2.24), history of maternal health problem during pregnancy (AOR = 1.64; 95% CI:1.34-2.01), children staying in an incubator for more than two days (AOR = 1.57, 95% CI: 1.29-1.91), having less educated fathers (AOR = 1.55, 95% CI: 1.24-1.95) and belonging to the middle social class (AOR = 1.40, 95% CI: 1.24-1.58). CONCLUSION: The identified types and determinants for each DD are allowing for the implementation of tailored programs for school children's life skills promotion for achieving the most sustainable effects on children's biological and psychological health and well-being.

A national screening for the prevalence and profile of disability types among Egyptian children aged 6-12 years: a community-based population study.

AIM: This study aimed to determine the prevalence of disability domains among Egyptian children in the age group of 6-12 years as well as assess their socio-demographic, epidemiological, and perinatal predictors. METHODS: A national population-based cross-sectional household survey targeting 20,324 children from eight governorates was conducted. The screening questionnaire was derived from the WHO ten-question survey tool validated for the identification of disabilities. RESULTS: The prevalence of children with at least one type of disability was 9.2%. Learning/ comprehension was the most prevalent type (4.2%), followed by speech/communication (3.7%), physical/ mobility and seizures (2.2% for each), intellectual impairment (1.5%), visual (0.7%), and hearing (0.4%). The commonest predictors for disabilities were children who suffered from convulsions or cyanosis after birth and maternal history of any health problem during pregnancy. However, preterm and low birth weight (LBW) babies or being admitted to incubators for more than two days were strong predictors for all disabilities except hearing disability. A history of jaundice after birth significantly carried nearly twice the odds for seizures (AOR = 2.2, 95% CI:1.5-3.4). History of difficult labor was a predictor of intellectual impairment (AOR = 1.5, 95% CI:1.1-2.0). A disabled mother was a strong predictor for all disabilities except seizures, while a disabled father was a predictor for visual and learning/ comprehension disabilities (AOR = 3.9, 95% CI:2.2-7.1 & AOR = 1.6, 95% CI:1.1-2.4 respectively). Meanwhile, both higher maternal and paternal education decreased significantly the odds to have, physical/ mobility and Learning/ comprehension by at least 30%. CONCLUSION: The study found a high prevalence of disability among Egyptian children aged 6-12 years. It spotted many modifiable determinants of disability domains. The practice of early screening for disability is encouraged to provide early interventions.

National screening for Egyptian children aged 1 year up to 12 years at high risk of Autism and its determinants: a step for determining what ASD surveillance needs.

This study aimed to provide a national estimate of the prevalence of the high risk of autism spectrum disorder (ASD) and their determinants. A national screening survey was conducted for 41,640 Egyptian children aged 1 to 12 years in two phases. Tools used were Vineland's Adaptive Behavior Scales, Modified Checklist for Autism in Toddlers, Gilliam Autism Rating scale, and Denver II Developmental screening test. The overall prevalence of children at high risk of ASD was 3.3% (95% CI:3.1%-3.5%). Children living without mothers in homes, suffered from convulsions (AOR = 3.67; 95%CI:2.8-4.8), a history of cyanosis after birth (AOR = 1.87; 95% CI:1.35-2.59) or history of LBW babies (AOR = 1.53; 95% CI:1.23-1.89) carried higher odds of being at high risk of ASD.

A national prevalence and profile of single and multiple developmental delays among children aged from 1 year up to 12 years: an Egyptian community-based study.

OBJECTIVE: This study aimed at providing a national prevalence of single and multiple developmental delays (DDs) among 41,640 Egyptian children aged 1 to 12 years and exploring DDs' associated risk and protective factors. METHODS: A national household survey from eight governorates of Egypt representing the four major subdivisions of Egypt was conducted through systematic probability proportionate to size. All enrolled children were assessed according to Vineland Adaptive Behavior Scales, (VABS) as a reliable screening questionnaire for identifying categories of DDs that were verified by pediatrics' specialists. RESULTS: The overall prevalence of children with DDs was 6.7%. The prevalence of a single DD was 3.9% versus 2.8% multiple DDs. Communication deficit was the most prevalent type (5.3%). Lower prevalence was identified for fine motor delay (1.0%), gross motor delay, and socialization deficit (1.5% each). Whereas deficits in daily life skills (self-help and adaptive behavior delay) amounted to 2.3%. Living without mothers and/or fathers in homes was associated with increased odds of having DDs by one and a half times (OR = 1.72 and OR = 1.34 respectively). Multiple logistic regression analysis revealed the most predictors for DDs including children who suffer from convulsions after birth (OR = 3.10), low birth weight babies (OR = 1.94), male sex (OR = 1.75), mothers having health problems during pregnancy (OR = 1.70) and belonging to middle socioeconomic status (OR = 1.41). Children who suffered from cyanosis after birth was found to be at risk for any or multiple DDs. Difficult labor was significantly associated with increased odds for multiple DDs (OR = 1.55). Higher paternal and maternal education was associated with decreased odds to have any DDs by 40% (OR = 0.60 and OR = 0.58 respectively). CONCLUSIONS: The detected prevalence of DDs is within the estimated range of prevalence of DDs for the pediatric population. The majority of the detected risk factors are preventable. Developmental screening is recommended to be implemented in all primary care settings as a routine practice.

Monitoring the decomposition of wealth-related inequality in the use of regular antenatal care in Egypt (1995-2014).

BACKGROUND: Between 1995 and 2014 Egypt successfully increased the use of regular antenatal care (URAC) among women from 30.4 to 82.9%. The same period saw a decrease in the wealth-based inequality in URAC. This paper investigates the changes in the main determinants contributing to the wealth-based inequality in URAC for the 2 years of 1995 and 2014, and the determinants that underlined the declines in this inequality. METHODS: The secondary analysis was based on data from the 1995 and 2014 rounds of the Egypt Demographic and Health Survey. Logistic regression was implemented to model URAC for the 2 years and inequality was measured using the concentration index. Decomposition of the concentration index and Blinder -Oaxaca decomposition were implemented to assess the contribution of the URAC determinants to its inequality and the changes between 1995 and 2014. RESULTS: Decomposition of inequalities in URAC in 1995 and 2014 showed that social determinants were the main contributors to these inequalities. More than 90% of the inequalities were explained by the living in rural Upper Egypt, women and their husbands secondary and higher education, the household standard of living, and birth order. These same determinants were responsible for more than 76% of the decline in the inequality in URAC between 1995 and 2014. Wide spread of poverty in rural Upper Egypt was found to contribute significantly to the inequality in URAC. Women and their husbands who have secondary or higher education maintained their high odds of URAC. CONCLUSION: Since poverty in rural Upper Egypt, and inequality in education and parity are crucial social determinants of URAC inequality and its change overtime, new policies and interventions need to focus not only on the health system but on social initiatives with an equity lens to tackle the structural causes underlying these factors and their inequalities.

3+ parity in Egypt: a multilevel decomposition of wealth-based inequality.

BACKGROUND: Wealth disparities in levels of fertility are well documented in Egypt. Data from the Egypt Demographic and Health Survey (2014) showed that 61% of births to mothers from the poorest wealth quintile were of the third order or higher compared to 33% among mothers from the richest wealth quintile. The current paper investigates the main individual and socio-contextual level determinants of having more than two living children among women aged 30 and older, and decomposes its wealth-based inequality. METHODS: The secondary analysis was based on the 2014 Egypt Demographic and Health Survey. Multilevel linear regression was used to model the number of additional living children a woman has after her first two living children. A decomposition analysis of the wealth-based concentration index was applied using a multilevel model. RESULTS: Individual level and area level attributes explained 83 and 17% of the variation in 3+ parity, respectively. Only areas not well served by the health system were significantly related to 3+ parity. Decomposition of the wealth-based concentration index revealed that 55.7 and 44.3% of the 3+ parity inequality were attributed to individual level attributes and area level attributes, respectively. At the individual level, early marriage accounted for 26% of the inequality in 3+ parity inequality. At the area level, living in areas not well served by the health system accounted for 22.3% of the 3+ parity wealth- based inequality, while highly gendered areas contributed 5.8% to this inequality. Areas' random effects contributed 7.1% to the 3+ parity inequality, assist in identifying specific areas that require targeted policies. CONCLUSION: Multilevel decomposition allowed the contributions of both the individual and area level attributes to be quantified. The decomposition highlighted the need for more tailored policies that target different social groups and different areas. Decomposition analysis also pinpointed specific areas that require additional targeted policies. This targeted approach can be used to support the efficient use of limited resources within any society.

Measurement of health equity as a driver for impacting policies.

This paper proposes measurement tracks of health equity (HE) and presents practical illustrations to influence, inform and guide the uptake of equity-sensitive policies. It discusses the basic requirements that allow the effective use of the proposed measurement tracks. Egypt is used as a demonstration of this practice. The paper differentiates between the policy needs of two groups of countries. The first set of measurement tracks are specifically tailored to countries at the early stages of considering health equity, requiring support in placing HE on the policy agenda. Key messages for this group of countries are that the policy influence of measurement can be strengthened through the implementation of four self-reinforcing tracks that recognize the need to effectively use the available current databases prior to engaging in new data collection, emphasize the importance of a social justice reframing of the documented health inequities, present health inequity facts in simple visual messages and move beyond the why to what needs to be done and how. The tracks also recognizes that placing an issue on the policy agenda is a complex matter requiring reinforcement from many actors and navigation among competing forces and policy circles. For the second group of countries the paper discusses the monitoring framework. The key messages include the importance of moving toward a more comprehensive system that sustains the monitoring system which is embedded within affective participatory accountability mechanisms. The paper discusses the basic requirements and the institutional, financial, technical and human capacity-building considerations for implementing the proposed measurement tracks.

Socioeconomic status and obesity in Cairo, Egypt: a heavy burden for all.

Studies have generally shown a positive association between socioeconomic status (SES) and obesity in low-income countries, but few have tested this relationship in the Middle East where obesity prevalence is extraordinarily high and the nutrition profile more closely resembles developed world contexts. The objective of this study is to examine the SES-obesity association in Cairo, Egypt. Multinomial regression analyses were conducted and predicted probabilities were found for overweight and obesity status among adult men and women in a stratified analysis. Data were taken from the 2007 Cairo Urban Inequity Study which collected information on 3993 individuals from 50 neighborhoods in the Cairo Governorate. Five different measures of SES were utilized - education, household expenditures, household assets, subjective wealth, and father's education. No significant associations were found between most measures of SES and overweight/obesity in this population. Overweight and obesity are prevalent across the SES spectrum. These findings suggest that obesity programs and policies should be targeted at all SES groups in Cairo, although specific mechanisms may vary by SES and should be explored further in future studies.

Differences in self-reported physical limitation among older women and men in Ismailia, Egypt.

OBJECTIVES: This study explores the reasons for gender differences in self-reported physical limitation among older adults in Ismailia, Egypt. METHOD: 435 women and 448 men, 50 years and older in Ismailia, Egypt, participated in a social survey and tests of physical performance. Ordered logit models were estimated to compare unadjusted gender differences in reported disability with these differences adjusted sequentially for (a) age and objective measures of physical performance, (b) self-reported morbidities and health care use, and (c) social and economic attributes. RESULTS: Compared with men, women more often reported higher levels of limitation in activities of daily living (ADLs), upper-extremity range of motion (ROM), and lower-extremity gross mobility (GM). Adjusting for age and objective measures of physical performance, women and men had similar odds of self-reporting difficulty with ADLs. With sequential adjustments for the remaining variables, women maintained significantly higher odds of self-reported difficulty with upper-extremity ROM and lower-extremity GM. DISCUSSION: Cross-culturally, gender differences in self-reported disability may arise from objective and subjective perceptions of disability. Collectively, these results and those from prior studies in Bangladesh and the United States suggest that gender gaps in self-reported physical limitation may be associated with the degree of gender equality in society.

Obstetricians' perspective towards cesarean section delivery based on professional level: experience from Egypt.

OBJECTIVES: (1) To investigate Egyptian obstetricians' views towards cesarean delivery on maternal request, (2) to investigate Egyptian obstetricians' views towards some of the "potentially neglected" or controversial obstetrical skills or maneuvers as external cephalic version (ECV), fetal scalp pH measurement or tubal ligation during CS and (3) to examine the effect of professional level on the above factors. STUDY DESIGN: This is a descriptive study performed at the 8th annual Obstetrics and Gynecology conference of Suez Canal University held at Ismailia city in Egypt in June 2011 via a structured self administered questionnaire. Questionnaire was distributed to 223 conference attendants from the three professional levels (consultants, specialists and registrars) working at the two major institutions in Egypt: University and Ministry of Health. The structured questionnaire was based on informed opinion and professional guidelines. In total, 167 (75%) completed the questionnaire. RESULTS: Cesarean delivery on maternal request was accepted by 66% of the studied group and acceptance was significantly higher among consultants. There was no difference in all physicians' practices of cesarean section in both private and public settings. Limited access to medical equipment such as cardiotocogram (CTG) was shown in consultant group reflecting improper private sector preparations. The study revealed that 59% of obstetricians accepted vaginal breech delivery, and only 14% would consider ECV. Fetal scalp pH taking in cases of abnormal CTG was accepted by only 16.3% and 49% rejected the practice of instrumental delivery. There were significant differences among the three professional and the two institutional groups regarding these attitudes. There were different views regarding tubal sterilization during CS. CONCLUSIONS: Lack of knowledge, the need to improve some clinical skills and some professional attitudes may shed light on rising CS rates in Egypt.

Is access to neighborhood green space associated with BMI among Egyptians? A multilevel study of Cairo neighborhoods.

Evidence of a link between green space and obesity has increased in the developed world, but few studies have been conducted in the developing world. Our study tests whether availability of neighborhood green space is associated with BMI among adults in Cairo, Egypt. Using data from the 2007 Cairo Urban Inequity Study, we conducted multilevel analyses and found no significant green space-BMI association, leading us to conclude that this intervention may not be as promising in this developing world context as it has been in some western urban contexts. Other aspects of the urban environment should be evaluated to better understand neighborhood variations in obesity in Cairo.

Social conditions and urban health inequities: realities, challenges and opportunities to transform the urban landscape through research and action.

The process of urbanization entails social improvements with the consequential better quality-of-life for urban residents. However, in many low-income and some middle-income countries, urbanization conveys inequality and exclusion, creating cities and dwellings characterized by poverty, overcrowded conditions, poor housing, severe pollution, and absence of basic services such as water and sanitation. Slums in large cities often have an absence of schools, transportation, health centers, recreational facilities, and other such amenities. Additionally, the persistence of certain conditions, such as poverty, ethnic heterogeneity, and high population turnover, contributes to a lowered ability of individuals and communities to control crime, vandalism, and violence. The social vulnerability in health is not a "natural" or predefined condition but occurs because of the unequal social context that surrounds the daily life of the disadvantaged, and often, socially excluded groups. Social exclusion of individuals and groups is a major threat to development, whether to the community social cohesion and economic prosperity or to the individual self-realization through lack of recognition and acceptance, powerlessness, economic vulnerability, ill health, diminished life experiences, and limited life prospects. In contrast, social inclusion is seen to be vital to the material, psychosocial, and political aspects of empowerment that underpin social well-being and equitable health. Successful experiences of cooperation and networking between slum-based organizations, grassroots groups, local and international NGOs, and city government are important mechanisms that can be replicated in urban settings of different low- and middle-income countries. With increasing urbanization, it is imperative to design health programs for the urban poor that take full advantage of the social resources and resourcefulness of their own communities.

Are neighborhood education levels associated with BMI among adults in Cairo, Egypt?

This study examined the association between area-level education and BMI among adults in Cairo, Egypt. A sample of 3993 households including 1990 men and 2003 women were analyzed from the 2007 Cairo Urban Inequity Study, a study which aimed to identify potential intra-urban inequities in health related to the environment and living conditions in Cairo. Using multilevel analysis, we found that residents of high education neighborhoods were significantly less likely to be obese compared to low education neighborhoods. An inverse association between neighborhood education and individual BMI was observed whereby each unit increase in percentage of households with greater than a high school education was associated with a 0.036 kg/m(2) decrease in BMI of individuals. This translated into a difference between high and low education neighborhoods of 6.86 kg (15.1 lb) for women based on an average height of 1.65 m and 6.10 kg (13.4 lb) for men based on an average height of 1.75 m after adjusting for sociodemographic, socioeconomic, health and environmental factors. These findings suggest that programs aiming to reduce BMI among adults in this setting may be well-served by focusing on education since it appears to have an effect at the neighborhood level over and above the impact it has at the individual level. This may be due to several factors such as greater access to knowledge and information regarding health and nutrition, greater food availability, and shifting cultural perceptions of beauty away from an ideal body shape of plumpness in favor of thinness in high education neighborhoods. The cross-sectional nature of our study does not allow for causal interpretations, however, so further studies exploring why the neighborhood education-BMI association is so significant is warranted.

Differences in levels of social integration among older women and men in Egypt.

The current study explores factors underlying the observed gender differences in levels of social integration among older adults within the context of the Arab countries. Reports on older adults' engagement in social activities were classified into two broad categories; "private activities that are child-centered" and "public activities that are adult-centered and extend beyond the realm of the family's children." Findings revealed that gender differences in older adults' involvement in both types of activities were found to be insignificant, a result that indicates older women's withdrawal from shouldering private-type activities and their increase engagement in public-type activities. Patrilocal residence, which is very common in the Arab countries, exhibited two different patterns of effects on levels of social integration. It increased older adults' reports of involvement in private-type activities in general, but decreases older women's reports of their involvement in these activities. Modernization and its impact on older adults' levels of social integration were also investigated in terms of both education and urban/rural residence. Education was positively correlated with older adults' engagements in private-type activities, but not public-type activities. Urban residence and living in a less restricted social environment in general was associated with decreases in older adults' reports of their involvement in private-type activities. Nevertheless, older women residing in urban settings were found to report more involvement in both private and public activities. The current study highlights the need for more future studies that explore aspects of older adults' integration within the family and the community, the interplay between attributes of older adults and members of their social network as well as the impact of social integration on the well-being of older adults within various normative cultural contexts.

Monitoring socioeconomic inequity in maternal health indicators in Egypt: 1995-2005.

BACKGROUND: Egypt's longstanding commitment to safe motherhood and maternal health has paid off in substantial declines in maternal mortality ratio and significant improvement in the levels of many maternal health indicators. The current study aims to monitor trends of maternal health indicators and their socioeconomic inequities among Egyptian women over ten-year period (1995-2005). It poses the question "to what extent have the recent maternal health improvements been shared among the various socioeconomic categories of women?" METHODS: The current paper uses data on maternal health available in three consecutive Demographic and Health Surveys (1995-2000-2005). Concentration index is used to assess the levels of health inequity over the ten year period. RESULTS: Although previous efforts in maternal health have contributed to substantial improvements in the general levels of maternal health indicators, these improvements were not enjoyed equally by women in various social groups. Indicators that have long been the focus of health policy such as fertility and contraceptive use showed some declines in disparities but they are far behind from achieving equity. Other indicators which relate to unmet need, prenatal care, delivery, postnatal care still loaded with high levels of inequity and call for more comprehensive policy interventions.

A biosocial model of medication use among older women and men in Ismailia, Egypt.

In Western industrialized countries, women report using health services, and certain medications, more often than do men. Often, analyses are based on data that exclude objective measures of morbidity and that come from cross-sectional surveys, which precludes the use of socioeconomic covariates that are endogenous to seeking care. Here, differences in objective cognitive and physical function, as well as differences in reporting on illness, propensity to seek care, and socioeconomic resources are expected to account for differences in care-seeking behaviour among women and men. This model is applied to the question of medication use in Ismailia, Egypt, using two waves of survey data and in-home tests of physical function from 896 adults aged 50 years and older. The results show that women use "modern" medications more often than do men, and that differences between women and men in reported morbidity and disability, observed cognitive and physical function, and economic resources account for women's greater use of medication. The findings underline a need for biosocial models to understand differences in women's and men's care-seeking behaviour in later life.