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Previous research in India has identified urbanisation, human mobility and population demographics as key variables associated with higher district level COVID-19 incidence. However, the spatiotemporal dynamics of mobility patterns in rural and urban areas in India, in conjunction with other drivers of COVID-19 transmission, have not been fully investigated. We explored travel networks within India during two pandemic waves using aggregated and anonymized weekly human movement datasets obtained from Google, and quantified changes in mobility before and during the pandemic compared with the mean baseline mobility for the 8-week time period at the beginning of 2020. We fit Bayesian spatiotemporal hierarchical models coupled with distributed lag non-linear models (DLNM) within the integrated nested Laplace approximate (INLA) package in R to examine the lag-response associations of drivers of COVID-19 transmission in urban, suburban, and rural districts in India during two pandemic waves in 2020-2021. Model results demonstrate that recovery of mobility to 99% that of pre-pandemic levels was associated with an increase in relative risk of COVID-19 transmission during the Delta wave of transmission. This increased mobility, coupled with reduced stringency in public intervention policy and the emergence of the Delta variant, were the main contributors to the high COVID-19 transmission peak in India in April 2021. During both pandemic waves in India, reduction in human mobility, higher stringency of interventions, and climate factors (temperature and precipitation) had 2-week lag-response impacts on the R t of COVID-19 transmission, with variations in drivers of COVID-19 transmission observed across urban, rural and suburban areas. With the increased likelihood of emergent novel infections and disease outbreaks under a changing global climate, providing a framework for understanding the lagged impact of spatiotemporal drivers of infection transmission will be crucial for informing interventions.
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BACKGROUND: Evidence suggests that obstetric violence has been prevalent globally and is finally getting some attention through research. This human rights violation takes several forms and is best understood through the narratives of embodied experiences of disrespect and abuse from women and other people who give birth, which is of utmost importance to make efforts in implementing respectful maternity care for a positive birthing experience. This study focused on the drivers of obstetric violence during labor and birth in Bihar, India. METHODS: Participatory qualitative visual arts-based method of data collection-body mapping-assisted interviews (adapted as birth mapping)-was conducted to understand women's perception of why they are denied respectful maternity care and what makes them vulnerable to obstetric violence during labor and childbirth. This study is embedded in feminist and critical theories that ensure women's narratives are at the center, which was further ensured by the feminist relational discourse analysis. Eight women participated from urban slums and rural villages in Bihar, for 2-4 interactions each, within a week. The data included transcripts, audio files, body maps, birthing stories, and body key, which were analyzed with the help of NVivo 12. FINDINGS: Women's narratives suggested drivers that determine how they will be treated during labor and birth, or any form of sexual, reproductive, and maternal healthcare seeking presented through the four themes: (1) "I am admitted under your care, so, I will have to do what you say"-Influence of power on care during childbirth; (2) "I was blindfolded because there were men"-Influence of gender on care during childbirth; (3) "The more money we give the more convenience we get"-Influence of structure on care during childbirth; and (4) "How could I ask him, how it will come out?"-Influence of culture on care during childbirth. How women will be treated in the society and in the obstetric environment is determined by their identity at the intersections of age, class, caste, marital status, religion, education, and many other sociodemographic factors. The issues related to each of these are intertwined and cross-cutting, which made it difficult to draw clear categorizations because the four themes influenced and overlapped with each other. Son preference, for example, is a gender-based issue that is part of certain cultures in a patriarchal structure as a result of power-based imbalance, which makes the women vulnerable to disrespect and abuse when their baby is assigned female at birth. DISCUSSION: Sensitive unique feminist methods are important to explore and understand women's embodied experiences of trauma and are essential to understand their perspectives of what drives obstetric violence during childbirth. Sensitive methods of research are crucial for the health systems to learn from and embed women's wants, to address this structural challenge with urgency, and to ensure a positive experience of care.
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BACKGROUND: Female migrant domestic workers (MDW), approximately 8.5 million globally, often live in their employer's home under vulnerable conditions. In Hong Kong, MDWs currently comprise 5% of the population. This study was conducted to assess the association between employment conditions and mental health, and the mediating roles stress and job satisfaction have, among female MDWs in Hong Kong. METHODS: Participants completed an online cross-sectional survey. A total of 1,965 survey were collected between August 2020 and August 2021. Questions in the survey were related to MDWs background information, employment conditions, stress, job satisfaction, and two mental health outcomes: anxiety and depression. An employment conditions score was created to assess the cumulative effect poor employment conditions had on mental health. A multicategorical parallel mediation analysis was used to assess the direct effect employment conditions have on mental health and the indirect effects through stress and job satisfaction. RESULTS: Overall, 17.7% of MDWs were reported to be suffering from anxiety and 30.8% from depression. An increase in poor employment conditions was statistically associated with an increase in both outcomes, while stress levels and job satisfaction mediated this association. CONCLUSIONS: The findings call for increased scrutiny of employment conditions and mental well-being of MDWs.
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Salud Mental , Migrantes , Humanos , Femenino , Hong Kong/epidemiología , Estudios Transversales , Análisis de Mediación , Empleo/psicologíaRESUMEN
OBJECTIVES: To identify and investigate complex pathways to stunting among children aged 6-24 months to determine the mediating effects of dietary diversity and continued breast feeding on the association between socioeconomic factors and child stunting. DESIGN, SETTING AND PARTICIPANTS: We analysed the most recent cross-sectional Demographic and Health Survey data from Cambodia (2014). We applied structural path analysis on a sample of 1365 children to model the complex and inter-related pathways of factors determining children's height for age. Explanatory variables included a composite indicator of maternal employment, household wealth, maternal education, current breastfeeding status and dietary diversity score. Results are presented both in terms of non-standardised and standardised coefficients. OUTCOME MEASURE: The primary outcome measure was height-for-age Z-scores as a continuous measure. RESULTS: Findings suggest that children's dietary diversity and continued breast feeding mediate the association between socioeconomic status and children's height. While there was no significant direct effect of maternal education on children's height, results suggested significant indirect pathways through which maternal education effects children's height; operating through household wealth, maternal employment, dietary diversity and continued breastfeeding status (p<0.001). Most notably, 41% of the effect of maternal employment on children's height was mediated by either dietary diversity or continued breast feeding. CONCLUSION: We provide evidence to support targeted nutrition interventions which account for the different ways in which underlying socioeconomic factors influence infant and young child feeding practices, and the potential impact on child nutritional status.
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Trastornos del Crecimiento , Fenómenos Fisiológicos Nutricionales del Lactante , Lactante , Niño , Femenino , Humanos , Estudios Transversales , Cambodia/epidemiología , Trastornos del Crecimiento/epidemiología , Trastornos del Crecimiento/etiología , Lactancia Materna , Factores Socioeconómicos , Clase Social , Estado NutricionalRESUMEN
BACKGROUND: Evidence on obstetric violence is reported globally. In India, research shows that almost every woman goes through some level of disrespect and abuse during childbirth, more so in states such as Bihar where over 70% of women give birth in hospitals. OBJECTIVE: 1) To understand how women experience and attach meaning to respect, disrespect and abuse during childbirth; and 2) document women's expectations of respectful care. METHODS: 'Body mapping', an arts-based participatory method, was applied. The analysis is based on in-depth interviews with eight women who participated in the body mapping exercise at their homes in urban slums and rural villages. Analysis was guided by feminist relational discourse analysis. FINDINGS: Women reported their experiences of birthing at home, public facilities, and private hospitals in simple terms of what they felt 'good' and 'bad'. Good experiences included being spoken to nicely, respecting privacy, companion of choice, a bed to rest, timely care, lesser interventions, obtaining consent for vaginal examination and cesarean section, and better communication. Bad experiences included unconsented interventions including multiple vaginal examinations by different care providers, unanesthetized episiotomy, repairs and uterine exploration, verbal, physical, sexual abuse, extortion, detention and lack of privacy. DISCUSSION: The body maps capturing birth experiences, created through a participatory method, accurately portray women's respectful and disrespectful births and are useful to understand women's experience of a sensitive issue in a patriarchal culture. An in-depth understanding of women's choices, experiences and expectations can inform changes practices in and policies and help to develop a culture of sharing birth experiences.
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Actitud del Personal de Salud , Cesárea , Parto Obstétrico , Femenino , Humanos , Parto , Embarazo , ViolenciaRESUMEN
BACKGROUND: Disrespect and abuse during childbirth can result in fear of childbirth. Consequently, women may be discouraged to seek care, increasing the likelihood for women to choose elective cesarean section in order to avoid humiliation, postnatal depression and even maternal mortality. This study investigates the causes underlying mistreatment of women during childbirth by health care providers in India, where evidence of disrespect and abuse has been reported. METHODS: Qualitative research was undertaken involving 34 in-depth interviews with midwifery and nursing leaders from India who represent administration, advocacy, education, regulation, research and service provision at state and national levels. Data are analysed thematically with NVivo12. The analysis added value by bringing an international perspective from interviews with midwifery leaders from Switzerland and the United Kingdom. FINDINGS: The factors leading to disrespect and abuse of women relate to characteristics of both women and their midwives. Relevant woman-related attributes include her age, gender, physical appearance and education, extending to the social environment including her social status, family support, culture of abuse, myths around childbirth and sex-based discrimination. Midwife-related factors include gender, workload, medical hierarchy, bullying and powerlessness. DISCUSSION: The intersectionality of factors associated with mistreatment during childbirth operate at individual, infrastructural, social and policy levels for both the women and nurse-midwives, and these factors could exacerbate existing gender-based inequalities. Maternal health policies should address the complex interplay of these factors to ensure a positive birthing experience for women in India. CONCLUSION: Maternal health interventions could improve by integrating women-centred protocols and monitoring measures to ensure respectful and dignified care during childbirth.
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Cesárea , Servicios de Salud Materna , Actitud del Personal de Salud , Parto Obstétrico , Femenino , Personal de Salud , Humanos , Parto , Embarazo , Relaciones Profesional-Paciente , Calidad de la Atención de SaludRESUMEN
We investigate the climatic influence on COVID-19 transmission risks in 228 cities globally across three climatic zones. The results, based on the application of a Boosted Regression Tree algorithm method, show that average temperature and average relative humidity explain significant variations in COVID-19 transmission across temperate and subtropical regions, whereas in the tropical region, the average diurnal temperature range and temperature seasonality significantly predict the infection outbreak. The number of positive cases showed a decrease sharply above an average temperature of 10°C in the cities of France, Turkey, the US, the UK, and Germany. Among the tropical countries, COVID-19 in Indian cities is most affected by mean diurnal temperature, and those in Brazil by temperature seasonality. The findings have implications on public health interventions, and contribute to the ongoing scientific and policy discourse on the complex interplay of climatic factors determining the risks of COVID-19 transmission.
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COVID-19 , COVID-19/epidemiología , Ciudades/epidemiología , Brotes de Enfermedades , Humanos , SARS-CoV-2 , TemperaturaRESUMEN
BACKGROUND: In India, nursing regulation is generally weak, midwifery coexists with nursing, and 88% of nursing and midwifery education is provided by the private health sector. The Indian health system faces major challenges for health care provision due to poor quality, indeterminate regulatory functions and lack of reforms. METHODS: We undertook a qualitative investigation to understand midwifery and nursing education, and regulatory systems in India, through a review of the regulatory Acts, and an investigation of the perceptions and experiences of senior midwifery and nursing leaders representing administration, advocacy, education, regulation, research and service provision in India with an international perspective. RESULTS: There is a lack of importance accorded to midwifery roles within the nursing system. The councils and Acts do not adequately reflect midwifery practice, and remain a barrier to good quality care provision. The lack of required amendment of Acts, lack of representation of midwives and nurses in key governance positions in councils and committees have restrained and undermined leadership positions, which have also impaired the growth of the professions. A lack of opportunities for professional practice and unfair assessment practices are critical concerns affecting the quality of nursing and midwifery education in private institutions across India. Midwifery and nursing students are generally more vulnerable to discrimination and have less opportunities compared to medical students exacerbated by the gender-based challenges. CONCLUSIONS: India is on the verge of a major regulatory reform with the National Nursing and Midwifery Commission Bill, 2020 being drafted, which makes this study a crucial and timely contribution. Our findings present the challenges that need to be addressed with regulatory reforms to enable opportunities for direct-entry into the midwifery profession, improving nursing education and practice by empowering midwives and nurses with decision-making powers for nursing and midwifery workforce governance.
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Educación en Enfermería/métodos , Legislación de Enfermería , Partería/educación , Partería/legislación & jurisprudencia , Política Pública , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , India , Masculino , Persona de Mediana Edad , Enfermería , Encuestas y CuestionariosRESUMEN
OBJECTIVE: To generate cross-national forecasts of COVID-19 trajectories and quantify the associated impact on essential critical care resources for disease management in Gulf Cooperation Council (GCC) countries. DESIGN: Population-level aggregate analysis. SETTING: Bahrain, Kuwait, Oman, Qatar, United Arab Emirates (UAE) and Saudi Arabia. METHODS: We applied an extended time-dependent SEICRD compartmental model to predict the flow of people between six states, susceptible-exposed-infected-critical-recovery-death, accounting for community mitigation strategies and the latent period between exposure and infected and contagious states. Then, we used the WHO Adaptt Surge Planning Tool to predict intensive care unit (ICU) and human resources capacity based on predicted daily active and cumulative infections from the SEICRD model. MAIN OUTCOME MEASURES: Predicted COVID-19 infections, deaths, and ICU and human resources capacity for disease management. RESULTS: COVID-19 infections vary daily from 498 per million in Bahrain to over 300 per million in UAE and Qatar, to 9 per million in Saudi Arabia. The cumulative number of deaths varies from 302 per million in Oman to 89 in Qatar. UAE attained its first peak as early as 21 April 2020, whereas Oman had its peak on 29 August 2020. In absolute terms, Saudi Arabia is predicted to have the highest COVID-19 mortality burden, followed by UAE and Oman. The predicted maximum number of COVID-19-infected patients in need of oxygen therapy during the peak of emergency admissions varies between 690 in Bahrain, 1440 in Oman and over 10 000 in Saudi Arabia. CONCLUSION: Although most GCC countries have managed to flatten the epidemiological curve by August 2020, trends since November 2020 show potential increase in new infections. The pandemic is predicted to recede by August 2021, provided the existing infection control measures continue effectively and consistently across all countries. Current health infrastructure including the provision of ICUs and nursing staff seem adequate, but health systems should keep ICUs ready to manage critically ill patients.
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COVID-19 , Síndrome Respiratorio Agudo Grave , Bahrein/epidemiología , Cuidados Críticos , Humanos , Kuwait/epidemiología , Omán/epidemiología , Pandemias , Qatar , SARS-CoV-2 , Arabia Saudita/epidemiología , Emiratos Árabes Unidos/epidemiologíaRESUMEN
We analysed population data from the 2015-16 National Family Health Survey to disentangle the intricate underlying effects of reproductive behaviours and fertility preferences on child growth. We expected birth interval length to be more strongly associated with stunting than sibsize and these effects to be moderated by whether the child was wanted or unintended (mistimed/unwanted). Regression analyses showed strong and equal effects of short birth interval and sibsize on stunting, when adjusted for potential confounders and unobserved between-mother heterogeneity. There were no statistical associations between stunting and mistiming/unwantedness of index children, suggesting the absence of discrimination against such children. We conclude that while fertility preferences have no effect, reproductive behaviours exert significant influence on child growth. Sibsize has been falling for many years in India but birth interval lengths have remained largely unchanged. The results underscore the need for strengthening uptake of reversible contraceptives to enable longer birth intervals.
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Intervalo entre Nacimientos , Fertilidad , Niño , Familia , Servicios de Planificación Familiar , Humanos , IndiaRESUMEN
OBJECTIVE: To investigate social inequalities underlying low birthweight (LBW) outcomes in Sri Lanka. DESIGN: Cross-sectional study. SETTING: This study used the Sri Lanka Demographic and Health Survey 2016, the first such survey to cover the entire country since the Civil War ended in 2001. PARTICIPANTS: Birthweight data extracted from the child health development records available for 7713 babies born between January 2011 and the date of interview in 2016. OUTCOME MEASURES: The main outcome variable was birth weight, classified as LBW (≤2500 g) and normal. METHODS: We applied random intercept three-level logistic regression to examine the association between LBW and maternal, socioeconomic and geographic variables. Concentration indices were estimated for different population subgroups. RESULTS: The population-level prevalence of LBW was 16.9% but was significantly higher in the estate sector (28.4%) compared with rural (16.6%) and urban (13.6%) areas. Negative concentration indices suggest a relatively higher concentration of LBW in poor households in rural areas and the estate sector. Results from fixed effects logistic regression models confirmed our hypothesis of significantly higher risk of LBW outcomes across poorer households and Indian Tamil communities (AOR 1.70, 95% CI 1.02 to 2.83, p<0.05). Results from random intercept models confirmed there was substantial unobserved variation in LBW outcomes at the mother level. The effect of maternal biological variables was larger than that of socioeconomic factors. CONCLUSION: LBW rates are significantly higher among babies born in poorer households and Indian Tamil communities. The findings highlight the need for nutrition interventions targeting pregnant women of Indian Tamil ethnicity and those living in economically deprived households.
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Peso al Nacer , Niño , Estudios Transversales , Femenino , Humanos , India , Recién Nacido , Embarazo , Factores de Riesgo , Factores Socioeconómicos , Sri Lanka/epidemiologíaRESUMEN
BACKGROUND: Fertility rates remain persistently high in Nigeria, with little difference across socioeconomic groups. While the desire for large family size is culturally rooted, there is little understanding of how repeated child mortality experiences influence fertility behaviour and parity transition in Nigeria. METHODS: Using birth history data from the 2013 Nigeria Demographic and Health Survey (NDHS), we applied life table techniques and proportional-hazard regression model to explore the effect of child survival experience on parity transitions. We hypothesize that a woman with one or more child death experience is at elevated risk of progressing towards higher parities. RESULTS: Our findings show that child mortality is concentrated among mothers living in deprived conditions especially in rural areas of the northern part of Nigeria and among those with little or no education and, among those belonging to Hausa/Fulani ethnicity and Islam religion. Mothers with repeated experience of child deaths were significantly at a higher rate of progressing to higher parities than their counterparts (HR: 1.45; 95% CI: 1.31-1.61), when adjusted for relevant biological and socio-demographic characteristics. CONCLUSION: Recurrent experience of child deaths exacerbates the risks to higher parity transition. Interventions aimed at reducing fertility in Nigeria should target promoting child survival and family planning concurrently.
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Intervalo entre Nacimientos/estadística & datos numéricos , Tasa de Natalidad , Mortalidad del Niño/tendencias , Servicios de Planificación Familiar/estadística & datos numéricos , Edad Materna , Paridad , Adolescente , Adulto , Orden de Nacimiento , Niño , Femenino , Humanos , Persona de Mediana Edad , Dinámica Poblacional , Embarazo , Factores Socioeconómicos , Adulto JovenRESUMEN
Contraceptive use in Nigeria has remained low at less than 15% for over two decades. Although husbands' opposition is acknowledged as one of the factors impeding women's contraceptive use, little is known about how wives negotiate when their husbands oppose family planning. We addressed this research gap by conducting thematic analyses of qualitative data from 30 interviews of married couples. We employed thematic analysis to identify relevant themes from the transcribed data. The findings clearly demonstrate attitudes highlighting an imbalance in power relations and contraceptive decision-making within marital relationships. By initially complying with the husband's wish as a 'sign of honour', and then making further attempts at convincing him about family planning use, a woman can achieve her contraceptive target, or through the involvement of a third party. Wives are less empowered to overtly use contraceptives when their husbands oppose family planning. However, there are accepted justifications for covert use. The findings underscore the need to strengthen family planning interventions to enable behavioural change among Nigerian men, promote gender and reproductive health rights, and empower women with better negotiation skills.
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Conducta Anticonceptiva , Servicios de Planificación Familiar , Negociación , Poder Psicológico , Desempeño de Papel , Sexismo , Adulto , Antropología Cultural , Femenino , Humanos , Masculino , Nigeria , Investigación Cualitativa , Esposos/psicologíaRESUMEN
OBJECTIVE: To investigate the socio-economic differentials underlying minimum dietary diversity (MDD) among children aged 6-23 months in three economically diverse South-East Asian countries. DESIGN: The outcome variable MDD was defined as the proportion of children aged 6-23 months who received foods from four of the seven recommended food groups within the 24 h prior to interview. The association between socio-economic factors and MDD, adjusting for relevant characteristics, was examined using logistic regression. SETTING: We used cross-sectional population data from recent Demographic and Health Surveys from Cambodia (2014), Myanmar (2015-16) and Indonesia (2012). SUBJECTS: Total of 8364 children aged 6-23 months. RESULTS: Approximately half of all children met the MDD, varying from 47·7 % in Cambodia (n 1023) to 58·2 % in Indonesia (n 2907) and 24·6 % in Myanmar (n 301). The likelihood (adjusted OR; 95 % CI) of meeting MDD increased for children in the richest households (Cambodia: 2·4; 1·7, 3·4; Myanmar: 1·8; 1·1, 3·0; Indonesia: 2·0; 1·6, 2·5) and those residing in urban areas (Cambodia: 1·4; 1·1, 1·9; Myanmar: 1·7; 1·2, 2·4; Indonesia: 1·7; 1·5, 1·9). MDD deprivation was most severe among children from the poorest households in rural areas. The association between mother's labour force participation and MDD was positive in all three countries but reached significance only in Indonesia (1·3; 1·1, 1·5). CONCLUSIONS: MDD deprivation among young children was significantly high in socio-economically disadvantaged families in all three study settings. MDD requirements are not being met for approximately half of young children in these three South-East Asian countries.
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Ingestión de Energía , Necesidades Nutricionales , Asia Sudoriental , Estudios Transversales , Demografía , Femenino , Humanos , Lactante , Masculino , Factores SocioeconómicosRESUMEN
Although China's family planning programme is often referred to in the singular, most notably the One-Child policy, in reality there have been a number of different policies in place simultaneously, targeted at different sub-populations characterized by region and socioeconomic conditions. This study attempted to systematically assess the differential impact of China's family planning programmes over the past 40 years. The contribution of Parity Progression Ratios to fertility change among different sub-populations exposed to various family planning policies over time was assessed. Cross-sectional birth history data from six consecutive rounds of nationally representative population and family planning surveys from the early 1970s until the mid-2000s were used, covering all geographical regions of China. Four sub-populations exposed to differential family planning regimes were identified. The analyses provide compelling evidence of the influential role of family planning policies in reducing higher Parity Progression Ratios across different sub-populations, particularly in urban China where fertility dropped to replacement level even before the implementation of the One-Child policy. The prevailing socioeconomic conditions in turn have been instrumental in adapting and accelerating family planning policy responses to reducing fertility levels across China.
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Países en Desarrollo , Política de Planificación Familiar/tendencias , Paridad , Historia Reproductiva , Adolescente , Adulto , Niño , China , Estudios de Cohortes , Estudios Transversales , Demografía , Femenino , Fertilidad , Humanos , Recién Nacido , Masculino , Persona de Mediana Edad , Dinámica Poblacional , Embarazo , Política Pública/tendencias , Estudios Retrospectivos , Adulto JovenRESUMEN
OBJECTIVE: Evidence from the last three Demographic and Health Surveys (DHS) in Nigeria shows slow progress in family planning (FP) uptake, despite programmatic interventions. While socioeconomic and religious barriers continue to exist, psychosocial factors such as negative contraceptive perceptions by male partners may influence both spousal FP demand and use. Therefore, this research investigates the influence of male partners' contraceptive perceptions on spousal FP demand and use. METHODS: We analysed the couple dataset from the 2013 Nigeria DHS. RESULTS: One in five men held the perception that contraceptive use is women's business whereas two in five men reported that women who use family planning may become promiscuous, especially older men, those with no formal education, Muslims and residents in rural areas and northern region. Results from regression models, controlling for relevant sociodemographic characteristics, show that men's perception that contraception is women's business did not significantly influence FP demand. However, their fear that women who use family planning may become promiscuous was associated with lower odds of FP demand (AOR: 0.86; 95% CI: 0.76-0.97) and increased the odds of traditional methods use (AOR: 1.34; 95% CI: 1.01-1.79). CONCLUSION: The findings direct the need to adopt targeted approach focusing on couples, and reorient policy and program efforts for FP counselling and behavioural changes in men.
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Conducta Anticonceptiva/psicología , Anticoncepción/psicología , Parejas Sexuales/psicología , Adulto , Servicios de Planificación Familiar/métodos , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Nigeria , Educación Sexual , Factores Socioeconómicos , Adulto JovenRESUMEN
OBJECTIVE: Road traffic injuries (RTIs) are the leading cause of disability-adjusted life years lost in Oman, Saudi Arabia and United Arab Emirates. Injury prevention strategies often overlook the interaction of individual and behavioural risk factors in assessing the severity of RTI outcomes. We conducted a systematic investigation of the underlying interactive effects of age and gender on the severity of fatal and non-fatal RTI outcomes in the Sultanate of Oman. METHODS: We used the Royal Oman Police national database of road traffic crashes for the period 2010-2014. Our study was based on 35 785 registered incidents: of these, 10.2% fatal injuries, 6.2% serious, 27.3% moderate, 37.3% mild injuries and 19% only vehicle damage but no human injuries. We applied a generalised ordered logit regression to estimate the effect of age and gender on RTI severity, controlling for risk behaviours, personal characteristics, vehicle, road, traffic, environment conditions and geographical location. RESULTS: The most dominant group at risk of all types of RTIs was young male drivers. The probability of severe incapacitating injuries was the highest for drivers aged 25-29 (26.6%) years, whereas the probability of fatal injuries was the highest for those aged 20-24 (26.9%) years. Analysis of three-way interactions of age, gender and causes of crash show that overspeeding was the primary cause of different types of RTIs. In particular, the probability of fatal injuries among male drivers attributed to overspeeding ranged from 3%-6% for those aged 35 years and above to 13.4% and 17.7% for those aged 25-29 years and 20-24 years, respectively. CONCLUSIONS: The high burden of severe and fatal RTIs in Oman was primarily attributed to overspeed driving behaviour of young male drivers in the 20-29 years age range. Our findings highlight the critical need for designing early gender-sensitive road safety interventions targeting young male and female drivers.
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BACKGROUND: Total domestic and international funding for malaria is inadequate to achieve WHO global targets in burden reduction by 2030. We describe the trends of investments in malaria-related research in sub-Saharan Africa and compare investment with national disease burden to identify areas of funding strength and potentially neglected populations. We also considered funding for malaria control. METHODS: Research funding data related to malaria for 1997-2013 were sourced from existing datasets, from 13 major public and philanthropic global health funders, and from funding databases. Investments (reported in US$) were considered by geographical area and compared with data on parasite prevalence and populations at risk in sub-Saharan Africa. 45 sub-Saharan African countries were ranked by amount of research funding received. FINDINGS: We found 333 research awards totalling US$814·4 million. Public health research covered $308·1 million (37·8%) and clinical trials covered $275·2 million (33·8%). Tanzania ($107·8 million [13·2%]), Uganda ($97·9 million [12·0%]), and Kenya ($92·9 million [11·4%]) received the highest sum of research investment and the most research awards. Malawi, Tanzania, and Uganda remained highly ranked after adjusting for national gross domestic product. Countries with a reasonably high malaria burden that received little research investment or funding for malaria control included Central African Republic (ranked 40th) and Sierra Leone (ranked 35th). Congo (Brazzaville) and Guinea had reasonably high malaria mortality, yet Congo (Brazzaville) ranked 38th and Guinea ranked 25th, thus receiving little investment. INTERPRETATION: Some countries receive reasonably large investments in malaria-related research (Tanzania, Kenya, Uganda), whereas others receive little or no investments (Sierra Leone, Central African Republic). Research investments are typically highest in countries where funding for malaria control is also high. Investment strategies should consider more equitable research and operational investments across countries to include currently neglected and susceptible populations. FUNDING: Royal Society of Tropical Medicine and Hygiene and Bill & Melinda Gates Foundation.
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Financiación Gubernamental/tendencias , Obtención de Fondos/tendencias , Malaria , Apoyo a la Investigación como Asunto/tendencias , Investigación/tendencias , África del Sur del Sahara , Ensayos Clínicos como Asunto/economía , Salud Global , Humanos , Inversiones en Salud , Salud Pública , Investigación/economíaRESUMEN
Background: : Disparities in health between immigrants and their host populations have been described across countries and continents. Hence, interventions for improving health targeting general populations are not necessarily effective for immigrants. To conduct a systematic search of the literature evaluating health interventions for immigrants; to map the characteristics of identified studies including range of interventions, immigrant populations and their host countries, clinical areas targeted and reported evaluations, challenges and limitations of the interventions identified. Following the results, to develop recommendations for research in the field. A scoping review approach was chosen to provide an overview of the type, extent and quantity of research available. Studies were included if they empirically evaluated health interventions targeting immigrants and/or their descendants, included a control group, and were published in English (PubMed and Embase from 1990 to 2015). Most of the 83 studies included were conducted in the USA, encompassed few immigrant groups and used a randomized controlled trial (RCT) or cluster RCT design. Most interventions addressed chronic and non-communicable diseases and attendance at cancer screening services, used individual targeted approaches, targeted adult women and recruited participants from health centres. Outcome measures were often subjective, with the exception of interventions for cardiovascular risk and diabetes. Generally, authors claimed that interventions were beneficial, despite a number of reported limitations. Recommendations for enhancing interventions to improve immigrant health are provided to help researchers, funders and health care commissioners when deciding upon the scope, nature and design of future research in this area.