Differences in the healthcare needs of older adults attending primary health centers in urban and rural areas of Taiwan.

PURPOSE: As the older adult population in Taiwan continues to increase, primary health centers (PHCs) play a crucial role in geriatric care. This study explored the differences in the PHC experiences and usage needs of older adults in urban versus rural areas. METHODS: A qualitative study was conducted. Twenty-one older adults were recruited from PHCs in northern, central, southern, and eastern Taiwan. Semistructured interviews were used to collect data, and the interview guidelines included their reasons for visiting PHCs, the health-care services they received, their evaluation of the services, and the advantages and disadvantages of these centers. The data were analyzed using thematic content analysis. RESULTS: The PHC usage needs of older adults in urban areas differ from those of older adults in rural areas in the following 3 aspects: (1) Medical services: older adults in rural areas demand clinics specializing in various medical domains, mobile and home medical care, and case management, whereas those in urban areas demand mobile health examinations. (2) Environment and transportation: older adults in rural areas demand diverse medical equipment, shuttle services, and accessible facilities, whereas those in urban areas demand recreational facilities. (3) Active aging: older adults in rural areas demand health education courses, and those in urban areas demand diverse senior citizen courses as well as opportunities to volunteer and build interpersonal relationships. CONCLUSION: The older adults in urban and rural areas had different PHC usage needs. The older adults in rural areas generally focused on medical care and transportation services in PHCs, whereas those in urban areas generally focused on health promotion as a means of social participation and active aging.

Changes in Chinese early adolescents' group orientation and mental health from before to during the COVID-19 pandemic.

Adolescence is a critical period for formulating and developing value orientations. The COVID-19 pandemic has dramatically restricted people's lives, potentially leading adolescents to reevaluate what they prioritize in life (i.e., their values) and affecting their mental health. Previous studies suggest that Chinese early adolescents' group orientation is negatively associated with mental health more strongly in rural than in urban, whereas this rural-urban differs may vary after the outbreak of the pandemic. To examine potential changes in group orientation, mental health, and their associations during the pandemic, two cross-sectional surveys of ninth-grade students in the same three school were conducted in rural and urban China in 2019 and 2021. The results showed that compared with students before the pandemic (2019, N = 516, 48.8% girls, Mage = 14.87 years), students during the pandemic (2021, N = 655, 48.1% girls, Mage = 14.80 years) displayed lower group orientation such as group responsibility and rule abiding of rural students, and higher loneliness and depressive symptoms. Social equality, group responsibility and rule abiding were all significantly negatively associated with loneliness and depressive symptoms. Those negative associations were stronger in the urban regions than in the rural region. Follow-up invariance analysis revealed that this rural-urban difference in the relations between social equality, group responsibility, and rule abiding and mental health problems was only significant during (and not before) the pandemic. The protective effect of group orientation on mental health seems to be weakened only in rural contexts. The results suggest that significant changes in macrolevel contexts may play an important role in shaping adolescents' value orientation and mental health.

Changes in transmucosal buprenorphine utilization for opioid use disorder treatment during the COVID-19 pandemic in Kentucky.

PURPOSE: With surging opioid-involved overdoses, maintaining access to opioid use disorder (OUD) treatment is critical during the COVID-19 pandemic. We examined changes in transmucosal buprenorphine prescribing for OUD treatment in Kentucky after the national COVID-19 emergency declaration, with a focus on rural-urban differences. METHODS: Using 2019-2020 prescription monitoring data, we performed segmented regression analysis for an interrupted time series design to evaluate changes in weekly rates (per 100,000 residents) of dispensed prescriptions, unique individuals with dispensed prescriptions, and average days' supply for dispensed prescriptions of transmucosal buprenorphine. FINDINGS: The weekly rates of dispensed prescriptions and unique individuals with dispensed prescriptions were higher for rural residents than urban residents. After the national COVID-19 emergency declaration, rural and urban residents experienced similar immediate drops in the rate of dispensed prescriptions (rural -33.4; urban -24.3) and unique patients with dispensed prescriptions (rural -25.0; urban -17.1), followed by similar sustained increases. Both measures surpassed the prepandemic levels in mid-June 2020. Patients residing in urban areas received averagely longer prescriptions at baseline (urban: 11.0 days; rural: 10.5 days). The average weekly days' supply increased in the week after the national emergency declaration, but the estimated increase was higher (P = .004) for urban (0.8 days) versus rural (0.5 days) residents. CONCLUSIONS: Transmucosal buprenorphine utilization increased during the COVID-19 pandemic after experiencing interruption during the initial weeks of the pandemic. Future studies should evaluate the contribution of the relaxed telemedicine buprenorphine prescribing regulations during the COVID-19 national emergency on initiation and maintenance of buprenorphine treatment.

Rural urban differences in self-rated health among older adults: examining the role of marital status and living arrangements.

BACKGROUND: The rural-urban gap in socioeconomic and morbidity status among older adults is prevalent in India. These disparities may impact the levels and factors of self-rated health (SRH). The objective of the study is to compare the levels and determinants of SRH between rural and urban areas by considering the moderating effects of marital status and living arrangements. SUBJECTS AND METHODS: The present study used data from the Longitudinal Ageing Study in India (LASI) wave 1 (2017-18). A total sample of 30,633 older adults aged 60 years and above were selected for the study. Descriptive statistics, bivariate chi-square test, the interaction effect of living arrangements and marital status, and logistic estimation were applied to accomplish the study objectives. RESULTS: The prevalence of poor SRH was found 7% higher in rural areas compared to urban counterparts. A substantial rural-urban disparity in the patterns of poor SRH was also observed. The interaction effect of marital status and living arrangement on self-rated health suggested that older adults who were currently unmarried and living alone were 38% more likely to report poor SRH than those who were currently married and co-residing in rural India. In addition to marital status and living situation, other factors that significantly influenced SRH include age, socio-cultural background (educational attainment and religion), economic background (employment status), health status (ADLs, IADLs, multi-morbidities), and geographic background (region). CONCLUSION: The present study's findings demonstrated that, notwithstanding local variations, marital status and living circumstances significantly influenced SRH in India. In the present study, unmarried older people living alone were more susceptible to poor SRH in rural areas. The present study supports the importance of reinforcing the concepts of care and support for older individuals. There is a need for special policy attention to older individuals, particularly those unmarried and living alone. Although older individuals had difficulty performing ADLs and IADLs and had multi-morbidities, they reported poorer health. Therefore, offering them social support and top-notch medical assistance is crucial.

A comparison of rural-urban differences in out-of-pocket expenses among older Mexicans with diabetes.

Objective: To compare total out-of-pocket expenses for physician visits and medications among older adults living with diabetes in Mexico from urban, semi-urban, and rural areas. Methods: The sample included 2,398 Mexicans aged 65 years and older with self-reported diabetes from the 2018 Mexican Health and Aging Study. Out-of-pocket expenses for physician visits and medications were regressed on locality, controlling for several factors. Results: The profile of those with higher out-of-pocket medication expenditures included rural localities, higher education, unmarried, depressive symptoms, participation in Seguro Popular, and lacking insurance. In the multivariate analysis, rural older adults with diabetes paid a higher amount in medication expenditures compared with other localities. Conclusion: Differences in locality are closely tied to the effective implementation of Seguro Popular. Although this program has improved access to care, participants have higher out-of-pocket expenditures for medications than those on employer-based plans across all localities. Among all groups, the uninsured bare the highest burden of expenditures, highlighting a continued need to address health inequities for the most underserved populations.

Living in a rural area: a potential risk factor for falls in people with Parkinson disease.

INTRODUCTION: Falls are prevalent in patients with Parkinson disease (PD). Previous work focused on the impact of motor and non-motor symptoms on falls and ignored the impact of environmental factors, such as residence, economic level, and nursing status. The aim of this study was to investigate the prevalence and risk factors of falls in patients with PD and explore the impact of residence on falls. METHODS: A cross-sectional study of 100 patients with PD was carried out. Patients were recruited from Anhui Provincial Hospital (Hefei, Anhui province, China) between July 2017 and December 2020. Participants were grouped based on whether they had fallen in the previous 3 months, and demographic information was collected through detailed interviews. In addition, severity of motor symptoms, cognitive function, and self-care abilities were assessed with the Unified Parkinson's Disease Rating Scale part III (UPDRS-III), the Hoehn-Yahr (H&Y) scale, the Mini-Mental State Examination (MMSE), and the Barthel Index. The results were analyzed using student t-test, Mann-Whitney U-test, χ2 test and multivariate binary logistic regression analyses. RESULTS: A total of 42% of the patients had fallen in the previous 3 months. The patients who had fallen were older and with a longer disease period, a higher UPDRS-III score, a higher H&Y stage, a lower MMSE score, and a lower Barthel Index score (all p<0.05). According to the logistic regression analysis, living in a rural area (odds ratio (OR)=3.34, 95% confidence interval (CI) 1.15-9.65), MMSE<24 (OR=4.79, 95%CI 1.17-19.65), having sleep disorders (OR=4.97, 95%CI 1.74-14.2), and having a high UPDRS-III score (OR=1.07, 95%CI 1.02-1.11) were independent risk factors for falls. The incidence of falls was higher in rural areas. Urban and rural patients showed different levels of disease severity; rural patients had higher H&Y stages, higher UPDRS-III scores and lower Barthel Index scores. CONCLUSION: Falls are caused by a variety of factors in people with PD. Multidimensional factors should be considered comprehensively to develop a personalized plan to prevent falls in PD patients.

The role of neighborhood social capital on health and health inequality in rural and urban China.

Given the "community lost" vs. "community saved" debate on how neighborhood solidarity changes with urbanization, we compared the rural-urban difference in the association of individuals' neighborhood social capital with health and the interaction effect between neighborhood social capital and income-poverty on health in China, where huge rural-urban disparities existed. Participants were 5014 Chinese adults (≥ 18 years) (rural: 2034; urban: 2980) from the 2012 cross-sectional Chinese General Social Survey. Health outcome was a factor score constructed by three items. Neighborhood social capital was divided into structural (neighborhood network size, frequency of socializing with neighbors, voting in neighborhood committee election, and participation in neighborhood voluntary activities) and cognitive (perceived neighborhood social cohesion) dimensions. Multivariable linear regression models showed positive associations between perceived neighborhood social cohesion and health in rural (ß = 0.08, 95% CI: 0.03,0.14) and urban (ß = 0.09, 95% CI: 0.05,0.12) areas. Only in rural but not urban areas was a neighborhood network of 10 or more persons (ref.: none) associated with better health (ß = 0.25, 95% CI: 0.05,0.46). Interaction analysis showed that only in rural but not urban areas, with the increase of neighborhood network size, the health gap between the income-poor and the non-income-poor decreased generally. Our study suggested that cohesive neighborhoods benefit both rural and urban residents' health. Health interventions to improve neighborhood social cohesion should be designed to cope with the challenge of urbanization. Policymakers should avoid damaging neighborhood social capital when implementing other public policies, especially in rural areas where neighborhood network seems to matter more for health.

Rural-urban differences in uptake of diabetes self-management education among Medicare beneficiaries: Results from the 2016 to 2018 Medicare Current Beneficiary Survey.

PURPOSE: To assess rural-urban differences in participation rates of diabetes self-management education and associated factors among Medicare beneficiaries with type 2 diabetes (T2DM). METHODS: Data were from the 2016 to 2018 Medicare Current Beneficiary Survey (MCBS). Participation in diabetes self-management education was self-reported. The study sample included 3,799 beneficiaries aged 65 years and older with self-reported T2DM. Logistic regression was used to assess the association of participation in diabetes self-management education and residential location. Sampling weights embedded in the MCBS were incorporated into all analyses. FINDINGS: Overall, the participation rate of diabetes self-management education was 46.8% (95% CI: 44.4%-49.2%). The rate was 40.3% for beneficiaries in rural areas, 48.0% for suburban areas, and 47.3% for urban areas. About 31% of beneficiaries newly diagnosed with diabetes did not participate within the past year. Controlling for other covariates, beneficiaries in rural areas were less likely to have participated in diabetes self-management education (AOR = 0.73, 95% CI: 0.55-0.95) than those living in urban areas. Asian Americans were less likely to have participated (AOR = 0.49, 95% CI: 0.28-0.84) than Whites. Those who were older, with lower education, and lower income levels were less likely to have participated (P < .05). CONCLUSIONS: Recent MCBS data indicate that more than half of Medicare beneficiaries with T2DM did not participate in diabetes self-management education, and the participation rate in rural areas was 7 percentage points lower than that ​in urban areas. The study findings highlight challenges to maximize the benefits of participating in diabetes self-management education, particularly in rural areas.

Socio-Economic and Rural-Urban Differences in Healthcare and Catastrophic Health Expenditure Among Cancer Patients in China: Analysis of the China Health and Retirement Longitudinal Study.

Objective: In China, cancer accounts for one-fifth of all deaths, and exerts a heavy toll on patients, families, healthcare systems, and society as a whole. This study aims to examine the temporal trends in socio-economic and rural-urban differences in treatment, healthcare service utilization and catastrophic health expenditure (CHE) among adult cancer patients in China. We also investigate the relationship between different types of treatment and healthcare service utilization, as well as the incidence of CHE. Materials and Methods: We analyzed data from the 2011 and 2015 China Health and Retirement Longitudinal Study, a nationally representative survey including 17,224 participants (234 individuals with cancer) in 2011 and 19,569 participants (368 individuals with cancer) in 2015. The study includes six different types of cancer treatments: Chinese traditional medication (TCM); western modern medication (excluding TCM and chemotherapy medications); a combination of TCM & western medication; surgery; chemotherapy; and radiation therapy. Multivariable regression models were performed to investigate the association between cancer treatments and healthcare service utilization and CHE. Results: The age-adjusted prevalence of cancer increased from 1.37% to 1.84% between 2011 and 2015. More urban patients (54%) received cancer treatment than rural patients (46%) in 2015. Patients with high socio-economic status (SES) received a higher proportion of surgical and chemotherapy treatments compared to patients with low SES in 2015. Incidence of CHE declined by 22% in urban areas but increased by 31% in rural areas. We found a positive relationship between cancer treatment and outpatient visits (OR = 2.098, 95% CI = 1.453, 3.029), hospital admission (OR = 1.961, 95% CI = 1.346, 2.857) and CHE (OR = 1.796, 95% CI = 1.231, 2.620). Chemotherapy and surgery were each associated with a 2-fold increased risk of CHE. Conclusions: Significant improvements in health insurance benefit packages are necessary to ensure universal, affordable and patient-centered health coverage for cancer patients in China.

Rural-urban differences in home-based care willingness among older adults: A cross-sectional study in Shandong, China.

OBJECTIVE: To examine the rural-urban disparities of home-based care willingness among older adults and identify the influencing factors. DESIGN: A cross-sectional study. SETTING: The data used in this cross-sectional study were conducted in Shandong province. STUDY PARTICIPANTS: 7070 older adults (60 years and older) with complete data were included in this analysis from the 2017 Survey of the Shandong Elderly Family Health Service. INTERVENTION: N/A. MAIN OUTCOME MEASURE: The data were analyzed using logistic regression models to examine whether socio-demographic characteristic, physical health, loneliness score and other factors were associated with home-based care willingness in rural and urban older adults. After exploring the factors, we compared the difference. RESULTS: Of 7070 participants, 66.9% were rural older adults and 33.1% were urban. The urban older adults less likely chose home-based care than the rural (OR = 0.667; P < 0.05). Binary logistic regression analysis showed that age (P < 0.05), income (P < 0.05), current employment (P < 0.05) and loneliness (P < 0.05) were significantly associated with the home-based care willingness both in rural and urban residence. Besides, the number of family members (P = 0.010), education years (P = 0.026) and financial support from children (P = 0.017) were associated factors of rural respondents' home-based care willingness. The bad self-reported-health-status-urban-older adults (P = 0.026) were more willing for home-based care. CONCLUSIONS: The research we have done suggests that there is a residence difference toward home-based care willingness among older adults. Targeted policies and an age-friendly environment should be made for different subgroups of older adults.

Rural-urban differences in willingness to pay for organic vegetables: Evidence from Vietnam.

Concerns about food safety together with rising disposable income means consumers in developing countries are willing to pay more for safe and high-quality food such as organic vegetables. At the same time, socioeconomic profiles differ in rural versus urban areas leading to differing intakes. This paper investigates regional differences in the determinants of willingness to pay (WTP) for organic vegetables in Vietnam. A contingent valuation survey was used to collect information on consumer preferences of organic vegetables in two regions of Hanoi. Using interval regression model, we found that consumer perception about organic vegetables, trust in labels, and disposable family income increased WTP for organic vegetables in both urban and rural regions. Risk perception of conventional vegetables was high in both regions. However, higher WTP prevailed only in the rural region. Besides, growing vegetables at home affected the WTP only in the rural region while education played a role in the WTP in the urban region. Since rural and urban consumers have different preferences toward organic food, they should not be treated as a homogenous group in formulating organic food policy. This paper also shows that very high price of organic vegetables and lack of trust in organic labels are key barriers to organic purchase. Thus, creating more trust and reducing the price of organic vegetables through lowering certification cost might be a good strategy to expand the organic vegetable market in Vietnam.

Falls and risk factors of falls for urban and rural community-dwelling older adults in China.

BACKGROUND: Falls among older people have become a public health concern due to serious health consequences. Despite abundant literature on falls in older people, little is known about the rural-urban differentials in falls among older people in China. This research fills the voids of prior literature by investigating falls and the associated risk factors among Chinese seniors, with a particular focus on the rural-urban differences. METHODS: Data are from the 2010 wave of Chinese Longitudinal Survey on Urban and Rural Elderly. The analysis includes 16,393 respondents aged 65 and over, with 8440 and 7953 of them living in urban and rural areas, respectively. Descriptive analyses are performed to examine incidence, locations, circumstances and consequences of falls in older people. Regression analysis is used to investigate the effects of risk factors on falls among older people in urban and rural China. RESULTS: The incidence of falls is higher among rural than urban older people. In both settings, older people are more likely to fell outside of home. But common outdoor falls among rural and urban older people differ in terms of locations and circumstances. Urban older people are more likely to report falling on the road whereas their rural counterparts have experienced more falls in the yard. Falls occurring within homes or immediate home surroundings are also common; but few falls occurred in public areas. The rate of hospitalization of urban seniors after falling is higher than that of rural ones. Most risk factors of falls show similar than different effects on rural and urban elders' risks of falling. CONCLUSIONS: Incidence, locations, circumstances and consequences of falls vary among Chinese rural and urban older people. But most risk factors for falls show similar effects on rural and urban elders' odds of falling. Implications drawn from this research provide suggestions for the government and local agencies to develop suitable fall prevention strategies which may well be applicable to other countries.

Identifying rural-urban differences in the predictors of emergency ambulance service demand and misuse.

OBJECTIVE: This study aims to assess rural-urban differences in the predictors of emergency ambulance service (EAS) demand and misuse in New Taipei City. Identifying the predictors of EAS demand will help the EAS service managing authority in formulating focused policies to maintain service quality. METHODS: Over 160,000 electronic EAS usage records were used with a negative binomial regression model to assess rural-urban differences in the predictors of EAS demand and misuse. RESULTS: The factors of 1) ln-transformed population density, 2) percentage of residents who completed up to junior high school education, 3) accessibility of hospitals without an emergency room, and 4) accessibility of EAS were found to be predictors of EAS demand in rural areas, whereas only the factor of percentage of people aged above 65 was found to predict EAS demand in urban areas. For EAS misuse, only the factor of percentage of low-income households was found to be a predictor in rural areas, whereas no predictor was found in the urban areas. CONCLUSION: Results showed that the factors predicting EAS demand and misuse in rural areas were more complicated compared to urban areas and, therefore, formulating EAS policies for rural areas based on the results of urban studies may not be appropriate.

Rural-urban difference in blood pressure measurement frequency among elderly with hypertension: a cross-sectional study in Shandong, China.

BACKGROUND: Blood pressure measurement is the first step in preventing and controlling hypertension. The objective of this study is to examine the rural-urban difference towards blood pressure measurement among elderly with hypertension. METHODS: A total of 2007 elderly (65+) were selected from the fifth Health Service Survey of Shandong Province in 2013. A standardized questionnaire was used to investigate the demographic characters, socioeconomic status, self-rated health, and blood pressure related index. Three logistic regression models were used to examine the difference in blood pressure measurement between rural and urban elderly. Unadjusted and adjusted logistic regression models were used to explore the associated factors of blood pressure measurement in both rural areas and urban areas. RESULTS: The prevalence of weekly blood pressure measurement in urban elderly was higher than that in rural elderly (63.9% vs 34.3%). The rural elderly had an odds ratio (OR) for weekly blood pressure measurement of 0.467 (95%CI = 0.380-0.575) compared with urban elderly. Binary logistic regression analysis showed that medication frequency and accepting health care professionals' guidance were common associated factors of blood pressure measurement among both rural and urban elderly; personal income was unique associated factor of blood pressure measurement among rural elderly; marital status, education level, self-rated health, and blood pressure level currently were unique associated factors of blood pressure measurement among urban elderly. CONCLUSIONS: There is a big difference in blood pressure measurement between rural and urban elderly. Interventions targeting identified at-risk subgroups, especially for those rural elderly, should be made to reduce such a gap.

Factors affecting seasonal changes in blood pressure in North India: A population based four-seasons study.

OBJECTIVE: There are no community based, longitudinal, intra individual epidemiological studies on effect of weather and season on blood pressure (BP). We evaluated the effect of season and temperature on prevalence and epidemiology of BP in tropical climate. METHODS AND RESULTS: It was a longitudinal cross sectional survey of rural and urban subjects in their native surroundings. BP was measured in four different seasons in same subjects. A total of 978 subjects (452 rural and 521 urban) were included in the current analysis. Demographic characteristics such as age, gender, education, occupational based physical activity and body mass index (BMI) were recorded. Mean BP, both systolic and diastolic were significantly higher in winter season as compared to summer season. Mean difference between winter and summer was 9.01 (95% CI: 7.74-10.28, p<0.001) in systolic BP and 5.61 (95% CI: 4.75-6.47, p<0.001) in diastolic BP. This increase in BP was more marked in rural areas and elderly subjects. Prevalence of hypertension was significantly higher during winter (23.72%) than in summer (10.12%). CONCLUSION: BP increases significantly during winter season as compared to summer season. Increase is more marked in rural areas and elderly subjects. Seasonal variation in BP should be taken into account while looking at prevalence of hypertension in epidemiological studies.

Rural-urban difference in the use of annual physical examination among seniors in Shandong, China: a cross-sectional study.

BACKGROUND: Regular physical examination contributes to early detection and timely treatment, which is helpful in promoting healthy behaviors and preventing diseases. The objective of this study is to compare the annual physical examination (APE) use between rural and urban elderly in China. METHODS: A total of 3,922 participants (60+) were randomly selected from three urban districts and three rural counties in Shandong Province, China, and were interviewed using a standardized questionnaire. We performed unadjusted and adjusted logistic regression models to examine the difference in the utilization of APE between rural and urban elderly. Two adjusted logistic regression models were employed to identify the factors associated with APE use in rural and urban seniors respectively. RESULTS: The utilization rates of APE in rural and urban elderly are 37.4% and 76.2% respectively. Factors including education level, exercise, watching TV, and number of non-communicable chronic conditions, are associated with APE use both in rural and urban elderly. Hospitalization, self-reported economic status, and health insurance are found to be significant (p < 0.05) predictors for APE use in rural elderly. Elderly covered by Urban Resident Basic Medical Insurance (URBMI) (p < 0.05, OR = 1.874) are more likely to use APE in urban areas. CONCLUSIONS: There is a big difference in APE utilization between rural and urban elderly. Interventions targeting identified at-risk subgroups, especially for those rural elderly, are essential to reduce such a gap. To improve health literacy might be helpful to increase the utilization rate of APE among the elderly.

The Rural-Urban Difference in Interpersonal Regret.

The present research examined rural-urban differences in interpersonal regret. In Study 1, participants who grew up in rural areas reported stronger interpersonal regret than those who grew up in large cities. In Study 2, we conducted an experiment and found that participants who were assigned to imagine a rural life reported greater interpersonal regret than those who were assigned to imagine an urban life. Moreover, this rural-urban difference was mediated by the degree to which participants wrote about informal social control such as gossip and reputation concerns. Finally, in Study 3, we used the pictorial eye manipulation, which evokes a concern for informal social control, and found that participants from large cities who were exposed to the eyes reported more intense interpersonal regret than those who were not exposed to the eyes. Together, these studies demonstrate that informal social control is a key to understanding rural-urban differences in interpersonal regret.

Childhood mortality and its association with household wealth in rural and semi-urban Burkina Faso.

BACKGROUND: This study aimed to investigate the relationship between household wealth and under-5 year mortality in rural and semi-urban Burkina Faso. METHODS: The study included 15 543 children born between 2005 and 2010 in the Nouna Health and Demographic Surveillance System. Information on household wealth was collected in 2009. Two separate wealth indicators were calculated by principal components analysis for the rural and the semi-urban households, which were then divided into quintiles accordingly. Multivariable Cox proportional hazards regression was used to study the effect of the respective wealth measure on under-5 mortality. RESULTS: We observed 1201 childhood deaths, corresponding to 5-year survival probability of 93.6% and 88% in the semi-urban and rural area, respectively. In the semi-urban area, household wealth was significantly related to under-5 mortality after adjustment for confounding. There was a similar but non-significant effect of household wealth on infant mortality, too. There was no effect of household wealth on under-5 mortality in rural children. CONCLUSIONS: Results from this study indicate that the more privileged children from the semi-urban area with access to piped water and electricity have an advantage in under-5 survival, while under-5 mortality in the rural area is rather homogeneous and still relatively high.

Socio-demographic determinants of timely adherence to BCG, Penta3, measles, and complete vaccination schedule in Burkina Faso.

OBJECTIVE: To identify the determinants of timely vaccination among young children in the North-West of Burkina Faso. METHODS: This study included 1665 children between 12 and 23 months of age from the Nouna Health and Demographic Surveillance System, born between September 2006 and December 2008. The effect of socio-demographic variables on timely adherence to the complete vaccination schedule was studied in multivariable ordinal logistic regression with 3 distinct endpoints: (i) complete timely adherence, (ii) failure, and (iii) missing vaccination. Three secondary endpoints were timely vaccination with BCG, Penta3, and measles, which were studied with standard multivariable logistic regression. RESULTS: Mothers' education, socio-economic status, season of birth, and area of residence were significantly associated with failure of timely adherence to the complete vaccination schedule. Year of birth, ethnicity, and the number of siblings was significantly related to timely vaccination with Penta3 but not with BCG or measles vaccination. Children living in rural areas were more likely to fail timely vaccination with BCG than urban children (OR=1.79, 95%CI=1.24-2.58 (proximity to health facility), OR=3.02, 95%CI=2.18-4.19 (long distance to health facility)). In contrast, when looking at Penta3 and measles vaccination, children living in rural areas were far less likely to have failed timely vaccinations than urban children. Mother's education positively influenced timely adherence to the vaccination schedule (OR=1.42, 95%CI 1.06-1.89). There was no effect of household size or the age of the mother. CONCLUSIONS: Additional health facilities and encouragement of women to give birth in these facilities could improve timely vaccination with BCG. Rural children had an advantage over the urban children in timely vaccination, which is probably attributable to outreach vaccination teams amongst other factors. As urban children rely on their mothers' own initiative to get vaccinated, urban mothers should be encouraged more strongly to get their children vaccinated in time.

Epidemiological findings on prevalence of mental disorders in India.

Fifteen epidemiological studies on psychiatric morbidity in India have been analysed. National all-India prevalence rates for 'all mental disorders' and five specific disorders have been worked out The national prevalence rates for 'all mental disorders' arrived at are 70.5 (rural), 73 (urban) and 73 (rural + urban) per 1000 population. Prevalence of schizophrenia is 2.5/1000 and this seems to be the only disorder whose prevalence is consistent across cultures and over time. Rates for depression, anxiety neurosis, hysteria and mental retardation are provided. Urban morbidity in India is 3.5 percent higher than the rural rate, but rural-urban differences are not consistent for different disease categories. In Hindi speaking north India, mental morbidity amongst factory workers is two and half times that of the non-industrial urban inhabitants and five times the rural morbidity. The present data are expected to serve as baseline rates for mental health planners and for psychiatrists interested in epidemiological studies.