An evolution of inequality of opportunity in the nutritional outcomes of under-five children in Malawi.

Background: Malnutrition among children is a significant public health and development issue, especially in low- and middle-income countries, Malawi inclusive, which contributes to preventable diseases and deaths. Significant socioeconomic disparities persist, which affect access to and equal distribution of basic nutrition. This study analyzed the extent and trends of Inequality of Opportunity (IOP) in the nutritional outcomes of children aged 0-59 months. Methods: The study used nationally representative data from the 2006, 2013-14, and 2019-20 Malawi Multiple Indicator Cluster Survey. In terms of method, we examined IOP in stunting, wasting, and underweight indicators, using the Human Opportunity Index and the Dissimilarity Index in 55,723 children. The Shapley-value technique decomposed the relative IOP. Results: We find the largest share of circumstance-driven inequality in stunting (8.96 percent), followed by underweight (1.91 percent), and then wasting (0.90 percent). The Shapley-value decomposition results indicate the child's age (29.15 percent for stunting, 12.42 percent for underweight, and 52.36 percent for wasting) and gender (8.28 percent, 18.36 percent and 8.87 percent), wealth (6.36 percent, 22.87 percent and 8.54 percent), and mother's education (6.28 percent, 11.29 percent and 5.51 percent) as the dominant contributors to IOP for all three nutritional outcome indicators; stunting, underweight and wasting, respectively. Conclusion: The findings suggest that policies aimed at narrowing the wealth and education inequality gap could help equalize nutrition opportunities for children in Malawi.

COVID-19 vaccine inequity in African low-income countries.

Equitable access and utilization of the COVID-19 vaccine is the main exit strategy from the pandemic. This paper used proceedings from the Second Extraordinary Think-Tank conference, which was held by the Health Economics and Policy Unit at the Kamuzu University of Health Sciences in collaboration with the Malawi Ministry of Health, complemented by a review of literature. We found disparities in COVID-19 vaccine coverage among low-income countries. This is also the case among high income countries. The disparities are driven mainly by insufficient supply, inequitable distribution, limited production of the vaccine in low-income countries, weak health systems, high vaccine hesitancy, and vaccine misconceptions. COVID-19 vaccine inequity continues to affect the entire world with the ongoing risks of emergence of new COVID-19 variants, increased morbidity and mortality and social and economic disruptions. In order to reduce the COVID-19 vaccination inequality in low-income countries, there is need to expand COVAX facility, waive intellectual property rights, transform knowledge and technology acquired into vaccines, and conduct mass COVID-19 vaccination campaigns.

Determinants of self-reported hypertension among women in South Africa: evidence from the population-based survey.

BACKGROUND: Hypertension (HTN), characterized by an elevation of blood pressure, is a serious public health chronic condition that significantly raises the risks of heart, brain, kidney, and other diseases. In South Africa, the prevalence of HTN (measured objectively) was reported at 46.0% in females, nonetheless little is known regarding the prevalence and risks factors of self-reported HTN among the same population. Therefore, the aim of this study was to examine determinants of self-reported HTN among women in South Africa. METHODS: The study used data obtained from the 2016 South African Demographic and Health Survey. In total, 6,027 women aged ≥ 20 years were analyzed in this study. Self-reported HTN was defined as a case in which an individual has not been clinically diagnosed with this chronic condition by a medical doctor, nurse, or health worker. Multiple logistic regression models were employed to examine the independent factors of self-reported HTN while considering the complex survey design. RESULTS: Overall, self-reported HTN was reported in 23.6% (95% confidence interval [CI], 23.1-24.1) of South African women. Being younger (adjusted odds ratio [aOR], 0.04; 95% CI, 0.03-0.06), never married (aOR, 0.69; 95% CI, 0.56-0.85), and not covered by health insurance (aOR, 0.74; 95% CI, 0.58-0.95) reduced the odds of self-reported HTN. On the other hand, being black/African (aOR, 1.73; 95% CI, 1.17-2.54), perception of being overweight (aOR, 1.72; 95% CI, 1.40-2.11), and perception of having poor health status (aOR, 3.53; 95% CI, 2.53-5.21) and the presence of other comorbidities (aOR, 7.92; 95% CI, 3.63-17.29) increased the odds of self-reported HTN. CONCLUSIONS: Self-reported HTN was largely associated with multiple sociodemographic, health, and lifestyle factors and the presence of other chronic conditions. Health promotion and services aiming at reducing the burden of HTN in South Africa should consider the associated factors reported in this study to ensure healthy aging and quality of life among women.

Explaining socioeconomic inequality in cervical cancer screening uptake in Malawi.

BACKGROUND: Cervical cancer is a prevalent public health concern and is among the leading causes of death among women globally. Malawi has the second highest cervical cancer prevalence and burden in the world. Due to the cervical cancer burden, the Malawi government scaled up national cancer screening services in 2011, which are free for all women. This paper is the first study to examine the socioeconomic inequality in cervical cancer screening uptake using concentration indices, in Malawi. Furthermore, it decomposes the concentration index to examine how each factor contributes to the level of inequality in the uptake of cervical cancer screening. METHODS: The data used in this paper were obtained from the nationally representative Malawi Population HIV Impact Assessment (MPHIA) household survey, which was conducted in 2015. Concentration curves were constructed to explore whether there was any socioeconomic inequality in cervical cancer screening and, if so, its extent. This was complemented by concentration indices that were computed to quantify the magnitude of socioeconomic inequality. A decomposition analysis was then conducted to examine the factors that explained/were associated with greater socioeconomic inequality in cervical cancer screening. The methodology in this paper followed that of previous studies found in the literature and used the wealth index to measure socioeconomic status. RESULTS: The results showed that the concentration curves lay above the line of equality, implying a pro-rich inequality in cervical cancer screening services. Confirming the results from the concentration curves, the overall concentration index was positive and significant (0.142; %95 CI = 0.127, 0.156; p < 0.01). The magnitude was lower in rural areas (0.075; %95CI = 0.059, 0.090; p < 0.01) than in urban areas (0.195; %95CI = 0.162, 0.228 p < 0.001). After undertaking a decomposition of the concentration index, we found that age, education, rural or urban location, and wealth status account for more than 95% of the socioeconomic inequality in cervical cancer uptake. CONCLUSION: Despite the national scale-up of free cancer care at the point of use, cervical cancer screening uptake in Malawi remains pro rich. There is a need to implement parallel demand-side approaches to encourage uptake among poorer groups. These may include self-testing and mobile screening centres, among others.

Correction to: Malawi at the Crossroads: Does the Fear of Contracting COVID-19 Affect the Propensity to Vote?

[This corrects the article DOI: 10.1057/s41287-020-00353-1.].

A spatial analysis of out-of-pocket payments for healthcare in Malawi.

Out-of-pocket (OOP) expenditures on health remain high in many low- and middle-income countries despite policy efforts aiming to reduce these health costs by targeting their hotspots. Hotspot targeting remains inadequate, particularly where the OOP expenditures are related across geographic regions due to unequal demand, supply and prices of healthcare services. In this paper, we investigate the existence of geographical correlations in OOP health expenditures by employing a spatial Durbin model on data from 778 clusters obtained from the 2016 Malawi's Integrated Household Survey. Results reveal that Malawian communities face geographical spillovers of OOP health expenditures. Furthermore, we find that factors including household size, education and geographical location are important drivers of the OOP health expenditure's spatial dependency. The paper calls for policy in low-income countries to improve the quality and quantity of healthcare services in both OOP hotspots and their neighbouring communities.

Malawi at the Crossroads: Does the Fear of Contracting COVID-19 Affect the Propensity to Vote?

The new coronavirus disease (COVID-19) has paralysed many sectors of human life, including economic, social-cultural and political processes. In the political arena, several countries have postponed elections due to the COVID-19 pandemic. Other countries, including Malawi, went ahead with their planned elections. Malawi held a presidential election at a time when the number of COVID-19 cases was increasing rapidly. In this paper, we assess the effect of the perceived risk of catching COVID-19 on willingness to vote in the Malawi presidential election that was held on 23 June 2020. Turn out in this election was ten percentage points lower than in the general elections that were held a year earlier. The paper draws on a nationally representative survey of adult Malawians (n = 1155). In our main analysis, we use instrumental variables to account for potential endogeneity. We find that nearly two thirds of Malawians thought that they were likely to catch COVID-19 at some point. Notwithstanding the COVID-19 risk, 86% of the country's citizens were willing to vote. Our analysis shows that an individual's perceived risk of catching COVID-19 is associated with a lower likelihood of voting (ß = - 0.096; p < 0.05). This suggests that voter turnout in Malawi's fresh presidential election may have been highly affected by the perceived risk of catching COVID-19. The policy implication is that instituting and enforcing primary preventive measures may help reduce the perceived risk of catching COVID-19 and mitigate voter apathy.

La nouvelle maladie à coronavirus (COVID-19) a paralysé de nombreux secteurs de la vie humaine, y compris au niveau économique, socioculturel et politique. Au niveau politique, plusieurs pays ont reporté des élections en raison de la pandémie de COVID-19. D'autres pays, comme le Malawi, ont maintenu les élections qui étaient prévues. Le Malawi a organisé l'élection présidentielle au moment où le nombre de cas de COVID-19 augmentait rapidement. Dans cet article, nous évaluons l'effet que la perception du risque de contracter la COVID-19 a eu sur la volonté de se rendre aux urnes à l'occasion de l'élection présidentielle qui s'est tenue le 23 juin 2020 au Malawi. Le taux de participation à cette élection était inférieur de dix points de pourcentage à celui des élections générales qui ont eu lieu un an plus tôt. L'étude s'appuie sur une enquête nationale représentative des personnes adultes du Malawi (n = 1155). Dans notre analyse principale, nous utilisons des variables instrumentales pour tenir compte d'un potentiel biais d'endogénéité. Nous constatons que près de deux tiers des Malawites pensaient qu'ils étaient susceptibles de contracter la COVID-19 à un moment ou à un autre. En dépit du risque de contracter la COVID-19, 86% des citoyens et citoyennes du pays étaient prêt.es à voter. Notre analyse montre que la perception du risque qu'a une personne de contracter la COVID-19 est associée à une probabilité plus faible de se render aux urnes (ß = − 0.096; p < 0.05). Cela suggère que la participation électorale à la nouvelle élection présidentielle au Malawi a pu être fortement impactée par la perception du risque de contracter la COVID-19. En terme de politique, cela signifie que la mise en place et l'application de mesures de prévention primaire peuvent aider à réduire la perception du risque de contracter la COVID-19 et ainsi permettre d'atténuer l'apathie des électeurs.

Inequalities in Knowledge About COVID-19 in the Kingdom of Saudi Arabia.

Background: As the world is still being ravaged by the coronavirus disease 2019 (COVID-19) pandemic, the first line of prevention lies in understanding the causative and preventive factors of the disease. However, given varied socioeconomic circumstances, there may be some inequality in the level of proper knowledge of COVID-19. Despite a proliferation of studies on COVID-19, the extent and prevalence of inequalities in knowledge about COVID-19 in Saudi Arabia are not known. Most related studies have only focused on understanding the determinants of COVID-19 knowledge. Therefore, the aim of this study was to assess the socioeconomic inequalities in knowledge regarding COVID-19 in Saudi Arabia. Methods: Data were extracted from an online cross-sectional self-reported questionnaire conducted on the knowledge about COVID-19 from 3,388 participants. Frequencies and graphs were used to identify the level and distribution of inequality in knowledge about COVID-19. Concentration curves and concentration indices were further used to assess and quantify the income- and education-related inequality in knowledge about COVID-19. Results: The level of COVID-19 knowledge was high among the surveyed sample, although the extent of knowledge varied. The findings further suggest the existence of socioeconomic inequality in obtaining proper knowledge about COVID-19, indicating that inequality in comprehensive knowledge is disproportionately concentrated among the wealthy (concentration index = 0.016; P < 0.001) and highly educated individuals (concentration index = 0.003; P = 0.029) in Saudi Arabia. Conclusions: There is inequality in the level of knowledge about COVID-19 among the more socioeconomically privileged population of Saudi Arabia. Given that COVID-19 cases ebb and flow in different waves, it is important that proper policies be put in place that will help in improving knowledge among the lower income and less educated individuals, leading to behavior that can help reduce transmission.

Economic Analysis of Inequality in Preventive Health Check-Ups Uptake in Saudi Arabia.

Background: Undertaking preventive health check-ups has proven to be an important strategy in the fight against several diseases. However, various socioeconomic circumstances may hinder participating in such an important health exercise for many people. With the growth in the burden of non-communicable diseases in Saudi Arabia, it is thus essential that people take an active role in undertaking preventive health check-ups. However, the extent to which this behavior is determined by inequalities in socioeconomic circumstances remains not well-documented. The aim of this study was to examine the socioeconomic inequalities in undertaking preventive health check-ups in Saudi Arabia, using a national survey with a sample of 11,528 respondents. Methods: Data from the Saudi Family Health Survey conducted in 2018 by the General Authority for Statistics were used for the analysis of this study. Univariate, bivariate, and multivariate logistic regression analyses were employed to examine the socioeconomic factors associated with undertaking preventive health check-ups. Concentration indices were calculated, and associated concentration curves were used to assess the socioeconomic inequalities in preventive health check-ups uptake. Moreover, decomposition analysis was performed to examine the extent to which the socioeconomic variables affect uptake of preventive health check-ups. Results: The results reveal that being older adults, more educated, insured, and married increase the probability of undertaking preventive health check-ups. Regarding socioeconomic inequalities, preventive health check-ups uptake was concentrated among the wealthier (concentration index: 0.0831; P < 0.001). However, some differences were observed in terms of socioeconomic inequality across the regions. Decomposition of the Erreygers index supported the analysis of the determinants and suggested that income, and education were the primary drivers of the associated inequality. Conclusions: These results suggest that the government of Saudi Arabia should develop intervention programs and strategies that promote the uptake of health check-ups among the vulnerable group to reduce inequalities. Of particular importance is the need for more health-related education among the poor and those with lower education in order to raise their awareness on the benefits and advantages of conducting health examinations.

Acceptability of a COVID-19 Vaccine among the Saudi Population.

To investigate the associated factors underlying vaccination intentions for Coronavirus Disease 2019 (COVID-19), an online cross-sectional survey was conducted among adults 18 years or over in the Kingdom of Saudi Arabia. Data were collected between 8 and 14 December 2020. A logistic regression analysis was employed to examine and identify the variables associated with vaccination intentions for COVID-19, with the odds ratio (OR) and 95% confidence interval (CI) also calculated. A total of 2137 respondents completed the questionnaire. Overall, about 48% of Saudi adults were willing to receive the COVID-19 vaccine. Participants had stronger intentions to receive a vaccination if they resided in the southern region (OR: 1.95; 95% CI: 1.21-3.14), received the seasonal influenza vaccination in the past (OR: 1.52; 95% CI: 1.17-1.97), believed in mandatory COVID-19 vaccination (OR: 45.07; 95% CI: 31.91-63.65), or reported high levels of concern about contracting COVID-19 (OR: 1.91; 95% CI: 1.29-2.81). Participants were less likely to have an intention to be vaccinated if they had a history of vaccine refusal (OR: 0.28; 95% CI: 0.19-0.40). The low acceptance rate among the Saudi population should be targeted with multifaceted interventions aimed at raising awareness and emphasizing the safety and efficacy of the COVID-19 vaccine.

Acceptability of a COVID-19 Vaccine Among Healthcare Workers in the Kingdom of Saudi Arabia.

Objective: This study aims to determine the acceptability of a COVID-19 vaccine among healthcare workers in Saudi Arabia and the factors affecting their intention to accept the vaccine. Methods: The study used data from an online cross-sectional survey that was conducted in Saudi Arabia between 8 December 2020 and 14 December 2020. This study employed bivariate and multivariable regression analyses. The bivariate was used to describe and tabulate the frequency of all the variables, including the sociodemographic characteristics, the risk perception and the acceptance of the COVID-19 vaccination and a chi-squared test of independence was calculated. Multivariable logistic regression models were employed to examine and identify the factors associated with an intention to have the COVID-19 vaccination and the factors associated with its immediate acceptance. Results: Of the total of 736 healthcare workers who began the online questionnaire, 673 completed it (a 91.44% completion rate). Among the study participants, 50.52% were willing to have the COVID-19 vaccine, of which 49.71% intended to have the vaccine as soon as it becomes available in the country, while 50.29% would delay until the vaccine's safety is confirmed. Being a male healthcare worker, perceiving a high risk of infection, and believing that the COVID-19 vaccine should be compulsory for all citizens and residents in the country increased the probability of intention to vaccinate against COVID-19 and the probability of accepting the COVID-19 vaccination as soon as possible. Conclusion: This study calls for more health-related education among healthcare workers to alleviate any fears that might be associated with the COVID-19 vaccine.

Impact of Safety Nets on Household Coping Mechanisms for COVID-19 Pandemic in Malawi.

Background: Covid-19 pandemic induced various shocks to households in Malawi, many of which were failing to cope. Household coping mechanisms to shocks have an implication on household poverty status and that of a nation as a whole. In order to assist households to respond to the pandemic-induced shocks positively, the government of Malawi, with support from non-governmental organizations introduced Covid-19 Urban Cash Intervention (CUCI) and other safety nets to complement the existing social protection programs in cushioning the impact of the shocks during the pandemic. With these programmes in place, there is a need for evidence regarding how the safety nets are affecting coping. Therefore, this paper investigated the impact that safety nets during Covid-19 pandemic had on the following household coping mechanisms: engaging in additional income-generating activities, receiving assistance from friends and family; reducing food consumption; relying on savings; and failure to cope. Methods: The study used a nationally representative panel data from the Malawi High Frequency Phone Survey on Covid-19 (HFPS Covid-19) and complemented it with the fifth Integrated Household Panel Survey (IHPS), also known as living standards measurement survey. Five Random Effects Probit Models were estimated, one for each coping mechanism. Results: Findings from this study indicated that beneficiaries of safety net programs were more likely to rely on remittances from friends and family than the people who had no safety nets. Furthermore, the safety net recipients were less likely to reduce food consumption or rely on savings than the non-recipients. Despite the interesting findings, we also noticed that safety nets had no significant impact on household engagement in other income-generating activities in response to shocks. Conclusion: The results imply that safety nets in Malawi during the Covid-19 pandemic had a positive impact on consumption and prevented the dissolving of savings. Therefore, these programs have to be scaled up, and the volumes be revised upwards.

Socioeconomic inequality in premiums for a community-based health insurance scheme in Rwanda.

Community-based health insurance (CBHI) has gained popularity in many low- and middle-income countries, partly as a policy response to calls for low-cost, pro-poor health financing solutions. In Africa, Rwanda has successfully implemented two types of CBHI systems since 2005, one of which with a flat rate premium (2005-10) and the other with a stratified premium (2011-present). Existing CBHI evaluations have, however, tended to ignore the potential distributional aspects of the household contributions made towards CBHI. In this paper, we investigate the pattern of socioeconomic inequality in CBHI household premium contributions in Rwanda within the implementation periods. We also assess gender differences in CBHI contributions. Using the 2010/11 and 2013/14 rounds of national survey data, we quantify the magnitude of inequality in CBHI payments, decompose the concentration index of inequality, calculate Kakwani indices and implement unconditional quantile regression decomposition to assess gender differences in CBHI expenditure. We find that the CBHI with stratified premiums is less regressive than CBHI with a flat rate premium system. Decomposition analysis indicates that income and CBHI stratification explain a large share of the inequality in CBHI payments. With respect to gender, female-headed households make lower contributions towards CBHI expenditure, compared with male-headed households. In terms of policy implications, the results suggest that there may be a need for increasing the premium bracket for the wealthier households, as well as for the provision of more subsidies to vulnerable households.

Levels of and changes in socioeconomic inequality in delivery care service: A decomposition analysis using Bangladesh Demographic Health Surveys.

BACKGROUND: Socioeconomic inequality in maternity care is well-evident in many developing countries including Bangladesh, but there is a paucity of research to examine the determinants of inequality and the changes in the factors of inequality over time. This study examines the factors accounting for the levels of and changes in wealth-related inequality in three outcomes of delivery care service: health facility delivery, skilled birth attendance, and C-section delivery in Bangladesh. METHODS: This study uses from the Bangladesh Demographic and Health Survey of 2011 and 2014. We apply logistic regression models to examine the association between household wealth status and delivery care measures, controlling for a wide range of sociodemographic variables. The Erreygers normalised concentration index is used to measure the level of inequalities and decomposition method is applied to disentangle the determinants contributing to the levels of and changes in the observed inequalities. RESULTS: We find a substantial inequality in delivery care service utilisation favouring woman from wealthier households. The extent of inequality increased in health facility delivery and C-section delivery in 2014 while increase in skilled birth attendance was not statistically significant. Wealth and education were the main factors explaining both the extent of and the increase in the degree of inequality between 2011 and 2014. Four or more antenatal care (ANC4+) visits accounted for about 8% to 14% of the observed inequality, but the contribution of ANC4+ visits declined in 2014. CONCLUSION: This study reveals no progress in equity gain in the use of delivery care services in this decade compared to a declining trend in inequity in the last decade in Bangladesh. Policies need to focus on improving the provision of delivery care services among women from poorer socioeconomic groups. In addition, policy initiatives for promoting the completion of quality education are important to address the stalemate of equity gain in delivery care services in Bangladesh.

Effects of Financial Inclusion on Access to Emergency Funds for Healthcare in the Kingdom of Saudi Arabia.

BACKGROUND: Having access to convenient and quality healthcare at all times is not only a human right but also a goal that many countries strive to achieve for their population. However, access to healthcare might face blocks in the presence of financial exclusions. Saudi Arabia has, over the years, continued to pursue policy and system reforms to enhance its population's access to financial inclusion, as well as proper health coverage to improve health outcomes. This study seeks to estimate the effects of financial inclusion on the financial hardships in accessing healthcare in Saudi Arabia. METHODS: This study uses a nationally representative survey conducted with 1009 adults, using the 2017 World Bank Global Findex Study data. The study estimates the conditional probability of coming up with emergency funds and the conditional probability of borrowing for medical purposes to understand access to healthcare. A composite value is created for financial inclusion using several variables for individuals' interactions with financial institutions, such as access to financial services and loans. RESULTS: The results revealed that financially included individuals have a higher conditional probability of both borrowing for medical purposes and coming up with emergency funds, compared to those who are financially excluded. Additionally, the study showed that individuals in low-income brackets are more likely to be financially excluded and have a reduced chance of coming up with emergency funds and borrowing for medical purposes. CONCLUSION: These findings indicate that there is need for authorities to roll out a financial inclusion drive that will not only incentivise the financially excluded population to become included but that will also aim at promoting various financial products so that those who are already financially included have a wide range from which they can choose.

Knowledge, Attitude and Practice Toward COVID-19 Among the Public in the Kingdom of Saudi Arabia: A Cross-Sectional Study.

Background: Saudi Arabia has taken unprecedented and stringent preventive and precautionary measures against COVID-19 to control its spread, safeguard citizens and ensure their well-being. Public adherence to preventive measures is influenced by their knowledge and attitude toward COVID-19. This study investigated the knowledge, attitudes, and practices of the Saudi public, toward COVID-19, during the pandemic. Methods: This is a cross-sectional study, using data collected via an online self-reported questionnaire, from 3,388 participants. To assess the differences in mean scores, and identify factors associated with knowledge, attitudes, and practices toward COVID-19, the data were run through univariate and multivariable regression analyses, respectively. Results: The majority of the study participants were knowledgeable about COVID-19. The mean COVID-19 knowledge score was 17.96 (SD = 2.24, range: 3-22), indicating a high level of knowledge. The mean score for attitude was 28.23 (SD = 2.76, range: 6-30), indicating optimistic attitudes. The mean score for practices was 4.34 (SD = 0.87, range: 0-5), indicating good practices. However, the results showed that men have less knowledge, less optimistic attitudes, and less good practice toward COVID-19, than women. We also found that older adults are likely to have better knowledge and practices, than younger people. Conclusions: Our finding suggests that targeted health education interventions should be directed to this particular vulnerable population, who may be at increased risk of contracting COVID-19. For example, COVID-19 knowledge may increase significantly if health education programs are specifically targeted at men.

Decomposition of Gender Differences in Body Mass Index in Saudi Arabia using Unconditional Quantile Regression: Analysis of National-Level Survey Data.

Understanding gender differences in body mass index (BMI) between males and females has been much debated and received considerable attention. This study aims to decompose gender differentials in the BMI of people of the Kingdom of Saudi Arabia. The study decomposed the BMI gender gap into its associated factors across the entire BMI distribution by using counterfactual regression methods. The main method of analysis was newly developed unconditional quantile regression-based decomposition, which applied Blinder-Oaxaca decomposition using data from the Saudi Health Interview Survey. Gender differentials were found in the BMI, with females showing a higher BMI than males. The aggregate decomposition showed that both the covariate effect and the structural effect were significant at the 25th and 50th quantiles. Detailed decomposition indicated that income level and employment status as well as soda consumption and the consumption of red meat were significantly correlated in explaining gender differentials in BMI across various quantiles, but the magnitude varied by quantile. Our study suggests the government should consider introducing programs that specifically target women to help them reduce BMI. These programs could include organizing sporting events at the workplace and at the national level. Furthermore, the effect of soda consumption could be reduced by levying a tax on beverages, which might reduce the demand for soda due to the increased price.

Does prolonged television viewing affect Body Mass Index? A case of the Kingdom of Saudi Arabia.

BACKGROUND: The rising prevalence of overweight and obesity and their health implications is a major public health concern worldwide. This study set out to understand the relationship between the number of hours spent watching television and Body Mass Index (BMI) in the Kingdom of Saudi Arabia using data from the Saudi Health Interview Survey. METHODS: The study employed both ordinary least squares and quantile regressions to estimate the mean and distributional association of prolonged television watching and BMI. RESULTS: The findings showed that prolonged television viewing is associated with larger BMI values. Additionally, the relationship was found to be greater towards the lower and upper tails of the BMI range and insignificant in the middle of the BMI distribution. Furthermore, the findings also showed that there is a gender gap in BMI levels, where females are likely to have higher BMI values than males. CONCLUSIONS: The creation of more proactive recreational programs that can act as substitutes to television watching is recommended in order to reduce the amount of time that individuals spend watching television. It is also recommended that such interventions are tailored towards improving females' levels of physical activity. The inclusion of television programs aimed at encouraging physical exercise and healthy diets is also imperative.

Socio-economic inequalities in diabetes prevalence in the Kingdom of Saudi Arabia.

BACKGROUND: Rising prevalence of non-communicable diseases, including diabetes in the Middle East, is a major public health concern of the 21st century. However, there is a paucity of literature to understand and measure socio-economic inequalities in diabetes prevalence in this region, including the Kingdom of Saudi Arabia (KSA). METHODS: This study investigated socio-economic inequalities in diabetes prevalence in the KSA using data from the Saudi Arabia Health Interview Survey. Concentration curve, concentration index, and multivariate logistic regression were used to measure and examine income- and education-related inequalities in diabetes prevalence. RESULTS: The results showed significant socio-economic inequalities in the prevalence of diabetes through analysing a nationally representative sample of the KSA population. Diabetes prevalence was concentrated among the poor and among people with less education. In addition, education-related inequality was higher than income-related inequality. CONCLUSIONS: The findings of this study are important for policymakers to combat both the increasing prevalence of and socio-economic inequalities in diabetes. The government should promote health education programmes and increase the level of public awareness of diabetes management, especially among the lower educated population in the KSA.

The Impact of Ghana's National Health Insurance on Psychological Distress.

BACKGROUND: Poor mental health is among the growing number of noncommunicable diseases in low- and middle-income countries. Despite poor mental health accounting for an already considerable and growing burden of disease in many low- and middle-income countries, policy action to confront the challenge has been limited, at both international and national levels. Recently, several low- and middle-income countries have embarked on the journey toward universal health coverage by expanding their public health insurance provision, with the ultimate objective of improving population health, in addition to other health system objectives. Mental health interventions typically may not have been specifically covered in the publicly funded benefit package, and this raises the question of whether, and if so, by how much, the expansion of public health insurance may have directly or indirectly contributed to improved mental health. OBJECTIVE: We assessed the impact of Ghana's implementation of national health insurance on psychological distress. METHODS: Our study used the first wave of the 2009-2010 Ghana Social Economic Panel survey, including 10,007 respondents. We employed instrumental variable and propensity score matching methods to estimate the causal impact of health insurance on psychological distress, measured by the Kessler Psychological Distress Scale (K10). Higher K10 values indicate greater psychological distress. RESULTS: The median K10 score in Ghana was 16 (P < 0.001), with a minimum of 10 (P < 0.001) and a maximum of 45 (P < 0.001). The results from the instrumental variable estimations, without matching, indicated that the K10 score for the insured was 11.8% lower (P < 0.001) than that of the uninsured. After running the instrumental variable regression on the matched sample, the K10 score for the insured was 10.6% (P < 0.001) lower than that of the uninsured. Similarly, the estimates based on propensity score matching indicated that the insured had a lower K10 score (- 0.023; P < 0.05). Furthermore, the beneficial impact of health insurance on psychological distress is larger for wealthier than poorer insurance members and varies across regions in Ghana. The findings were robust to the various estimation methods. CONCLUSION: This study suggests that having health insurance is associated with reduced psychological distress and hence improved mental health, even though mental illness treatment or prevention were at best only partially covered by the National Health Insurance Scheme in Ghana.