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1.
BMJ Glob Health ; 4(6): e001862, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31798997

RESUMO

Introduction: Malaria continues to be a major cause of morbidity and mortality in sub-Saharan Africa (SSA) without effective interventions. Bacillus Calmette-Guérin (BCG) vaccine possesses protective non-specific effects, which extend beyond protection against tuberculosis. This study explores whether BCG is associated with protection against malaria in children under the age of 5 years in SSA. Methods: We used data from the Demographic Health Survey programme, including 34 206 children from 13 SSA countries. BCG status was taken from vaccination cards when present; if not, mother's recall was used. Presence of malaria was defined as a positive rapid diagnostic test. Maternally reported presence or absence of fever in the previous 2 weeks defined symptomatic status. Multilevel logistic regression was used to account for the two-stage cluster sampling method. Results: Of the 34 206 children, 12 325 (36.0%) children were malaria positive and 29 766 (87.0%) were BCG vaccinated. After correction for relevant child, maternal and household factors, BCG vaccination was associated with a lower malaria prevalence (adjusted OR (aOR)=0.94, 95% CI 0.90 to 0.98), especially among children of whom BCG information was retrieved from a vaccination card (aORcard=0.88, 95% CI 0.82 to 0.94). Restricting the analysis to children from regions with suboptimal BCG coverage increased the association (aORcard=0.81, 95% CI 0.73 to 0.89). We observed an increasingly beneficial association with each month of age of the child (aORcard=0.996, 95% CI 0.993 to 0.999). BCG associations were similar for asymptomatic (aORcard=0.86, 95% CI 0.81 to 0.92) and symptomatic (aORcard=0.89, 95% CI 0.78 to 1.01) malaria. Conclusions: BCG vaccination is associated with protection against malaria. This protection is highest in regions with suboptimal BCG coverage. These results indicate a possible role for timely BCG vaccination in the protection of malaria and its elimination by reducing the transmission reservoir. If confirmed in further research, our findings have substantial implications for global efforts to reduce malaria burden.

2.
J Water Health ; 17(4): 633-646, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31314000

RESUMO

Clean water provision remains a serious problem in low- and middle-income countries. In 2017, about 30% of the world population relied on unimproved water sources located outside of the dwellings. Often women and children are occupied in fetching water. This situation increases the prevalence of water-related diseases such as diarrhoea and reduces children's study time. School attendance may decrease due to the combined effects of diarrhoea and time spent on fetching water. We investigate the effects on school absenteeism and primary school enrolment in Indonesia, using a panel data set for 295 districts over the period 1994-2014. Districts with higher diarrhoea prevalence are found to have lower school enrolment (B: -0.202, sig p < 0.01) and higher school absenteeism (B: 2.334, sig p < 0.001). Districts where more households have access to private water facilities have higher school enrolment (B: 0.025, sig p < 0.01) and lower school absenteeism (B: -0.027, sig p < 0.01). More use of piped and bottled water in a district is associated with a lower diarrhoea prevalence (B: -0.004, sig p < 0.05). Policy-makers should take the benefits of improved water supply into account when making cost-benefit analyses regarding investments in water infrastructure.


Assuntos
Absenteísmo , Água Potável/microbiologia , Criança , Feminino , Humanos , Indonésia , Instituições Acadêmicas , Abastecimento de Água
3.
Sci Data ; 6: 190038, 2019 03 12.
Artigo em Inglês | MEDLINE | ID: mdl-30860498

RESUMO

In this paper we describe the Subnational Human Development Database. This database contains for the period 1990-2017 for 1625 regions within 161 countries the national and subnational values of the Subnational Human Development Index (SHDI), for the three dimension indices on the basis of which the SHDI is constructed - education, health and standard of living --, and for the four indicators needed to create the dimension indices -- expected years of schooling, mean years of schooling, life expectancy and gross national income per capita. The subnational values of the four indicators were computed using data from statistical offices and from the Area Database of the Global Data Lab, which contains indicators aggregated from household surveys and census datasets. Values for missing years were estimated by interpolation and extrapolation from real data. By normalizing the population-weighted averages of the indicators to their national levels in the UNDP-HDI database, values of the SHDI and its dimension indices were obtained that at national level equal their official versions of the UNDP.


Assuntos
Bases de Dados Factuais , Fatores Socioeconômicos , Educação , Humanos , Expectativa de Vida , Saúde Pública
4.
Hum Genet ; 138(1): 61-72, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30535804

RESUMO

ATP2B2 encodes the PMCA2 Ca2+ pump that plays an important role in maintaining ion homeostasis in hair cells among others by extrusion of Ca2+ from the stereocilia to the endolymph. Several mouse models have been described for this gene; mice heterozygous for loss-of-function defects display a rapidly progressive high-frequency hearing impairment. Up to now ATP2B2 has only been reported as a modifier, or in a digenic mechanism with CDH23 for hearing impairment in humans. Whole exome sequencing in hearing impaired index cases of Dutch and Polish origins revealed five novel heterozygous (predicted to be) loss-of-function variants of ATP2B2. Two variants, c.1963G>T (p.Glu655*) and c.955delG (p.Ala319fs), occurred de novo. Three variants c.397+1G>A (p.?), c.1998C>A (p.Cys666*), and c.2329C>T (p.Arg777*), were identified in families with an autosomal dominant inheritance pattern of hearing impairment. After normal newborn hearing screening, a rapidly progressive high-frequency hearing impairment was diagnosed at the age of about 3-6 years. Subjects had no balance complaints and vestibular testing did not yield abnormalities. There was no evidence for retrocochlear pathology or structural inner ear abnormalities. Although a digenic inheritance pattern of hearing impairment has been reported for heterozygous missense variants of ATP2B2 and CDH23, our findings indicate a monogenic cause of hearing impairment in cases with loss-of-function variants of ATP2B2.


Assuntos
Biomarcadores/análise , Predisposição Genética para Doença , Perda Auditiva/genética , Mutação , ATPases Transportadoras de Cálcio da Membrana Plasmática/genética , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Seguimentos , Heterozigoto , Humanos , Masculino , Pessoa de Meia-Idade , Linhagem , Prognóstico , Adulto Jovem
5.
Soc Sci Med ; 205: 90-98, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29677583

RESUMO

Globally an estimated 159 million children under 5 years of age are being too short for one's age (stunted). More than one third of these children is living in Africa. Given the substantial number of sub-Saharan African (SSA) children living in households with co-residing grandparents and the negative effects of stunting on productivity and economic growth, gaining insight into the role grandparents play for children's stunting, has become increasingly important. By applying multilevel logistic regression analysis on a database with information on 344,748 children aged 6-60 months living in 31 SSA countries, the strength of the relationship between grandparental co-residence and children's stunting is examined. Interaction analysis is used to explore how this relationship is moderated by characteristics of the household and of the context in which the household is situated. Children in households with a co-residing grandmother have significantly lower odds of being stunted than other children, provided that the grandmother is in the 50-75 age range. When the grandmother is very young or very old, the likelihood of being stunted is higher. For grandfathers, no significant overall relationship is found, but our findings show that co-residence of a grandfather is associated with less stunting of girls, in poor households and in polygamous households.


Assuntos
Avós , Transtornos do Crescimento/epidemiologia , África ao Sul do Saara/epidemiologia , Idoso , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos
6.
Otol Neurotol ; 39(4): e231-e239, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29494467

RESUMO

INTRODUCTION: Cochlear implant (CI) electrode design impacts the clinical performance of patients. Stability and the occurrence of electrode array migration, which is the postoperative movement of the electrode array, were investigated using a mid-scalar electrode array and postoperative image analysis. METHODS: A prospective observational study was conducted. A mid-scalar electrode was surgically placed using a mastoidectomy, followed by a posterior tympanotomy and an extended round-window or cochleostomy insertion. A few days after surgery and 3 months later Cone Beam Computed Tomography (CBCT) was performed. The two different CBCT's were fused, and the differences between the electrode positions in three dimensions were calculated (the migration). A migration greater than 0.5 mm was deemed clinically relevant. RESULTS: Fourteen subjects participated. The mid-scalar electrode migrated in one patient (7%). This did not lead to the extrusion of an electrode contact. The mean migration of every individual electrode contact in all patients was 0.36 mm (95% confidence interval 0.22-0.50 mm), which approximates to the estimated measurement error of the CBCT technique. CONCLUSION: A mid-scalar electrode array achieves a stable position in the cochlea in a small but representative group of patients. The methods applied in this work can be used for providing postoperative feedback for surgeons and for benchmarking electrode designs.


Assuntos
Implante Coclear/métodos , Implantes Cocleares , Adulto , Cóclea/cirurgia , Feminino , Migração de Corpo Estranho , Humanos , Masculino , Estudos Prospectivos
7.
Hum Nat ; 29(1): 65-89, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29222651

RESUMO

Under poor circumstances, co-residence of a grandmother is generally considered to be beneficial for (grand)children. Empirical evidence does not unequivocally support this expectation and suggests that the grandmother's importance depends on the family's circumstances. We study the relationship between grandmother's co-residence and children's schooling in sub-Saharan Africa under a broad range of circumstances. Results make clear that the effect of a co-residing grandmother varies but is almost always positive. Grandmothers over age 60 are most effective in helping their (grand)children. They are particularly important for girls, and when the mother is deceased or not living in the household. Grandmothers are less effective in situations with few opportunities, as in very poor regions or in communities with few schooling opportunities. Our findings indicate that providing support to grandmothers should not be overlooked when designing policies aimed at strengthening the position of women and children in the sub-Saharan African context.


Assuntos
Educação Infantil/etnologia , Educação , Relações Familiares/etnologia , Avós , Pobreza , Adolescente , África ao Sul do Saara/etnologia , Idoso , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
8.
J Water Health ; 15(6): 1004-1014, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29215362

RESUMO

In recent years, the consumption of refillable bottled water has increased considerably in emerging countries. However, the quality of this water is often questionable, as authorities lack the capacity to properly check refilling depots. Given that refillable bottled water not only replaces unimproved water sources, but also better-quality sources, like piped and branded bottled water, its increasing use poses a major health risk. We investigate the motives behind the decision to switch to refillable bottled water in Indonesia. Findings indicate that this switch is driven by lifestyle motives, as well as by cost and availability considerations. It is mostly the young affluent households who switch from piped and 'other' sources to refillable bottled water. In rural areas, the tendency to make this switch is negatively affected by availability problems and the higher price of refillable bottled water. Availability and cost also influence the switch from branded bottled to refillable bottled water, but here it is the poorer households who have a higher propensity to switch. Further exploration of the lifestyle motive and affordability issues, as well as better monitoring of the refilling depots, are needed to improve the quality of drinking water in Indonesia and other emerging countries.


Assuntos
Água Potável/análise , Características da Família , Medição de Risco , Fatores Socioeconômicos , Abastecimento de Água/normas , Humanos , Indonésia , Motivação , Abastecimento de Água/economia
9.
Scientometrics ; 113(1): 633-650, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29056794

RESUMO

To gain insight into the duration and quality of the scientific peer review process, we analyzed data from 3500 review experiences submitted by authors to the SciRev.sc website. Aspects studied are duration of the first review round, total review duration, immediate rejection time, the number, quality, and difficulty of referee reports, the time it takes authors to revise and resubmit their manuscript, and overall quality of the experience. We find clear differences in these aspects between scientific fields, with Medicine, Public health, and Natural sciences showing the shortest durations and Mathematics and Computer sciences, Social sciences, Economics and Business, and Humanities the longest. One-third of journals take more than 2 weeks for an immediate (desk) rejection and one sixth even more than 4 weeks. This suggests that besides the time reviewers take, inefficient editorial processes also play an important role. As might be expected, shorter peer review processes and those of accepted papers are rated more positively by authors. More surprising is that peer review processes in the fields linked to long processes are rated highest and those in the fields linked to short processes lowest. Hence authors' satisfaction is apparently influenced by their expectations regarding what is common in their field. Qualitative information provided by the authors indicates that editors can enhance author satisfaction by taking an independent position vis-à-vis reviewers and by communicating well with authors.

10.
Lancet Glob Health ; 5(7): e673-e679, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28578941

RESUMO

BACKGROUND: Sub-Saharan Africa has the world's highest under-5 and neonatal mortality rates as well as the highest naturally occurring twin rates. Twin pregnancies carry high risk for children and mothers. Under-5 mortality has declined in sub-Saharan Africa over the last decades. It is unknown whether twins have shared in this reduction. METHODS: We pooled data from 90 Demographic and Health Surveys for 30 sub-Saharan Africa countries on births reported between 1995 and 2014. We used information on 1 685 110 singleton and 56 597 twin livebirths to compute trends in mortality rates for singletons and twins. We examined whether the twin-singleton rate ratio can be attributed to biological, socioeconomic, care-related factors, or birth size, and estimated the mortality burden among sub-Saharan African twins. FINDINGS: Under-5 mortality among twins has declined from 327·7 (95% CI 312·0-343·5) per 1000 livebirths in 1995-2001 to 213·0 (196·7-229·2) in 2009-14. This decline of 35·0% was much less steep than the 50·6% reduction among singletons (from 128·6 [95% CI 126·4-130·8] per 1000 livebirths in 1995-2001 to 63·5 [61·6-65·3] in 2009-14). Twins account for an increasing share of under-5 deaths in sub-Saharan Africa: currently 10·7% of under-5 mortality and 15·1% of neonatal mortality. We estimated that about 315 000 twins (uncertainty interval 289 000-343 000) die in sub-Saharan African each year. Excess twin mortality cannot be explained by common risk factors for under-5 mortality, including birthweight. The difference with singletons was especially stark for neonatal mortality (rate ratio 5·0, 95% CI 4·5-5·6). 51·7% of women pregnant with twins reported receiving medical assistance at birth. INTERPRETATION: The fate of twins in sub-Saharan Africa is lagging behind that of singletons. An alarming one-fifth of twins in the region dies before age 5 years, three times the mortality rate among singletons. Twins account for a substantial and growing share of under-5 and neonatal mortality, but they are largely neglected in the literature. Coordinated action is required to improve the situation of this extremely vulnerable group. FUNDING: None.


Assuntos
Peso ao Nascer , Demografia , Mortalidade Infantil/tendências , Gêmeos , Adolescente , Adulto , África ao Sul do Saara , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Gravidez , Fatores de Risco , Fatores Socioeconômicos
11.
Glob Public Health ; 12(9): 1141-1155, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-26758565

RESUMO

Diarrhoea is an important health issue in low- and middle-income countries, including Indonesia. We applied a multilevel regression analysis on the Indonesian Demographic and Health Survey to examine the effects of drinking water and sanitation facilities at the household and community level on diarrhoea prevalence among children under five (n = 33,339). The role of the circumstances was explored by studying interactions between the water and sanitation variables and other risk factors. Diarrhoea prevalence was reported by 4820 (14.4%) children, who on average were younger, poorer and were living in a poorer environment. At the household level, piped water was significantly associated with diarrhoea prevalence (OR = 0.797, 95% CI: 0.692-0.918), improved sanitation had no direct effect (OR = 0.992, 95% CI: 0.899-1.096) and water treatment was not related to diarrhoea incidence (OR = 1.106, 95% CI: 0.994-1.232). At the community level, improved water coverage had no direct effect (OR = 1.002, 95% CI: 0.950-1.057) but improved sanitation coverage was associated with lower diarrhoea prevalence (OR = 0.917, 95% CI: 0.843-0.998). Our interaction analysis showed that the protective effects of better sanitation at the community level were increased by better drinking water at the community level. This illustrates the importance of improving both drinking water and sanitation simultaneously.


Assuntos
Diarreia/etiologia , Diarreia/prevenção & controle , Saneamento , Abastecimento de Água/normas , Pré-Escolar , Diarreia/epidemiologia , Características da Família , Humanos , Higiene , Indonésia/epidemiologia , Prevalência
12.
EBioMedicine ; 8: 341-348, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27428443

RESUMO

BACKGROUND: Bacillus Calmette-Guérin (BCG) vaccination possesses effects on health beyond its target disease, the so called "non-specific effects". We evaluate these effects, as well as the effect of timing of BCG and other vaccinations, on stunting in Sub-Saharan African (SSA) children under five. METHODS: We use a Big Data design, including cross-sectional data for 368,450 children from 33 SSA countries. Logistic regression analysis is used with control factors at child, mother, household and context level. RESULTS: Overall, BCG vaccination did not affect stunting in SSA children (OR 1.00 [0.98-1.03]). Timing of BCG vaccination was of importance (ßtime=0.067 [0.061-0.073]): compared to unvaccinated children, BCG was associated with lower odds on stunting for children vaccinated early in life (OR 0.92 [0.89-0.94]) and higher odds for children vaccinated later in infancy (OR 1.64 [1.53-1.76]). Similar findings were done for diphtheria-tetanus-pertussis (DTP)1 and measles vaccination, and when hemoglobin concentration was used as outcome variable. CONCLUSIONS: We found a general time-dependent pattern of non-specific effects of vaccination, with positive associations for vaccinations given early in life and negative associations for vaccinations given later in infancy. If confirmed in further research, our findings may provide a new perspective on the non-specific effects of vaccination.


Assuntos
Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/etiologia , Vacinação , Vacinas , África ao Sul do Saara/epidemiologia , Pré-Escolar , Estudos Transversais , Feminino , Geografia , Humanos , Lactente , Recém-Nascido , Masculino , Razão de Chances , Vigilância da População , Prevalência , Estudos Retrospectivos , Fatores de Tempo , Vacinação/efeitos adversos , Vacinas/efeitos adversos
13.
Ann Otol Rhinol Laryngol ; 125(5): 378-84, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26631764

RESUMO

OBJECTIVE: To improve the estimation of the perceived pitch in a single-sided deaf cochlear implant (CI) listener by using accurate 3-dimensional (3D) image analysis of the cochlear electrode positions together with the predicted tonotopical function for humans. METHODS: An SSD CI user underwent a Cone-Beam computed tomography (CBCT) scan. Electrode contacts were marked in 3D space in relation to the nearest point on the cochlear lateral wall. Distance to the base of the lateral wall was calculated and plotted against the place-pitch function for humans. An adaptive procedure was used to elicit the perceived pitch of electrically evoked stimulation by matching it with a contralateral acoustic pitch. RESULTS: The electrically evoked pitch percept matched well with the calculated frequency. The median mismatch in octaves was 0.12 for our method in comparison to 0.69 using the conventional Stenvers view. CONCLUSION: A method of improved image analysis is described that can be used to predict the pitch percept on corresponding cochlear electrode positions. This method shows the potential of 3D imaging in CI fitting optimization.


Assuntos
Implantes Cocleares , Tomografia Computadorizada de Feixe Cônico/métodos , Perda Auditiva Neurossensorial/diagnóstico por imagem , Imagem Tridimensional , Nível de Discriminação Sonora/fisiologia , Estimulação Acústica , Feminino , Perda Auditiva Neurossensorial/fisiopatologia , Perda Auditiva Neurossensorial/cirurgia , Humanos , Pessoa de Meia-Idade , Pessoas com Deficiência Auditiva
14.
PLoS One ; 10(6): e0131897, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26121362

RESUMO

BACKGROUND: Short birth intervals are independently associated with increased risk of adverse maternal, perinatal, infant and child outcomes. Anemia in children, which is highly prevalent in Africa, is associated with an increased risk of morbidity and mortality. Birth spacing is advocated as a tool to reduce anemia in preschool African children, but the role of gender differences and contextual factors has been neglected. The present study aims to determine to what extent the length of preceding birth interval influences the hemoglobin levels of African preschool children in general, as well as for boys and girls separately, and which contextual factors thereby play a crucial role. METHODS AND FINDINGS: This cross-sectional study uses data from Demographic and Health Surveys (DHS) conducted between 2003 and 2011 in 20 African countries. All preschool children aged 6-59 months with a valid hemoglobin measurement and a preceding birth interval of 7-72 months as well as their corresponding multigravida mothers aged 21-49 years were included in the study. Hemoglobin levels of children and mothers were measured in g/l, while birth intervals were calculated as months difference between consecutive births. Multivariate analyses were done to examine the relationship between length of preceding birth interval and child hemoglobin levels, adjusted for factors at the individual, household, community, district, and country level. A positive linear relationship was observed between birth interval and the 49,260 included children's hemoglobin level, whereby age and sex of the child, hemoglobin level of the mother, household wealth, mother's education and urbanization of place of residence also showed positive associations. In the interaction models, the effect of a month increase in birth interval is associated with an average increase of 0.025 g/l in hemoglobin level (P = 0.001) in girls, while for boys the effect was not significant. In addition, for girls, the effect of length of preceding birth interval was highest in young mothers and mothers with higher hemoglobin levels, while for boys, the highest effect was noticed for those living in more highly educated regions. Finally, significantly higher hemoglobin levels of girls compared to boys were observed at birth but with increasing age, the sex difference in hemoglobin level gradually becomes smaller. CONCLUSIONS: A longer birth interval has a modest positive effect on early childhood hemoglobin levels of girls, and this effect is strongest when their mothers are in their early twenties and have a high hemoglobin level. Remarkably, although the physiological iron requirement is higher for boys than girls, birth spacing has little influence on hemoglobin levels of preschool boys. We speculate that the preference for male offspring in large parts of Africa significantly influences nutritional patterns of African preschool boys and girls, and as such also determines the different effect of birth spacing. Finally, gender aspects should be considered in intervention programs that aim to improve anemia in African children.


Assuntos
Intervalo entre Nascimentos , Hemoglobinas/análise , Adulto , África , Fatores Etários , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Gravidez , Fatores Sexuais , Adulto Jovem
15.
PLoS One ; 9(6): e99952, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24964142

RESUMO

Evolutionary theory predicts humans to be more altruistic towards genetically more closely related kin. Because fathers face uncertainty about the relation to their children, the asymmetric parental altruism hypothesis predicts mothers to provide a higher share of parental care than fathers. We tested this hypothesis using parental choice experiments in rural Tanzania, in which fathers and mothers could choose between an outcome that benefited themselves and an outcome that benefited their children. When a parent was solely responsible for the outcome, mothers chose more altruistic than fathers. However when the choice situation was changed into a coordination game in which responsibility was shared with the partner, the sex difference disappeared. Fathers then chose somewhat more altruistic, but mothers substantially less. Our findings thus partly support the asymmetric parental altruism hypothesis, but they also show that parental altruism is influenced by the context in which choices are taken.


Assuntos
Altruísmo , Comportamento de Escolha , Pai/psicologia , Mães/psicologia , Comportamento Social , Adulto , Criança , Feminino , Humanos , Masculino , Relações Pais-Filho , Tanzânia
16.
J Epidemiol Community Health ; 68(2): 116-22, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24098045

RESUMO

BACKGROUND: The prevalence of anaemia in Africa is the highest in the world. Especially women are at risk because of blood loss during menstruation and increased iron requirements during pregnancy. This study examined determinants of the haemoglobin (Hb) level of African women at individual/household, cluster, district, and national level. Special attention was paid to socioeconomic factors and the presence of health facilities. METHODS: Data were derived from Demographic and Health Surveys conducted between 2003 and 2010 in 21 African countries. We included all women aged 15-49 who participated in a women's survey and had a Hb measurement. Multilevel models were used to examine the influence of various factors at different hierarchical levels simultaneously. RESULTS: 104 899 women were included in the study, of which 23.1% were anaemic (Hb<110 g/L). Socioeconomic factors were strongly related to the Hb level of women. Wealth, education, having a job, occupation of the partner, presence of a toilet facility, context educational level and preventive health measures were positively associated with the Hb level. Interaction analysis indicated that socioeconomic differences in the Hb level of women were reduced by the presence of health facilities. CONCLUSIONS: Interventions aimed at improving the Hb level of African women should take socioeconomic and contextual aspects into account. Increasing availability of health facilities might be a tool for reducing socioeconomic differences.


Assuntos
Anemia Ferropriva/epidemiologia , Comportamentos Relacionados com a Saúde , Instalações de Saúde/estatística & dados numéricos , Hemoglobinas/análise , Saúde da Mulher , Adolescente , Adulto , África , Anemia Ferropriva/sangue , Biomarcadores/sangue , Análise por Conglomerados , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Hemoglobinas/fisiologia , Humanos , Pessoa de Meia-Idade , Análise Multinível , Gravidez , Serviços Preventivos de Saúde/estatística & dados numéricos , Características de Residência , Fatores Socioeconômicos , Adulto Jovem
17.
Afr J Reprod Health ; 17(2): 23-38, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24069749

RESUMO

We study how the availability and use of family planning services in African countries influences the family planning situation of households and through this the educational participation of young children. A district panel dataset is used for 441 urban and rural areas within 233 districts of 25 countries. Path analysis shows that a decrease in the number of births is associated with an increase in educational participation in the area. The number of births is negatively associated with acceptance, knowledge and actual use of contraceptives in the area. As reversed causality and selection bias seem unlikely, the identified relationship probably is at least partially causal. Hence, investments in family planning services in poor areas are not only important because they allow women to plan their births better, but also because they may lead to higher primary enrolment rates and thus contribute to the region's future economic growth.


Assuntos
Serviços de Planejamento Familiar , Instituições Acadêmicas , Estudantes , África , Coeficiente de Natalidade , Comportamento Contraceptivo , Feminino , Acesso aos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Recém-Nascido , Masculino , Modelos Teóricos , Aceitação pelo Paciente de Cuidados de Saúde , Fatores Socioeconômicos
18.
Soc Indic Res ; 110(2): 819-836, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23329862

RESUMO

We develop a new theoretical framework that explains the engagement in child labor of children in developing countries. This framework distinguishes three levels (household, district and nation) and three groups of explanatory variables: Resources, Structure and Culture. Each of the three groups refers to another strand of the literature; economics, sociology and anthropology. The framework is tested by applying multilevel analysis on data for 239,120 children living in 221 districts of 18 developing countries. This approach allows us to simultaneously investigate effects of household and context factors. At the household level, we find that resources and structural characteristics influence child labor, whereas cultural characteristics have no effect. With regard to context factors, we find that children work more in rural areas, especially if there are more unskilled manual jobs, and in more traditional urban areas. In more developed regions, girls tend to work significantly less.

19.
Int J Epidemiol ; 42(1): 211-8, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23230300

RESUMO

BACKGROUND: The male:female (M:F) mortality ratio for under-five mortality varies considerably across and within societies. Maternal education has been linked to better outcomes for girls, but the evidence is mixed. We examined how the M:F ratio for under-five mortality varies by maternal education in sub-Saharan Africa and southern Asia. METHODS: We used recent Demographic and Health Surveys from 31 sub-Saharan African and 4 southern Asian countries. M:F mortality ratios were determined using information on 49 769 deaths among 521 551 children. We estimate M:F ratios for under-five (month 0-59), neonatal (month 0), post-neonatal (month 1-11) and child mortality (month 12-59) by maternal education while controlling for demographic and household characteristics. M:F ratios for under-five mortality and child mortality are compared with more 'gender neutral' thresholds (of 1.25 and 1.17, respectively) estimated on the basis of the Human Mortality Database. RESULTS: In sub-Saharan Africa, the M:F ratio for under-five mortality is 1.09 [95% confidence interval (CI) 1.06-1.13] among non-educated mothers, 1.14 (95% CI 1.09-1.19) among mothers with some primary education and 1.25 (95% CI 1.16-1.34) among mothers with some secondary or more education. For southern Asia, the ratios are 0.88 (95% CI 0.82-0.95), 1.10 (95% CI 0.97-1.25) and 1.13 (95% CI 1.02-1.26), respectively. The M:F ratio for child mortality also shows an educational gradient in both regions, with the M:F ratio being lower among non-educated mothers. In southern Asia, the M:F ratio for child mortality is particularly low among mothers with no education, M:F ratio = 0.54 (95% CI 0.41-0.72). CONCLUSIONS: Among mothers with more education, the difference in the mortality chances of boys and girls more closely resembles a 'gender neutral' situation than among women with no or little education. Girls benefit both in absolute and relative terms from having a more educated mother.


Assuntos
Mortalidade da Criança , Escolaridade , Mortalidade Infantil , Mães/educação , Adulto , África ao Sul do Saara/epidemiologia , Ásia/epidemiologia , Pré-Escolar , Assistência à Saúde , Demografia , Feminino , Inquéritos Epidemiológicos , Humanos , Lactente , Recém-Nascido , Masculino , Distribuição por Sexo , Fatores Socioeconômicos
20.
Stud Fam Plann ; 43(2): 127-34, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23175951

RESUMO

This study examines the relationship between women's family planning outcomes and primary school enrollment among their 8-11-year-old children. We analyze household- and wider-context-level data for 103,000 children in 30 sub-Saharan African countries. Negative associations with school enrollment are found for those who have short preceding or succeeding birth intervals, a young sibling, or a mother who is pregnant. These findings remain unchanged after controlling for socioeconomic and demographic characteristics. Analysis of interaction effects shows that many associations with family planning outcomes depend on the context in which the household is living, revealing the importance of a situation-specific approach. Findings indicate that helping families improve their pregnancy planning will increase children's schooling opportunities and lead to more effective use of household and community resources.


Assuntos
Serviços de Planejamento Familiar , Instituições Acadêmicas , Estudantes , África ao Sul do Saara , Intervalo entre Nascimentos , Criança , Feminino , Humanos , Entrevistas como Assunto , Modelos Logísticos , Masculino , Gravidez , Irmãos
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