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1.
Sci Rep ; 14(1): 8393, 2024 04 10.
Artigo em Inglês | MEDLINE | ID: mdl-38600134

RESUMO

Identifying factors linked to autism traits in the general population may improve our understanding of the mechanisms underlying divergent neurodevelopment. In this study we assess whether factors increasing the likelihood of childhood autism are related to early autistic trait emergence, or if other exposures are more important. We used data from 536 toddlers from London (UK), collected at birth (gestational age at birth, sex, maternal body mass index, age, parental education, parental language, parental history of neurodevelopmental conditions) and at 18 months (parents cohabiting, measures of socio-economic deprivation, measures of maternal parenting style, and a measure of maternal depression). Autism traits were assessed using the Quantitative Checklist for Autism in Toddlers (Q-CHAT) at 18 months. A multivariable model explained 20% of Q-CHAT variance, with four individually significant variables (two measures of parenting style and two measures of socio-economic deprivation). In order to address variable collinearity we used principal component analysis, finding that a component which was positively correlated with Q-CHAT was also correlated to measures of parenting style and socio-economic deprivation. Our results show that parenting style and socio-economic deprivation correlate with the emergence of autism traits at age 18 months as measured with the Q-CHAT in a community sample.


Assuntos
Transtorno do Espectro Autista , Transtorno Autístico , Recém-Nascido , Humanos , Pré-Escolar , Lactente , Transtorno Autístico/epidemiologia , Pais , Escolaridade , Poder Familiar , Características da Família , Transtorno do Espectro Autista/epidemiologia
2.
J Health Popul Nutr ; 43(1): 49, 2024 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-38580998

RESUMO

BACKGROUND: Reducing malnutrition is a key priority for governments in low- and middle-income countries given its lasting effects on child development, health, income, and economic growth. Strategies to improve recommended infant and young child feeding (IYCF) practices, especially during the first two years of life, are considered among the most effective. METHODS: In this paper, we evaluate the long-run impacts of an innovative education strategy based on interactive play and performing arts implemented in El Alto, Bolivia on caregivers' IYCF knowledge and practices. Two thousand and fifteen households were randomly assigned to intervention and control groups. Two rounds of data were collected approximately 30 and 42 months after baseline. We estimate short-term (30 month) and longer-term (42 month) intent-to-treat effects using multivariate linear regression analysis, with and without controlling for covariates. RESULTS: The program significantly increased caregiver IYCF knowledge by 0.13 SDs in the short run, and this effect grew over time. The program also improved adherence to recommended IYCF practices by 0.23 standard deviations (SDs) in the short term, but the effect on practices dissipated over time, and no longer-term impacts were detected. Caregivers with above median baseline knowledge, number of children, and age appear to have benefited most from the program. CONCLUSIONS: Our findings suggest that entertainment-education interventions are a promising model for improving and maintaining IYCF knowledge. However, their ability to sustain more permanent changes in IYCF practices is less certain. Further evidence is needed to identify other avenues for producing long-term, sustainable behavior change, especially among indigenous populations in Latin America, where literature on education and behavior-change interventions related to IYCF practices is limited.


Assuntos
Comportamento Alimentar , Fenômenos Fisiológicos da Nutrição do Lactente , Lactente , Criança , Humanos , Feminino , Educação em Saúde , Desenvolvimento Infantil , Características da Família , Aleitamento Materno , Dieta
3.
Nat Commun ; 15(1): 3477, 2024 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-38658529

RESUMO

Streptococcus dysgalactiae subspecies equisimilis (SDSE) and Streptococcus pyogenes share skin and throat niches with extensive genomic homology and horizontal gene transfer (HGT) possibly underlying shared disease phenotypes. It is unknown if cross-species transmission interaction occurs. Here, we conduct a genomic analysis of a longitudinal household survey in remote Australian First Nations communities for patterns of cross-species transmission interaction and HGT. Collected from 4547 person-consultations, we analyse 294 SDSE and 315 S. pyogenes genomes. We find SDSE and S. pyogenes transmission intersects extensively among households and show that patterns of co-occurrence and transmission links are consistent with independent transmission without inter-species interference. We identify at least one of three near-identical cross-species mobile genetic elements (MGEs) carrying antimicrobial resistance or streptodornase virulence genes in 55 (19%) SDSE and 23 (7%) S. pyogenes isolates. These findings demonstrate co-circulation of both pathogens and HGT in communities with a high burden of streptococcal disease, supporting a need to integrate SDSE and S. pyogenes surveillance and control efforts.


Assuntos
Transferência Genética Horizontal , Sequências Repetitivas Dispersas , Infecções Estreptocócicas , Streptococcus pyogenes , Streptococcus , Streptococcus pyogenes/genética , Streptococcus pyogenes/isolamento & purificação , Streptococcus pyogenes/classificação , Infecções Estreptocócicas/transmissão , Infecções Estreptocócicas/microbiologia , Humanos , Streptococcus/genética , Streptococcus/isolamento & purificação , Sequências Repetitivas Dispersas/genética , Austrália , Genoma Bacteriano/genética , Feminino , Masculino , Criança , Características da Família , Adulto , Pré-Escolar , Adolescente , Estudos Longitudinais , Farmacorresistência Bacteriana/genética , Adulto Jovem
4.
Front Public Health ; 12: 1346133, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38651124

RESUMO

This paper investigates the impact of health investment on household income distribution, drawing from data spanning over 10 years from the China Nutrition and Health Survey. The study aims to contribute to the literature by examining the nuanced pathways through which health investment influences income distribution. Utilizing a rich dataset, rigorous empirical methods including quantile regression and cross-sectional data modeling are employed to explore the relationship between health investment and income distribution. The analysis reveals a robust positive association between health investment and both absolute and relative income levels across various demographic and occupational groups. Additionally, the study elucidates the pathways through which health investment influences income, including its effects on illness duration, employment opportunities, effective working time, and educational attainment. The findings demonstrate the dynamic nature of the relationship, indicating that as income levels rise, the impact of health investment on income becomes more pronounced. Moreover, the analysis highlights the role of health investment in facilitating upward income mobility, particularly for low-income households. Overall, these findings provide valuable insights for policymakers, suggesting that strategic health investment initiatives can contribute to achieving more equitable income distribution.


Assuntos
Renda , Humanos , China , Renda/estatística & dados numéricos , Estudos Longitudinais , Pessoa de Meia-Idade , Adulto , Masculino , Feminino , Estudos Transversais , Características da Família , Inquéritos Epidemiológicos
5.
Int J Tuberc Lung Dis ; 28(4): 176-182, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38563339

RESUMO

BACKGROUNDTanzanian TB guidelines recommend facility-based TB screening for symptomatic household contacts (HHCs) or those aged <5 years, but cost remains a major barrier. In this study, we evaluate the use of unconditional cash transfers (UCTs) to facilitate completion of HHC TB screening.METHODSIn this prospective interventional study, we enrolled index people diagnosed with TB (PWTB) within 8 weeks of TB treatment initiation from the TB clinic at Haydom Lutheran Hospital, Haydom, Tanzania, and surrounding TB dispensaries in rural Tanzania. The study provided at the time of enrollment an UCT up to 40,000 Tanzanian shillings (USD16.91) directly to heads of households with PWTB, covered medical costs from screening activities and provided three bi-weekly phone reminders to facilitate HHC TB screening. The primary outcome was TB screening completion for all HHCs compared to the same period of the preceding year.RESULTSWe enrolled 120 index PWTB, including 398 HHCs between July and December 2022. The median age for index PWTB was 35 years; 38% were females. Sixty-five (54%) households completed screening for all HHCs, compared to 7% during the same period of the preceding year.CONCLUSIONThese interventions may considerably improve completion of HHC TB screening in rural Tanzania..


Assuntos
Tuberculose , Feminino , Humanos , Adulto , Masculino , Tuberculose/terapia , Tanzânia/epidemiologia , Estudos Prospectivos , Programas de Rastreamento , Características da Família
6.
Malar J ; 23(1): 109, 2024 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-38632581

RESUMO

BACKGROUND: Malaria remains a burden globally, with the African region accounting for 94% of the overall disease burden and deaths in 2019. It is the major cause of morbidity and mortality among children in Nigeria. Though different environmental factors have been assessed to influence the distribution and transmission of malaria vectors, there is a shortage of information on how they may influence malaria transmission among under-fives in Nigeria. METHODS: This study was based on the secondary data analysis of the Nigeria Malaria Indicator Survey 2021. The study sample comprised 10,645 women (aged 15-49) who delivered a child in the 2 years preceding the survey. The study was restricted to under-fives. Logistic regression was used to identify factors associated with the risk of malaria. RESULTS: There was a positive association between the risk of malaria and heard/seen malaria messages in the last 6 months (AOR 1.39, 95% CI 1.19-1.62), houses with walls built using rudimentary materials (AOR = 1.38, 95% CI 1.04-1.83), at least 6 children living in the house (AOR 1.22, 95% CI 1.00-1.49), children being 1 or 2 years old was associated with increased odds (AOR 1.89, 95% CI 1.50-2.34 and AOR 1.89, 95% CI 1.52-2.36), children from households with only treated nets (AOR 1.23, 95% CI 1.04-1.46) and those from the North West or South East regions (AOR 1.50, 95% CI 1.10-2.05 and AOR 1.48, 95% CI 1.01-2.16), respectively. All other predictors were not associated with the risk of malaria. CONCLUSION: The factors associated with the risk of malaria in this study included sleeping under treated mosquito nets, the age of the children, residing in the northwest and southeast regions, wall construction material, 6 children and above in the household and hearing/seen malaria messages in the last 6 months. Continuous health education and public health interventions, such as the provision of LLITNs, will reduce the risk of malaria and improve the health and well-being of children under 5 years of age.


Assuntos
Mosquiteiros Tratados com Inseticida , Malária , Criança , Humanos , Feminino , Pré-Escolar , Nigéria , Estudos Transversais , Mosquiteiros , Características da Família , Fatores de Risco
7.
Child Care Health Dev ; 50(3): e13260, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38600783

RESUMO

AIM: This study aims to assess the general health status and factors affecting the general health status in the 0-14 age group in Turkey. METHODS: This cross-sectional study was conducted using the Turkish Statistical Institute Turkey Health Survey 2022 micro data set. RESULTS: This study included 7019 participants. Household heads described the general health status of 91.3% of children and the dental and gum status of 82.4% of children as very good or good, and 9.2% of children had any chronic disease. Although the median breastfeeding duration was 15 months, there is statistical significant association between sex and general health status (p = 0.014) and sex and duration of breastfeeding (p = 0.006). A statistical difference was found between duration of breastfeeding and general health status (p = 0.009) and dental and gum status (p = 0.001). CONCLUSION: In 2022, the majority of children in Turkey had very good or good general health and dental and gum status. More than a third of children were breastfed for less than 12 months. Considering the possibility of neglecting oral and dental health problems, it is recommended to prioritize oral and dental health literacy trainings and to continue breastfeeding promotion programmes.


Assuntos
Aleitamento Materno , Características da Família , Criança , Feminino , Humanos , Estudos Transversais , Nível de Saúde , Turquia/epidemiologia , Masculino
8.
PLoS One ; 19(4): e0298784, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38626056

RESUMO

INTRODUCTION: As one of the agglomeration models targeting cluster-based rural development, cluster farming has been promoted in Ethiopia and it is already reported to have significant welfare implications, but participation rates are not as high as expected. This study examines the role of land as a constraint to the development of cluster-based development in Ethiopia both using extensive and intensive measures of cluster farming. The study further disaggregates farm households based on their farm size to better understand potential heterogeneities in the relationship between farm size and cluster farming. The paper also documents other household socio-economic and network characteristics that may matter in cluster farming. METHODS: We use a large-scale farm household data from 3,969 households coupled with some expert insights on cluster farming in Ethiopia. Households in the study areas grow major staples such as maize, wheat, teff, malt barley, and sesame in four main regions of Ethiopia. We employ a double hurdle model to examine both the decision to participate and the extent to which households participate in cluster farming. By extent of participation, we refer to the amount of land and share of land farm households contribute to cluster farming. For robustness purposes, we also estimate the Tobit and Linear Probability Models. RESULTS: We show a positive association between farm size and cluster farming both at the extensive and intensive margins. This relationship turns negative for large amounts of land. This shows that cluster farming increases with farm size up to a threshold beyond which it declines. We also find suggestive evidence that participation rates are lower for small-scale farms, but also declines for large-scale farms. In addition, we show that access to information and network characteristics also matter in enabling cluster farming. CONCLUSION: The findings of this study are relevant in the framework of plans to upscale the cluster-based development initiative in Ethiopia. Attention to landholding issues is key and may be an important area where policy action can be geared to boost cluster farming. Moreover, our results inform potential targeting plans that aim to increase the participation of small-scale farmers who are usually the intended targets of such programs.


Assuntos
Agricultura , Fazendeiros , Humanos , Etiópia , Agricultura/métodos , Fazendas , Características da Família
9.
Vital Health Stat 1 ; (207): 1-31, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38630839

RESUMO

The National Health Interview Survey (NHIS), conducted by the National Center for Health Statistics since 1957, is the principal source of information on the health of the U.S. civilian noninstitutionalized population. NHIS selects one adult (Sample Adult) and, when applicable, one child (Sample Child) randomly within a family (through 2018) or a household (2019 and forward). Sampling weights for the separate analysis of data from Sample Adults and Sample Children are provided annually by the National Center for Health Statistics. A growing interest in analysis of parent-child pair data using NHIS has been observed, which necessitated the development of appropriate analytic weights. Objective This report explains how dyad weights were created such that data users can analyze NHIS data from both Sample Children and their mothers or fathers, respectively. Methods Using data from the 2019 NHIS, adult-child pair-level sampling weights were developed by combining each pair's conditional selection probability with their household-level sampling weight. The calculated pair weights were then adjusted for pair-level nonresponse, and large sampling weights were trimmed at the 99th percentile of the derived sampling weights. Examples of analyzing parent-child pair data by means of domain estimation methods (that is, statistical analysis for subpopulations or subgroups) are included in this report. Conclusions The National Center for Health Statistics has created dyad or pair weights that can be used for studies using parent-child pairs in NHIS. This method could potentially be adapted to other surveys with similar sampling design and statistical needs.


Assuntos
Características da Família , Mães , Adulto , Feminino , Estados Unidos , Humanos , Lactente , National Center for Health Statistics, U.S. , Coleta de Dados , Projetos de Pesquisa , Relações Pais-Filho , Acesso aos Serviços de Saúde , Fatores Socioeconômicos
10.
PLoS One ; 19(4): e0301662, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38635842

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic has affected vulnerable households' livelihoods in developing countries. Using high-frequency phone survey data from the World Bank, we assess rural Indian households' vulnerability and poverty status during the pandemic. Results reveal that over three-fifths of Indian rural households are vulnerable to poverty in the context of COVID-19, despite India's evident progress in mitigating poverty in the pre-pandemic era. Poverty plays a major role in accounting for variations in household vulnerability; however, the impact of risks on household welfare is not negligible. On average, households with more members, older household heads, and more outmigrants are more vulnerable to poverty during the pandemic. The impacts of the gender of the household head, access to masks, consumption loans, and COVID-related information are nevertheless insignificant. Results stress the urgent necessity of deploying concerted interventions to strengthen household vulnerability in rural India.


Assuntos
COVID-19 , Humanos , COVID-19/epidemiologia , Características da Família , Pobreza , População Rural , Índia/epidemiologia
11.
BMC Womens Health ; 24(1): 206, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38561703

RESUMO

BACKGROUND: Russia's military aggression against Ukraine set in motion a large number of refugees. Considerable amount of them came and stayed in Czechia. Refugees represent special vulnerable individuals often affected by war physically and psychologically. Due to the national regulations not allowing most of Ukrainian men aged 18-60 to leave the country, nowadays Ukrainian forced migration is relatively young and strongly gendered. Evidence suggests the higher probability for searching the safe refuge abroad among Ukrainian women with small children as well as those with relatively higher economic and cultural capital. The aim of this study is to identify the structural features of systemic risks associated with war migration by examining determinants of self-rated health among forcibly displaced highly educated Ukrainian women of productive age residing in Czechia. METHODS: Data from one wave of the panel survey among Ukrainian refugees in Czechia conducted in September 2022 was used. Determinants of self-rated health including self-reported diseases and healthcare factors, lifestyle, human and social capital, economic factors, and migration characteristics were analysed using binary logistic regression. RESULTS: About 45% highly educated Ukrainian women refugees in Czechia assessed their health as poor. The poor self-rated health was mostly associated with the number of diseases and depressive symptoms, and by social capital and economic factors. Having four and more diseases (OR = 13.26; 95%-CI: 5.61-31.35), showing some severe depressive symptoms (OR = 7.20; 95%-CI: 3.95-13.13), experiencing difficulties to seek help from others (OR = 2.25; 95%-CI: 1.20-4.23), living alone in a household (OR = 2.67; 95%-CI: 1.37-5.27), having severe material deprivation (OR = 2.70; 95%-CI: 1.35-5.41) and coming originally from the eastern part of Ukraine (OR = 2.96; 95%-CI: 1.34-6.55) increased the chance of these refugees to assess their health as poor. CONCLUSION: Social and economic determinants such as lack of social contacts for seeking help and material deprivation were found to be crucial for self-rated health and should be tackled via migration policies. Further, qualitative research is needed to better understand the mechanisms behind the factors affecting subjectively assessed health.


Assuntos
Refugiados , Masculino , Criança , Humanos , Feminino , Fatores Socioeconômicos , Estudos Transversais , República Tcheca , Características da Família
12.
BMJ Glob Health ; 9(4)2024 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-38569661

RESUMO

Without complete data on under-5 mortality, tracking progress towards achieving Sustainable Development Goal 3.2 will be challenging. Such data are also needed to ensure proper planning and prioritisation of scarce resources in low-income and middle-income countries. However, most low-income and middle-income countries have weak Civil Registration and Vital Statistics (CRVS) systems, leaving a critical gap in understanding under-5 mortality dynamics. This paper outlines a community-based approach to enhance under-5 mortality surveillance in low-income countries, using The Gambia as a case study. The methodology involves Health and Demographic Surveillance Systems (HDSSs) in Basse and Fuladu West, employing unique identification numbers, periodical household visits and collaboration with communities, village reporters and project field workers to ensure comprehensive data collection. Verbal autopsies (VAs) are conducted by trained field workers, and causes of death are determined using the physician-certified VA method. Between 1 September 2019 and 1 September 2023, 1333 deaths were detected, for which causes of death were determined for 97.1% (1294 of 1333). The most common causes of death detected were acute respiratory infections including pneumonia, sepsis, diarrhoeal diseases and birth asphyxia. Challenges include the cost of maintaining the HDSSs, poor road infrastructure, Electronic Data Capture transition challenges, and the need for national integration of HDSS data into the CRVS system. The success of this model highlights its potential for scalable and adaptable under-5 mortality surveillance in resource-limited settings.


Assuntos
Países em Desenvolvimento , Estatísticas Vitais , Humanos , Gâmbia/epidemiologia , Pobreza , Características da Família
13.
J Nutr Sci ; 13: e19, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38572366

RESUMO

We aimed to analyse the association between processed food consumption and the risk of non-communicable diseases (NCDs) in South Africa. In this empirical study, we analysed nationally representative secondary data obtained from the South African Demographic and Health Survey (SADHS) VII. The survey included 13,288 occupied households, of which 11,083 were interviewed. In the interviewed households, 12,717 eligible adults aged 15 and older were identified and 10,336 were successfully interviewed. The study included four processed food groups (i.e. fried foods, takeaway foods/fast foods, salty snacks/packed chips, and processed meats) and eight NCDs (i.e. hypertension, cardiac arrest, cancer, stroke, hypercholesterolaemia, diabetes, chronic bronchitis, and asthma). As per the logistic regression results following adjustment, none of the disease states showed association with all four processed food groups. However, at least three processed food groups showed a significant positive association with hypertension, cardiac arrest, and diabetes. Two processed food groups showed significant positive association with stroke, and chronic bronchitis; one with hypercholesterolaemia and asthma; and cancer was not associated with any food groups. Processed meat and salted snacks/packed chips were each associated with five chronic conditions. In summary, we found that the consumption of any of the processed food groups increased the risk of NCDs in the South African population. Enabling policy and regulatory efforts in the production and distribution of processed foods, combined with improved awareness among the population need to be prioritised for immediate action. Facilitating the populations to choose traditional healthy diets would be a sustainable strategy for the prevention of NCDs.


Assuntos
Asma , Bronquite Crônica , Diabetes Mellitus , Parada Cardíaca , Hipercolesterolemia , Hipertensão , Doenças não Transmissíveis , Acidente Vascular Cerebral , Humanos , Alimento Processado , África do Sul/epidemiologia , Doenças não Transmissíveis/epidemiologia , Hipertensão/epidemiologia , Diabetes Mellitus/epidemiologia , Características da Família
14.
PLoS One ; 19(4): e0296301, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38564649

RESUMO

Apart from the morbidity and mortality, the Coronavirus disease 2019 (COVID-19) pandemic has increased the predisposition of households in Nigeria to forgone care, thereby increasing their vulnerability to adverse health consequences. Since there is no previous study in Nigeria on the evolution of pandemic-related forgone care and its drivers, our study assess the evolution of the problem using descriptive and nationally representative panel data analyses. We found about a 30% prevalence of forgone care during the lockdown, which declined progressively afterwards, dropping by 69.50 percentage points between April 2020 and April 2022. This decline produced a surge in households needing care from about 35.00% in the early pandemic to greater than 50%, beginning in early 2021. The forgone care was primarily due to financial hindrances, movement restrictions, and supply-side disruptions. Household socioeconomic factors such as income loss had 2.74 [95%CI: 1.45-5.17] times higher odds of forgone care, job loss, food insecurity, and poverty were 87% (OR: 1.87 [95%CI: 1.25-2.79]), 60% (OR: 1.60 [95%CI: 1.12-2.31]) and 76% (OR: 1.76 [95%CI: 1.12-2.75]) more likely to predispose households to forgone care, respectively. Also, geographical location, such as the South-South zone, induced 1.98 [95%CI: 1.09-3.58] times higher odds of forgone care than North-Central. A married female household head increased the odds by 6.07 [95%CI: 1.72-21.47] times compared with an unmarried female head. However, having a married household head, social assistance, and North-East or North-West zone compared with North-Central increased the chance of accessing care by 69% (OR 0.31 [95%CI: 0.16-0.59]), 59%,(OR 0.41 [95%CI: 0.21-0.77]), 72% (OR 0.28 [95%CI: 0.15-0.53]) and 64% (OR 0.36 [95%CI: 0.20-0.65]), respectively. Non-communicable diseases, disability, old age, large household size and rural-urban location did not affect the forgone care. Our study highlights the need to strengthen Nigeria's health system, create policies to promote healthcare accessibility and prepare the country for future pandemic challenges.


Assuntos
COVID-19 , Pandemias , Humanos , Feminino , Nigéria/epidemiologia , COVID-19/epidemiologia , Controle de Doenças Transmissíveis , Características da Família
15.
BMC Womens Health ; 24(1): 216, 2024 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-38570833

RESUMO

INTRODUCTION: Decisions made at the household level have great impact on the welfare of the individual, the local community, as well as the welfare of the nation. Women's independent decision on reproductive health increases women's access to health information and utilization of reproductive services. This has great impact on maternal and child health outcomes. However, women in developing or low-income countries often have limited autonomy and control over their household decisions. Therefore the main purpose of this research project is to investigate the potential determinants of rural women's household decision making autonomy. METHODS: A multi level analysis was performed using the fourth Ethiopian Demographic and Health Survey (EDHS) 2016 data set. A weighted sample of 8,565 married rural women was included in the final analysis. Women were considered to be autonomous if they made decisions alone or jointly with their husband in all three household decision components. It was dichotomized as yes = 1 and no = 0. Multico linearity and chi-square tests were checked and variables which did not fulfill the assumptions were excluded from the analysis. Four models were fitted. Variables with p-value ≤ 0.25 in the bi-variable multilevel logistic regression were included in the multivariable multilevel logistic regression. The Adjusted Odds Ratio (AOR) with a 95% confidence interval (95% CI) was computed. Variables with a P-value of less than 0.05 in the multi-variable multilevel logistic regression were declared as statistically significant predictors. RESULT: A total of 8,565 weighted participants involved. From the total respondents, 68.55% (CI: 67.5%, 69.5%) of women had decision making autonomy. wealth index (poor: AOR: 0.84; 95% CI: 0.72, 0.97 and middle: AOR: 0.85; 95% CI 0.73, 0.98), literacy (illiterate: AOR: 0.75; 95% CI: 0.66, 0.86), respondents working status (Not working; AOR 0.68; 95% CI; 0.60, 0.76) ,who decides on marriage (parents: AOR 0.76; 95% CI; 0.67, 0.87), and proportion of early marriage in the community (high proportion of early marriage AOR: 1.35; 95% CI; 1.10, 1.72). CONCLUSION: Women decision making autonomy was significantly determined by women economic participation (their wealth and their working status), women's literacy, proportion of early marriage in the community and women's involvement in decision of their marriage. Improving women's economic participation and enhancing women's participation to decide on their marriage will enhance women's decision making autonomy.


Assuntos
Características da Família , Casamento , Criança , Feminino , Humanos , Fatores Socioeconômicos , Análise Multinível , Tomada de Decisões , Etiópia , Inquéritos Epidemiológicos
16.
J Health Popul Nutr ; 43(1): 45, 2024 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-38570888

RESUMO

BACKGROUND: Malawi has one of the highest under-five mortality rates in Sub Sahara Africa. Understanding the factors that contribute to child mortality in Malawi is crucial for the development and implementation of effective interventions to reduce child mortality. The aim of this study is to use survival analysis in modeling time to death for under-five children in Malawi. In turn, identify potential risk factors for child mortality and inform the development of interventions to reduce child mortality in the country. METHOD: This study used data from all births that occurred in the five years leading up to the 2015/16 Malawi Demographic and Health Survey. The Frailty hazard model was applied to predict infant survival in Malawi. In this analysis, the outcome of interest was death and it had two possible outcomes: "dead" or "alive". Age at death was regarded as the survival time variable. Infants who were still alive at the time of the study as of the day of the interview were considered as censored observations in the analysis. RESULTS: A total of 17,286 live births born during the 5 years preceding the survey were analysed. The study found that the risk of death was higher among children born to mothers aged 30-39 and 40 or older compared to teen mothers. Infants whose mothers attended fewer than four antenatal care visits were also found to be at a higher risk of death. On the other hand, the study found that using mosquito nets and early breastfeeding were associated with a lower risk of death, as were being male and coming from a wealthier household. CONCLUSION: The study reveals a notable decline in infant mortality rates as under-five children age, underscoring the challenge of ensuring newborn survival. Factors such as maternal age, birth order, socioeconomic status, mosquito net usage, early breastfeeding initiation, geographic location, and child's sex are key predictors of under-five mortality. To address this, public health strategies should prioritize interventions targeting these predictors to reduce under-five mortality rates.


Assuntos
Mortalidade Infantil , Cuidado Pré-Natal , Lactente , Recém-Nascido , Adolescente , Criança , Masculino , Humanos , Feminino , Gravidez , Malaui/epidemiologia , Análise de Sobrevida , Características da Família
17.
PLoS One ; 19(4): e0297780, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38574022

RESUMO

BACKGROUND: The impact of Productive Safety Net Programs (PSNPs) on food security, poverty, and livelihoods has been examined in several studies. While some studies found positive impacts on food security and agricultural productivity, there are still gaps in understanding the long-term effects of these programs on poverty reduction and food security. This study aims to investigate the impact of PSNP on the livelihood of beneficiaries based on indicators including access to basic services, income, expenditure on food, adaptive capacity, and dietary diversity. METHODOLOGY: This article used quasi-experimental design and treatment effects model taking into account access to basic services, income, food expenditure, assets, adaptive capacity, and household dietary diversity as outcome variables of interest. 300 respondents were randomly selected from the population of safety net beneficiaries and non-beneficiaries in the study area. Out of the 300 respondents, 150 were selected as the treatment group, who were beneficiaries of the safety net program. The algorithms used in analysis include regression adjustment, inverse probability weighing and propensity score matching. RESULTS: The study's results reveal that the PSNP has no statistically significant impact on access to basic services and income based on all three algorithms, yet it does show a significant and negative effect on food expenditure and assets. The coefficients across all three models consistently demonstrate this negative impact, underscoring its statistical significance at the conventional significance level (p = 0.05). This suggests that the PSNP leads to a reduction in food expenditure. Furthermore, the analysis highlights substantial differences between PSNP members and non-members across all three variables, with non-members having higher mean values for assets. This difference is statistically significant at the 1% level, suggesting that membership in the PSNP has a tangible impact on asset ownership. The study's mixed findings emphasize the complexities of designing effective social protection programs that can adequately address the multifaceted nature of poverty.


Assuntos
Características da Família , Abastecimento de Alimentos , Etiópia , Pobreza , Renda
18.
Food Nutr Bull ; 45(1): 24-37, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38661354

RESUMO

BACKGROUND: Food-based strategies have a high potential of improving the diet quality and reducing the prevalence of nutrient deficiencies in agriculture-dependent communities. Their design is however complex with trade-offs that are rarely systematically presented to allow replication and efficient contextualization. OBJECTIVE: The systematic design of a food-based strategy to improve the dietary diversity of children in rural farming communities in Uganda. METHODS: The intervention mapping protocol was used to provide a systematic approach to developing theory-based and evidence-based intervention methods and strategy. RESULTS: The priority behavioral and environmental determinants identified were related to food production, consumption, and efficacy while the personal determinants focused on knowledge, skills, self-efficacy, attitude, and outcome expectations. The aim of the resulting strategy was set to improve the availability, accessibility, and consumption of diverse foods, with a particular focus on production diversity, production practices, market access, and market diversity. Behaviour change methods were selected to enhance ability and self-efficacy, strategic goal setting, and provision of feedback. The strategy focused on household groups for learning, demonstration, practice, and social support. The validation showed that the determinants and actors incorporated in the strategy were important and relevant for improving the productivity, food availability, dietary diversity, livelihoods, and health of rural farming households and communities. CONCLUSION: Application of the protocol yielded a contextualized food-based strategy that can be adjusted for use in other smallholder contexts in developing countries by piloting implementation plans based on the strategy; reassessing the key determinants and implementing the revised strategy; or replicating the whole design process.


Plain language titleDesigning a Food-Based Strategy to Improve the Dietary Diversity of Children in Farming Households in Central UgandaPlain language summaryFood-based strategies have a high potential of improving the diet quality of communities that depend on agriculture for their food and livelihoods. However, the design of food-based strategies is complex and rarely systematically presented to allow replication and efficient contextualization. The intervention mapping protocol was used to systematically design a food-based strategy to improve the dietary diversity of children in rural farming communities in Uganda. Through this process, the main factors influencing dietary diversity were identified. The factors were related to food production and consumption, knowledge, skills, self-assuredness, attitude, and the expected outcomes. The developed strategy was designed to improve the availability, accessibility, and consumption of diverse foods. The strategy mainly focused on the diversity of foods produced by households, the production practices used, household access to markets, and the diversity of foods available in these markets. Household groups were central to the selected behavior change methods as they would provide an environment for learning, demonstration, practice, and provide social support. The strategy and its development process can be used as per the implementation plan or further adjusted for use in other smallholder settings in developing countries.


Assuntos
Agricultura , Dieta , Características da Família , População Rural , Humanos , Uganda , Criança , Dieta/métodos , Agricultura/métodos , Abastecimento de Alimentos/métodos , Feminino , Masculino , Pré-Escolar
19.
Glob Public Health ; 19(1): 2329216, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38626242

RESUMO

The government of India introduced the Accredited Social Health Activist (ASHA) programme in 2006 to connect marginalised communities to the health system. ASHAs are mandated to increase the uptake of modern contraception through the doorstep provision of services. There is currently no evidence on the impact of ASHAs on the uptake of contraception at the national level. This paper examines the impact of ASHAs on the uptake of modern contraception using nationally representative National and Family Health Survey data collected in 2019-21 in India. A multilevel logistic regression analysis was performed to determine the effect of contact with ASHAs on the uptake of modern contraception, controlling for regional variability and socio-demographic variables. The data provide strong evidence that ASHAs have succeeded in increasing modern contraceptive use. Women exposed to ASHAs had twice the odds of being current users of modern contraception compared to those with no contact, even after controlling for household and individual characteristics. However, only 28.1% of women nationally reported recent contact with ASHA workers. The ASHA programme should remain central to the strategy of the government of India and should be strengthened to achieve universal access to modern contraception and meet sustainable development goals by 2030.


Assuntos
Ativismo Político , Feminino , Humanos , Características da Família , Índia , Programas Governamentais , Agentes Comunitários de Saúde , Anticoncepção
20.
F1000Res ; 13: 205, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38606206

RESUMO

Introduction: High percentage of OOP (Out-of-Pocket) costs can lead to poverty and exacerbate existing poverty, with 21.9% of India's 1.324 billion people living below the poverty line. Factors such as increased patient cost-sharing, high-deductible health plans, and expensive medications contribute to high OOP costs. Understanding the poverty-inducing impact of healthcare payments is essential for formulating effective measures to alleviate it. Methods: The study used data from the 75th round of the National Sample Survey Organization (Household Social Consumption in India: Health) from July 2017-June 2018, focusing on demographic-socio-economic characteristics, morbidity status, healthcare utilization, and expenditure. The analysis included 66,237 hospitalized individuals in the last 365 days. Logistic regression model was used to examine the impact of OOP expenditures on impoverishment. Results: Logistic regression analysis shows that there is 0.2868 lower odds of experiencing poverty due to OOP expenditures in households where there is the presence of at least one child aged 5 years and less present in the household compared to households who do not have any children. There is 0.601 higher odds of experiencing poverty due to OOP expenditures in urban areas compared to households in rural areas. With an increasing duration of stay in the hospital, there is a higher odds of experiencing poverty due to OOP health expenditures. There is 1.9013 higher odds of experiencing poverty due to OOP expenditures if at least one member in the household used private healthcare facility compared to households who never used private healthcare facilities. Conclusion: In order to transfer demand from private to public hospitals and reduce OOPHE, policymakers should restructure the current inefficient public hospitals. More crucially, there needs to be significant investment in rural areas, where more than 70% of the poorest people reside and who are more vulnerable to OOP expenditures because they lack coping skills.


Assuntos
Características da Família , Pobreza , Criança , Humanos , Hospitalização , Índia , Hospitais Públicos
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