Odds of Receiving Vaccines, but Not Vitamin A, Increased over Time in Urban and Rural Ethiopia, 2000–2016: A Secondary Data Analysis of DHS Data (P04-095-19)

Abstract Objectives Childhood vaccines and biannual vitamin A delivery by health systems are key to child health; suboptimal administration may be a result of inadequate coverage or access to health systems. There have been national programs set in Ethiopia, such as the health sector development program, to improve child health. Therefore, we sought to describe trends in infant vaccines and vitamin A in urban and rural settings in Ethiopia. We hypothesized there would be an increase over time in infants (1) receiving all basic vaccines and (2) vitamin A in the past 6 months. We also hypothesized (3) coverage would be higher in urban settings. Methods We used four nationally representative Demographic and Health Surveys (DHS) from Ethiopia between 2000 and 2016. The analysis comprised 11,621 infants 6–23 months old. Logistic regression models using a forward-stepwise approach were created to test these 3 hypotheses, controlling for wealth, age, sex of infant, and mother's highest education level. Interaction terms were fitted between survey year and education level, setting and education level, and setting and wealth index quintile, and tested using the Wald test. Results (1) The percentage of infants having received all basic vaccines increased from 11.1% in 2000 to 31.0% in 2016; the odds of having received these vaccines increased over time also. (2) This is not true for vitamin A, where there was no pattern in the odds of having received vitamin A between survey years. (3) Rural infants were 40% less likely to have received all basic vaccines, compared to urban infants (adjusted odds ratio (AOR): 0.60; 95% CI: 0.43, 0.83), and there was no evidence of an association between setting and receiving vitamin A (AOR: 0.81; 95% CI: 0.61, 1.09). There was strong evidence for interaction between setting and mother's highest education level, setting and wealth index quintile, and survey year and education level (all P < 0.01). Conclusions These results suggest that (1) while there has been improvement in infants receiving basic vaccines, (2) progress may be slowing slightly in vitamin A coverage and (3)there is a need to improve coverage of basic vaccines for infants in rural areas. Strengthening of and improved access to health services should remain a priority to ensure proper distribution of vaccines and vitamin A in Ethiopia. Funding Sources N/A. Supporting Tables, Images and/or Graphs

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Trends, prevalence and risk factors of overweight and obesity among women of reproductive age in Bangladesh: a pooled analysis of five national cross-sectional surveys

BMJ Open ◽

10.1136/bmjopen-2017-018468 ◽

2018 ◽

Vol 8 (7) ◽

pp. e018468 ◽

Cited By ~ 22

Author(s):

Muhammad Abdul Baker Chowdhury ◽

Md Mohiuddin Adnan ◽

Md Zakiul Hassan

Keyword(s):

Risk Factors ◽

Rural Areas ◽

Low Cost ◽

Wealth Index ◽

Overweight And Obesity ◽

Reproductive Age ◽

Demographic And Health Surveys ◽

Obesity Prevalence ◽

Women Of Reproductive Age ◽

Cross Sectional

ObjectiveTo determine the trends, prevalence and risk factors of overweight and obesity among Bangladeshi women of reproductive age from 1999 to 2014.DesignWe analysed nationally representative data from the 1999, 2004, 2007, 2011 and 2014 cross-sectional Bangladesh Demographic and Health Surveys.SettingBangladesh.ParticipantsWomen aged 15–49 years.Primary outcomeOverweight/obesity.ResultsA total of 58 192 women were included in the analysis. The prevalence of overweight and obesity among women of reproductive age increased significantly from 7.53% (95% CI 6.83 to 8.29) and 1.82% (95% CI 1.48 to 2.24) in 1999 to 28.37% (95% CI 27.49 to 29.28) and 10.77% (95% CI 10.22 to 11.35) in 2014, respectively. Age, education, wealth index, watching television and contraceptive use were associated with overweight and obesity in both urban and rural areas.ConclusionsOverweight and obesity prevalence increased significantly among Bangladeshi women of reproductive age between 1999 and 2014. Development of effective low-cost strategies to address the increasing burden of obesity should be a high priority.

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Enablers of vitamin A coverage among children under five years of age from multi-country analyses of global demographic and health surveys in selected LMIC and LIC countries in Africa and Asia: a random forest analysis

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20185279 ◽

2018 ◽

Vol 6 (1) ◽

pp. 395 ◽

Cited By ~ 1

Author(s):

Manoj Kumar Raut ◽

J. C. Reddy ◽

Debabrata Bera ◽

Kirti Warvadekar

Keyword(s):

Random Forest ◽

Mass Media ◽

Vitamin A ◽

Health Surveys ◽

Vitamin A Deficiency ◽

Wealth Index ◽

Demographic And Health Surveys ◽

Vitamin A Supplementation ◽

Mother’S Education ◽

Mother's Education

Background: Vitamin A deficiency is a common form of micronutrient malnutrition. The estimated relative risks associated with vitamin A deficiency in children were 1.86 (95% CI 1.32–2.59) for measles mortality, 2.15 (95% CI 1.83–2.58) for diarrhoea mortality, 1.78 (95% CI 1.43–2.19) for malaria mortality, 1.13 (95% CI 1.01–1.32) for other infectious disease mortality. Vitamin A supplementation reduces night blindness, child morbidity and mortality.Methods: This paper tries to explore the socio-demographic causes of receipt of vitamin A in selected lower-middle-income and low income countries by analysing the data of the demographic and health surveys from 2012 and 2016 using PASW 18.0 software. Multivariate binary logistic regressions were conducted to explore the role of socio-demographic covariates in the receipt of vitamin A supplementation. In addition, random forest (RF) analyses were conducted using Python 3.6.Results: After adjusting for related socio-economic and demographic factors, mother’s work status and education and among mass media channels, exposure to television seems to play an important role in predicting receipt of vitamin A in the selected countries in Asia, while education of the mother was significantly associated with the receipt of vitamin A in the selected countries of Africa. In all the selected countries, the RF analyses revealed mother’s education followed by wealth index and mass media (TV), as the variable of most importance.Conclusions: It can be concluded that mother’s education and mass media seems to be working well in making the mothers aware about the vitamin A campaign, especially, the exposure to television. It also figures in the variable importance matrix in addition to wealth index.

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Socio-demographic determinants of vitamin A supplementation in Bangladesh: evidence from two rounds of Bangladesh demographic and health surveys, 2007 and 2011

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20180775 ◽

2018 ◽

Vol 5 (3) ◽

pp. 1149

Author(s):

Manoj Kumar Raut

Keyword(s):

Mass Media ◽

Vitamin A ◽

Confidence Interval ◽

Health Surveys ◽

Development Program ◽

Prevalence Ratio ◽

Current Status ◽

Family Welfare ◽

Demographic And Health Surveys ◽

Vitamin A Supplementation

Background: Vitamin A supplementation reduces night blindness, child morbidity and mortality. In Bangladesh, Vitamin A deficiency among children 6-59 months has remained just about stagnant at 20.5 per cent as per the latest Bangladesh National Micronutrient Status Survey 2011-12 declining by a meagre 1.2 per cent from 21.7 per cent in 1997 (IPHN/HKI, 1997). Alarmingly, there is an absolute decline of 24 percentage points in VAS supplementation from 2007 to 2011 according to the Bangladesh Demographic & Health Surveys (BDHS). The current status of vitamin A supplementation raises concern because the Ministry of Health and Family Welfare (MoHFW)’s Health, Population and Nutrition Sector Development Program (HPNSDP) 2011-2016 target of 90 per cent needs to be achieved by 2016.Methods: This paper tries to explore the socio-demographic causes of receipt of Vitamin A in Bangladesh by analysing the data of the demographic and health surveys for 2007 and 2011 using SAS software. A log binomial regression was conducted to explore the effect of education and exposure to mass media on receipt of vitamin A supplementation.Results: After adjusting for related socio-economic and demographic factors, parent’s education and among mass media channels, television seems to play an important role in predicting receipt of Vitamin A, (Prevalence Ratio [PR]: 1.0973, 95% Confidence Interval [CI] 1.0499-1.1469) in BDHS 2011. Similarly, also those who watched television were more likely to have received vitamin A (Prevalence Ratio [PR]: 1.0542, 95% Confidence Interval [CI] 1.0304-1.0784).Conclusions: It can be concluded that mass media seems to be working well in making the mothers aware about the vitamin A campaign, especially, the exposure to television. Though mother’s education was not associated in the 2007 survey, but it was significantly associated with the receipt of vitamin A in the 2011 survey.

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Determinants of disease prevalence and antibiotic consumption for children under five in Nepal: analysis and modelling of demographic health survey data from 2006 to 2016

10.1101/2020.07.08.20149153 ◽

2020 ◽

Author(s):

Charlotte Zheng ◽

Abilasha Karkey ◽

Tianyi Wang ◽

Gerald Makuka ◽

Rogier van Doorn ◽

...

Keyword(s):

Rural Areas ◽

Wealth Index ◽

Antibiotic Use ◽

Antibiotic Consumption ◽

Disease Prevalence ◽

Access To Healthcare ◽

Clean Fuel ◽

Children Under Five ◽

Under Five ◽

Over Time

Abstract Objectives Our aim was to examine the geographic, socio-economic and behavioural factors associated with disease and antibiotic consumption in Nepal from 2006 to 2016; as well as explore healthcare seeking patterns and the source of antibiotics. Methods Cross-sectional data on children under five in households from Nepal was extracted from the 2006, 2011 and 2016 Demographic Health Surveys (DHS). Univariate and multivariate analyses were carried out to assess the association of disease prevalence and antibiotic use with age, sex, ecological zone, urban/rural location, wealth index, maternal smoking, use of clean fuel, sanitation, nutrition, access to healthcare and vaccinations. Results Prevalence of fever, acute respiratory infection (ARI) and diarrhoea decreased from 2006 to 2016, while the proportion using antibiotics increased. Wealth, use of clean fuel, improved toilet sanitation, nutrition and access to healthcare were associated with reduced rates of disease. Those in the highest wealth index are starting to use less antibiotics and antibiotic consumption in rural areas has surpassed urban regions over time. Health-seeking from the private sector has overtaken government facilities since 2006 with source of antibiotics mainly originating from pharmacies and private hospitals. Adherence to WHO recommended antibiotics has reduced over time. Conclusions With rising wealth, there has been decline in disease prevalence but increase in antibiotic use with greater access to unregulated sources. Understanding antibiotic use and identifying associated behavioural and socio-economic factors could help to inform methods in reducing inappropriate antibiotic use whilst ensuring access to those who need them.

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Impact of International Monetary Fund programs on child health

Proceedings of the National Academy of Sciences ◽

10.1073/pnas.1617353114 ◽

2017 ◽

Vol 114 (25) ◽

pp. 6492-6497 ◽

Cited By ~ 23

Author(s):

Adel Daoud ◽

Elias Nosrati ◽

Bernhard Reinsberg ◽

Alexander E. Kentikelenis ◽

Thomas H. Stubbs ◽

...

Keyword(s):

Child Health ◽

Protective Effect ◽

International Monetary Fund ◽

Health Care Access ◽

Rural Areas ◽

Structural Adjustment ◽

Parental Education ◽

Demographic And Health Surveys ◽

Cross Sectional ◽

Imf Programs

Parental education is located at the center of global efforts to improve child health. In a developing-country context, the International Monetary Fund (IMF) plays a crucial role in determining how governments allocate scarce resources to education and public health interventions. Under reforms mandated by IMF structural adjustment programs, it may become harder for parents to reap the benefits of their education due to wage contraction, welfare retrenchment, and generalized social insecurity. This study assesses how the protective effect of education changes under IMF programs, and thus how parents’ ability to guard their children’s health is affected by structural adjustment. We combine cross-sectional stratified data (countries, 67; children, 1,941,734) from the Demographic and Health Surveys and the Multiple Indicator Cluster Surveys. The sample represents ∼2.8 billion (about 50%) of the world’s population in year 2000. Based on multilevel models, our findings reveal that programs reduce the protective effect of parental education on child health, especially in rural areas. For instance, in the absence of IMF programs, living in an household with educated parents reduces the odds of child malnourishment by 38% [odds ratio (OR), 0.62; 95% CI, 0.66–0.58]; in the presence of programs, this drops to 21% (OR, 0.79; 95% CI, 0.86–0.74). In other words, the presence of IMF conditionality decreases the protective effect of parents’ education on child malnourishment by no less than 17%. We observe similar adverse effects in sanitation, shelter, and health care access (including immunization), but a beneficial effect in countering water deprivation.

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Equality Analysis of Main Health Indicators among Children under 5 Years in Uganda

Ethiopian Journal of Health Sciences ◽

10.4314/ejhs.v29i2.8 ◽

1970 ◽

Vol 29 (2) ◽

Author(s):

Adel Hussein Elduma

Keyword(s):

Child Health ◽

Health Services ◽

Rural Areas ◽

Urban Areas ◽

Health Indicators ◽

Great Effort ◽

Access To Health Services ◽

Data Set ◽

Access To Health ◽

Children Under 5

BACKGROUND: Inequality in the access to health services is a major cause of health problemsamong children under five old. The aim of this analysis is to measure the inequality among children under-5 years in relation to main health indicators inUganda.METHOD: Main child health indicators data in Uganda were obtained from WHO inequity data set for the years 1995, 2000, 2001 and 2011. Indicators such as under-5 years mortality rate, underweight prevalence and full vaccination converge and child with infection access to health facilities were included in th analysis. For simple indicators, inequality difference wascalculated, and relative concentration index for complex order indicators was used. Four different inequality dimensions were used to work as stratifies for these indicators.RESULTS: Inequality regarding child health indicators was observed in different dimensions. It was clear that inequality among people living in rural areas were more than urban areas. Femaleshad high inequality than males. Poor and uneducated people are more likely to have inequality than rich and educated people.CONCLUSION: Great effort should be made to decrease inequality among children less than five years through access to health services for all groups in different areas.

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Predictors of Teenage Pregnancy in Zambia Between 2007-2018

10.21203/rs.3.rs-640287/v1 ◽

2021 ◽

Author(s):

Claire H. Packer ◽

Nelly-Claire Muntalima ◽

Ana Langer ◽

Michael T. Mbizvo

Keyword(s):

Rural Areas ◽

Teenage Pregnancy ◽

Sexual Debut ◽

Reference Group ◽

Statistical Significance ◽

Wealth Index ◽

P Value ◽

Demographic And Health Surveys ◽

Reproductive Health Services ◽

Logistic Regression Models

Abstract Background: In Zambia, 29% of adolescents aged 10-19 have begun childbearing. Early childbearing has been shown to have detrimental social and medical outcomes. As far as we are aware, there has been no study in Zambia that has investigated the drivers of teenage pregnancies over a 10-year period. Using DHS data, we sought to determine predictors of teenage pregnancies among teenagers in Zambia between the years of 2007 and 2018. Methods: We analyzed survey data of 11,194 adolescents from the 2007, 2014 and 2018 Demographic and Health Surveys (DHS), which are nationally representative. Analyses were conducted with Stata/SE software and we examined rates of teenage pregnancy based on multiple predictors of interest. Chi-square tests and multivariable logistic regression models were employed for statistical comparison using a p-value of 0.05 to indicate statistical significance. Results:After exclusions, 11,194 adolescents under the age of 19 were included in our analysis, with a 29% prevalence of teenage pregnancy. Teenagers were more likely to become pregnant if they were married, had younger sexual debut, had less education, were illiterate, lived in rural areas, or were of the poorest wealth index than if they were not. Among adolescents with teenage pregnancies, utilization of sexual and reproductive health services among teen mothers significantly increased between 2007 and 2018. On multivariate analysis, teenage pregnancy was found to be significantly different given predictors when compared to the reference group, with significant effect modification due to marital status. Conclusion: Our study identified significant demographic, intrapersonal, and socioeconomic factors that have impacted rates of teenage pregnancy in Zambia over the past 10 years. Understanding these drivers can inform programmatic interventions targeting reduction of teenage pregnancies.

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Anthropometric data quality assessment in multisurvey studies of child growth

American Journal of Clinical Nutrition ◽

10.1093/ajcn/nqaa162 ◽

2020 ◽

Vol 112 (Supplement_2) ◽

pp. 806S-815S

Author(s):

Nandita Perumal ◽

Sorrel Namaste ◽

Huma Qamar ◽

Ashley Aimone ◽

Diego G Bassani ◽

...

Keyword(s):

Child Health ◽

Data Quality ◽

Composite Index ◽

Population Based ◽

Demographic And Health Surveys ◽

Principal Component Factor Analysis ◽

Z Score ◽

Anthropometric Data ◽

Over Time

ABSTRACT Background Population-based surveys collect crucial data on anthropometric measures to track trends in stunting [height-for-age z score (HAZ) < −2SD] and wasting [weight-for-height z score (WHZ) < −2SD] prevalence among young children globally. However, the quality of the anthropometric data varies between surveys, which may affect population-based estimates of malnutrition. Objectives We aimed to develop composite indices of anthropometric data quality for use in multisurvey analysis of child health and nutritional status. Methods We used anthropometric data for children 0–59 mo of age from all publicly available Demographic and Health Surveys (DHS) from 2000 onwards. We derived 6 indicators of anthropometric data quality at the survey level, including 1) date of birth completeness, 2) anthropometric measure completeness, 3) digit preference for height and age, 4) difference in mean HAZ by month of birth, 5) proportion of biologically implausible values, and 6) dispersion of HAZ and WHZ distribution. Principal component factor analysis was used to generate a composite index of anthropometric data quality for HAZ and WHZ separately. Surveys were ranked from the highest (best) to the lowest (worst) index values in anthropometric quality across countries and over time. Results Of the 145 DHS included, the majority (83 of 145; 57%) were conducted in Sub-Saharan Africa. Surveys were ranked from highest to lowest anthropometric data quality relative to other surveys using the composite index for HAZ. Although slightly higher values in recent DHS suggest potential improvements in anthropometric data quality over time, there continues to be substantial heterogeneity in the quality of anthropometric data across surveys. Results were similar for the WHZ data quality index. Conclusions A composite index of anthropometric data quality using a parsimonious set of individual indicators can effectively discriminate among surveys with excellent and poor data quality. Such indices can be used to account for variations in anthropometric data quality in multisurvey epidemiologic analyses of child health.

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Factors associated with the nutritional status of children less than 5 years of age

Revista de Saúde Pública ◽

10.1590/s0034-8910.2015049005441 ◽

2015 ◽

Vol 49 (0) ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

Teresa Cristina Miglioli ◽

Vania Matos Fonseca ◽

Saint Clair Gomes Junior ◽

Katia Silveira da Silva ◽

Pedro Israel Cabral de Lira ◽

...

Keyword(s):

Vitamin A ◽

Nutritional Status ◽

Socioeconomic Factors ◽

Rural Areas ◽

Vitamin A Deficiency ◽

Geographical Area ◽

Serum Levels ◽

Canonical Function ◽

Access To Health ◽

Nutritional Status Of Children

OBJECTIVE To analyze if the nutritional status of children aged less than five years is related to the biological conditions of their mothers, environmental and socioeconomic factors, and access to health services and social programs.METHODS This cross-sectional population-based study analyzed 664 mothers and 790 children using canonical correlation analysis. Dependent variables were characteristics of the children (weight/age, height/age, BMI/age, hemoglobin, and retinol serum levels). Independent variables were those related to the mothers’ nutritional status (BMI, hemoglobin, and retinol serum levels), age, environmental and socioeconomic factors and access to health service and social programs. A < 0.05 significance level was adopted to select the interpreted canonical functions (CF) and ± 0.40 as canonical load value of the analyzed variables.RESULTS Three canonical functions were selected, concentrating 89.9% of the variability of the relationship among the groups. In the first canonical function, weight/age (-0.73) and height/age (-0.99) of the children were directly related to the mother’s height (-0.82), prenatal appointments (-0.43), geographical area of the residence (-0.41), and household incomeper capita (-0.42). Inverse relationship between the variables related to the children and people/room (0.44) showed that the larger the number of people/room, the poorer their nutritional status. Rural residents were found to have the worse nutritional conditions. In the second canonical function, the BMI of the mother (-0.48) was related to BMI/age and retinol of the children, indicating that as women gained weight so did their children. Underweight women tended to have children with vitamin A deficiency. In the third canonical function, hemoglobin (-0.72) and retinol serum levels (-0.40) of the children were directly related to the mother’s hemoglobin levels (-0.43).CONCLUSIONS Mothers and children were associated concerning anemia, vitamin A deficiency and anthropometric markers. Living in rural areas is a determining factor for the families health status.

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Association of Socio-economic and Demographic Factors with Indonesian Women’s Premature Menopause: Analysis of the Demographic and Health Surveys Program (DHS) of 2017

Studies on Ethno-Medicine ◽

10.31901/24566772.2021/15.1-2.627 ◽

2021 ◽

Vol 15 (1-2) ◽

Author(s):

Vonny Khresna Dewi

Keyword(s):

Rural Areas ◽

Urban Areas ◽

Wealth Index ◽

Wealth Quintile ◽

Demographic Variables ◽

Premature Menopause ◽

Demographic And Health Surveys ◽

Early Menopause ◽

Urban Settlements ◽

The Relationship

The research objective of this study was to analyse the influence of early menopause factors on Indonesian women with demographic and socio-economic indicators, such as age, wealth index, education, employment status, rural-urban settlements, including those associated with media exposure and smoking. The data used in this study were from the Indonesian Demographic and Health Survey in Indonesia in 2017. The relationship between the variables and the significant influence of socio-economic and demographic variables on early menopause was analysed using bivariate and multivariate analysis. The results showed that Indonesian women who experienced premature menopause were 12.35 percent. Early menopause tends to be shared more by Indonesian women in urban areas than in rural areas. Women with higher education, and women with the richest wealth quintile were more likely to experience premature menopause. Meanwhile, women who are housewives, and women who smoke are more likely to experience premature menopause. The problem of premature menopause should receive serious attention because it has negative health consequences.

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