SDG3-related inequalities in women’s, children’s and adolescents’ health: an SDG monitoring baseline for Latin America and the Caribbean using national cross-sectional surveys

ObjectivesLatin America and the Caribbean (LAC) countries have made important progress towards achieving the Sustainable Development Goal (SDG) targets related to health (SDG3) at the national level. However, vast within-country health inequalities remain. We present a baseline of health inequalities in the region, against which progress towards the SDGs can be monitored.SettingWe studied 21 countries in LAC using data from Demographic and Health Surveys and Multiple Indicator Cluster Survey carried out from 2011 to 2016ParticipantsThe surveys collect nationally representative data on women and children using multistage sampling. In total, 288 207 women and 195 092 children made part of the surveys in the 21 countries.Outcome measuresFive health intervention indicators were studied, related to reproductive and maternal health, along with adolescent fertility and neonatal and under-five mortality rates. Inequalities in these indicators were assessed through absolute and relative measures.ResultsIn most countries, subnational geographical health gradients were observed for nearly all women, child, and adolescent (WCA) indicators. Coverage of key interventions was higher in urban areas and among the richest, compared with rural areas and poorer quintiles. Analyses by woman’s age showed that coverage was lower in adolescent girls than older women for family planning indicators. Pro-urban and pro-rich inequalities were also seen for mortality in most countries.ConclusionsRegional averages hide important health inequalities between countries, but national estimates hide still greater inequalities between subgroups of women, children and adolescents. To achieve the SDG3 targets and leave no one behind, it is essential to close health inequality gaps within as well as between countries.

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Breastfeeding and the nutritional transition in the Latin American and Caribbean Region: a success story?

Cadernos de Saúde Pública ◽

10.1590/s0102-311x2003000700013 ◽

2003 ◽

Vol 19 (suppl 1) ◽

pp. S119-S127 ◽

Cited By ~ 21

Author(s):

Rafael Pérez-Escamilla

Keyword(s):

Latin America ◽

Latin American ◽

Rural Areas ◽

Urban Areas ◽

Secondary Data ◽

Breastfeeding Duration ◽

Caribbean Region ◽

Demographic And Health Surveys ◽

Rural And Urban Areas ◽

The Caribbean

The objectives of this paper are to examine recent breastfeeding duration trends in Latin America and the Caribbean to document: (a) rural-urban differentials, (b) differences in educational levels, and (c) changes in breastfeeding duration across time. Secondary data analyses were conducted with 23 Demographic and Health Surveys collected between the mid-1980s and mid-1990s. Results indicate that median breastfeeding duration is still greater in rural (as compared to urban) areas and among less (versus more) educated women, although these differentials are decreasing with time. In five of the six countries examined for secular trends, breastfeeding duration continues to increase in both rural and urban areas. Breastfeeding duration in urban and rural areas was strongly correlated within countries. Breastfeeding duration improved more among women with the highest and declined among those with the lowest levels of education. Results indicate that breastfeeding duration has increased in Latin America and the Caribbean at a time when the opposite was predicted, given the region's increased urbanization. Breastfeeding protection policies and promotion programs may explain part of the increase in breastfeeding duration.

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Mental Distress in Rural Areas of Indonesia

Nurse Media Journal of Nursing ◽

10.14710/nmjn.v10i1.23244 ◽

2019 ◽

Vol 10 (1) ◽

pp. 1-10 ◽

Cited By ~ 1

Author(s):

Azam David Saifullah ◽

Nur Latifah ◽

Eria Riski Artanti ◽

Kadek Dewi Cahyani ◽

Umi Rahayu ◽

...

Keyword(s):

Mental Health ◽

Rural Areas ◽

Urban Areas ◽

Mental Distress ◽

National Level ◽

The Elderly ◽

Cross Sectional Study ◽

Elderly Male ◽

Related Factors ◽

Cross Sectional

Background: There is a higher prevalence of mental distress in rural areas compared to urban areas in Indonesia. The rural areas of Indonesia have various socio-demographic and sophisticated cultural characteristics, but less exposed to foreign cultures. Thus, the study about the prevalence, associated factors, and predictors of mental distress in rural areas is necessary.Purpose: This study aimed to identify the population's status and related factors of mental distress in rural areas in Indonesia.Methods: A descriptive cross-sectional study was conducted to achieve the aims of the study. An Indonesian version of the Self-Rated Questionnaire, consisting of 20 items, was used to measure mental distress status of population in rural areas in Yogyakarta, Indonesia. A number of 872 records were included and analyzed using both univariate and bivariate analyses in this study.Results: The prevalence of mental distress in this population was 6%. The correlated factors of mental distress were age (χ2=6.93, p=0.01), gender (χ2=0.07, p=0.03), occupation (χ2=0.26, p=0.02), housing dimension (χ2=5.45, p=0.02), and illness status (χ2=0.01, p<0.01).Conclusion: The prevalence of mental distress in rural areas of Indonesia is relatively lower than that of the national level. Future mental health programs may be focused on improving mental health on the elderly, male, vulnerable workers, overcrowded housing, and people who got a chronic illness.

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Recent Underweight and Overweight Trends by Rural–Urban Residence among Women in Low- and Middle-Income Countries

Journal of Nutrition ◽

10.3945/jn.114.203562 ◽

2014 ◽

Vol 145 (2) ◽

pp. 352-357 ◽

Cited By ~ 53

Author(s):

Lindsay M Jaacks ◽

Meghan M Slining ◽

Barry M Popkin

Keyword(s):

Rural Areas ◽

Urban Areas ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

Urban Residence ◽

African Countries ◽

Middle Income ◽

Rate Of Increase ◽

Nationally Representative ◽

Sub Saharan

AbstractBackground: Long-term trends mask critical recent dynamics in the prevalence of under- and overweight.Objective: The objective of this study was to compare annualized prevalence rates of both under- and overweight among nonpregnant women aged 19–49 y during the periods covering 1) the 1990s–the early 2000s and 2) the early 2000s–the late 2000s or early 2010s, by rural–urban residence.Methods: Data are from nationally representative surveys (29 Demographic and Health Surveys and 4 national surveys). Standardized protocols were used to measure weight and height. Underweight was defined as body mass index (BMI) < 18.5 kg/m2 and overweight as BMI ≥ 25 kg/m2.Results: From the 1990s to the early 2000s, most countries were making progress on decreasing the prevalence of underweight, especially in rural areas. Although many countries continued to make progress more recently, several countries in Sub-Saharan Africa that previously had a decreasing prevalence of underweight now have an increasing prevalence of underweight. For example, in rural areas of Senegal, the prevalence of underweight decreased 0.23% annually between 1992 and 2005, then increased 1.60% annually between 2005 and 2010. Meanwhile, the prevalence of overweight is increasing in nearly all countries, and in approximately half of all countries, the rate of increase is greater in rural areas than in urban areas. Although underweight persists as more prevalent than overweight in rural areas of many East Asian, South Asian, and Sub-Saharan African countries, the ratio of underweight to overweight in many countries has decreased over time, indicating that this trend is reversing.Conclusions: Select countries in Sub-Saharan Africa may be more susceptible to food crises and should be targets for intervention. At the same time, global health efforts need to focus on preventing overweight, particularly in rural areas, which are quickly catching up to their urban counterparts.

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Trends in body mass index among ever-married Bangladeshi women, 2004–14: evidence from nationally representative population-based surveys

Journal of Nutritional Science ◽

10.1017/jns.2021.1 ◽

2021 ◽

Vol 10 ◽

Author(s):

Md. Rafiqul Islam ◽

Md. Sabbir Hossain ◽

Md. Mostaured Ali Khan ◽

Md. Shafiur Rahman

Keyword(s):

Body Weight ◽

Rural Areas ◽

Urban Areas ◽

Weight Status ◽

National Level ◽

Overweight And Obesity ◽

Rate Of Change ◽

Annual Rate ◽

Demographic And Health Surveys ◽

Rapid Reduction

Abstract Both high and low body weight are associated with adverse health risk for both mother and children. Studies evaluating trends in the coverage of undernutrition and overnutrition among ever-married Bangladeshi women are limited. The objective of the present study is to assess the trends and develop future projections of body weight status among Bangladeshi women and to estimate the smoothed mean BMI by women's age for the national level and across urban and rural areas. Data from Bangladesh Demographic and Health Surveys conducted between 2004 and 2014 were used. The annual rate of change in the prevalence of underweight, overweight, and obesity, and smoothed age-specific mean BMI was estimated. During 2004–14, the prevalence of underweight reduced with an annual rate of 5⋅9 % at the national level, while the prevalence of overweight and obesity increased with an annual rate of 8⋅6 and 9⋅6 %, respectively. With the recent trends, the prevalence of underweight is expected to reduce from 11⋅9 % in 2020 to 6⋅5 % by 2025. In 2020, the prevalence of overweight and obesity were 30⋅0 and 6⋅9 %, respectively, which are projected to increase to 38⋅5 and 9⋅0 %, respectively, by 2025, if present trends continue. By 2030, the prevalence of overweight was predicted to be much higher in urban areas (44⋅7 %) compared with rural areas (36⋅5 %). Multifaceted nutrition programme should be introduced for rapid reduction of undernutrition and to halt the rise of the prevalence of overweight and obesity.

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Interaction between sex and rurality on the prevalence of diabetes in Guyana: a nationally representative study

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2020-001349 ◽

2020 ◽

Vol 8 (1) ◽

pp. e001349

Author(s):

Calvin Ke ◽

Shamdeo Persaud ◽

Kavita Singh ◽

Brian Ostrow ◽

Gerald Lebovic ◽

...

Keyword(s):

Rural Women ◽

Rural Areas ◽

Urban Areas ◽

Fasting Blood Glucose ◽

Cross Sectional Study ◽

Diabetes Prevalence ◽

Cross Sectional ◽

Glucose Testing ◽

Representative Study ◽

Nationally Representative

IntroductionDiabetes prevalence has never been measured in Guyana. We conducted a nationally representative cross-sectional study to estimate the prevalence of diabetes and pre-diabetes, and the association between sex and diabetes.Research design and methodsIn 2016, the Ministry of Public Health led Guyana’s first national STEPS survey among adults aged 18–69 years. Half of the participants were randomly selected for hemoglobin A1c and fasting blood glucose testing. We estimated the prevalence of diabetes and pre-diabetes and measured the association between sex and diabetes prevalence using logistic regression to compute adjusted ORs.ResultsWe included 805 adults (511 women, 294 men, mean age 41.8 (SD 14.4) years). The national prevalence of diabetes was 18.1% (95% CI: 15.4% to 20.8%), with higher rates among women (21.4%, 95% CI: 18.0% to 24.7%) than men (15.1%, 95% CI: 10.9% to 19.3%). Sex-specific diabetes prevalence varied significantly across urban and rural areas (p=0.002 for interaction). In rural areas, diabetes was twice as common among women (24.1%, 95% CI: 20.1% to 28.2%) compared with men (11.8%, 95% CI: 7.7% to 15.9%). After adjusting for prespecified covariates, rural women had double the odds of diabetes compared with rural men (OR 2.1, 95% CI: 1.20 to 3.82). This prevalence pattern was reversed in urban areas (diabetes prevalence, women: 13.9%, 95% CI: 8.7% to 19.0%; men: 22.0%, 95% CI: 12.9% to 31.1%), with urban women having half the odds of diabetes compared with urban men (OR 0.4, 95% CI: 0.20 to 0.99). We estimated that nearly one-third of women and over a quarter of men had diabetes or pre-diabetes.ConclusionsThe burden of diabetes in Guyana is considerably higher than previously estimated, with an unexpectedly high prevalence among women—particularly in rural areas.

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Rural-Urban Disparity of Under-Five Mortality Rate in Iran from 1990 to 2015

Iranian Journal of Public Health ◽

10.18502/ijph.v49i4.3182 ◽

2020 ◽

Author(s):

Younes MOHAMMADI ◽

Manoochehr KARAMI ◽

Nasrin DERAKHSHANZADEH

Keyword(s):

Mortality Rate ◽

Rural Areas ◽

Urban Areas ◽

Maternal Age ◽

National Level ◽

Demographic And Health Surveys ◽

Live Births ◽

Under Five ◽

Rural And Urban Areas ◽

Rural And Urban

Background: To estimate under-five mortality rate (U5MR), as one of the sustainable development goals, in rural and urban areas of Iran from 1990 to 2015. Methods: We used the data collected through two censuses and one Demographic and Health Surveys (DHS). We analyzed the Summary Birth History (SBH) data via 2 approaches including Maternal Age Cohort (MAC) and Maternal Age Period (MAP) methods, and then, Gaussian Process Regression (GPR) was used to combine the three trends and with 95% uncertainty. Finally, Ratio of U5MR in rural to urban was calculated. Results: At the national level and in urban areas, U5MR in 1990, 2000, 2010, and 2015 was 66, 34, 18, and 13 per 1000 live births, respectively. Corresponding values in rural areas in 1990, 2000, 2010, and 2015 was 129, 64, 31, and 21 per 1000 live births, respectively. Accordingly, the ratio of U5MR in rural to urban at the national level was 1.93, 1.86, 1.72 and 1.63 in the same years. At the sub-national level, U5MR in urban areas ranged from 11.2 per 1000 live births in Isfahan to 18.2 per 1000 live births in Hormuzagn. U5MR in rural areas ranged from 14.1 per 1000 live births in Isfahan to 29.5 per 1000 live births in Sistan and Baluchistan Conclusion: There is still a gap between rural and urban areas, although it has decreased during the 25 years of the study. To alleviate this gap, health system authorities are advised to plan appropriate actions using multisectoral capacities

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Is neighbourhood walkability related to body mass index among different age groups? A cross-sectional study of Canadian urban areas

BMJ Open ◽

10.1136/bmjopen-2019-032475 ◽

2019 ◽

Vol 9 (11) ◽

pp. e032475 ◽

Cited By ~ 1

Author(s):

Justin Thielman ◽

Ray Copes ◽

Laura C Rosella ◽

Maria Chiu ◽

Heather Manson

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Rural Areas ◽

Urban Areas ◽

Age Groups ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Neighbourhood Walkability ◽

Nationally Representative ◽

Objectively Measured

BackgroundStudies of neighbourhood walkability and body mass index (BMI) have shown mixed results, possibly due to biases from self-reported outcomes or differential effects across age groups. Our objective was to examine relationships between walkability and objectively measured BMI in various age groups, in a nationally representative population.MethodsThe study population came from the 2007–2011 Canadian Health Measures Survey, a cross-sectional survey of a nationally representative Canadian population. In our covariate-adjusted analyses, we included survey respondents aged 6–79 who were not pregnant, did not live in rural areas, were not missing data and were not thin/underweight. We used objectively measured height and weight to calculate BMI among adults aged 18–79 and zBMI among children aged 6–17. We categorised respondents into walkability quintiles based on their residential Street Smart Walk Score values. We performed linear regression to estimate differences between walkability quintiles in BMI and zBMI. We analysed adults and children overall; age subgroups 6–11, 12–17, 18–29, 30–44, 45–64 and 65–79; and sex subgroups.ResultsThe covariate-adjusted models included 9265 respondents overall. After adjustment, differences between walkability quintiles in BMI and zBMI were small and not statistically significant, except for males aged 6–17 in the second-highest walkability quintile who had significantly lower zBMIs than those in the lowest quintile.ConclusionAfter accounting for confounding factors, we did not find evidence of a relationship between walkability and BMI in children or adults overall, or in any age subgroup with sexes combined. However, post hoc analysis by sex suggested males aged 6–17 in more walkable areas may have lower zBMIs.

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Seroprevalence of IgG antibodies against SARS-CoV-2 among the general population and healthcare workers in India, June–July 2021: A population-based cross-sectional study

PLoS Medicine ◽

10.1371/journal.pmed.1003877 ◽

2021 ◽

Vol 18 (12) ◽

pp. e1003877

Author(s):

Manoj V. Murhekar ◽

Tarun Bhatnagar ◽

Jeromie Wesley Vivian Thangaraj ◽

V. Saravanakumar ◽

Muthusamy Santhosh Kumar ◽

...

Keyword(s):

General Population ◽

Rural Areas ◽

Urban Areas ◽

Nucleocapsid Protein ◽

Healthcare Workers ◽

National Level ◽

Cross Sectional Study ◽

Igg Antibodies ◽

Cross Sectional ◽

June July

Background India began COVID-19 vaccination in January 2021, initially targeting healthcare and frontline workers. The vaccination strategy was expanded in a phased manner and currently covers all individuals aged 18 years and above. India experienced a severe second wave of COVID-19 during March–June 2021. We conducted a fourth nationwide serosurvey to estimate prevalence of SARS-CoV-2 antibodies in the general population aged ≥6 years and healthcare workers (HCWs). Methods and findings We did a cross-sectional study between 14 June and 6 July 2021 in the same 70 districts across 20 states and 1 union territory where 3 previous rounds of serosurveys were conducted. From each district, 10 clusters (villages in rural areas and wards in urban areas) were selected by the probability proportional to population size method. From each district, a minimum of 400 individuals aged ≥6 years from the general population (40 individuals from each cluster) and 100 HCWs from the district public health facilities were included. The serum samples were tested for the presence of IgG antibodies against S1-RBD and nucleocapsid protein of SARS-CoV-2 using chemiluminescence immunoassay. We estimated the weighted and test-adjusted seroprevalence of IgG antibodies against SARS-CoV-2, along with 95% CIs, based on the presence of antibodies to S1-RBD and/or nucleocapsid protein. Of the 28,975 individuals who participated in the survey, 2,892 (10%) were aged 6–9 years, 5,798 (20%) were aged 10–17 years, and 20,285 (70%) were aged ≥18 years; 15,160 (52.3%) participants were female, and 21,794 (75.2%) resided in rural areas. The weighted and test-adjusted prevalence of IgG antibodies against S1-RBD and/or nucleocapsid protein among the general population aged ≥6 years was 67.6% (95% CI 66.4% to 68.7%). Seroprevalence increased with age (p < 0.001) and was not different in rural and urban areas (p = 0.822). Compared to unvaccinated adults (62.3%, 95% CI 60.9% to 63.7%), seroprevalence was significantly higher among individuals who had received 1 vaccine dose (81.0%, 95% CI 79.6% to 82.3%, p < 0.001) and 2 vaccine doses (89.8%, 95% CI 88.4% to 91.1%, p < 0.001). The seroprevalence of IgG antibodies among 7,252 HCWs was 85.2% (95% CI 83.5% to 86.7%). Important limitations of the study include the survey design, which was aimed to estimate seroprevalence at the national level and not at a sub-national level, and the non-participation of 19% of eligible individuals in the survey. Conclusions Nearly two-thirds of individuals aged ≥6 years from the general population and 85% of HCWs had antibodies against SARS-CoV-2 by June–July 2021 in India. As one-third of the population is still seronegative, it is necessary to accelerate the coverage of COVID-19 vaccination among adults and continue adherence to non-pharmaceutical interventions.

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Implementation of secondary preventive practice important for cervical cancer among women who use oral contraception

Archive of oncology ◽

10.2298/aoo1304091a ◽

2013 ◽

Vol 21 (3-4) ◽

pp. 91-96

Author(s):

Ljiljana Antic ◽

Dejana Vukovic ◽

Bosiljka Ðikanovic ◽

Dragan Antic ◽

Slavisa Jankovic ◽

...

Keyword(s):

Cervical Cancer ◽

Multivariate Analysis ◽

Rural Areas ◽

Urban Areas ◽

Preventive Measures ◽

Population Sample ◽

Cross Sectional Study ◽

National Health Survey ◽

Cross Sectional ◽

Nationally Representative

Background: In the course of the previous 50 years, demographic trends in Serbia have been quite unfavorable and there is the epidemiological transition. The aim of the study was to examine the factors that influence women's decision to take oral contraceptives (OC) and to examine preventive measures for the cervical cancer. Method: We analyzed data that were collected in a cross-sectional study National Health Survey in Serbia in 2006, which was based on a nationally representative population sample. Our subsample included 2,378 women aged from 20 to 49 years. Results: The results of this multivariate analysis confirmed the association of the OC usage with socio-demographic factors, such as marital status and region of living. Respondents from Vojvodina took OC more often than those from Belgrade (OR= 0.48, 95% CI, 0.30-0.78) and Central Serbia (OR=0.42, 95% CI 0.29-0.61). The results of adjusted multivariate analysis showed that the level of education, place of living, and region were significantly associated with secondary preventive measures for the cervical cancer (regular check-ups and Pap tests). Secondary preventive measures are more frequently used among less educated participants who live in the urban areas and in the region of Vojvodina, compared to the more educated women from rural areas and living in the capital Belgrade. Conclusion: Our study did not confirm association of OC usage with secondary preventive measures for the cervical cancer.

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Trends in the socioeconomic patterning of overweight/obesity in India: a repeated cross-sectional study using nationally representative data

BMJ Open ◽

10.1136/bmjopen-2018-023935 ◽

2018 ◽

Vol 8 (10) ◽

pp. e023935 ◽

Cited By ~ 18

Author(s):

Shammi Luhar ◽

Poppy Alice Carson Mallinson ◽

Lynda Clarke ◽

Sanjay Kinra

Keyword(s):

Higher Education ◽

Rural Women ◽

Rural Areas ◽

Urban Areas ◽

Cross Sectional Study ◽

Obesity Prevalence ◽

Sectional Study ◽

Cross Sectional ◽

Men And Women ◽

Nationally Representative

ObjectivesWe aimed to examine trends in prevalence of overweight/obesity among adults in India by socioeconomic position (SEP) between 1998 and 2016.DesignRepeated cross-sectional study using nationally representative data from India collected in 1998/1999, 2005/2006 and 2015/2016. Multilevel regressions were used to assess trends in prevalence of overweight/obesity by SEP.Setting26, 29 and 36 Indian states or union territories, in 1998/99, 2005/2006 and 2015/2016, respectively.Participants628 795 ever-married women aged 15–49 years and 93 618 men aged 15–54 years.Primary outcome measureOverweight/obesity defined by body mass index >24.99 kg/m2.ResultsBetween 1998 and 2016, overweight/obesity prevalence increased among men and women in both urban and rural areas. In all periods, overweight/obesity prevalence was consistently highest among higher SEP individuals. In urban areas, overweight/obesity prevalence increased considerably over the study period among lower SEP adults. For instance, between 1998 and 2016, overweight/obesity prevalence increased from approximately 15%–32% among urban women with no education. Whereas the prevalence among urban men with higher education increased from 26% to 34% between 2005 and 2016, we did not observe any notable changes among high SEP urban women between 1998 and 2016. In rural areas, more similar increases in overweight/obesity prevalence were found among all individuals across the study period, irrespective of SEP. Among rural women with higher education, overweight/obesity increased from 16% to 25% between 1998 and 2016, while the prevalence among rural women with no education increased from 4% to 14%.ConclusionsWe identified some convergence of overweight/obesity prevalence across SEP in urban areas among both men and women, with fewer signs of convergence across SEP groups in rural areas. Efforts are therefore needed to slow the increasing trend of overweight/obesity among all Indians, as we found evidence suggesting it may no longer be considered a ‘diseases of affluence’.

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