The double burden of malnutrition in India: Trends and inequalities (2006–2016)

Rapid urban expansion has important health implications. This study examines trends and inequalities in undernutrition and overnutrition by gender, residence (rural, urban slum, urban non-slum), and wealth among children and adults in India. We used National Family Health Survey data from 2006 and 2016 (n = 311,182 children 0-5y and 972,192 adults 15-54y in total). We calculated differences, slope index of inequality (SII) and concentration index to examine changes over time and inequalities in outcomes by gender, residence, and wealth quintile. Between 2006 and 2016, child stunting prevalence dropped from 48% to 38%, with no gender differences in trends, whereas child overweight/obesity remained at ~7–8%. In both years, stunting prevalence was higher in rural and urban slum households compared to urban non-slum households. Within-residence, wealth inequalities were large for stunting (SII: -33 to -19 percentage points, pp) and declined over time only in urban non-slum households. Among adults, underweight prevalence decreased by ~13 pp but overweight/obesity doubled (10% to 21%) between 2006 and 2016. Rises in overweight/obesity among women were greater in rural and urban slum than urban non-slum households. Within-residence, wealth inequalities were large for both underweight (SII -35 to -12pp) and overweight/obesity (+16 to +29pp) for adults, with the former being more concentrated among poorer households and the latter among wealthier households. In conclusion, India experienced a rapid decline in child and adult undernutrition between 2006 and 2016 across genders and areas of residence. Of great concern, however, is the doubling of adult overweight/obesity in all areas during this period and the rise in wealth inequalities in both rural and urban slum households. With the second largest urban population globally, India needs to aggressively tackle the multiple burdens of malnutrition, especially among rural and urban slum households and develop actions to maintain trends in undernutrition reduction without exacerbating the rapidly rising problems of overweight/obesity.

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Assessing the Impact of Urban Expansion on Surrounding Forested Landscape Connectivity across Space and Time

Land ◽

10.3390/land10040359 ◽

2021 ◽

Vol 10 (4) ◽

pp. 359

Author(s):

Zhouqiao Ren ◽

Jianhua He ◽

Qiaobing Yue

Keyword(s):

Landscape Connectivity ◽

Urban Expansion ◽

Landscape Fragmentation ◽

Sustainable Urban Development ◽

Delayed Response ◽

Conservation Practices ◽

Rapid Urbanization ◽

Dynamic Landscapes ◽

The Impact ◽

Over Time

Landscape connectivity is important for all organisms as it directly affects population dynamics. Yet, rapid urbanization has caused serious landscape fragmentation, which is the primary contributor of species extinctions worldwide. Previous studies have mostly used spatial snap-shots to evaluate the impact of urban expansion on landscape connectivity. However, the interactions among habitats over time in dynamic landscapes have been largely ignored. Here, we demonstrated that overlooking temporal connectivity can lead to the overestimation of the impact of urban expansion. How much greater the overestimation is depends on the amount of net habitat loss. Moreover, we showed that landscape connectivity may have a delayed response to urban expansion. Our analysis shifts the way to understand the ecological consequences of urban expansion. Our framework can guide sustainable urban development and can be inspiring to conservation practices under other contexts (e.g., climate change).

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Fatores relacionados à autopercepção do estado de saúde em idosos residentes no meio rural do Brasil

Scientia Medica ◽

10.15448/1980-6108.2018.3.29698 ◽

2018 ◽

Vol 28 (3) ◽

pp. 29698 ◽

Cited By ~ 1

Author(s):

Eleia De Macedo ◽

Vivian Ulrich ◽

Antonio Miguel Gonçalves Bós ◽

Ângelo José Gonçalves Bós

Keyword(s):

Health Status ◽

Family Health ◽

Rural Elderly ◽

Urban Elderly ◽

Self Perception ◽

Rural And Urban ◽

Health Strategy ◽

The Family ◽

Family Health Strategy ◽

Perception Of Health

AIMS: To compare the self-perception of health status between rural and urban elderly and their possible associated factors.METHODS: The study consisted of a secondary analysis of data from the National Health Survey of 2013, conducted by the National Institute of Geography and Statistics, which included elderly who lived in rural and urban environments. The dependent variable was the self-perception of health status (evaluated as very good, good, fair, bad and very bad); and the independent variables were socio-demographic factors, clinical data, functionality of the elderly and household data. Relationships between the variables were tested by the chi-square test, and adjusted by self-perception of health status. The analysis were performed through the Epi InfoTM program version 7.2.1, accepting p<0.05 as significant.RESULTS: Rural elderly people were predominantly males, brown, married, illiterate and gainfully employed, despite having a low economic class. Among the rural elderly, self-perceived health status was more often regular or poor, the household was more often enrolled in the Family Health Strategy and most had no complementary health plan. Rural elderly also had better performance in the Basic Activities of Daily Living and worse performance in the Instrumental Activities of Daily Living, had less depressive symptoms and less multimorbidity. Rural elderly presented lower chances of self-perception of good or very good health, even adjusting for gender, race, marital status, occupation, socioeconomic class, coverage by the Family Health Strategy, depressive symptoms, multimorbidity, and performance in the Basic Activities of Daily Living.CONCLUSIONS: The rural elderly have worse self-perception of health status than the urban elderly, even controlling socio-demographic, economic, clinical and health access characteristics.

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A study about the sustainable challenges of extended areas in Taiwan and lessons for Ho Chi Minh, Dong Nai and Binh Duong regions

Thu Dau Mot University Journal of Science ◽

10.37550/tdmu.ejs/2020.04.085 ◽

2020 ◽

pp. 413-421

Keyword(s):

Economic Growth ◽

Social Policy ◽

Urban Development ◽

Policy Change ◽

Global Economy ◽

Urban Expansion ◽

Urban Spaces ◽

Rural And Urban ◽

Agricultural Regions ◽

Urban Activities

This paper examines the main challenges of the processes of space and social policy change present to current urbanization trends of Taiwan. The chapter argues that one of the main challenges is economic growth, increasing integration into the global economy and making Taiwan competitive in the global economy. This process leads to the growth of large urban regions that present many challenges to the urban development in the future. In particular, the paper focuses on the most fragile areas of the extended urban spaces are the rural and urban margins, where urban activities are expanding into densely populated agricultural regions. It is argued that in these areas, local policies should be developed that adapt to local ecosystems. The paper presents lessons of interventions in this field for Ho Chi Minh, Dong Nai and Binh Duong Region for urban expansion.

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The trend of full vaccination coverage in infants and inequalities by wealth quintile and maternal education: Analysis from four recent Demographic and Health Surveys in Nepal

10.21203/rs.2.13937/v3 ◽

2019 ◽

Author(s):

Kiran Acharya ◽

Yuba Raj Paudel ◽

Dinesh Dharel

Keyword(s):

Vaccination Coverage ◽

Maternal Education ◽

Immunization Coverage ◽

Wealth Quintile ◽

Educational Status ◽

Household Wealth ◽

Demographic And Health Surveys ◽

Relative Index ◽

Index Of Inequality ◽

Over Time

Abstract Background Despite policy intention to reach disadvantaged populations, inequalities in child health care use and health outcomes persist in Nepal. The current study aimed to investigate the trend of full vaccination coverage among infants and its equity gaps between Nepal Demographic and Health Surveys (NDHS) 2001 and 2016.Methods Using data from NDHS conducted in 2001, 2006, 2011 and 2016, we investigated the trend of coverage of six antigens:Bacille Calmette Guerin (BCG), Diptheria, Pertussis, Tetanus (DPT), Polio, and Measles during their infancy among children aged 12-23 months. We presented trends and correlates of vaccination coverage by different socio-demographic factors. We measured inequalities in full vaccination coverage by wealth quintile and maternal education using absolute measure (slope index of inequality) and relative measures (Relative index of inequality, concentration index) of inequalities.Results Full immunization coverage among infants steadily increased from 65.6% in 2001 to 87.0% in 2011; however, it decreased to 77.8% in 2016. Province 2 had a significantly lower full vaccination coverage compared to Province1.Although decreasing over time, there were significant inequalities by household wealth quintiles and maternal educational status. The slope index of inequality (SII) for wealth quintiles decreased from -32.3 [-45.5,-19.1] in 2001 to an SII of-8.4 [-18.6,-1.7] in 2016. Similarly, the SII for education decreased from -61.8 [-73.5,-50.1] in 2001 to an SII of -30.5 [-40.7,-20.2] in 2016. Similarly, the relative index of inequality (RII) also showed an improvement over time, indicating the narrowing equity gap. Additionally, concentration index on full immunization coverage by wealth quintiles dropped from 0.21 (0.12-0.28) in 2001 to 0.054 (-0.01-0.12) in 2016. Absolute and relative inequalities were persistently larger by maternal educational status compared to household wealth quintiles throughout the study period.Conclusion Full vaccination coverage in Nepal increased from 2001 until 2011 but saw a significant decrement away from the national target after 2011. However, the equity gap by household wealth quintile and maternal education status has narrowed over time. National Immunization programs need to give higher emphasis to infants born to mothers with less education, those born in the poorer wealth quintile households, and those living in Province 2.

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Trends in and determinants of visiting private health facilities for maternal and child health care in Nepal: Comparison of three Nepal Demographic Health Surveys, 2006, 2011, and 2016.

10.21203/rs.3.rs-40846/v1 ◽

2020 ◽

Author(s):

Ramesh Prasad Adhikari ◽

Manisha Laxmi Shrestha ◽

Emily N. Satinsky ◽

Nawaraj Upadhaya

Keyword(s):

Health Care ◽

Child Health ◽

Maternal And Child Health ◽

Health Surveys ◽

Wealth Quintile ◽

Health Facilities ◽

Child Health Care ◽

Health Seeking ◽

And Child Health ◽

Over Time

Abstract Background: Maternal and child health care services are available in both public and private facilities in Nepal. No study has yet looked at trends in maternal and child health service use over time in Nepal. This paper assesses trends in and determinants of visiting private health facilities for maternal and child health needs using nationally representative data from the last three successive Nepal Demographic Health Surveys (NDHS). Methods: Data from the NDHS conducted in 2006, 2011, and 2016 were used. Maternal and child health-seeking was established using data on place of antenatal care (ANC), place of delivery, and place of treatment for child diarrhoea and fever/cough. Logistic regression models were fitted to identify trends in and determinants of health-seeking at private facilities. Results: The results indicate an increase in the use of private facilities for maternal and child health care over time. Across the three survey waves, women from the highest wealth quintile had the highest odds of accessing ANC services at private health facilities (AOR=6.0, CI= 3.78 -9.52 in 2006; AOR=5.6, CI= 3.51 – 8.81 in 2011; AOR=3.0, CI= 1.53 -5.91 in 2016). Women from the highest wealth quintile (AOR=8.3 CI= 3.97 – 17.42 in 2006; AOR=7.3, CI= 3.91 – 13.54 in 2011; AOR=3.3, CI= 1.54 – 7.09 in 2016) and women with more years of schooling (AOR=1.1, CI= 1.07 – 1.16 in 2006; AOR=1.1, CI= 1.04 – 1.14 in 2011; AOR=1.2, CI= 1.17 -1.27 in 2016) were more likely to deliver in private health facilities. Likewise, children belonging to the highest wealth quintile (AOR=6.4, CI= 1.59 – 25.85 in 2006; AOR=8.0, CI= 2.43 – 26.54 in 2016) were more likely to receive diarrhoea treatment in private health facilities.Conclusions: Women are increasingly visiting private health facilities for maternal and child health care in Nepal. Household wealth quintile, and the mother’s years of schooling were the major determinants for selecting private health facilities for these services. These trends indicate the importance of collaboration between private and public health facilities in Nepal to foster a public private partnership approach in the Nepalese health care sector.

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Prevalence and Determinants of Adequate Compliance with Antenatal Care in Peru

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics ◽

10.1055/s-0041-1732463 ◽

2021 ◽

Vol 43 (06) ◽

pp. 442-451

Author(s):

Cesar Tello-Torres ◽

Akram Hernández-Vásquez ◽

Karla F. Dongo ◽

Rodrigo Vargas-Fernández ◽

Guido Bendezu-Quispe

Keyword(s):

Antenatal Care ◽

Health Care Professionals ◽

Age Groups ◽

Family Health ◽

Wealth Quintile ◽

First Trimester ◽

Sociodemographic Factors ◽

Cross Sectional Study ◽

Cross Sectional ◽

First Trimester Of Pregnancy

Abstract Objective To determine the adequacy of compliance with antenatal care (ANC) by pregnant women in Peru and to identify the associated factors. Methods An analytical cross-sectional study of data from the 2019 Peruvian Demographic and Family Health Survey (Encuesta Demográfica y de Salud Familiar, ENDES, in Spanish) was conducted. The dependent variable was adequate compliance with ANC (provided by skilled health care professionals; first ANC visit during the first trimester of pregnancy; six or more ANC visits during pregnancy; ANC visits with appropriate content) by women aged 15 to 49 years in their last delivery within the five years prior to the survey. Crude and adjusted prevalence ratios and their 95% confidence intervals were calculated using a log-binomial regression model. Results A total of 18,386 women were analyzed, 35.0% of whom adequately complied with ANC. The lowest proportion of compliance was found with the content of ANC (42.6%). Sociodemographic factors and those related to pregnancy, such as being in the age groups of 20 to 34 years and 35 to 49 years, having secondary or higher education, belonging to a wealth quintile of the population other than the poorest, being from the Amazon region, not being of native ethnicity, having a second or third pregnancy, and having a desired pregnancy, increased the probability of presenting adequate compliance with ANC. Conclusion Only 3 out of 10 women in Peru showed adequate compliance with ANC. Compliance with the content of ANC must be improved, and strategies must be developed to increase the proportion of adequate compliance with ANC.

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Archiving Fragments of Time

10.26686/wgtn.16971214 ◽

2021 ◽

Author(s):

◽

Alice Charles

Keyword(s):

Urban Expansion ◽

Urban Context ◽

True Story ◽

Architectural Representation ◽

Multiple Voices ◽

Critical Method ◽

The Rich ◽

A Site ◽

Allegorical Interpretation ◽

Over Time

Beneath the urban concrete of Wellington city lies a plethora of lost stories and voices, sometimes only accessible as fragments, which should contribute to the rich polyvocal narratives of a site. Recognition of these stories, even as fragments, enables local inhabitants and a wider audience to begin to understand the significance of place. Heritage stories transform from one time period to the next, creating overlapping layers of a site’s identity evolving over time. Each layer, while potentially representing its own unique story, contributes to the meta-narrative of a place. This design-led research investigation looks at the problem that arises when important stories of a place are lost when a site has transformed over time. The true story of a site is represented by the hidden layers from previous time periods, which have often fragmented or faded over time. This thesis proposes that lost layers, fragmented stories and faded voices can be reawakened through speculative architectural representation. Fragments of stories can be used to stimulate the imagination. The allegorical interpretation of fragments can be used to generate dreamscapes. Within a dreamscape, the multiple voices of multiple fragments can be heard together, even when they represent stories from different times. When dreamscapes are captured as allegorical drawing fragments, these multiple voices can be heard and retained even when they have partially faded away. This thesis explores how an allegorical architectural project, framed within techniques found in allegorical narrative fiction, can be successfully used as a critical method to help reawaken and unveil lost voices of place and generate speculative architectural outcomes that allow these voices to be heard. This design-led research proposes to reawaken lost voices of place through mapping the field of imagination, collage and the creation of dreamscapes, and allegorical drawing fragments. Italo Calvino’s Invisible Cities and Alan Lightman’s Einstein’s Dreams are examples of literary approaches to the allegorical interpretation of fragments. They are used in this investigation as literary provocateurs—allegorical generators to engage the imagination to reawaken lost voices as fragments and allow them to be heard in a collection—an archive of fragments. These two novels are effectively re-presenting place and time as dreamscapes. By enabling a series of fragmented stories to be heard as one, a richly polyvocal narrative is established that allows the reader to understand the significance of a place. Two neighbouring urban sites along the edge of Wellington Harbour have been selected for this investigation: the Taranaki Wharf Cut-out and the Kumutoto Stream Outlet. Both have unique tales to tell. The Kumutoto Stream Outlet is the site of the first culverted stream in Wellington. This entire stream has been silenced and has disappeared forever, yet it survives deep underground; this narrow outlet along the Wellington Harbour edge is the last vestigial remnant of its tale. The Taranaki Wharf Cut-out exposes the lost shoreline of Wellington before urban expansion. This shoreline has been silenced and has disappeared forever, and the cut-out provides the last visual connection to the lost landscape below. Fragments of the urban concrete have been removed from both these sites to reveal the lost remnants of the sites tales they once concealed. These sites are engaged as allegorical portals that invite a viewer below the surface of Wellington’s urban concrete to explore the lost layers of fragmented stories that lay hidden beneath. These sites are presented as ‘characters’ that narrate ‘stories’ of Wellington waterfront’s surrounding context and the transformation of the landscape over time. The original heritage conditions of a place often cannot be physically returned to their sites without disrupting the contemporary urban context. In this investigation, sites are not engaged as grounds for architectural intervention. Instead, they are provocateurs for how an allegorical architectural project can dig below the urban concrete and reawaken and unveil lost voices of a place. These voices are presented as a speculative archive of fragmented artefacts that invite viewers to witness, through these allegorical artefacts, an urban environment’s rich litany of heritage stories that may have been permanently lost or displaced. These artefacts take the form of maps, collages and drawings, and they are designed to read both as individual artefacts and together as a collection within an archive, this bound codex of work—an Archive of Fragments of Time. This thesis asks:How can an allegorical architectural project be successfully used as a critical method to reawaken and unveil lost voices of a place, and generate speculative architectural outcomes that allow these voices to be heard?

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Wealth of nomads – an exploratory analysis of livestock inequality in the Saami reindeer husbandry

10.31235/osf.io/zv92t ◽

2021 ◽

Author(s):

Marius Warg Næss ◽

Bård-Jørgen Bårdsen

Keyword(s):

Primary Source ◽

Wealth Inequality ◽

External Factors ◽

Social Differentiation ◽

Reindeer Herding ◽

Reindeer Husbandry ◽

The Poor ◽

Wealth Inequalities ◽

Rank Differences ◽

Over Time

Social inequality is pervasive in contemporary human societies. Nevertheless, there is a view that livestock, as the primary source of wealth, limits the development of inequalities, making pastoralism unable to support complex or hierarchical organisations. Thus, complex nomadic pastoral organisation is predominantly caused by external factors, i.e., historically nomadic political organisation mirrored the neighbouring sedentary population's sophistication. Using governmental statistics on reindeer herding in Norway (2001 - 2018), this study demonstrates nothing apparent in the pastoral adaptation with livestock as the main base of wealth that level wealth inequalities and limits social differentiation. This study found that inequality was generally decreasing in terms of the Gini coefficient and cumulative wealth. For example, the proportion owned by the wealthy decreased from 2001 to 2018, while the proportion owned by the poor increased. Nevertheless, rank differences persist over time with minor changes. Especially, being poor is stable: around 50% of households ranked as poor in 2001 continued to be so in 2018. In sum, results from this study indicate that pastoral wealth inequality follows the same patterns as all forms of wealth. Wealth accumulates over time, and because the highest earners can save much of their income (i.e., newborn livestock), low earners cannot. High earners can thus accumulate more and more wealth over time, leading to considerable wealth inequalities.

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Socioeconomic and Gender Inequalities in Leisure-Time Physical Activity and Access to Public Policies in Brazil From 2013 to 2019

Journal of Physical Activity and Health ◽

10.1123/jpah.2021-0291 ◽

2021 ◽

pp. 1-8

Author(s):

Andrea Wendt ◽

Luiza I.C. Ricardo ◽

Caroline S. Costa ◽

Alan G. Knuth ◽

Maria C.M. Tenório ◽

...

Keyword(s):

Physical Activity ◽

Leisure Time ◽

Leisure Time Physical Activity ◽

National Level ◽

Public Spaces ◽

Population Based ◽

Gender Inequalities ◽

Public Programs ◽

Wealth Inequalities ◽

Over Time

Background: This study aims to describe changes in gender and wealth inequalities in leisure-time physical activity (PA) of Brazilians during a 6-year interval. It also aims to evaluate inequalities regarding PA public programs awareness, participation, and access to public spaces for PA. Methods: Data from 2 population-based surveys conducted in 2013 and 2019 were used. Leisure-time PA prevalence was assessed considering those reporting ≥150 minutes per week. The authors evaluated gender inequalities calculating differences and ratios, and wealth inequalities using the slope index of inequality and the concentration index— assessing changes over time. Results: National levels of leisure-time PA increased from 2013 to 2019, and an increase in inequalities was observed; women and the poorest groups still presented lower prevalence. A decline in socioeconomic inequalities was observed from 2013 to 2019 regarding the availability of public spaces and awareness about public programs. However, outcomes remained more common among the richest group. Inequalities did not vary for participation in public programs. Conclusion: Although leisure-time PA increased from 2013 to 2019 at a national level, there were no improvements in gender inequalities, and wealth inequalities worsened over time. Indicators of public strategies for PA increased for the population, but inequalities remain.

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