scholarly journals Educational differentials in adult mortality in low- and middle-income countries

2017 ◽  
Vol 4 (1) ◽  
Author(s):  
Bruno Masquelier ◽  
Alessandra Garbero
Keyword(s):  
Educational Attainment ◽  
Urban Areas ◽  
Adult Mortality ◽  
Demographic And Health Surveys ◽  
Middle Income ◽  
Niveau D’Instruction ◽  
Middle Income Countries ◽  
Mortality Differentials ◽  
Generalized Linear Mixed Effects ◽  
Low And Middle Income

RésuméDans les pays à haut revenu, il a été amplement démontré que la mortalité des adultes est plus faible au sein des catégories professionnelles favorisées ainsi que chez les personnes bénéficiant d’un niveau d’instruction élevé ou d’un revenu confortable. Dans les pays à revenu faible ou intermédiaire, les différentiels de mortalité aux âges adultes sont par contre nettement moins bien étudiés en raison du manque d'information sur les caractéristiques socio-économiques des personnes décédées. Cet article vise à évaluer si les informations fournies dans des enquêtes sur la survie des sœurs peuvent aider à combler cette lacune. Puisque les niveaux d’instruction sont très corrélés au sein des familles, les niveaux atteints par les fem­mes enquêtées peuvent servir à approximer le niveau d’instruction de leurs sœurs. Afin de quantifier les différences de mortalité, nous combinons toutes les Enquêtes Démographiques et de Santé dans un même modèle linéaire généralisé à effets mixtes. Dans la plupart des enquêtes, nous observons une relation inverse entre le niveau d’instruction et la mortalité adulte, en particulier dans les zones urbaines, mais des gradients opposés sont observés dans plusieurs pays durement frappés par l’épidémie du VIH/sida. L’hypothèse selon laquelle les femmes moins instruites auraient tendance à omettre disproportionnellement certains décès de leurs sœurs n’est pas vérifiée dans les données. Les données sur la survie des soeurs semblent plutôt bien refléter la complexité de la relation entre mortalité et éducation des adultes, en particulier dans les pays touchés par l’épidémie du SIDA. Dans l’ensem­ble, le recours à ces données ouvre de nouvelles voies pour mesurer les inégalités de mortalité aux âges adultes dans les pays à revenu faible ou intermédiaire.AbstractIn high-income countries, there is extensive evidence showing that higher levels of educational attainment, higher income and higher occupational classes are correlated with lower mortality rates among adults. In low- and middle-income countries, far less is known on mortality differentials in this age group due to the lack of information on the socio-economic characteristics of the deceased. In this paper, we evaluate whether survey reports on the survival of sisters can help to fill this gap. We find that levels of educational attainment are correlated within families, and therefore characteristics of the deceased can be inferred from levels attained by their sisters responding to the survey. Because estimates based on sibling survival histories have large confidence intervals, we pool all Demographic and Health Surveys together and apply a generalized linear mixed-effects model to capture mortality differentials. In most surveys, higher education is indeed associated with lower risks of dying, especially in urban areas, but reverse gradients are observed in several countries experiencing generalized HIV epidemics. There is limited support for the hypothesis that women with less education are disproportionately omitting to report some deaths. Instead, we argue that sibling histories truly reflect the complexity of the relationship between adult mortality and education, especially in countries affected by the HIV/AIDS epidemic. Overall, the sibling approach offers new avenues for measuring inequalities in adult mortality in low- and middle-income countries. 

scholarly journals The co-occurrence of overweight/obesity and anaemia among adult women, adolescent girls and children living in 52 low-and middle-income countries

2021 ◽  
pp. 1-25
Author(s):  
Ana Irache ◽  
Paramjit Gill ◽  
Rishi Caleyachetty
Keyword(s):  
Adolescent Girls ◽  
Urban Areas ◽  
Household Wealth ◽  
Education Level ◽  
Demographic And Health Surveys ◽  
Adult Women ◽  
Middle Income ◽  
Middle Income Countries ◽  
Percentage Points ◽  
Low And Middle Income

Abstract Objective: To investigate the magnitude and distribution of concurrent overweight/obesity and anaemia among adult women, adolescent girls and children living in low-and middle-income countries (LMICs). Design: We selected the most recent Demographic and Health Surveys with anthropometric and haemoglobin level measures. Prevalence estimates and 95% CIs of concurrent overweight/obesity and anaemia were calculated for every country, overall and stratified by household wealth quintile, education level, area of residence and sex (for children only). Regional and overall pooled prevalences were estimated using a random-effects model. We measured gaps, expressed in percentage points, to display inequalities in the distribution of the double burden of malnutrition (DBM). Setting: Nationally representative surveys from 52 LMICs. Participants: Adult women (n=825,769) aged 20-49 years, adolescent girls (n=192,631) aged 15-19 years, and children (n=391,963) aged 6-59 months. Results: The pooled prevalence of concurrent overweight/obesity and anaemia was 12.4% (95% CI: 11.1, 13.7) among adult women, 4.5% (95% CI: 4.0, 5.0) among adolescent girls and 3.0% (95% CI: 2.7, 3.3) among children. Overall, the DBM followed an inverse social gradient, with a higher prevalence among the richest quintile, most educated groups and in urban areas; however, important variations exist. The largest inequality gaps were observed among adult women in Yemen by household wealth (24.0 percentage-points) and in Niger by education level (19.6 percentage-points) and area of residence (11.9 percentage-points). Differences were predominantly significant among adult women; but less among girls and children. Conclusions: Context-specific, multifaceted, responses with an equity-lens are needed to reduce all forms of malnutrition.

scholarly journals Reasons for nonuse of contraceptive methods by women with demand for contraception not satisfied: an assessment of low and middle-income countries using demographic and health surveys

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Laísa Rodrigues Moreira ◽  
Fernanda Ewerling ◽  
Aluisio J. D. Barros ◽  
Mariangela Freitas Silveira
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Reproductive Age ◽  
Demographic And Health Surveys ◽  
Contraceptive Methods ◽  
Middle Income ◽  
Health Concerns ◽  
Middle Income Countries ◽  
Low And Middle Income ◽  
Lack Of Knowledge

Abstract Background Nonuse of contraceptive methods by women in need of contraception may impact their sexual and reproductive health. The aim of this study was to describe the reasons for nonuse of contraception among women with demand for contraception not satisfied in low and middle-income countries (considering both overall countries and various subgroups of women). Methods We used the latest Demographic and Health Survey data from 47 countries. A descriptive analysis of the reasons for nonuse of contraceptive methods was performed among sexually active women with demand for contraception not satisfied. The prevalence of each reported reason was also evaluated according to marital status, woman’s age and schooling, area of residence, wealth index, and parity. Wealth-related absolute inequality for each reason was also evaluated using the Slope Index of Inequality. A pro-rich inequality pattern means that the reason is more prevalent among the richest women while a pro-poor means the reason is more common among the poorest ones. Results On average, 40.9% of women in need of contraception were not using any contraceptive methods to avoid pregnancy. Overall, the most prevalent reasons for nonuse of contraceptives were “health concerns” and “infrequent sex,” but the prevalence of each reason varied substantially across countries. Nonuse due to “opposition from others” was higher among married than unmarried women; in turn, the prevalence of nonuse due to “lack of access” or “lack of knowledge” was about two times higher in rural areas than in urban areas. Women with less schooling more often reported nonuse due to “lack of access.” Pro-rich inequality was detected for reasons “health concerns,” “infrequent sex,” and “method-related”, while the reasons “other opposed,” “fatalistic,” “lack of access,” and “lack of knowledge” were linked to patterns of pro-poor inequality. Conclusions Family planning promotion policies must take into account the different reasons for the nonuse of contraceptive methods identified in each country as well as the contextual differences regarding women of reproductive age (such as social norms and barriers that prevent women from accessing and using contraceptives).

scholarly journals Finding Children with High Risk of Non-Vaccination in 92 Low- and Middle-Income Countries: A Decision Tree Approach

Vaccines ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 646
Author(s):  
Thiago M. Santos ◽  
Bianca O. Cata-Preta ◽  
Cesar G. Victora ◽  
Aluisio J. D. Barros
Keyword(s):  
High Risk ◽  
Decision Tree ◽  
Immunization Coverage ◽  
Risk Groups ◽  
Demographic And Health Surveys ◽  
Middle Income ◽  
Agenda 2030 ◽  
Middle Income Countries ◽  
Tree Approach ◽  
Low And Middle Income

Reducing vaccination inequalities is a key goal of the Immunization Agenda 2030. Our main objective was to identify high-risk groups of children who received no vaccines (zero-dose children). A decision tree approach was used for 92 low- and middle-income countries using data from Demographic and Health Surveys and Multiple Indicator Cluster Surveys, allowing the identification of groups of children aged 12–23 months at high risk of being zero dose (no doses of the four basic vaccines—BCG, polio, DPT and measles). Three high-risk groups were identified in the analysis combining all countries. The group with the highest zero-dose prevalence (42%) included 4% of all children, but almost one in every four zero-dose children in the sample. It included children whose mothers did not receive the tetanus vaccine during and before the pregnancy, who had no antenatal care visits and who did not deliver in a health facility. Separate analyses by country presented similar results. Children who have been missed by vaccination services were also left out by other primary health care interventions, especially those related to antenatal and delivery care. There is an opportunity for better integration among services in order to achieve high and equitable immunization coverage.

scholarly journals Co-morbid anaemia and stunting among children of pre-school age in low- and middle-income countries: a syndemic

2018 ◽  
Vol 22 (1) ◽  
pp. 35-43 ◽  
Author(s):  
Thach Duc Tran ◽  
Beverley-Ann Biggs ◽  
Sara Holton ◽  
Hau Thi Minh Nguyen ◽  
Sarah Hanieh ◽  
...  
Keyword(s):  
Rural Areas ◽  
Secondary Analysis ◽  
Logistic Models ◽  
Demographic And Health Surveys ◽  
Healthy Children ◽  
Middle Income ◽  
Disadvantaged Children ◽  
Middle Income Countries ◽  
Co Morbidity ◽  
Low And Middle Income

AbstractObjectiveTo determine the prevalence of co-morbidity of two important global health challenges, anaemia and stunting, among children aged 6–59 months in low- and middle-income countries.DesignSecondary analysis of data from Demographic and Health Surveys (DHS) conducted 2005–2015. Child stunting and anaemia were defined using current WHO classifications. Sociodemographic characteristics of children with anaemia, stunting and co-morbidity of these conditions were compared with those of ‘healthy’ children in the sample (children who were not stunted and not anaemic) using multiple logistic models.SettingLow- and middle-income countries.SubjectsChildren aged 6–59 months.ResultsData from 193 065 children from forty-three countries were included. The pooled proportion of co-morbid anaemia and stunting was 21·5 (95 % CI 21·2, 21·9) %, ranging from the lowest in Albania (2·6 %; 95 % CI 1·8, 3·7 %) to the highest in Yemen (43·3; 95 % CI 40·6, 46·1 %). Compared with the healthy group, children with co-morbidity were more likely to be living in rural areas, have mothers or main carers with lower educational levels and to live in poorer households. Inequality in children who had both anaemia and stunting was apparent in all countries.ConclusionsCo-morbid anaemia and stunting among young children is highly prevalent in low- and middle-income countries, especially among more disadvantaged children. It is suggested that they be considered under a syndemic framework, the Childhood Anaemia and Stunting (CHAS) Syndemic, which acknowledges the interacting nature of these diseases and the social and environmental factors that promote their negative interaction.

Strategies used to establish palliative care in rural low- and middle-income countries: an integrative review

2020 ◽  
Vol 35 (8) ◽  
pp. 1110-1129
Author(s):  
Atsede Aregay ◽  
Margaret O’Connor ◽  
Jill Stow ◽  
Nicola Ayers ◽  
Susan Lee
Keyword(s):  
Palliative Care ◽  
Low Income ◽  
Rural Areas ◽  
Urban Areas ◽  
Care Home ◽  
Sub Saharan Africa ◽  
Integrative Review ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

Abstract Globally, 40 million people need palliative care; about 69% are people over 60 years of age. The highest proportion (78%) of adults are from low- and middle-income countries (LMICs), where palliative care still developing and is primarily limited to urban areas. This integrative review describes strategies used by LMICs to establish palliative care in rural areas. A rigorous integrative review methodology was utilized using four electronic databases (Ovid MEDLINE, Ovid Emcare, Embase classic+Embase and CINAHL). The search terms were: ‘palliative care’, ‘hospice care’, ‘end of life care’, ‘home-based care’, ‘volunteer’, ‘rural’, ‘regional’, ‘remote’ and ‘developing countries’ identified by the United Nations (UN) as ‘Africa’, ‘Sub-Saharan Africa’, ‘low-income’ and ‘middle- income countries’. Thirty papers published in English from 1990 to 2019 were included. Papers were appraised for quality and extracted data subjected to analysis using a public health model (policy, drug availability, education and implementation) as a framework to describe strategies for establishing palliative care in rural areas. The methodological quality of the reviewed papers was low, with 7 of the 30 being simple programme descriptions. Despite the inclusion of palliative care in national health policy in some countries, implementation in the community was often reliant on advocacy and financial support from non-government organizations. Networking to coordinate care and medication availability near-patient homes were essential features of implementation. Training, role play, education and mentorship were strategies used to support health providers and volunteers. Home- and community-based palliative care services for rural LMICs communities may best be delivered using a networked service among health professionals, community volunteers, religious leaders and technology.

scholarly journals Inequalities in Antenatal Care Coverage and Quality: an Analysis From 63 Low and Middle-income Countries Using the ANCq Content-qualified Coverage Indicator

2020 ◽  
Author(s):  
Luisa Arroyave ◽  
Ghada E Saad ◽  
Cesar G Victora ◽  
Aluisio J D Barros
Keyword(s):  
Antenatal Care ◽  
Urban Areas ◽  
Global Analysis ◽  
Socioeconomic Inequalities ◽  
Middle Income ◽  
National Surveys ◽  
Middle Income Countries ◽  
Wide Range ◽  
The Difference ◽  
Low And Middle Income

Abstract Background: Antenatal care (ANC) is an essential intervention associated with a reduction of maternal and new-born morbidity and mortality. However, evidence suggested substantial inequalities in maternal and child health, mainly in low- and middle-income countries (LMICs). We aimed to conduct a global analysis of socioeconomic inequalities in ANC using national surveys from LMICs.Methods: ANC was measured using the ANCq, a novel content-qualified ANC coverage indicator, created and validated using national surveys, based upon contact with the health services and content of care received. We performed stratified analysis to explore the socioeconomic inequalities in ANCq. We also estimated the slope index of inequality, which measures the difference in coverage along the wealth spectrum. Results: We analyzed 63 national surveys carried out from 2010 to 2017. There were large inequalities between and within countries. Higher ANCq scores were observed among women living in urban areas, with secondary or more level of education, belonging to wealthier families and with higher empowerment in nearly all countries. Countries with higher ANCq mean presented lower inequalities; while countries with average ANCq scores presented wide range of inequality, with some managing to achieve very low inequality.Conclusions: Despite all efforts in ANC programs, important inequalities in coverage and quality of ANC services persist. If maternal and child mortality Sustainable Development Goals are to be achieved, those gaps we documented must be bridged.

scholarly journals Expanding the use of community health workers in urban settings: a potential strategy for progress towards universal health coverage

2019 ◽  
Author(s):  
Brian Wahl ◽  
Susanna Lehtimaki ◽  
Stefan Germann ◽  
Nina Schwalbe
Keyword(s):  
Health Services ◽  
Community Health ◽  
Low Income ◽  
Urban Areas ◽  
Access To Health Services ◽  
Middle Income ◽  
Urban Settings ◽  
Middle Income Countries ◽  
Access To Health ◽  
Low And Middle Income

Abstract Community health worker (CHW) programmes have been used for decades to improve access to health services in rural settings in low- and middle-income countries. With more than half of the world’s population currently living in urban areas and this population expected to grow, equitable access to health services in urban areas is critically important. To understand the extent to which CHW programmes have been successfully deployed in low-income urban settings, we conducted a review of the literature between 2000 and 2018 to identify studies evaluating and describing CHW programmes implemented fully or partially in urban or peri-urban settings. We identified 32 peer-reviewed articles that met our inclusion criteria. Benefits have been documented in several urban settings in low- and middle-income countries including those to address TB/HIV, child health, maternal health and non-communicable diseases through a variety of study designs.

scholarly journals Medical injection and access to sterile injection equipment in low- and middle-income countries: a meta-analysis of Demographic and Health Surveys (2010–2017)

2019 ◽  
Vol 12 (5) ◽  
pp. 388-394
Author(s):  
Emmanuel O Adewuyi ◽  
Asa Auta
Keyword(s):  
Health Surveys ◽  
Meta Analysis ◽  
Healthcare Services ◽  
Demographic And Health Surveys ◽  
Injection Equipment ◽  
Middle Income ◽  
Middle Income Countries ◽  
Unsafe Injection ◽  
Injection Practices ◽  
Low And Middle Income

Abstract Background Unsafe injection practices contribute to increased risks of blood-borne infections, including human immunodeficiency virus, hepatitis B and hepatitis C viruses. The aim of this study was to estimate the prevalence of medical injections as well as assess the level of access to sterile injection equipment by demographic factors in low- and middle-income countries (LMICs). Methods We carried out a meta-analysis of nationally representative Demographic and Health Surveys (DHSs) conducted between 2010 and 2017 in 39 LMICs. Random effects meta-analysis was used in estimating pooled and disaggregated prevalence. All analyses were conducted using Stata version 14 and Microsoft Excel 2016. Results The pooled 12-month prevalence estimate of medical injection was 32.4% (95% confidence interval 29.3–35.6). Pakistan, Rwanda and Myanmar had the highest prevalence of medical injection: 59.1%, 56.4% and 53.0%, respectively. Regionally, the prevalence of medical injection ranged from 13.5% in west Asia to 42.7% in south and southeast Asia. The pooled prevalence of access to sterile injection equipment was 96.5%, with Pakistan, Comoros and Afghanistan having comparatively less prevalence: 86.0%, 90.3% and 90.9%, respectively. Conclusions Overuse of medical injection and potentially unsafe injection practices remain a considerable challenge in LMICs. To stem the tides of these challenges, national governments of LMICs need to initiate appropriate interventions, including education of stakeholders, and equity in access to quality healthcare services.

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