Measuring Community Strengths – Using Data from The First Nations Regional Health Survey Linked with A Whole-Population Administrative Data Repository

IntroductionAdministrative data studies routinely report that First Nations mothers and children experience a disproportionate burden of poor health. Due to the nature of administrative data, research often takes a deficits-oriented approach. First Nations health research needs to consider the role that community- and individual-level strengths play in promoting wellbeing and examine how these interact with the delivery and outcomes of health programs. Objectives and ApproachThe First Nations Health and Social Secretariat of Manitoba (FNHSSM) and the University of Manitoba partnered to construct measures of community-level strengths that can be linked with administrative data to examine the delivery and outcomes associated with population health programs delivered in First Nations communities. We linked data from the FNHSSM-administered Regional Health Survey (RHS) with administrative data housed in the Manitoba Population Research Data Repository. We identified 60 questions from the child, youth, and adult versions of the RHS to measure community strengths. We used principal component analysis to identify strength-based constructs. We used Eigen values and percent of variance explained to determine the final number of factors. We used random group resampling and bootstrap methods to test for community-level homogeneity. Community-level factor scores were calculated as the scaled combination of RHS questions within each factor and averaged to the community. ResultsWe identified 12 constructs of community strength: 5 from child responses, 4 from youth, and 3 from adult responses. Strength-based constructs common to all age groups included knowledge of traditional language, involvement in cultural events, and connection with community. Conclusion / ImplicationsColonial approaches to health research perpetuate deficit-based dialogues and negative portrayal of First Nations peoples. First Nations health research should consider how community strengths promote health and interact with program delivery. Including measures of community strength leads to richer understandings of factors that promote wellness among First Nations peoples.

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Mental and physical health impacts of water/sanitation infrastructure in First Nations communities in Canada: An analysis of the Regional Health Survey

World Development ◽

10.1016/j.worlddev.2021.105517 ◽

2021 ◽

Vol 145 ◽

pp. 105517

Author(s):

Melanie O'Gorman

Keyword(s):

Physical Health ◽

First Nations ◽

Health Survey ◽

Health Impacts ◽

Regional Health ◽

Sanitation Infrastructure ◽

Mental And Physical Health

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The health of Canada’s Aboriginal children: results from the First Nations and Inuit Regional Health Survey

International Journal of Circumpolar Health ◽

10.3402/ijch.v69i2.17439 ◽

2010 ◽

Vol 69 (2) ◽

pp. 158-167 ◽

Cited By ~ 23

Author(s):

Harriet L. MacMillan ◽

Ellen Jamieson ◽

Chrstine Walsh ◽

Michael Boyle ◽

Allison Crawford ◽

...

Keyword(s):

First Nations ◽

Health Survey ◽

Regional Health ◽

Aboriginal Children

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256-S: Injuries Among Canadian Aboriginal on-Reserve Children and Youth: Findings from the First Nations and Inuit Regional Health Survey

American Journal of Epidemiology ◽

10.1093/aje/161.supplement_1.s64c ◽

2005 ◽

Vol 161 (Supplement_1) ◽

pp. S64-S64

Author(s):

A Ritchie ◽

J Reading ◽

B Elias

Keyword(s):

First Nations ◽

Health Survey ◽

Children And Youth ◽

Regional Health

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Geographical variations and associated factors of defaulting from immunization among children aged 12 to 23 months in Ethiopia: using spatial and multilevel analysis of 2016 Ethiopian Demographic and Health Survey

Environmental Health and Preventive Medicine ◽

10.1186/s12199-021-00984-8 ◽

2021 ◽

Vol 26 (1) ◽

Author(s):

Mukemil Awol ◽

Zewdie Aderaw Alemu ◽

Nurilign Abebe Moges ◽

Kemal Jemal

Keyword(s):

Multilevel Analysis ◽

Health Survey ◽

Associated Factors ◽

Demographic And Health Survey ◽

Community Level ◽

Scan Statistics ◽

Moran’S I ◽

Moran's I ◽

Depth Analysis ◽

Global Moran’S I

Abstract Background In Ethiopia, despite the considerable improvement in immunization coverage, the burden of defaulting from immunization among children is still high with marked variation among regions. However, the geographical variation and contextual factors of defaulting from immunization were poorly understood. Hence, this study aimed to identify the spatial pattern and associated factors of defaulting from immunization. Methods An in-depth analysis of the 2016 Ethiopian Demographic and Health Survey (EDHS 2016) data was used. A total of 1638 children nested in 552 enumeration areas (EAs) were included in the analysis. Global Moran’s I statistic and Bernoulli purely spatial scan statistics were employed to identify geographical patterns and detect spatial clusters of defaulting immunization, respectively. Multilevel logistic regression models were fitted to identify factors associated with defaulting immunization. A p value < 0.05 was used to identify significantly associated factors with defaulting of child immunization. Results A spatial heterogeneity of defaulting from immunization was observed (Global Moran’s I = 0.386379, p value < 0.001), and four significant SaTScan clusters of areas with high defaulting from immunization were detected. The most likely primary SaTScan cluster was seen in the Somali region, and secondary clusters were detected in (Afar, South Nation Nationality of people (SNNP), Oromiya, Amhara, and Gambella) regions. In the final model of the multilevel analysis, individual and community level factors accounted for 56.4% of the variance in the odds of defaulting immunization. Children from mothers who had no formal education (AOR = 4.23; 95% CI: 117, 15.78), and children living in Afar, Oromiya, Somali, SNNP, Gambella, and Harari regions had higher odds of having defaulted immunization from community level. Conclusions A clustered pattern of areas with high default of immunization was observed in Ethiopia. Both the individual and community-level characteristics were statistically significant factors of defaulting immunization. Therefore, the Federal Ethiopian Ministry of Health should prioritize the areas with defaulting of immunization and consider the identified factors for immunization interventions.

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Individual and community-level risk factors of women’s acceptance of intimate partner violence in Ethiopia: multilevel analysis of 2011 Ethiopian Demographic Health Survey

BMC Women s Health ◽

10.1186/s12905-021-01427-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Emiru Merdassa Atomssa ◽

Araya Abrha Medhanyie ◽

Girmatsion Fisseha

Keyword(s):

Risk Factors ◽

Intimate Partner Violence ◽

Health Survey ◽

Women's Education ◽

Partner Violence ◽

Significant Risk ◽

Intimate Partner ◽

Community Level ◽

State Region ◽

The Individual

Abstract Background The prevalence of Intimate partner violence (IPV) is higher in societies with higher acceptance of norms that support IPV. In Ethiopia, the proportion of women’s acceptance of IPV was 69%, posing a central challenge in preventing IPV. The main objective of this study was to assess the individual and community-level factors associated with women’s acceptance of IPV. Methods Two-level mixed-effects logistic regression was applied to the 2011 Ethiopia Demographic and Health Survey data. A total of 16,366 women nested in the 596 clusters were included in the analysis. Results The acceptability of the IPV was estimated to be 69%. Among the individual-level factors: women’s education with secondary and above (AOR = 0.38; 95% CI 0.29–0.52), partner’s education secondary and above (AOR = 0.71; 95% CI 0.54–0.82), women aged 35–49 years (AOR = 0.67; 95% CI 0.54–0.82), fully empowered in household level decision making (AOR = 0.67; 95% CI0.54–0.81), literate (AOR = 0.76; 95% CI 0.62–0.92), and perceived existence of law that prevents IPV (AOR = 0.56; 95% CI 0.50–0.63) were significantly associated with women’s acceptance of IPV. Similarly, rural residence (AOR = 1.93; 95% CI 1.53–2.43) and living in the State region (AOR = 2.37; 95% CI 1.81–3.10) were significantly associated with the women’s acceptance of IPV among the community-level factors. Conclusion Both individual and community-level factors were significant risk factors for the acceptability of intimate partner violence. Women's education, women's age, women’s empowerment, partner education level, perceived existence of the law, and literacy were among individual factors. State region and residence were among community-level risk factors significantly associated women’s acceptance of IPV.

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Less than one-fifth of the mothers practised exclusive breastfeeding in the emerging regions of Ethiopia: a multilevel analysis of the 2016 Ethiopian demographic and health survey

BMC Public Health ◽

10.1186/s12889-020-10071-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Tsegaye Gebremedhin ◽

Demiss Mulatu Geberu ◽

Asmamaw Atnafu

Keyword(s):

Health Survey ◽

Exclusive Breastfeeding ◽

Household Wealth ◽

Community Level ◽

Wealth Status ◽

Individual Level ◽

Factors Associated ◽

Breastfeeding Practices ◽

The Individual ◽

Low Coverage

Abstract Background The burden of low coverage of exclusive breastfeeding (EBF) has a significant impact on the health of a newborn and also on the family and social economy in the long term. Even though the prevalence of EBF practices in Ethiopia is low, the practices in the pastoral communities, in particular, are significantly low and affected by individual and community-level factors. Besides, its adverse outcomes are mostly unrecognised. Therefore, this study aimed to assess the individual and community-level factors of low coverage of EBF practices in the emerging regions of Ethiopia. Methods In this analysis, data from 2016 Ethiopian Demographic and Health Survey (EDHS) were used. A two-stage stratified sampling technique was used to identify 1406 children aged 0 to 23 months in the emerging regions of Ethiopia. A multilevel mixed-effect binary logistic regression analysis was used to determine the individual and community level factors associated with exclusive breastfeeding practices. In the final model, variables with a p-value of < 0.05 and Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were found to be statistically significant factors that affect exclusive breastfeeding practices. Results Overall, 17.6% (95% CI: 15.6–19.6) of the children aged 0 to 23 months have received exclusive breastfeeding. Employed mothers (AOR: 0.33, 95% CI: 0.21–0.53), richer household wealth status (AOR: 0.39, 95% CI: 0.16–0.96), mothers undecided to have more children (AOR: 2.29, 95% CI: 1.21–4.29), a child with a history of diarrhoea (AOR: 0.31, 95% CI: 0.16–0.61) were the individual-level factors, whereas Benishangul region (AOR: 2.63, 95% CI: 1.44–4.82) was the community-level factors associated with the exclusive breastfeeding practices. Conclusions Less than one-fifth of the mothers have practised exclusive breastfeeding in the emerging regions of Ethiopia. The individual-level factors such as mother’s employment status, household wealth status, desire for more children, presence of diarrhoea and community-level factors such as region have contributed to the low coverage of exclusive breastfeeding. Therefore, the federal and regional health bureaus and other implementers should emphasise to those emerging regions by creating awareness and strengthening the existing community-based health extension program to enhance exclusive breastfeeding practices.

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A multilevel analysis of overweight and obesity among non-pregnant women of reproductive age in Malawi: evidence from the 2015–16 Malawi Demographic and Health Survey

International Health ◽

10.1093/inthealth/ihy093 ◽

2018 ◽

Vol 11 (6) ◽

pp. 496-506 ◽

Cited By ~ 3

Author(s):

Peter Austin Morton Ntenda ◽

Jane Flora Kazambwe

Keyword(s):

Pregnant Women ◽

Health Survey ◽

Media Coverage ◽

White Collar ◽

Overweight And Obesity ◽

Demographic And Health Survey ◽

Community Level ◽

Reproductive Age ◽

The Individual ◽

Maternal Overweight

Abstract Background Overweight and obesity are well-known risk factors for non-communicable diseases such as cardiovascular disease, diabetes, some cancers and musculoskeletal disorders. In Malawi, the proportion of women who are overweight/obese has doubled, from 10% in 1992 to 21% in 2015–16. Therefore we aimed to explore the individual- and community-level factors associated with overweight and obesity among non-pregnant women of child-bearing age. Methods Secondary analysis of the 2015–16 Malawi Demographic and Health Survey was conducted. Overweight was defined as a body mass index (BMI) of 25 to <30 kg/m2, while obesity was defined as a BMI ≥30 kg/m2. Two-level multilevel multivariable logistic regression models were constructed using a logit-link function with a binomial distribution on 7326 women living in 850 different communities. Results At the individual level, the adjusted multilevel regression results showed that women 15–19 y of age as well as women from the poorest households had reduced odds of being overweight/obese. However, women with white collar jobs and women who were affiliated with the Church of Central Africa Presbyterian and the Roman Catholic church had increased odds of being overweight/obese. At the community level, women from urban areas and women who resided in communities with a low percentage of media exposure had increased odds of being overweight or obese. While women from poor communities had reduced odds of being overweight and obese, the proportion change in variance showed that 56, 77 and 78% of total variations in the odds of overweight, obese and overweight/obese across the communities were explained by both individual- and community-level factors. The median odds ratio showed that the likelihood of maternal overweight, obese and overweight/obese increased by 63, 39 and 84% when the women moved from low- to high-risk neighbourhoods. Conclusions Older women, Christian women, women with white collar jobs and women from the richest households should be targeted during policy formulation. At the community level, media coverage should be spread evenly so that health awareness messages, consequences and means of overweight and obesity prevention are getting to the targeted women. Our study revealed evidence of clustering effects of overweight and obesity at the community level, hence neighbourhood variations with respect to maternal overweight and obesity should be taken into account when designing nutritional policies.

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