Diarrhea in Under Five Year-old Children in Nepal: A Spatiotemporal Analysis Based on Demographic and Health Survey Data

Background: Diarrhea in children under five years of age remains a challenge in reducing child mortality in Nepal. Understanding the spatiotemporal patterns and influencing factors of the disease is important for control and intervention. Methods: Data regarding diarrhea prevalence and its potential influencing factors were extracted from the Demographic and Health Surveys in Nepal and other open-access databases. A Bayesian logistic regression model with district-specific spatio-temporal random effects was applied to explore the space and time patterns of diarrhea risk, as well as the relationships between the risk and the potential influencing factors. Results: Both the observed prevalence and the estimated spatiotemporal effects show a decreasing diarrhea risk trend from 2006 to 2016 in most districts of Nepal, with a few exceptions, such as Achham and Rasuwa. The disease risk decreased with mothers’ years of education (OR 0.93, 95% Bayesian Credible Interval (BCI) 0.87, 0.997). Compared to spring, autumn and winter had lower risks of diarrhea. The risk firstly increased and then decreased with age and children under 12–24 months old were the highest risk group (OR 1.20, 95% BCI 1.04, 1.38). Boys had higher risk than girls (OR 1.24, 95% BCI 1.13, 1.39). Even though improved sanitation wasn’t found significant within a 95% BCI, there was 93.2% of chance of it being a protective factor. There were no obvious spatiotemporal clusters among districts and each district tended to have its own spatiotemporal diarrhea prevalence pattern. Conclusions: The important risk factors identified by our Bayesian spatial-temporal modeling provide insights for control and intervention on children diarrhea in Nepal. Special attention should be paid to high risk groups of children and high risk seasons, as well as districts with high risk or increased trend of risk. Effective actions should be implemented to improve sanitation and women’s education level. District-specific control planning is recommended for local governments for effective control of children diarrhea in Nepal.

Download Full-text

Impact of High-Risk Fertility Behaviour on Under-five Mortality in Asia and Africa: Evidence from Demographic and Health Surveys

10.21203/rs.3.rs-29205/v2 ◽

2020 ◽

Author(s):

Rafi Amir-ud-Din ◽

Lubna Naz ◽

Anila Rubi ◽

Muhammad Usman ◽

Umesh Ghimire

Keyword(s):

Risk Factors ◽

High Risk ◽

Birth Order ◽

Birth Interval ◽

Health Surveys ◽

Maternal Age ◽

Demographic And Health Surveys ◽

Index Child ◽

Under Five ◽

Fertility Behaviour

Abstract Background: Smaller or older maternal age, smaller inter-pregnancy birth interval, and higher birth order of the child are considered to be high-risk fertility behaviour (HRFB). Under-five mortality being disproportionately concentrated in Asia and Africa, this study analyses the association between HRFB and under-five mortality in selected Asian and African countries. Methods: This study used Integrated Public Microdata Series-Demographic and Health Surveys (IPUMS-DHS) data from 32 countries in Sub-Saharan Africa, Middle East, North Africa, and South Asia from 1986 to 2017 (N=1,467,728). Previous evidence hints at four markers of HRFB: women's age at the birth of index child <18 years or >34 years, smaller preceding birth interval (PBI) <24 months, and child's birth order >3. Using logistic regression, we analysed the change in the odds of under-five mortality as a result of i) exposure to HRFB individually, ii) exposure to any single HRFB risk factor, iii) exposure to multiple HRFB risk factors, and iv) exposure to specific combinations of HRFB risk factors. Results: Mother's age at the birth of index child <18 years and preceding birth interval (PBI) <24 months were significant risk factors of under-five mortality, while a child's birth order >3 was a protective factor against under-five mortality. Presence of any single HRFB was associated with 1.067 times higher risk of under-five mortality (OR = 1.067; 95% CI: 1.042 - 1.090; P < 0.001). Presence of multiple HRFBs was associated with 1.392 times higher risk of under-five mortality (OR = 1.392; 95% CI: 1.355 - 1.431; P < 0.001). Some specific combinations of risky fertility behaviour such as younger maternal age (<18 years) and smaller preceding birth interval (PBI <24) significantly increased the odds of under-five mortality.Conclusion: Younger maternal age and small preceding birth interval significantly increase the risk of under-five mortality. This highlights the need for effective legislation to curb child marriages and increased public investment in reproductive healthcare with a focus on higher contraceptive use for an optimal interpregnancy interval.

Download Full-text

Impact of High-Risk Fertility Behaviour on Under-five Mortality in Asia and Africa: Evidence from Demographic and Health Surveys

10.21203/rs.3.rs-29205/v3 ◽

2020 ◽

Author(s):

Rafi Amir-ud-Din ◽

Lubna Naz ◽

Anila Rubi ◽

Muhammad Usman ◽

Umesh Ghimire

Keyword(s):

Risk Factors ◽

High Risk ◽

Birth Order ◽

Birth Interval ◽

Health Surveys ◽

Maternal Age ◽

Demographic And Health Surveys ◽

Index Child ◽

Under Five ◽

Fertility Behaviour

Abstract Background: Younger or older maternal age, short inter-pregnancy birth interval, and higher birth order of the child are considered to be high-risk fertility behaviour (HRFB). Under-five mortality being disproportionately concentrated in Asia and Africa, this study analyses the association between HRFB and under-five mortality in selected Asian and African countries.Methods: This study used Integrated Public Microdata Series-Demographic and Health Surveys (IPUMS-DHS) data from 32 countries in Sub-Saharan Africa, Middle East, North Africa, and South Asia from 1986 to 2017 (N=1,467,728). Previous evidence hints at four markers of HRFB: women’s age at the birth of index child <18 years or >34 years, short preceding birth interval (PBI) <24 months, and child’s birth order >3. Using logistic regression, we analysed the change in the odds of under-five mortality as a result of i) exposure to HRFB individually, ii) exposure to any single HRFB risk factor, iii) exposure to multiple HRFB risk factors, and iv) exposure to specific combinations of HRFB risk factors. Results: Mother’s age at the birth of index child <18 years and preceding birth interval (PBI) <24 months were significant risk factors of under-five mortality, while a child’s birth order >3 was a protective factor against under-five mortality. Presence of any single HRFB was associated with 1.067 times higher risk of under-five mortality (OR = 1.067; 95% CI: 1.042 - 1.090; P < 0.001). Presence of multiple HRFBs was associated with 1.392 times higher risk of under-five mortality (OR = 1.392; 95% CI: 1.355 - 1.431; P < 0.001). Some specific combinations of risky fertility behaviour such as younger maternal age (<18 years) and short preceding birth interval (PBI <24) significantly increased the odds of under-five mortality.Conclusion: Younger maternal age and short preceding birth interval significantly increase the risk of under-five mortality. This highlights the need for effective legislation to curb child marriages and increased public investment in reproductive healthcare with a focus on higher contraceptive use for an optimal interpregnancy interval.

Download Full-text

Exploring spatiotemporal distribution of under-five mortality in Ethiopia: further analysis of Ethiopian Demographic and Health Surveys 2000, 2005, 2011 and 2016

BMJ Paediatrics Open ◽

10.1136/bmjpo-2021-001047 ◽

2021 ◽

Vol 5 (1) ◽

pp. e001047

Author(s):

Alemneh Mekuriaw Liyew ◽

Ayenew Kassie ◽

Achamyeleh Birhanu Teshale ◽

Adugnaw Zeleke Alem ◽

Yigizie Yeshaw ◽

...

Keyword(s):

High Risk ◽

Health Surveys ◽

Spatiotemporal Distribution ◽

Scan Statistics ◽

Demographic And Health Surveys ◽

Hotspot Analysis ◽

Under Five ◽

Geographical Regions ◽

Risk Areas ◽

Benishangul Gumuz Region

ObjectiveThe aim of this study was to explore spatiotemporal distribution of under-five mortality in Ethiopia using data from four (2000, 2005, 2011 and 2016) consecutive demographic and health surveys.MethodsA total of 41 498 children were included from four consecutive Ethiopian Demographic and Health Surveys. The geospatial analysis was conducted by using ArcGIS V.10.7 and saTScan V.9.6. Thus, spatial autocorrelation, hotspot analysis, spatial interpolation and spatial scan statistics were carried out for each survey separately to show the temporal pattern of geographically risk areas of under-five mortality in Ethiopia. Finally, the most under-five mortality rate (U5MR) risk areas in each survey period were mapped.ResultsUnder-five mortality was spatially clustered in Ethiopia (Moran’s Index: 0.046–0.096, p<0.01). The Benishangul-Gumuz region was consistently at a higher risk in the last two decades. Additional hotspot areas were detected at Afar and Amhara (in 2000, 2005, 2016), at Gambala (in 2011) and the South Nation Nationality and People’s (SNNP) Region (in 2016). Moreover, 160 primary clusters were identified. Of these, 85 clusters (log-likelihood ratio (LLR)=13.10, p<0.01) were from Benishangul-Gumuz and Amhara regions (in 2000); 67 clusters (LLR=12.93, p<0.01) were from Afar and Amhara regions (in 2005); 4 clusters (LLR=10.54, p<0.01) were from Benishangul-Gumuz region (in 2011); and another 4 clusters (LLR=11.85, p<0.01) were from Afar region (in 2016).ConclusionHigh-risk areas were detected mainly in the Benishangul-Gumuz and Afar regions. As a result, designing under-five population targeted intervention programmes in those high-risk geographical regions was vital to reduce under-five mortality in Ethiopia.

Download Full-text

Impact of High-Risk Fertility Behavior on Under-five Mortality in Asia and Africa: Evidence from Demographic and Health Surveys

10.21203/rs.3.rs-29205/v1 ◽

2020 ◽

Author(s):

Rafi Amir-ud-Din ◽

Lubna Naz ◽

Anila Rubi ◽

Muhammad Usman ◽

Umesh Ghimire

Keyword(s):

High Risk ◽

Birth Order ◽

Child Mortality ◽

South Asian ◽

Birth Interval ◽

Health Surveys ◽

Demographic And Health Surveys ◽

African Countries ◽

Under Five ◽

Increased Risk

Abstract Background High-risk fertility behaviors (HRFBs) are common in African and South Asian countries and can potentially affect child survival. This study examines the high-risk fertility behaviors concerning child mortality across the countries. Method Data from a series of Demographic and Health Surveys from the year 1987 to 2016 from 24 South Asian and African countries (N=1,224,832) were included in this study. Four HRFB parameters - women’s age <18 or >=34 years at childbirth, birth spacing <24 months, and child order of birth >3, were categorized into three exposure levels: i) exposure to any HRFBs category (exposure to any of four parameters); ii) exposure to single and multiple HRFB category (a combination of two or more parameters); and iii) the specific type of HRFB category (either single or multiple HRFB categories). Bivariate descriptive analysis and a multivariate logistic regression model were used to examine the association between under-five child mortality and various measures of HRFBs. Results Our pooled data analysis reported that HRFBs was associated with an increased risk of under-five child mortality in Asian and African countries. Children of women exposed to HRFBs were at increased risk of under-five mortality by 77% (Adjusted Odds Ratio (AOR) = 1.771, 95% confidence interval (CI): 1.722 - 1.821). Children born within 24 months’ birth interval were four times more likely to die (AOR = 4.995, 95% CI: 4.842-5.152) than their counterparts. However, a single high-risk category was not associated with under-five mortality, and birth order was found to be a protective factor against under-five mortality. Age of women (<18 or >=34 years) was found to be a risk factor of Under-five child mortality in 16 countries. The association between under-five mortality risk and birth interval of less than 24 months was highly significant in all countries. Conclusion Women’s age at childbirth, birth interval, and birth order were significantly associated with under-five mortality. Quality care for women and newborns need to be ensured through investment in the healthcare system, and by promoting health services with more focus given to the valuable populations through sexual and reproductive health education programs and empowering women.

Download Full-text

A Peri-Implant Disease Risk Score for Patients with Dental Implants: Validation and the Influence of the Interval between Maintenance Appointments

Journal of Clinical Medicine ◽

10.3390/jcm8020252 ◽

2019 ◽

Vol 8 (2) ◽

pp. 252 ◽

Cited By ~ 4

Author(s):

Miguel de Araújo Nobre ◽

Francisco Salvado ◽

Paulo Nogueira ◽

Evangelista Rocha ◽

Peter Ilg ◽

...

Keyword(s):

High Risk ◽

Risk Score ◽

Disease Risk ◽

Disease Incidence ◽

Risk Groups ◽

Risk Profile ◽

Moderate Risk ◽

C Statistic ◽

Disease Risk Score ◽

Very High

Background: There is a need for tools that provide prediction of peri-implant disease. The purpose of this study was to validate a risk score for peri-implant disease and to assess the influence of the recall regimen in disease incidence based on a five-year retrospective cohort. Methods: Three hundred and fifty-three patients with 1238 implants were observed. A risk score was calculated from eight predictors and risk groups were established. Relative risk (RR) was estimated using logistic regression, and the c-statistic was calculated. The effect/impact of the recall regimen (≤ six months; > six months) on the incidence of peri-implant disease was evaluated for a subset of cases and matched controls. The RR and the proportional attributable risk (PAR) were estimated. Results: At baseline, patients fell into the following risk profiles: low-risk (n = 102, 28.9%), moderate-risk (n = 68, 19.3%), high-risk (n = 77, 21.8%), and very high-risk (n = 106, 30%). The incidence of peri-implant disease over five years was 24.1% (n = 85 patients). The RR for the risk groups was 5.52 (c-statistic = 0.858). The RR for a longer recall regimen was 1.06, corresponding to a PAR of 5.87%. Conclusions: The risk score for estimating peri-implant disease was validated and showed very good performance. Maintenance appointments of < six months or > six months did not influence the incidence of peri-implant disease when considering the matching of cases and controls by risk profile.

Download Full-text

Trajectory data based freeway high-risk events prediction and its influencing factors analyses

Accident Analysis & Prevention ◽

10.1016/j.aap.2021.106085 ◽

2021 ◽

Vol 154 ◽

pp. 106085

Author(s):

Rongjie Yu ◽

Lei Han ◽

Hui Zhang

Keyword(s):

High Risk ◽

Influencing Factors ◽

Trajectory Data

Download Full-text

Trends of inequalities in care seeking behavior for under-five children with suspected pneumonia in Ethiopia: evidence from Ethiopia demographic and health surveys (2005–2016)

BMC Public Health ◽

10.1186/s12889-021-10232-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Gebretsadik Shibre ◽

Betregiorgis Zegeye ◽

Dina Idriss-Wheeler ◽

Sanni Yaya

Keyword(s):

Health Surveys ◽

Demographic And Health Surveys ◽

Care Seeking ◽

Health Seeking ◽

Under Five ◽

Under Five Children ◽

Care Seeking Behavior ◽

Seeking Behavior ◽

Index Of Inequality ◽

Suspected Pneumonia

Abstract Background Pneumonia is a leading public health problem in under-five children worldwide and particularly in Africa. Unfortunately, progress in reducing pneumonia related mortality has been slow. The number of children with symptoms of pneumonia taken to health facilities for treatment is low in Ethiopia, and disparities among sub-groups regarding health seeking behavior for pneumonia have not been well explored in the region. This study assessed the trends of inequalities in care seeking behavior for children under five years of age with suspected pneumonia in Ethiopia. Methods Using cross-sectional data from the 2005, 2011 and 2016 Ethiopia Demographic and Health Surveys (DHS) and the World Health Organization’s (WHO) Health Equity Assessment Toolkit (HEAT), this study investigated the inequalities in health seeking behavior for children with suspected pneumonia. Four measures of inequality were calculated: Difference, Ratio, Slope Index of Inequality and Relative Index of Inequality. Results were disaggregated by wealth, education, residence, and sex with computed 95% Uncertainty Intervals for each point estimate to determine significance. Results The percentage of under-five children with symptoms of pneumonia who were taken to a health facility was significantly lower for children in the poorest families, 15.48% (95% UI; 9.77, 23.64) as compared to children in the richest families, 61.72% (95% UI; 45.06, 76.02) in 2011. Substantial absolute (SII = 35.61; 95% UI: 25.31, 45.92) and relative (RII = 4.04%; 95% UI: 2.25, 5.84) economic inequalities were also observed. Both educational and geographic inequalities were observed; (RII = 2.07; 95% UI: 1.08, 3.06) and (D = 28.26; 95% UI: 7.14, 49.37), respectively. Economic inequality decreased from 2011 to 2016. There was no statistically significant difference between male and female under-five children with pneumonia symptoms taken to health facility, in all the studied years. Conclusions Health care seeking behavior for children with pneumonia was lower among the poorest and non-educated families as well as children in rural regions. Policies and strategies need to target subpopulations lagging behind in seeking care for pneumonia treatment as it impedes achievement of key UN sustainable development goals (SDGs).

Download Full-text

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

Vaccines ◽

10.3390/vaccines9060646 ◽

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.

Download Full-text

HYPERTENSION – A PUBLIC HEALTH PROBLEM

10.5644/pi2019.181.04 ◽

2019 ◽

Author(s):

Adia Pilav ◽

Emira Tanović-Mikulec ◽

Suada Branković ◽

Vedran Đido

Keyword(s):

Public Health ◽

High Risk ◽

Public Health Problem ◽

Integrated Approach ◽

Community Level ◽

Effective Control ◽

Population Approach ◽

Hypertension Control ◽

Adequate Model ◽

High Prevalence

Aim. The aim of this paper is to present public health importance of hypertension in population as one of the major CVD risk factor as well as a model of integrated approach to hypertension control at community level. Background. In spite of wide knowledge of pathophysiology and epidemiology in development of hypertension, ability to easily diagnose it, availability of efficient medications, hypertension continues to have high prevalence and setting up hypertension controls poses significant public health challenge. High prevalence of hypertension exists in all countries of the world, regardless of socioeconomic status of the country. It is estimated that the number of people with hypertension by 2025 will rise by 15-20%, and the number of sick people will increase up to 1.5 billion people worldwide. Methods. A review of the relevant literature which discusses the importance of defining clear strategies and interventions in the control of hypertension in countries, with particular emphasis on integrated hypertension management that has the greatest impact. Discussion. Effective and efficient hypertension control requires two approaches: population approach and individual approach to high-risk individuals. The balanced combination of population approach and an approach to access high-risk individuals is vital for the effective control of hypertension and cardiovascular diseases. Conclusions. Health systems in every country must be flexible and ready to provide adequate model of integrated approach to hypertension control at community level understanding their own local needs.

Download Full-text

Health-related quality of life and its influencing factors in individuals with high cardiovascular disease risk: a cross-sectional study based on EQ-5D utility scores in Inner Mongolia, China

10.21203/rs.3.rs-386347/v1 ◽

2021 ◽

Author(s):

Ning Cao ◽

Yunfeng Xi ◽

Yumin Gao ◽

Hailing Li ◽

Yanchao Liu ◽

...

Keyword(s):

Quality Of Life ◽

High Risk ◽

Influencing Factors ◽

Inner Mongolia ◽

Health Related Quality ◽

Tobit Regression ◽

Cvd Risk ◽

Related Quality ◽

Health Related

Abstract Background The high risk of cardiovascular disease (CVD) being associated with impaired Health-related quality of life (HRQoL). However, few studies have assessed the HRQoL of individuals with a high risk of CVD in Inner Mongolia, or even in China. We aimed to assess health-related quality of life (HRQoL) among individuals in Inner Mongolia with a high risk of CVD and its risk factors, to provide a reference to improve HRQoL in individuals with high CVD risk. Methods From 2015 to 2017, residents of six villages or communities in Inner Mongolia, selected using a multi-stage stratified cluster random sampling method, were invited to complete a questionnaire and undergo physical examination and laboratory testing. We selected participants whose predicted 10-year risk for CVD exceeded 10% as those with high CVD risk. HRQoL in individuals with high CVD risk was investigated based on the EuroQol-5 Dimension (EQ-5D) scale. The Chinese utility value integral system was used to calculate EQ-5D utility scores, and the Tobit regression model were used to analyze the influencing factors of HRQoL among individuals with high CVD risk. Results Of 13,359 participants with high CVD risk, 65.63% reported no problems in any of the five dimensions; the most frequently reported difficulty was pain/discomfort. The mean utility score was 1.000 (0.869, 1.000). Tobit regression analysis showed that sex, age, education level, residence area, household income, physical activity, hypertension, and dyslipidemia were influencing factors of HRQoL. Conclusion We found that female sex, older age, living in an urban area, lower education level, lower household income, and lower physical activity levels were associated with reduced HRQoL. People with a high risk of CVD should maintain their blood glucose and lipid levels within the normal range.

Download Full-text