Skin-to-skin contact and breastfeeding practices in Nigeria: a study of socioeconomic inequalities

Background The effects of breastfeeding practices on children’s health are undoubtedly of great interest. However, inequalities in breastfeeding practices and mother and newborn skin-to-skin contact (SSC) exist in many resource-constrained settings. This study examined the regional prevalence and socioeconomic inequalities in exclusive breastfeeding (EBF), early initiation of breastfeeding and SSC in Nigeria. Methods Data on 2936 infants under six months were extracted from the 2018 Nigeria Demographic and Health Survey (NDHS) to determine EBF. In addition, data on 21,569 children were analysed for early initiation of breastfeeding and SSC. Concentration index and curves were used to measure socioeconomic inequalities in EBF, early initiation of breastfeeding and SSC. Results The prevalence of EBF, early initiation of breastfeeding and SSC were 31.8, 44.2 and 12.1% respectively. Furthermore, Ogun state had the highest prevalence of EBF (71.4%); while Bayelsa state had the highest prevalence of SSC (67.8%) and early initiation of breastfeeding (96.2%) respectively. Urban dwellers had higher prevalence of EBF, SSC and early initiation of breastfeeding across household wealth quintile and by levels of mothers’ education in contrast to their rural counterparts. We quantified inequalities in early initiation of breastfeeding, EBF, and SSC according to household wealth and maternal education. The study outcomes had greater coverage in higher household wealth, in contrast to the lower household wealth groups; early initiation of breastfeeding (concentration index = 0.103; p = 0.002), EBF (concentration index = 0.118; p < 0.001), and SSC (concentration index = 0.152; p < 0.001) respectively. Furthermore, early initiation of breastfeeding (concentration index = 0.091; p < 0.001), EBF (concentration index = 0.157; p < 0.001) and SSC (concentration index = 0.156; p < 0.001) had greater coverage among mothers with higher educational attainment. Conclusion Low prevalence and socioeconomic inequalities in early initiation of breastfeeding, EBF and SSC were identified. We recommend that health promotion programs targeted and co-designed with disadvantaged mothers are critical to meet global breastfeeding targets. Also, future researchers should conduct further studies especially clinical control trials and qualitative studies to unravel the possible reasons for differences in the indicators.

Equity of Social Health Insurance Coverage for Migrants in Thailand: A Concentration Index Analysis

Thailand is attempting to implement an effective health insurance scheme to cover all migrant workers in the country. One of the remarkable policies is the Social Security Scheme (SSS). This study aims to assess the equity of SSS coverage among migrant workers in Thailand, sorted by types of businesses (agriculture, services and industrial sectors) and Gross Provincial Product (GPP) per capita. A secondary data analysis on time series cross-sectional data was employed. The dataset comprised: (1) the number of migrant insurees under the SSS; (2) the volume of migrant insurees in formal and informal sectors; and (3) provincial economic level and provincial population by years from 2015–2018. Descriptive statistics, Spearman’s rank correlation, and concentration index analysis on the ratio of SSS insurees to all migrants ranked by GPP per capita and business types from 2015–2018 were performed. Results showed that the ratio of SSS insurees to all migrants increased from 38.5% to 58.9%. Spearman’s correlation found a positive relationship between the SSS coverage and GPP per capita and business types in 2018. The statistical significance (p < 0.001) was found only in the industrial sector (rs = 0.346). Significant CIs were found in SSS coverage in the industrial sector in 2016 (CI = 0.147, p < 0.001), and SSS coverage in the industrial sector in 2017 (CI = 0.137, p < 0.001). In conclusion, the trend of CIs displayed a movement towards zero for all business types. This implied that the distribution of migrants in SSS shifted toward the equitable distribution across provinces in Thailand. A possible explanation was a major change in Thai politics in 2014 and a change in employment legislation for migrants in 2017. To expand the insurance coverage, the government should use the CI as a guide to consider specific provinces or target specific economic sectors as a priority to expedite the insurance enrolment for migrants.

Time Series Trend Analysis of Rainfall and Temperature over Kolkata and Surrounding Region

Study of long term variability of temperature and rainfall in the context of climate change is of much importance particularly in the region where rainfed agriculture is predominant. Long term trends of temperature and rainfall have been investigated over Kolkata, India, a tropical region using gridded monthly precipitation and temperature data obtained from Global Precipitation and Climate Centre (GPCC V7) with 0.5° X 0.5° resolution for the period 1901 to 2014. Precipitation concentration index, coefficient of variation, rainfall anomaly have been calculated and Palmer drought severity index data have been analyzed. Furthermore, Mann-Kendall test and sen’s slope estimator have been used to detect time series trend. Annual temperature and rainfall have been increased with a rate of 0.0082°C/ year and 0.03 mm/ year respectively. Statistically significant increasing trend has been observed for most of the months for temperature and rainfall. Winter and monsoon period shows highest and lowest inter-annual variability respectively. Rainfall with high precipitation concentration index (16-20) has been observed for the period 1951-1975 and 1976-2000. It has been observed that the number of years with dry conditions have been increased. However, the intensity of dryness is very near to zero. The information from this study will be helpful for the farmers to plan for resilient farming.

Omadacycline Potentiates Clarithromycin Activity Against Mycobacterium abscessus

Mycobacterium abscessus is a difficult respiratory pathogen to treat, when compared to other nontuberculus mycobacteria (NTM), due to its drug resistance. In this study, we aimed to find a new clarithromycin partner that potentiated strong, positive, synergy against M. abscessus among current anti-M. abscessus drugs, including omadacycline, amikacin, rifabutin, bedaquiline, and cefoxitine. First, we determined the minimum inhibitory concentrations required of all the drugs tested for M. abscessus subsp. abscessus CIP104536T treatment using a resazurin microplate assay. Next, the best synergistic partner for clarithromycin against M. abscessus was determined using an in vitro checkerboard combination assay. Among the drug combinations evaluated, omadacycline showed the best synergistic effect with clarithromycin, with a fractional inhibitory concentration index of 0.4. This positive effect was also observed against M. abscessus clinical isolates and anti-M. abscessus drug resistant strains. Lastly, this combination was further validated using a M. abscessus infected zebrafish model. In this model, the clarithromycin-omadacyline regimen was found to inhibit the dissemination of M. abscessus, and it significantly extended the lifespan of the M. abscessus infected zebrafish. In summation, the synergy between two anti-M. abscessus compounds, clarithromycin and omadacycline, provides an attractive foundation for a new M. abscessus treatment regimen.

The dynamics of industrial geographic distribution: evidence from Brazil (2002-2014)

ABSTRACT The geographical distribution of Brazilian industries changed between 2002 and 2014, and it was more significant for some industries. Based on Dumais et al. (2002), we explore the dynamics of these changes by a decomposition of the employment variation and concentration index for manufacturing industries grouped by technological intensity, and we identify the direction of the locational movements of the firms among microregions. In general., the results indicate that between 2002 and 2014, there was a trend of convergence among the microregions’ participation in industrial employment, contributing to industrial deconcentration in the country, with the exception of the group of high-technology industries, which became more concentrated. Components of the life cycle of industries, especially the growth of employment generated by new industries in non-metropolitan microregions, are identified as main propelling of this evidence. In general., the results are consistent with the importance of agglomeration economies over historic accidents to explain the industrial concentration in Brazil between 2002 and 2014.

Predictors of wealth-related inequality in institutional delivery: a decomposition analysis using Nepal multiple Indicator cluster survey (MICS) 2019

Background Inequality in maternal healthcare use is a major concern for low-and middle-income countries (LMICs). Maternal health indicators at the national level have markedly improved in the last couple of decades in Nepal. However, the progress is not uniform across different population sub-groups. This study aims to identify the determinants of institutional delivery, measure wealth-related inequality, and examine the key components that explain the inequality. Methods Most recent nationally representative Multiple Indicator Cluster Survey (MICS) 2019 was used to extract data about married women (15-49 years) with a live birth within two years preceding the survey. Logistic regression models were employed to assess the association of independent variables with the institutional delivery. The concentration curve (CC) and concentration index (CIX) were used to analyze the inequality in institutional delivery. Wealth index scores were used as a socio-economic variable to rank households. Decomposition was performed to identify the determinants that explain socio-economic inequality. Results The socio-economic status of households to which women belong was a significant predictor of institutional delivery, along with age, parity, four or more ANC visits, education status of women, area of residence, sex of household head, religious belief, and province. The concentration curve was below the line of equality and the relative concentration index (CIX) was 0.097 (p < 0.001), meaning the institutional delivery was disproportionately higher among women from wealthy groups. The decomposition analysis showed the following variables as the most significant contributor to the inequality: wealth status of women (53.20%), education of women (17.02%), residence (8.64%) and ANC visit (6.84%). Conclusions To reduce the existing socio-economic inequality in institutional delivery, health policies and strategies should focus more on poorest and poor quintiles of the population. The strategies should also focus on raising the education level of women especially from the rural and relatively backward province (Province 2). Increasing antenatal care (ANC) coverage through outreach campaigns is likely to increase facility-based delivery and decrease inequality. Monitoring of healthcare indicators at different sub-population levels (for example wealth, residence, province) is key to ensure equitable improvement in health status and achieve universal health coverage (UHC).

Changes in Inequality in Utilization of Maternal Health Care: Evidence from Skilled Birth Attendance in Mauritania for the Period 2007-2015

Background: The presence of a skilled health professional at delivery is critical to reduce infant and maternal mortality. Health development plans and strategies, especially in developing countries, consider equity in access to maternal health care services as a priority. This study aimed to measure and analyze the inequality in the use of skilled births attendance services in Mauritania. The study identifies the inequality determinants and to explore its changes over the period 2007&ndash;2015. Methods: The concentration curve, concentration index, decomposition of the concentration index and Oaxaca-type decomposition technique were performed to measure socio-economics related inequalities in skilled birth attendance services utilization and identify contribution of different determinants to such inequality as well as the changes in inequality overtime using data from Mauritania Multiple Indicator Cluster Surveys (MICS) 2007, 2011 and 2015. Results: The concentration index for skilled birth attendance services utilization dropped from 0.6324 [P &lt; 0.001] in 2007 to 0.5852 [P &lt; 0.001] in 2015. Prenatal care, household wealth Status and urban-rural location made the biggest contributions to socio-economic related inequalities. Decomposition of the concentration index and Oaxaca-type decomposition revealed changes prenatal care, rural-urban location made positive contributions to decline in inequality. However, alternation in household wealth score, woman&rsquo;s age, her education level and the number of living children pushed the equality toward deterioration. Conclusion: Clearly, the pro-rich inequality in skilled birth attendance is high in Mauritania despite a slight decrease during the study period. Policy actions on eliminating urban-rural and wealth index disparity should target increase access to skilled birth attendance. Multisectoral Policy actions is needed to improve social determinants of health and to remove health system bottlenecks including socio-economic empowerment of women and girls, enhancing availability and affordability of Reproductive and Maternal Health commodities, improving availability of obstetrical providers in rural area, promoting a better distribution and quality of health infrastructure particularly health posts and health centers, and replacing user fees by an equitable, efficient and sustainable financing scheme under an universal health coverage vision.

Understanding socio-economic inequalities in the prevalence of asthma in India: an evidence from national sample survey 2017–18

Background Today, over 300 million people reside with asthma worldwide and India alone is home for 6% of children and 2% of adults suffering from this chronic disease. A common notion of disparity persists in terms of health outcomes across the poor and better-off section of the society. Thus, there is a need to explore socio-economic inequality in the contribution of various factors associated with asthma prevalence in India. Methods Data for the study were carved out from the 75th round of National Sample Survey (NSS), collected by the National Sample Survey Organization (NSSO) during 2017–18. The sample size for this study was 555,289 individuals, for which data was used for the analysis. Descriptive statistics were used to show the distribution of the study population. Further, bivariate and multivariate analysis was performed to identify the factors associated with Asthma prevalence. The concentration index was used to measure the inequality. Further, we used decomposition analysis to find the contribution of factors responsible for socio-economic status-related inequality in asthma prevalence. Results The prevalence of asthma was 2 per 1000 in the whole population; however, the prevalence differs by age groups in a significant manner. Age, sex, educational status, place of residence, cooking fuel, source of drinking water, household size and garbage disposal facility were significantly associated with asthma prevalence in India. It was found that asthma was more concentrated among individuals from higher socioeconomic status (concentration index: 0.15; p < 0.05). While exploring socio-economic inequality for asthma, richest wealth status (53.9%) was the most significant contributor in explaining the majority of the inequality followed by the urban place of residence (37.9%) and individual from age group 45–65 years (33.3%). Additionally, individual aged 65 years and above (27.9%) and household size less than four members (14.7%) contributed in explaining socio-economic inequality for asthma. Conclusion Due to the heterogeneous nature of asthma, associations between different socio-economic indicators and asthma can be complex and may point in different directions. Hence, considering the concentration of asthma prevalence in vulnerable populations and its long-term effect on general health, a comprehensive programme to tackle chronic respiratory diseases and asthma, in particular, is urgently needed.

Determinants of change in the inequality and associated predictors of teenage pregnancy in Uganda for the period 2006–2016: analysis of the Uganda Demographic and Health Surveys

ObjectiveTeenage pregnancy has become a public health concern in Uganda because of its negative consequences to both the mother and child. The objective of this study was to examine the determinants of change in the inequality and associated predictors of teenage pregnancy in Uganda for the period 2006–2016.Study designA retrospective national cross-sectional study.SettingUganda.ParticipantsUganda Demographic and Health Survey secondary data of only female teenagers aged 15–19 years. The samples selected for analyses were 1936 in 2006; 2048 in 2011 and 4264 in 2016.Outcome measureThe primary outcome was teenage pregnancy. Analysis was performed using the logistic regression, equiplots, concentration curve, normalised concentration index, decomposition of the concentration index and Oaxaca-type decomposition.ResultsThe prevalence of teenage pregnancy has seemingly remained high and almost constant from 2006 to 2016 with the risk worsening to the disadvantage of the poor. Household wealth-index, teenagers’ years of education, early sexual debut and child marriage were the main key predictors and contributors of the large inequality in teenage pregnancy from 2006 to 2016.ConclusionTeenage pregnancy is disproportionately prevalent among different subpopulations of adolescent girls in Uganda. We therefore recommend policy actions to sensitise communities and enforcement of child rights and child protection laws to stop child marriages. There is also need to promote girl child education, improving household incomes, and intensifying mass media awareness on the risks of early pregnancies. Further, ensuring that villages have operational adolescent and youth friendly services as well as incorporating sex education and other different adolescent reproductive health programmes in school curriculum will be key measures in reducing the large inequality in teenage pregnancy.

Inequalities in Knowledge About COVID-19 in the Kingdom of Saudi Arabia

Background: As the world is still being ravaged by the coronavirus disease 2019 (COVID-19) pandemic, the first line of prevention lies in understanding the causative and preventive factors of the disease. However, given varied socioeconomic circumstances, there may be some inequality in the level of proper knowledge of COVID-19. Despite a proliferation of studies on COVID-19, the extent and prevalence of inequalities in knowledge about COVID-19 in Saudi Arabia are not known. Most related studies have only focused on understanding the determinants of COVID-19 knowledge. Therefore, the aim of this study was to assess the socioeconomic inequalities in knowledge regarding COVID-19 in Saudi Arabia.Methods: Data were extracted from an online cross-sectional self-reported questionnaire conducted on the knowledge about COVID-19 from 3,388 participants. Frequencies and graphs were used to identify the level and distribution of inequality in knowledge about COVID-19. Concentration curves and concentration indices were further used to assess and quantify the income- and education-related inequality in knowledge about COVID-19.Results: The level of COVID-19 knowledge was high among the surveyed sample, although the extent of knowledge varied. The findings further suggest the existence of socioeconomic inequality in obtaining proper knowledge about COVID-19, indicating that inequality in comprehensive knowledge is disproportionately concentrated among the wealthy (concentration index = 0.016; P &lt; 0.001) and highly educated individuals (concentration index = 0.003; P = 0.029) in Saudi Arabia.Conclusions: There is inequality in the level of knowledge about COVID-19 among the more socioeconomically privileged population of Saudi Arabia. Given that COVID-19 cases ebb and flow in different waves, it is important that proper policies be put in place that will help in improving knowledge among the lower income and less educated individuals, leading to behavior that can help reduce transmission.