Determinants of Regional Economic Resilience to Economic Crisis: Evidence from Chinese Economies

The severity of the 2007–2008 economic crisis and the spatial heterogeneity of its impact have accelerated the study of regional economic resilience. The economic crisis has affected most parts of the world, and its impact is highly heterogeneous within China. The aim of this study was to explore the determinants of regional economic resilience across 284 Chinese cities from 2003–2018. Both nation-based and province-based regional economic resilience were examined. A multilevel logistic regression model was established, finding a disparity of provincial effects on regional performance during the economic crisis. Regional economic resilience is significantly affected by provincial trajectories, economy size, and resources. There are five significant determinants of economic resilience: income inequality, innovation, government intervention, human capital, and financial development. The results provide evidence for the government to design region-based policies, taking into consideration the size and the resources of the region’s economy to build a resilient wall to defend against external shocks and to form a basis for sustainable development.

Pediatric Medication Noninitiation in Spain

OBJECTIVES To estimate medication noninitiation prevalence in the pediatric population and identify the explanatory factors underlying this behavior. METHODS Observational study of patients (<18 years old) receiving at least 1 new prescription (28 pharmaceutical subgroups; July 2017 to June 2018) in Catalonia, Spain. A prescription was considered new when there was no prescription for the same pharmaceutical subgroup in the previous 6 months. Noninitiation occurred when a prescription was not filled within 1 month or 6 months (sensitivity analysis). Prevalence was estimated as the proportion of total prescriptions not initiated. To identify explanatory factors, a multivariable multilevel logistic regression model was used, and adjusted odds ratios were reported. RESULTS Overall, 1 539 003 new prescriptions were issued to 715 895 children. The overall prevalence of 1-month noninitiation was 9.0% (ranging from 2.6% [oral antibiotics] to 21.5% [proton pump inhibitors]), and the prevalence of 6-month noninitiation was 8.5%. Noninitiation was higher in the youngest and oldest population groups, in children from families with a 0% copayment rate (vulnerable populations) and those with conditions from external causes. Out-of-pocket costs of drugs increased the odds of noninitiation. The odds of noninitiation were lower when the prescription was issued by a pediatrician (compared with a primary or secondary care clinician). CONCLUSIONS The prevalence of noninitiation of medical treatments in pediatrics is high and varies according to patients’ ages and medical groups. Results suggest that there are inequities in access to pharmacologic treatments in this population that must be taken into account by health care planners and providers.

Sex Differences in Migraine: A Twin Study

Migraine is a neurological disorder with a prominent sex difference such that two thirds of sufferers are female. The mechanisms behind the preponderance of migraine in women have yet to be elucidated. With data on 51,872 participants from the Swedish Twin Registry, we report results from two distinct analyses intended to clarify the degree to which genetic and environmental factors contribute to sex differences in migraine. First, we fit a sex-limitation model to determine if quantitative genetic differences (i.e., is migraine equally heritable across men and women) and/or qualitative genetic differences (i.e., are different genes involved in migraine across men and women) were present. Next, we used a multilevel logistic regression model to compare the prevalence of migraine in individuals from opposite-sex and same-sex twin pairs to determine whether differences in the prenatal hormone environment contribute to migraine risk. In the final analytic sample, women were found to have a significantly higher rate of migraine without aura relative to men (17.6% vs. 5.5%). The results from an ADE sex-limitation model indicate that migraine is equally heritable in men and women, with a broad sense heritability of 0.45, (95% CI = 0.40–0.50), while results from a reduced AE sex-limitation model provide subtle evidence for differences in the genes underlying migraine across men and women. The logistic regression analysis revealed a significant increase in migraine risk for females with a male co-twin relative to females with a female co-twin (OR = 1.51, 95% CI = 1.26–1.81). These results suggest that the prominent sex difference in migraine prevalence is not entirely accounted for by genetic factors, while demonstrating that masculinization of the prenatal environment may increase migraine risk for females. This effect points to a potential prenatal neuroendocrine factor in the development of migraine.

Sex differences in migraine: A twin study

Migraine is a neurological disorder with a prominent sex difference such that two thirds of sufferers are female. The mechanisms behind the preponderance of migraine in women have yet to be elucidated. With data on 51,872 participants from the Swedish Twin Registry, we report results from two distinct analyses intended to clarify the degree to which genetic and environmental factors contribute to sex differences in migraine. First, we fit a sex-limitation model to determine if quantitative genetic differences (i.e., is migraine equally heritable across men and women) and/or qualitative genetic differences (i.e., are different genes involved in migraine across men and women) were present. Next, we used a multilevel logistic regression model to compare the prevalence of migraine in individuals from opposite-sex and same-sex twin pairs to determine whether differences in the prenatal hormone environment contribute to migraine risk. In the final analytic sample, women were found to have a significantly higher rate of migraine without aura relative to men (17.6% vs 5.5%). The results from an ADE sex-limitation model indicate that migraine is equally heritable in men and women, with a broad sense heritability of .45, (95% CI = .40 - .50), while results from a reduced AE sex-limitation model provide subtle evidence for differences in the genes underlying migraine across men and women. The logistic regression analysis revealed a significant increase in migraine risk for females with a male co-twin relative to females with a female co-twin (OR = 1.51, 95% CI = 1.26 - 1.81). These results suggest that the prominent sex difference in migraine prevalence is not entirely accounted for by genetic factors while demonstrating that masculinization of the prenatal environment may increase migraine risk for females. This effect points to a potential prenatal neuroendocrine factor in the development of migraine.

Multilevel Analysis of Determinants of Stunting Prevalence among Children under Age Five in Ethiopia

Background: Stunting is a well-established child health indicator of chronic malnutrition related to environmental and socio-economic circumstances. In Ethiopia, childhood stunting is the most widely prevalent among children under the age of five years. Objective: To estimate the prevalence of stunting and model the determinants of stunting prevalence among children under age five in Ethiopia. Methods: Data were extracted from 2016 EDHS, and samples of 8487 children under age five were used in this study. The sample was selected using a two-stage stratified sampling process, and a multilevel logistic regression model was used to determine the factors associated with childhood stunting in Ethiopia. Results: This study revealed that the prevalence of stunting among children under age five years in Ethiopia was around 39.39%. The multilevel binary logistic regression analysis was performed to investigate the variation of predictor variables of stunting prevalence among children under age five. Accordingly, it has been identified that the ages of the child above 12 months, male gender, children from poor households, and no mother education significantly affect the prevalence of stunting in Ethiopia. It is found that variances related to the random term were statistically significant, implying a variation in the prevalence of stunting across Ethiopia's regional states. Conclusion: The current study confirmed that the prevalence of stunting among children under aged five years in Ethiopia was a severe public health problem. Therefore, governmental or stakeholders should pay attention to all the significant factors mentioned in this study's analysis.

Individual and community-level determinants of poor tetanus toxoid immunization among pregnant women in Ethiopia using data from 2016 Ethiopian demographic and health survey; multilevel analysis

Background Tetanus is a vaccine-preventable disease that can occur in all populations, with neonates and pregnant women being at the most risk. Ethiopia has the highest maternal and neonatal tetanus morbidity and mortality rates. Besides, only 49% of mothers get vaccinated with adequate tetanus toxoid in Ethiopia which is below the world health organization recommendation. To date, there is limited evidence on the individual and community level determinants of poor tetanus toxoid (TT) immunization. Therefore, this study aimed to assess individual and community-level factors associated with poor TT immunization coverage in Ethiopia. Method Secondary data analysis was conducted using the 2016 Ethiopian demographic and health survey. A total of 7043 pregnant women were included in the current study. A multilevel logistic regression model was used to identify individual and community level determinants of poor tetanus toxoid immunization. Finally, the adjusted odds ratio with a 95% confidence interval was reported. Results In the multilevel logistic regression model adjustment, having no Antenatal care visit (AOR = 5.64; 95% CI:2.48,7.30) and having one to three antenatal care visit (AOR = 1.50; 95% CI: 1.19–1.82); poor wealth index (AOR = 1.26; 95% CI: 1.03, 1.54); not being exposed to media (AOR = 1.29; 95% CI: 1.10, 1.51); maternal unemployment (AOR = 1.15; 95% CI: 1.10, 1.31); rural residence (AOR = 1.13; 95% CI: 1.08, 1.72); and high community illiteracy (AOR = 1.28; 95% CI: 1.03, 1.58) were associated with higher odds of poor tetanus toxoid immunization. Whereas, iron uptake during pregnancy (AOR = 0.59; 95% CI: 0.51, 0.68), was associated with lower odds of poor tetanus toxoid immunization. Conclusion In this study tetanus toxoid (TT) vaccine utilization was affected by both community and individual-level factors. Therefore, focusing on antenatal care services especially encouraging pregnant women to have at least four visits, consulting women to be exposed to media, improving community literacy and maternal employment will help to minimize TT underutilization.

Antimicrobial Resistance Patterns of Escherichia coli Isolated from Sheep and Beef Farms in England and Wales: A Comparison of Disk Diffusion Interpretation Methods

Little data exist on the levels of antimicrobial resistance from bacteria isolated from British sheep and beef cattle. The aim of this study was to investigate antimicrobial resistance patterns on sheep and beef farms in England and Wales using multiple interpretation methods. Fecal samples (n = 350) from sheep and beef cattle were collected from 35 farms. Disk diffusion antimicrobial susceptibility testing against ten antimicrobials was carried out for 1115 (699 sheep, 416 beef) β-glucuronidase-positive Escherichia coli isolates. Susceptibility was interpreted using clinical breakpoints, which determine clinically resistant bacteria, and epidemiological and livestock-specific cut-off values, which determine microbiological-resistant bacteria (non-wild type). Using livestock-specific cut-off values, a high frequency of wild type for all ten antimicrobials was observed in isolates from sheep (90%) and beef cattle (85%). Cluster analysis was performed to identify patterns in antimicrobial resistance. Interpretation of susceptibility using livestock-specific cut-off values showed a cluster of isolates that were non-wild type to cefotaxime and amoxicillin/clavulanic acid, whereas clinical breakpoints did not. A multilevel logistic regression model determined that tetracycline use on the farm and soil copper concentration were significantly associated with tetracycline non-wild type isolates. The results suggest that using human clinical breakpoints could lead to both the under-reporting and over-reporting of antimicrobial resistance in sheep and beef cattle.

Factors Associated with Neonatal Mortality in Bangladesh: A Multilevel Analysis

This study aims at disentangling the influence of both individual and community level factors on neonatal death in Bangladesh. For analysis purpose, data are extracted from Bangladesh Demographic and Health Survey 2014. Bivariate analysis is used to examine the differentials in neonatal mortality by selected background variables of both levels. As the survey is based on a two-stage stratified sample of households, multilevel logistic regression model is used to analyze the cluster effect and to determine the factors associated with neonatal mortality. Multilevel logistic model confirmed that there exists clustering impact on neonatal death. Moreover, the study has suggested implementation of intervention addressing several individual and community level factors to ameliorate the current neonatal health scenario in Bangladesh. Dhaka Univ. J. Sci. 69(1): 15-21, 2021 (January)

Early Marriage and Its Determinants among Married Reproductive Age Group Women in Amhara Regional State, Ethiopia: A Multilevel Analysis

Introduction. Amhara region has one of the highest rates of female child early marriage in Ethiopia, with eighty percent of girls in the region being married at the age of eighteen. Therefore, this study was intended to assess the prevalence and determinants of early marriage among women, in Amhara regional state. Methods. The data were extracted from the 2016 Ethiopian Demographic and Health Survey. The study included a sample of 2887 (weighted) married women from 645 clusters in Amhara regional state. The data were collected using a two-stage cluster design that includes the selection of enumeration areas as a first stage and selection of households as a second stage. A multilevel logistic regression model was fitted to determine the individual and community-level factors associated with early marriage. Result. The study revealed that 73% [95% CI 71.38, 74.62] of women aged 15–49 years were married before 18 years old. In the multilevel multivariable model; living as a rural dweller ( AOR = 4.33 ; 95% CI: 2.17, 8.64), no education ( AOR = 2.52 ; 95% CI: 2.23, 9.51), attending only primary education ( AOR = 2.31 ; 95% CI: 1.68, 8.53), parental decision-maker when to get marriage ( AOR = 3.44 ; 95% CI: 2.20, 5.39), being poorer ( AOR = 1.38 ; 95% CI: 1.16, 4.83), and poorest wealth status ( AOR = 2.37 ; 95% CI: 2.19, 7.83) were the independent predictors of early marriage. Conclusion. The prevalence of early marriage was high in Amhara region compared to other regions of the country. Therefore, the regional government should give due attention to access to education and encourage women’s decision-making power upon the time of marriage especially those residing in rural parts of the region.

Determinants of postnatal care utilization in sub-Saharan Africa: a meta and multilevel analysis of data from 36 sub-Saharan countries

Introduction Globally, over 65% of maternal deaths occur during the first 42 days of postpartum while the same proportion of neonatal deaths occur during the first 7 days of life. In sab- Saharan Africa, 4.7 million mothers, newborns, and children die on annual basis. As to our knowledge, there is no study on postnatal care utilization that incorporates all sub-Saharan Africa countries that had DHS data. Therefore, this study aimed at identifying pooled magnitude and determinants of postnatal care utilization in sub-Saharan Africa. Method A population-based cross-sectional study from the most recent Demographic and Health Surveys data from the period of 2006 to 2018 of 36 SSA countries were used. A total weighted sample of 286,255 reproductive-age women who gave birth 5 years preceding the survey were included in the study. A meta-analysis of DHS data of each Sub-Saharan countries was conducted to generate pooled magnitude and a forest plot was used to present it. A multilevel logistic regression model was fitted to identify determinants of postnatal care utilization. The AOR (Adjusted Odds Ratio) with their 95% CI and p-value ≤0.05 was used to declare that determinates associated with postnatal care utilization. Result The pooled magnitude of postnatal care utilization in sub-Saharan Africa countries was 52.48% [95% CI: 52.33, 52.63], with the highest postnatal care utilization in the Central Region of Africa (73.51%) and the low postnatal care utilization in Eastern Regions of Africa (31.71%). In the multilevel logistic regression model region, residence, age group, maternal education, maternal occupation, media exposure, ANC visit, place of delivery, and accessing health care were determinants of postnatal care utilization in Sub-Saharan Africa. Conclusion The coverage of postnatal care service utilization was low with high disparities among the region. Being in rural residence, young age group, low education level, had no occupation, not exposed to media, a big problem to access health care, not had ANC visit, and home delivery was associated with low postnatal care service utilization. This study evidenced that there is a wide gap in postnatal care utilization between SSA countries. Special attention is required to improve health accessibility, utilization, and quality of maternal health services to increase postnatal care service utilization in the region.