Decomposition of factors associated with housing material inequality in under-five deaths in low and middle-income countries

Background Low-and Medium-Income Countries (LMIC) continue to record a high burden of under-five deaths (U5D). There is a gap in knowledge of the factors contributing to housing materials inequalities in U5D. This study examined the contributions of the individual- and neighbourhood-level factors to housing materials inequalities in influencing U5D in LMIC. Methods We pooled data from the most recent Demographic and Health Surveys for 56 LMIC conducted between 2010 and 2018. In all, we analysed the data of 798,796 children living in 59,791 neighbourhoods. The outcome variable was U5D among live births within 0 to 59 months of birth. The main determinate variable was housing material types, categorised as unimproved housing materials (UHM) and improved housing materials (IHM) while the individual-level and neighbourhood-level factors are the independent variables. Data were analysed using the Fairlie decomposition analysis at α = 0.05. Results The overall U5D rate was 53 per 1000 children, 61 among children from houses built with UHM, and 41 among children from houses built with IHM (p < 0.001). This rate was higher among children from houses that were built with UHM in all countries except Malawi, Zambia, Lesotho, Gambia, Liberia, Sierra Leone, Indonesia, Maldives, Jordan, and Albania. None of these countries had significant pro-IHM inequality. The factors explaining housing inequalities in U5D include household wealth status, residence location, source of drinking water, media access, paternal employment, birth interval, and toilet type. Conclusions There are variations in individual- and neighbourhood-level factors driving housing materials inequalities as it influences U5D in LMIC. Interventions focusing on reducing the burden of U5D in households built with UHM are urgently needed.

Exploring the Geographic Variation in Fruit and Vegetable Purchasing Behaviour Using Supermarket Transaction Data

The existence of dietary inequalities is well-known. Dietary behaviours are impacted by the food environment and are thus likely to follow a spatial pattern. Using 12 months of transaction records for around 50,000 ‘primary’ supermarket loyalty card holders, this study explores fruit and vegetable purchasing at the neighbourhood level across the city of Leeds, England. Determinants of small-area-level fruit and vegetable purchasing were identified using multiple linear regression. Results show that fruit and vegetable purchasing is spatially clustered. Areas purchasing fewer fruit and vegetable portions typically had younger residents, were less affluent, and spent less per month with the retailer.

Border Regimes: Homophobia and LGBT Place Making in Six Ordinary Cities in Europe

European nation states increasingly hail LGBT identities as part of modern values; LGBT recognitions have become a symbol of secular achievements. Discourses around gay rights and sexual diversity are increasingly pitted against presumably homophobic and intolerant ‘others’. An increased intolerant and repressive attitude towards migrants and racialised minorities is justified by their supposed threat to exactly these values. LGBT people are finding themselves positioned as ‘border patrollers’ who can count as part of the modern liberal nation. This paper analyses 92 interviews with LGBT participants who live in six small and medium sized ordinary cities in Europe. It discusses how their fear of homophobia is evaluated according to perceived sexual and gendered norms and attitudes at the neighbourhood level. Neighbourhoods are considered either LGBT friendly or unfriendly according to their socio-demographic characteristics that focus on social class and/or migration and that intersects with race, ethnicity and religion. Based on the findings, neighbourhoods are both a geographical and a cultural terrain that can be understood, organised and contested through a sexuality discourse in the production of border regimes that discipline and produce the confines of the normative, the ‘modern’ and the ‘backward’. Not only are LGBT people positioned as border patrollers but their fear of homophobia is also expressed through bordering. The neighbourhood can then be understood, organised and contested through a sexuality discourse in the production of border regimes.

A City of Promenades

Studying old maps showing the transformation of Mexico City can unveil possible footprints of historic facilities and utilities that have disappeared in the process of urban modernization. The objective of this exercise is to uncover the location of old structures of Pre-Hispanic and Colonial Mexico City as a basis for creating a new footprint of urban memory and identity. A city of promenades proposes the remembrance and use of public space, such as the recuperation of lost cultural and geographic landscapes. It takes the routes and paths, the aqueducts, the roads, the moats, the ramparts, the gates of the historic city and its connections to other villages, which now conform this great metropolitan area and it revives them in order to bring communities together. Inhabitants experience a sense of belonging to a meaningful place, while looking back to the past of a growing city. These paths will serve as initiators of projects and actions which will improve patterns of use and sense of identity, offering landmarks, establishing linear parks as connectors of different scales of existing parks and, through modern design, creating a rediscovered footprint of monuments, landscapes and infrastructures long gone. This proposal is an integral project for the Mexico City Metropolitan Area. It begins at the neighbourhood level and forms part of an urban park system; connecting the surrounding natural landscapes and woodlands, the urban parks, sports clubs, neighbourhood parks, squares, bridges, central reservations, sidewalks, tree and flower beds, chapels, rights of way, unused railways, roads, avenues, greenhouses, agricultural trails, cemeteries, brooks and waterways, ravines, canals, terraces, balconies, cloisters and convent patios, archeological sites and unbuilt urban block cores. The city of paths and strolls, of boulevards, of old roads to haciendas and convents, of dikes, gateways, old custom house gates, water fountains and springs, canals, causeways, watermills and aqueducts is an academic exercise with students and teachers to find a meaningful representation of the layers of history that builds a city and creates identity.

Neighbourhood-level income and Zika virus infection during pregnancy in Recife, Pernambuco, Brazil: an ecological perspective, 2015–2017

Zika virus (ZIKV) infections during pregnancy can lead to adverse neurodevelopmental and clinical outcomes in congenitally infected offspring. As the city of Recife in Pernambuco State, Brazil—the epicentre of the Brazilian microcephaly epidemic—has considerable disparities in living conditions, this study used an ecological approach to investigate the association between income at the neighbourhood level and the risk of ZIKV infections in pregnant individuals between December 2015 and April 2017. The spatial distribution of pregnant individuals with ZIKV infection was plotted on a map of Recife stratified into four categories based on mean monthly income of household heads. Additionally, a Poisson regression model with robust variance was fitted to compare proportions of ZIKV infections among pregnant individuals in relation to the mean monthly income of household heads, based on the 2010 census data, across 94 neighbourhoods in Recife. The results provide evidence that the risk of ZIKV infection to pregnant individuals was higher among those residing in lower-income neighbourhoods: relative to neighbourhoods that had a mean monthly income of ≥5 times minimum wage, neighbourhoods with <1 and 1 to <2 times minimum wage had more than four times the risk (incidence rate ratio, 95% CI 4.08, 1.88 to 8.85 and 4.30, 2.00 to 9.20, respectively). This study provides evidence of a strong association between neighbourhood-level income and ZIKV infection risks in the pregnant population of Recife. In settings prone to arboviral outbreaks, locally targeted interventions to improve living conditions, sanitation, and mosquito control should be a key focus of governmental interventions to reduce risks associated with ZIKV infections during pregnancy.

Is neighbourhood income inequality associated with maternal mental health? A longitudinal analysis of pregnant and new mothers living in Calgary, Alberta

ObjectivesRising income inequality is a potential risk factor for poor mental health, however, little work has investigated this link among mothers. Our goal was to determine if neighbourhood-level income inequality was associated with maternal mental health over time.DesignSecondary data analysis using a retrospective cohort study design.Setting and participantsData from the All Our Families (AOF) ongoing cohort study in the city of Calgary (Canada) were used, with our sample including 2461 mothers. Participant data were collected at six time points from 2008 to 2014, corresponding to <25 weeks of pregnancy to 3 years post partum. AOF mothers were linked to 196 geographically defined Calgary neighbourhoods using postal code information and 2006 Canada Census data.Main outcome measuresAnxiety symptoms measured using the Spielberger State Anxiety Inventory, and depressive symptoms measured using the Edinburgh Postnatal Depression Scale and the Centre for Epidemiologic Studies-Depression Scale.ResultsMultilevel regression modelling was used to quantify the associations between neighbourhood-level income inequality and continuous mental health symptoms over time. For anxiety symptoms, the interaction term between neighbourhood Gini and time was significant (β=0.0017, 95% CI=0.00049 to 0.0028, p=0.005), indicating an excess rate of change over time. Specifically, a SD increase in Gini (Z-score) was associated with an average monthly rate increase in anxiety symptom scores of 1.001% per month. While depressive symptom scores followed similar longitudinal trajectories across levels of income inequality, we did not find significant evidence for an association between inequality and depressive symptoms. There was no evidence of a cross-level interaction between inequality and household income on either outcome.ConclusionIncome inequality within neighbourhoods appears to adversely impact the mental health trajectories of pregnant and new mothers. Further research is needed to understand the mechanisms that explain this relationship, and how interventions to reduce income inequality could benefit mental health.

COVID-19 Cases Among Facility-Staff by Neighbourhood of Residence and Social and Structural Determinants: An Observational Study (Preprint)

BACKGROUND Disproportionate risks of COVID-19 in congregate settings including long-term care homes, retirement homes, and shelters both affect and are affected by SARS-CoV-2 infections among facility-staff. In cities across Canada, there has been a consistent trend of geographic clustering of COVID-19 cases. However, there remain limited data on how COVID-19 among facility-staff reflect urban neighbourhood disparities, particularly stratified by the social and structural determinants of community-level transmission. OBJECTIVE To compare the concentration of cumulative cases by geography and social/structural determinants across three mutually exclusive subgroups in the Greater Toronto Area (population 7.1 million): community, facility-staff, and healthcare workers (HCW) in other settings. METHODS We conducted a retrospective, observational study using surveillance data on laboratory-confirmed COVID-19 cases (January 23 to December 13, 2020; prior to vaccination roll-out). We derived neighbourhood-level social/structural determinants from census data, and generated Lorenz curves and Gini coefficients to visualize and quantify inequalities in cases. RESULTS The hardest-hit neighbourhoods (comprising 20% of the population) accounted for 53.4% of community cases, 48.6% of facility-staff cases, and 42.3% of other HCW cases. Compared with other HCW, cases in facility-staff more closely reflected the distribution of community cases. Cases in facility-staff reflected greater social and structural inequalities (larger Gini coefficients) than other HCW across all determinants. Facility-staff cases were also more likely than community cases to be concentrated in lower income neighbourhoods (Gini 0.24[0.15-0.38] vs 0.14[0.08-0.21] with lower household density (Gini 0.23[0.17-0.29] vs 0.17[0.12-0.22]) and with a greater proportion working in other essential services (Gini 0.29 [0.21-0.40], 0.22[0.17-0.28]). CONCLUSIONS COVID-19 cases among facility-staff largely reflects neighbourhood-level heterogeneity and disparities; even more so than cases in other HCW. Findings signal the importance of interventions prioritized and tailored to home geographies of facility-staff in addition to workplace measures, including prioritization and reach of vaccination at home (neighbourhood-level) and at work.