Prevalence and determinants of antenatal tetanus vaccination in Sudan: a cross-sectional analysis of the Multiple Indicator Cluster Survey

Background Tetanus vaccination is an indispensable component of the antenatal care (ANC) and is considered one of the most effective and protective measures against tetanus deaths. However, data on antenatal tetanus vaccination in Sudan are scarce. We aimed to explore the level of antenatal tetanus vaccination and to identify the influencing factors in a nationally representative population sample. Methods We used the latest available data (2014) of the Sudan Multiple Indicator Cluster Survey (MICS), developed by the United Nations Children’s Fund (UNICEF). We assessed the level of antenatal tetanus vaccination among women of childbearing age who gave at least one birth preceding the survey and defined adequate antenatal tetanus vaccination according to the World Health Organization (WHO) recommendations. Data analysis was performed using descriptive statistics, bivariate analysis, and multivariate logistic regression analysis. Results The total number of women of childbearing age involved in this analysis was 5433. Most of the participants (28.6%) were 25–29 years old, and vast majority of them (73.7%) live in rural areas. The prevalence of mothers who had adequate tetanus vaccination was 60.0%. Antenatal tetanus vaccination was significantly associated with higher level of mothers’ education (AOR = 1.70, 95% CI 1.25–2.32), higher household wealth index (AOR = 1.89, 95% CI 1.41–2.54), having four or more ANC visits (AOR = 1.49, 95% CI 1.30–1.71), and living in areas with low intensity of armed conflicts (AOR = 1.34, 95% CI 1.14–1.57). Conclusions Socioeconomic status had a significant impact on adequate antenatal tetanus vaccination. The results indicate the existence of variable rates and unequal access to tetanus vaccination among women of childbearing age in Sudan.

Socio-economic Correlates of Marital Status and Marriage Timing Among Adult Men in Nigeria

There is a gradual tendency towards prolonged bachelorhood among men in Nigeria. Studies have linked this to socio-economic factors, but this evidence is sparsely explored in the context of Nigeria. Hence, this study fills the knowledge gap. The 2016/17 Nigeria Multiple Indicator Cluster Survey data of 7803 adult men (aged 18–34 years) was analysed by using descriptive and fitting binary logitic regression and Cox regression models. Results show that slightly more than one-third of adult men in Nigeria (35%) had a marriage history and their median age at first marriage was about 24 years. Educated men (than the uneducated) and those in middle wealth group (than the poor men) were less likely to have ever been married and to delay marriage, respectively. Wealthy men were more likely to delay marriage. Employed men were more likely to have a marriage history and to delay marriage.

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).

Determinants of Overweight and Underweight among Children under 5 in Kazakhstan

Background: During the last 10 years, the prevalence of underweight has decreased considerably in Kazakhstan and, nowadays, it is set under 3% for children under 5 years old. However, the prevalence of overweight, which was not important at all in the 90s, is reaching 10% for children under 5 nowadays. This means that there is a co-existence between being underweight and overweight in the same country and, in some cases, within the same region. In order to design policies addressing both problems and avoiding policies, which may solve underweight but worsening overweight, and vice versa, the aim of this paper is to analyse the socioeconomic determinants of the two problems. Methods: We estimate the probability of occurrence using the Multiple Indicator Cluster Survey (MICS) collected by the United Nations Children’s Fund (UNICEF) and Agency of Statistics of the Republic of Kazakhstan for the years 2006, 2010-2011 and 2015. This survey includes a questionnaire for children younger than 5 years old containing information on maternal and child health. We consider that a child is overweight if she/he falls over two standard deviations of the World Health Organization standards (WHO) for her/his age. Similarly, we consider that a child is underweight if she/he falls below the two standard deviations of the WHO standards. Results: Children of mothers with higher education have a higher probability of being overweight (6,8%) and less probability of being underweight (-5,5%). This effect disappears for children older than 2 years old. Children of Russian origin and other ethnic groups show a lower probability of being overweight in comparison with their Kazakh peers. Being born in the highest wealth quintile reduces the risk of a child under 2 years old being underweight (-2,9%). On the other side, children in rich families at age 2-4 years old have a higher probability of being overweight (3,7%). Conclusion: Health policy aimed to improve family and institution´s knowledge on child nutrition could be effective measures to reduce infant overweight.

Reduction in Blood Lead Concentration in Children across the Republic of Georgia following Interventions to Address Widespread Exceedance of Reference Value in 2019

In recent years, reports of lead contamination have dramatically increased in Georgia. Given concerns about the exposure of children to lead (Pb), the National Multiple Indicator Cluster Survey (MICS-2018) included a blood sampling component. The results showed that 41% of the children that participated had blood Pb levels (BLL) ≥ 5 µg/dL and that BLL in children living in Western Georgia were higher than those in Eastern regions. In response to these findings, NCDC implemented written and verbal advice to the families of children who participated in the MICS-2018 on how to reduce Pb exposure. From August 2019 onwards, the state program of clinical follow-up was implemented. The design of this study was a longitudinal study. The intervention of interest was the public health advice and medical follow-up, and the outcome was defined as the difference in BLL between the MICS-2018 survey and the state program follow-up. We observed a significant overall reduction in median BLL between MICS-2018 and state program follow-up in both August 2019 and the latest results (until December 2019). However, we did not observe any significant further reduction between August and the most recent BLL results. In the Georgian setting, written and verbal communication targeting individual households, alongside home visits to the most exposed, effectively reduced BLL in children.

PATTERN OF SCHOOL ABSENTEEISM IN SOME SELECTED COUNTRIES

School absenteeism is treated as a barrier towards quality education. It is related to school dropout, depression, anxiety and academic performance. This study uses Multiple Indicator Cluster Survey dataset to analyze the pattern of school absenteeism in five lower middle-income countries: Bangladesh, Djibouti, Nigeria, Ukraine and Vietnam. Primary and secondary level students are considered in this study. Authors accomplish descriptive analyses to trace out the pattern of school absenteeism. This study finds that nearly one-third students in Bangladesh, about half of the students in Djibouti and more than half students in Vietnam missed at least one instructional day in a week. Additionally, more than 80 percent students in Nigeria and Ukraine missed one instructional day in a week. This study reveals that age and wealth status are negatively related to school absenteeism. Furthermore, it is evident that tendency of school absenteeism is higher among rural and primary level students. Thus, this study suggests for providing conditional cash transfer among primary level students and specific incentive for rural students to address the problem of absenteeism.

On Prevention of Diarrheal Disease: Assessing the Factors of Effective Handwashing Facilities in Bangladesh

People in Bangladesh usually do not utilize handwashing facilities properly, which makes it challenging to implement hygiene practices of handwashing to reduce diarrhea and other health risks. Against this backdrop, this research attempts to assess the factors associated with Effective Handwashing Facilities (EHFs) in Bangladesh utilizing the Multiple Indicator Cluster Survey 2019. This study utilizes descriptive statistics techniques and also bivariate and multivariable logistic regression methods by representing odd ratios to identify the relationship between associated factors and EHF in Bangladesh. The descriptive statistics show that about 74.22% of the households in Bangladesh have EHFs. Gender, education, ethnicity, male-head households, household wealth status, source of water, sanitation status, sharing toilet facility are identified as the potential determinants of EHF. As a result, we recommend that all levels of society in Bangladesh have continuous access to handwashing equipment and facilities to reduce hygiene-related illnesses especially diarrheal disease.

Risk factors for early childhood disability in Bangladesh: Evidence from Multiple Indicator Cluster Survey 2019

Introduction Early childhood is a vital part of human life because most of the brain developments occur in this particular period. Early childhood disability is a significant global public health burden, which can negatively impact the children’s quality of life and their overall productivity. It is also a major social and economic problem in Bangladesh. Therefore, it is very important to understand the associated factors for early childhood disability, which may help disability prevention, better management and policy formulation. The main objective of this study is to investigate the child, family, and community-level factors associated with early childhood disability in Bangladesh. Methods A cross sectional nationally representative data was derived from Multiple Indicator Cluster Survey (MICS), 2019. A total of 14,072 Bangladeshi children under five years of age were selected for this study. Various types of statistical analysis (simple, bivariate, multivariable) were performed. To assess the bivariate relationship between chosen categorical variables (independent) and early childhood disability (dependent), a chi-square test was used. The multivariable ordinal logistic regression was used to find out the association of disability with child, family, and community-level factors. Results The results show that 2.0% of the children have at least one disability and 0.8% have more disabilities. Several factors namely not attending in early childhood education [Odds Ratio (OR) = 0.65; 95% confidence interval (CI) = 0.13–1.17 Ρ = 0.01], having mother’s functional difficulty (OR = 1.23; 95% (CI) = 0.58–1.88 Ρ <0.001), unhappy mother’s life (OR = 0.85; 95% CI = 0.30–1.39 Ρ <0.001), parents without internet access (OR = 0.68; 95% CI = 0.06–1.29 Ρ = 0.03) and parents using mobile phone (OR = 0.52; 95% CI = 0.09–0.95 Ρ = 0.02) were found to be important for early childhood disability in Bangladesh. Conclusion Early childhood disability is still neglected in Bangladesh and further epidemiological studies are recommended. The findings of this study may help policy makers and relevant stakeholders to develop interventions for reducing the overall burden of early childhood disability.

Predictors of health insurance enrolment and wealth-related inequality in Nepal: evidence from Multiple Indicator Cluster Survey (MICS) 2019

ObjectivesWe analysed predictors of health insurance enrolment in Nepal, measured wealth-related inequality and decomposed inequality into its contributing factors.DesignCross-sectional study.SettingWe used nationally representative data based on Nepal Multiple Indicator Cluster Survey 2019. Out of 10 958 households included in this study, 6.95% households were enroled in at least one health insurance scheme.Primary outcomemeasures health insurance (of any type) enrolment.ResultsHouseholds were more likely to have health insurance membership when household head have higher secondary education or above compared with households without formal education (adjusted OR 1.87; 95% CI: 1.32 to 2.64)). Households with mass media exposure were nearly three times more likely to get enroled into the schemes compared with their counterparts (adjusted OR 2.96; 95% CI 2.03 to 4.31). Hindus had greater odds of being enroled (adjusted OR 1.82; 95% CI 1.20 to 2.77) compared with non-Hindus. Dalits were less likely to get enroled compared with Brahmin, Chhetri and Madhesi (adjusted OR 0.66; 95% CI 0.47 to 0.94). Households from province 2, Bagmati and Sudurpaschim were less likely to have membership compared with households from province 1. Households from Richer and Richest wealth quintiles were more than two times more likely to have health insurance membership compared with households from the poorest wealth quintile. A positive concentration index 0.25 (95% CI 0.21 to 0.30; p<0.001) indicated disproportionately higher health insurance enrolment among wealthy households.ConclusionsEducation of household head, exposure to mass media, religious and ethnic background, geographical location (province) and wealth status were key predictors of health insurance enrolment in Nepal. There was a significant wealth-related inequality in health insurance affiliation. The study recommends regular monitoring of inequality in health insurance enrolment across demographic and socioeconomic groups to ensure progress towards Universal Health Coverage.