Socio-economic inequalities in adolescent mental health in the UK: multiple socio-economic indicators and reporter effects

There are socio-economic inequalities in the experience of mental ill-health. However, less is known about the extent of inequalities by different indicators of socio-economic position (SEP). This is relevant for insights into the mechanisms by which these inequalities arise. For young people's mental health there is an additional layer of complexity provided by the widespread use of proxy reporters. Using data from the UK Millennium Cohort Study (N=10,969), we investigated the extent to which five objective SEP indicators (parent education, household income, household wealth, parent occupational status, and relative neighbourhood deprivation) predict adolescent internalising mental health and how this varies as a function of reporter. Both parent report and adolescent self-report were considered. Regression models demonstrated that whilst all five SEP indicators were associated with parent-reported adolescent mental health (regression coefficients for the most disadvantaged groups and adolescent mental health: parent education β=0.53 [0.44;0.62], household income β=0.56 [0.50;0.62], household wealth β=0.18 [0.10;0.27], parent occupational status β=0.40 [0.35;0.46], and relative neighbourhood deprivation β=0.41 [0.33;0.49]), only income (β=0.11 [0.04;0.17]), wealth (β=0.12 [0.02;0.21]), and occupational status (β=0.08 [0.03;0.13]) were associated with self-reported mental health. The magnitude of these effects was greater for parent-reported than self-reported adolescent internalising symptoms: SEP indicators jointly predicted 5.2% of the variance in parent-reported compared to 1.4% of the variance in self-reported internalising mental health. Income predicted the most variance in both parent (4.2% variance) and self-reported internalising symptoms (0.5% variance). Interestingly, the gradient of parent-reported adolescent mental health across SEP indicators mirrors that of parent's own mental health (for example, income predicted 7.3% variance). Our findings highlight that the relevance of different SEP indicators to adolescent internalising mental health differs between parent and adolescent reports. Therefore, it is important to consider the various perspectives of mental health inequalities gained from different types of reporters.

A structured additive modeling of diabetes and hypertension in Northeast India

Background Multiple factors are associated with the risk of diabetes and hypertension. In India, they vary widely even from one district to another. Therefore, strategies for controlling diabetes and hypertension should appropriately address local risk factors and take into account the specific causes of the prevalence of diabetes and hypertension at sub-population levels and in specific settings. This paper examines the demographic and socioeconomic risk factors as well as the spatial disparity of diabetes and hypertension among adults aged 15–49 years in Northeast India. Methods The study used data from the Indian Demographic Health Survey, which was conducted across the country between 2015 and 2016. All men and women between the ages of 15 and 49 years were tested for diabetes and hypertension as part of the survey. A Bayesian geo-additive model was used to determine the risk factors of diabetes and hypertension. Results The prevalence rates of diabetes and hypertension in Northeast India were, respectively, 6.38% and 16.21%. The prevalence was higher among males, urban residents, and those who were widowed/divorced/separated. The functional relationship between household wealth index and diabetes and hypertension was found to be an inverted U-shape. As the household wealth status increased, its effect on diabetes also increased. However, interestingly, the inverse was observed in the case of hypertension, that is, as the household wealth status increased, its effect on hypertension decreased. The unstructured spatial variation in diabetes was mainly due to the unobserved risk factors present within a district that were not related to the nearby districts, while for hypertension, the structured spatial variation was due to the unobserved factors that were related to the nearby districts. Conclusion Diabetes and hypertension control measures should consider both local and non-local factors that contribute to the spatial heterogeneity. More importance should be given to efforts aimed at evaluating district-specific factors in the prevalence of diabetes within a region.

Residential Food Environment, Household Wealth and Maternal Education Association to Preschoolers’ Consumption of Plant-Based Vitamin A-Rich Foods: The EAT Addis Survey in Addis Ababa

Vitamin A deficiency is common among preschoolers in low-income settings and a serious public health concern due to its association to increased morbidity and mortality. The limited consumption of vitamin A-rich food is contributing to the problem. Many factors may influence children’s diet, including residential food environment, household wealth, and maternal education. However, very few studies in low-income settings have examined the relationship of these factors to children’s diet together. This study aimed to assess the importance of residential food availability of three plant-based groups of vitamin A-rich foods, household wealth, and maternal education for preschoolers’ consumption of plant-based vitamin A-rich foods in Addis Ababa. A multistage sampling procedure was used to enroll 5467 households with under-five children and 233 residential food environments with 2568 vendors. Data were analyzed using a multilevel binary logistic regression model. Overall, 36% (95% CI: 34.26, 36.95) of the study children reportedly consumed at least one plant-based vitamin A-rich food group in the 24-h dietary recall period. The odds of consuming any plant-based vitamin A-rich food were significantly higher among children whose mothers had a higher education level (AOR: 2.55; 95% CI: 2.01, 3.25), those living in the highest wealth quintile households (AOR: 2.37; 95% CI: 1.92, 2.93), and in residentials where vitamin A-rich fruits were available (AOR: 1.20; 95% CI: 1.02, 1.41). Further research in residential food environment is necessary to understand the purchasing habits, affordability, and desirability of plant-based vitamin A-rich foods to widen strategic options to improve its consumption among preschoolers in low-income and low-education communities.

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.

Prevalence and Determinants of Under-Nutrition Among Under-Five Children in Afar Region, Ethiopia: Evidence From 2016 Ethiopian Demographic and Health Survey

Background: Undernutrition is one of the major public health concerns among infants and young children in the country. Childhood under-nutrition is widespread in low and middle-income countries. This study was initiated to assess the prevalence of under-nutrition and its associated factors among under-five children in Afar Region, Ethiopia. Methods: The data for this study were extracted from the Ethiopian Demographic and Health Survey (EDHS) 2016. The information collected from 937 children born 5 years before the survey was considered in the analysis. A multivariable binary logistic regression analysis was used at a 5% level of significance to determine the individual- and community-level factors associated with childhood malnutrition.Results: The prevalence of stunting, underweight and wasting in Afar region were 41.1%, 36.2% and 17.7%, respectively. About 26.7% of children in Afar region were both stunting and underweight, 12.7% were both underweight and wasting, 7.6% were both stunting and wasting and only 7.0% of children had all the three under-nutrition conditions. Among the factors considered in this study, age of a child in months, anemia level, mothers’ BMI, household wealth index, size of child at birth, number of living children and place of residence were significantly associated with stunting, underweight and wasting in Afar Region. Conclusions: The prevalence of all stunting, underweight and wasting was relatively high. Undernutrition is one of the major public health concerns among children in Afar Region. The effect of these factors should be considered to develop strategies to reduce under-nutrition in the study area. Thus, intervention should be focused on improving the under-nutrition determinants of the children to improve the child's nutritional status and reduce child morbidity and mortality.

Two decades of regional trends in vaccination completion and coverage among children aged 12-23 months: an analysis of the Uganda Demographic Health Survey data from 1995 to 2016

Background Childhood vaccination is an important public health intervention but there is limited information on coverage, trends, and determinants of vaccination completion in Uganda at the regional level. We examined trends in regional vaccination coverage and established the determinants of vaccination completion among children aged 12-23 months in Uganda. Methods We analyzed data from the women’s questionnaire for the 1995-2016 Uganda Demographic Health Survey (UDHS). Vaccine completion was defined as having received a dose of Bacillus-Calmette Guerin (BCG) vaccine; three doses of diphtheria, pertussis, and tetanus (DPT) vaccine; three doses of oral polio vaccine (OPV) (excluding OPV given at birth); and one dose of measles vaccine. We performed Chi-square tests to compare vaccination completion by socio-demographic factors stratified by 10 sub-regions: Eastern, East Central, Central 1, Central 2, Kampala, Karamoja, North, Western, West Nile, and Southwest. We performed logistic regression analysis for each of the regions to identify factors associated with vaccination completion at 5% level of statistical significance. Results Overall vaccination completion was 48.6% (95%CI, 47.2, 50.1) and ranged from 17.3% in Central 1 to 65.9% in Southwest. Vaccination completion rates declined significantly by 10.4% (95% confidence interval (CI), − 16.1, − 4.6) between 1995 and 2000, and increased significantly by 10.0% (95% CI, 4.6, 15.4) between 2000 and 2006, and by 5.4% (95% CI, 0.2, 10.6) between 2006 and 2011. Maternal education (secondary or higher level), receipt of tetanus toxoid (TT) during pregnancy, and possession of a child health card were associated with vaccination completion across all the sub-regions. Other factors like place of residence, religious affiliation, household wealth, maternal age, childbirth order, size of child at birth, and place of delivery were associated with vaccination completion but differed between the 10 sub-regions. Conclusion Besides considerable regional variations, the vaccination completion rate among children aged 12-23 months in Uganda remains suboptimal despite the availability of vaccines. Maternal education, receipt of TT, and possession of a child health card are associated with a higher likelihood of vaccination completion among children aged 12-23 months in all the regions of Uganda. Interventions to improve the utilization of vaccination services in Uganda should consider these factors.

Trends and Determinants of Underweight among Children under Five Years in Ethiopia: Further Analysis with Ethiopian Demographic and Health Survey 2005–2016—Multivariate Decomposition Analysis

Background. Underweight is one of the paramount major worldwide health problems, and it traces a big number of populations from infancy to old age. This study aimed to analyze the trends and predictors of change in underweight among children under five years in Ethiopia. Method. The data for this study were accessed from three Ethiopian Demographic and Health Survey data sets 2005, 2011, and 2016. The trend was examined separately for the periods 2005–2011, 2005–2016, and 2011–2016. Multivariate decomposition analysis of change in underweight was employed to answer the major research question of this study. The technique employed the output from the logistic regression model to parcel out the observed difference in underweight into components, and STATA 14 was utilized for data management and analysis. Result. Perceiving the overall trend, the rate of underweight was decreased from 38% in 2005 to 24% in 2016. The decomposition analysis results revealed that, about 12.60% of declines in underweight have been explained by the difference in population characteristics or endowments (E) over the study period. The size of the child at birth, husband’s education, women’s education, and household wealth index contributed significantly to the compositional decline in underweight. Conclusion. The magnitude of underweight among children under five years indicates a remarkable decline over the last ten years in Ethiopia. In this study, two-twelfth of the overall decrease in underweight among children under five years over the decade was due to the difference in characteristics between 2005 and 2016. Continuing to educate the population and boost the population’s economy is needed on the government side in Ethiopia.

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.

Socio-economic determinants of child mortality in Pakistan and the moderating role of household’s wealth index

Background Child mortality is an important social indicator that describes the health conditions of a country as well as determines the country’s overall socio-economic development. The Government of Pakistan has been struggling to reduce child mortality (67.2 per thousand live births in 2019). Pakistan could not achieve the target set for Millennium Development Goals to reduce child mortality and still working to meet the target set by the Sustainable Development Goals. This study has investigated the socio-economic determinants of child mortality in Pakistan by using household-level data. Socio-economic characteristics related to women (mothers) and households have been considered as possible determinants of child mortality. The moderating role of a household’s wealth index on the association between woman’s education and child mortality has also been investigated. Methods The comprehensive dataset of the Pakistan Demographic and Health Survey 2017–18 has been used to explore the determinants of child mortality by using multivariable logistic regression. The interaction term of women’s education and household wealth index has been used to investigate the moderating role of the household’s wealth index. Results The results indicate that the likelihood of child mortality decreases with an increase in women’s education, their empowerment, their husband’s education, the wealth status of their households, access to clean drinking water, access to toilet facilities, and exposure to mass media. Whereas, an increase in unmet need for family planning increases the likelihood of child mortality. The study also identified the moderating role of a household’s wealth index on the association between woman’s education and child mortality. Conclusions Household wealth status moderates the association between women’s education and child mortality. The absolute slope of the curve showing the association of women’s education and child mortality is higher (more negative) for richer households than poorer households. It implies that a household’s wealth status strengthens the relationship between women’s education and child mortality. With the increase in the household’s wealth status, the effect of a mother’s education on child mortality becomes more pronounced.

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.