Health equity impact of community-initiated kangaroo mother care: a randomized controlled trial

Background Kangaroo mother care (KMC) can substantially enhance overall survival of low birthweight babies. In a large randomized controlled trial, we recently showed that supporting mothers to provide community initiated KMC (ciKMC) can reduce mortality among infants up to 180 days of life by 25% (hazard ratio (HR) 0.75). With the current analysis, we aimed to explore if ciKMC promotion leads to increased inequity in survival. Methods In the trial we randomized 8402 low birthweight babies to a ciKMC (4480 babies) and a control (3922 babies) arm, between 2015 and 2018 in Haryana, India. We estimated the difference in concentration indices, which measure inequality, between babies in the ciKMC and control arms for survival until 180 days of life. Further, we compared the effect of ciKMC promotion across subgroups defined by socioeconomic status, caste, maternal literacy, infant’s sex, and religion. Results Our intervention did not increase survival inequity, as the concentration index in the ciKMC arm of the trial was 0.05 (95% CI -0.07 to 0.17) lower than in the control arm. Survival impact was higher among those belonging to the lower two wealth quintiles, those born to illiterate mothers and those belonging to religions other than Hindu. Conclusions We found that ciKMC promotion did not increase inequity in survival associated with wealth. The beneficial impact of ciKMC tended to be larger among vulnerable groups. Supporting mothers to provide KMC at home to low birthweight babies will not increase and could indeed reduce inequities in infant survival. Trial registration ClinicalTrials.gov, NCT02653534. Registered January 12, 2016—Retrospectively registered.

Book Review: The Great Reversal by Thomas Philippon

Thomas Philippon’s The Great Reversal: How America Gave Up on Free Markets is a remarkable piece of research that draws our attention to a timely and relevant issue: the rise of market power and its macroeconomic implications. The book documents the facts, offers a number of hypotheses to explain those facts, and discusses the policy interventions needed to remedy market power. This essay reviews the contribution of the book, especially the conceptual and empirical foundations that lead to the main conclusions. The main virtue of the book is to offer a wealth of facts and implications that highlight the different aspects of the evolution of market power. This essay also considers instances that permit an alternative viewpoint. First, I maintain that the reliance on concentration indices to measure market power can be misleading. Second, the essay argues that to date there is no evidence that bestows a different experience in the evolution of market power in Europe compared to the United States. Third, the book gives most air time to antitrust and merger review as the main cause. While antitrust is relevant, technological change is at least as, if not more, important for the observed rise of market power. This essay manifests that technological change has fundamental implications for welfare and therefore for policy intervention. (JEL D24, E22, G31, G34, K21, L13)

Greater inequalities in dental caries treatment than in caries experience: a concentration index decomposition approach

Background The aim of the current study was to (a) measure the socioeconomic inequalities in oral health and examine whether the inequalities are greater in disease experience or in its treatment and to (b) decompose the factors that influence oral health inequalities among the adults of Guangdong Province. Methods A cross-sectional study was conducted among 35- to 44-year-old and 65- to 74-year-old adults in Guangdong Province. All participants underwent oral health examinations and answered questionnaires about their oral health. We measured the concentration indices of the DMFT and its separate components, namely, decayed teeth (DT), missing teeth (MT), and filled teeth (FT), to explore the inequalities in oral health status; then, we analysed its decomposition to interpret the factors that influence the inequalities. Results The results showed that significant inequality was concentrated on FT (CI = 0.24, 95% CI = 0.14/0.33, SE = 0.05). The concentration indices for the DMFT (CI = 0.02, 95% CI = 0.02/0.06, SE = 0.02) and MT (CI = 0.02, 95% CI 0.03/0.08, SE = 0.03) were small and close to zero, while the concentration for DT (CI = − 0.04, 95% CI = − 0.01/0.02, SE = 0.03) was not statistically significant. The results from the decomposition analysis suggested that a substantial proportion of the inequality was explained by household income, high education level, regular oral examination and type of insurance (5.1%, 12.4%, 43.2%, − 39.6% (Urban Employee Basic Medical Insurance System) and 34.5% (New-Type Rural Medical Collaboration System), respectively). Conclusions The results indicated greater inequalities in dental caries than in caries experience. Among the included factors, household income, high education level, and regular oral health examinations had the greatest impact on the inequalities in the number of FT. In addition, the current medical insurance systems, including the Urban Employee Basic Medical Insurance System, Urban Resident Basic Medical Insurance System, and the New-Type Rural Medical Collaboration System, have not been effectively used in oral treatment. Policy-making and the implementation of interventions for tackling socioeconomic oral health inequalities should focus on reducing the burden of treatment and providing greater access to dental care for low-income groups. Welfare policies are skewed towards rural areas and low-income people.

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 < 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.

Differences in the Content of Zn Fractions in the Profiles of Soils from Allotment and Domestic Gardens in South-Eastern Poland

The aim of the research was to show the distribution of fractions as well as bioavailability and the total forms of Zn in the profiles of soils from domestic gardens and family allotment gardens in six cities in south-eastern Poland. Results found that the level of Zn total form varied in the ranges from A horizon: 12.75–154.75 mg·kg−1 in sandy soils and 18.20–104.00 mg·kg−1 in silty soils. Accumulation of metals was assessed using concentration indices, Igeo, and the Cav/Ct and BF indices of bioavailable forms. The analysis took into account the role of organic matter as an important component in binding the analyzed metals in soil horizons subjected to long-term horticultural cultivation. In the two groups of sandy and silty soils distinguished according to their particle size distribution, horticultural treatments were found to exert a greater impact on sandy soils. Additionally, higher contents of the examined element were stated in the humus horizons, as indicated by the high values of concentration and Igeo indices showing high Zn pollution in the soils. The content of bioavailable zinc forms was significantly high, especially in soils with a higher metal content.

Dynamics of inequality in child under-nutrition in Ethiopia

Introduction Although Ethiopia has already achieved a remarkable progress in reducing under-five mortality in the last decades, undernutrition among children is still a common problem in this country. Socioeconomic inequalities in health outcomes in Ethiopia have been thus of focus in academia and policy spheres for a while now. This study provides new evidence on child undernutrition inequalities in Ethiopia using longitudinal perspective. Method Using three round of household panel survey (from 2012 to 2016), we use concentration index (associated curve), different mobility index approaches for measuring inequalities and its dynamics, and decomposition method to identify contributing factors. Results In all concentration index computing approaches and socioeconomic status ranking variables, the concentration indices are significant with negative value. This implies that in either of short-run or long-run inequality estimates, the burden of unequal distribution of undernutrition remains on the poor with significant difference across regions. While employing different SES ranking variables, the difference in the concentration indices is only found significant in case of Height-for-age Z-score. It signifies that relatively higher inequality is measured using consumption as ranking variable. Significant difference in inequality is also shown across regions. With respect to dynamics of inequalities, results on mobility indices computed based on Allanson et al. (Longitudinal analysis of income-related health inequality. Dundee Discussion Working Paper No. 214, 2010) approach show that inequality remain stable (persistent) in Height-for- age Z-score, and reduction of inequality in Weight-for- age Z-score while in case of Weight-for- height Z-score, there is no clear trend over subsequent waves. Results on decomposition of inequalities show that the major contributors are wealth index, consumption and mother’s education. Conclusion The argument of the choice of welfare indicator can have a large and significant impact on measured socioeconomic inequalities in a health variable which it depends on the variable examined. Employing longitudinal perspective rather than weighted average of cross-sectional data is justifiable to see the dynamic of inequality in child malnutrition. In both socioeconomic status ranking variables, the bulk of inequality in malnutrition is caused by inequality in socioeconomic status in which it disfavours the poor in both cases. This calls for enhancing the policy measures that narrow socioeconomic gaps between groups in the population and targeting on early childhood intervention and nutrition sensitive.

Health equity impact of community-initiated kangaroo mother care: A randomized controlled trial

BackgroundKangaroo mother care (KMC) can substantially enhance overall survival of low birthweight babies. In a large randomized controlled trial, we recently showed that supporting mothers to provide community initiated KMC (ciKMC) can reduce early infant mortality by 25% (hazard ratio (HR) 0.75). With the current analysis we aimed to explore if ciKMC promotion leads to increased inequity in survival.MethodsIn the trial we randomised 8402 low birthweight babies to a ciKMC (4480 babies) and a control (3922 babies) arm, between 2015 and 2018 in Haryana, India. The main outcome of interest was the difference in concentration indices between babies in the ciKMC and control arms for survival until 180 days of life.ResultsOur intervention did not increase survival inequity, as reflected in a reduction of the concentration index by 0.05 (95% CI -0.07 to 0.17). Survival impact tended to be higher among those born to illiterate mothers (HR 0.65, 95% CI 0.47 to 0.89), and those in poor families (HR 0.69, 95% CI 0.51 to 0.93).ConclusionsWe found that ciKMC promotion did not increase inequity in survival associated with wealth. The beneficial impact of ciKMC tended to be larger among vulnerable groups. Supporting mothers to provide KMC at home to low birthweight babies will not increase and could indeed reduce inequities in infant survival.Trial registrationClinicalTrials.gov, NCT02653534. Registered January 12, 2016 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT02653534

Socioeconomic determinants and inequalities in the prevalence of non-communicable diseases in Saudi Arabia

Background Non-communicable diseases (NCDs) are increasingly becoming a challenge worldwide, causing high mortality and morbidity. Saudi Arabia has one of the highest rates of NCDs globally and the highest in the Arabian Gulf region. Epidemiological data indicate that NCDs are responsible for 70 % of all deaths in Saudi Arabia. The aim of this study was to examine the socioeconomic determinants and inequalities in the prevalence of NCDs in Saudi Arabia. Methods Data from the Saudi Family Health Survey conducted in 2018 by the General Authority for Statistics were used for this study. Univariate, bivariate, and multivariate logistic regression analyses were employed to examine the socioeconomic factors associated with the prevalence of NCDs. Moreover, the concentration curve and concentration indices were used to assess inequalities in the prevalence of NCDs. Results Among the 11,527 respondents, the prevalence of NCDs was 32.15 %. The prevalence of NCDs was higher among women and among elderly respondents aged ≥ 60 years. With respect to the determinants of the prevalence of NCDs, the logistic regression results showed that the likelihood of reporting NCDs was lower among people with a higher education (OR: 0.599, 95 % CI: 0.497–0.723, p < 0.01) compared with that of people with an education below the primary school level. Other factors significantly associated with the prevalence of NCDs were age, marital status, nationality, and region of residence. The inequality analysis showed that at the national level, the prevalence of NCDs was concentrated among less educated people (concentration index = − 0.338, p < 0.01), but with significant regional variations. Gender disaggregation showed that both income-based and education-based concentration indices were significantly negative among women, indicating that the prevalence of NCDs is concentrated among women with a lower income level and with less education. Conclusions The findings of this study are important for policymakers to combat both the increasing prevalence of and socio-economic inequalities in NCDs. The government should develop targeted intervention strategies to control NCDs and achieve health equality considering socio-economic status. Future policies should target women and the lower educated population in Saudi Arabia.

The Income-Related Distribution of Cognitive Function And Its Mobility Among The Chinese Elderly Over 14 Years

Background:With population aging, cognitive function among the elderly has been growing public health concern in China. This study aimed to investigate the trend of income-related inequality in cognitive function, and to track the health-related income mobility among the Chinese elderly. Methods: The data were drawn from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) in 2005, 2008, 2011, 2014 and 2018, with a sample of 10203 Chinese aged 65 and older. The cognitive function was evaluated by the Mini-Mental State Examination (MMSE). The cross-sectional and longitudinal concentration indices were used to measure the magnitudes of inequalities at different length of time. The mobility index was used to capture the discrepancy between the short-term and long-term measures. The contribution of determinants to mobility was estimated by decomposition analysis. Results:The results showed that, the cognitive function among the Chinese elderly scored 21.13 at the baseline. Men, activities, daily living ability, education, marriage status, income, community service, vision and hearing condition were positively associated with cognitive function, whereas age, negative well-being and drinking were negatively associated with cognitive function. The cross-sectional concentration index was positive and significant only at the baseline. In the long run, however, the concentration indices were all positive and became larger over time. After five waves, the mobility reached -4.84. The largest negative contributor to the mobility index was daily living ability, followed by relaxing activity, domestic activity and hearing condition. The two largest positive contributors were negative well-being and income. Conclusion:Our study found that, as a whole, the cognitive function was not performed well among the Chinese elderly. In the long term, the weighted cross-sectional concentration indices underestimated the inequality in cognitive function and good cognitive performance was concentrated more among the rich. When formulating intervention measures, the Chinese government could give priority to vulnerable groups, especially the elderly who are poor or downwardly income mobile.