101
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Harding KL, Aguayo VM, Masters WA, Webb P. Education and micronutrient deficiencies: an ecological study exploring interactions between women's schooling and children's micronutrient status. BMC Public Health 2018; 18:470. [PMID: 29636013 PMCID: PMC5894221 DOI: 10.1186/s12889-018-5312-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 03/14/2018] [Indexed: 11/29/2022] Open
Abstract
Background Formal education can be a nutrition-sensitive intervention that supports the scale-up and impact of nutrition-specific actions. Maternal education has long been linked to child survival, growth, and development while adult earnings and nutrition are tied to years in school as a child. However, less is known about the relationship between maternal education and the micronutrient status of children, women and the general population. Methods Using country-level data and an ecological study design, we explored the global associations between women’s educational attainment and: a) anemia and vitamin A deficiency (VAD) in children aged 6–59 months; b) anemia in non-pregnant women; and c) zinc deficiency, urinary iodine excretion (UIE), and the proportion of infants protected against iodine deficiency in the general population Cross-sectional relationships (2005–2013) were assessed using linear regression models. Results Percentage of women without schooling was negatively associated with all outcomes. Number of years of schooling among women was positively associated with all outcomes except for UIE and the proportion of infants protected against iodine deficiency. Income level was a significant effect modifier of the effect of years of women’s schooling on child anemia as well as of the proportion of women without formal education on zinc deficiency in the population. The relationship was strongest in low-income countries for child anemia, and was not significant in upper middle-income countries. For zinc deficiency, the relationship was not significant in low or lower middle income countries, which may suggest that a minimum threshold of resources needs to be reached before education can influence zinc status. Conclusions While relationships between maternal schooling and micronutrient outcomes vary around the globe, more schooling is generally linked to lower rates of deficiency. These findings draw policy-relevant connections between formal education and anemia and micronutrient status globally. It is necessary to examine the mechanisms through which this relationship may be working at both household and country level. Electronic supplementary material The online version of this article (10.1186/s12889-018-5312-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kassandra L Harding
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, 02111, USA. .,Yale School of Public Health, Yale University, 135 College Street, New Haven, CT, 06510, USA.
| | - Victor M Aguayo
- UNICEF Nutrition Programme, Programme Division, New York, NY, USA
| | - William A Masters
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, 02111, USA
| | - Patrick Webb
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, 02111, USA
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102
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Hajizadeh M. Socioeconomic inequalities in child vaccination in low/middle-income countries: what accounts for the differences? J Epidemiol Community Health 2018; 72:719-725. [DOI: 10.1136/jech-2017-210296] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 03/14/2018] [Accepted: 03/15/2018] [Indexed: 11/04/2022]
Abstract
BackgroundSocioeconomic inequalities in child vaccination continue to be a global public health concern. This study aimed to measure and identify factors associated with socioeconomic inequalities in full immunisation coverage against the four core vaccine-preventable diseases (ie, bacille Calmette-Guérin, diphtheria-tetanus-pertussis (three doses), polio (three doses) and measles vaccines) in 46 low/middle-income countries.MethodsThe most recent nationally representative samples of children (aged 10–59 months, n=372 499) collected through the Demographic Health Surveys were used to measure vaccination rates. The concentration index (C) was used to quantify socioeconomic inequalities in vaccination coverage. Furthermore, meta-regression analyses were used to determine factors affecting socioeconomic inequalities in vaccination coverage across countries.ResultsResults suggested that immunisation coverage was pro-rich in most countries (median C=0.161, IQR 0.131). Gambia (C=−0.146, 95% CI −0.223 to −0.069), Namibia (C=−0.093, 95% CI −0.145 to −0.041) and Kyrgyz Republic (C=−0.227, 95% CI −0.304 to −0.15) were the only countries where children who belong to higher socioeconomic status group were less likely to receive all the four core vaccines than their lower socioeconomic status counterparts. Meta-regression analyses suggested that, across countries, the concentration of antenatal care visits among wealthier mothers was positively associated with the concentration of vaccination coverage among wealthier children (coefficient=0.606, 95% CI 0.301 to 0.911).ConclusionsPro-rich distribution of child vaccination in most low/middle-income countries remains an important public health policy concern. Policies aimed to improve antenatal care visits among mothers in lower socioeconomic groups may mitigate socioeconomic inequalities in vaccination coverage in low/middle-income countries.
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103
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Vikram K. Social capital and child nutrition in India: The moderating role of development. Health Place 2018; 50:42-51. [PMID: 29339291 PMCID: PMC5834388 DOI: 10.1016/j.healthplace.2017.12.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 12/09/2017] [Accepted: 12/22/2017] [Indexed: 10/18/2022]
Abstract
Empirical studies of social capital rarely take into account the socioeconomic context of the region in which it operates, indeed as most of this research has been located in high income countries. It is imperative to investigate how development may influence the impact of social capital, especially in developing countries. This paper examines the relationship between social capital and child nutrition using the India Human Development Survey, 2005-2006. Using a multilevel framework and a sample of 6770 rural children under the age of five, it finds that household based bridging social capital, expressed as connections with development based organizations, is positively associated with child nutrition. Bonding social capital, expressed as ties with caste and religious based organizations, has the opposite impact. At the village level, contextual measures of social capital are associated with nutritional status of children, but their influence is conditional on local development.
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Affiliation(s)
- Kriti Vikram
- Department of Sociology, National University of Singapore, Singapore.
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104
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De Neve JW, Subramanian SV. Causal Effect of Parental Schooling on Early Childhood Undernutrition: Quasi-Experimental Evidence From Zimbabwe. Am J Epidemiol 2018; 187:82-93. [PMID: 29309520 DOI: 10.1093/aje/kwx195] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 02/15/2017] [Indexed: 11/12/2022] Open
Abstract
An estimated 3.1 million children die each year because of undernutrition. Although cross-sectional and longitudinal studies have found a protective association between greater parental education and undernutrition in their children, no randomized trial has identified a causal effect, to our knowledge. Using the 1980 education reform in Zimbabwe as a natural experiment, we estimated the causal effect of additional parental schooling on the probability of anthropometric failure in their children under 5 years of age (ages 3 through 59 months). Analyzing data on 8,243 children from the 1988, 1999, 2005-2006, and 2010-2011 Demographic and Health Surveys, we found no effect of parental schooling on early childhood undernutrition at the national level in Zimbabwe. Among households in the urban and high-wealth-index subsamples, each additional year of maternal schooling led to absolute reductions in the probability of a child's being wasted of 5.2 percentage points (95% confidence interval (CI): -9.3, -1.2) and 3.6 percentage points (95% CI: -6.9, -0.4), respectively. In the subsample of children between the ages of 3 and 23 months, each additional year of paternal schooling increased the probability of a child's being stunted by 9.6 percentage points (95% CI: 1.4, 17.9). Secondary schooling alone may not be enough to improve early childhood nutrition in low-resource settings.
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Affiliation(s)
- Jan-Walter De Neve
- Institute of Public Health, Heidelberg University, Heidelberg, Germany
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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105
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Forshaw J, Gerver SM, Gill M, Cooper E, Manikam L, Ward H. The global effect of maternal education on complete childhood vaccination: a systematic review and meta-analysis. BMC Infect Dis 2017; 17:801. [PMID: 29281990 PMCID: PMC5745980 DOI: 10.1186/s12879-017-2890-y] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 12/06/2017] [Indexed: 11/10/2022] Open
Abstract
Background There is an established correlation between maternal education and reduction in childhood mortality. One proposed link is that an increase in maternal education will lead to an increase in health care access and vaccine uptake. Vaccinations are a central preventative child health tool, therefore demonstrating the importance of understanding factors that can improve coverage. This review aims to establish if there is a correlation between increasing maternal education and vaccine uptake and if this varies between continents, setting and time. Methods An electronic database search was conducted using Medline Ovid, Embase and The Cochrane Library using a combination of keywords and appropriate MeSH terms for maternal education and child vaccination. Bibliographies were also hand searched. Data was extracted and entered onto a Microsoft Excel spreadsheet and analysed using STATA 13.0 software. The primary outcome of effect size of maternal education on completion of childhood vaccinations was analysed at different levels. Secondary outcomes were explored using subgroup analyses of differences between continents, rural or urban settings, and dates. Results The online search yielded 3430 papers, 37 were included in this study. The analysis showed increasing child vaccination uptake with increasing maternal education. Overall, analysis showed that the odds of full childhood vaccination were 2.3 times greater in children whose mother received secondary or higher education when compared to children whose mother had no education. There was large variability in the effect size between the studies included. Conclusions Improving maternal education is important for increasing childhood vaccination uptake and coverage. Further research is needed in higher income countries. Trial registration PROSPERO Registration No: CRD42016042409.
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Affiliation(s)
- Jennifer Forshaw
- School of Public Health, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
| | - Sarah M Gerver
- School of Public Health, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
| | - Moneet Gill
- St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Emily Cooper
- St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Logan Manikam
- UCL Great Ormond Street Institute of Child Health, 30 Guildford Street, London, WC1N 1EH, UK.
| | - Helen Ward
- School of Public Health, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
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106
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The effect of partners' education on women's reproductive and maternal health in developing countries. Soc Sci Med 2017; 197:104-115. [PMID: 29223685 DOI: 10.1016/j.socscimed.2017.11.054] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 09/25/2017] [Accepted: 11/29/2017] [Indexed: 11/23/2022]
Abstract
The effect of partners' education on women's and children's health in developing countries has received relatively little attention to date. This study uses couple data from 37 recent Demographic and Health Surveys fielded in sub-Saharan African and Asian countries to assess the effect of partners' schooling on women's modern contraceptive use, frequency of antenatal care visits, and skilled birth attendance. Using multilevel logistic regressions, the study shows that partners' schooling has strong effects on their spouses' maternal healthcare utilization; especially when partners had secondary or higher levels of schooling. Overall, women whose partners had an above secondary level of education were 32% more likely to use modern contraceptives, 43% more likely to attend at least four antenatal care visits, and 55% more likely to deliver their most recent baby with a health professional, compared to women whose partner had no education, after controlling for individual and community-level covariates. Finally, interacting the partners' years of schooling, we found that an additional year of partners' schooling was 1) positively associated with modern contraceptive use when the women had low educational attainment (substitution effect), but negatively associated when women were better educated, 2) positively and increasingly associated with the frequency of antenatal care visits as women's education increased (multiplicative effect), and 3) positively and significantly associated with skilled birth attendance for less educated women (substitution effect). This study highlights the importance of male education in shaping their wife's health behaviours in developing countries and provides strong impetus for male education beyond primary level (as well as for women), something that has been neglected in past policy discourse.
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107
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Gupta A, Spears D. Health externalities of India's expansion of coal plants: Evidence from a national panel of 40,000 households. JOURNAL OF ENVIRONMENTAL ECONOMICS AND MANAGEMENT 2017; 86:262-276. [PMID: 29129948 PMCID: PMC5669305 DOI: 10.1016/j.jeem.2017.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Indexed: 06/07/2023]
Abstract
Coal power generation is expanding rapidly in India and other developing countries. In addition to consequences for climate change, present-day health externalities may also substantially increase the social cost of coal. Health consequences of air pollution have proven important in studies of developed countries, but, despite clear importance, similarly well-identified estimates are less available for developing countries, and no estimates exist for the important case of coal in India. We exploit panel data on Indian households, matched to local changes in exposure to coal plants. Increased exposure to coal plants is associated with worse respiratory health. Consistent with a causal mechanism, the effect is specific: no effect is seen on diarrhea or fever, and no effect on respiratory health is seen of new non-coal plants. Our result is not due to endogenous avoidance behavior, or to differential trends in determinants of respiratory health, either before the period studied or simultaneously.
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Affiliation(s)
- Aashish Gupta
- Population Studies Center, University of Pennsylvania
| | - Dean Spears
- Economics Department, University of Texas at Austin, 2225 Speedway, Austin, TX 78712 and Economics and Planning Unit, Indian Statistical Institute – Delhi Centre
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108
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Joshi N, Bolorhon B, Narula I, Zhu S, Manaseki-Hollan S. Social and environmental determinants of child health in Mongolia across years of rapid economic growth: 2000-2010. Int J Equity Health 2017; 16:189. [PMID: 29084537 PMCID: PMC5663099 DOI: 10.1186/s12939-017-0684-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 10/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To understand the effect of economic growth on health, we investigated the trend in socio-economic and regional determinants of child health in Mongolia. This Central Asian country had the fastest economic growth amongst low and middle-income countries (LMICs) from 2000 to 2010 and a healthcare system in transition. METHODS Data was from Mongolian multiple indicator cluster surveys (MICS) in 2000, 2005 and 2010. Child nutrition/growth was measured by height-for-age z-score (HAZ), weight-for-age z-score (WAZ), prevalence of stunted (HAZ < -2) and underweight (WAZ < -2) children. Access to health care was measured by prevalence of fully immunised children <5 years. Multivariate multi-level logistic mixed modelling was used to estimate the effect of socio-economic and environmental health determinants on each outcome in each year; 2000, 2005 and 2010. T-tests were used to measure significant change in HAZ and WAZ over the decade. RESULTS Overall, from 2000 to 2010, there was a significant improvement (p < 0.001) in all three outcomes, but the effect of socio-economic factors increased on both stunting and weight. In 2000, region was a significant determinant: children living in three provinces were significantly more likely to be stunted and less likely to be immunised than Ulaanbaatar, but this was not significant by 2010. By 2010, none of the factors were significant determinants of immunisation in children. In 2000, economic status had no effect on stunting (OR = 0.91; 95%CI:0.49,1.66), however by 2010, children in the poorest economic quintile were 4 times more likely to be stunted than the richest (OR = 0.24; 95% CI:0.13,0.45; p < 0.001). The effect of maternal education on stunting prevalence continued over the 10 years, in both 2000 and 2010 children were twice as likely to be stunted if their mother had no education compared to university education (2000 OR = 0.45; 95% CI:0.28,0.73, p < 0.01,2010 OR =0.55; 95% CI:0.35,0.87, p < 0.05). CONCLUSION Economic growth in Mongolia from 2000 to 2010 resulted in an increase in the effect of social determinants of child health; whilst focused policy improved access to immunisation. Children with less educated mothers and lower household incomes should be targeted in interventions to reduce health inequity.
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Affiliation(s)
- Nehal Joshi
- Medicine, University of Birmingham, Birmingham, UK
| | - Bolormaa Bolorhon
- Medical Student, Health Sciences University of Mongolia, Ulaanbaatar, Mongolia
| | | | - Shihua Zhu
- Research Fellow in Health Economics and Mathematical Modelling, Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Semira Manaseki-Hollan
- Clinical Senior Lecturer, Department of Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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109
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Hu Y, Chen Y, Wang Y, Liang H. Knowledge, Attitude and Practice of Pregnant Women towards Varicella and Their Children's Varicella Vaccination: Evidence from Three Distrcits in Zhejiang Province, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14101110. [PMID: 28946647 PMCID: PMC5664611 DOI: 10.3390/ijerph14101110] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 09/15/2017] [Accepted: 09/22/2017] [Indexed: 11/16/2022]
Abstract
Background: The objectives of this study were to examine the knowledge, attitudes and practice (KAP) towards varicella and varicella vaccine (VarV) vaccination among pregnant women in three distrcits in Zhejiang Province, China. Methods: From 1 January to 31 March 2014, pregnant women with ≥12 gestational weeks were recruited and received a self-administrated questionnaire. The first dose of VarV (VarV1) vaccination status of children from present pregnancy was extracted at 24 months of age from Zhejiang provincial immunization information system (ZJIIS). Three variables was defined as the main outcomes, which included: (1) knowing about both the availability of VarV and the number of doses required; (2) positive attitude towards the utility of varicella vaccination; (3) the vaccination coverage of VarV1, which meant the proportion of children having received the VarV1. Counts and proportions were used to describe the socio-demographic characteristics of study participants, and their relationship with study outcomes were tested using chi-square tests in univariate analysis and logistic regression in multivariable analysis. Results: A total of 629 pregnant women participated in this study. The majority of the participants (68.0%) answered correctly about the transmission route of varicella. The proportion of participants who heard about varicella vaccination was 76.5% and 66.8% knew that VarV was currently available. Only 13.5% of the participants answered correctly that the complete VarV series needed two doses. Age, immigration status, education level, household income, and number of children of the pregnant women were significant predictors of the KAP regarding the VarV vaccination. Conclusions: The current survey indicated that optimal KAP levels and coverage on VarV vaccination were observed in three districts of Zhejiang Province. Health education programs on varicella and VarV vaccination directed towards both pre-natal and post-natal women are needed, which will result in a better attitude on vaccination of VarV and in a high coverage of VarV.
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Affiliation(s)
- Yu Hu
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, No. 3399 Binsheng Road, Binjiang District, Hangzhou 310051, China.
| | - Yaping Chen
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, No. 3399 Binsheng Road, Binjiang District, Hangzhou 310051, China.
| | - Ying Wang
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, No. 3399 Binsheng Road, Binjiang District, Hangzhou 310051, China.
| | - Hui Liang
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, No. 3399 Binsheng Road, Binjiang District, Hangzhou 310051, China.
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Palanisamy B, Kosalram K, Gopichandran V. Dimensions of social capital of families with thalassemia in an indigenous population in Tamil Nadu, India - a qualitative study. Int J Equity Health 2017; 16:109. [PMID: 28646907 PMCID: PMC5483308 DOI: 10.1186/s12939-017-0609-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 06/20/2017] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Studies have shown that social capital is positively associated with health, and the association is context-based. Indigenous populations with poor access to health care largely depend on social capital for their health care needs. This study was conducted to explore the dimensions and types of social capital and its utilization by families with thalassemia for their health and well-being in an indigenous population in Tamil Nadu, India. METHODS The participants in the study were parents who had children with thalassemia, belonged to an indigenous community in Tamil Nadu, were poor and marginalized, and had poor access to health care. Different dimensions and types of social capital were examined with the help of qualitative in-depth interviews using a phenomenological approach. A total of 8 in-depth interviews were conducted and transcribed. Thematic analysis of the data was performed. RESULTS The social capital identified through the in-depth interviews consisted of various levels of family support, financial support from relatives and neighbors, the provision of information from formal and informal networks, and trust in the physician. Indigenous communities are close-knit due to their geographical remoteness and limited accessibility. Family ties were a form of social capital that encouraged bonding, and provided support and care to the children affected by thalassemia. The bonding also helped to meet the regular requirement of blood donation for the children. Relatives and neighbors were an asset that served as a bridge for the families affected, helping them in times of immediate and urgent financial need, making it easier to sustain long-term treatment and providing emotional support. There were informal networks that bridged parents belonging to indigenous and non-indigenous communities, with the latter providing the former with information to help them choose better health care at an affordable cost. The other formal links were the ties between the parents and nongovernmental organizations, such as the local thalassemia association, which connected members belonging to different areas. It was these ties that were of the greatest assistance to the families affected in coping with the disease, enabling them to sustain the treatment, and assisting them to choose and carry out the complicated bone marrow transplantation, which is the definitive treatment for this condition. CONCLUSION The bonding, bridging, and linking dimensions of social capital help communities cope with thalassemia, the more so in indigenous and marginalized communities.
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Affiliation(s)
- Bharathi Palanisamy
- Doctoral Research Scholar, School of Public Health, SRM University, Kancheepuram District, Tamil Nadu India
| | - Kalpana Kosalram
- School of Public Health, SRM University, Kancheepuram District, Tamil Nadu India
| | - Vijayaprasad Gopichandran
- Department of Community Medicine, ESIC Medical College & Postgraduate Institute of Medical Sciences and Research, KK Nagar Chennai, 600078 Tamil Nadu India
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111
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Hu Y, Wang Y, Chen Y, Li Q. Determinants of inequality in the up-to-date fully immunization coverage among children aged 24-35 months: Evidence from Zhejiang province, East China. Hum Vaccin Immunother 2017; 13:1902-1907. [PMID: 28604178 DOI: 10.1080/21645515.2017.1327108] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE This study aimed to determine the degree and determinants of inequality in up-to-date fully immunization (UTDFI) coverage among children of Zhejiang province, east China. METHOD We used data from the Zhejiang provincial vaccination coverage survey of 2014 and the health outcome was the UTDFI status among children aged 24-35 months. The household income per month was used as an index of socio-economic status for the inequality analysis. The concentration index (CI) was used to quantify the degree of inequality and the decomposition approach was applied to quantify the contributions from demographic factors to inequality in UTDFI coverage. RESULTS The UTDFI coverage was 80.63% and the CI for UTDFI coverage was 0.12028 (95% CI: 0.10852-0.13175), indicating that immunization practice significantly favored children with relatively higher socio-economic status. The results of decomposition analysis suggested that 68.2% of the socio-economic inequality in UTDFI coverage should be explained by the mother's education level. Furthermore, factors such as birth order, ethnic group, maternal employment status, residence, immigration status, GDP per-capital and percentage of public health spending of the total health spending also could explain the disparity in UTDFI coverage. CONCLUSION There exists inequality in UTDFI coverage among the socio-economic disadvantage children. Health interventions of narrowing the socio-economic inequality in UTDFI coverage will benefit from being supplemented with strategies aimed at poverty and illiteracy reduction.
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Affiliation(s)
- Yu Hu
- a Institute of Immunization and Prevention , Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou , Zhejiang , China
| | - Ying Wang
- a Institute of Immunization and Prevention , Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou , Zhejiang , China
| | - Yaping Chen
- a Institute of Immunization and Prevention , Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou , Zhejiang , China
| | - Qian Li
- a Institute of Immunization and Prevention , Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou , Zhejiang , China
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112
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Story WT, Carpiano RM. Household social capital and socioeconomic inequalities in child undernutrition in rural India. Soc Sci Med 2017; 181:112-121. [DOI: 10.1016/j.socscimed.2017.03.043] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 03/16/2017] [Accepted: 03/19/2017] [Indexed: 11/29/2022]
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113
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Balogun SA, Yusuff HA, Yusuf KQ, Al-Shenqiti AM, Balogun MT, Tettey P. Maternal education and child immunization: the mediating roles of maternal literacy and socioeconomic status. Pan Afr Med J 2017; 26:217. [PMID: 28690731 PMCID: PMC5491723 DOI: 10.11604/pamj.2017.26.217.11856] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 04/19/2017] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Previous studies in Nigeria have documented significant association between maternal education and child immunization. However, little is known about the pathway through which maternal education improves immunization uptake. This study aims to examine whether maternal literacy and socioeconomic status mediates the relationship between maternal education and complete immunization coverage in children. METHODS Nationally representative data from the first wave of the Nigeria General Household Survey-Panel were used, which includes 661 children aged one year and below. Regression analyses were used to model the association between maternal education and child's immunization uptake; we then examined whether maternal literacy and household economic status mediates this association. RESULTS Of the 661 children, 40% had complete immunization. The prevalence ratio (PR) of complete immunization in children whose mothers were educated versus those whose mothers were not educated was 1.44 (95% CI: 1.16-1.77). Maternal literacy substantially reduced the estimated association between maternal education and complete immunization by 90%, whereas household economic status reduced the estimates by 27%. CONCLUSION These findings suggest that complete immunization was higher in children whose mothers were educated, partly because maternal education leads to acquisition of literacy skills and better health-seeking behavior which then improves immunization uptake for their children. Socioeconomic status is an alternative pathway but with less substantial indirect effect.
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Affiliation(s)
- Saliu Adejumobi Balogun
- Menzies Institute for Medical Research, University of Tasmania, Australia.,Otun Centre for Health and Social Research, Lagos, Nigeria
| | - Hakeem Abiola Yusuff
- Otun Centre for Health and Social Research, Lagos, Nigeria.,State Ministry of Health, Abeokuta, Ogun State, Nigeria
| | - Kehinde Quasim Yusuf
- College of Medical Rehabilitation Sciences, Taibah University, Madinah, Saudi Arabia
| | | | | | - Prudence Tettey
- Menzies Institute for Medical Research, University of Tasmania, Australia
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114
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Khan MT, Zaheer S, Shafique K. Maternal education, empowerment, economic status and child polio vaccination uptake in Pakistan: a population based cross sectional study. BMJ Open 2017; 7:e013853. [PMID: 28283489 PMCID: PMC5353333 DOI: 10.1136/bmjopen-2016-013853] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To explore the association of maternal education and empowerment with childhood polio vaccination using nationally representative data of Pakistani mothers in a reproductive age group. DESIGN Cross-sectional. SETTING Secondary analysis of Pakistan Demographic and Health Survey (PDHS), 2012-2013 data was performed. PARTICIPANTS Of the 13 558 mothers included in the survey sample, 6982 mothers were able to provide information regarding polio vaccinations. MAIN OUTCOME MEASURES Polio vaccination coverage among children aged up to 5 years was categorised as complete vaccination (all four oral polio vaccine (OPV) doses), incomplete vaccination, and no vaccination (zero OPV dose received). Mothers' empowerment status was assessed using standard 'Measure DHS' questions regarding their involvement in decision-making related to health, household possessions and visits among family and friends. Education was categorised as no education, primary, secondary and higher education. Results of multinomial regression analyses were reported as adjusted OR with 95% CI. We adjusted for age, wealth index, urban/rural residence, place of delivery, and antenatal and postnatal visits. RESULTS Only 56.4% (n=3936) of the children received complete polio vaccination. Women with no education had significantly higher odds of their child receiving no polio vaccination (OR 2.34, 95% CI 1.05 to 5.18; p<0.01) and incomplete vaccination (OR 1.40, 95% CI 1.04 to 1.87; p<0.01). Further, unempowered women also had significantly higher odds of not taking their child for any polio vaccination (OR 1.58, 95% CI 1.17 to 2.12; p<0.01) and incomplete vaccination (OR 1.18, 95% CI 1.00 to 1.41; p=0.04). CONCLUSIONS Illiteracy, socioeconomic status and empowerment of women remained significant factors linked to poorer uptake of routine polio vaccination.
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Affiliation(s)
- Muhammad Tahir Khan
- School of Public Health, Dow University of Health Sciences, Karachi, Pakistan
| | - Sidra Zaheer
- School of Public Health, Dow University of Health Sciences, Karachi, Pakistan
| | - Kashif Shafique
- School of Public Health, Dow University of Health Sciences, Karachi, Pakistan
- Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK
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Ntenda PAM, Chuang KY, Tiruneh FN, Chuang YC. Analysis of the effects of individual and community level factors on childhood immunization in Malawi. Vaccine 2017; 35:1907-1917. [PMID: 28284678 DOI: 10.1016/j.vaccine.2017.02.036] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 02/16/2017] [Accepted: 02/17/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Empirical evidence regarding the relationship between childhood immunization and individual- and community-level factors in low-income countries has received little attention. We compared the trends and the effects of a wide range of individual- and community-level socioeconomic factors on the likelihood of a child being immunized between 2004 and 2010 in Malawi. METHODS We used data from the 2004 and 2010 Malawi Demographic and Health Survey and applied generalized estimating logistic regression equation to analyze data respectively on 2042 and 3496 children aged 12-23months. We compared the relationship between individual- and community-level socioeconomic factors and a child's vaccination status for four basic vaccines recommended by the World Health Organization: bacillus Calmette-Guérin (BCG) vaccine, diphtheria-tetanus-pertussis (DPT3) vaccine, oral polio vaccine (OPV3), and measles-containing vaccine 1 (MCV1). RESULTS The trends of vaccination had a similar pattern in 2004 and 2010. The coverage of the four vaccinations was highest for BCG and lowest for OPV3 and complete immunization was higher in 2010. The multivariate analyses show that mother's low education, having one or none antenatal visits, having no immunization card, having immunization card but not seen, residing in poor households, and living in central region were the most significant factors associated with decreased odds of achieving vaccination coverage and complete vaccination in both 2004 and 2010. However, maternal education was more likely to be associated with children's immunization in 2010, while the geographical region was more likely to be associated with children's immunization in 2004. CONCLUSIONS There were marked improvements in the national immunization coverage from 2004 to 2010. In order to achieve complete immunization, to further enhance the national immunization coverage as well as to lessen the gaps and disparities in childhood vaccination in Malawi, policy makers should design interventions based on the factors addressed in this study.
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Affiliation(s)
| | - Kun-Yang Chuang
- School of Public Health, Taipei Medical University, No. 250, Wuhsing St, Taipei City 110, Taiwan
| | - Fentanesh Nibret Tiruneh
- School of Public Health, Taipei Medical University, No. 250, Wuhsing St, Taipei City 110, Taiwan
| | - Ying-Chih Chuang
- School of Public Health, Taipei Medical University, No. 250, Wuhsing St, Taipei City 110, Taiwan.
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Kazungu JS, Adetifa IM. Crude childhood vaccination coverage in West Africa: Trends and predictors of completeness. Wellcome Open Res 2017; 2:12. [PMID: 28459105 PMCID: PMC5407439 DOI: 10.12688/wellcomeopenres.10690.1] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2017] [Indexed: 12/21/2022] Open
Abstract
Background: Africa has the lowest childhood vaccination coverage worldwide. If the full benefits of childhood vaccination programmes are to be enjoyed in sub-Saharan Africa, all countries need to improve on vaccine delivery to achieve and sustain high coverage. In this paper, we review trends in vaccination coverage, dropouts between vaccine doses and explored the country-specific predictors of complete vaccination in West Africa. Methods: We utilized datasets from the Demographic and Health Surveys Program, available for Benin, Burkina Faso, The Gambia, Ghana, Guinea, Cote d'Ivoire, Liberia, Mali, Niger, Nigeria, Senegal, Sierra Leone and Togo, to obtain coverage for Bacillus Calmette-Guerin, polio, measles, and diphtheria, pertussis and tetanus (DPT) vaccines in children aged 12 - 23 months. We also calculated the DPT1-to-DPT3 and DPT1-to-measles dropouts, and proportions of the fully immunised child (FIC). Factors predictive of FIC were explored using Chi-squared tests and multivariable logistic regression. Results: Overall, there was a trend of increasing vaccination coverage. The proportion of FIC varied significantly by country (range 24.1-81.4%, mean 49%). DPT1-to-DPT3 dropout was high (range 5.1% -33.9%, mean 16.3%). Similarly, DPT1-measles dropout exceeded 10% in all but four countries. Although no single risk factor was consistently associated with FIC across these countries, maternal education, delivery in a health facility, possessing a vaccine card and a recent post delivery visit to a health facility were the key predictors of complete vaccination. Conclusions: The low numbers of fully immunised children and high dropout between vaccine doses highlights weaknesses and the need to strengthen the healthcare and routine immunization delivery systems in this region. Country-specific correlates of complete vaccination should be explored further to identify interventions required to increase vaccination coverage. Despite the promise of an increasing trend in vaccination coverage in West African countries, more effort is required to attain and maintain global vaccination coverage targets.
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Affiliation(s)
- Jacob S. Kazungu
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
- Department of Public Health, Pwani University, Kilifi, Kenya
| | - Ifedayo M.O. Adetifa
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- College of Medicine, University of Lagos, Lagos, Nigeria
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Ghosh A, Laxminarayan R. Demand- and supply-side determinants of diphtheria-pertussis-tetanus nonvaccination and dropout in rural India. Vaccine 2017; 35:1087-1093. [PMID: 28081971 PMCID: PMC5297340 DOI: 10.1016/j.vaccine.2016.12.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 12/08/2016] [Accepted: 12/09/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although 93% of 12- to 23-month-old children in India receive at least one vaccine, typically Bacillus Calmette-Guérin, only 75% complete the recommended three doses of diphtheria-pertussis-tetanus (DPT, also referred to as DTP) vaccine. Determinants can be different for nonvaccination and dropout but have not been examined in earlier studies. We use the three-dose DPT series as a proxy for the full sequence of recommended childhood vaccines and examine the determinants of DPT nonvaccination and dropout between doses 1 and 3. METHODS We analyzed data on 75,728 6- to 23-month-old children in villages across India to study demand- and supply-side factors determining nonvaccination with DPT and dropout between DPT doses 1 and 3, using a multilevel approach. Data come from the District Level Household and Facility Survey 3 (2007-08). RESULTS Individual- and household-level factors were associated with both DPT nonvaccination and dropout between doses 1 and 3. Children whose mothers had no schooling were 2.3 times more likely not to receive any DPT vaccination and 1.5 times more likely to drop out between DPT doses 1 and 3, compared with children whose mothers had 10 or more years of schooling. Although supply-side factors related to availability of public health facilities and immunization-related health workers in villages were not correlated with dropout between DPT doses 1 and 3, children in districts where 46% or more villages had a healthcare subcentre were 1.5 times more likely to receive at least one dose of DPT vaccine compared with children in districts where 30% or fewer villages had subcentres. CONCLUSIONS Nonvaccination with DPT in India is influenced by village- and district-level contextual factors over and above individuals' background characteristics. Dropout between DPT doses 1 and 3 is associated more strongly with demand-side factors than with village- and district-level supply-side factors.
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Affiliation(s)
- Arpita Ghosh
- Public Health Foundation of India, Gurgaon, Haryana, India.
| | - Ramanan Laxminarayan
- Center for Disease Dynamics, Economics & Policy, Washington, DC, USA; Princeton University, Princeton, NJ, USA.
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Arsenault C, Harper S, Nandi A, Rodríguez JMM, Hansen PM, Johri M. An equity dashboard to monitor vaccination coverage. Bull World Health Organ 2016; 95:128-134. [PMID: 28250513 PMCID: PMC5327933 DOI: 10.2471/blt.16.178079] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 09/20/2016] [Accepted: 09/22/2016] [Indexed: 11/27/2022] Open
Abstract
Equity monitoring is a priority for Gavi, the Vaccine Alliance, and for those implementing The2030 agenda for sustainable development. For its new phase of operations, Gavi reassessed its approach to monitoring equity in vaccination coverage. To help inform this effort, we made a systematic analysis of inequalities in vaccination coverage across 45 Gavi-supported countries and compared results from different measurement approaches. Based on our findings, we formulated recommendations for Gavi’s equity monitoring approach. The approach involved defining the vulnerable populations, choosing appropriate measures to quantify inequalities, and defining equity benchmarks that reflect the ambitions of the sustainable development agenda. In this article, we explain the rationale for the recommendations and for the development of an improved equity monitoring tool. Gavi’s previous approach to measuring equity was the difference in vaccination coverage between a country’s richest and poorest wealth quintiles. In addition to the wealth index, we recommend monitoring other dimensions of vulnerability (maternal education, place of residence, child sex and the multidimensional poverty index). For dimensions with multiple subgroups, measures of inequality that consider information on all subgroups should be used. We also recommend that both absolute and relative measures of inequality be tracked over time. Finally, we propose that equity benchmarks target complete elimination of inequalities. To facilitate equity monitoring, we recommend the use of a data display tool – the equity dashboard – to support decision-making in the sustainable development period. We highlight its key advantages using data from Côte d’Ivoire and Haiti.
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Affiliation(s)
- Catherine Arsenault
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, Quebec H3A 1A2, Canada
| | - Sam Harper
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, Quebec H3A 1A2, Canada
| | - Arijit Nandi
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, Quebec H3A 1A2, Canada
| | | | | | - Mira Johri
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
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Pierce H, Gibby AL, Forste R. Caregiver Decision-Making: Household Response to Child Illness in sub-Saharan Africa. POPULATION RESEARCH AND POLICY REVIEW 2016; 35:581-597. [PMID: 28794575 PMCID: PMC5546145 DOI: 10.1007/s11113-016-9396-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We draw upon a framework outlining household recognition and response to child illness proposed by Colvin and colleagues (2013) to examine factors predictive of treatment sought for a recent child illness. In particular, we model whether no treatment, middle layer treatment (traditional healer, pharmacy, community health worker, etc.), or biomedical treatment was sought for recent episodes of diarrhea, fever, or cough. Based on multinomial, multilevel analyses of Demographic and Health Surveys from 19 countries in sub-Saharan Africa, we determine that if women have no say in their own healthcare, they are unlikely to seek treatment in response to child illness. We find that women in sub-Saharan Africa need healthcare knowledge, the ability to make healthcare decisions, as well as resources to negotiate cost and travel, in order to access biomedical treatment. Past experience with medical services such as prenatal care and a skilled birth attendant also increase the odds that biomedical treatment for child illness is sought. We conclude that caregiver decision-making in response to child illness within households is critical to reducing child morbidity and mortality in sub-Saharan Africa.
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Affiliation(s)
- Hayley Pierce
- Department of Demography and Sociology, 2232 Piedmont Ave, University of California, Berkeley, Berkeley, CA 94720,
| | - Ashley Larsen Gibby
- Department of Sociology, 512 Oswald Tower, Penn State University, State College, Pennsylvania, 16801,
| | - Renata Forste
- Department of Sociology, 2025 JFSB, Brigham Young University, Provo, Utah 84602, Office phone: 801-422-3146, ,
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Devasenapathy N, Ghosh Jerath S, Sharma S, Allen E, Shankar AH, Zodpey S. Determinants of childhood immunisation coverage in urban poor settlements of Delhi, India: a cross-sectional study. BMJ Open 2016; 6:e013015. [PMID: 27566644 PMCID: PMC5013380 DOI: 10.1136/bmjopen-2016-013015] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES Aggregate data on childhood immunisation from urban settings may not reflect the coverage among the urban poor. This study provides information on complete childhood immunisation coverage among the urban poor, and explores its household and neighbourhood-level determinants. SETTING Urban poor community in the Southeast district of Delhi, India. PARTICIPANTS We randomly sampled 1849 children aged 1-3.5 years from 13 451 households in 39 clusters (cluster defined as area covered by a community health worker) in 2 large urban poor settlements. Of these, 1343 completed the survey. We collected information regarding childhood immunisation (BCG, oral polio vaccine, diphtheria-pertussis-tetanus vaccine, hepatitis B and measles) from vaccination cards or mothers' recall. We used random intercept logistic regression to explore the sociodemographic determinants of complete immunisation. RESULTS Complete immunisation coverage was 46.7% and 7.5% were not immunised. The odds of complete vaccination (OR, 95% CI) were lower in female children (0.70 (0.55 to 0.89)) and Muslim households (0.65 (0.45 to 0.94)). The odds of complete vaccination were higher if the mother was literate (1.6 (1.15 to 2.16)), if the child was born within the city (2.7 (1.97 to 3.65)), in a health facility ( 1.5 (1.19 to 2.02)), belonged to the highest wealth quintile (compared with the poorest; 2.46 (1.5 to 4.02)) or possessed a birth certificate (1.40 (1.03 to 1.91)). Cluster effect due to unmeasured neighbourhood factors expressed as median OR was 1.32. CONCLUSIONS Immunisation coverage in this urban poor area was much lower than that of regional surveys reporting overall urban data. Socioeconomic status of the household, female illiteracy, health awareness and gender inequality were important determinants of coverage in this population. Hence, in addition to enhancing the infrastructure for providing mother and child services, efforts are also needed to address these issues in order to improve immunisation coverage in deprived urban communities. TRIAL REGISTRATION NUMBER CTRI/2011/091/000095.
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Affiliation(s)
- Niveditha Devasenapathy
- Indian Institute of Public Health, Delhi, Public Health Foundation of India, Gurgaon, Haryana, India
| | - Suparna Ghosh Jerath
- Indian Institute of Public Health, Delhi, Public Health Foundation of India, Gurgaon, Haryana, India
| | - Saket Sharma
- Indian Institute of Public Health, Delhi, Public Health Foundation of India, Gurgaon, Haryana, India
| | - Elizabeth Allen
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Anuraj H Shankar
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Sanjay Zodpey
- Indian Institute of Public Health, Delhi, Public Health Foundation of India, Gurgaon, Haryana, India
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Kumar C, Singh PK, Singh L, Rai RK. Socioeconomic disparities in coverage of full immunisation among children of adolescent mothers in India, 1990-2006: a repeated cross-sectional analysis. BMJ Open 2016; 6:e009768. [PMID: 27519918 PMCID: PMC4985793 DOI: 10.1136/bmjopen-2015-009768] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Studies have highlighted that children of adolescent (aged 15-19 years) mothers are likely to receive relatively poor healthcare. With an unacceptably high adolescent birth rate, India houses the highest number of adolescent mothers globally, putting children at risk of inadequate vaccination. This paper assesses trends and extent of socioeconomic disparities in the coverage of full immunisation among children of adolescent mothers in India. DESIGN Repeated cross-sectional analytical study. DATA SOURCES 3 consecutive rounds of the National Family Health Survey (NFHS) conducted during 1992-1993, 1998-1999 and 2005-2006 were used. Besides, the required information is also extracted from the 2011 Indian Census. PARTICIPANTS Children (aged 12-23 months) of adolescent (aged 15-19 years) mothers. Sample inclusion criteria involved the last child of the adolescent eligible to avail full immunisation. SETTING Nationally representative sample. DATA ANALYSIS The Cochran-Armitage test, χ(2) test and binary logistic regression methods were applied to attain the study objective. RESULTS Between 1990 and 2006, a non-significant increase of 4 percentage points in full immunisation of children of adolescent mothers was estimated. During the same period, a large difference between the probability of children of adolescent mothers receiving full immunisation belonging to the least (predicted probability (PP): 0.196 in 1990-1993, and PP: 0.213 in 2003-2006) and the most (PP: 0.589 in 1990-1993, and PP: 0.645 in 2003-2006) socioeconomically privileged group was estimated, and this disparity persisted over the survey period. CONCLUSIONS During 1990-2006, an insufficient improvement in provision of full immunisation to children born to adolescent mothers was recorded. The study underscored the suboptimum immunisation of rural, illiterate and poor children of adolescent women. The programme and policymakers could focus on district-wise concentration of adolescent women, especially those belonging to the underprivileged groups, to design a targeted intervention to elevate the level of immunisation of children of adolescent mothers.
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Affiliation(s)
- Chandan Kumar
- Department of Geography, School of Earth Sciences, Central University of Karnataka, Kalaburagi, Karnataka, India
| | - Prashant Kumar Singh
- Population Health & Nutrition Research Program, Institute for Human Development, New Delhi, Delhi, India
| | - Lucky Singh
- National Institute of Medical Statistics, Indian Council of Medical Research, New Delhi, Delhi, India
| | - Rajesh Kumar Rai
- Society for Health and Demographic Surveillance, Suri, West Bengal, India
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Chatterjee K, Sinha RK, Kundu AK, Shankar D, Gope R, Nair N, Tripathy PK. Social determinants of inequities in under-nutrition (weight-for-age) among under-5 children: a cross sectional study in Gumla district of Jharkhand, India. Int J Equity Health 2016; 15:104. [PMID: 27391031 PMCID: PMC4938901 DOI: 10.1186/s12939-016-0392-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 07/01/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Jharkhand, a state with substantial tribal population in Eastern India has very high rate of undernutrition. The study tries to understand the social determinants of inequities in under-nutrition (weight-for-age) among children aged less than 5 years, in Gumla District of the State. METHODS Cross sectional study of 1070 children from 32 villages of 4 Blocks of Gumla District. RESULTS 54.3 % (95 % CI 51.3-57.3) children were found to be underweight (less than -2SD), with insignificant difference between girls and boys. Multivariate analysis showed that poverty was the single most important predictor of undernutrition, where a child from the poorest quintile was 70 % more likely to be underweight (aOR 1.70, CI 1.13-2.57), compared to one from the least poor group (Quintile 5). While the difference in weight-for-age status between Scheduled Tribes and "OBC and other communities" was non-significant (95 % OR 1.12, CI 0.88-1.42) in the study context; community disaggregated data revealed that there were large variations within the tribal community, and numerically smaller communities also ranked lower in wealth, and their children showed poorer nutritional status. Other factors like maternal education beyond matriculation level also had some bearing. Bivariate analysis showed that chances of a child being underweight (<-2SD) was 43 % more and being severely underweight (<-3SD) was 26 % more for mothers with less than 10 years of schooling compared to those who had attended school for more than 10 years. Educational attainment of mothers did not show any significant difference between tribal and non-tribal communities. CONCLUSION Overall nutritional status of children in Gumla is very grim and calls for immediate interventions, with universal coverage. Risk was almost equal for both genders, and for tribal and non-tribal population, though within tribal communities, it was slightly higher for smaller tribal communities, calling for soft targeting. Comprehensive programme addressing poverty and higher education for girls would be important to overcome the structural barriers, and should be integral part of any intervention. The study highlights the importance of soft targeting vulnerable communities within the universal coverage of government programmes for better nutritional outcomes.
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Affiliation(s)
- Keya Chatterjee
- Ekjut- NGO in India, Chakradharpur, West Singhbhum, Jharkhand India
| | | | - Alok Kumar Kundu
- Ekjut- NGO in India, Chakradharpur, West Singhbhum, Jharkhand India
| | | | - Rajkumar Gope
- Ekjut- NGO in India, Chakradharpur, West Singhbhum, Jharkhand India
| | - Nirmala Nair
- Ekjut- NGO in India, Chakradharpur, West Singhbhum, Jharkhand India
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Heaton TB, Crookston B, Pierce H, Amoateng AY. Social inequality and children's health in Africa: a cross sectional study. Int J Equity Health 2016; 15:92. [PMID: 27301658 PMCID: PMC4906977 DOI: 10.1186/s12939-016-0372-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 05/19/2016] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND This study examines socioeconomic inequality in children's health and factors that moderate this inequality. Socioeconomic measures include household wealth, maternal education and urban/rural area of residence. Moderating factors include reproductive behavior, access to health care, time, economic development, health expenditures and foreign aid. METHODS Data are taken from Demographic and Health Surveys conducted between 2003 and 2012 in 26 African countries. RESULTS Birth spacing, skilled birth attendants, economic development and greater per capita health expenditures benefit the children of disadvantaged mothers, but the wealthy benefit more from the services of a skilled birth attendant and from higher per capita expenditure on health. CONCLUSION Some health behavior and policy changes would reduce social inequality, but the wealthy benefit more than the poor from provision of health services.
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Affiliation(s)
- Tim B Heaton
- Department of Sociology, Brigham Young University, 2033 JFSB, Provo, UT, 84602, USA.
| | | | - Hayley Pierce
- Department of Sociology, Brigham Young University, 2033 JFSB, Provo, UT, 84602, USA
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Sharma A, Kaplan WA, Chokshi M, Zodpey SP. Role of the private sector in vaccination service delivery in India: evidence from private-sector vaccine sales data, 2009-12. Health Policy Plan 2016; 31:884-96. [PMID: 26976803 DOI: 10.1093/heapol/czw008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND India's Universal Immunization Programme (UIP) provides basic vaccines free-of-cost in the public sector, yet national vaccination coverage is poor. The Government of India has urged an expanded role for the private sector to help achieve universal immunization coverage. We conducted a state-by-state analysis of the role of the private sector in vaccinating Indian children against each of the six primary childhood diseases covered under India's UIP. METHODS We analyzed IMS Health data on Indian private-sector vaccine sales, 2011 Indian Census data and national household surveys (DHS/NFHS 2005-06 and UNICEF CES 2009) to estimate the percentage of vaccinated children among the 2009-12 birth cohort who received a given vaccine in the private sector in 16 Indian states. We also analyzed the estimated private-sector vaccine shares as function of state-specific socio-economic status. RESULTS Overall in 16 states, the private sector contributed 4.7% towards tuberculosis (Bacillus Calmette-Guérin (BCG)), 3.5% towards measles, 2.3% towards diphtheria-pertussis-tetanus (DPT3) and 7.6% towards polio (OPV3) overall (both public and private sectors) vaccination coverage. Certain low income states (Uttar Pradesh, Rajasthan, Madhya Pradesh, Orissa, Assam and Bihar) have low private as well as public sector vaccination coverage. The private sector's role has been limited primarily to the high income states as opposed to these low income states where the majority of Indian children live. Urban areas with good access to the private sector and the ability to pay increases the Indian population's willingness to access private-sector vaccination services. CONCLUSION In India, the public sector offers vaccination services to the majority of the population but the private sector should not be neglected as it could potentially improve overall vaccination coverage. The government could train and incentivize a wider range of private-sector health professionals to help deliver the vaccines, especially in the low income states with the largest birth cohorts. We recommend future studies to identify strengths and limitations of the public and private health sectors in each Indian state.
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Affiliation(s)
- Abhishek Sharma
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA Precision for Value, Boston, MA, USA
| | - Warren A Kaplan
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA
| | - Maulik Chokshi
- Indian Institute of Public Health, Public Health Foundation of India, New Delhi, India
| | - Sanjay P Zodpey
- Indian Institute of Public Health, Public Health Foundation of India, New Delhi, India
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Maternal determinants of immunization status of children aged 12–23 months in urban slums of Varanasi, India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2015. [DOI: 10.1016/j.cegh.2014.07.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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126
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Rammohan A, Awofeso N. District-level variations in childhood immunizations in India: The role of socio-economic factors and health infrastructure. Soc Sci Med 2015; 145:163-72. [DOI: 10.1016/j.socscimed.2015.05.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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The Influence of Women’s Empowerment on Child Immunization Coverage in Low, Lower-Middle, and Upper-Middle Income Countries: A Systematic Review of the Literature. Matern Child Health J 2015; 20:172-186. [DOI: 10.1007/s10995-015-1817-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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128
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Effect of combining a health program with a microfinance-based self-help group on health behaviors and outcomes. Public Health 2015; 129:1510-8. [PMID: 26304181 PMCID: PMC4652626 DOI: 10.1016/j.puhe.2015.07.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Revised: 07/07/2015] [Accepted: 07/13/2015] [Indexed: 11/21/2022]
Abstract
Objectives Women's participation in microfinance-based self-help groups (SHGs) and the resultant social capital may provide a basis to address the gap in health attainment for poor women and their children. We investigated the effect of combining a health program designed to improve health behaviours and outcomes with a microfinance-based SHG program. Design A mixed method study was conducted among 34 villages selected from three blocks or district subdivisions of India; one in Gujarat, two in Karnataka. Methods A set of 17 villages representing new health program areas were pair-matched with 17 comparison villages. Two rounds of surveys were conducted with a total of 472 respondents, followed by 17 key informant interviews and 17 focus group discussions. Results Compared to a matched comparison group, women in SHGs that received the health program had higher odds of delivering their babies in an institution (OR: 5.08, 95% CI 1.21–21.35), feeding colostrum to their newborn (OR: 2.83, 95% CI 1.02–5.57), and having a toilet at home (OR: 1.53, 95% CI 0.76–3.09). However, while the change was in the expected direction, there was no statistically significant reduction in diarrhoea among children in the intervention community (OR: 0.86, 95% CI 0.42–1.76), and the hypothesis that the health program would result in decreased out-pocket expenditures on treatment was not supported. Conclusion Our study found evidence that health programs implemented with microfinance-based SHGs is associated with improved health behaviours. With broad population coverage of SHGs and the social capital produced by their activities, microfinance-based SHGs may provide an avenue for addressing the health needs of poor women. Combining a health program with SHGs is associated with an improvement in key health behaviours in the study population. However, the program led to no significant improvement in diarrhoea among children, and no effect on spending on treatment. The structure of SHGs and duration of association played a role in promoting trust between members and the host organization. Working with SHGs provides a basis for addressing the gap in health attainment for women and their children.
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The Relationship Between Maternal Education and Child Health Outcomes in Urban Australian Children in the First 12 Months of Life. Matern Child Health J 2015; 19:2501-11. [DOI: 10.1007/s10995-015-1771-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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130
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Kosec K, Avula R, Holtemeyer B, Tyagi P, Hausladen S, Menon P. Predictors of Essential Health and Nutrition Service Delivery in Bihar, India: Results From Household and Frontline Worker Surveys. GLOBAL HEALTH, SCIENCE AND PRACTICE 2015; 3:255-73. [PMID: 26085022 PMCID: PMC4476863 DOI: 10.9745/ghsp-d-14-00144] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 02/19/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND In Bihar, India, coverage of essential health and nutrition interventions is low. These interventions are provided by 2 national programs--the Integrated Child Development Services (ICDS) and Health/National Rural Health Mission (NRHM)--through Anganwadi workers (AWWs) and Accredited Social Health Activists (ASHAs), respectively. Little is known, however, about factors that predict effective service delivery by these frontline workers (FLWs) or receipt of services by households. This study examined the predictors of use of 4 services: (1) immunization information and services, (2) food supplements, (3) pregnancy care information, and (4) general nutrition information. METHODS Data are from a 2012 cross-sectional survey of 6,002 households in 400 randomly selected villages in 1 district of Bihar state, as well as an integrated survey of 377 AWWs and 382 ASHAs from the same villages. For each of the 4 service delivery outcomes, logistic regression models were specified using a combination of variables hypothesized to be supply- and demand-side drivers of service utilization. RESULTS About 35% of households reported receiving any of the 4 services. Monetary immunization incentives for AWWs (OR = 1.55, CI = 1.02-2.36) and above-median household head education (OR = 1.39, CI = 1.05-1.82) were statistically significant predictors of household receipt of immunization services. Higher household socioeconomic status was associated with significantly lower odds of receiving food supplements (OR = 0.87, CI = 0.79-0.96). ASHAs receiving incentives for institutional delivery (OR = 1.52, CI = 0.99-2.33) was marginally associated with higher odds of receiving pregnancy care information, and ASHAs who maintained records of pregnant women was significantly associated with households receiving such information (OR = 2.25, CI = 1.07-4.74). AWWs receiving immunization incentives was associated with significantly higher odds of households receiving general nutrition information (OR = 1.92, CI = 1.08-3.41), suggesting a large spillover effect of incentives from product- to information-oriented services. CONCLUSION Product-oriented incentives affect delivery of both product- and information-oriented services, although household factors are also important. In India, existing government programs can mitigate supply- and demand-side constraints to receiving essential interventions by optimizing existing incentives for FLWs in national programs, helping FLWs better organize their work, and raising awareness among groups who are less likely to access services.
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Affiliation(s)
- Katrina Kosec
- International Food Policy Research Institute, Washington, DC, USA
| | - Rasmi Avula
- International Food Policy Research Institute, New Delhi, India
| | - Brian Holtemeyer
- International Food Policy Research Institute, Washington, DC, USA
| | - Parul Tyagi
- International Food Policy Research Institute, New Delhi, India
| | - Stephanie Hausladen
- Harvard University Graduate School of Education, Cambridge, Massachusetts, USA
| | - Purnima Menon
- Harvard University Graduate School of Education, Cambridge, Massachusetts, USA
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131
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Vaccination coverage in India: A small area estimation approach. Vaccine 2015; 33:1731-8. [DOI: 10.1016/j.vaccine.2015.01.083] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 01/27/2015] [Accepted: 01/30/2015] [Indexed: 11/15/2022]
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Sharma A, Kaplan WA, Chokshi M, Hasan Farooqui H, Zodpey SP. Implications of private sector Hib vaccine coverage for the introduction of public sector Hib-containing pentavalent vaccine in India: evidence from retrospective time series data. BMJ Open 2015; 5:e007038. [PMID: 25712822 PMCID: PMC4342586 DOI: 10.1136/bmjopen-2014-007038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE Haemophilus influenzae type b (Hib) vaccine has been available in India's private sector market since 1997. It was not until 14 December 2011 that the Government of India initiated the phased public sector introduction of a Hib (and DPT, diphtheria, pertussis, tetanus)-containing pentavalent vaccine. Our objective was to investigate the state-specific coverage and behaviour of Hib vaccine in India when it was available only in the private sector market but not in the public sector. This baseline information can act as a guide to determine how much coverage the public sector rollout of pentavalent vaccine (scheduled April 2015) will need to bear in order to achieve complete coverage. SETTING 16 of 29 states in India, 2009-2012. DESIGN Retrospective descriptive secondary data analysis. DATA (1) Annual sales of Hib vaccines, by volume, from private sector hospitals and retail pharmacies collected by IMS Health and (2) national household surveys. OUTCOME MEASURES State-specific Hib vaccine coverage (%) and its associations with state-specific socioeconomic status. RESULTS The overall private sector Hib vaccine coverage among the 2009-2012 birth cohort was low (4%) and varied widely among the studied Indian states (minimum 0.3%; maximum 4.6%). We found that private sector Hib vaccine coverage depends on urban areas with good access to the private sector, parent's purchasing capacity and private paediatricians' prescribing practices. Per capita gross domestic product is a key explanatory variable. The annual Hib vaccine uptake and the 2009-2012 coverage levels were several times higher in the capital/metropolitan cities than the rest of the state, suggesting inequity in access to Hib vaccine delivered by the private sector. CONCLUSIONS If India has to achieve high and equitable Hib vaccine coverage levels, nationwide public sector introduction of the pentavalent vaccine is needed. However, the role of private sector in universal Hib vaccine coverage is undefined as yet but it should not be neglected as a useful complement to public sector services.
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Affiliation(s)
- Abhishek Sharma
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Center for Global Health and Development, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Warren A Kaplan
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Center for Global Health and Development, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Maulik Chokshi
- Indian Institute of Public Health, Public Health Foundation of India, New Delhi, India
| | - Habib Hasan Farooqui
- Indian Institute of Public Health, Public Health Foundation of India, New Delhi, India
| | - Sanjay P Zodpey
- Indian Institute of Public Health, Public Health Foundation of India, New Delhi, India
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Aluisio AR, Maroof Z, Chandramohan D, Bruce J, Masher MI, Manaseki-Holland S, Ensink JHJ. Risk factors associated with recurrent diarrheal illnesses among children in Kabul, Afghanistan: a prospective cohort study. PLoS One 2015; 10:e0116342. [PMID: 25679979 PMCID: PMC4332656 DOI: 10.1371/journal.pone.0116342] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 12/08/2014] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Childhood diarrheal illnesses are a major public health problem. In low-income settings data on disease burden and factors associated with diarrheal illnesses are poorly defined, precluding effective prevention programs. This study explores factors associated with recurrent diarrheal illnesses among children in Kabul, Afghanistan. METHODS A cohort of 1-11 month old infants was followed for 18 months from 2007-2009. Data on diarrheal episodes were gathered through active and passive surveillance. Information on child health, socioeconomics, water and sanitation, and hygiene behaviors was collected. Factors associated with recurrent diarrheal illnesses were analyzed using random effects recurrent events regression models. RESULTS 3,045 children were enrolled and 2,511 (82%) completed 18-month follow-up. There were 14,998 episodes of diarrheal disease over 4,200 child-years (3.51 episodes/child-year, 95%CI 3.40-3.62). Risk of diarrheal illness during the winter season was 63% lower than the summer season (HR = 0.37, 95%CI 0.35-0.39, P<0.001). Soap for hand washing was available in 72% of households and 11.9% had toilets with septic/canalization. Half of all mothers reported using soap for hand washing. In multivariate analysis diarrheal illness was lower among children born to mothers with post-primary education (aHR = 0.79, 95%CI 0.69-0.91, p = 0.001), from households where maternal hand washing with soap was reported (aHR = 0.83, 95%CI 0.74-0.92, p<0.001) and with improved sanitation facilities (aHR = 0.76, 95%CI 0.63-0.93, p = 0.006). Malnourished children from impoverished households had significantly increased risks for recurrent disease [(aHR = 1.15, 95%CI 1.03-1.29, p = 0.016) and (aHR = 1.20, 95%CI 1.05-1.37, p = 0.006) respectively]. CONCLUSIONS Maternal hand washing and improved sanitation facilities were protective, and represent important prevention points among public health endeavors. The discrepancy between soap availability and utilization suggests barriers to access and knowledge, and programs simultaneously addressing these aspects would likely be beneficial. Enhanced maternal education and economic status were protective in this population and these findings support multi-sector interventions to combat illness. TRIAL REGISTRATION www.ClinicalTrials.gov NCT00548379 https://www.clinicaltrials.gov/ct2/show/NCT00548379.
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Affiliation(s)
- Adam R. Aluisio
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Emergency Medicine, Division of International Emergency Medicine, SUNY Downstate Medical Center, Brooklyn, New York, United States of America
| | - Zabihullah Maroof
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Daniel Chandramohan
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jane Bruce
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mohammad I. Masher
- Department of Paediatrics, Kabul Medical University, Kabul, Afghanistan Department of Pediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Semira Manaseki-Holland
- School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Jeroen H. J. Ensink
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Abstract
OBJECTIVE Women (especially mothers) are theorized as critical to reducing household food insecurity through their work and caregiver roles. The present study tests these assumptions, assessing how maternal economic and social resources are associated with food insecurity in households with young children. DESIGN Data from a population-based sample of households was collected in León, Nicaragua (n 443). Data include a newly validated measure of household food insecurity (ELCSA), maternal resource measures, and household economic status and demographics. Regression analysis tests the statistical associations (P<0·05) of maternal resources with household, adult-specific and child-specific food insecurity. SETTING Municipality of León, Nicaragua. SUBJECTS Households with children aged 3-11 years in rural and urban León. RESULTS Only 25% of households with young children were food secure, with 50% mildly food insecure and 25% moderately/severely food insecure. When mothers contributed substantially to household income, the odds of moderate/severe household food insecurity were 34% lower than when their spouse/partner was the main provider. The odds of food insecurity were 60% lower when mothers managed household money, 48% lower when mothers had a secondary (v. primary) education, 65% higher among single mothers and 16% lower with each indicator of social support. Results were similar for adult- and child-specific food insecurity. CONCLUSIONS This research provides new evidence that maternal economic and social resources are important for reducing household food insecurity and adult- and child-specific food insecurity. Women's social status, social support and access to economic resources need to be enhanced as a part of policies aimed to reduce food insecurity in high-poverty settings.
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135
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Mukherjee S, Madhivanan P, Li T, Albatineh A, Srinivas V, Jaykrishna P, Arun A, Krupp K. Correlates of completing routine vaccination among children in Mysore, India. J Infect Public Health 2015; 8:62-71. [DOI: 10.1016/j.jiph.2014.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Revised: 04/29/2014] [Accepted: 05/24/2014] [Indexed: 11/28/2022] Open
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Heaton TB. Are Improvements in Child Health Due to Increasing Status of Women in Developing Nations? BIODEMOGRAPHY AND SOCIAL BIOLOGY 2015; 61:252-265. [PMID: 26652680 DOI: 10.1080/19485565.2015.1047487] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This research tests the hypothesis that change over time in women's status leads to improvements in their children's health. Specifically, we examine whether change in resources and empowerment in mother's roles as biological mothers, caregivers, and providers and social contexts that promote the rights and representation of and investment in women are associated with better nutritional status and survival of young children. Analysis is based on a broad sample of countries (n = 28), with data at two or more points in time to enable examination of change. Key indicators of child health show improvement in the last 13 years in developing nations. Much of this improvement--90 percent of the increase in nutritional status and 47 percent of the reduction in mortality--is associated with improving status of women. Increased maternal education, control over reproduction, freedom from violence, access to health care, legislation and enforcement of women's rights, greater political representation, equality in the education system, and lower maternal mortality are improving children's health. These results imply that further advancement of women's position in society would be beneficial.
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Affiliation(s)
- Tim B Heaton
- a Department of Sociology , Brigham Young University , Provo , Utah , USA
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137
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Karkee R, Baral OB, Khanal V, Lee AH. The role of obstetric knowledge in utilization of delivery service in Nepal. HEALTH EDUCATION RESEARCH 2014; 29:1041-1048. [PMID: 25274718 DOI: 10.1093/her/cyu059] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Birth Preparedness and Complication Readiness (BP/CR) program has been promoted in Nepal to equip pregnant women with obstetric knowledge so as to motivate them to seek professional care. Using a prospective design of 701 pregnant women of more than 5 months gestation in a central hills district of Nepal, we evaluated if having obstetric knowledge could make a difference in maternal delivery behaviour. The results suggested that BP/CR program was effective in raising women's obstetric knowledge, which was significantly associated with facility delivery according to logistic regression analysis. In particular, women who acknowledged that unexpected problems could occur during pregnancy and childbirth were more likely (odds ratio [OR] 5.83, 95% confidence interval [CI] 2.95-11.52) to deliver at a health facility than others unaware of the possible consequences. Similarly, women who knew any antepartum danger sign (OR 2.16, 95% CI: 1.17-3.98), any intrapartum danger sign (OR 3.80, 95% CI: 2.07-6.96) and any postpartum danger sign (OR 3.47 95% CI: 1.93-6.25), tended to deliver at a health facility. Convincing and counselling the pregnant women of the health consequences of pregnancy and childbirth would increase their utilization of delivery service.
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Affiliation(s)
- Rajendra Karkee
- School of Public Health and Community Medicine, BP Koirala Institute of Health Sciences, Dharan, Stichting Sarangkot, Kaski, Sanjeevani College of Medical Sciences, Butwal, Rupandehi, Nepal and School of Public Health, Curtin University, Perth, WA, Australia
| | - Om Bahadur Baral
- School of Public Health and Community Medicine, BP Koirala Institute of Health Sciences, Dharan, Stichting Sarangkot, Kaski, Sanjeevani College of Medical Sciences, Butwal, Rupandehi, Nepal and School of Public Health, Curtin University, Perth, WA, Australia
| | - Vishnu Khanal
- School of Public Health and Community Medicine, BP Koirala Institute of Health Sciences, Dharan, Stichting Sarangkot, Kaski, Sanjeevani College of Medical Sciences, Butwal, Rupandehi, Nepal and School of Public Health, Curtin University, Perth, WA, Australia
| | - Andy H Lee
- School of Public Health and Community Medicine, BP Koirala Institute of Health Sciences, Dharan, Stichting Sarangkot, Kaski, Sanjeevani College of Medical Sciences, Butwal, Rupandehi, Nepal and School of Public Health, Curtin University, Perth, WA, Australia
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138
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Johnston DW, Lordan G, Shields MA, Suziedelyte A. Education and health knowledge: evidence from UK compulsory schooling reform. Soc Sci Med 2014; 127:92-100. [PMID: 25459203 DOI: 10.1016/j.socscimed.2014.10.026] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 10/08/2014] [Accepted: 10/14/2014] [Indexed: 11/29/2022]
Abstract
We investigate if there is a causal link between education and health knowledge using data from the 1984/85 and 1991/92 waves of the UK Health and Lifestyle Survey (HALS). Uniquely, the survey asks respondents what they think are the main causes of ten common health conditions, and we compare these answers to those given by medical professionals to form an index of health knowledge. For causal identification we use increases in the UK minimum school leaving age in 1947 (from 14 to 15) and 1972 (from 15 to 16) to provide exogenous variation in education. These reforms predominantly induced adolescents who would have left school to stay for one additionally mandated year. OLS estimates suggest that education significantly increases health knowledge, with a one-year increase in schooling increasing the health knowledge index by 15% of a standard deviation. In contrast, estimates from instrumental-variable models show that increased schooling due to the education reforms did not significantly affect health knowledge. This main result is robust to numerous specification tests and alternative formulations of the health knowledge index. Further research is required to determine whether there is also no causal link between higher levels of education - such as post-school qualifications - and health knowledge.
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Affiliation(s)
- David W Johnston
- Centre for Health Economics, Monash Business School, Monash University, Australia
| | | | - Michael A Shields
- Centre for Health Economics, Monash Business School, Monash University, Australia
| | - Agne Suziedelyte
- Centre for Health Economics, Monash Business School, Monash University, Australia
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139
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Sissoko D, Trottier H, Malvy D, Johri M. The influence of compositional and contextual factors on non-receipt of basic vaccines among children of 12-23-month old in India: a multilevel analysis. PLoS One 2014; 9:e106528. [PMID: 25211356 PMCID: PMC4161331 DOI: 10.1371/journal.pone.0106528] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 08/05/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Children unreached by vaccination are at higher risk of poor health outcomes and India accounts for nearly a quarter of unvaccinated children worldwide. The objective of this study was to investigate compositional and contextual determinants of non-receipt of childhood vaccines in India using multilevel modelling. METHODS AND FINDINGS We studied characteristics of unvaccinated children using the District Level Health and Facility Survey 3, a nationally representative probability sample containing 65 617 children aged 12-23 months from 34 Indian states and territories. We developed four-level Bayesian binomial regression models to examine the determinants of non-vaccination. The analysis considered two outcomes: completely unvaccinated (CUV) children who had not received any of the eight vaccine doses recommended by India's Universal Immunization Programme, and children who had not received any dose from routine immunisation services (no RI). The no RI category includes CUV children and those who received only polio doses administered via mass campaigns. Overall, 4.83% (95% CI: 4.62-5.06) of children were CUV while 12.01% (11.68-12.35) had received no RI. Individual compositional factors strongly associated with CUV were: non-receipt of tetanus immunisation for mothers during pregnancy (OR = 3.65 [95% CrI: 3.30-4.02]), poorest household wealth index (OR = 2.44 [1.81-3.22] no maternal schooling (OR = 2.43 [1.41-4.05]) and no paternal schooling (OR = 1.83 [1.30-2.48]). In rural settings, the influence of maternal illiteracy disappeared whereas the role of household wealth index was reinforced. Factors associated with no RI were similar to those for CUV, but effect sizes for individual compositional factors were generally larger. Low maternal education was the strongest risk factor associated with no RI in all models. All multilevel models found significant variability at community, district, and state levels net of compositional factors. CONCLUSION Non-vaccination in India is strongly related to compositional characteristics and is geographically distinct. Tailored strategies are required to overcome current barriers to immunisation.
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Affiliation(s)
- Daouda Sissoko
- Department of Social and Preventive Medicine, Faculty of Public Health, Université de Montréal, Montreal, Quebec, Canada
- Sainte-Justine Hospital Research Center, Montreal, Quebec, Canada
- International Health Unit (USI), Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada
- * E-mail:
| | - Helen Trottier
- Department of Social and Preventive Medicine, Faculty of Public Health, Université de Montréal, Montreal, Quebec, Canada
- Sainte-Justine Hospital Research Center, Montreal, Quebec, Canada
| | - Denis Malvy
- Département des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- INSERM 897 & Centre René-Labusquière, Université de Bordeaux, Bordeaux, France
| | - Mira Johri
- International Health Unit (USI), Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada
- Department of Health Administration, School of Public Health, Université de Montréal, Montreal, Quebec, Canada
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140
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Njau JD, Stephenson R, Menon MP, Kachur SP, McFarland DA. Investigating the important correlates of maternal education and childhood malaria infections. Am J Trop Med Hyg 2014; 91:509-19. [PMID: 25002302 DOI: 10.4269/ajtmh.13-0713] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The relationship between maternal education and child health has intrigued researchers for decades. This study explored the interaction between maternal education and childhood malaria infection. Cross-sectional survey data from three African countries were used. Descriptive analysis and multivariate logistic regression models were completed in line with identified correlates. Marginal effects and Oaxaca decomposition analysis on maternal education and childhood malaria infection were also estimated. Children with mothers whose education level was beyond primary school were 4.7% less likely to be malaria-positive (P < 0.001). The Oaxaca decomposition analysis exhibited an 8% gap in childhood malaria infection for educated and uneducated mothers. Over 60% of the gap was explained by differences in household wealth (26%), household place of domicile (21%), malaria transmission intensities (14%), and media exposure (12%). All other correlates accounted for only 27%. The full adjusted model showed a robust and significant relationship between maternal education and childhood malaria infection.
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Affiliation(s)
- Joseph D Njau
- Department of Health Policy and Management, Rollins School of Public Health of the Emory University, Atlanta, Georgia; Malaria Branch, Division of Parasitic Disease and Malaria, Division of Global Immunization, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Hubert Department of Global Health, Rollins School of Public Health of the Emory University, Atlanta, Georgia; Department of Medicine, Division of Medical Oncology/Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington
| | - Rob Stephenson
- Department of Health Policy and Management, Rollins School of Public Health of the Emory University, Atlanta, Georgia; Malaria Branch, Division of Parasitic Disease and Malaria, Division of Global Immunization, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Hubert Department of Global Health, Rollins School of Public Health of the Emory University, Atlanta, Georgia; Department of Medicine, Division of Medical Oncology/Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington
| | - Manoj P Menon
- Department of Health Policy and Management, Rollins School of Public Health of the Emory University, Atlanta, Georgia; Malaria Branch, Division of Parasitic Disease and Malaria, Division of Global Immunization, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Hubert Department of Global Health, Rollins School of Public Health of the Emory University, Atlanta, Georgia; Department of Medicine, Division of Medical Oncology/Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington
| | - S Patrick Kachur
- Department of Health Policy and Management, Rollins School of Public Health of the Emory University, Atlanta, Georgia; Malaria Branch, Division of Parasitic Disease and Malaria, Division of Global Immunization, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Hubert Department of Global Health, Rollins School of Public Health of the Emory University, Atlanta, Georgia; Department of Medicine, Division of Medical Oncology/Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington
| | - Deborah A McFarland
- Department of Health Policy and Management, Rollins School of Public Health of the Emory University, Atlanta, Georgia; Malaria Branch, Division of Parasitic Disease and Malaria, Division of Global Immunization, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Hubert Department of Global Health, Rollins School of Public Health of the Emory University, Atlanta, Georgia; Department of Medicine, Division of Medical Oncology/Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington
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Manthiram K, Blood EA, Kuppuswamy V, Martins Y, Narayan A, Burmeister K, Parvathy K, Hassan A. Predictors of optional immunization uptake in an urban south Indian population. Vaccine 2014; 32:3417-23. [PMID: 24736005 PMCID: PMC11057911 DOI: 10.1016/j.vaccine.2014.04.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 02/24/2014] [Accepted: 04/02/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND In Tamil Nadu, India, bacille Calmette-Guérin, diphtheria-tetanus-pertussis, oral poliomyelitis, hepatitis B, and measles vaccines are part of the routine immunization schedule and are available free from government health centers. All other vaccines are optional and available in the private sector at a cost to families. This study assesses immunization rates of routine and optional vaccines and examines parental attitudes toward vaccines in Pallavapuram, Tamil Nadu. METHODS The cluster sampling method was used to estimate immunization coverage. Seven children 18 to 36 months old were selected from 30 clusters for a total sample of 210 children. Demographics and vaccination data were collected from interviews and immunization records. Predictors of vaccination status were identified with logistic regression models. In addition, 21 parents participated in semi-structured interviews regarding their attitudes toward vaccination. Interviews were analyzed qualitatively for themes. RESULTS Eighty one percent of children were fully immunized with routine vaccines. However, only 21% received all "major" optional vaccines, defined as 3 doses of Haemophilus influenzae type b vaccine, one dose of measles, mumps, rubella vaccine, and one dose of varicella zoster virus vaccine. Birth in a private hospital (OR 5.6, 95% CI 1.3 to 22.9, P<0.01), higher income (P=0.03), and maternal completion of high school (OR 6.4, 95% CI 1.5 to 27.6, P<0.01) were significant predictors of receiving all major optional vaccines. Elucidated themes from interviews included (1) strong parental support for immunizations, (2) low concern for side effects, and (3) low uptake of optional vaccines due to high cost and lack of awareness. CONCLUSIONS Coverage of optional vaccines is low despite positive attitudes toward immunizations. Efforts to reduce cost and increase awareness of these vaccines particularly among low-income families or to include these vaccines in the routine schedule may increase uptake and reduce morbidity and mortality from vaccine-preventable diseases.
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Affiliation(s)
- Kalpana Manthiram
- Division of Pediatric Infectious Disease, Vanderbilt University Medical Center, Nashville, TN, United States.
| | - Emily A Blood
- Division of Adolescent Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States; Clinical Research Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | | | - Yolanda Martins
- Center for Population Sciences, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Athi Narayan
- Department of Neonatalogy, Emory Johns Creek Hospital, Johns Creek, GA, United States
| | - Kelly Burmeister
- Center for Population Sciences, Dana-Farber Cancer Institute, Boston, MA, United States
| | - K Parvathy
- Pallavaram Children's Medical Centre, Pallavaram, Tamil Nadu, India
| | - Areej Hassan
- Division of Adolescent Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
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142
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Social capital and the utilization of maternal and child health services in India: a multilevel analysis. Health Place 2014; 28:73-84. [PMID: 24769216 DOI: 10.1016/j.healthplace.2014.03.011] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 03/25/2014] [Accepted: 03/30/2014] [Indexed: 11/23/2022]
Abstract
This study examines the association between social capital and the utilization of antenatal care, professional delivery care, and childhood immunizations using a multilevel analytic sample of 10,739 women who recently gave birth and 7403 children between one and five years of age in 2293 communities and 22 state-groups from the 2005 India Human Development Survey. Exploratory factor analysis was used to create and validate six social capital measures that were used in multilevel logistic regression models to examine whether each form of social capital had an independent, contextual effect on health care use. Results revealed that social capital operated at the community level in association with all three care-seeking behaviors; however, the results differed based on the type of health care utilized. Specifically, components of social capital that led to heterogeneous bridging ties were positively associated with all three types of health care use, whereas components of social capital that led to strong bonding ties were negatively associated with the use of preventive care, but positively associated with professional delivery care.
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143
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Larson HJ, Jarrett C, Eckersberger E, Smith DMD, Paterson P. Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: a systematic review of published literature, 2007-2012. Vaccine 2014; 32:2150-9. [PMID: 24598724 DOI: 10.1016/j.vaccine.2014.01.081] [Citation(s) in RCA: 1200] [Impact Index Per Article: 120.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 01/18/2014] [Accepted: 01/28/2014] [Indexed: 12/11/2022]
Abstract
Vaccine "hesitancy" is an emerging term in the literature and discourse on vaccine decision-making and determinants of vaccine acceptance. It recognizes a continuum between the domains of vaccine acceptance and vaccine refusal and de-polarizes previous characterization of individuals and groups as either anti-vaccine or pro-vaccine. The primary aims of this systematic review are to: 1) identify research on vaccine hesitancy; 2) identify determinants of vaccine hesitancy in different settings including its context-specific causes, its expression and its impact; and 3) inform the development of a model for assessing determinants of vaccine hesitancy in different settings as proposed by the Strategic Advisory Group of Experts Working Group (SAGE WG) for dealing with vaccine hesitancy. A broad search strategy, built to capture multiple dimensions of public trust, confidence and hesitancy around vaccines, was applied across multiple databases. Peer-reviewed studies were selected for inclusion if they focused on childhood vaccines [≤ 7 years of age], used multivariate analyses, and were published between January 2007 and November 2012. Our results show a variety of factors as being associated with vaccine hesitancy but they do not allow for a complete classification and confirmation of their independent and relative strength of influence. Determinants of vaccine hesitancy are complex and context-specific - varying across time, place and vaccines.
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Affiliation(s)
- Heidi J Larson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom.
| | - Caitlin Jarrett
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom.
| | - Elisabeth Eckersberger
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom.
| | - David M D Smith
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom.
| | - Pauline Paterson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom.
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144
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Ushie BA, Fayehun OA, Ugal DB. Trends and patterns of under-5 vaccination in Nigeria, 1990-2008: what manner of progress? Child Care Health Dev 2014; 40:267-74. [PMID: 23573874 DOI: 10.1111/cch.12055] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/26/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite efforts towards reducing childhood morbidity and mortality, Nigeria ranks among countries with the highest rates of vaccine-preventable diseases including tuberculosis, poliomyelitis, measles, diphtheria, pertussis and tetanus. These efforts include regular rounds of immunization days and routine exercises. The government of Nigeria periodically undertakes National Demographic and Health (NDH) surveys, which tap information on various health indices including vaccination coverage. Limited studies have used the NDHS data to examine the trends in vaccination coverage for the assessment of successes or failures of the immunization efforts. METHODS This study used four NDH Surveys datasets between 1990 and 2008, which generated child health information including the proportion that had had any or all basic childhood vaccines. A combined total of 44,071 (weighted) children were involved in the study. The trend and pattern of vaccination over 18 years were examined while selected factors were regressed to obtain predictors of child vaccinations in Nigeria. RESULTS The most recent survey (2008) reported more complete vaccination apart from 1990, which was said to be inaccurate. In all surveys, children from mothers with higher education, who were delivered in hospitals, lived in urban areas, and whose mothers work outside the home had significantly higher proportions of completed basic vaccination. A lower level of childhood vaccination is observed in the northern parts, while higher rates are observed in the southern parts. More complete vaccination coverage was reported in the 1990 survey, followed by 2008, 1999 and 2003. In addition, children from mothers with higher levels of education, who were delivered in hospitals, who lived in urban areas, and whose mothers work outside the home had significantly higher proportions of completed basic vaccination. CONCLUSION Much more work needs to be done if more children are to be covered and thus reduce vaccine-preventable diseases.
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Affiliation(s)
- B A Ushie
- Institute of Child Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
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145
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Immunization coverage: role of sociodemographic variables. Adv Prev Med 2013; 2013:607935. [PMID: 24386572 PMCID: PMC3872377 DOI: 10.1155/2013/607935] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 10/03/2013] [Accepted: 10/30/2013] [Indexed: 11/30/2022] Open
Abstract
Children are considered fully immunized if they receive one dose of BCG, three doses of DPT and polio vaccine each, and one measles vaccine. In India, only 44% of children aged 12–23 months are fully vaccinated and about 5% have not received any vaccination at all. Even if national immunization coverage levels are sufficiently high to block disease transmission, pockets of susceptibility may act as potential reservoirs of infection. This study was done to assess the immunization coverage in an urban slum area and determine various sociodemographic variables affecting the same. A total of 210 children were selected from study population using WHO's 30 cluster sampling method. Coverage of BCG was found to be the highest (97.1%) while that of measles was the lowest. The main reason for noncompliance was given as child's illness at the time of scheduled vaccination followed by lack of knowledge regarding importance of immunization. Low education status of mother, high birth order, and place of delivery were found to be positively associated with low vaccination coverage. Regular IEC activities (group talks, role plays, posters, pamphlets, and competitions) should be conducted in the community to ensure that immunization will become a “felt need” of the mothers in the community.
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146
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The role of socioeconomic status in longitudinal trends of cholera in Matlab, Bangladesh, 1993-2007. PLoS Negl Trop Dis 2013; 7:e1997. [PMID: 23326618 PMCID: PMC3542183 DOI: 10.1371/journal.pntd.0001997] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 11/21/2012] [Indexed: 11/19/2022] Open
Abstract
There has been little evidence of a decline in the global burden of cholera in recent years as the number of cholera cases reported to WHO continues to rise. Cholera remains a global threat to public health and a key indicator of lack of socioeconomic development. Overall socioeconomic development is the ultimate solution for control of cholera as evidenced in developed countries. However, most research has focused on cross-county comparisons so that the role of individual- or small area-level socioeconomic status (SES) in cholera dynamics has not been carefully studied. Reported cases of cholera in Matlab, Bangladesh have fluctuated greatly over time and epidemic outbreaks of cholera continue, most recently with the introduction of a new serotype into the region. The wealth of longitudinal data on the population of Matlab provides a unique opportunity to explore the impact of socioeconomic status and other demographic characteristics on the long-term temporal dynamics of cholera in the region. In this population-based study we examine which factors impact the initial number of cholera cases in a bari at the beginning of the 0139 epidemic and the factors impacting the number of cases over time. Cholera data were derived from the ICDDR,B health records and linked to socioeconomic and geographic data collected as part of the Matlab Health and Demographic Surveillance System. Longitudinal zero-inflated Poisson (ZIP) multilevel regression models are used to examine the impact of environmental and socio-demographic factors on cholera counts across baris. Results indicate that baris with a high socioeconomic status had lower initial rates of cholera at the beginning of the 0139 epidemic (γ01 = −0.147, p = 0.041) and a higher probability of reporting no cholera cases (α01 = 0.156, p = 0.061). Populations in baris characterized by low SES are more likely to experience higher cholera morbidity at the beginning of an epidemic than populations in high SES baris. Cholera is a bacterial disease usually spread through contaminated water that causes severe diarrhea and dehydration. Modern sewage and water treatment have virtually eliminated cholera in industrialized countries but cholera is still present throughout much of SE Asia, Latin America and sub-Saharan Africa. One of the reasons cholera is still problematic is that genetically distinct forms of the bacteria (often called biotypes) have developed and spread rapidly because the population has no natural immunity to the new biotype. In Bangladesh, the 0139 biotype developed in 1993 and caused a large epidemic. Although it is widely accepted that poor conditions place people at risk for cholera, very few studies have examine what role low socioeconomic status plays in cholera risk, especially during a new epidemic of the disease. In this paper, we explore how local-level socioeconomic status, measured using assets, education and sanitation, affect the severity of the cholera outbreak experienced during the O139 epidemic in Matlab, Bangladesh. We believe our study highlights the importance of improving overall socioeconomic status, not just sanitation and water treatment, in controlling the spread of cholera.
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147
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Arooj S, Ali S, Baber N, Abbasi A, Ali M. Socioeconomic factors effecting polio vaccination in Pakistan. Health (London) 2013. [DOI: 10.4236/health.2013.55117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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