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Zhao M, Huang CC, Mendoza M, Tovar X, Lecca L, Murray M. Subjective socioeconomic status: an alternative to objective socioeconomic status. BMC Med Res Methodol 2023; 23:73. [PMID: 36977997 PMCID: PMC10044732 DOI: 10.1186/s12874-023-01890-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Subjective "ladder" measurements of socio-economic status (SES) are easy-to-administer tools that ask respondents to rate their own SES, allowing them to evaluate their own material resources and determine where it places them relative to their community. Here, we sought to compare the MacArthur Scale of Subjective Social status to the WAMI, an objective measure of SES that includes data on water and sanitation, asset ownership, education, and income. METHODS Leveraging a study of 595 tuberculosis patients in Lima, Peru, we compared the MacArthur ladder score to the WAMI score using weighted Kappa scores and Spearman's rank correlation coefficient. We identified outliers that fell outside the 95th percentile and assessed the durability of the inconsistencies between scores by re-testing a subset of participants. We then used Akaike information criterion (AIC) to compare the predictability of logistic regression models evaluating the association between the two SES scoring systems and history of asthma. RESULTS The correlation coefficient between the MacArthur ladder and WAMI scores was 0.37 and the weighted Kappa was 0.26. The correlation coefficients differed by less than 0.04 and the Kappa ranged from 0.26 to 0.34, indicating fair agreement. When we replaced the initial MacArthur ladder scores with retest scores, the number of individuals with disagreements between the two scores decreased from 21 to 10 and the correlation coefficient and weighted Kappa both increased by at least 0.03. Lastly, we found that when we categorized WAMI and MacArthur ladder scores into three groups, both had a linear trend association with history of asthma with effect sizes and AICs that differed by less than 15% and 2 points, respectively. CONCLUSION Our findings demonstrated fair agreement between the MacArthur ladder and WAMI scores. The agreement between the two SES measurements increased when they were further categorized into 3-5 categories, the form in which SES is often used in epidemiologic studies. The MacArthur score also performed similarly to WAMI in predicting a socio-economically sensitive health outcome. Researchers should consider subjective SES tools as an alternative method for measuring SES, particularly in large health studies where data collection is a burden.
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Affiliation(s)
- Maryann Zhao
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave, Boston, MA, 02115, USA
| | - Chuan-Chin Huang
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave, Boston, MA, 02115, USA
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | | | - Ximena Tovar
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave, Boston, MA, 02115, USA
| | - Leonid Lecca
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave, Boston, MA, 02115, USA
- Socios En Salud, Lima, 15001, Peru
| | - Megan Murray
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave, Boston, MA, 02115, USA.
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, 02115, USA.
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How reliable is the asset score in measuring socioeconomic status? Comparing asset ownership reported by male and female heads of households. PLoS One 2023; 18:e0279599. [PMID: 36827269 PMCID: PMC9955958 DOI: 10.1371/journal.pone.0279599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 12/10/2022] [Indexed: 02/25/2023] Open
Abstract
Asset scores are widely used as the preferred method of measuring socioeconomic wellbeing of households in developing countries. We examine the degree of discrepancies in reporting asset ownership by male and female heads of the same household. Household asset scores were estimated separately for male and female responses, using Principal Component Analysis, the method widely used in the literature, and households were categorized into wealth quintiles. The results indicate that only half of the households belonged to the same quintile groups for both male and female response-based asset scores. In addition, the two estimates of asset scores within the same quintile deviate by more than 20% for 71% of households in the top three quintiles and for 18% in the poorest two quintiles. Inter-individual (male/female) variability in reporting the asset ownership was high enough to raise concerns about the validity and reliability of asset scores as a metric of household socioeconomic status. Although the study did not try to ascertain underlying reasons for differential reporting, possible explanations could be a lack of awareness among household members on asset ownership or differential propensity to demonstrate relatively better social status of the household by male and female respondents. To improve reliability of asset scores, methodology for collecting asset ownership information should define who in the household may or may not be used as a respondent. Visual verification of reported ownership of assets will reduce male-female discrepancies but the verification process is time-consuming and intrusive, thus negating the advantages of collecting asset data. Alternatives to asset-based scoring need to be considered and one approach could be to solicit subjective opinions from male and female heads on the location of households in the social hierarchy.
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Soltani S, Moghadam MM, Amani S, Akbari S, Shiani A, Soofi M. Socioeconomic disparities in using rehabilitation services among Iranian adults with disabilities: a decomposition analysis. BMC Health Serv Res 2022; 22:1449. [PMID: 36447232 PMCID: PMC9708139 DOI: 10.1186/s12913-022-08811-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/08/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Persons with disabilities (PWD) generally experience various barriers in using health care compared to the general population, and these problems are more worsened for those with disabilities in lower socioeconomic status. The study aimed to estimate socioeconomic inequality in using rehabilitation services (URS) in adults with disabilities in Iran. METHODS This cross-sectional study was conducted at a national level in Iran. 786 PWD (aged 18 years and older) participated in the study between September and December 2020. Socioeconomic-related inequality in URS was estimated by the Concentration Index (C). The C was decomposed to identify factors explaining the variability within the socioeconomic inequality in URS. RESULTS In the present study 8.10% (N = 61) of the study population used rehabilitation services during the past three months. In this study, the value of the C was estimated 0.25 (p-value = 0.025) that shows URS was unequally distributed, and concentrated among the higher SES groups. The results of decomposition analysis indicated that the wealth index was the largest contributor (94.22%) to the observed socioeconomic inequalities in URS among PWD. Following the wealth index, Age and marital status were the major contributors to the unequal distribution of URS among the study population. CONCLUSIONS Our findings revealed that socioeconomic inequality in using rehabilitation services was concentrated among well-off PWD. Accordingly, rehabilitation financing through appropriate mechanisms for individuals with low SES is suggested.
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Affiliation(s)
- Shahin Soltani
- grid.412112.50000 0001 2012 5829Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Shiva Amani
- grid.412112.50000 0001 2012 5829Students Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shahram Akbari
- grid.412112.50000 0001 2012 5829Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Amir Shiani
- grid.412112.50000 0001 2012 5829Clinical Research Development Center, Taleghani and Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Moslem Soofi
- grid.412112.50000 0001 2012 5829Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Asset and consumption gradient of health estimates in India: Implications for survey and public health research. SSM Popul Health 2022; 19:101258. [PMID: 36238815 PMCID: PMC9550646 DOI: 10.1016/j.ssmph.2022.101258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 08/29/2022] [Accepted: 10/02/2022] [Indexed: 11/06/2022] Open
Abstract
The wealth index based on household assets and amenities is been increasingly used to explain economic variations of health outcomes in the developing countries. While the variables used to compute the wealth index are easy to collect and time- and cost-effective, the wealth index tends to have an urban bias, uses arbitrary weighting, does not provide per capita measures and is a poor measure of inequality. We used micro data from two of the large-scale population-based surveys, the Longitudinal Ageing Study in India, 2017–18 and the India Human Development Survey, 2011–12 that covered over 42,000 households each and collected data on household consumption, assets and amenities in India. We examined the variations and inequality in health estimates by consumption per capita and asset-based measures in India. Descriptive statistics, logistic regression model, concentration index, and concentration curve were used in the analyses. We found a weak association between monthly per capita consumption expenditure (MPCE) and wealth index in both the surveys. Some of the health conditions such as hypertension, cataract, refractive error, and diabetes tended to be underestimated in the bottom 40% of the population when economic well-being was measured using the wealth index compared to consumption. Socio-economic inequality in health outcome, inpatient and outpatient health services were underestimated when measured using the wealth index than when measured using MPCE. We conclude that economic gradients of health by consumption and wealth index are inconsistent and that per capita consumption predicts health estimates better than the wealth index. It is recommended that public health research using population-based surveys that provide data on consumption and wealth index use per capita consumption to explain economic variations in health and health care utilization. We also suggest that the future rounds of the health surveys of National Sample Survey and the National Family and Health Surveys include an abridged version of the consumption schedule to predict better economic variations in health and health care utilization in India. Wealth index has been increasingly used to explain economic variations in health outcomes in India. Association between monthly per capita consumption expenditure and wealth index is weak. Health estimates by consumption and wealth index are not consistent in India. Some of the measured health conditions are underestimated for the poor when economic well-being was measured using the wealth index compared to consumption. Socio-economic inequality in health outcome, inpatient and outpatient health services were underestimated when measured using the wealth index compared to consumption.
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Clair V, Musau A, Mutiso V, Tele A, Atkinson K, Rossa-Roccor V, Bosire E, Ndetei D, Frank E. Blended-eLearning Improves Alcohol Use Care in Kenya: Pragmatic Randomized Control Trial Results and Parallel Qualitative Study Implications. Int J Ment Health Addict 2022; 20:3410-3437. [PMID: 35975214 PMCID: PMC9373889 DOI: 10.1007/s11469-022-00841-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 12/16/2022] Open
Abstract
Alcohol use is the 5th most important risk factor contributing to the global burden of diseases, with stigma and a lack of trained health workers as the main barriers to adequate care. This study assesses the impact of providing blended-eLearning courses teaching the alcohol, smoking, and substance involvement screening test (ASSIST) screening and its linked brief intervention (BI). In public and private facilities, two randomized control trials (RCTs) showed large and similar decreases in alcohol use in those receiving the BI compared to those receiving only the ASSIST feedback. Qualitative findings confirm a meaningful reduction in alcohol consumption; decrease in stigma and significant practice change, suggesting lay health workers and clinicians can learn effective interventions through blended-eLearning; and significantly improve alcohol use care in a low- and middle-income country (LMIC) context. In addition, our study provides insight into why lay health workers feedback led to a similar decrease in alcohol consumption compared to those who also received a BI by clinicians.
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Affiliation(s)
- Veronic Clair
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Abednego Musau
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Victoria Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Albert Tele
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Katlin Atkinson
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Verena Rossa-Roccor
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Edna Bosire
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - David Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Erica Frank
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- Annenberg Physician Training Program in Addiction Medicine, Vancouver, Canada
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Oyando R, Barasa E, Ataguba JE. Socioeconomic Inequity in the Screening and Treatment of Hypertension in Kenya: Evidence From a National Survey. FRONTIERS IN HEALTH SERVICES 2022; 2:786098. [PMID: 36925851 PMCID: PMC10012826 DOI: 10.3389/frhs.2022.786098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 02/21/2022] [Indexed: 11/13/2022]
Abstract
Background Non-communicable diseases (NCDs) account for 50% of hospitalisations and 55% of inpatient deaths in Kenya. Hypertension is one of the major NCDs in Kenya. Equitable access and utilisation of screening and treatment interventions are critical for reducing the burden of hypertension. This study assessed horizontal equity (equal treatment for equal need) in the screening and treatment for hypertension. It also decomposed socioeconomic inequalities in care use in Kenya. Methods Cross-sectional data from the 2015 NCDs risk factors STEPwise survey, covering 4,500 adults aged 18-69 years were analysed. Socioeconomic inequality was assessed using concentration curves and concentration indices (CI), and inequity by the horizontal inequity (HI) index. A positive (negative) CI or HI value suggests a pro-rich (pro-poor) inequality or inequity. Socioeconomic inequality in screening and treatment for hypertension was decomposed into contributions of need [age, sex, and body mass index (BMI)] and non-need (wealth status, education, exposure to media, employment, and area of residence) factors using a standard decomposition method. Results The need for hypertension screening was higher among poorer than wealthier socioeconomic groups (CI = -0.077; p < 0.05). However, wealthier groups needed hypertension treatment more than poorer groups (CI = 0.293; p <0.001). Inequity in the use of hypertension screening (HI = 0.185; p < 0.001) and treatment (HI = 0.095; p < 0.001) were significantly pro-rich. Need factors such as sex and BMI were the largest contributors to inequalities in the use of screening services. By contrast, non-need factors like the area of residence, wealth, and employment status mainly contributed to inequalities in the utilisation of treatment services. Conclusion Among other things, the use of hypertension screening and treatment services in Kenya should be according to need to realise the Sustainable Development Goals for NCDs. Specifically, efforts to attain equity in healthcare use for hypertension services should be multi-sectoral and focused on crucial inequity drivers such as regional disparities in care use, poverty and educational attainment. Also, concerted awareness campaigns are needed to increase the uptake of screening services for hypertension.
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Affiliation(s)
- Robinson Oyando
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.,Health Economics Unit, Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Edwine Barasa
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.,Center for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - John E Ataguba
- Health Economics Unit, Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
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Varghese JS, Adair LS, Patel SA, Bechayda SA, Bhargava SK, Carba DB, Horta BL, Lima NP, Martorell R, Menezes AMB, Norris SA, Richter LM, Ramirez-Zea M, Sachdev HS, Wehrmeister FC, Stein AD. Changes in asset-based wealth across the life course in birth cohorts from five low- and middle-income countries. SSM Popul Health 2021; 16:100976. [PMID: 34901377 PMCID: PMC8637637 DOI: 10.1016/j.ssmph.2021.100976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 01/08/2023] Open
Abstract
Background Temporally-harmonized asset-based measures of wealth can be used to study the association of life-course wealth exposures in the same scale with health outcomes in low- and middle-income countries (LMICs). The within-individual longitudinal stability of asset-based indices of wealth in LMICs is poorly understood. Methods Using data from five birth cohorts from three continents, we developed temporally-harmonized asset indices over the life course through polychoric principal component analysis of a common set of assets collected consistently over time (18 years in Brazil to 50 years in Guatemala). For each cohort, we compared the harmonized index to cross-sectional indices created using more comprehensive asset measures using rank correlations. We evaluated the rank correlation of the harmonized index in early life and adulthood with maternal schooling and own attained schooling, respectively. Results Temporally-harmonized asset indices developed from a consistently-collected set of assets (range: 10 in South Africa to 30 in Philippines) suggested that mean wealth improved over time for all birth cohorts. Cross-sectional indices created separately for each study wave were correlated with the harmonized index for all cohorts (Brazil: r = 0.78 to 0.96; Guatemala: r = 0.81 to 0.95; India: 0.75 to 0.93; Philippines: r = 0.92 to 0.99; South Africa: r = 0.84 to 0.96). Maternal schooling (r = 0.15 to 0.56) and attained schooling (r = 0.23 to 0.53) were positively correlated with the harmonized asset index in childhood and adulthood respectively. Conclusions Temporally-harmonized asset indices displayed coherence with cross-sectional indices as well as construct validity with schooling. Temporally-harmonized asset indices are useful to assess relative importance of wealth at different life stages with health on the same scale. Harmonized indices using a subset of assets were correlated with cross-sectional asset indices using all available assets in five LMIC birth cohorts. Harmonized indices displayed construct validity, as demonstrated by its correlation with schooling. Harmonized indices were robust to alternate specifications such as shorter lists of assets, study years, and factor extraction procedures.
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Key Words
- CLHNS, Cebu Longitudinal Health and Nutrition Survey
- COHORTS, Consortium On Health Orientated Research in Transitioning Societies
- EFA, Exploratory Factor Analysis
- INCAP, Institute of Nutrition for Central America and Panama
- LMIC, Low- and middle-income countries
- Life course epidemiology
- MCA, Multiple Correspondence Analysis
- NDBC, New Delhi Birth Cohort
- PCA, Principal Component Analysis
- SD, standard deviation
- SEP, Socio-economic position
- Social mobility
- Wealth index
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Affiliation(s)
- Jithin Sam Varghese
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA, USA
| | - Linda S Adair
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Shivani A Patel
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Sonny Agustin Bechayda
- USC-Office of Population Studies Foundation, Inc, University of San Carlos, Cebu City, Philippines.,Department of Anthropology, Sociology, and History, University of San Carlos, Cebu City, Philippines
| | | | - Delia B Carba
- USC-Office of Population Studies Foundation, Inc, University of San Carlos, Cebu City, Philippines
| | - Bernardo L Horta
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Natalia P Lima
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil
| | - Reynaldo Martorell
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA, USA.,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Ana M B Menezes
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Shane A Norris
- SAMRC Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Linda M Richter
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Manuel Ramirez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | | | | | - Aryeh D Stein
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA, USA.,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Asuman D, Ackah CG, Fenny AP, Agyire-Tettey F. Assessing socioeconomic inequalities in the reduction of child stunting in sub-Saharan Africa. J Public Health (Oxf) 2020. [DOI: 10.1007/s10389-019-01068-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Najafi F, Soltani S, Karami Matin B, Kazemi Karyani A, Rezaei S, Soofi M, Salimi Y, Moradinazar M, Hajizadeh M, Barzegar L, Pasdar Y, Hamzeh B, Haghdoost AA, Malekzadeh R, Poustchi H, Eghtesad S, Nejatizadeh A, Moosazadeh M, Zare Sakhvidi MJ, Joukar F, Hashemi-Shahri SM, Vakilian A, Niknam R, Faramarzi E, Akhavan Akbari G, Ghorat F, Khaledifar A, Vahabzadeh D, Homayounfar R, Safarpour AR, Hosseini SV, Rezvani R, Hosseini SA. Socioeconomic - related inequalities in overweight and obesity: findings from the PERSIAN cohort study. BMC Public Health 2020; 20:214. [PMID: 32046684 PMCID: PMC7014739 DOI: 10.1186/s12889-020-8322-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 02/05/2020] [Indexed: 12/21/2022] Open
Abstract
Background Overweight and obesity are major health concerns worldwide, with adverse health consequences during the life span. This study measured socioeconomic inequality in overweight and obesity among Iranian adults. Methods Data were extracted from 129,257 Iranian adults (aged 35 years and older) participated in the Prospective Epidemiologic Research Studies in IrAN (PERSIAN) in 14 provinces of Iran in 2014. Socioeconomic-related inequality in overweight and obesity was estimated using the Concentration Index (Cn). The Cn further decomposed to find factors explaining the variability within the Socioeconomic related inequality in overweight and obesity. Results Of the total number of participants, 1.98, 26.82, 40.76 and 30.43% had underweight, normal weight, overweight and obesity respectively. The age-and sex standardized prevalence of obesity was higher in females than males (39.85% vs 18.79%). People with high socioeconomic status (SES) had a 39 and 15% higher chance of being overweight and obese than low SES people, respectively. The positive value of Cn suggested a higher concentration of overweight (0.081, 95% confidence interval [CI]; 0.074–0.087) and obesity (0.027, 95% CI; 0.021–0.034) among groups with high SES. There was a wide variation in socioeconomic-related inequality in overweight and obesity rate across 14 provinces. The decomposition results suggested that SES factor itself explained 66.77 and 89.07% of the observed socioeconomic inequalities in overweight and obesity among Iranian adults respectively. Following SES, province of residence, physical activity, using hookah and smoking were the major contributors to the concentration of overweight and obesity among the rich. Conclusions Overall, we found that overweight and obesity is concentrated among high SES people in the study population. . Accordingly, it seems that intersectional actions should be taken to control and prevent overweight and obesity among higher socioeconomic groups.
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Affiliation(s)
- Farid Najafi
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shahin Soltani
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran. .,Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Behzad Karami Matin
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ali Kazemi Karyani
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Satar Rezaei
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Moslem Soofi
- Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Yahya Salimi
- Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mehdi Moradinazar
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad Hajizadeh
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, Canada
| | - Loghman Barzegar
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Yahya Pasdar
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Behrooz Hamzeh
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ali Akbar Haghdoost
- Modeling in Health Research Center, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Reza Malekzadeh
- Liver and pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Poustchi
- Liver and pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sareh Eghtesad
- Liver and pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Azim Nejatizadeh
- Molecular Medicine Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Mahmood Moosazadeh
- Health Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad Javad Zare Sakhvidi
- Occupational Health Research Centre, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Farahnaz Joukar
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Alireza Vakilian
- Dept. of Neurology, Medical School, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Ramin Niknam
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Elnaz Faramarzi
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical sciences, Tabriz, Iran
| | - Ghodrat Akhavan Akbari
- Digestive Disease Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Fershteh Ghorat
- Traditional and Complementary Medicine Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Arsalan Khaledifar
- Modeling in Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Davoud Vahabzadeh
- Social Determinants of Health Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Reza Homayounfar
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Ali Reza Safarpour
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Reza Rezvani
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyyed Ahmad Hosseini
- Nutrition and Metabolic Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Ataguba JE, Ojo KO, Ichoku HE. Explaining socio-economic inequalities in immunization coverage in Nigeria. Health Policy Plan 2016; 31:1212-24. [PMID: 27208896 DOI: 10.1093/heapol/czw053] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2016] [Indexed: 11/14/2022] Open
Abstract
Globally, in 2013 over 6 million children younger than 5 years died from either an infectious cause or during the neonatal period. A large proportion of these deaths occurred in developing countries, especially in sub-Saharan Africa. Immunization is one way to reduce childhood morbidity and deaths. In Nigeria, however, although immunization is provided without a charge at public facilities, coverage remains low and deaths from vaccine preventable diseases are high. This article seeks to assess inequalities in full and partial immunization coverage in Nigeria. It also assesses inequality in the 'intensity' of immunization coverage and it explains the factors that account for disparities in child immunization coverage in the country. Using nationally representative data, this article shows that disparities exist in the coverage of immunization to the advantage of the rich. Also, factors such as mother's literacy, region and location of the child, and socio-economic status explain the disparities in immunization coverage in Nigeria. Apart from addressing these issues, the article notes the importance of addressing other social determinants of health to reduce the disparities in immunization coverage in the country. These should be in line with the social values of communities so as to ensure acceptability and compliance. We argue that any policy that addresses these issues will likely reduce disparities in immunization coverage and put Nigeria on the road to sustainable development.
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Affiliation(s)
- John E Ataguba
- Health Economics Unit, School of Public Health and Family Medicine, Health Sciences Faculty, University of Cape Town, Anzio Road, Observatory, 7925, South Africa
| | - Kenneth O Ojo
- Centre for Health Economics and Development, Abuja, Nigeria
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Hussain MA, Huxley RR, Al Mamun A. Multimorbidity prevalence and pattern in Indonesian adults: an exploratory study using national survey data. BMJ Open 2015; 5:e009810. [PMID: 26656028 PMCID: PMC4679940 DOI: 10.1136/bmjopen-2015-009810] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES To estimate the prevalence and pattern of multimorbidity in the Indonesian adult population. DESIGN Cross-sectional study. SETTING Community-based survey. The sampling frame was based on households in 13 of the 27 Indonesian provinces, representing about 83% of the Indonesian population. PARTICIPANTS 9438 Indonesian adults aged 40 years and above. MAIN OUTCOME MEASURES Prevalence and pattern of multimorbidity by age, gender and socioeconomic status. RESULTS The mean number of morbidities in the sample was 1.27 (SE ± 0.01). The overall age and sex standardised prevalence of multimorbidity was 35.7% (34.8% to 36.7%), with women having significantly higher prevalence of multimorbidity than men (41.5% vs 29.5%; p<0.001). Of those with multimorbidity, 64.6% (62.8% to 66.3%) were aged less than 60 years. Prevalence of multimorbidity was positively associated with age (p for trend <0.001) and affluence (p for trend <0.001) and significantly greater in women at all ages compared with men. For each 5-year increment in age there was an approximate 20% greater risk of multimorbidity in both sexes (18% in women 95% CI 1.14 to 1.22 and 22% in men 95% CI 1.18 to 1.26). Increasing age, female gender, non-Javanese ethnicity, and high per-capital expenditure were all significantly associated with higher odds of multimorbidity. The combination of hypertension with cardiac diseases, hypercholesterolemia, arthritis, and uric acid/gout were the most commonly occurring disease pairs in both sexes. CONCLUSIONS More than one-third of the Indonesian adult population are living with multimorbidity with women and the more wealthy being particularly affected. Of especial concern was the high prevalence of multimorbidity among younger individuals. Hypertension was the most frequently occurring condition common to most individuals with multimorbidity.
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Affiliation(s)
- Mohammad Akhtar Hussain
- Division of Epidemiology and Biostatistics, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Rachel R Huxley
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Abdullah Al Mamun
- Division of Epidemiology and Biostatistics, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
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Methodological challenges in evaluating health care financing equity in data-poor contexts: Lessons from Ghana, South Africa and Tanzania. ACTA ACUST UNITED AC 2015. [DOI: 10.1108/s0731-2199(2009)0000021009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Vanderelst D, Speybroeck N. An adjusted bed net coverage indicator with estimations for 23 African countries. Malar J 2013; 12:457. [PMID: 24359227 PMCID: PMC4021220 DOI: 10.1186/1475-2875-12-457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 07/10/2013] [Indexed: 11/10/2022] Open
Abstract
Background Many studies have assessed the level of bed net coverage in populations at risk of malaria infection. These revealed large variations in bed net use across countries, regions and social strata. Such studies are often aimed at identifying populations with low access to bed nets that should be prioritized in future interventions. However, often spatial differences in malaria endemicity are not taken into account. By ignoring variability in malaria endemicity, these studies prioritize populations with little access to bed nets, even if these happen to live in low endemicity areas. Conversely, populations living in regions with high malaria endemicity will receive a lower priority once a seizable proportion is protected by bed nets. Adequately assigning priorities requires accounting for both the current level of bed net coverage and the local malaria endemicity. Indeed, as shown here for 23 African countries, there is no correlation between the level of bed net coverage and the level of malaria endemicity in a region. Therefore, the need for future interventions can not be assessed based on current bed net coverage alone. This paper proposes the Adjusted Bed net Coverage (ABC) statistic as a measure taking into account both local malaria endemicity and the level of bed net coverage. The measure allows setting priorities for future interventions taking into account both local malaria endemicity and bed net coverage. Methods A mathematical formulation of the ABC as a weighted difference of bed net coverage and malaria endemicity is presented. The formulation is parameterized based on a model of malaria epidemiology (Smith et al. Trends Parasitol 25:511-516, 2009). By parameterizing the ABC based on this model, the ABC as used in this paper is proxy for the steady-state malaria burden given the current level of bed net coverage. Data on the bed net coverage in under five year olds and malaria endemicity in 23 Sub-Saharan countries is used to show that the ABC prioritizes different populations than the level of bed net coverage by itself. Data from the following countries was used: Angola, Burkina Faso, Burundi, Cameroon, Congo Democratic Republic, Ethiopia, Ghana, Guinea, Kenya, Liberia, Madagascar, Malawi, Mali, Mozambique, Namibia, Nigeria, Rwanda, Senegal, Sierra Leone, Tanzania, Uganda, Zambia and Zimbabwe. The priority order given by the ABC and the bed net coverage are compared at the countries’ level, the first level administrative divisions and for five different wealth quintiles. Results Both at national level and at the level of the administrative divisions the ABC suggests a different priority order for selecting countries and divisions for future interventions. When taking into account malaria endemicity, measures assessing equality in access to bed nets across wealth quintiles, such as slopes of inequality, are prone to change. This suggests that when assessing inequality in access to bed nets one should take into account the local malaria endemicity for populations from different wealth quintiles. Conclusion Accounting for malaria endemicity highlights different countries, regions and socio-economic strata for future intervention than the bed net coverage by itself. Therefore, care should be taken to factor out any effects of local malaria endemicity in assessing bed net coverage and in prioritizing populations for further scale-up of bed net coverage. The ABC is proposed as a simple means to do this that is derived from an existing model of malaria epidemiology.
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Affiliation(s)
- Dieter Vanderelst
- University Antwerp Faculty of Applied Economics Prinsstraat 13, Antwerp 2000, Belgium.
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Abstract
BACKGROUND Very little is known about socioeconomic related inequalities in multimorbidity, especially in developing countries. Traditionally, studies on health inequalities have mainly focused on a single disease condition or different conditions in isolation. This paper examines socioeconomic inequality in multimorbidity in illness and disability in South Africa between 2005 and 2008. METHODS Data were drawn from the 2005, 2006, 2007, and 2008 rounds of the nationally representative annual South African General Household Surveys (GHS). Indirectly standardised concentration indices were used to assess socioeconomic inequality. A proxy index of socioeconomic status was constructed, for each year, using a selected set of variables that are available in all the GHS rounds. Multimorbidity in illness and disability were constructed using data on nine illnesses and six disabilities contained in the GHS. RESULTS Multimorbidity affects a substantial number of South Africans. Most often, based on the nine illness conditions and six disability conditions considered, multimorbidity in illness and multimorbidity in disability are each found to involve only two conditions. In 2008 in South Africa, the multimorbidity that affected the greatest number of individuals (0.6% of the population) combined high blood pressure (BP) with at least one other illness. The combination of sexually transmitted diseases (STDs) and other condition or conditions is the least reported (i.e. 0.02% of the population). Between 2005 and 2008, multimorbidity in illness and disability is more prevalent among the poor; in disabilities this is yet more consistent. The concentration index of multiple illnesses in 2005 and 2008 are -0.0009 and -0.0006 respectively. The corresponding values for multiple disabilities are -0.0006 and -0.0006 respectively. CONCLUSION While there is a dearth of information on the socioeconomic distribution of multimorbidity in many developing countries, this paper has shown that its distribution in South Africa indicates that the poor bear a greater burden of multimorbidity. This is more so for disability than for illness. This paper argues that, given the high burden and skewed socioeconomic distribution of multimorbidity, there is a need to design policies to address this situation. Further, there is a need to design surveys that specifically assess multimorbidity.
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Affiliation(s)
- John Ele-Ojo Ataguba
- Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Observatory, Cape Town 925, South Africa.
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Ochieng CA, Vardoulakis S, Tonne C. Are rocket mud stoves associated with lower indoor carbon monoxide and personal exposure in rural Kenya? INDOOR AIR 2013; 23:14-24. [PMID: 22563898 DOI: 10.1111/j.1600-0668.2012.00786.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
UNLABELLED Household use of biomass fuels is a major source of indoor air pollution and poor health in developing countries. We conducted a cross-sectional investigation in rural Kenya to assess household air pollution in homes with traditional three-stone stove and rocket mud stove (RMS), a low-cost unvented wood stove. We conducted continuous measurements of kitchen carbon monoxide (CO) concentrations and personal exposures in 102 households. Median 48-h kitchen and personal CO concentrations were 7.3 and 6.5 ppm, respectively, for three-stone stoves, while the corresponding concentrations for RMS were 5.8 and 4.4 ppm. After adjusting for kitchen location, ventilation, socio-economic status, and fuel moisture content, the use of RMS was associated with 33% lower levels of kitchen CO [95% Confidence Interval (CI), 64.4-25.1%] and 42% lower levels of personal CO (95% CI, 66.0-1.1%) as compared to three-stone stoves. Differences in CO concentrations by stove type were more pronounced when averaged over the cooking periods, although they were attenuated after adjusting for confounding. In conclusion, RMS appear to lower kitchen and personal CO concentrations compared to the traditional three-stone stoves but overall, the CO concentrations remain high. PRACTICAL IMPLICATIONS The rocket mud stoves (RMS) were associated with lower CO concentrations compared to three-stone stoves. However, the difference in concentrations was modest and concentrations in both stove groups exceeded the WHO guideline of 7 μg/m(3) , suggesting the unvented RMSs on their own are unlikely to appreciably benefit health in this population. Greater air quality benefit could be realized if the stoves were complemented with behavior change, including education on extinguishing fire when not in use as well as fuel drying, and cooking in locations that are separate from the main house.
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Affiliation(s)
- C A Ochieng
- Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK.
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Roetynck S, Olotu A, Simam J, Marsh K, Stockinger B, Urban B, Langhorne J. Phenotypic and functional profiling of CD4 T cell compartment in distinct populations of healthy adults with different antigenic exposure. PLoS One 2013; 8:e55195. [PMID: 23383106 PMCID: PMC3557244 DOI: 10.1371/journal.pone.0055195] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 12/19/2012] [Indexed: 01/26/2023] Open
Abstract
Background Multiparameter flow cytometry has revealed extensive phenotypic and functional heterogeneity of CD4 T cell responses in mice and humans, emphasizing the importance of assessing multiple aspects of the immune response in correlation with infection or vaccination outcome. The aim of this study was to establish and validate reliable and feasible flow cytometry assays, which will allow us to characterize CD4 T cell population in humans in field studies more fully. Methodology/Principal Findings We developed polychromatic flow cytometry antibody panels for immunophenotyping the major CD4 T cell subsets as well as broadly characterizing the functional profiles of the CD4 T cells in peripheral blood. We then validated these assays by conducting a pilot study comparing CD4 T cell responses in distinct populations of healthy adults living in either rural or urban Kenya. This study revealed that the expression profile of CD4 T cell activation and memory markers differed significantly between African and European donors but was similar amongst African individuals from either rural or urban areas. Adults from rural Kenya had, however, higher frequencies and greater polyfunctionality among cytokine producing CD4 T cells compared to both urban populations, particularly for “Th1” type of response. Finally, endemic exposure to malaria in rural Kenya may have influenced the expansion of few discrete CD4 T cell populations with specific functional signatures. Conclusion/Significance These findings suggest that environmentally driven T cell activation does not drive the dysfunction of CD4 T cells but is rather associated with greater magnitude and quality of CD4 T cell response, indicating that the level or type of microbial exposure and antigenic experience may influence and shape the functionality of CD4 T cell compartment. Our data confirm that it is possible and mandatory to assess multiple functional attributes of CD4 T cell response in the context of infection.
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Affiliation(s)
- Sophie Roetynck
- Division of Parasitology, MRC National Institute for Medical Research, London, United Kingdom
| | - Ally Olotu
- Kenya Medical Research Institute/Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Joan Simam
- Kenya Medical Research Institute/Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Kevin Marsh
- Kenya Medical Research Institute/Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
- Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Brigitta Stockinger
- Division of Molecular Immunology, MRC National Institute for Medical Research, London, United Kingdom
| | - Britta Urban
- Kenya Medical Research Institute/Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
- Molecular Parasitology and Immunology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Jean Langhorne
- Division of Parasitology, MRC National Institute for Medical Research, London, United Kingdom
- * E-mail:
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Mbuba CK, Ngugi AK, Fegan G, Ibinda F, Muchohi SN, Nyundo C, Odhiambo R, Edwards T, Odermatt P, Carter JA, Newton CR. Risk factors associated with the epilepsy treatment gap in Kilifi, Kenya: a cross-sectional study. Lancet Neurol 2012; 11:688-96. [PMID: 22770914 PMCID: PMC3404220 DOI: 10.1016/s1474-4422(12)70155-2] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background Many people with epilepsy in low-income countries do not receive appropriate biomedical treatment. This epilepsy treatment gap might be caused by patients not seeking biomedical treatment or not adhering to prescribed antiepileptic drugs (AEDs). We measured the prevalence of and investigated risk factors for the epilepsy treatment gap in rural Kenya. Methods All people with active convulsive epilepsy identified during a cross-sectional survey of 232 176 people in Kilifi were approached. The epilepsy treatment gap was defined as the percentage of people with active epilepsy who had not accessed biomedical services or who were not on treatment or were on inadequate treatment. Information about risk factors was obtained through a questionnaire-based interview of sociodemographic characteristics, socioeconomic status, access to health facilities, seizures, stigma, and beliefs and attitudes about epilepsy. The factors associated with people not seeking biomedical treatment and not adhering to AEDs were investigated separately, adjusted for age. Findings 673 people with epilepsy were interviewed, of whom 499 (74%) reported seeking treatment from a health facility. Blood samples were taken from 502 (75%) people, of whom 132 (26%) reported taking AEDs, but 189 (38%) had AEDs detectable in the blood. The sensitivity and specificity of self-reported adherence compared with AEDs detected in blood were 38·1% (95% CI 31·1–45·4) and 80·8% (76·0–85·0). The epilepsy treatment gap was 62·4% (58·1–66·6). In multivariable analysis, failure to seek biomedical treatment was associated with a patient holding traditional animistic religious beliefs (adjusted odds ratio 1·85, 95% CI 1·11–2·71), reporting negative attitudes about biomedical treatment (0·86, 0·78–0·95), living more than 30 km from health facilities (3·89, 1·77–8·51), paying for AEDs (2·99, 1·82–4·92), having learning difficulties (2·30, 1·29–4·11), having had epilepsy for longer than 10 years (4·60, 2·07–10·23), and having focal seizures (2·28, 1·50–3·47). Reduced adherence was associated with negative attitudes about epilepsy (1·10, 1·03–1·18) and taking of AEDs for longer than 5 years (3·78, 1·79–7·98). Interpretation The sensitivity and specificity of self-reported adherence is poor, but on the basis of AED detection in blood almost two-thirds of patients with epilepsy were not on treatment. Education about epilepsy and making AEDs freely available in health facilities near people with epilepsy should be investigated as potential ways to reduce the epilepsy treatment gap. Funding Wellcome Trust.
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Affiliation(s)
- Caroline K Mbuba
- KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
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Ataguba JE, Akazili J, McIntyre D. Socioeconomic-related health inequality in South Africa: evidence from General Household Surveys. Int J Equity Health 2011; 10:48. [PMID: 22074349 PMCID: PMC3229518 DOI: 10.1186/1475-9276-10-48] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Accepted: 11/10/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inequalities in health have received considerable attention from health scientists and economists. In South Africa, inequalities exist in socio-economic status (SES) and in access to basic social services and are exacerbated by inequalities in health. While health systems, together with the wider social determinants of health, are relevant in seeking to improve health status and health inequalities, those that need good quality health care too seldom get it. Studies on the burden of ill-health in South Africa have shown consistently that, relative to the wealthy, the poor suffer more from more disease and violence. However, these studies are based on selected disease conditions and only consider a single point in time. Trend analyses have yet to be produced. This paper specifically investigates socio-economic related health inequality in South Africa and seeks to understand how the burden of self-reported illness and disability is distributed and whether this has changed since the early 2000s. METHODS Several rounds (2002, 2004, 2006, and 2008) of the South African General Household Surveys (GHS) data were used, with standardized and normalized self-reported illness and disability concentration indices to assess the distribution of illness and disability across socio-economic groups. Composite indices of socio-economic status were created using a set of common assets and household characteristics. RESULTS This study demonstrates the existence of socio-economic gradients in self-reported ill-health in South Africa. The burden of the major categories of ill-health and disability is greater among lower than higher socio-economic groups. Even non-communicable diseases, which are frequently seen as diseases of affluence, are increasingly being reported by lower socio-economic groups. For instance, the concentration index of flu (and diabetes) declined from about 0.17 (0.10) in 2002 to 0.05 (0.01) in 2008. These results have also been confirmed internationally. CONCLUSION The current burden and distribution of ill-health indicates how critical it is for the South African health system to strive for access to and use of health services that is in line with need for such care. Concerted government efforts, within both the health sector and other social and economic sectors are therefore needed to address the significant health inequalities in South Africa.
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Affiliation(s)
- John E Ataguba
- Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Observatory, 7925, South Africa
| | - James Akazili
- Navrongo Health Research Centre, Ghana Health Service, P. O. Box 114, Navrongo, Ghana
| | - Di McIntyre
- Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Observatory, 7925, South Africa
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Howe LD, Hargreaves JR, Ploubidis GB, De Stavola BL, Huttly SRA. Subjective measures of socio-economic position and the wealth index: a comparative analysis. Health Policy Plan 2010; 26:223-32. [PMID: 20817696 DOI: 10.1093/heapol/czq043] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION The wealth index is a commonly-used measure of socio-economic position (SEP) in low- and middle-income settings, but there is concern that it is strongly influenced by community-level as well as household-level factors. Subjective SEP indicators are infrequently used in health research. METHODS We use data from 11 280 households included in the Malawi Integrated Household Survey 2004/5. We compare the wealth index with four subjective measures of SEP: perceived food consumption adequacy, perceived overall consumption adequacy, an economic ladder question, and perceived income sufficiency. The wealth index is compared with each subjective SEP measure in terms of: (i) agreement of classification of households, (ii) targeting accuracy with respect to US$1-a-day poverty based on consumption expenditure, and (iii) the socio-economic processes (household- and community-level) giving rise to the SEP scores. RESULTS Each subjective SEP indicator resulted in considerable differential classification of households compared with the wealth index. Three measures of subjective SEP (perceived food consumption adequacy, economic ladder question, and perceived income sufficiency) identified a higher proportion of dollar-a-day poor households as poor than the wealth index. The wealth index was strongly influenced by community infrastructure, but all subjective SEP indicators were free from strong community-level influence. CONCLUSION The strengths and limitations of any measure of SEP depend on the context and purpose for which it is being used. In these data, the wealth index was strongly influenced by community infrastructure, whereas the subjective SEP measures were not, perhaps allowing analyses using them to disentangle household and community influences. Several subjective measures also corresponded to dollar-a-day poverty more strongly than the wealth index. Subjective measures may therefore be preferable to the wealth index in some circumstances, although they have their own set of potential biases.
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Affiliation(s)
- Laura D Howe
- MRC Centre for Causal Analyses in Translational Epidemiology, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK.
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Russell TL, Lwetoijera DW, Maliti D, Chipwaza B, Kihonda J, Charlwood JD, Smith TA, Lengeler C, Mwanyangala MA, Nathan R, Knols BGJ, Takken W, Killeen GF. Impact of promoting longer-lasting insecticide treatment of bed nets upon malaria transmission in a rural Tanzanian setting with pre-existing high coverage of untreated nets. Malar J 2010; 9:187. [PMID: 20579399 PMCID: PMC2902500 DOI: 10.1186/1475-2875-9-187] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Accepted: 06/28/2010] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The communities of Namawala and Idete villages in southern Tanzania experienced extremely high malaria transmission in the 1990s. By 2001-03, following high usage rates (75% of all age groups) of untreated bed nets, a 4.2-fold reduction in malaria transmission intensity was achieved. Since 2006, a national-scale programme has promoted the use of longer-lasting insecticide treatment kits (consisting of an insecticide plus binder) co-packaged with all bed nets manufactured in the country. METHODS The entomological inoculation rate (EIR) was estimated through monthly surveys in 72 houses randomly selected in each of the two villages. Mosquitoes were caught using CDC light traps placed beside occupied bed nets between January and December 2008 (n = 1,648 trap nights). Sub-samples of mosquitoes were taken from each trap to determine parity status, sporozoite infection and Anopheles gambiae complex sibling species identity. RESULTS Compared with a historical mean EIR of approximately 1400 infectious bites/person/year (ib/p/y) in 1990-94; the 2008 estimate of 81 ib/p/y represents an 18-fold reduction for an unprotected person without a net. The combined impact of longer-lasting insecticide treatments as well as high bed net coverage was associated with a 4.6-fold reduction in EIR, on top of the impact from the use of untreated nets alone. The scale-up of bed nets and subsequent insecticidal treatment has reduced the density of the anthropophagic, endophagic primary vector species, Anopheles gambiae sensu stricto, by 79%. In contrast, the reduction in density of the zoophagic, exophagic sibling species Anopheles arabiensis was only 38%. CONCLUSION Insecticide treatment of nets reduced the intensity of malaria transmission in addition to that achieved by the untreated nets alone. Impacts were most pronounced against the highly anthropophagic, endophagic primary vector, leading to a shift in the sibling species composition of the A. gambiae complex.
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Affiliation(s)
- Tanya L Russell
- Biomedical and Environmental Thematic Group, Ifakara Health Institute, P.O. Box 53, Ifakara, Tanzania
- Department of Biological and Biomedical Sciences, Durham University, South Road, Durham, DH1 3LE, UK
- Vector Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Dickson W Lwetoijera
- Biomedical and Environmental Thematic Group, Ifakara Health Institute, P.O. Box 53, Ifakara, Tanzania
- Department of Zoology and Marine Biology, University of Dar es Salaam, P.O. Box 35064, Dar es Salaam, Tanzania
| | - Deodatus Maliti
- Biomedical and Environmental Thematic Group, Ifakara Health Institute, P.O. Box 53, Ifakara, Tanzania
- Vector Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Beatrice Chipwaza
- Biomedical and Environmental Thematic Group, Ifakara Health Institute, P.O. Box 53, Ifakara, Tanzania
| | - Japhet Kihonda
- Biomedical and Environmental Thematic Group, Ifakara Health Institute, P.O. Box 53, Ifakara, Tanzania
| | - J Derek Charlwood
- DBL Centre for Health Research & Development, 57 Thorvaldensvej, Fredriksberg -C, DK 1870, Denmark
| | - Thomas A Smith
- Department of Public Health and Epidemiology, Swiss Tropical Institute, Socinstrasse 57, Basel, CH 4002, Switzerland
| | - Christian Lengeler
- Department of Public Health and Epidemiology, Swiss Tropical Institute, Socinstrasse 57, Basel, CH 4002, Switzerland
| | - Mathew A Mwanyangala
- Biomedical and Environmental Thematic Group, Ifakara Health Institute, P.O. Box 53, Ifakara, Tanzania
| | - Rose Nathan
- Biomedical and Environmental Thematic Group, Ifakara Health Institute, P.O. Box 53, Ifakara, Tanzania
| | - Bart GJ Knols
- Division of Infectious Diseases, Tropical Medicine & AIDS Academic Medical Center, F4-217, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Willem Takken
- Laboratory of Entomology, Wageningen University and Research Centre, P.O. Box 8031, 6700 EH, Wageningen, The Netherlands
| | - Gerry F Killeen
- Biomedical and Environmental Thematic Group, Ifakara Health Institute, P.O. Box 53, Ifakara, Tanzania
- Department of Biological and Biomedical Sciences, Durham University, South Road, Durham, DH1 3LE, UK
- Vector Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
- Department of Public Health and Epidemiology, Swiss Tropical Institute, Socinstrasse 57, Basel, CH 4002, Switzerland
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Chuma J, Okungu V, Molyneux C. The economic costs of malaria in four Kenyan districts: do household costs differ by disease endemicity? Malar J 2010; 9:149. [PMID: 20515508 PMCID: PMC2890678 DOI: 10.1186/1475-2875-9-149] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Accepted: 06/02/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria inflicts significant costs on households and on the economy of malaria endemic countries. There is also evidence that the economic burden is higher among the poorest in a population, and that cost burdens differ significantly between wet and dry seasons. What is not clear is whether, and how, the economic burden of malaria differs by disease endemicity. The need to account for geographical and epidemiological differences in the estimation of the social and economic burden of malaria is well recognized, but there is limited data, if any, to support this argument. This study sought to contribute towards filling this gap by comparing malaria cost burdens in four Kenyan districts of different endemicity. METHODS A cross-sectional household survey was conducted during the peak malaria transmission season in the poorest areas in four Kenyan districts with differing malaria transmission patterns (n = 179 households in Bondo; 205 Gucha; 184 Kwale; 141 Makueni). FINDINGS There were significant differences in duration of fever, perception of fever severity and cost burdens. Fever episodes among adults and children over five years in Gucha and Makueni districts (highland endemic and low acute transmission districts respectively) lasted significantly longer than episodes reported in Bondo and Kwale districts (high perennial transmission and seasonal, intense transmission, respectively). Perceptions of illness severity also differed between districts: fevers reported among older children and adults in Gucha and Makueni districts were reported as severe compared to those reported in the other districts. Indirect and total costs differed significantly between districts but differences in direct costs were not significant. Total household costs were highest in Makueni (US$ 19.6 per month) and lowest in Bondo (US$ 9.2 per month). CONCLUSIONS Cost burdens are the product of complex relationships between social, economic and epidemiological factors. The cost data presented in this study reflect transmission patterns in the four districts, suggesting that a relationship between costs burdens and the nature of transmission might exist, and that the same warrants more attention from researchers and policy makers.
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Affiliation(s)
- Jane Chuma
- Kenya Medical Research Institute-Wellcome Trust Research Programme, P,O Box, 230, Kilifi, Kenya.
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Pullan RL, Bukirwa H, Staedke SG, Snow RW, Brooker S. Plasmodium infection and its risk factors in eastern Uganda. Malar J 2010; 9:2. [PMID: 20044942 PMCID: PMC2822788 DOI: 10.1186/1475-2875-9-2] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Accepted: 01/04/2010] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Malaria is a leading cause of disease burden in Uganda, although surprisingly few contemporary, age-stratified data exist on malaria epidemiology in the country. This report presents results from a total population survey of malaria infection and intervention coverage in a rural area of eastern Uganda, with a specific focus on how risk factors differ between demographic groups in this population. METHODS In 2008, a cross-sectional survey was conducted in four contiguous villages in Mulanda, sub-county in Tororo district, eastern Uganda, to investigate the epidemiology and risk factors of Plasmodium species infection. All permanent residents were invited to participate, with blood smears collected from 1,844 individuals aged between six months and 88 years (representing 78% of the population). Demographic, household and socio-economic characteristics were combined with environmental data using a Geographical Information System. Hierarchical models were used to explore patterns of malaria infection and identify individual, household and environmental risk factors. RESULTS Overall, 709 individuals were infected with Plasmodium, with prevalence highest among 5-9 year olds (63.5%). Thin films from a random sample of 20% of parasite positive participants showed that 94.0% of infections were Plasmodium falciparum and 6.0% were P. malariae; no other species or mixed infections were seen. In total, 68% of households owned at least one mosquito although only 27% of school-aged children reported sleeping under a net the previous night. In multivariate analysis, infection risk was highest amongst children aged 5-9 years and remained high in older children. Risk of infection was lower for those that reported sleeping under a bed net the previous night and living more than 750 m from a rice-growing area. After accounting for clustering within compounds, there was no evidence for an association between infection prevalence and socio-economic status, and no evidence for spatial clustering. CONCLUSION These findings demonstrate that mosquito net usage remains inadequate and is strongly associated with risk of malaria among school-aged children. Infection risk amongst adults is influenced by proximity to potential mosquito breeding grounds. Taken together, these findings emphasize the importance of increasing net coverage, especially among school-aged children.
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Affiliation(s)
- Rachel L Pullan
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
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Uthman OA. Using extended concentration and achievement indices to study socioeconomic inequality in chronic childhood malnutrition: the case of Nigeria. Int J Equity Health 2009; 8:22. [PMID: 19500356 PMCID: PMC2698869 DOI: 10.1186/1475-9276-8-22] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2008] [Accepted: 06/05/2009] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES To assess and quantify the magnitude of inequalities in under-five child malnutrition, particularly those ascribable to socio-economic status METHODS Data on 4187 under-five children were derived from the Nigeria 2003 Demographic and Health Survey. Household asset index was used as the main indicator of socio-economic status. Socio-economic inequality in chronic childhood malnutrition was measured using the "extended" illness concentration and achievement indices. RESULTS There are considerable pro-rich inequalities in the distribution of stunting. South-east and south-west regions had low average levels of childhood malnutrition, but the inequalities between the poor and the better-off were very large. By contrast, North-east and North-west had fairly small gaps between the poor and the better-off on childhood malnutrition, but the average values of the childhood malnutrition was extremely high. CONCLUSION There are significant differences in under-five child malnutrition that favour the better-off of society as a whole and all geopolitical regions. Like other studies have reported, reliance on global averages alone can be misleading. Thus there is a need for evaluating policies not only in terms of improvements in averages, but also improvements in distribution.
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Affiliation(s)
- Olalekan A Uthman
- Center for Evidence-Based Global Health, Ilorin, PO Box 5146, Kwara State, Nigeria.
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Matovu F, Goodman C, Wiseman V, Mwengee W. How equitable is bed net ownership and utilisation in Tanzania? A practical application of the principles of horizontal and vertical equity. Malar J 2009; 8:109. [PMID: 19460153 PMCID: PMC2695473 DOI: 10.1186/1475-2875-8-109] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2008] [Accepted: 05/21/2009] [Indexed: 11/06/2022] Open
Abstract
Background Studies show that the burden of malaria remains huge particularly in low-income settings. Although effective malaria control measures such as insecticide-treated nets (ITNs) have been promoted, relatively little is known about their equity dimension. Understanding variations in their use in low-income settings is important for scaling up malaria control programmes particularly ITNs. The objective of this paper is to measure the extent and causes of inequalities in the ownership and utilisation of bed nets across socioeconomic groups (SEGs) and age groups in Tanga District, north-eastern Tanzania. Methods A questionnaire was administered to heads of 1,603 households from rural and urban areas. Households were categorized into SEGs using both an asset-based wealth index and education level of the household head. Concentration indices and regression-based measures of inequality were computed to analyse both vertical and horizontal inequalities in ownership and utilisation of bed nets. Focus Group Discussions (FGDs) were used to explore community perspectives on the causes of inequalities. Results Use of ITNs remained appallingly low compared to the RBM target of 80% coverage. Inequalities in ownership of ITNs and all nets combined were significantly pro-rich and were much more pronounced in rural areas. FGDs revealed that lack of money was the key factor for not using ITNs followed by negative perceptions about the effect of insecticides on the health of users. Household SES, living within the urban areas and being under-five were positively associated with bed net ownership and/or utilisation. Conclusion The results highlight the need for mass distribution of ITN; a community-wide programme to treat all untreated nets and to promote the use of Long-Lasting Insecticidal nets (LLINs) or longer-lasting treatment of nets. The rural population and under-fives should be targeted through highly subsidised schemes and mass distribution of free nets. Public campaigns are also needed to encourage people to use treated nets and mitigate negative perceptions about insecticides.
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Affiliation(s)
- Fred Matovu
- Faculty of Economics and Management, Makerere University, PO Box, 7062 Kampala, Uganda.
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