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Campbell LS, Knight L, Masquillier C, Wouters E. Including the Household: Individual, Community and Household Factors Affecting Antiretroviral Therapy Adherence After ART Initiation in Cape Town, South Africa. AIDS Behav 2024:10.1007/s10461-024-04447-3. [PMID: 39090458 DOI: 10.1007/s10461-024-04447-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2024] [Indexed: 08/04/2024]
Abstract
Antiretroviral therapy (ART) adherence is crucial for health outcomes of people living with HIV (PLHIV), influenced by a complex interplay of individual, community, and household factors. This article focuses on the influence of household factors, as well as individual and community factors, on ART adherence among PLHIV in Cape Town who have recently initiated ART. Baseline data for a cluster-randomized controlled trial were collected from 316 PLHIV in 12 districts in Cape Town between 6th May 2021 and 22nd May 2022. Zero-inflated Poisson models, with cluster-adjusted standard errors, were used to analyse the association between individual, household, and community factors and ART adherence measures. At the household-level, household support was associated with both better self-rated adherence (exp(β) = 0.81, z = - 4.68, p < 0.001) and fewer days when pills were missed (exp(β) = 0.65, z = - 2.92, p = 0.003). Psychological violence (exp(β) = 1.37, z = 1.97, p = 0.05) and higher household asset scores (exp(β) = 1.29, z = - 2.83, p = 0.05) were weakly associated with poorer ART adherence. At the individual-level, male gender (exp(β) = 1.37, z = 3.95, p < 0.001) and reinitiating ART (exp(β) = 1.35, z = 3.64, p < 0.001) were associated with worse self-rated ART adherence; higher education levels (exp(β) = 0.30 times, z = - 3.75, p < 0.001) and better HIV knowledge (exp(β) = 0.28, z = - 2.83, p = 0.005) were associated with fewer days where pills were missed. At the community-level, community stigma was associated with worse self-rated ART adherence (exp(β) = 1.24, z = 3.01, p = 0.003). When designing interventions to improve ART adherence, household, individual and community factors should all be considered, particularly in addressing gender-based disparities, reducing stigma, tackling violence, and enhancing household support.Clinical Trial Number: Pan African Clinical Trial Registry, PACTR201906476052236. Registered on 24 June 2019.
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Affiliation(s)
- Linda S Campbell
- Faculty of Social Sciences, Centre for Population, Family and Health, University of Antwerp, Prinsstraat 13, 2000, Antwerp, Belgium.
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - Lucia Knight
- Division of Social and Behavioural Sciences, Faculty of Health Sciences, School of Public Health, University of Cape Town, Cape Town, South Africa
- School of Public Health, Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Caroline Masquillier
- Faculty of Social Sciences, Centre for Population, Family and Health, University of Antwerp, Prinsstraat 13, 2000, Antwerp, Belgium
- Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Edwin Wouters
- Faculty of Social Sciences, Centre for Population, Family and Health, University of Antwerp, Prinsstraat 13, 2000, Antwerp, Belgium
- Centre for Health Systems Research & Development, University of the Free State, Bloemfontein, South Africa
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Prevalence of Breakfast Skippers among Tunisian Preschool and School Children and Association with Weight Status: A Cross-Sectional Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020392. [PMID: 36832521 PMCID: PMC9954857 DOI: 10.3390/children10020392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 02/09/2023] [Accepted: 02/13/2023] [Indexed: 02/19/2023]
Abstract
Breakfast is considered the most important meal of the day. This study aimed to assess breakfast frequency and quality in Tunisian children and to determine the relationship between breakfast skipping and the weight status of the children. A total of 1200 preschool and school children aged 3 to 9 years were randomly selected under a cross-sectional design. Breakfast habits and socio-economic characteristics were collected using a questionnaire. Participants who consumed breakfast less than five times the previous week were categorized as breakfast skippers. The other breakfast consumers were considered as non-skippers. The overall prevalence of breakfast skipping in Tunisian children was 8.3% and 83% of them consumed breakfast all the weekdays. At least two out of three children had a poor breakfast quality. Only 1% of children consumed breakfast in accordance with the composition guidelines. No relationships between breakfast skipping and weight status were detected in this study after adjustment for age, sex and all socio-economic factors (OR = 1.16, 95% CI = 0.72-1.89, p = 0.541). Further school-based interventions should be implemented to improve breakfast quality and to promote a healthy weight in Tunisian children.
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Minakawa N, Kawada H, Kongere JO, Sonye GO, Lutiali PA, Awuor B, Isozumi R, Futami K. Effectiveness of screened ceilings over the current best practice in reducing malaria prevalence in western Kenya: a cluster randomised controlled trial. Parasitology 2022; 149:1-39. [PMID: 35437129 PMCID: PMC10090608 DOI: 10.1017/s0031182022000415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 03/13/2022] [Accepted: 03/17/2022] [Indexed: 11/06/2022]
Abstract
Increases in bed net coverage and antimalarial treatment have reduced the risk of malaria in sub-Saharan Africa. However, the pace of reduction has slowed, and new tools are needed to reverse this trend. We evaluated houses screened with insecticide-treated ceiling nets using a cluster randomized-controlled trial in western Kenya. The primary endpoints were Plasmodium falciparum PCR-positive prevalence (PCRPf PR) of children from 7 months to 10 years old and anopheline density. Ceiling nets and bed nets were provided to 1073 houses, and 1162 houses were provided with bed nets only. The treatment and control arms each had four clusters. We conducted three epidemiological and entomological post-intervention surveys over the course of a year and a half. Each epidemiological survey targeted 150 children per cluster, and entomological surveys targeted 25 houses. When the three surveys were combined, the median PCRPf PRs were 23% (IQR 8%) in the intervention arm and 42% (IQR 12%) in the control arm. The adjusted risk ratio (RR) was 0.53 [95% confidence interval (CI) 0.41–0.71; P = 0.029]. The median anopheline densities were 0.4 (IQR 0.4) and 2.0 (IQR 1.4), respectively. The adjusted RR was 0.41 (95% CI 0.29–0.90; P = 0.029). The present study indicates additional protection from insecticide-screened ceilings over the current best practice.
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Affiliation(s)
- Noboru Minakawa
- Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki 852-8523, Japan
| | - Hitoshi Kawada
- Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki 852-8523, Japan
| | - James O. Kongere
- Kenya Medical Research Institute, Nairobi, Kenya
- Center for Research in Tropical Medicine and Community Development (CRTMCD), Nairobi, Kenya
| | | | - Peter A. Lutiali
- Kenya Medical Research Institute, Nairobi, Kenya
- Center for Research in Tropical Medicine and Community Development (CRTMCD), Nairobi, Kenya
| | | | - Rie Isozumi
- Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki 852-8523, Japan
| | - Kyoko Futami
- Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki 852-8523, Japan
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Ultra-Processed Foods Are the Major Sources of Total Fat, Saturated and Trans-Fatty Acids among Tunisian Preschool and School Children: A Cross-Sectional Study. CHILDREN 2022; 9:children9020126. [PMID: 35204847 PMCID: PMC8869835 DOI: 10.3390/children9020126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 12/03/2022]
Abstract
Excessive fat and fatty acids intake are associated with significant health hazards such as obesity or chronic diseases. This study aimed to provide the first data on total fat, saturated fatty acids (SFA) and trans fatty acids (TFA) intakes and their major food sources in Tunisian children. A total of 1200 children, aged 3 to 9 years old, were randomly selected from primary schools and kindergartens under a cross-sectional design. The 24-h dietary recall method and diet history for the month preceding the survey were used to assess dietary intake. The energy percentages of total fat, SFA and TFA in Tunisian children were 29.6%, 11.4% and 0.15%, respectively. No sex differences were found. The WHO recommendations for total fat, SFA and TFA were adopted by 58%, 39% and 89% of the study population, respectively. The leading food groups of fat and fatty acids were ultra-processed foods, breakfast cereals and dairy products. The meat, fish, eggs, and fish alternatives were the fifth main contributors to Tunisian children’s total fat and SFA intakes. The implementation of a relevant strategy for fat reduction, especially from ultra-processed foods, considered as low nutrient energy-dense products, is needed to promote health among children and prevent diet-related chronic diseases.
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Larson PS, Ono M, Changoma M, Goto K, Kaneko S, Moji K, Minakawa N. Presence of dogs and proximity to a wildlife reserve increase household level risk of tungiasis in Kwale, Kenya. Trop Med Health 2021; 49:54. [PMID: 34225821 PMCID: PMC8256484 DOI: 10.1186/s41182-021-00338-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/26/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Tungiasis is a ectopic skin disease caused by some species of fleas in the Tunga genus, most notably T. penetrans. The disease afflicts poor and marginalized communities in developing countries. Transmission of tungiasis comprises a complex web of factors including domesticated animals and wildlife. This research explores animal and environmental risk factors for tungiasis in an area adjacent to a wildlife reserve in Kwale, Kenya. Methods A two-stage complex sampling strategy was used. Households were selected from three areas in and around Kwale Town, Kenya, an area close to the Kenyan Coast. Households were listed as positive if at least one member had tungiasis. Each household was administered a questionnaire regarding tungiasis behaviors, domesticated animal assets, and wild animal species that frequent the peridomiciliary area. Associations of household tungiasis were tests with household and environmental variables using regression methods. Results The study included 319 households. Of these, 41 (12.85%) were found to have at least one person who had signs of tungiasis. There were 295 (92.48%) households that possessed at least one species of domesticated animal. It was reported that wildlife regularly come into the vicinity of the home 90.59% of households. Presence of dogs around the home (OR 3.85; 95% CI 1.84; 8.11) and proximity to the park were associated with increased risk for tungiasis infestation in humans in a multivariate regression model. Conclusions Human tungiasis is a complex disease associated with domesticated and wild animals. Canines in particular appear to be important determinants of household level risk.
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Affiliation(s)
- Peter S Larson
- Nagasaki University Institute of Tropical Medicine-Kenya Medical Research Institute (NUITM-KEMRI) project, Kenya, Nagasaki, Nagasaki, Japan. .,University of Michigan School of Natural Resources and Environment, Ann Arbor, MI, USA.
| | - Masanobu Ono
- Nagasaki University Institute of Tropical Medicine-Kenya Medical Research Institute (NUITM-KEMRI) project, Kenya, Nagasaki, Nagasaki, Japan
| | - Mwatasa Changoma
- Nagasaki University Institute of Tropical Medicine-Kenya Medical Research Institute (NUITM-KEMRI) project, Kenya, Nagasaki, Nagasaki, Japan.,Chemi Chemi, Kwale, Kenya
| | - Kensuke Goto
- Division of Health and Safety Sciences Education, Osaka Kyoiku University, Osaka, Japan
| | - Satoshi Kaneko
- Nagasaki University Institute of Tropical Medicine-Kenya Medical Research Institute (NUITM-KEMRI) project, Kenya, Nagasaki, Nagasaki, Japan
| | - Kazuhiko Moji
- Nagasaki University School of Tropical Medicine and Global Health (TMGH), Nagasaki, Japan
| | - Noboru Minakawa
- Nagasaki University Institute of Tropical Medicine-Kenya Medical Research Institute (NUITM-KEMRI) project, Kenya, Nagasaki, Nagasaki, Japan
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Samuels AM, Odero NA, Odongo W, Otieno K, Were V, Shi YP, Sang T, Williamson J, Wiegand R, Hamel MJ, Kachur SP, Slutsker L, Lindblade KA, Kariuki SK, Desai MR. Impact of Community-Based Mass Testing and Treatment on Malaria Infection Prevalence in a High-Transmission Area of Western Kenya: A Cluster Randomized Controlled Trial. Clin Infect Dis 2021; 72:1927-1935. [PMID: 32324850 DOI: 10.1093/cid/ciaa471] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 04/21/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Global gains toward malaria elimination have been heterogeneous and have recently stalled. Interventions targeting afebrile malaria infections may be needed to address residual transmission. We studied the efficacy of repeated rounds of community-based mass testing and treatment (MTaT) on malaria infection prevalence in western Kenya. METHODS Twenty clusters were randomly assigned to 3 rounds of MTaT per year for 2 years or control (standard of care for testing and treatment at public health facilities along with government-sponsored mass long-lasting insecticidal net [LLIN] distributions). During rounds, community health volunteers visited all households in intervention clusters and tested all consenting individuals with a rapid diagnostic test. Those positive were treated with dihydroartemisinin-piperaquine. Cross-sectional community infection prevalence surveys were performed in both study arms at baseline and each year after 3 rounds of MTaT. The primary outcome was the effect size of MTaT on parasite prevalence by microscopy between arms by year, adjusted for age, reported LLIN use, enhanced vegetative index, and socioeconomic status. RESULTS Demographic and behavioral characteristics, including LLIN usage, were similar between arms at each survey. MTaT coverage across the 3 annual rounds ranged between 75.0% and 77.5% in year 1, and between 81.9% and 94.3% in year 2. The adjusted effect size of MTaT on the prevalence of parasitemia between arms was 0.93 (95% confidence interval [CI], .79-1.08) and 0.92 (95% CI, .76-1.10) after year 1 and year 2, respectively. CONCLUSIONS MTaT performed 3 times per year over 2 years did not reduce malaria parasite prevalence in this high-transmission area. CLINICAL TRIALS REGISTRATION NCT02987270.
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Affiliation(s)
- Aaron M Samuels
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nobert Awino Odero
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Wycliffe Odongo
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Kephas Otieno
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Vincent Were
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Ya Ping Shi
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tony Sang
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - John Williamson
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ryan Wiegand
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mary J Hamel
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - S Patrick Kachur
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Laurence Slutsker
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kim A Lindblade
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Simon K Kariuki
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Meghna R Desai
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Dogui D, Doggui R, El Ati J, El Ati-Hellal M. Association between Overweight and Diet Diversity Score: A Cross-Sectional Study Conducted among Tunisian Children. CHILDREN (BASEL, SWITZERLAND) 2021; 8:536. [PMID: 34202419 PMCID: PMC8303938 DOI: 10.3390/children8070536] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/07/2021] [Accepted: 06/09/2021] [Indexed: 12/15/2022]
Abstract
AIM This study explored the association between the diet diversity score (DDS) and overweight among Tunisian children. METHODS A representative sample of children living in Greater Tunis was selected based on a two-stage clustered sampling design. A total of 1200 children (3-9 years) were recruited. Dietary assessment was realized using a 24 h dietary recall. Anthropometric measurements were realized, and overweight was defined according to the World Health Organization standards. Logistic regression was used for the association between DDS with overweight. RESULTS A quarter of children were found to be overweight. Overweight prevalence was found to decrease with the increase of mother education level (p = 0.010) among children <6 years. Crude DDS score was higher among non-overweight children irrespective of the age class (p = 0.002). Tunisian children appeared to consume much more than six food groups, corresponding to a more than recommended intake of most nutrients. Intriguingly, DDS was positively associated with the occurrence of overweight children <6 years, adjusted odd ratio = 1.37, 95% CI (1.03-1.82). CONCLUSION Overweight is a public health problem among Tunisian children. A high DDS signifies adequate nutrient intake. An increase of DDS was found to be a positive predictor of overweight only in pre-school children.
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Affiliation(s)
- Darine Dogui
- INNTA (National Institute of Nutrition and Food Technology), SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Laboratory, Tunis 1007, Tunisia; (D.D.); (J.E.A.)
- INAT (National Agronomic Institute of Tunisia), University of Carthage, Tunis 1082, Tunisia
| | - Radhouene Doggui
- INNTA (National Institute of Nutrition and Food Technology), SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Laboratory, Tunis 1007, Tunisia; (D.D.); (J.E.A.)
- Centre de Formation Médicale du Nouveau-Brunswick (Université de Sherbrooke), Pavillon J.-Raymond-Frenette, Université de Moncton, 18 Antonine-Maillet Ave, Moncton, NB E1A 3E9, Canada
- Department of Family and Emergency Medicine, Université de Sherbrooke, Sherbrooke, QC J1K 2R1, Canada
| | - Jalila El Ati
- INNTA (National Institute of Nutrition and Food Technology), SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Laboratory, Tunis 1007, Tunisia; (D.D.); (J.E.A.)
| | - Myriam El Ati-Hellal
- IPEST (Preparatory Institute for Scientific and Technical Studies), University of Carthage, Laboratory Materials Molecules and Applications, P.B. 51, Tunis 2070, Tunisia;
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Minakawa N, Kongere JO, Sonye GO, Lutiali PA, Awuor B, Kawada H, Isozumi R, Futami K. Long-Lasting Insecticidal Nets Incorporating Piperonyl Butoxide Reduce the Risk of Malaria in Children in Western Kenya: A Cluster Randomized Controlled Trial. Am J Trop Med Hyg 2021; 105:461-471. [PMID: 34125699 PMCID: PMC8437186 DOI: 10.4269/ajtmh.20-1069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 03/22/2021] [Indexed: 11/10/2022] Open
Abstract
Malaria vectors have acquired an enzyme that metabolizes pyrethroids. To tackle this problem, we evaluated long-lasting insecticidal nets incorporating piperonyl butoxide (PBO-LLINs) with a community-based cluster randomized control trial in western Kenya. The primary endpoints were anopheline density and Plasmodium falciparum polymerase chain reaction (PCR)-positive prevalence (PCRpfPR) of children aged 7 months to 10 years. Four clusters were randomly selected for each of the treatment and control arms (eight clusters in total) from 12 clusters, and PBO-LLINs and standard LLINs were distributed in February 2011 to 982 and 1,028 houses for treatment and control arms, respectively. Entomological surveys targeted 20 houses in each cluster, and epidemiological surveys targeted 150 children. Cluster-level permutation tests evaluated the effectiveness using the fitted values from individual level regression models adjusted for baseline. Bootstrapping estimated 95% confidence intervals (CIs). The medians of anophelines per house were 1.4 (interquartile range [IQR]: 2.3) and 3.4 (IQR: 3.7) in the intervention and control arms after 3 months, and 0.4 (IQR: 0.2) and 1.6 (IQR: 0.5) after 10 months, respectively. The differences were -2.5 (95% CI: -6.4 to -0.6) and -1.3 (95% CI: -2.0 to -0.7), respectively. The datasets of 861 and 775 children were analyzed in two epidemiological surveys. The median PCRpfPRs were 25% (IQR: 11%) in the intervention arm and 52% (IQR: 11%) in the control arm after 5 months and 33% (IQR: 11%) and 45% (IQR: 5%) after 12 months. The PCRpfPR ratios were 0.67 (95% CI: 0.38, 0.91) and 0.74 (95% CI: 0.53, 0.90), respectively. We confirmed the superiority of PBO-LLINs.
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Affiliation(s)
- Noboru Minakawa
- Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
| | - James O. Kongere
- Kenya Medical Research Institute, Nairobi, Kenya
- Center for Research in Tropical Medicine and Community Development (CRTMCD), Nairobi, Kenya
| | | | - Peter A. Lutiali
- Kenya Medical Research Institute, Nairobi, Kenya
- Center for Research in Tropical Medicine and Community Development (CRTMCD), Nairobi, Kenya
| | | | - Hitoshi Kawada
- Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
| | - Rie Isozumi
- Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
| | - Kyoko Futami
- Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
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Varghese JS, Maluccio JA, Cunningham SA, Ramirez-Zea M, Stein AD. Development of a temporally harmonized asset index: evidence from across 50 years of follow up of a birth cohort in Guatemala. BMC Med Res Methodol 2021; 21:85. [PMID: 33902451 PMCID: PMC8074514 DOI: 10.1186/s12874-021-01263-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/30/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Asset-based indices are widely-used proxy measures of wealth in low and middle-income countries (LMIC). The stability of these indices within households over time is not known. METHODS We develop a harmonized household asset index using Principal Component Analysis for the participants (n = 2392) of INCAP Longitudinal Study, Guatemala using data from six waves of follow-up over the period of 1965-2018. We estimate its cross-sectional association with parental schooling (in 1967-75) and attained schooling (in 2015-18) of cohort members. We study how patterns of cross-sectional loadings change over time and between urban-rural settings. We assess its robustness to omission of assets or study waves and alternate specifications of factor extraction procedure (exploratory factor analysis, multiple correspondence analysis). RESULTS The harmonized index constructed using 8 assets and 11 housing characteristics explained 32.4% of the variance. Most households increased in absolute wealth over time with median wealth (25th percentile, 75th percentile; households) increasing from - 3.74 (- 4.42, - 3.07; 547) in 1967 to 2.08 (1.41, 2.67; 1145) in 2017-18. Ownership of television, electricity, quality of flooring and sanitary installation explained the largest proportion of variance. The index is positively associated with measures of schooling (maternal: r = 0.16; paternal: r = 0.10; attained: r = 0.35, all p < 0.001). In 2015-18, house ownership versus housing characteristics and ownership of electronic goods differentiate households in urban and rural areas respectively. The index is robust for omission of assets or study waves, indicator categorization and factor extraction method. CONCLUSION A temporally harmonized asset index constructed from consistently administered surveys in a cohort setting over time may allow study of associations of life-course social mobility with human capital outcomes in LMIC contexts. The approach permits exploration of trends in household wealth of the sample over a follow-up period against repeated cross-sectional surveys which permit the estimation of only the mean trajectory.
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Affiliation(s)
- Jithin Sam Varghese
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA, USA
| | - John A Maluccio
- Economics Department at Middlebury College, Middlebury College, Middlebury, VT, USA
| | - Solveig A Cunningham
- Hubert Department of Global Health, Emory University, 1518 Clifton Rd NE, #7007, Atlanta, GA, 30322, USA
| | - Manuel Ramirez-Zea
- INCAP Research Centre for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Aryeh D Stein
- Hubert Department of Global Health, Emory University, 1518 Clifton Rd NE, #7007, Atlanta, GA, 30322, USA.
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Minakawa N, Kongere JO, Sonye GO, Lutiali PA, Awuor B, Kawada H, Isozumi R, Futami K. A preliminary study on designing a cluster randomized control trial of two new mosquito nets to prevent malaria parasite infection. Trop Med Health 2020; 48:98. [PMID: 33372641 PMCID: PMC7720478 DOI: 10.1186/s41182-020-00276-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although long-lasting insecticidal nets (LLINs) are the most effective tool for preventing malaria parasite transmission, the nets have some limitations. For example, the increase of LLIN use has induced the rapid expansion of mosquito insecticide resistance. More than two persons often share one net, which increases the infection risk. To overcome these problems, two new mosquito nets were developed, one incorporating piperonyl butoxide and another covering ceilings and open eaves. We designed a cluster randomized controlled trial (cRCT) to evaluate these nets based on the information provided in the present preliminary study. RESULTS Nearly 75% of the anopheline population in the study area in western Kenya was Anopheles gambiae s. l., and the remaining was Anopheles funestus s. l. More female anophelines were recorded in the western part of the study area. The number of anophelines increased with rainfall. We planned to have 80% power to detect a 50% reduction in female anophelines between the control group and each intervention group. The between-cluster coefficient of variance was 0.192. As the number of clusters was limited to 4 due to the size of the study area, the estimated cluster size was 7 spray catches with an alpha of 0.05. Of 1619 children tested, 626 (48%) were Plasmodium falciparum positive using a rapid diagnostic test (RDT). The prevalence was higher in the northwestern part of the study area. The number of children who slept under bed nets was 929 (71%). The P. falciparum RDT-positive prevalence (RDTpfPR) of net users was 45%, and that of non-users was 55% (OR 0.73; 95% CI 0.56, 0.95). Using 45% RDTpfPR of net users, we expected each intervention to reduce prevalence by 50%. The intracluster correlation coefficient was 0.053. With 80% power and an alpha of 0.05, the estimated cluster size was 116 children. Based on the distribution of children, we modified the boundaries of the clusters and established 300-m buffer zones along the boundaries to minimize a spillover effect. CONCLUSIONS The cRCT study design is feasible. As the number of clusters is limited, we will apply a two-stage procedure with the baseline data to evaluate each intervention.
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Affiliation(s)
- Noboru Minakawa
- Institute of Tropical Medicine (NEKKEN), Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.
| | - James O Kongere
- Kenya Medical Research Institute, Nairobi, Kenya
- Center for Research in Tropical Medicine and Community Development (CRTMCD), Nairobi, Kenya
| | | | - Peter A Lutiali
- Kenya Medical Research Institute, Nairobi, Kenya
- Center for Research in Tropical Medicine and Community Development (CRTMCD), Nairobi, Kenya
| | | | - Hitoshi Kawada
- Institute of Tropical Medicine (NEKKEN), Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Rie Isozumi
- Institute of Tropical Medicine (NEKKEN), Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Kyoko Futami
- Institute of Tropical Medicine (NEKKEN), Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
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11
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Tamari N, Minakawa N, Sonye GO, Awuor B, Kongere JO, Hashimoto M, Kataoka M, Munga S. Protective effects of Olyset® Net on Plasmodium falciparum infection after three years of distribution in western Kenya. Malar J 2020; 19:373. [PMID: 33076928 PMCID: PMC7574443 DOI: 10.1186/s12936-020-03444-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 10/10/2020] [Indexed: 12/23/2022] Open
Abstract
Background Several types of insecticides, treating technologies and materials are available for long-lasting insecticide-treated nets (LLINs). The variations may result in different efficacies against mosquitoes and correspondingly infection risks for the Plasmodium falciparum malaria parasite. This cross-sectional study investigated whether infection risk varied among children who slept under different LLIN brands in rural villages of western Kenya. Methods Children sleeping under various types of LLINs were tested for P. falciparum infection using a diagnostic polymerase chain reaction (PCR) assay. Data were collected for other potential factors associated with infection risk: sleeping location (with bed/without bed), number of persons sharing the same net, dwelling wall material, gap of eaves (open/close), proportional hole index, socio-economic status, and density of indoor resting anophelines. Bed-net efficacy against the Anopheles gambiae susceptible strain was estimated using the WHO cone test and the tunnel test. The residual insecticide content on nets was measured. Results Seven LLIN brands were identified, and deltamethrin-based DawaPlus® 2.0 was the most popular (48%) followed by permethrin-based Olyset® Net (28%). The former LLIN was distributed in the area about six months before the present study was conducted, and the latter net was distributed at least three years before. Of 254 children analysed, P. falciparum PCR-positive prevalence was 58% for DawaPlus® 2.0 users and 38% for Olyset® users. The multiple regression analysis revealed that the difference was statistically significant (adjusted OR: 0.67, 95% credible interval: 0.45–0.97), whereas the confounders were not statistically important. Among randomly selected net samples, all DawaPlus® 2.0 (n = 20) and 95% of Olyset® (n = 19) passed either the cone test or the tunnel test. Conclusions Olyset® was more effective in reducing infection risk compared with DawaPlus® 2.0. Although the data from the present study were too limited to explain the mechanism clearly, the results suggest that the characteristics of the former brand are more suitable for the conditions, such as vector species composition, of the study area.
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Affiliation(s)
- Noriko Tamari
- Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, Nagasaki, 852-8523, Japan. .,College of Public Health, The University of Arizona, 1295 N Martin Ave, Tucson, AZ, 85724, USA.
| | - Noboru Minakawa
- Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, Nagasaki, 852-8523, Japan
| | - George O Sonye
- Ability To Solve By Knowledge Project, Mbita, Homa Bay, Kenya
| | - Beatrice Awuor
- Ability To Solve By Knowledge Project, Mbita, Homa Bay, Kenya
| | - James O Kongere
- Centre for Research in Tropical Medicine and Community Development, Nairobi, Kenya
| | - Muneaki Hashimoto
- National Institute of Advanced Industrial Science and Technology (AIST), Health Research Institute, Kagawa, Japan
| | - Masatoshi Kataoka
- National Institute of Advanced Industrial Science and Technology (AIST), Health Research Institute, Kagawa, Japan
| | - Stephen Munga
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
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12
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Djossinou DRA, Savy M, Fanou‐Fogny N, Landais E, Accrombessi M, Briand V, Yovo E, Hounhouigan DJ, Gartner A, Martin‐Prevel Y. Changes in women's dietary diversity before and during pregnancy in Southern Benin. MATERNAL & CHILD NUTRITION 2020; 16:e12906. [PMID: 31833230 PMCID: PMC7083447 DOI: 10.1111/mcn.12906] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 09/12/2019] [Accepted: 10/08/2019] [Indexed: 11/30/2022]
Abstract
Dietary diversity before and during pregnancy is crucial to ensure optimal foetal health and development. We carried out a cohort study of women of reproductive age living in the Sô-Ava and Abomey-Calavi districts (Southern Benin) to investigate women's changes in dietary diversity and identify their determinants both before and during pregnancy. Nonpregnant women were enrolled (n = 1214) and followed up monthly until they became pregnant (n = 316), then every 3 months during pregnancy. One 24-hr dietary recall was administered before conception and during each trimester of pregnancy. Women's dietary diversity scores (WDDS) were computed, defined as the number of food groups out of a list of 10 consumed by the women during the past 24 hr. The analysis included 234 women who had complete data. Mixed-effects linear regression models were used to examine changes in the WDDS over the entire follow-up, while controlling for the season, subdistrict, socio-demographic, and economic factors. At preconception, the mean WDDS was low (4.3 ± 1.1 food groups), and the diet was mainly composed of cereals, oils, vegetables, and fish. The mean WDDS did not change during pregnancy and was equally low at all trimesters. Parity and household wealth index were positively associated with the WDDS before and during pregnancy in the multivariate analysis. Additional research is needed to better understand perceptions of food consumption among populations, and more importantly, efforts must be made to encourage women and communities in Benin to improve the diversity of their diets before and during pregnancy.
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Affiliation(s)
- Diane R. A. Djossinou
- Nutripass, Institut de Recherche pour le Développement (IRD)Université de MontpellierMontpellierFrance
- Faculté des Sciences Agronomiques de l'Université d'Abomey‐Calavi (FSA/UAC), Campus d'Abomey‐Calavi, CotonouBénin
| | - Mathilde Savy
- Nutripass, Institut de Recherche pour le Développement (IRD)Université de MontpellierMontpellierFrance
| | - Nadia Fanou‐Fogny
- Faculté des Sciences Agronomiques de l'Université d'Abomey‐Calavi (FSA/UAC), Campus d'Abomey‐Calavi, CotonouBénin
| | - Edwige Landais
- Nutripass, Institut de Recherche pour le Développement (IRD)Université de MontpellierMontpellierFrance
| | - Manfred Accrombessi
- Faculté des Sciences Agronomiques de l'Université d'Abomey‐Calavi (FSA/UAC), Campus d'Abomey‐Calavi, CotonouBénin
- UMR 216‐MERIT, Institut de Recherche pour le Développement (IRD)Université Paris DescartesParisFrance
| | - Valérie Briand
- UMR 216‐MERIT, Institut de Recherche pour le Développement (IRD)Université Paris DescartesParisFrance
| | - Emmanuel Yovo
- Faculté des Sciences Agronomiques de l'Université d'Abomey‐Calavi (FSA/UAC), Campus d'Abomey‐Calavi, CotonouBénin
| | - D. Joseph Hounhouigan
- Nutripass, Institut de Recherche pour le Développement (IRD)Université de MontpellierMontpellierFrance
| | - Agnès Gartner
- Nutripass, Institut de Recherche pour le Développement (IRD)Université de MontpellierMontpellierFrance
| | - Yves Martin‐Prevel
- Nutripass, Institut de Recherche pour le Développement (IRD)Université de MontpellierMontpellierFrance
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13
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Adubra L, Le Port A, Kameli Y, Fortin S, Mahamadou T, Ruel MT, Martin-Prevel Y, Savy M. Conditional cash transfer and/or lipid-based nutrient supplement targeting the first 1000 d of life increased attendance at preventive care services but did not improve linear growth in young children in rural Mali: results of a cluster-randomized controlled trial. Am J Clin Nutr 2019; 110:1476-1490. [PMID: 31562508 DOI: 10.1093/ajcn/nqz238] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 08/27/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In 2014, the World Food Programme added to an ongoing health and nutrition program named "Santé Nutritionnelle à Assise Communautaire dans la région de Kayes" (SNACK), the distribution of cash to mothers and/or lipid-based nutrient supplement (LNS) to children aged 6-23 mo, conditional upon attendance at community health centers (CHCs) during the first 1000 d of life. OBJECTIVE We evaluated the additional impact of the distribution of cash and/or LNS on mean height-for-age z scores (HAZ; primary outcome), stunting (HAZ < -2), and on intermediate outcomes along the program impact pathways. METHODS In a cluster-randomized controlled trial using a 2 × 2 factorial design, 76 CHCs were randomly assigned to deliver either SNACK, SNACK + Cash, SNACK + LNS, or SNACK + Cash + LNS. Cross-sectional surveys among 12- to 42-mo-old children and their mothers were conducted at baseline (2013, n = 5046) and at endline (2016, n = 5098). RESULTS Factorial analysis showed no interaction between cash and LNS treatments for HAZ, but found an antagonistic interaction for stunting (OR: 1.55; 95% CI: 1.05, 2.31; P = 0.03). There were no impacts of the cash, LNS, or cash + LNS treatments, compared with the SNACK alone, on either HAZ or stunting (treatment × time interaction). There were significant impacts of the LNS and cash + LNS treatments on attendance at ≥1 growth monitoring (GM) session (OR: 3.95; 95% CI: 1.69, 9.24; OR: 3.90; 95% CI: 1.73, 8.81, respectively) and half the expected sessions (OR: 4.72; 95% CI: 1.47, 15.17; OR: 5.25; 95% CI: 1.82, 15.11, respectively), mothers' knowledge on importance of GM (OR: 1.98; 95% CI: 1.16, 3.39; OR: 3.12; 95% CI: 1.60, 6.09, respectively), and, only for the LNS group, appropriate timing for complementary feeding (OR: 1.62; 95% CI: 1.09, 2.41). CONCLUSIONS Implementation constraints and suboptimal participation in program activities may explain the lack of impact on child linear growth in this rural region of Mali.This trial was registered at www.isrctn.com as ISRCTN08435964.
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Affiliation(s)
- Laura Adubra
- NUTRIPASS, University of Montpellier, French National Research Institute for Sustainable Development (IRD), Montpellier SupAgro, Montpellier, France.,Sorbonne University, Pierre and Marie Curie University Paris 06, Paris, France
| | - Agnes Le Port
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Dakar, Senegal
| | - Yves Kameli
- NUTRIPASS, University of Montpellier, French National Research Institute for Sustainable Development (IRD), Montpellier SupAgro, Montpellier, France
| | - Sonia Fortin
- NUTRIPASS, University of Montpellier, French National Research Institute for Sustainable Development (IRD), Montpellier SupAgro, Montpellier, France
| | | | - Marie T Ruel
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Yves Martin-Prevel
- NUTRIPASS, University of Montpellier, French National Research Institute for Sustainable Development (IRD), Montpellier SupAgro, Montpellier, France
| | - Mathilde Savy
- NUTRIPASS, University of Montpellier, French National Research Institute for Sustainable Development (IRD), Montpellier SupAgro, Montpellier, France
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Docrat S, Cleary S, Chisholm D, Lund C. The household economic costs associated with depression symptoms: A cross-sectional household study conducted in the North West province of South Africa. PLoS One 2019; 14:e0224799. [PMID: 31689332 PMCID: PMC6830818 DOI: 10.1371/journal.pone.0224799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 10/22/2019] [Indexed: 11/19/2022] Open
Abstract
AIM The aim of this study was to assess the association between depression symptom severity and household income, consumption, asset-based wealth, debt and use of distress financing strategies, to understand how depression symptom severity and household economic welfare are related. METHODS A household survey was administered to the households of primary health clinic-attenders who were screened for depression symptoms using the 9-item Patient Health Questionnaire in the chronic care units of four primary health clinics in the North West province of South Africa. Univariate and multivariable regression models were used to assess whether a range of household economic measures were significant predictors of depression symptom severity; and whether depression symptom severity significantly predicted changes to household economic welfare, across a number of different economic measures using both multiple linear regression and logistic regression analyses. RESULTS On univariate analysis, certain characteristics were associated with significantly worse (higher) PHQ-9 scores, namely: households in which the household head was younger, female, and unmarried; households in which the indexed patient was younger, and did not receive an education beyond primary school; increasing household size, receipt of a social grant, households living in housing constructed of metal sheet walls and households making use of a public tap as their primary water source. In addition, univariate analysis demonstrated that higher log-transformed food expenditure, lower log-transformed capacity to pay, the presence of household debt and both reducing the size or frequency of meals and drawing up retail shop accounts in response to financial distress over the past three years were associated with significantly worse (higher) PHQ-9 scores. Multivariable analysis demonstrated that larger household sizes (p<0.05), receipt of social grants (p<0.05), higher food expenditure (p<0.01), and drawing up retail shop accounts in response to financial distress (p<0.05) were independently predictive of worse (higher) PHQ-9 scores. Inversely, increasing age of the household head (p<0.05), having piped water directly into the household (as opposed to making use of a public water sources) (p<0.01), and increasing capacity to pay (p<0.01) were independently predictive of better (lower) PHQ-9 scores. Similarly, multivariable analysis demonstrated that worse (higher) PHQ-9 scores were independently predictive of lower household capacity to pay (p<0.10) and higher food expenditure (p<0.01). CONCLUSIONS This study is the first of its kind in South Africa, identifying household economic factors associated with increased depression symptom severity on a continuum; and demonstrating that financial risk protection efforts are needed across this continuum. The study demonstrates that the relationship between poverty and mental health extends beyond the individual to affect household economic functioning. These findings must be included in policy considerations to achieve effective protection for vulnerable households facing the interaction of depression and adverse economic circumstances.
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Affiliation(s)
- Sumaiyah Docrat
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Susan Cleary
- Health Economics Unit, University of Cape Town, Cape Town, South Africa
| | - Dan Chisholm
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Crick Lund
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Centre for Global Mental Health, King’s Global Health Institute, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, England, United Kingdom
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15
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Abassi MM, Sassi S, El Ati J, Ben Gharbia H, Delpeuch F, Traissac P. Gender inequalities in diet quality and their socioeconomic patterning in a nutrition transition context in the Middle East and North Africa: a cross-sectional study in Tunisia. Nutr J 2019; 18:18. [PMID: 30898119 PMCID: PMC6427851 DOI: 10.1186/s12937-019-0442-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 03/04/2019] [Indexed: 12/13/2022] Open
Abstract
Background In a context of nutrition transition and major shifts in lifestyle and diet, the Middle East and North Africa features a marked gender excess adiposity gap detrimental to women. In this setting, where gender issues are especially acute, we investigated gender differences in dietary intake with a focus on diet quality, and how the differences varied with the area of residence and socio-demographic characteristics. Methods The study was conducted in 2009–2010 in the Greater Tunis region (Tunisia), as a case study of an advanced nutrition transition context in the region. A cross-sectional survey used a random, stratified, clustered sample of households: 1689 women and 930 men aged 20–49 years were analyzed. Dietary intake was assessed using a 3-day food record. Nutrient content was derived from a specific Tunisian food composition database. We analysed the Diet Quality Index-International (DQI-I) and sub-scores (variety, adequacy, moderation and balance). A score of DQI-I > 60 defined good diet quality. Inequality measures were women vs. men differences in means for interval variables and odds-ratios (OR) for DQI-I > 60. Their variation with socio-demographic characteristics was estimated using models featuring gender x covariate interactions. Results Mean energy intake/day was 2300 ± 15 kcal for women vs. 2859 ± 32 kcal for men. By 1000 g/kcal/d women consumed more fruits and sweets but less red meat and soft drinks than men. Women had a higher mean moderation sub-score than men (+ 1.8[1.4, 2.2], P < 0.0001) but lower variety (− 2.0[− 2.3, − 1.6], P < 0.0001) and adequacy (− 1.8[− 2.0, − 1.5], P < 0.0001). Thus, the overall mean DQI-I was lower among women than men (58.6 ± 0.3 vs. 60.4 ± 0.3, − 1.8[− 2.6, − 1.0], P < 0.0001) as was the proportion of DQI-I > 60 (45.2% vs. 55.7%, OR = 0.7[0.5, 0.8], P < 0.0001). Adjusted gender differences in DQI-I decreased with age but were higher in larger households and extreme categories of education (no-schooling and university) vs. the middle categories. Conclusion In this nutrition transition context with only average diet quality, it was somewhat lower for women. Socioeconomic patterning of gender contrasts was mild. Beyond, that women had lower adequacy and variety scores but better moderation is a possible pathway for gender specific prevention messages. Electronic supplementary material The online version of this article (10.1186/s12937-019-0442-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mohamed Mehdi Abassi
- Faculté des Sciences de Tunis, Université Tunis El Manar, 2092, Tunis, Tunisia.,INNTA (National Institute of Nutrition and Food Technology), SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Laboratory, 11 rue Jebel Lakhdar, Bab Saadoun, Tunis, Tunisia
| | - Sonia Sassi
- Faculté des Sciences de Tunis, Université Tunis El Manar, 2092, Tunis, Tunisia.,INNTA (National Institute of Nutrition and Food Technology), SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Laboratory, 11 rue Jebel Lakhdar, Bab Saadoun, Tunis, Tunisia
| | - Jalila El Ati
- INNTA (National Institute of Nutrition and Food Technology), SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Laboratory, 11 rue Jebel Lakhdar, Bab Saadoun, Tunis, Tunisia
| | - Houda Ben Gharbia
- INNTA (National Institute of Nutrition and Food Technology), SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Laboratory, 11 rue Jebel Lakhdar, Bab Saadoun, Tunis, Tunisia
| | - Francis Delpeuch
- IRD (French Research Institute for Sustainable Development), NUTRIPASS Unit, IRD - Université de Montpellier - SupAgro Montpellier, 911 avenue Agropolis, 34394, Montpellier, France
| | - Pierre Traissac
- IRD (French Research Institute for Sustainable Development), NUTRIPASS Unit, IRD - Université de Montpellier - SupAgro Montpellier, 911 avenue Agropolis, 34394, Montpellier, France.
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16
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Jiang Y, Zheng H, Zhao T. Socioeconomic Status and Morbidity Rate Inequality in China: Based on NHSS and CHARLS Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E215. [PMID: 30646540 PMCID: PMC6351904 DOI: 10.3390/ijerph16020215] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/03/2019] [Accepted: 01/10/2019] [Indexed: 11/20/2022]
Abstract
Previous studies have shown there are no consistent and robust associations between socioeconomic status and morbidity rates. This study focuses on the relationship between the socioeconomic status and the morbidity rates in China, which helps to add new evidence for the fragmentary relationship between socioeconomic status and morbidity rates. The National Health Services Survey (NHSS) and China Health and Retirement Longitudinal Study (CHARLS) data are used to examine whether the association holds in both all-age cohorts and in older only cohorts. Three morbidity outcomes (two-week incidence rate, the prevalence of chronic diseases, and the number of sick days per thousand people) and two socioeconomic status indicators (income and education) are mainly examined. The results indicate that there are quadratic relationships between income per capita and morbidities. This non-linear correlation is similar to the patterns in European countries. Meanwhile, there is no association between education years and the morbidity in China, i.e., either two-week incidence rate or prevalence rate of chronic diseases has no statistically significant relationship with the education level in China.
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Affiliation(s)
- Yunyun Jiang
- School of Economics, Peking University, Beijing 100871, China.
| | - Haitao Zheng
- School of Economics and Management, Beihang University, Beijing 100083, China.
| | - Tianhao Zhao
- School of Economics and Management, Beihang University, Beijing 100083, China.
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17
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Measuring health facility readiness and its effects on severe malaria outcomes in Uganda. Sci Rep 2018; 8:17928. [PMID: 30560884 PMCID: PMC6298957 DOI: 10.1038/s41598-018-36249-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 11/06/2018] [Indexed: 12/14/2022] Open
Abstract
There is paucity of evidence for the role of health service delivery to the malaria decline in Uganda We developed a methodology to quantify health facility readiness and assessed its role on severe malaria outcomes among lower-level facilities (HCIIIs and HCIIs) in the country. Malaria data was extracted from the Health Management Information System (HMIS). General service and malaria-specific readiness indicators were obtained from the 2013 Uganda service delivery indicator survey. Multiple correspondence analysis (MCA) was used to construct a composite facility readiness score based on multiple factorial axes. Geostatistical models assessed the effect of facility readiness on malaria deaths and severe cases. Malaria readiness was achieved in one-quarter of the facilities. The composite readiness score explained 48% and 46% of the variation in the original indicators compared to 23% and 27%, explained by the first axis alone for HCIIIs and HCIIs, respectively. Mortality rate was 64% (IRR = 0.36, 95% BCI: 0.14–0.61) and 68% (IRR = 0.32, 95% BCI: 0.12–0.54) lower in the medium and high compared to low readiness groups, respectively. A composite readiness index is more informative and consistent than the one based on the first MCA factorial axis. In Uganda, higher facility readiness is associated with a reduced risk of severe malaria outcomes.
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18
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Intra-household double burden of malnutrition in a North African nutrition transition context: magnitude and associated factors of child anaemia with mother excess adiposity. Public Health Nutr 2018; 22:44-54. [DOI: 10.1017/s1368980018002495] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AbstractObjectiveIn the Middle East and North Africa region, the nutrition transition has resulted in drastic increases in excess adiposity, particularly among women, while some types of undernutrition remain prevalent, especially among pre-school children. We assessed the magnitude, nature and associated factors of the within-household co-occurrence of anaemia in children and excess adiposity in mothers.DesignCross-sectional survey using stratified two-stage random cluster sampling to survey households with women aged 20–49 years. BMI≥25·0 kg/m2 defined overweight and BMI≥30·0 kg/m2 obesity, while anaemia for children was defined as Hb<110 g/l. The associations between child anaemia and mother excess adiposity, and sociodemographic and lifestyle factors were estimated by multinomial regression.SettingGreater Tunis area, Tunisia, in 2009–2010.SubjectsChildren aged 6–59 months living with their 20–49-year-old mothers (437 child–mother pairs).ResultsThe most prevalent double burden of malnutrition in child–mother pairs by far was the anaemic child and overweight mother (24·4 %; 95 % CI 20·1, 29·3 %). A significant proportion of pairs were anaemic child and obese mother (14·4 %; 95 % CI 11·0, 18·5 %). The co-occurrence of anaemia in child and excess adiposity in mother was neither synergetic nor antagonistic (P=0·59 and 0·40 for anaemia–overweight and anaemia–obesity, respectively). This double burden was more frequent among child–mother pairs with younger children, with mothers of higher parity and higher energy intakes.ConclusionsThe high prevalence of anaemic child and overweight or obese mother requires special attention e.g. through interventions which simultaneously target both types of malnutrition within the same household.
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19
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Antimalarial bednet protection of children disappears when shared by three or more people in a high transmission setting of western Kenya. Parasitology 2018; 146:363-371. [PMID: 30198452 DOI: 10.1017/s003118201800149x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A sizeable proportion of households is forced to share single long-lasting insecticide treated net (LLIN). However, the relationship between increasing numbers of people sharing a net and the risk for Plasmodium infection is unclear. This study revealed whether risk for Plasmodium falciparum infection is associated with the number of people sharing a LLIN in a holoendemic area of Kenya. Children ⩽5 years of age were tested for P. falciparum infection using polymerase chain reaction. Of 558 children surveyed, 293 (52.5%) tested positive for parasitaemia. Four hundred and fifty-eight (82.1%) reported sleeping under a LLIN. Of those, the number of people sharing a net with the sampled child ranged from 1 to 5 (median = 2). Children using a net alone or with one other person were at lower risk than non-users (OR = 0.29, 95% CI 0.10-0.82 and OR = 0.47, 95% CI 0.22-0.97, respectively). On the other hand, there was no significant difference between non-users and children sharing a net with two (OR = 0.88, 95% CI 0.44-1.77) or more other persons (OR = 0.75, 95% CI 0.32-1.72). LLINs are effective in protecting against Plasmodium infection in children when used alone or with one other person compared with not using them. Public health professionals should inform caretakers of the risks of too many people sharing a net.
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20
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Chasekwa B, Maluccio JA, Ntozini R, Moulton LH, Wu F, Smith LE, Matare CR, Stoltzfus RJ, Mbuya MNN, Tielsch JM, Martin SL, Jones AD, Humphrey JH, Fielding K. Measuring wealth in rural communities: Lessons from the Sanitation, Hygiene, Infant Nutrition Efficacy (SHINE) trial. PLoS One 2018; 13:e0199393. [PMID: 29953495 PMCID: PMC6023145 DOI: 10.1371/journal.pone.0199393] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 05/25/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Poverty and human capital development are inextricably linked and therefore research on human capital typically incorporates measures of economic well-being. In the context of randomized trials of health interventions, for example, such measures are used to: 1) assess baseline balance; 2) estimate covariate-adjusted analyses; and 3) conduct subgroup analyses. Many factors characterize economic well-being, however, and analysts often generate summary measures such as indices of household socio-economic status or wealth. In this paper, a household wealth index is developed and tested for participants in the cluster-randomized Sanitation, Hygiene, Infant Nutrition Efficacy (SHINE) trial in rural Zimbabwe. METHODS Building on the approach used in the Zimbabwe Demographic and Health Survey (ZDHS), we combined a set of housing characteristics, ownership of assets and agricultural resources into a wealth index using principal component analysis (PCA) on binary variables. The index was assessed for internal and external validity. Its sensitivity was examined considering an expanded set of variables and an alternative statistical approach of polychoric PCA. Correlation between indices was determined using the Spearman's rank correlation coefficient and agreement between quintiles using a linear weighted Kappa statistic. Using the 2015 ZDHS data, we constructed a separate index and applied the loadings resulting from that analysis to the SHINE study population, to compare the wealth distribution in the SHINE study with rural Zimbabwe. RESULTS The derived indices using the different methods were highly correlated (r>0.9), and the wealth quintiles derived from the different indices had substantial to near perfect agreement (linear weighted Kappa>0.7). The indices were strongly associated with a range of assets and other wealth measures, indicating both internal and external validity. Households in SHINE were modestly wealthier than the overall population of households in rural Zimbabwe. CONCLUSION The SHINE wealth index developed here is a valid and robust measure of wealth in the sample.
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Affiliation(s)
- Bernard Chasekwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - John A. Maluccio
- Department of Economics, Middlebury College, Middlebury, VT, United States of America
| | - Robert Ntozini
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Lawrence H. Moulton
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Fan Wu
- Department of Economics, Middlebury College, Middlebury, VT, United States of America
| | - Laura E. Smith
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, NY, United States of America
| | - Cynthia R. Matare
- Program in International Nutrition, Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States of America
| | - Rebecca J. Stoltzfus
- Program in International Nutrition, Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States of America
| | - Mduduzi N. N. Mbuya
- Global Alliance for Improved Nutrition (GAIN), Washington, DC, United States of America
| | - James M. Tielsch
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, United States of America
| | - Stephanie L. Martin
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC, United States of America
| | - Andrew D. Jones
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, United States of America
| | - Jean H. Humphrey
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Katherine Fielding
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Probst C, Parry CDH, Wittchen HU, Rehm J. The socioeconomic profile of alcohol-attributable mortality in South Africa: a modelling study. BMC Med 2018; 16:97. [PMID: 29936909 PMCID: PMC6016129 DOI: 10.1186/s12916-018-1080-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 05/18/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Globally, illness and life expectancy follow a social gradient that puts people of lower socioeconomic status (SES) at higher risk of dying prematurely. Alcohol consumption has been shown to be a factor contributing to socioeconomic differences in mortality. However, little evidence is available from low- and middle-income countries. The objective of this study was to quantify mortality attributable to alcohol consumption in the adult (15+ years) general population of South Africa in 2015 by SES, age, and sex. METHODS A comparative risk assessment was performed using individual and aggregate data from South Africa and risk relations reported in the literature. Alcohol-attributable fractions (AAFs) and alcohol-attributable mortality rates were estimated for cause-specific mortality by SES, sex, and age. Monte Carlo simulation techniques were used to calculate 95% uncertainty intervals (UI). RESULTS Overall, approximately 62,300 (95% UI 27,000-103,000) adults died from alcohol-attributable causes in South Africa in 2015, with 60% of deaths occurring in people in the low and 15% in the high SES groups. Age-standardized, alcohol-attributable mortality rates per 100,000 adults were highest for the low SES group (727 deaths, 95% UI 354-1208 deaths) followed by the middle (377 deaths, 95% UI 165-687 deaths) and high SES groups (163 deaths, 95% UI 71-289 deaths). The socioeconomic differences were highest for mortality from infectious diseases. People of low SES had a lower prevalence of current alcohol use but heavier drinking patterns among current drinkers. Among men, AAFs were elevated at low and middle SES, particularly for the middle and higher age groups (35+). Among women, AAFs differed less across SES groups and, in the youngest age group (15-34), women of high SES had elevated AAFs. CONCLUSIONS Alcohol use contributed to vast socioeconomic differences in mortality. Where observed, elevated AAFs for people of low and middle SES arose from higher levels of consumption among current drinkers and not from the prevalence of current alcohol use per se. The findings can direct preventive measures and interventions on those at highest risk. Future research is needed to investigate socioeconomic differences in the risk functions relating alcohol use to cause-specific mortality.
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Affiliation(s)
- Charlotte Probst
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Russell Street, Toronto, ON, M5S 2S1, Canada.
- Institute for Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany.
| | - Charles D H Parry
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, Tygerberg, 7505, South Africa
- Department of Psychiatry, Stellenbosch University, Cape Town, Tygerberg, 7505, South Africa
| | - Hans-Ulrich Wittchen
- Institute for Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany
- Research Group Clinical Psychology and Psychotherapy, Psychiatric University Hospital, Ludwig-Maximilians-University, Nußbaumstraße 7, 80336, Munich, Germany
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Russell Street, Toronto, ON, M5S 2S1, Canada
- Institute for Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany
- Addiction Policy, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada
- Institute of Medical Science, University of Toronto, Faculty of Medicine, Medical Sciences Building, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON, M5T 1R8, Canada
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Alonso S, Munguambe K, Sicuri E. Market for Artemether-Lumefantrine to treat childhood malaria in a district of southern Mozambique. HEALTH ECONOMICS 2017; 26:e345-e360. [PMID: 28548247 DOI: 10.1002/hec.3514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 01/24/2017] [Accepted: 03/13/2017] [Indexed: 06/07/2023]
Abstract
Malaria is one of the leading causes of death in sub-Saharan Africa. Artemisinin-based combination therapies are used as first-line treatment drugs, but their market is far from competitive. Market failures include limited availability, low quality, lack of information, and high costs of access. We estimated the theoretical demand for one of the most common artemisinin-based combination therapies, artemether-lumefantrine (AL), and its determinants among caregivers of children with malaria seeking care at public health facilities, thus, entitled to receive drugs for free, in southern Mozambique (year 2012). The predicted theoretical demand was contrasted with international and local private market AL prices. Respondents stated high willingness to pay but lower ability to pay (ATP), which was defined as the theoretical demand. The ATP was on average of 0.94 USD for the treatment of a malaria episode. This implied an average gap of 1.04 USD between average local private prices and theoretical demand. Predicted ATP decreased by 14% for every additional malaria episode that the child had suffered during the malaria season. The market price was unaffordable for a large share of our sample, highlighting an unequal welfare distribution between suppliers and potential consumers, as well as issues of inequity in the private delivery of AL.
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Affiliation(s)
- Sergi Alonso
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique
| | - Khátia Munguambe
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Elisa Sicuri
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Health Economics group, School of Public Health, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
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Hruschka DJ, Hadley C, Hackman J. Material wealth in 3D: Mapping multiple paths to prosperity in low- and middle- income countries. PLoS One 2017; 12:e0184616. [PMID: 28886176 PMCID: PMC5590995 DOI: 10.1371/journal.pone.0184616] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 08/28/2017] [Indexed: 11/18/2022] Open
Abstract
Material wealth is a key factor shaping human development and well-being. Every year, hundreds of studies in social science and policy fields assess material wealth in low- and middle-income countries assuming that there is a single dimension by which households can move from poverty to prosperity. However, a one-dimensional model may miss important kinds of prosperity, particularly in countries where traditional subsistence-based livelihoods coexist with modern cash economies. Using multiple correspondence analysis to analyze representative household data from six countries-Nepal, Bangladesh, Ethiopia, Kenya, Tanzania and Guatemala-across three world regions, we identify a number of independent dimension of wealth, each with a clear link to locally relevant pathways to success in cash and agricultural economies. In all cases, the first dimension identified by this approach replicates standard one-dimensional estimates and captures success in cash economies. The novel dimensions we identify reflect success in different agricultural sectors and are independently associated with key benchmarks of food security and human growth, such as adult body mass index and child height. The multidimensional models of wealth we describe here provide new opportunities for examining the causes and consequences of wealth inequality that go beyond success in cash economies, for tracing the emergence of hybrid pathways to prosperity, and for assessing how these different pathways to economic success carry different health risks and social opportunities.
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Affiliation(s)
- Daniel J. Hruschka
- School of Human Evolution and Social Change, Arizona State University, Tempe, Arizona, United States of America
| | - Craig Hadley
- Anthropology Department, Emory University, Atlanta, Georgia, United States of America
| | - Joseph Hackman
- School of Human Evolution and Social Change, Arizona State University, Tempe, Arizona, United States of America
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Bohra T, Benmarhnia T, McKinnon B, Kaufman JS. Decomposing Educational Inequalities in Child Mortality: A Temporal Trend Analysis of Access to Water and Sanitation in Peru. Am J Trop Med Hyg 2016; 96:57-64. [PMID: 27821698 DOI: 10.4269/ajtmh.15-0745] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 09/23/2016] [Indexed: 11/07/2022] Open
Abstract
Previous studies of inequality in health and mortality have largely focused on income-based inequality. Maternal education plays an important role in determining access to water and sanitation, and inequalities in child mortality arising due to differential access, especially in low- and middle-income countries such as Peru. This article aims to explain education-related inequalities in child mortality in Peru using a regression-based decomposition of the concentration index of child mortality. The analysis combines a concentration index created along a cumulative distribution of the Demographic and Health Surveys sample ranked according to maternal education, and decomposition measures the contribution of water and sanitation to educational inequalities in child mortality. We observed a large education-related inequality in child mortality and access to water and sanitation. There is a need for programs and policies in child health to focus on ensuring equity and to consider the educational stratification of the population to target the most disadvantaged segments of the population.
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Affiliation(s)
- Tasneem Bohra
- Master of Public Health, School of Public Health, Ecole des Hautes Études en Santé Publique (EHESP), Rennes, France
| | - Tarik Benmarhnia
- Institute for Health and Social Policy, McGill University, Montreal, Canada.
| | - Britt McKinnon
- Institute for Health and Social Policy, McGill University, Montreal, Canada
| | - Jay S Kaufman
- Institute for Health and Social Policy, McGill University, Montreal, Canada.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
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Kabudula CW, Houle B, Collinson MA, Kahn K, Tollman S, Clark S. Assessing Changes in Household Socioeconomic Status in Rural South Africa, 2001-2013: A Distributional Analysis Using Household Asset Indicators. SOCIAL INDICATORS RESEARCH 2016; 133:1047-1073. [PMID: 28931968 PMCID: PMC5579134 DOI: 10.1007/s11205-016-1397-z] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/18/2016] [Indexed: 06/07/2023]
Abstract
Understanding the distribution of socioeconomic status (SES) and its temporal dynamics within a population is critical to ensure that policies and interventions adequately and equitably contribute to the well-being and life chances of all individuals. This study assesses the dynamics of SES in a typical rural South African setting over the period 2001-2013 using data on household assets from the Agincourt Health and Demographic Surveillance System. Three SES indices, an absolute index, principal component analysis index and multiple correspondence analysis index, are constructed from the household asset indicators. Relative distribution methods are then applied to the indices to assess changes over time in the distribution of SES with special focus on location and shape shifts. Results show that the proportion of households that own assets associated with greater modern wealth has substantially increased over time. In addition, relative distributions in all three indices show that the median SES index value has shifted up and the distribution has become less polarized and is converging towards the middle. However, the convergence is larger from the upper tail than from the lower tail, which suggests that the improvement in SES has been slower for poorer households. The results also show persistent ethnic differences in SES with households of former Mozambican refugees being at a disadvantage. From a methodological perspective, the study findings demonstrate the comparability of the easy-to-compute absolute index to other SES indices constructed using more advanced statistical techniques in assessing household SES.
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Affiliation(s)
- Chodziwadziwa W. Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Brian Houle
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Demography, The Australian National University, Canberra, Australia
- Institute of Behavioral Science, University of Colorado at Boulder, Boulder, CO USA
| | - Mark A. Collinson
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
- Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
- Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
- Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Samuel Clark
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Institute of Behavioral Science, University of Colorado at Boulder, Boulder, CO USA
- INDEPTH Network, Accra, Ghana
- Department of Sociology, University of Washington, Seattle, WA USA
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Gender inequalities in excess adiposity and anaemia combine in a large double burden of malnutrition gap detrimental to women in an urban area in North Africa. Public Health Nutr 2016; 19:1428-37. [PMID: 27049694 DOI: 10.1017/s1368980016000689] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The nutrition transition has exacerbated the gender gap in health in the Middle East and North Africa region as the increase in excess adiposity has been much higher among women than men. This is not exclusive of the persistence of anaemia, generally also more prevalent among women. We assessed the magnitude and sociodemographic factors associated with gender inequality vis-à-vis the double burden of excess adiposity and anaemia. DESIGN Cross-sectional study, stratified two-stage cluster sample. BMI (=weight/height2) ≥25·0 kg/m2 defined overweight and BMI≥30·0 kg/m2 obesity. Anaemia was defined as Hb <120 g/l for women, <130 g/l for men. Gender inequalities vis-à-vis the within-subject coexistence of excess adiposity and anaemia were assessed by women v. men relative prevalence ratios (RPR). Their variation with sociodemographic characteristics used models including gender × covariate interactions. SETTING Greater Tunis area in 2009-2010. SUBJECTS Adults aged 20-49 years (women, n 1689; men, n 930). RESULTS Gender inequalities in excess adiposity were high (e.g. overweight: women 64·9 % v. men 48·4 %; RPR=2·1; 95 % CI 1·6, 2·7) and much higher for anaemia (women 38·0 % v. men 7·2 %; RPR=8·2; 95 % CI 5·5, 12·4). They were striking for overweight and anaemia (women 24·1 % v. men 3·4 %; RPR=16·2; 95 % CI 10·3, 25·4). Gender inequalities in overweight adjusted for covariates increased with age but decreased with professional activity and household wealth score; gender inequality in anaemia or overweight and anaemia was more uniformly distributed. CONCLUSIONS Women were much more at risk than men, from both over- and undernutrition perspectives. Both the underlying gender-related and sex-linked biological determinants of this remarkable double burden of malnutrition inequality must be addressed to promote gender equity in health.
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27
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El Ati-Hellal M, Doggui R, Hedhili A, Traissac P, El Ati J. Zinc and copper status in childbearing age Tunisian women: Relation to age, residential area, socioeconomic situation and physiologic characteristics. CHEMOSPHERE 2016; 149:231-237. [PMID: 26859607 DOI: 10.1016/j.chemosphere.2016.01.100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 01/17/2016] [Accepted: 01/24/2016] [Indexed: 06/05/2023]
Abstract
Plasma zinc and copper status of 1689 non pregnant Tunisian women, aged 20-49 years old, was determined by flame atomic absorption spectrometry. A multiple regression was run to predict plasma trace element concentrations from age, BMI, marital status, menopause, education level, professional activity, economic level and area of living. The mean zinc and copper values were similar to those measured among comparable populations in earlier studies. However, a high prevalence of low plasma zinc and copper concentrations was observed assuming that women at childbearing age are at high risk of zinc and copper deficiencies and specific intervention may be considered. In univariate analysis, the mean values of plasma zinc and copper were associated with sitting areas and professional activity. For only plasma copper levels, there was an increase with BMI and parity, and a decrease with increasing schooling level and economic score. After adjustment for all variables, profession and parity showed a significant relationship between plasma levels copper.
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Affiliation(s)
- Myriam El Ati-Hellal
- Laboratoire de Toxicologie, Unité de Toxicologie Recherche et Environnement, 10, rue Abou El Kacem Chabbi, Montfleury, 1008 Tunis Cedex, Tunisia.
| | - Radhouene Doggui
- Laboratoire de Surveillance et Epidémiologie nutritionnelles en Tunisie (SURVEN), Institut National de nutrition et de Technologie Alimentaire, 11 Rue Jebel Lakhdar, 1007 Bab Saadoun, Tunis, Tunisia
| | - Abderrazek Hedhili
- Laboratoire de Toxicologie, Unité de Toxicologie Recherche et Environnement, 10, rue Abou El Kacem Chabbi, Montfleury, 1008 Tunis Cedex, Tunisia
| | - Pierre Traissac
- IRD (Institut de Recherche pour le Développement), NUTRIPASS Unit, IRD-UM-SupAgro, Montpellier, France
| | - Jalila El Ati
- Laboratoire de Surveillance et Epidémiologie nutritionnelles en Tunisie (SURVEN), Institut National de nutrition et de Technologie Alimentaire, 11 Rue Jebel Lakhdar, 1007 Bab Saadoun, Tunis, Tunisia
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Townend J, Minelli C, Harrabi I, Obaseki DO, El-Rhazi K, Patel J, Burney P. Development of an international scale of socio-economic position based on household assets. Emerg Themes Epidemiol 2015; 12:13. [PMID: 26396585 PMCID: PMC4578326 DOI: 10.1186/s12982-015-0035-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 09/08/2015] [Indexed: 11/10/2022] Open
Abstract
Background The importance of studying associations between socio-economic position and health has often been highlighted. Previous studies have linked the prevalence and severity of lung disease with national wealth and with socio-economic position within some countries but there has been no systematic evaluation of the association between lung function and poverty at the individual level on a global scale. The BOLD study has collected data on lung function for individuals in a wide range of countries, however a barrier to relating this to personal socio-economic position is the need for a suitable measure to compare individuals within and between countries. In this paper we test a method for assessing socio-economic position based on the scalability of a set of durable assets (Mokken scaling), and compare its usefulness across countries of varying gross national income per capita. Results Ten out of 15 candidate asset questions included in the questionnaire were found to form a Mokken type scale closely associated with GNI per capita (Spearman’s rank rs = 0.91, p = 0.002). The same set of assets conformed to a scale in 7 out of the 8 countries, the remaining country being Saudi Arabia where most respondents owned most of the assets. There was good consistency in the rank ordering of ownership of the assets in the different countries (Cronbach’s alpha = 0.96). Scores on the Mokken scale were highly correlated with scores developed using principal component analysis (rs = 0.977). Conclusions Mokken scaling is a potentially valuable tool for uncovering links between disease and socio-economic position within and between countries. It provides an alternative to currently used methods such as principal component analysis for combining personal asset data to give an indication of individuals’ relative wealth. Relative strengths of the Mokken scale method were considered to be ease of interpretation, adaptability for comparison with other datasets, and reliability of imputation for even quite large proportions of missing values.
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Affiliation(s)
- John Townend
- National Heart and Lung Institute, Imperial College, Emmanuel Kaye Building, 1b Manresa Road, London, SW3 6LR UK
| | - Cosetta Minelli
- National Heart and Lung Institute, Imperial College, Emmanuel Kaye Building, 1b Manresa Road, London, SW3 6LR UK
| | | | - Daniel O Obaseki
- Department of Medicine, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Karima El-Rhazi
- Laboratoire d'épidémiologie, Recherche Clinique et Santé Communautaire, Faculté de Médecine de Fès, Université SidiMohammed Ben Abdellah, Fez, Morocco
| | - Jaymini Patel
- National Heart and Lung Institute, Imperial College, Emmanuel Kaye Building, 1b Manresa Road, London, SW3 6LR UK
| | - Peter Burney
- National Heart and Lung Institute, Imperial College, Emmanuel Kaye Building, 1b Manresa Road, London, SW3 6LR UK
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Van Durme T, Schmitz O, Cès S, Anthierens S, Maggi P, Delye S, De Almeida Mello J, Declercq A, Macq J, Remmen R, Aujoulat I. A comprehensive grid to evaluate case management's expected effectiveness for community-dwelling frail older people: results from a multiple, embedded case study. BMC Geriatr 2015; 15:67. [PMID: 26084701 PMCID: PMC4472179 DOI: 10.1186/s12877-015-0069-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 06/08/2015] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Case management is a type of intervention expected to improve the quality of care and therefore the quality of life of frail, community-dwelling older people while delaying institutionalisation in nursing homes. However, the heterogeneity, multidimensionality and complexity of these interventions make their evaluation by the means of classical approaches inadequate. Our objective was twofold: (i) to propose a tool allowing for the identification of the key components that explain the success of case management for this population and (ii) to propose a typology based on the results of this tool. METHODS The process started with a multiple embedded case study design in order to identify the key components of case management. Based on the results of this first step, data were collected among 22 case management interventions, in order to evaluate their expected effectiveness. Finally, multiple correspondence analyses was conducted to propose a typology of case management. The overall approach was informed by Wagner's Chronic Care Model and the theory of complexity. RESULTS The study identified a total of 23 interacting key components. Based on the clustering of response patterns of the 22 case management projects included in our study, three types of case management programmes were evidenced, situated on a continuum from a more "socially-oriented" type towards a more "clinically-oriented" type of case management. The type of feedback provided to the general practitioner about both the global geriatric assessment and the result of the intervention turned out to be the most discriminant component between the types. CONCLUSION The study design allowed to produce a tool that can be used to distinguish between different types of case management interventions and further evaluate their effect on frail older people in terms of the delaying institutionalisation, functional and cognitive status, quality of life and societal costs.
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Affiliation(s)
- Thérèse Van Durme
- IRSS, Institute of Health and Society, Université catholique de Louvain clos Chapelle-aux-Champs, 30.13 B-1200, Brussels, Belgium.
| | - Olivier Schmitz
- IRSS, Institute of Health and Society, Université catholique de Louvain clos Chapelle-aux-Champs, 30.13 B-1200, Brussels, Belgium.
| | - Sophie Cès
- IRSS, Institute of Health and Society, Université catholique de Louvain clos Chapelle-aux-Champs, 30.13 B-1200, Brussels, Belgium.
| | - Sibyl Anthierens
- Faculty of Medicine and Health Care Sciences, Universiteit Antwerpen Universiteitsplein, 1 B-2610, Wilrijk, Belgium.
| | - Patrick Maggi
- Faculty of Public Health Université de Liège Avenue de l'hôpital, 3 B-4000, Liège, Belgium.
| | - Sam Delye
- Faculty of Public Health Université de Liège Avenue de l'hôpital, 3 B-4000, Liège, Belgium.
| | - Johanna De Almeida Mello
- LUCAS, Centre for Care Research and Consultancy KU Leuven (University of Leuven), Kapucijnenvoer 39, B-3000, Leuven, Belgium.
| | - Anja Declercq
- LUCAS, Centre for Care Research and Consultancy KU Leuven (University of Leuven), Kapucijnenvoer 39, B-3000, Leuven, Belgium.
| | - Jean Macq
- IRSS, Institute of Health and Society, Université catholique de Louvain clos Chapelle-aux-Champs, 30.13 B-1200, Brussels, Belgium.
| | - Roy Remmen
- Faculty of Medicine and Health Care Sciences, Universiteit Antwerpen Universiteitsplein, 1 B-2610, Wilrijk, Belgium.
| | - Isabelle Aujoulat
- IRSS, Institute of Health and Society, Université catholique de Louvain clos Chapelle-aux-Champs, 30.13 B-1200, Brussels, Belgium.
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Foster N, Vassall A, Cleary S, Cunnama L, Churchyard G, Sinanovic E. The economic burden of TB diagnosis and treatment in South Africa. Soc Sci Med 2015; 130:42-50. [PMID: 25681713 DOI: 10.1016/j.socscimed.2015.01.046] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Social protection against the cost of illness is a central policy objective of Universal Health Coverage and the post-2015 Global strategy for Tuberculosis (TB). Understanding the economic burden associated with TB illness and care is key to identifying appropriate interventions towards achieving this target. The aims of this study were to identify points in patient pathways from start of TB symptoms to treatment completion where interventions could be targeted to reduce the economic impact on patients and households, and to identify those most vulnerable to these costs. Two cohorts of patients accessing TB services from ten clinics in four provinces in South Africa were surveyed between July 2012 and June 2013. One cohort of 351 people with suspected TB were interviewed at the point of receiving a TB diagnostic and followed up six months later. Another cohort of 168 patients on TB treatment, at the same ten facilities, was interviewed at two-months and five-months on treatment. Patients were asked about their health-seeking behaviour, associated costs, income loss, and coping strategies used. Patients incurred the greatest share of TB episode costs (41%) prior to starting treatment, with the largest portion of these costs being due to income loss. Poorer patients incurred higher direct costs during treatment than those who were less poor but only 5% of those interviewed were accessing cash-transfers during treatment. Indirect costs accounted for 52% of total episode cost. Despite free TB diagnosis and care in South Africa, patients incur substantial direct and indirect costs particularly prior to starting treatment. The poorest group of patients were incurring higher costs, with fewer resources to pay for it. Both the direct and indirect cost of illness should be taken into account when setting levels of financial protection and social support, to prevent TB illness from pushing the poor further into poverty.
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Affiliation(s)
- Nicola Foster
- Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory 7925, South Africa.
| | - Anna Vassall
- Social and Mathematical Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
| | - Susan Cleary
- Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory 7925, South Africa
| | - Lucy Cunnama
- Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory 7925, South Africa
| | - Gavin Churchyard
- Aurum Institute, Queens Road, Parktown, Johannesburg, South Africa; Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
| | - Edina Sinanovic
- Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory 7925, South Africa
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Traissac P, Pradeilles R, El Ati J, Aounallah-Skhiri H, Eymard-Duvernay S, Gartner A, Béji C, Bougatef S, Martin-Prével Y, Kolsteren P, Delpeuch F, Ben Romdhane H, Maire B. Abdominal vs. overall obesity among women in a nutrition transition context: geographic and socio-economic patterns of abdominal-only obesity in Tunisia. Popul Health Metr 2015; 13:1. [PMID: 25745363 PMCID: PMC4350904 DOI: 10.1186/s12963-015-0035-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 01/13/2015] [Indexed: 01/31/2023] Open
Abstract
Background Most assessments of the burden of obesity in nutrition transition contexts rely on body mass index (BMI) only, even though abdominal adiposity might be specifically predictive of adverse health outcomes. In Tunisia, a typical country of the Middle East and North Africa (MENA) region, where the burden of obesity is especially high among women, we compared female abdominal vs. overall obesity and its geographic and socio-economic cofactors, both at population and within-subject levels. Methods The cross-sectional study used a stratified, three-level, clustered sample of 35- to 70-year-old women (n = 2,964). Overall obesity was BMI = weight/height2 ≥ 30 kg/m2 and abdominal obesity waist circumference ≥ 88 cm. We quantified the burden of obesity for overall and abdominal obesity separately and their association with place of residence (urban/rural, the seven regions that compose Tunisia), plus physiological and socio-economic cofactors by logistic regression. We studied the within-subject concordance of the two obesities and estimated the prevalence of subject-level “abdominal-only” obesity (AO) and “overall-only” obesity (OO) and assessed relationships with the cofactors by multinomial logistic regression. Results Abdominal obesity was much more prevalent (60.4% [57.7-63.0]) than overall obesity (37.0% [34.5-39.6]), due to a high proportion of AO status (25.0% [22.8-27.1]), while the proportion of OO was small (1.6% [1.1-2.2]). We found mostly similar associations between abdominal and overall obesity and all the cofactors except that the regional variability of abdominal obesity was much larger than that of overall obesity. There were no adjusted associations of AO status with urban/rural area of residence (P = 0.21), education (P = 0.97) or household welfare level (P = 0.94) and only non-menopausal women (P = 0.093), lower parity women (P = 0.061) or worker/employees (P = 0.038) were somewhat less likely to be AO. However, there was a large residual adjusted regional variability of AO status (from 16.6% to 34.1%, adjusted P < 0.0001), possibly of genetic, epigenetic, or developmental origins. Conclusion Measures of abdominal adiposity need to be included in population-level appraisals of the burden of obesity, especially among women in the MENA region. The causes of the highly prevalent abdominal-only obesity status among women require further investigation.
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Affiliation(s)
- Pierre Traissac
- IRD (Institut de Recherche pour le Développement), NUTRIPASS Unit, IRD-UM-SupAgro, 911 av. Agropolis, 34394 Montpellier, France
| | - Rebecca Pradeilles
- IRD (Institut de Recherche pour le Développement), NUTRIPASS Unit, IRD-UM-SupAgro, 911 av. Agropolis, 34394 Montpellier, France
| | - Jalila El Ati
- INNTA (National Institute of Nutrition and Food Technology), 11 rue Jebel Lakhdar, Bab Saadoun, 1007 Tunis, Tunisia ; SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Laboratory, 11 rue Jebel Lakhdar, Bab Saadoun, 1007 Tunis, Tunisia
| | - Hajer Aounallah-Skhiri
- SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Laboratory, 11 rue Jebel Lakhdar, Bab Saadoun, 1007 Tunis, Tunisia ; INSP (National Institute of Public Health), 5-7 rue de Khartoum, 1002 Tunis, Tunisia ; Faculty of Medicine, Tunis El Manar University, 15 rue Jebel Lakhdar, Bab Saadoun, 1007 Tunis, Tunisia
| | - Sabrina Eymard-Duvernay
- IRD (Institut de Recherche pour le Développement), NUTRIPASS Unit, IRD-UM-SupAgro, 911 av. Agropolis, 34394 Montpellier, France
| | - Agnès Gartner
- IRD (Institut de Recherche pour le Développement), NUTRIPASS Unit, IRD-UM-SupAgro, 911 av. Agropolis, 34394 Montpellier, France
| | - Chiraz Béji
- INNTA (National Institute of Nutrition and Food Technology), 11 rue Jebel Lakhdar, Bab Saadoun, 1007 Tunis, Tunisia
| | - Souha Bougatef
- INSP (National Institute of Public Health), 5-7 rue de Khartoum, 1002 Tunis, Tunisia
| | - Yves Martin-Prével
- IRD (Institut de Recherche pour le Développement), NUTRIPASS Unit, IRD-UM-SupAgro, 911 av. Agropolis, 34394 Montpellier, France
| | - Patrick Kolsteren
- ITM (Institute of Tropical Medicine), 155 Nationalestraat, 2000 Antwerp, Belgium
| | - Francis Delpeuch
- SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Laboratory, 11 rue Jebel Lakhdar, Bab Saadoun, 1007 Tunis, Tunisia
| | - Habiba Ben Romdhane
- Epidemiology and Prevention of Cardiovascular Diseases Research Laboratory, Faculty of Medicine, 15 rue Jebel Lakhdar, Bab Saadoun, 1007 Tunis, Tunisia
| | - Bernard Maire
- IRD (Institut de Recherche pour le Développement), NUTRIPASS Unit, IRD-UM-SupAgro, 911 av. Agropolis, 34394 Montpellier, France
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Socio-economic and behavioural determinants of fruit and vegetable intake in Moroccan women. Public Health Nutr 2014; 18:809-16. [PMID: 25166305 DOI: 10.1017/s1368980014001761] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To estimate daily fruit and vegetable intakes and to investigate socio-economic and behavioural differences in fruit and vegetable consumption among urban Moroccan women. DESIGN A cross-sectional survey. Fruit and vegetable intake was measured with a single 24 h recall. SETTINGS A representative population-based survey conducted in the area of Rabat-Salé. SUBJECTS Women (n 894) of child-bearing age (20-49 years). RESULTS Mean fruit and vegetable intake was 331 g/d (155 g/d for fruit and 176 g/d for vegetables). Only one-third (32.1 %) of women consumed ≥ 400 g/d and half the sample (50.6 %) were considered as low consumers, i.e. <280 g/d. Women of higher economic status ate significantly more fruit (P<0.05) and more fruit and vegetables combined (P<0.05). Women ate significantly less vegetables if they ate out of home more often or skipped at least one main meal (breakfast, lunch or dinner) or ate more processed foods (P<0.05, P<0.01 and P<0.001, respectively). Fruit and vegetable diversity was not associated with any of the factors investigated. CONCLUSIONS In this population, fruit and vegetable intakes are driven by different determinants. Indeed, while vegetable consumption was related only to behavioural determinants, fruit consumption was influenced only by economic status. Therefore, programmes promoting fruit and vegetable intake would be more effective if they account for these specific determinants in their design.
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Alaba O, Chola L. Socioeconomic inequalities in adult obesity prevalence in South Africa: a decomposition analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:3387-406. [PMID: 24662998 PMCID: PMC3987040 DOI: 10.3390/ijerph110303387] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 03/10/2014] [Accepted: 03/11/2014] [Indexed: 01/23/2023]
Abstract
In recent years, there has been a dramatic increase in obesity in low and middle income countries. However, there is limited research in these countries showing the prevalence and determinants of obesity. In this study, we examine the socioeconomic inequalities in obesity among South African adults. We use nationally representative data from the South Africa National Income Dynamic Survey of 2008 to: (1) construct an asset index using multiple correspondence analyses (MCA) as a proxy for socioeconomic status; (2) estimate concentration indices (CI) to measure socioeconomic inequalities in obesity; and (3) perform a decomposition analysis to determine the factors that contribute to socioeconomic related inequalities. Consistent with other studies, we find that women are more obese than men. The findings show that obesity inequalities exist in South Africa. Rich men are more likely to be obese than their poorer counterparts with a concentration index of 0.27. Women on the other hand have similar obesity patterns, regardless of socioeconomic status with CI of 0.07. The results of the decomposition analysis suggest that asset index contributes positively and highly to socio-economic inequality in obesity among females; physical exercise contributes negatively to the socio-economic inequality. In the case of males, educational attainment and asset index contributed more to socio-economic inequalities in obesity. Our findings suggest that focusing on economically well-off men and all women across socioeconomic status is one way to address the obesity problem in South Africa.
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Affiliation(s)
- Olufunke Alaba
- Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town 7925, South Africa.
| | - Lumbwe Chola
- PRICELESS SA, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg 2050, South Africa.
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Gartner A, El Ati J, Traissac P, Bour A, Berger J, Landais E, El Hsaïni H, Ben Rayana C, Delpeuch F. A double burden of overall or central adiposity and anemia or iron deficiency is prevalent but with little socioeconomic patterning among Moroccan and Tunisian urban women. J Nutr 2014; 144:87-97. [PMID: 24198310 DOI: 10.3945/jn.113.178285] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
In North Africa, overnutrition has dramatically increased with the nutrition transition while micronutrient deficiencies persist, resulting in clustering of opposite types of malnutrition that can present a unique difficulty for public health interventions. We assessed the magnitude of the double burden of malnutrition among urban Moroccan and Tunisian women, as defined by the coexistence of overall or central adiposity and anemia or iron deficiency (ID), and explored the sociodemographic patterning of individual double burden. In cross-sectional surveys representative of the region around the capital city, we randomly selected 811 and 1689 nonpregnant women aged 20-49 y in Morocco and Tunisia, respectively. Four double burdens were analyzed: overweight (body mass index ≥25 kg/m(2)) or increased risk abdominal obesity (waist circumference ≥80 cm) and anemia (blood hemoglobin <120 g/L) or ID (C-reactive protein-corrected serum ferritin <15 μg/L). Adjusted associations with 9 sociodemographic factors were estimated by logistic regression. The prevalence of overweight and ID was 67.0% and 45.2% in Morocco, respectively, and 69.5% and 27.0% in Tunisia, respectively, illustrating the population-level double burden. The coexistence of overall or central adiposity with ID was found in 29.8% and 30.1% of women in Morocco, respectively, and in 18.2% and 18.3% of women in Tunisia, respectively, quite evenly distributed across age, economic, or education groups. Generally, the rare, associated sociodemographic factors varied across the 4 subject-level double burdens and the 2 countries and differed from those usually associated with adiposity, anemia, or ID. Any double burden combining adiposity and anemia or ID should therefore be taken into consideration in all women. This trial was registered at clinicaltrials.gov as NCT01844349.
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Affiliation(s)
- Agnès Gartner
- Research Unit Nutripass (Prevention of Malnutrition and Associated Diseases), Institute of Research for Development, Montpellier, France
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The Use of Multiple Correspondence Analysis to Explore Associations between Categories of Qualitative Variables in Healthy Ageing. J Aging Res 2013; 2013:302163. [PMID: 24222852 PMCID: PMC3810057 DOI: 10.1155/2013/302163] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Revised: 08/23/2013] [Accepted: 08/30/2013] [Indexed: 01/07/2023] Open
Abstract
The main focus of this study was to illustrate the applicability of multiple correspondence analysis (MCA) in detecting and representing underlying structures in large datasets used to investigate cognitive ageing. Principal component analysis (PCA) was used to obtain main cognitive dimensions, and MCA was used to detect and explore relationships between cognitive, clinical, physical, and lifestyle variables. Two PCA dimensions were identified (general cognition/executive function and memory), and two MCA dimensions were retained. Poorer cognitive performance was associated with older age, less school years, unhealthier lifestyle indicators, and presence of pathology. The first MCA dimension indicated the clustering of general/executive function and lifestyle indicators and education, while the second association was between memory and clinical parameters and age. The clustering analysis with object scores method was used to identify groups sharing similar characteristics. The weaker cognitive clusters in terms of memory and executive function comprised individuals with characteristics contributing to a higher MCA dimensional mean score (age, less education, and presence of indicators of unhealthier lifestyle habits and/or clinical pathologies). MCA provided a powerful tool to explore complex ageing data, covering multiple and diverse variables, showing if a relationship exists and how variables are related, and offering statistical results that can be seen both analytically and visually.
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Atek M, Traissac P, El Ati J, Laid Y, Aounallah-Skhiri H, Eymard-Duvernay S, Mézimèche N, Bougatef S, Béji C, Boutekdjiret L, Martin-Prével Y, Lebcir H, Gartner A, Kolsteren P, Delpeuch F, Romdhane HB, Maire B. Obesity and association with area of residence, gender and socio-economic factors in Algerian and Tunisian adults. PLoS One 2013; 8:e75640. [PMID: 24116063 PMCID: PMC3792975 DOI: 10.1371/journal.pone.0075640] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 08/18/2013] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION The epidemiological transition has resulted in a major increase in the prevalence of obesity in North Africa. This study investigated differences in obesity and its association with area of residence, gender and socio-economic position among adults in Algeria and Tunisia, two countries with socio-economic and socio-cultural similarities. METHODS Cross-sectional studies used stratified, three-level, clustered samples of 35-70 year old adults in Algeria, (women n = 2741, men n = 2004) and Tunisia (women n = 2964, men n = 2379). Thinness was defined as Body Mass Index (BMI) = weight/height <18.5 kg/m(2), obesity as BMI ≥30, and abdominal obesity as waist circumference/height ≥0.6. Associations with area of residence, gender, age, education, profession and household welfare were assessed. RESULTS Prevalence of thinness was very low except among men in Algeria (7.3% C.I.[5.9-8.7]). Prevalence of obesity among women was high in Algeria (30.1% C.I.[27.8-32.4]) and Tunisia (37.0% C.I.[34.4-39.6]). It was less so among men (9.1% C.I.[7.1-11.0] and 13.3% C.I.[11.2-15.4]).The results were similar for abdominal obesity. In both countries women were much more obesity-prone than men: the women versus men obesity Odds-Ratio was 4.3 C.I.[3.4-5.5] in Algeria and 3.8 C.I.[3.1-4.7] in Tunisia. Obesity was more prevalent in urban versus rural areas in Tunisia, but not in Algeria (e.g. for women, urban versus rural Odds-Ratio was 2.4 C.I.[1.9-3.1] in Tunisia and only 1.2 C.I.[1.0-5.5] in Algeria). Obesity increased with household welfare, but more markedly in Tunisia, especially among women. Nevertheless, in both countries, even in the lowest quintile of welfare, a fifth of the women were obese. CONCLUSION The prevention of obesity, especially in women, is a public health issue in both countries, but there were differences in the patterning of obesity according to area of residence and socio-economic position. These specificities must be taken into account in the management of obesity inequalities.
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Affiliation(s)
- Madjid Atek
- INSP (National Institute of Public Health), Algiers, Algeria
| | - Pierre Traissac
- IRD (Institut de Recherche pour le Développement), NUTRIPASS Research Unit, Montpellier, France
| | - Jalila El Ati
- INNTA (National Institute of Nutrition and Food Technology), Tunis, Tunisia
- SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Unit, Tunis, Tunisia
| | - Youcef Laid
- INSP (National Institute of Public Health), Algiers, Algeria
| | - Hajer Aounallah-Skhiri
- SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Unit, Tunis, Tunisia
- INSP (National Institute of Public Health), Tunis, Tunisia
- Faculty of Medicine, El Manar University, Tunis, Tunisia
| | - Sabrina Eymard-Duvernay
- IRD (Institut de Recherche pour le Développement), NUTRIPASS Research Unit, Montpellier, France
| | - Nadia Mézimèche
- INSP (National Institute of Public Health), Algiers, Algeria
| | - Souha Bougatef
- INSP (National Institute of Public Health), Tunis, Tunisia
| | - Chiraz Béji
- INNTA (National Institute of Nutrition and Food Technology), Tunis, Tunisia
- SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Unit, Tunis, Tunisia
| | | | - Yves Martin-Prével
- IRD (Institut de Recherche pour le Développement), NUTRIPASS Research Unit, Montpellier, France
| | - Hassiba Lebcir
- INSP (National Institute of Public Health), Algiers, Algeria
| | - Agnès Gartner
- IRD (Institut de Recherche pour le Développement), NUTRIPASS Research Unit, Montpellier, France
| | | | - Francis Delpeuch
- IRD (Institut de Recherche pour le Développement), NUTRIPASS Research Unit, Montpellier, France
| | - Habiba Ben Romdhane
- Epidemiology and Prevention of Cardiovascular Diseases Unit, Faculty of Medicine, Tunis, Tunisia
| | - Bernard Maire
- IRD (Institut de Recherche pour le Développement), NUTRIPASS Research Unit, Montpellier, France
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Categorisation of input variables for deriving dietary patterns. Br J Nutr 2013; 109:772-4. [DOI: 10.1017/s000711451200551x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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