Contrasting children and women's health and the determinants of health in a small-sized city

Do women in major cities experience better health? A comparison of chronic conditions and their risk factors between women living in major cities and other cities in Indonesia

BACKGROUND

Inhabitants of rural areas can be tempted to migrate to urban areas for the type and range of facilities available. Although urban inhabitants may benefit from greater access to human and social services, living in a big city can also bring disadvantages to some residents due to changes in social and physical environments.

DESIGN

We analysed data from 4,208 women aged >15 years old participating in the fourth wave of the Indonesia Family Life Survey. Chronic condition risk factors - systolic and diastolic blood pressure (SBP and DBP), body mass index (BMI), and tobacco use - among women in four major cities in Indonesia (Jakarta, Surabaya, Medan, and Bandung) were compared against other cities. Fractional polynomial regression models were applied to examine the association between living in the major cities and SBP, DBP, BMI, and tobacco use. The models were also adjusted for age, education, employment status, migration status, ethnic groups, and religion. The patterns of SBP, DBP, and BMI were plotted and contrasted between groups of cities.

RESULTS

Chronic condition prevalence was higher for women in major cities than in contrasting cities (p<0.005). Living in major cities increased the risk of having higher SBP, DBP, BMI and being a current smoker. Chronic disease risk factors in major cities were evident from younger ages.

CONCLUSIONS

Women residing in Indonesia's major cities have a higher risk of developing chronic conditions, starting at younger ages. The findings highlight the challenges inherent in providing long-term healthcare with its associated cost within major Indonesian cities and the importance of chronic disease prevention programmes targeting women at an early age.

Sustainable development and child health in the Curitiba metropolitan mesoregion, State of Paraná, Brazil

The purpose of this study was to analyze social determinants of health through the relationship between Sustainable Development and child health outcomes. The population studied lives in 37 municipalities of the Curitiba mesoregion, in the State of Paraná, Brazil. It is a cross-cutting ecological study. In the 1st phase of the study, 16 contextual indicators were obtained from the 2010 demographic census performed by the Brazilian Institute of Geography and Statistics. Principal Components Factor Analysis was undertaken to demonstrate possible correlations between social determinants of health, resulting in Sustainable Development indices for the places where the children live. In the 2nd phase the mortality rate in children aged under 5 was obtained from the Ministry of Health database. Pearson's correlation demonstrated statistically significant, moderate and negative association between the mortality rate in children aged under 5 (2001-2010) and the Sustainable Development Index (r = -0.62, p<0.01); with the Equity component (r = -0.70, p<0.01); and with the clusters (r = -0.68, p<0.01). Contextual indicators of Sustainable Development for the places where the children live showed themselves to be associated with the child health outcome. As such, equitable and sustainable social policies, based on inclusive health promotion strategies, need to be integrated into the children's life context.

Rural life, lower socioeconomic status and parasitic infections

This study was conducted both to assess the prevalence of parasitic infections in two neighboring villages of Manisa province in Turkey, with different socioeconomic levels and investigate the influences of some individual and environmental factors on these infections. A total of 100 school children were enrolled and their cellophane tape and stool samples were examined for parasites. Pediculus capitis infestation was diagnosed by visual inspection of the hair. Although the prevalences of both intestinal parasitosis and pediculosis were high in both villages, there was a statistically significant difference for pediculosis, but not for intestinal parasitosis. Lack of social security and father's regular job were found to be highly correlated with all parasitic infections. Pediculosis was more common in younger children, girls and those in crowded families. These results indicate not only the high prevalence of parasitic infections, but also the urgent need for the improvement of basic health services and infrastructure in the rural areas, crowded with poorer immigrant population.

Fertility preferences, contraceptive behaviors and unmet needs: a gap between urban and suburban parts of a city

OBJECTIVES

To explore the differences in unwanted fertility in different parts of a city.

METHODS

Data were obtained from the 1999 Manisa Demographic and Health Survey (MDHS) in Turkey. We collected information from a representative sample of 1728 ever-married women aged 15-49 years on fertility, fertility preferences, unmet need for family planning, contraceptive discontinuation, and abortion. Data were analyzed using SPSS 10.0 for Windows.

RESULTS

Of the persons studied, 1238 (71.6%) were living in urban settlements and 490 (28.4%) in suburban (gecekondu) settlements. The total fertility rate is higher among gecekondu women (2.42) than among urban women (2.14) although gecekondu women have a lower wanted fertility rate (1.54) than urban women (1.77). Married women in the urban area were currently using a contraceptive method more frequently (75.6%) than those living in the gecekondu area (61.7%) (OR 2.5; 95% CI 1.9-3.2; p < 0.001). The unmet need percentage in gecekondu women (17.7%) is higher than in urban women (8.3%; p < 0.001). The induced abortion rate is higher in urban women (14.8 per 1000 pregnancies) than in gecekondu women (7.1 per 1000 pregnancies; OR 2.1; 95% CI 1.4-3.1; p < 0.001).

CONCLUSIONS

There are inequalities in the achievement of fertility preferences and in accessibility to family planning services between urban and suburban parts of the city.