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Hellwig F, Wado Y, Barros AJD. Association between women's empowerment and demand for family planning satisfied among Christians and Muslims in multireligious African countries. BMJ Glob Health 2024; 9:e013651. [PMID: 38724069 PMCID: PMC11085792 DOI: 10.1136/bmjgh-2023-013651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 02/21/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Although the levels of demand for family planning satisfied (DFPS) have increased in many countries, cultural norms remain a significant barrier in low- and middle-income countries. In the context of multireligious African countries, our objective was to investigate intersectional inequalities in DFPS by modern or traditional contraceptives according to religion and women's empowerment. METHODS Analyses were based on Demographic and Health Surveys carried out between 2010 and 2021 in African countries. Countries with at least 10% of Muslims and Christians were selected to analyse inequalities in family planning. The religious groups were characterised by wealth, area of residence, women's age and women's empowerment. The mean level of empowerment was estimated for each religious group, and multilevel Poisson regression was used to assess whether DFPS varied based on the level of women's empowerment among Muslims and Christians. RESULTS Our study sample of 14 countries comprised 35% of Muslim and 61% of Christian women. Christians had higher levels of empowerment across all three domains compared with Muslims and women with no/other religion. DFPS was also higher among Christians (57%) than among Muslims (36%). Pooled analysis indicated a consistent association between DFPS and women's empowerment, with higher prevalence ratios among Muslims than Christians, especially in the decision-making domain. CONCLUSIONS The gap between Muslims and Christians in DFPS significantly reduced as the level of empowerment increased. It highlights the importance of understanding and addressing cultural factors sensibly and respectfully to satisfy the demand for family planning services.
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Affiliation(s)
- Franciele Hellwig
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
- Posgraduate Program of Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Yohannes Wado
- African Population and Health Research Center, Nairobi, Kenya
| | - Aluisio J D Barros
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
- Posgraduate Program of Epidemiology, Federal University of Pelotas, Pelotas, Brazil
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Abreu de Carvalho C, Viola PCDAF, Magalhães EIDS, Machado SP, Matijasevich A, Menezes AMB, Tovo-Rodrigues L, Santos IS, Goncalves H, Wehrmeister FC, Horta BL, Moura da Silva AA. Association between breast feeding and food consumption according to the degree of processing in Brazil: a cohort study. BMJ Open 2024; 14:e083871. [PMID: 38569686 PMCID: PMC10989181 DOI: 10.1136/bmjopen-2024-083871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 03/05/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND The benefits of breast feeding may be associated with better formation of eating habits beyond childhood. This study was designed to verify the association between breast feeding and food consumption according to the degree of processing in four Brazilian birth cohorts. METHODS The duration of exclusive, predominant and total breast feeding was evaluated. The analysis of the energy contribution of fresh or minimally processed foods (FMPF) and ultra-processed foods (UPF) in the diet was evaluated during childhood (13-36 months), adolescence (11-18 years) and adulthood (22, 23 and 30 years). RESULTS Those who were predominantly breastfed for less than 4 months had a higher UPF consumption (β 3.14, 95% CI 0.82 to 5.47) and a lower FMPF consumption (β -3.47, 95% CI -5.91 to -1.02) at age 22 years in the 1993 cohort. Exclusive breast feeding (EBF) for less than 6 months was associated with increased UPF consumption (β 1.75, 95% CI 0.25 to 3.24) and reduced FMPF consumption (β -1.49, 95% CI -2.93 to -0.04) at age 11 years in the 2004 cohort. In this same cohort, total breast feeding for less than 12 months was associated with increased UPF consumption (β 1.12, 95% CI 0.24 to 2.19) and decreased FMPF consumption (β -1.13, 95% CI -2 .07 to -0.19). Children who did not receive EBF for 6 months showed an increase in the energy contribution of UPF (β 2.36, 95% CI 0.53 to 4.18) and a decrease in FMPF (β -2.33, 95% CI -4 .19 to -0.48) in the diet at 13-36 months in the 2010 cohort. In this cohort, children who were breastfed for less than 12 months in total had higher UPF consumption (β 2.16, 95% CI 0.81 to 3.51) and lower FMPF consumption (β -1.79, 95% CI -3.09 to -0.48). CONCLUSION Exposure to breast feeding is associated with lower UPF consumption and higher FMPF consumption in childhood, adolescence and adulthood.
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Affiliation(s)
| | | | | | | | - Alicia Matijasevich
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, Sao Paulo, Brazil
| | | | | | - Ina S Santos
- Universidade Federal de Pelotas, Pelotas, Brazil
| | - Helen Goncalves
- Social Medicine, Universidade Federal de Pelotas, Pelotas, Brazil
- Post-graduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
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Béhague DP, Gonçalves H, da Cruz SH, de Cruz L, Horta BL, Lima NP. The politicizing clinic: insights on 'the social' for mental health policy and practice. Soc Psychiatry Psychiatr Epidemiol 2024; 59:523-536. [PMID: 38108834 PMCID: PMC10944422 DOI: 10.1007/s00127-023-02573-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 09/28/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE In this paper, we explore how Brazilian socially sensitive therapy can respond to care-users' desire to change the social and political forces shaping their lives. We use this case to demonstrate the limits of the "social determinants of health" agenda which, when operationalized, tends to leave questions of lasting structural change aside. METHODS We report on mixed methods ethnographic and epidemiological results from the 1982 Pelotas (Brazil) birth cohort study, a prospective study of 5914 children. Ethnographic analysis explored the cyclical relationship between schooling, mental health care, conceptualizations of mental distress, social and political engagement, and experiences with diverse forms of discrimination. Epidemiological bivariate and multivariate analyses examined differences in socio-political participation and the reporting of discrimination at different time-points for participants who used therapy with those who did not. Effect modification analysis tested the hypothesis that the socially empowering effects of therapy were greater for marginalized and minoritized youth. RESULTS Most young people living in situations of precarity experienced therapy, particularly when based in schools, to be a blame-inducing process. A more fulfilling and impactful therapeutic experience took shape when young people were able to shift the focus away from symptom reduction and behavioral management toward narrative life analyses, social debate, and political agency. Use of socially sensitive therapy was statistically associated with increased political participation and reporting of discrimination after controlling for confounders. The empowering effects of therapy were greater for those with less formal education and family income, but not for young people who identified as black, brown, or non-white. CONCLUSION The findings underscore the importance of considering agency, sociality, and politics when theorizing "the social" in clinical practice, and health and social policy.
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Affiliation(s)
- Dominique P Béhague
- Vanderbilt University, Medicine Health, and Society, Nashville, Tennessee, USA.
- Kings College London, Social Medicine & Global Health, London, UK.
| | - Helen Gonçalves
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | | | - Larissa de Cruz
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Bernardo L Horta
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Natália P Lima
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
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Maruyama JM, Valente JY, Tovo-Rodrigues L, Santos IS, Barros AJD, Munhoz TN, Barros FC, Murray J, Matijasevich A. Maternal depression trajectories in childhood, subsequent maltreatment, and adolescent emotion regulation and self-esteem: the 2004 Pelotas birth cohort. Eur Child Adolesc Psychiatry 2023; 32:1935-1945. [PMID: 35731302 PMCID: PMC9214189 DOI: 10.1007/s00787-022-02022-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 06/01/2022] [Indexed: 11/26/2022]
Abstract
This study aimed to examine the impact of maternal depressive symptoms trajectories on 15-year-old adolescents' self-esteem and emotion regulation and test the mediating role of child maltreatment in this association. The 2004 Pelotas Birth Cohort is an ongoing cohort study originally comprised of 4231 live births in a southern Brazilian city. We examined a subsample of 1949 adolescents at age 15 years. Maternal depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale. Trajectories of maternal depression from 3 months until the 11-year follow-up were calculated using a group-based modeling approach. Child maltreatment at age 11 years was measured using the parent-report version of the Parent-Child Conflict Tactics Scale. Adolescent outcomes at age 15 years were assessed by the self-report version of the Rosenberg Self-esteem Scale and the Emotion Regulation Index for Children and Adolescents. Path model analysis was conducted using a structural equation modeling framework in Mplus software. All maternal depression trajectories were negatively associated with offspring self-esteem and emotion regulation compared to the reference group (low depression trajectory). There was a significant indirect effect of maternal depression trajectories on emotion regulation mediated via child maltreatment. No evidence of moderation by sex was found for any pathway. The effects of maternal depression on adolescents' emotion regulation are partly mediated by child maltreatment at age 11.
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Affiliation(s)
- Jessica Mayumi Maruyama
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, Av. Dr. Arnaldo 455, 2nd Floor, São Paulo, SP, CEP 01246-903, Brazil.
| | - Juliana Y Valente
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Iná S Santos
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- Postgraduate Program in Pediatrics and Child Health, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Aluísio J D Barros
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Tiago N Munhoz
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- Faculty of Psychology, Federal University of Pelotas, Pelotas, Brazil
| | - Fernando C Barros
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- Programa de Pós-graduação em Saúde e Comportamento, Universidade Católica de, Pelotas, Brazil
| | - Joseph Murray
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- Human Development and Violence Research Centre, Federal University of Pelotas, Pelotas, Brazil
| | - Alicia Matijasevich
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, Av. Dr. Arnaldo 455, 2nd Floor, São Paulo, SP, CEP 01246-903, Brazil
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
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Chisini L, Costa F, Horta B, Tovo-Rodrigues L, Demarco F, Correa M. Sweet Taste Receptor Gene and Caries Trajectory in the Life Course. J Dent Res 2023; 102:422-430. [PMID: 36609159 PMCID: PMC10041601 DOI: 10.1177/00220345221138569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
This study aims to investigate whether the trajectory of dental caries in the life course is associated with rs307355 (TAS1R3) and rs35874116 (TAS1R2) and if there is an epistatic association between rs307355 (TAS1R3) and rs35874116 (TAS1R2). A representative sample of all 5,914 births from the 1982 Pelotas birth cohort was prospectively investigated, and the decayed, missing, and filled teeth (DMF-T) components were assessed at ages 15 (n = 888), 24 (n = 720), and 31 (n = 539) y. Group-based trajectory modeling was used to identify groups with similar trajectories of DMF-T components in the life course. Genetic material was collected, and rs307355 (TAS1R3) and rs35874116 (TAS1R2) were genotyped. Ethnicity was evaluated using ADMIXTURE. Generalized multifactor dimensionality reduction software was used to investigate epistatic interactions. Considering rs307355 (TAS1R3) in the additive effect, the genotype TT was associated with the high decayed trajectory group (odds ratio [OR] = 4.52; 95% confidence interval [CI], 1.15-17.74) and the high missing trajectory group (OR = 3.35; 95% CI, 1.09-10.26). In the dominant effect, the genotype CT/TT was associated with the high decayed trajectory group (OR = 1.64; 95% CI, 1.14-2.35). Allele T was associated with an increased odds of 64% (OR = 1.64; 95% CI, 1.20-2.25) for the decayed component and 41% (OR = 1.41; 95% CI, 1.04-1.92) for the missing component. No associations were observed between rs307355 (TAS1R3) and the filled component. rs35874116 (TAS1R2) was not associated with DMF-T components. Positive epistatic interactions were observed involving rs307355 (TAS1R3) and rs35874116 (TAS1R2) with the decayed component (OR = 1.72; 95% CI, 1.04-2.84). Thus, rs307355 (TAS1R3) genotypes and alleles seem positively associated with the trajectory of decayed and missing components in the life course. Epistatic interaction between rs307355 and rs35874116 may increase the decayed caries trajectory.
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Affiliation(s)
- L.A. Chisini
- Graduate Program in Dentistry, Federal University of Juiz de Fora, Governador Valadares, MG, Brazil
| | - F.D.S. Costa
- International Center for Equity in Health, Postgraduate Program of Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - B.L. Horta
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - L. Tovo-Rodrigues
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - F.F. Demarco
- Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, RS, Brazil
| | - M.B. Correa
- Graduate Program in Dentistry, Federal University of Juiz de Fora, Governador Valadares, MG, Brazil
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Bozzini AB, Maruyama JM, Santos IS, Murray J, Tovo-Rodrigues L, Munhoz TN, Matijasevich A. Prevalence of adolescent's risk behaviors at age 11 and 15: data from the 2004 Pelotas birth cohort. Braz J Psychiatry 2022; 45:93-101. [PMID: 36318481 PMCID: PMC10154011 DOI: 10.47626/1516-4446-2022-2753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/15/2022] [Indexed: 05/04/2023]
Abstract
PURPOSE The objective of this study was to investigate the prevalence of the following risk behaviors: cigarette, electronic cigarette, alcohol, substance and sexual experimentation and delinquent behavior at age 15, stratified by sex and socioeconomic position. We also investigated the prevalence of cigarette and alcohol experimentation at age 11 and the persistence and cumulative incidence of these behaviors between 11 to 15 age. METHODS Cohort study. We included 3,491 11-year-old and 1,949 15-year-old adolescents from the 2004 Pelotas Birth Cohort. All outcomes were identified via confidential questionnaires and were analyzed as binary variables. RESULTS At age 11, we found a male preponderance of cigarette experimentation. At age 15, alcohol experimentation, cigarette experimentation and substance experimentation had a female preponderance; and cigarette experimentation and sexual experimentation were more prevalent in individuals belonging to low socioeconomic position. We found high rates of cumulative incidence of 'alcohol experimentation' in male and in female adolescents; and high rates of persistence of alcohol experimentation both in male and female. CONCLUSIONS Further research should clarify causal paths of high prevalence of risk behaviors during adolescence and its increase in female adolescents.
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Affiliation(s)
- Ana Beatriz Bozzini
- Departamento de Medicina Preventiva, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, Brasil
| | - Jessica Mayumi Maruyama
- Departamento de Medicina Preventiva, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, Brasil
| | - Iná S Santos
- Postgraduate Program in Pediatrics and Child Health, School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil. Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Joseph Murray
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil. Human Development and Violence Research Centre, Federal University of Pelotas, Pelotas, Brazil
| | | | - Tiago N Munhoz
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil. School of Psychology, Federal University of Pelotas, Pelotas, Brazil
| | - Alicia Matijasevich
- Departamento de Medicina Preventiva, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, Brasil. Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
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Arroyave L, Saad GE, Victora CG, Barros AJD. Inequalities in antenatal care coverage and quality: an analysis from 63 low and middle-income countries using the ANCq content-qualified coverage indicator. Int J Equity Health 2021; 20:102. [PMID: 33865396 PMCID: PMC8052706 DOI: 10.1186/s12939-021-01440-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/01/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Antenatal care (ANC) is an essential intervention associated with a reduction of maternal and new-born morbidity and mortality. However, evidence suggested substantial inequalities in maternal and child health, mainly in low- and middle-income countries (LMICs). We aimed to conduct a global analysis of socioeconomic inequalities in ANC using national surveys from LMICs. METHODS ANC was measured using the ANCq, a novel content-qualified ANC coverage indicator, created and validated using national surveys, based upon contact with the health services and content of care received. We performed stratified analysis to explore the socioeconomic inequalities in ANCq. We also estimated the slope index of inequality, which measures the difference in coverage along the wealth spectrum. RESULTS We analyzed 63 national surveys carried out from 2010 to 2017. There were large inequalities between and within countries. Higher ANCq scores were observed among women living in urban areas, with secondary or more level of education, belonging to wealthier families and with higher empowerment in nearly all countries. Countries with higher ANCq mean presented lower inequalities; while countries with average ANCq scores presented wide range of inequality, with some managing to achieve very low inequality. CONCLUSIONS Despite all efforts in ANC programs, important inequalities in coverage and quality of ANC services persist. If maternal and child mortality Sustainable Development Goals are to be achieved, those gaps we documented must be bridged.
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Affiliation(s)
- Luisa Arroyave
- International Center for Equity in Health, Federal University of Pelotas, Rua Marechal Deodoro, 1160, 3rd floor, Pelotas, RS, 96020-220, Brazil
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160, 3rd floor, Pelotas, RS, 96020-220, Brazil
| | - Ghada E Saad
- Faculty of Health Sciences, American University of Beirut, Riad El-Solh 1107 2020, Beirut, Lebanon
| | - Cesar G Victora
- International Center for Equity in Health, Federal University of Pelotas, Rua Marechal Deodoro, 1160, 3rd floor, Pelotas, RS, 96020-220, Brazil
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160, 3rd floor, Pelotas, RS, 96020-220, Brazil
| | - Aluisio J D Barros
- International Center for Equity in Health, Federal University of Pelotas, Rua Marechal Deodoro, 1160, 3rd floor, Pelotas, RS, 96020-220, Brazil.
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160, 3rd floor, Pelotas, RS, 96020-220, Brazil.
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Abstract
BACKGROUND While assessment of sex differentials in child mortality is straightforward, their interpretation must consider that, in the absence of gender bias, boys are more likely to die than girls. The expected differences are also influenced by levels and causes of death. However, there is no standard approach for determining expected sex differences. METHODS We performed a scoping review of studies on sex differentials in under-five mortality, using PubMed, Web of Science, and Scopus databases. Publication characteristics were described, and studies were grouped according to their methodology. RESULTS From the 17,693 references initially retrieved we included 154 studies published since 1929. Indian, Bangladeshi, and Chinese populations were the focus of 44% of the works, and most studies addressed infant mortality. Fourteen publications were classified as reference studies, as these aimed to estimate expected sex differentials based upon the demographic experience of selected populations, either considered as gender-neutral or not. These studies used a variety of methods - from simple averages to sophisticated modeling - to define values against which observed estimates could be compared. The 21 comparative studies mostly used life tables from European populations as standard for expected values, but also relied on groups without assuming those values as expected, otherwise, just as comparison parameters. The remaining 119 studies were categorized as narrative and did not use reference values, being limited to reporting observed sex-specific estimates or used a variety of statistical models, and in general, did not account for mortality levels. CONCLUSION Studies aimed at identifying sex differentials in child mortality should consider overall mortality levels, and report on more than one age group. The comparison of results with one or more reference values, and the use of statistical testing, are strongly recommended. Time trends analyses will help understand changes in population characteristics and interpret findings from a historical perspective.
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Affiliation(s)
- Janaína Calu Costa
- International Center for Equity in Health, Postgraduate Program in Epidemiology, Federal University of Pelotas. Marechal Deodoro, 1160, 3rd floor, Pelotas, 96020-220 Brazil
| | - Cesar G. Victora
- International Center for Equity in Health, Postgraduate Program in Epidemiology, Federal University of Pelotas. Marechal Deodoro, 1160, 3rd floor, Pelotas, 96020-220 Brazil
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Neves PAR, Barros AJD, Gatica-Domínguez G, Vaz JS, Baker P, Lutter CK. Maternal education and equity in breastfeeding: trends and patterns in 81 low- and middle-income countries between 2000 and 2019. Int J Equity Health 2021; 20:20. [PMID: 33413445 PMCID: PMC7792102 DOI: 10.1186/s12939-020-01357-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 12/14/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND In low- and middle-income countries (LMICs), low levels of formal maternal educational are positively associated with breastfeeding whereas the reverse is true among women with higher levels of formal education. As such, breastfeeding has helped to reduce health equity gaps between rich and poor children. Our paper examines trends in breastfeeding and formula consumption by maternal educational in LMICs over nearly two decades. METHODS We used 319 nationally representative surveys from 81 countries. We used WHO definitions for breastfeeding indicators and categorized maternal education into three categories: none, primary, and secondary or higher. We grouped countries according to the World Bank income groups and UNICEF regions classifications. The trend analyses were performed through multilevel linear regression to obtain average absolute annual changes in percentage points. RESULTS Significant increases in prevalence were observed for early initiation and exclusive breastfeeding across all education categories, but more prominently in women with no formal education for early breastfeeding and in higher level educated women for exclusive breastfeeding. Small decreases in prevalence were seen mostly for women with no formal education for continued breastfeeding at 1 and 2 years. Among formula indicators, only formula consumption between 6 and 23 months decreased significantly over the period for women with primary education. Analysis by world regions demonstrated that gains in early and exclusive breastfeeding were almost universally distributed among education categories, except in the Middle East and North Africa where they decreased throughout education categories. Continued breastfeeding at 1 and 2 years increased in South Asia, Latin America and the Caribbean, and Eastern Europe and Central Asia for primary or higher education categories. Declines occurred for the group of no formal education in South Asia and nearly all education categories in the Middle East and North Africa with a decline steeper for continued breastfeeding at 2 years. With a few exceptions, the use of formula is higher among children of women at the highest education level in all regions. CONCLUSIONS Over the course of our study, women with no formal education have worsening breastfeeding indicators compared to women with primary and secondary or higher education.
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Affiliation(s)
- Paulo A R Neves
- Federal University of Pelotas, International Center for Equity in Health. Rua Marechal Deodoro, 1160, 3rd floor, Pelotas, Brazil
| | - Aluisio J D Barros
- Federal University of Pelotas, International Center for Equity in Health. Rua Marechal Deodoro, 1160, 3rd floor, Pelotas, Brazil
| | - Giovanna Gatica-Domínguez
- Federal University of Pelotas, International Center for Equity in Health. Rua Marechal Deodoro, 1160, 3rd floor, Pelotas, Brazil
| | - Juliana S Vaz
- Federal University of Pelotas, International Center for Equity in Health. Rua Marechal Deodoro, 1160, 3rd floor, Pelotas, Brazil
| | - Phillip Baker
- Institute for Physical Activity and Nutrition, Deakin University, 221 Burwood Highway, Melbourne, Australia
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da Silva ICM, Everling F, Hellwig F, Ronsmans C, Benova L, Requejo J, Raj A, Barros AJD, Victora CG. Does women's age matter in the SDGs era: coverage of demand for family planning satisfied with modern methods and institutional delivery in 91 low- and middle-income countries. Reprod Health 2020; 17:55. [PMID: 32306969 PMCID: PMC7168879 DOI: 10.1186/s12978-020-0903-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 03/31/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Sustainable Development Goals (SDGs) include specific targets for family planning (SDG 3.7) and birth attendance (SDG 3.1.2), and require analyses disaggregated by age and other dimensions of inequality (SDG 17.18). We aimed to describe coverage with demand for family planning satisfied with modern methods (DFPSm) and institutional delivery in low- and middle-income countries across the reproductive age spectrum. We attempted to identify a typology of patterns of coverage by age and compare their distribution according to geographic regions, World Bank income groups and intervention coverage levels. METHODS We used Demographic and Health Survey and Multiple Indicator Cluster Surveys. For DFPSm, we considered the woman's age at the time of the survey, whereas for institutional delivery we considered the woman's age at birth of the child. Both age variables were categorized into seven groups of 5 year-intervals, 15-19 up to 45-49. Five distinct patterns were identified: (a) increasing coverage with age; (b) similar coverage in all age groups; (c) U-shaped; (d) inverse U-shaped; and (e) declining coverage with age. The frequency of the five patterns was examined according to UNICEF regions, World Bank income groups, and coverage at national level of the given indicator. RESULTS We analyzed 91 countries. For DFPSm, the most frequent age patterns were inverse U-shaped (53%, 47 countries) and increasing coverage with age (41%, 36 countries). Inverse-U shaped patterns for DFPSm was the commonest pattern among lower-middle income countries, while low- and upper middle-income countries showed a more balanced distribution between increasing with age and U-shaped patterns. In the first and second tertiles of national coverage of DFPSm, inverse U-shaped was observed in more than half of countries. For institutional delivery, declining coverage with age was the prevailing pattern (44%, 39 countries), followed by similar coverage across age groups (39%, 35 countries). Most (79%) upper-middle income countries showed no variation by age group while most low-income countries showed declining coverage with age (71%). CONCLUSION Large inequalities in DFPSm and institutional delivery were identified by age, varying from one intervention to the other. Policy and programmatic approaches must be tailored to national patterns, and in most cases older women and adolescents will require special attention due to lower coverage and because they are at higher risk for maternal mortality and other poor obstetrical outcomes.
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Affiliation(s)
- Inacio Crochemore M. da Silva
- International Center for Equity in Health, Post-graduate Program in Epidemiology, Federal University of Pelotas, Marechal Deodoro, 1160, Pelotas, RS 96020-220 Brazil
| | - Fernanda Everling
- International Center for Equity in Health, Post-graduate Program in Epidemiology, Federal University of Pelotas, Marechal Deodoro, 1160, Pelotas, RS 96020-220 Brazil
| | - Franciele Hellwig
- International Center for Equity in Health, Post-graduate Program in Epidemiology, Federal University of Pelotas, Marechal Deodoro, 1160, Pelotas, RS 96020-220 Brazil
| | - Carine Ronsmans
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Lenka Benova
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Jennifer Requejo
- Health and HIV Division of Planning, Analysis and Monitoring, UNICEF, New York, NY USA
| | - Anita Raj
- Center on Gender Equity and Health, Department of Medicine, University of California San Diego, San Diego, USA
- Department of Education Studies, University of California San Diego, San Diego, USA
| | - Aluisio J. D. Barros
- International Center for Equity in Health, Post-graduate Program in Epidemiology, Federal University of Pelotas, Marechal Deodoro, 1160, Pelotas, RS 96020-220 Brazil
| | - Cesar G. Victora
- International Center for Equity in Health, Post-graduate Program in Epidemiology, Federal University of Pelotas, Marechal Deodoro, 1160, Pelotas, RS 96020-220 Brazil
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Costa JC, da Silva ICM, Victora CG. Gender bias in under-five mortality in low/middle-income countries. BMJ Glob Health 2017; 2:e000350. [PMID: 29082002 PMCID: PMC5656133 DOI: 10.1136/bmjgh-2017-000350] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 06/02/2017] [Accepted: 06/11/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction Due to biological reasons, boys are more likely to die than girls. The detection of gender bias requires knowing the expected relation between male and female mortality rates at different levels of overall mortality, in the absence of discrimination. Our objective was to compare two approaches aimed at assessing excess female under-five mortality rate (U5MR) in low/middle-income countries. Methods We compared the two approaches using data from 60 Demographic and Health Surveys (2005–2014). The prescriptive approach compares observed mortality rates with historical patterns in Western societies where gender discrimination was assumed to be low or absent. The descriptive approach is derived from global estimates of all countries with available data, including those affected by gender bias. Results The prescriptive approach showed significant excess female U5MR in 20 countries, compared with only one country according to the descriptive approach. Nevertheless, both models showed similar country rankings. The 13 countries with the highest and the 10 countries with the lowest rankings were the same according to both approaches. Differences in excess female mortality among world regions were significant, but not among country income groups. Conclusion Both methods are useful for monitoring time trends, detecting gender-based inequalities and identifying and addressing its causes. The prescriptive approach seems to be more sensitive in the identification of gender bias, but needs to be updated using data from populations with current-day structures of causes of death.
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Affiliation(s)
- Janaína Calu Costa
- International Center for Equity in Health, Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | | | - Cesar Gomes Victora
- International Center for Equity in Health, Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
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