Socio-economic and demographic determinants of under-five mortality in rural northern Ghana

Background

In spite of global decline in under-five mortality, the goal of achieving MDG 4 still remains largely unattained in low and middle income countries as the year 2015 closes-in. To accelerate the pace of mortality decline, proven interventions with high impact need to be implemented to help achieve the goal of drastically reducing childhood mortality. This paper explores the association between socio-economic and demographic factors and under-five mortality in an impoverished region in rural northern Ghana.

Methods

We used survey data on 3975 women aged 15–49 who have ever given birth. First, chi-square test was used to test the association of social, economic and demographic characteristics of mothers with the experience of under-five death. Subsequently, we ran a logistic regression model to estimate the relative association of factors that influence childhood mortality after excluding variables that were not significant at the bivariate level.

Results

Factors that significantly predict under-five mortality included mothers’ educational level, presence of co-wives, age and marital status. Mothers who have achieved primary or junior high school education were 45% less likely to experience under-five death than mothers with no formal education at all (OR = 0.55, p < 0.001). Monogamous women were 22% less likely to experience under-five deaths than mothers in polygamous marriages (OR = 0.78, p = 0.01). Similarly, mothers who were between the ages of 35 and 49 were about eleven times more likely to experience under-five deaths than those below the age of 20 years (OR = 11.44, p < 0.001). Also, women who were married had a 27% less likelihood (OR = 0.73, p = 0.01) of experiencing an under-five death than those who were single, divorced or widowed.

Conclusion

Taken independently, maternal education, age, marital status and presence of co-wives are associated with childhood mortality. The relationship of these indicators with women’s autonomy, health seeking behavior, and other factors that affect child survival merit further investigation so that interventions could be designed to foster reductions in child mortality by considering the needs and welfare of women including the need for female education, autonomy and socioeconomic well-being.

     

The relative influence of individual and contextual socio-economic status on consumption of fruit and soft drinks among adolescents in Europe

BACKGROUND: The number of studies among children and adolescents that focus on socio-economic differences in food habits is limited. Moreover, most are done in only one country and often include a non-representative sample. The present study examines whether socio-economic differences in the consumption of fruit and soft drinks can be found among young adolescents in a wide range of European countries. METHODS: Multilevel statistical analysis of 114 558 school-pupils aged 11, 13 and 15 from 28 countries participating in the WHO collaborative cross-national study of Health Behaviours among School-aged Children 2001-2002. The individual outcomes were daily fruit and soft drink consumption and the socio-economic predictors at the individual level were occupation of the head of household and family material wealth. Family material wealth was aggregated at the country level to operationalize country-level socio-economic status. RESULTS: In general, girls and younger pupils consumed fruit more often and soft drinks less often. Significant between-school, between-country and between-region differences were found. Fruit consumption increased with family material wealth and higher parental occupational status. Soft drink consumption was lower among pupils of higher parental occupational status in Northern, Southern and Western European countries, but not in Central and Eastern European countries. Only in Central and Eastern European countries was a significant increase in soft drink consumption with increasing family affluence found. The country level of family affluence did not seem to have an effect on either outcome variable. CONCLUSION: The findings underscore the importance of socio-economic factors in relation to the food habits of young adolescents.     

Nutritional and socio-economic determinants of cognitive function and educational achievement of Aboriginal schoolchildren in rural Malaysia

A community-based cross-sectional study was carried out among Aboriginal schoolchildren aged 7-12 years living in remote areas in Pos Betau, Pahang, Malaysia to investigate the potential determinants influencing the cognitive function and educational achievement of these children. Cognitive function was measured by intelligence quotient (IQ), while examination scores of selected school subjects were used in assessing educational achievement. Blood samples were collected to assess serum Fe status. All children were screened for soil-transmitted helminthes. Demographic and socio-economic data were collected using pre-tested questionnaires. Almost two-thirds (67·6?%) of the subjects had poor IQ and most of them (72·6?%) had insufficient educational achievement. Output of the stepwise multiple regression model showed that poor IQ was significantly associated with low household income which contributed the most to the regression variance (r2 0·059; P?=?0·020). Low maternal education was also identified as a significant predictor of low IQ scores (r2 0·042; P?=?0·043). With educational achievement, Fe-deficiency anaemia (IDA) was the only variable to show significant association (r2 0·025; P?=?0·015). In conclusion, the cognitive function and educational achievement of Aboriginal schoolchildren are poor and influenced by household income, maternal education and IDA. Thus, effective and integrated measures to improve the nutritional and socio-economic status of rural children would have a pronounced positive effect on their education.     

Prevalence, pattern and determinants of mental disorders in rural Bangladesh

OBJECTIVES: Very few studies have examined mental health morbidity in Bangladesh. This community-based study of rural Bangladesh in 2000-2001 estimated the burden of mental morbidity among rural people of working age. STUDY DESIGN AND METHODS: Community surveys were conducted with one respondent from each household of three selected villages in the service provision area of a non-profit public health organization. General Health Questionnaire 60 (GHQ-60) was used as a screening tool in Stage I, and clinical examination by a Western-trained psychiatrist was undertaken for concurrent validation in Stage II. RESULTS: The overall prevalence of psychiatric disorders in this rural area was 16.5%. Depressive disorders and anxiety disorders constituted about one-half and one-third of the total cases, respectively. A significantly higher prevalence of mental disorders was found in the economically poor respondents, those over 45 years of age, and women from large families. CONCLUSION: There is a high prevalence of psychiatric disorders in rural Bangladesh. These findings should aid the planning of locally relevant and appropriate mental healthcare programmes. There is an urgent need for a national mental healthcare policy that strengthens primary mental healthcare services.     

Food neophobia and associations with cultural diversity and socio-economic status amongst rural and urban Australian adolescents

Exposure to diverse cultures and higher socio-economic status (SES) may increase knowledge of a wide variety of stimuli, including food, and be negatively associated with food neophobia. We contrasted questionnaire responses from two groups of Australian high school students (aged 12-18 years) from remote rural (rural, n=243) and cosmopolitan urban (city, n=696) locations to the food neophobia scale (FNS), familiarity with certain foods and willingness to try those foods. Cultural diversity measures and two SES scales were created. City students were less food neophobic than rural students (mean FNS scores 29.35 versus 34.68, p<0.001). City students were also significantly more familiar with different foods and more willing to try unfamiliar foods, were of higher SES and had greater exposure to cultural diversity. However, the association between the FNS and familiarity with foods, willingness to try unfamiliar foods, SES, and exposure to cultural diversity, were only weak or moderate for both city and rural students. Greater exposure to cultural diversity and higher SES has some influence on adolescents' responses to unfamiliar foods, but the relationship between these factors and the FNS score is tenuous.     

The combined impact of rural residence and socio-economic status on premature mortality

The health of rural and urban populations differs, with rural areas appearing healthier. However, it is unknown whether the benefit of living in rural areas is felt by individuals in all levels of deprivation, or whether some suffer a disadvantage of rural residence. For England and Wales 2001–2003 premature mortality rates were calculated, subdivided by individual deprivation and gender, for areas with differing rurality characteristics. Premature mortality data (age 50-retirement) and a measure of the individual's deprivation (National Statistics Socio-economic Classification 1–7) was obtained from death certificates. Overall premature mortality was examined as well as premature mortality subdivided by major cause. Male premature mortality rates (age 50–64) fell with increasing rurality for individuals in all socio-economic status classifications. The most deprived individuals benefitted most from residence in increasingly rural areas. Similar trends were observed when premature mortality was subdivided by the major causes of death. Female premature mortality rates (age 50–59) demonstrated similar trends but the differences between urban and rural areas were less marked.     

Demographic,socio-economic and geographic determinants of seasonal influenza vaccine uptake in rural western Kenya, 2011

Influenza-associated acute lower respiratory infections cause a considerable burden of disease in rural and urban sub-Saharan Africa communities with the greatest burden among children. Currently, vaccination is the best way to prevent influenza infection and accompanying morbidities.     

The socio-economic determinants of maternal health care utilization in Turkey

The purpose of this study is to investigate the individual-, household- and community-level factors that affect women's use of maternal health care services in Turkey. The data used for the study come from the 1993 Turkey Demographic and Health Survey (TDHS), a nationally representative survey of ever married women 15 to 49 years of age. In order to assess the impact of socio-economic factors on maternal health care utilization, we use logistical regression techniques to estimate models of the prenatal care use and birth delivery assistance among women who have had at least one birth in the three years prior to the survey. Separate models are also estimated for urban and rural women. The results indicate that educational attainment, parity level, health insurance coverage, ethnicity, household wealth and geographic region are statistically significant factors that affect the use of health care services thought essential to reduce infant and child mortality rates. The results of the model are used to provide insights for both micro- and macro-level planning of maternal health service delivery.     

The socio-economic determinants of alternative sources of antenatal care in Turkey

This paper tries to ascertain the factors affecting the choice of alternative sources for antenatal care. The analysis is based on data collected from ever-married women in the 1998 Turkey Demographic and Health Survey (TDHS). The developing country setting provides substantial variation in the type of facility chosen, ranging from no antenatal care, to formal health care personnel, to modern private hospitals. The alternatives vary greatly in quality and price, making this an ideal context for examining the role of these variables in choosing a facility. The logit model specifications estimated individual, household-level and community-level characteristics of the women in the urban and rural sample as well as in the total sample in this study. The estimation results indicate that individual characteristics such as educational attainment and birth order are significant determinants of choosing alternative sources for antenatal care. The results also indicate that household-level characteristics such as health insurance coverage, car ownership, household assets and community-level characteristics are the other significant determinants of using alternative sources for antenatal care.     

Assessing the socio-economic and demographic impact on health-related quality of life: evidence from Greece

Objectives:  The impact of socioeconomic status on health has been extensively studied and studies have shown that low socio-economic status is related to lower values of various health and quality-of-health measures. The aim of this study was to assess the influence of demographic and socio-economic factors on health- related quality of life (HRQoL). Methods:  A cross-sectional study was carried out in 2003 using a representative sample of a Greek general population (n = 1007, 18+ years old), living in Athens area. Multivariate stepwise linear regression analyses were performed to investigate the influence of socio-demographic and economic variables on HRQoL, measured by eight scales of the SF-36. Interaction effects between socioeconomic status (SES) and demographic variables were also performed Results:  Females and elderly people were associated with impaired HRQoL in all SF-36 scales. Disadvantaged SES i. e. primary education and low total household income was related to important decline in HRQoL and a similar relation was identified among men and women. Only the interaction effects between age and SES was statistically significant for some SF-36 scales. Multiple regression analyses produced models explaining significant portions of the variance in SF-36 scales, especially physical functioning. Conclusions:  The analysis presented here gives evidence of a relationship existing between SES and HRQoL similar to what has been found elsewhere. In order to protect people from the damaging effects of poverty in health it is important to formulate health promotion educational programs or to direct policies to empower the disposable income etc. Helping people in disadvantaged SES to achieve the good health that people in more advantaged SES attained would help to prevent the widening of health inequalities. Submitted: 05 May 2008; revised: 13 November 2008, 23 March 2009; accepted: 26 March 2009     

Relying on nature's pharmacy in rural Burkina Faso: empirical evidence of the determinants of traditional medicine consumption

Traditional medicine is believed to constitute a crucial healthcare option for poor or remote households in developing countries that have limited access to allopathic medicine and/or a strong cultural attachment to traditional medicine. However, little research has been performed on medicinal plant reliance in developing countries, and the determinants of medicinal plant consumption at the household level in these countries have not been empirically studied. Quantifying the use of traditional medicine at the household level is, therefore, essential to the development of sustainable healthcare policies in the developing world. This paper quantifies household-level use of traditional medicine and identifies determinants of the choice of traditional treatment in the south central region of Burkina Faso. Structured household interviews (n = 205) were conducted in nine villages of rural Burkina Faso from November 2007 to November 2008 and in November 2009 to collect data on household characteristics (e.g., income, education, demographics), illness frequencies, illness types, and treatment strategies employed. Comprehensive analysis of treatment choice was performed through bivariate analyses. Results indicate that traditional medicine was primarily relied on by middle-aged individuals from relatively uneducated households who were living in villages with limited allopathic medicine service provision. Moreover, a differential approach to medicinal plant consumption was used to distinguish between patients using traditional medicine as a self-care treatment and those visiting a traditional healer. Although poorer households were shown to use traditional medicine as a self-treatment, traditional healers’ services were relied on by wealthier households.     

我国东中西部地区的农村老年人抑郁状况及影响因素

目的 了解我国东中西部农村老年人的抑郁状况及其影响因素。方法 以2013年中国健康与养老追踪调查数据中2 896名65岁及以上的农村老年人为研究对象,采用二分类Logistic回归模型,从社会人口、社会经济、生活方式以及健康状况四个方面探讨东中西部的农村老年人抑郁状况的影响因素。结果 东中西部的农村老年人患抑郁状况的差异有统计学意义（χ²=33.63,P<0.001）,东中西部农村老年人抑郁率分别为24.34%、30.11%、36.77%。东中西部农村老年人的抑郁症状主要受性别、婚姻状况、家庭月均支出、参加社交活动、饮酒、慢性病以及自评健康的影响（均有P<0.05）,有伴侣（OR=0.774,95%CI：0.640~0.936）、中等家庭月均支出（OR=0.797,95%CI：0.651~0.977）、参加社交活动（OR=0.788,95%CI：0.668~0.930）及饮酒（OR=0.789,95%CI：0.649~0.960）为抑郁的保护因素,女性（OR=1.736,95%CI：1.400~2.153）、慢性病（OR=1.328,95%CI：1.091~1.618）及自评健康不良（OR=2.924,95%CI：2.259~3.784）为抑郁的危险因素。结论 防治农村老年人的抑郁,需要注重农村地区老年人的心理干预,加强社会支持。同时还需防治慢性病,全面提高老年人健康水平。     

宁夏儿童青少年BMI腰围与食物消费体力活动的相关性

评价儿童青少年超重肥胖与食物消费、体力活动和社会经济水平的关系,为制定营养教育和干预措施提供依据.方法 采用分层整群抽样方法,选取宁夏南部5个地区义务教育阶段三至九年级2 472名学生为调查对象,进行问卷调查和体格检查.结果 宁夏南部地区儿童青少年按体质量指数(BMI)判断的超重/肥胖率为4.3%,按照腰围(WC)和腰围身高比(WHtR)判断的腹型肥胖率分别为5.4%,10.6%.家庭经济水平、母亲职业、腌制食品摄入频率与儿童青少年BMI有关(P值均<0.05);家庭经济水平,母亲文化程度及职业,肉类食品、膨化食品及腌制食品摄入频率与儿童青少年WC有关(P值均<0.05);母亲职业与儿童青少年WHtR有关(P<0.05).Logistic回归结果显示,家庭经济水平高是BMI,WC增高的危险因素(OR值分别为2.078,2.336,95%CI值分别为1.024~4.250,1.201~4.660,P值均<0.05);母亲职业为职员、公务员和个体是WC,WHtR增高的危险因素(OR值分别为2.115,1.624,95% CI值分别为1.179~3.797,1.039~2.538,P值均<0.05);膨化食品摄入频率高是BMI,WC水平增高的危险因素(OR值分别为1.960,1.618,95%CI值分别为1.208~3.179,1.046~2.505,P值均<0.05);腌制食品摄入频率低者BMI,WC,WHtR均较高(OR值分别为0.348,0.368,0.679,95%CI值分别为0.189~0.640,0.217~0.624,0.473~0.974,P值均<0.05).结论 采用BMI,WC,WHtR判断的儿童青少年肥胖主要与社会经济水平和食物消费有关.     

Associations of adequate intake of calcium with diet, beverage consumption, and demographic characteristics among children and adolescents

OBJECTIVE: The objective of this study is to examine various factors associated with total calcium intake and percent adequate intake (% AI) of calcium by children and adolescents, with respect to age, gender, race/ethnicity, and diet and beverage choices. DESIGN: Data from the U.S. Department of Agriculture's Continuing Survey of Food Intake by Individuals 1994-96, 98 were used in the analyses. Age groupings (2-3, 4-8, 9-13, and 14-18 year olds) were based on the National Academy of Sciences recommendations for AI of calcium-500, 800, 1,300, and 1,300 mg calcium per day, respectively. RESULTS: Consumption of milk products was strongly and positively associated with calcium intake. Consumption of carbonated soft drinks and other non-dairy beverages was also positively associated with calcium intake, but this association was very weak. Beverage choices of African-American children and adolescents are significantly different than white and Hispanic children and adolescents. For example, African-American adolescent girls consume fewer milk products and more fruit drinks/ades. Average daily carbonated soft drink consumption is approximately 1.6 and 1.0 twelve ounce cans among 14-18 year old boys and girls, respectively. CONCLUSION: Carbonated soft drink consumption among adolescent girls is modest and does not appear to be linked to decreased calcium intake. The analyses in this paper show that creative effective, efficient, and targeted policies should be considered to help adolescent girls increase calcium intake. Making low-fat milk products, flavored milks, calcium-fortified beverages and foods more attractive and available will help encourage girls to consume more of this important mineral. When adequate calcium intake is not achieved through foods, health professionals should consider recommending calcium supplements.     

Housing assets and the socio-economic determinants of health and disability in old age

The influence of socio-economic determinants among the elderly is a complex subject. Although they rely on pension income, the wealth that they have accumulated over their lifetime (primarily housing assets), jointly with housing-related determinants, could have a more significant effect on health production. Hence, owning a house has more potential than income for reducing health inequalities. This study makes use of a representative cross-sectional database on the Spanish population aged 55 or over. Using a continuous variable to measure health and a measure of disabilities in old age, the study explores some socio-economic determinants of health and disability and provides a breakdown of inequalities in socio-economic status and in aggregate individual health. The study's findings indicate that housing equity overrides the effect of income as a determinant of health and (absence of) disability in old age. Furthermore, housing assets account for more than 90% of socio-economic inequalities and 54% of inequalities in disability.