Is Economic Inequality in Infant Mortality Higher in Urban Than in Rural India?

This paper examines the trends in economic inequality in infant mortality across urban–rural residence in India over last 14 years. We analysed data from the three successive rounds of the National Family Health Survey conducted in India during 1992–1993, 1998–1999, and 2005–2006. Asset-based household wealth index was used as the economic indicator for the study. Concentration index and pooled logistic regression analysis were applied to measure the extent of economic inequality in infant mortality in urban and rural India. Infant mortality rate differs considerably by urban–rural residence: infant mortality in rural India being substantially higher than that in urban India. The findings suggest that economic inequalities are higher in urban than in rural India in each of the three survey rounds. Pooled logistic regression results suggest that, in urban areas, infant mortality has declined by 22 % in poorest and 43 % in richest. In comparison, the decline is 29 and 32 % respectively in rural India. Economic inequality in infant mortality has widened more in urban than in rural India in the last two decades.     

Urban–Rural Differences in Physical Activity in Belgian Adults and the Importance of Psychosocial Factors

Recent research in urban planning and public health has drawn attention to the associations between urban form and physical activity in adults. Because little is known on the urban–rural differences in physical activity, the main aims of the present study were to examine differences in physical activity between urban and rural adults and to investigate the moderating effects of the physical environment on the relationship between psychosocial factors and physical activity. In Flanders, Belgium, five rural and five urban neighborhoods were selected. A sample of 350 adults (20–65 years of age; 35 adults per neighborhood) participated in the study. Participants wore a pedometer for 7 days, and self-reported physical activity and psychosocial data were also collected. Results showed that urban adults took more steps/day and reported more walking and cycling for transport in the neighborhood, more recreational walking in the neighborhood, and more walking for transportation outside the neighborhood than rural adults. Rural adults reported more recreational cycling in the neighborhoods. The physical environment was a significant moderator of the associations between several psychosocial factors (modeling from family, self-efficacy, and perceived barriers) and physical activity. In rural participants, adults with psychosocial scores above average were more physically active, whereas there were no differences in physical activity according to psychosocial factors in urban participants. These results are promising and plead for the development of multidimensional interventions, targeting specific population subgroups. In rural environments, where changing the environment would be a very challenging task, interventions focusing on modifiable psychosocial constructs could possibly be effective.     

Factors Influencing Nutritional Adequacy among Rural Households in Nigeria: How Does Dietary Diversity Stand among Influencers?

This study examined the influence of food consumption diversity on adequate intakes of food calories, proteins and micronutrients among households in rural Nigeria within the framework of panel data econometrics using a nationally representative data. We found that substantial proportion of households suffered deficiency of calories, proteins and certain micronutrients; with higher percentage of sufferer households occurring in the post-planting season. The different measures of dietary diversity (constructed and used for analysis) consistently indicate significant and positive influence of dietary diversity on the likelihood of adequate consumption of food nutrients. While higher level of income, education and non-farm enterprise engagement may strongly stimulate adequate nutrient intakes, increases in the number of adolescents would substantially diminish it. Although our findings call for renewed attention on diet diverseness, we stress the complementary/synergistic roles of education and rural income improvement, especially through non-farm enterprise diversification in tackling multiple nutritional deficiencies in rural Nigeria.     

Do People Agree on What Foods are Prestigious? Evidence of a Single,Shared Cultural Model of Food in Urban Ethiopia and Rural Brazil

To what extent do people agree on the meaning of foods, and does this vary by socioeconomic status, demographics, or household type? Addressing this question is critical for testing hypotheses about the relationship between food insecurity, food meaning, and mental well-being because it speaks directly to the social implications of food behaviors. In this study, we test for a shared cultural model of food meaning in two diverse settings: urban Ethiopia and rural Brazil. Using freelist and pile sort data from 63 respondents in Ethiopia and 62 from Brazil, we show strong consensus on the prestige value of various key food items in each context. Further, consensus varies little across household composition, food security status, and age and gender. This suggests that, in these two settings, consumption of widely available foods is an act that has both biological and social consequences.     

What are the costs of queuing for hip fracture surgery in Canada?

This paper investigates the effect of wait time for hip fracture surgery in Canada on post-surgery length of stay in hospital and inpatient mortality. After controlling for observed and unobserved patient and hospital characteristics, pre-surgery delay has little effect on either of the two outcome variables. Patients from higher income postal-codes experience only slightly shorter delays, and income has no substantial effect on post-surgery outcomes. For hip fracture patients surgery delay may lead to greater pre-surgery inpatient costs and more patient discomfort, but we find no evidence of a detrimental impact on post-surgery outcomes.     

Contraceptive Method Use by Rural–Urban Residence among Women and Men in the United States, 2006 to 2017

PurposePolicy and reproductive health practice changes in the past decade have affected use of different contraceptive methods, but no study has assessed contraceptive method use over this time by rural–urban residence in the United States.MethodsWe used female and male respondent data (2006–2017) from the National Survey of Family Growth (n = 29,133 women and n = 24,364 men) to estimate contraceptive method use by rural–urban residence over time and contraceptive method use by age, marital status, and parity/number of children.ResultsFrom 2006–2010 to 2013–2017, among urban women, we found increased use of two or more methods (11% to 14%); increased use of intrauterine devices (5% to 11%), implants (0 to 2%), and withdrawal (5 to 8%); and decreased use of sterilization (28% to 22%) and pills (26% to 22%). Among rural women, we found increased use of intrauterine devices (5% to 9%) and implants (1% to 5%). We found increased withdrawal use for urban men, but otherwise no differences among men across time. In data pooled across all survey periods (2006–2017), contraceptive method use varied by rural–urban residence across age, marital status, and parity/number of children.ConclusionsIn a nationally representative sample of reproductive age women and men, we found rural–urban differences in contraceptive method use from 2006–2010 to 2013–2017. Describing contraceptive use differences by rural–urban residence is necessary for tailoring reproductive health services to populations appropriately.     

Factors affecting non-coverage of measles-rubella vaccination among children aged 9–59 months in Tanzania

Globally, measles remains a major cause of child mortality, and rubella is the leading cause of birth defects among all infectious diseases. In 2012, the World Health Assembly endorsed the Global Vaccine Action Plan that set a target to eliminate Measles-Rubella (MR) in five of the six World Health Organization (WHO) regions by 2020. This was cross-sectional study employed both quantitative and qualitative research methods. The sample size was calculated to provide overall, age- and sex-specific coverage estimates for MR vaccine among children aged between 9 and 59 months at the national level. Using desired precision of ±5% with an expected coverage of 95%, a total of 15,235 households were required. The age of children, a child who had received the MR vaccine before the campaign, household wealth quintile, the age of caregivers, and their marital status were associated with non-coverage of MR vaccination among children aged 9–59 months in Tanzania. Nationally, an estimated 88.2% (95% CI: 87.3–89%) of children aged 9–59 months received the MR campaign dose, as assessed by caregivers’ recall. These estimates revealed slightly higher coverage in Zanzibar 89.6% (95% CI: 84.7–93%) compared to Mainland Tanzania 88.1% (95% CI 87.2–88.9%). These associated factors revealed causes of unvaccinated children and may be some of the reasons for Tanzania’s failure to meet the MR campaign target of 95 percent vaccination coverage. Thus, vaccine development must increase programmatic oversight in order to improve immunization activities and communication strategies in Tanzanian areas with low MR coverage.     

What Support Systems do Women Caring for Preterm Infants at Home Require in Urban Ghana? A Qualitative Study

Maternal and Child Health Journal - Caring for preterm infants and ensuring their survival beyond neonatal intensive care units remain a challenge in many low-income settings. While studies...     

Prevalence of Women’s Sexual Desire Problems: What Criteria Do We Use?

Problems of sexual desire are often cited as the most prevalent of the female sexual dysfunctions. Despite this finding, considerable variability exists when comparing prevalence figures across studies, highlighting the inconsistency in how these problems are defined and therefore measured. The current study was designed to determine how the prevalence estimates of women’s sexual desire problems varied according to the diagnostic criteria adopted to define such problems. The sample consisted of 741 women from Australia, the Americas, Europe, and Asia. Participants were between 18 and 71 years of age and were involved in a heterosexual relationship spanning between 3 months and 49 years duration. Sexual desire problems were defined using a variety of criteria, including (1) meeting DSM-IV-TR criteria for Hypoactive Sexual Desire Disorder (HSDD), (2) meeting DSM-IV-TR criteria for HSDD, removing the sexual thoughts/fantasy requirement, (3) self-identified “lack of sexual interest,” and (4) low average ratings of sexual desire levels, as assessed using the Female Sexual Desire Questionnaire. The prevalence of sexual desire problems varied from 3.0 to 31.0 % depending upon the criteria used to define such problems. It is important to reach a consensus with regard to the criteria used to define sexual desire problems, in order to standardize and compare studies investigating these problems. How women’s sexual desire problems are conceptualized has implications for their treatment. Therapists may or may not need to address absent sexual thoughts/fantasies and may be working with low normative levels of desire versus subjective evaluations of low desire.     

“Women’s Bodies are Shops”: Beliefs About Transactional Sex and Implications for Understanding Gender Power and HIV Prevention in Tanzania

Although transactional sex has been linked to undesirable sexual health outcomes, there is a lack of clarity as to the meaning of the practice, which appears to extend beyond behaviors related to women’s economic circumstances. This article explored the perspectives of parents and unmarried young people on motivations for, and beliefs about, transactional sex in rural Tanzania using an ethnographic research design. Data collection involved 17 focus groups and 46 in-depth interviews with young people aged 14–24 years and parents/caregivers. Transactional sex was widely accepted by both parents and young people. Male parents equated sexual exchange to buying meat from a butcher and interpreted women’s demand for exchange before sex with personal power. Young men referred to transactional sex as the easiest way to get a woman to satisfy their sexual desires while also proving their masculinity. Young women perceived themselves as lucky to be created women as they could exploit their sexuality for pleasure and material gain. They felt men were stupid for paying for “goods” (vagina) they could not take away. Mothers were in agreement with their daughters. Although young women saw exploitation of the female body in positive terms, they were also aware of the health risks but ascribed these to bad luck. Interventions aimed at tackling transactional sex in the interests of women’s empowerment and as a strategy for HIV prevention need to understand the cultural beliefs associated with the practice that may make it thrive despite the known risks.     

Prevalence of HCV Infection Among Clients in Community-Based Health Settings in Hawaii, 2002–2010: Assessing Risk Factors

Objectives. We sought to determine the prevalence of HCV infection and identify risk factors associated with HCV infection among at-risk clients presenting to community-based health settings in Hawaii.Methods. Clients from 23 community-based sites were administered risk factor questionnaires and screened for HCV antibodies from December 2002 through May 2010. We performed univariate and multivariate logistic regression analyses.Results. Of 3306 participants included in the analysis, 390 (11.8%) tested antibody positive for HCV. Highest HCV antibody prevalence (17.0%) was in persons 45 to 64 years old compared with all other age groups. Significant independent risk factors were current or prior injection drug use (P < .001), blood transfusion prior to July 1992 (P = .002), and having an HCV-infected sex partner (P = .03). Stratification by gender revealed sexual exposure to be significant for males (P = .001).Conclusions. Despite Hawaii’s ethnic diversity, high hepatocellular carcinoma incidence, and a statewide syringe exchange program in place since the early 1990s, our HCV prevalence and risk factor findings are remarkably consistent with those reported from the mainland United States. Hence, effective interventions identified from US mainland population studies should be generalizable to Hawaii.Hepatitis C is the most prevalent chronic blood-borne viral infection in the United States, with an estimated 1.3% of the population chronically infected.1 Chronic HCV infection is often asymptomatic; approximately 75% of infected persons may be unaware that they are infected.2 Transmission is mainly through direct blood-to-blood contact, and the most common risk factor in the United States is the sharing of injection drug use equipment.1,2 Complications from HCV infection include cirrhosis, hepatocellular carcinoma (HCC), and end-stage liver disease; more than one third of liver transplants in the United States can be attributed to HCV.3 There is currently no vaccine,4 and until recently, standard therapy with pegylated interferon and ribavirin achieved a sustained virologic response in only 40% to 50% of patients.5,6In May 2011, the US Food and Drug Administration approved 2 new HCV-specific protease inhibitors for the treatment of chronic genotype 1 HCV infections: boceprevir7,8 and telaprevir.9,10 In combination with standard therapy, these drugs have achieved significantly higher rates of sustained virologic response: up to 67% to 75%.7,10 Achieving sustained virologic response is key to reducing mortality, HCC, and other comorbidities.11,12 With such a large percentage of HCV-infected individuals unaware of their status and new successful treatments available, there is now increased rationale for health providers to screen their clients for chronic HCV infection.The population of Hawaii differs from that of the mainland United States on a number of key factors related to HCV and HCC. Hawaii has the highest incidence of HCC nationally.13 Asian/Pacific Islanders have the highest incidence of HCC in the United States,13 and 57% of the Hawaii’s population is Asian, either alone or in combination with other ethnic groups.14 The high HCC incidence among Asian/Pacific Islanders is attributed in large part to chronic hepatitis B virus (HBV) infection,13,15 and the identification and treatment of persons with chronic HBV or HCV infection is an important public health priority in Hawaii. In addition, Hawaii implemented a statewide syringe exchange program in the early 1990s, the first state to do so.16 The risk factor demonstrating the strongest association with HCV infection in the United States is injection drug use,1,17 and syringe exchange programs have demonstrated efficacy in reducing HCV infection among injection drug users.18,19To our knowledge, only 3 HCV prevalence studies have been conducted in Hawaii; however, each focused on a specific well-defined subgroup population: patients with HCC,20 HIV-infected persons enrolled in a state drug assistance plan,21 and adults from a homeless shelter.22The Adult Viral Hepatitis Prevention Program of the Hawaii State Department of Health, which offers risk-based HCV antibody testing based on reported national risk factors,1,23 has been collecting data on persons undergoing screening since 2002. We investigated the prevalence of HCV antibody positivity among at-risk clients of community-based health programs in Hawaii and identified demographic characteristics and independent risk factors associated with HCV infection.     

An Implication of Health Sector Reform for Disadvantaged Women's Struggle for Birth Control: A Case of Kurdish Rural–Urban Migrant Women in Van,Turkey

In this article, we examine how socioeconomically disadvantaged women are affected by health sector reform and family planning policy changes in Turkey through a case study of Kurdish women's struggles for birth control. In Turkey, a family planning program became relatively marginalized in primary health care services as a result of health sector reform as well as a shift of population policy toward a moderately pronatal approach. We argue that an emerging health care system would leave disadvantaged women unable to benefit from contraceptives and would perpetuate reproductive health inequalities between women in the country.     

What Factors Explain Disparities in Mammography Rates Among Asian-American Immigrant Women? A Population-Based Study in California

BackgroundThe purpose of this study was to compare rates of screening mammography among immigrant women in five Asian-American ethnic groups in California, and ascertain the extent to which differences in mammography rates among these groups are attributable to differences in known correlates of cancer screening.MethodsUsing 2009 data from the California Health Interview Survey, we compared the rates of mammography among Chinese, Filipino, Japanese, Korean, and Vietnamese immigrants 40 years and older. To assess the impact of Asian ethnicity on participation in screening, we performed multiple logistic regression analysis with models that progressively adjusted for acculturation, sociodemographic characteristics, access to health care, and breast cancer risk factors, and examined the predicted probabilities of screening after adjusting for these factors.FindingsParticipation in screening mammography differed according to ethnicity, with Filipina and Vietnamese Americans having the highest rates and Korean Americans having the lowest rates of lifetime and recent (past 2 years) screening. These differences decreased substantially after adjusting for acculturation, sociodemographic factors, and risk factors of breast cancer, but differences remained, most notably for Korean Americans, who continued to have the lowest predicted probability of screening even after adjustment for these factors.ConclusionsThis analysis draws attention to low mammography screening rates among Asian-American immigrants, especially recent immigrants who lack health insurance. Given that their breast cancer incidence is rising with length of stay in the United States, it is important to increase regular mammography screening in these groups.