Determinants of infant mortality in Pakistan: evidence from Pakistan Demographic and Health Survey 2017–18

Journal of Public Health - The infant mortality rate was very high in Pakistan until the early 1990s, at 86 deaths/1000 live births. It has decreased 24 points and declined to 62 deaths/1000 in the...     

Under-Five Child Mortality and Morbidity Associated with Consanguineous Child Marriage in Pakistan: Retrospective Analysis using Pakistan Demographic and Health Surveys, 1990–91, 2006–07, 2012–13

Objective To assess the combined effect of consanguineous and child marriages (CCM) on children health, which has not previously been explored, either globally or locally. Methods We analyzed secondary data from a series of cross-sectional, nationally representative Pakistan Demographic and Health Surveys 1990–91, 2006–07, and 2012–13. A total of 5406 mothers with 10,164 children were included in the analysis. Child health was assessed by variables such as history of diarrhea, acute respiratory infection (ARI), ARI with fever, Under-5 child mortality (U5CM) and small-size birth (SSB). Associations among variables were assessed by calculating unadjusted Odd Ratios (OR) and adjusted OR (AOR). Results A majority (n?=?6,247, 61%) of the births were to mothers having CCM as compare to non-CCM (3917, 39%). There was a significant association between CCM and U5CM during 1990–91 (AOR 1.24, 95% CI 1.03–1.49) and 2006–07 (AOR 1.25, 95% CI 1.05–1.51), and infant mortality in 1990–91 (AOR 1.39, 95% CI 1.05–1.85) and 2006–07 (AOR 1.61, 95% CI 1.17–2.21). A significant association was also found between CCM and SSB infants in the period 2006–07 (AOR 1.19, 95% CI 1.01–1.42) and 2012–13 (AOR 1.22, 95% CI 1.02–1.46). We noted no effect of CCM on diarrhea, ARI, and ARI with fever. Conclusion CCM increases the likelihood of U5CM, infant mortality and SSB infants. Further quantitative and qualitative research should be conducted to assess the effects of environmental, congenital and genetic factors on the health of children born to mothers in CCM.     

Factors Associated with Exclusive Breastfeeding in Timor-Leste: Findings from Demographic and Health Survey 2009–2010

Exclusive breastfeeding is known to have nutritional and health benefits. This study investigated factors associated with exclusive breastfeeding among infants aged five months or less in Timor-Leste. The latest data from the national Demographic and Health Survey 2009–2010 were analyzed by binary logistic regression. Of the 975 infants included in the study, overall 49% (95% confidence interval 45.4% to 52.7%) were exclusively breastfed. The exclusive breastfeeding prevalence declined with increasing infant age, from 68.0% at less than one month to 24.9% at five months. Increasing infant age, mothers with a paid occupation, who perceived their newborn as non-average size, and residence in the capital city Dili, were associated with a lower likelihood of exclusive breastfeeding. On the other hand, women who could decide health-related matters tended to breastfeed exclusively, which was not the case for others whose decisions were made by someone else. The results suggested the need of breastfeeding promotion programs to improve the exclusive breastfeeding rate. Antenatal counseling, peer support network, and home visits by health workers could be feasible options to promote exclusive breastfeeding given that the majority of births occur at home.     

Temporal Trends in Phthalate Exposures: Findings from the National Health and Nutrition Examination Survey, 2001–2010

Background: Phthalates are ubiquitous environmental contaminants. Because of potential adverse effects on human health, butylbenzyl phthalate [BBzP; metabolite, monobenzyl phthalate (MBzP)], di-n-butyl phthalate [DnBP; metabolite, mono-n-butyl phthalate (MnBP)], and di(2-ethylhexyl) phthalate (DEHP) are being replaced by substitutes including other phthalates; however, little is known about consequent trends in population-level exposures.Objective: We examined temporal trends in urinary concentrations of phthalate metabolites in the general U.S. population and whether trends vary by sociodemographic characteristics.Methods: We combined data on 11 phthalate metabolites for 11,071 participants from five cycles of the National Health and Nutrition Examination Survey (2001–2010). Percent changes and least square geometric means (LSGMs) were calculated from multivariate regression models.Results: LSGM concentrations of monoethyl phthalate, MnBP, MBzP, and ΣDEHP metabolites decreased between 2001–2002 and 2009–2010 [percent change (95% CI): –42% (–49, –34); –17% (–23, –9); –32% (–39, –23) and –37% (–46, –26), respectively]. In contrast, LSGM concentrations of monoisobutyl phthalate, mono(3-carboxypropyl) phthalate (MCPP), monocarboxyoctyl phthalate, and monocarboxynonyl phthalate (MCNP) increased over the study period [percent change (95% CI): 206% (178, 236); 25% (8, 45); 149% (102, 207); and 15% (1, 30), respectively]. Trends varied by subpopulations for certain phthalates. For example, LSGM concentrations of ΣDEHP metabolites, MCPP, and MCNP were higher in children than adults, but the gap between groups narrowed over time (p_interaction < 0.01).Conclusions: Exposure of the U.S. population to phthalates has changed in the last decade. Data gaps make it difficult to explain trends, but legislative activity and advocacy campaigns by nongovernmental organizations may play a role in changing trends.Citation: Zota AZ, Calafat AM, Woodruff TJ. 2014. Temporal trends in phthalate exposures: findings from the National Health and Nutrition Examination Survey, 2001–2010. Environ Health Perspect 122:235–241; http://dx.doi.org/10.1289/ehp.1306681     

Relationship between Diet Quality,Physical Activity and Health-Related Quality of Life in Older Adults: Findings from 2007–2014 National Health and Nutrition Examination Survey

Background

A growing body of research shows that diet quality and physical activity (PA) are associated with health-related quality of life (HRQOL). However, no study to date has assessed this association using the Healthy Eating Index-2015 as a measure of diet quality. Furthermore, few studies have examined the association between PA dose and HRQOL among a nationally representative sample of older adults. Objectives: To investigate the relationship between diet quality, physical activity, and HRQOL.

Objectives

To investigate the relationship between diet quality, physical activity, and HRQOL.

Design

A cross-sectional analysis was conducted using data obtained from 5,311 adults aged 60+ years who took part in the National Health and Nutrition Examination Survey between 2007 and 2014.

Measurements

HRQOL was assessed by general health status, and number of physically unhealthy days, mentally unhealthy days, and inactive days in past 30 days. Diet quality was assessed by the Healthy Eating Index-2015 using data generated by two 24-hour dietary recalls. PA was measured by the Global Physical Activity Questionnaire. Multivariate logistic/or linear regression models were used to examine the association between diet quality, PA and HRQOL controlling for confounders and accounting for complex sampling.

Results

Approximately half of the participants (55.2%) were women, 45.1% met current PA recommendations, 65% had less healthful diets according to the Healthy Eating Index-2015. Diet quality was associated with HROQL. For every 1-point diet quality score increase, the likelihood of respondents rating their general health as being excellent/good increased by 3% (OR=1.03, 95%CI: 1.02, 1.04), and number of inactive days (β =-0.03, 95%CI: -0.05, 0.00) and mental unhealthy days (β =-0.03, 95%CI: -0.05, -0.01) declined by 0.03 days. PA was associated with all HROQL measures and respondents with high PA levels reported better general health (OR=3.53, 95%CI: 2.69, 4.63), fewer inactive days (β =-1.53, 95%CI: -2.11, -0.95), fewer physical unhealthy days (β =-1.88, 95%CI: -2.74, -1.02) than individuals with low PA levels but not fewer mentally unhealthy days.

Conclusion

Among older adults in this study, eating a healthier diet and being physically active were associated with better general health and reporting fewer physical unhealthy days and inactive days. Study results provide valuable information that could inform policies, programs and interventions designed to improve HRQOL in older adults and reduce potentially preventable health disparities.

     

Women’s Decision-Making Autonomy and their Attitude towards Wife-Beating: Findings from the 2011 Ethiopia’s Demographic and Health Survey

The study examined the extent of wife-beating acceptance and factors that influence women’s attitude towards wife-beating in Ethiopia from a nationally representative sample of 11,658 participants in the 2011 Ethiopian Demographic and Health Survey. Multivariate logistic regressions were fitted to investigate the relationships between women’s attitude towards wife-beating and women’s decision-making autonomy after controlling for socio-demographic factors. The majority (56%) of women agreed that wife-beating is justified when wife neglects children, 53% when wife burns the food, 50% when wife argues with husband, 48% when wife goes out without telling husband, and nearly 45% when wife refuses to have sex with husband. Overall, 51% of women had shown highly favorable attitude towards wife-beating. Women’s place of residence, household wealth quintiles, educational levels, marital status, and husband/partner’s employment status have shown significant association with women’s attitude towards wife-beating. Women’s decision-making autonomy was also a significant predictor of women’s attitude towards wife-beating. The odds of having highly favorable attitude towards wife-beating deceased significantly as the level of decision-making autonomy of women improved. Given the widespread acceptance of wife-beating among Ethiopian women, social policies that empower women could serve as a positive force in changing attitudes towards wife-beating and violence against women.     

Associates of Neonatal,Infant and Child Mortality in the Islamic Republic of Pakistan: A Multilevel Analysis Using the 2012–2013 Demographic and Health Surveys

Objectives Pakistan is one of five nations contributing to half of the world’s child mortality and holds under-five mortality rates which are nearly double global targets. Reasons for this shortfall include civil conflicts, political uncertainty, low education, poverty, rural–urban disparities, and limited health care access. The aim of this study was to explore associations between individual characteristics, community factors, and child mortality in Pakistan. Methods Data were derived from the 2012 to 2013 Pakistan Demographic and Health Survey, and included 7399 live births and 380 child deaths. Multivariate, multilevel logistic regression was used to model risk of neonatal, infant and under-five child deaths. Results Seventy-one percent of child deaths occurred during the neonatal period. Significant factors (p < 0.05) associated with lower odds of child mortality included adhering to recommended minimum of 24 months interpregnancy interval and higher household wealth. These were significant for neonatal (OR 0.448; 0.871), infancy (OR 0.465; 0.881), and under-five deaths (OR 0.465; 0.879). Employed mothers had higher odds of neonatal (OR 1.479), infant (OR 1.506), and child mortality (OR 1.459). Likewise, women living in consanguineous marriages had higher odds of infant (OR 1.454) and under-five deaths (OR 1.381). Children in Balochistan, Punjab, and Sindh, regions disproportionately poor, rural with low levels of education, were at highest risk of dying. Conclusions for Practice Findings may assist in designing targeted interventions, developing appropriate public health messaging, and implementing policies designed to lower child mortality. Focusing on lowering rates of maternal poverty, increasing opportunities for education, and improving access to health care could assist in reducing child mortality in Pakistan.     

Metabolic syndrome and socioeconomic status in France: The French Nutrition and Health Survey (ENNS, 2006–2007)

Objectives

The main objective was to estimate, in France, the prevalence of metabolic syndrome (MetS) and to investigate the association between socioeconomic position and MetS.

Methods

The French National Nutrition and Health Survey (ENNS) cross-sectional national multistage sampling was carried out in 2006–2007. Data collection included waist circumference and blood pressure measurements, blood sample and sociodemographic and medication information. The prevalence of MetS was assessed using several definitions, including Joint Interim Statement (JIS). Association with sociodemographic covariates was assessed using logistic regression models.

Results

Among the 1,856 participants 18–74 years of age, MetS prevalence was found to vary from 14.6 % (National Cholesterol Education Program definition) to 21.1 % (JIS), with no difference between genders. After adjustment, risk of MetS increased with age in both men and women. In women, MetS risk was inversely associated with education level. Risk of MetS was higher in men born outside France than in French-born males.

Conclusions

MetS prevalence appeared to be lower in France than in most industrialised countries. The promoting of public health measures to reduce MetS, for example, lifestyle changes, is of utmost importance, particularly among less favourable socioeconomic categories and among migrants.     

Human papillomavirus vaccine uptake among males 11–26 years in United States: Findings from the National Health and Nutrition Examination Survey, 2011–2012

Anogenital human papillomavirus (HPV) infection is the leading sexually transmitted infection in the United States. In October 2011, the quadrivalent HPV vaccine (HPV4) was recommended for males in the U.S. We analyzed a subsample of 11–26 year old (N = 1012) males, from the National Health and Nutritional Examination Survey 2011–2012 dataset, to examine HPV vaccine uptake. The initiation rates in the 11–17 years and the 18–26 years age-groups were 10.7% (95% confidence interval (CI): 8.09–16.6%) and 5.5% (95%CI: 3.1–9.5%) respectively. The corresponding HPV vaccine completion rates were 39.3% (16.7–67.7%) for the 11–17 year old males and 59.1% (37.2–77.6) for the 18–26-year-old males. Despite a slight increase, HPV vaccine uptake remained low among males. These findings can help in HPV vaccination policy in the United States, with a focus on informational messages directed toward young males and their parents in order to increase uptake of HPV vaccine.     

Dietary Intakes of Preschool-Aged Children in Relation to Caregivers’ Race/Ethnicity, Acculturation, and Demographic Characteristics: Results from the 2007 California Health Interview Survey

Few studies have examined the influence of acculturation on dietary behaviors of young children while controlling for other demographic variables. The purpose of this study was to assess reported dietary intakes of preschool-aged children (3?C5?years) and subsequent associations with caregivers?? race/ethnicity, acculturation and demographic characteristics, using data from the 2007 California Health Interview Survey (CHIS). Analysis was restricted to Hispanic and non-Hispanic white caregivers and their preschool-aged children (n?=?1,105). Caregivers?? acculturation was assessed using place of birth, duration of United States residence, and language spoken at home. Proxy-reports by caregivers to a dietary screener were used to estimate children??s intakes of fruit, 100% fruit juice, vegetables, sweets, and sugar-sweetened beverages consumed. In multivariate analyses, Hispanic caregivers reported their children consumed fewer servings of vegetables than did the children of non-Hispanic white caregivers; there were no other statistically significant differences in children??s dietary intakes by caregivers?? race/ethnicity. Caregivers?? acculturation was associated with caregiver-reported consumption of sweets by children (???=?0.09, 95%CI?=?0.01?C0.18). Demographic characteristics that were associated with reported dietary intakes of children included caregivers?? age, education, and geographic region of residence. In contrast to past studies of acculturation and diet in older children and adults, this study suggests that for 3?C5?year olds, caregivers?? level of acculturation does not play as strong a role in the dietary intakes of the younger children under their care.     

Weight and Mental Health Status in Massachusetts,National Survey of Children’s Health, 2007

This study explores how weight status is related to mental health status among Massachusetts children, aged 10–17 years. We used data from the 2007 National Survey of Children’s Health to examine the association between weight status (body mass index-for-age) and parent-reported mental health status among Massachusetts children (N = 827). Multivariable log binomial regression was performed to calculate the adjusted prevalence ratios (aPR) of three mental health outcomes (behavioral, emotional, and social) as related to weight status, after controlling for covariates including physical activity, sex, race/ethnicity, maternal education, poverty status, special health needs, and neighborhood safety. Almost one-third (32.5 %) of Massachusetts children were either overweight or obese. Sex was a significant effect modifier of the association between weight status and negative emotions. After stratifying by sex and controlling for covariates, the relationship between weight status and negative emotions remained significant among girls (aPR = 1.8, 95 % CI 1.3–2.6). Children who did not exercise at all were significantly more likely to exhibit negative behaviors (aPR = 1.3, 95 % CI 1.0–1.6), negative emotions (boys’ aPR = 3.3, 95 % CI 1.6–6.9; girls’ aPR = 2.6, 95 % CI 1.5–4.5), and fewer social skills (aPR = 1.9, 95 % CI 1.3–2.9) than those who exercised at least 20 min every day of the week. Overweight/obese children, especially girls, were more likely than children of normal weight to have parent-reported negative emotions, suggesting an association between weight status and mental health. Lower levels of physical activity were associated with negative mental health outcomes, supporting the benefits of physical activity for all children.     

Oral Health Need and Access to Dental Services: Evidence from the National Survey of Children’s Health, 2007

This study examines associations between parents’ report of their children’s oral health and receipt of a dental visit for preventive care. We conducted a cross-sectional analysis of oral health status and receipt of a preventive dental visit among US children and youth, ages 1–17 years, using data from the 2007 National Survey of Children’s Health (n = 86,764). Survey-weighted logistic regression was used to estimate associations between perceived oral health status and receipt of a preventive dental health visit in the prior 12 months. Overall, 78 % of children and youth received at least one preventive dental health visit in the prior year. Among the youngest children, lower oral health status was associated with higher odds of receiving a preventive dental visit; among older children, lower oral health status was associated with lower odds of receiving a dental visit for preventive care. Use of preventive dental health care is below national target goals. Younger children in worse oral health are more likely, and older youth less likely, to receive preventive dental care. Public health efforts to educate parents to seek early and ongoing preventive oral health care, rather than services in response to problems, may yield oral health benefits later in childhood and over the life course.     

Social inequalities in vaccination uptake among children aged 0–59 months living in Madagascar: An analysis of Demographic and Health Survey data from 2008 to 2009

Background

Socioeconomic inequalities in vaccination can reduce the ability and efficiency of global efforts to reduce the burden of disease. Vaccination is particularly critical because the poorest children are often at the greatest risk of contracting preventable infectious diseases, and unvaccinated children may be clustered geographically, jeopardizing herd immunity. Without herd immunity, these children are at even greater risk of contracting disease and social inequalities in associated morbidity and mortality are amplified.

Methods

Data on vaccination for children under five came from the most recent Demographic and Health Survey in Madagascar (2008–2009). Vaccination status was available for diptheria, pertussis, tetanus, hepatitis B, measles, tuberculosis, poliomyelitis, and H. influenza type-B. Multilevel logistic regression was used to analyze childhood vaccination by parental socioeconomic status while accounting for shared district, cluster, and household variation. Maps were created to serve as a roadmap for efforts to increase vaccination.

Findings

Geographic variation in vaccination rates was substantial. Districts that were less covered were near other districts with limited coverage. Most districts lacked herd immunity for diphtheria, pertussis, poliomyelitis and measles. Full herd immunity was reached in a small number of districts clustered near the capital. While within-district variation in coverage was substantial; parental education and wealth were independently associated with vaccination.

Interpretation

Socioeconomic inequalities in vaccination reduce herd immunity and perpetuate inequalities by allowing infectious diseases to disproportionately affect the most vulnerable populations. Findings indicated that most districts had low immunization coverage rates and unvaccinated children were geographically clustered. The result was inequalities in vaccination and reduced herd immunity. To further improve coverage, interventions must take a multilevel approach that focuses on both supply- and demand-side barriers to delivering vaccination to underserved regions, and to the poorest children in those regions.     

Factors Affecting Delivery Health Service Satisfaction of Women and Fear of COVID− 19: Implications for Maternal and Child Health in Pakistan

Maternal and Child Health Journal - High maternal and neonatal mortality rates in developing regions like Pakistan are linked to low rates of institutional deliveries. One way to improve rates of...     

Sexual Minority Health Disparities in Adult Men and Women in the United States: National Health and Nutrition Examination Survey, 2001–2010

Objectives. We used nationally representative data to investigate health disparities associated with sexual minority status among adults in the United States.Methods. We analyzed data from 11 114 adults who participated in the 2001 to 2010 waves of the National Health and Nutrition Examination Survey. Using multiple logistic regressions, we examined the prevalence of HIV, sexually transmitted infections, mental health problems, cigarette smoking, and alcohol and illicit drug use in sexual minorities and heterosexual adults.Results. After adjusting for sociodemographic characteristics, sexual minority men had greater odds of mental health problems, testing positive for HIV and herpes simplex virus type 2 and self-reported gonorrhea and chlamydia. Sexual minority women had greater odds of mental health problems, testing positive for hepatitis C, smoking, heavy drinking, and illicit drug use.Conclusions. Numerous health disparities continue to face sexual minority men and women in the United States. Notably, health disparities persisted beyond the role of sociodemographic factors, including access to insurance and primary care, suggesting that further research is warranted to identify the determinants of health inequity for sexual minorities.A recently published and widely cited report by the Institute of Medicine called for the greater prioritization of research on the health of sexual minorities (i.e., individuals who identify as lesbian, gay, bisexual, or nonheterosexual) in the United States.1 Although this seminal review demonstrated that much progress has been made in documenting sexual minority health disparities and elucidating their determinants, the Institute of Medicine committee noted a number of critical research challenges. For example, most empirical literature that examines sexual minority health has been conducted using convenience samples and local studies. To inform, implement, and achieve coordinated public health responses at the national level, the report recommended increased attention to and investigation of the health of sexual minority populations from nationally representative data.Despite the paucity of population-based sexual minority research, accumulated data from nonprobability samples provide evidence of health disparities between sexual minority and heterosexual populations in the United States. For example, sentinel surveillance data reported by the Centers for Disease Control and Prevention illustrated that the rates of chlamydia, gonorrhea, herpes, and genital warts infections have increased in previous years, with gay, bisexual, and other men who have sex with men experiencing the largest spike in cases.2 Recent data also indicated that human papillomavirus (HPV) infections account for most incident and prevalent sexually transmitted infections (STIs) for both men and women in the United States.3 In addition to the established increased risk of STIs and HIV among sexual minority men,1,4,5 observational studies have also demonstrated higher rates of STIs among women who have sex with women compared with women who have sex with men only.6–8 Notably, gender differences in STIs have also been observed among samples of heterosexual adults. Although most studies suggest that men have a higher incidence of most STIs than women,9,10 1 study found that women were more likely to have herpes simplex virus type 2 (HSV-2) compared with men.11 As such, it stands to reason that there may be important differences in STI rates by both sexual orientation and biological gender.An increased risk of mental health problems, hazardous alcohol use, and illicit drug use among sexual minority populations has also been found in previous research. Studies using probability sampling have documented disparities by sexual minority status in the prevalence of psychiatric disorders,12–15 tobacco use,16 drug use,17 health care access,17,18 violence and victimization,17 and chronic disease risk, including cardiovascular risk, asthma, and obesity.19,20 With few exceptions, a limited number of population-based health studies have explicitly examined variability within sexual minority populations, as many single-state or single-wave population studies lack sufficient sample size to examine differences by key sociodemographics such as gender.17To examine sexual minority health disparities at the national level, we analyzed data from the 2001 to 2010 waves of the National Health and Nutrition Examination Survey (NHANES), a nationally representative sample of civilian, noninstitutionalized populations in the United States.21 Given the accumulating evidence for variability in health outcomes within sexual minority populations, we sought to describe trends separately for sexual minority men and sexual minority women compared with their heterosexual counterparts. Specifically, our aims were to utilize the NHANES to (1) investigate the prevalence of 5 of the most commonly reported STIs—gonorrhea, chlamydia, HSV-2, HIV, and HPV (as measured by reports of genital warts)—using a combination of biomarker and self-reported data; (2) assess prevalence of mental health and health behaviors, including number of poor mental health days, smoking, heavy drinking, and illicit drug use; and (3) examine disparities in health indicators between sexual minority men versus heterosexual men and sexual minority women versus heterosexual women.