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Background: Vitamin A deficiency is a common form of micronutrient malnutrition. The estimated relative risks associated with vitamin A deficiency in children were 1.86 (95% CI 1.32–2.59) for measles mortality, 2.15 (95% CI 1.83–2.58) for diarrhoea mortality, 1.78 (95% CI 1.43–2.19) for malaria mortality, 1.13 (95% CI 1.01–1.32) for other infectious disease mortality. Vitamin A supplementation reduces night blindness, child morbidity and mortality.Methods: This paper tries to explore the socio-demographic causes of receipt of vitamin A in selected lower-middle-income and low income countries by analysing the data of the demographic and health surveys from 2012 and 2016 using PASW 18.0 software. Multivariate binary logistic regressions were conducted to explore the role of socio-demographic covariates in the receipt of vitamin A supplementation. In addition, random forest (RF) analyses were conducted using Python 3.6.Results: After adjusting for related socio-economic and demographic factors, mother’s work status and education and among mass media channels, exposure to television seems to play an important role in predicting receipt of vitamin A in the selected countries in Asia, while education of the mother was significantly associated with the receipt of vitamin A in the selected countries of Africa. In all the selected countries, the RF analyses revealed mother’s education followed by wealth index and mass media (TV), as the variable of most importance.Conclusions: It can be concluded that mother’s education and mass media seems to be working well in making the mothers aware about the vitamin A campaign, especially, the exposure to television. It also figures in the variable importance matrix in addition to wealth index.
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Introduction: Child’s birth weight (BW) is an important aspect not only during childhood but also affects morbidity and mortality in adulthood. The focus of this study is to examine the role of different socioeconomic factors, along with women’s decision-making autonomy on the determination of infant BW. Methods: The dataset was obtained from the National Family Health Survey, India (2005-06). The respondents were women of reproductive age (15-49 years) having at least one living child at least five years old preceding the survey. This study considered only the last single live birth child having a recorded BW at the time of delivery. Results: The results showed that 19% of the infants were born with low birth weight (LBW) with regional variations ranging from 13% to 27%. The mean BW of infants of mothers from high autonomy category was 2.90±0.645 kg, while that of mothers with low autonomy was 2.75±0.702 kg. The proportion of LBW infants was significantly higher among mothers with low education, short stature, low BMI and poor wealth index category. Percentage of LBW infants were lower among mothers with autonomy including taking care of their own health (18% versus 21% who were not), making large purchases (17% vs 22%), visiting relatives (18% vs 22%), and allowed to go to the market (18% vs 22%). Conclusion: The findings indicated that the mother’s freedom of movement and financial independence were significantly associated with infant’s BW in India. Attention should be given to improving the socio-economic conditions and empowerment of Indian women.
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The third National Family Health Survey (NFHS-3) is a large dataset on indicators of family welfare, maternal and child health, and nutrition in India. This article using NFHS-3 data is an attempt to bring out the impact of economic status, i.e., the wealth index on maternal health. The study was based on an analysis of the NFHS-3 data. Independent variables taken were the wealth index, literacy, and age at first child birth. Effects of these variables on the maternal health care services were investigated. Out of the total 124,385 women aged 15-49 years included in the NFHS-3 dataset, 36,850 (29.6%) had one or more childbirth during the past 5 years. The number of antenatal care (ANC) visits increased as the wealth index increased and there was a pattern for choice of place of delivery (for all deliveries during the last 5 years) according to the wealth index. Logistic regression analysis of the abovementioned variables were sought to find out the independent role of key determinants of the different aspects of maternal health care. It showed that the wealth index is the leading key independent determinant for three or more ANC received: Tetanus toxoid (TT) received before delivery, iron tablet/syrup taken for more than 100 days, and institutional delivery. Mother's literacy was the leading independent key determinant for early antenatal registration. The study suggested that along with the mother's literacy, the wealth index that is an important predictor of maternal health care can be added for categorization of the districts for providing differential approach for maternal health care services.
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Background & objectives: An increase in prevalence of hypertension has been observed in all ethnic groups in India. The objective of the present study was to estimate prevalence and determinants of hypertension among tribals and their awareness, treatment practices and risk behaviours in nine States of India. Methods: A community based cross-sectional study adopting multistage random sampling procedure was carried out. About 120 Integrated Tribal Development Authority villages were selected randomly from each State. From each village, 40 households were covered randomly. All men and women ≥ 20 yr of age in the selected households were included for various investigations. Results: A total of 21141 men and 26260 women participated in the study. The prevalence of hypertension after age adjustment was 27.1 and 26.4 per cent among men and women, respectively. it was higher in the states of Odisha (50-54.4%) and Kerala (36.7-45%) and lowest in Gujarat (7-11.5%). The risk of hypertension was 6-8 times higher in elderly people and 2-3 times in 35-59 yr compared with 20-34 yr. Only <10 per cent of men and women were known hypertensives and more than half on treatment (55-68%). Men with general and abdominal obesity were at 1.69 (CI: 1.43-2.01) and 2.42 (CI: 2.01-2.91) times higher risk of hypertension, respectively, while it was 2.03 (CI=1.77-2.33) and 2.35 (CI 2.12-2.60) times higher in women. Those using tobacco and consuming alcohol were at a higher risk of hypertension compared with the non users. Interpretation & conclusions: The study revealed high prevalence of hypertension among tribals in India. Age, literacy, physical activity, consumption of tobacco, alcohol and obesity were significantly associated with hypertension. Awareness and knowledge about hypertension and health seeking behaviour were low. Appropriate intervention strategies need to be adopted to increase awareness and treatment practices of hypertension among tribals.
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Objective: To study the agreement of wealth index constructed using different methods, and the comparison of living standard measurements by the wealth index and traditional indicators. Methods:The data used in the study come from Rural Household Survey in Ningxia region, and the sample of this household survey included 6612 households, 28886 people. Using different weighting methods, such as principal component analysis and equal weighting, and data coded in different ways to construct 4 wealth indexes, and analyzing the agreement of these 4 wealth indexes. Respectively comparing the wealth indexes with the living standard measurements by total, per cap-ital and per adult household consumption. Results:The wealth indexes showed strong agreement with each other, and similarly weak agreement with consumption indicators. Conclusion: the indicators of living standard measurements each had advantages and disadvantages, and there was weak agreement between these indicators. Thus, when living standard was the main study result or the social determinant of study results, the appropriate indicator in the study should be selected according to the study results by different indicators and professional knowledge and experiences.
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Objective:To evaluate outcomes and differences of the equality indexes of health and health service utilization in different living standard indicators. Methods: Using multi-phase stratified random sampling to select samples of rural families in Ningxia region and collect data about sample families' income, consumption, wealth and some relevant data on family members' health status and health services utilization. Using concentration index to measure the equality of health and health services utilization with income, consumption or wealth index as living standard indicators respectively and discuss the differences of the outcomes. Results:For different living standard in-dicators, the correlation between each other was weak. The differences of concentration indexes with different living standard indicators between 0. 01 to 0. 21 , and most of whichweresignificant on the level of 0. 05. Conclusion: The impact of choice of living standard indicators on the equality index of health and health service utilization was signifi-cant. In a limited area, living standards measured by wealth index could be more accurate and objective than by in-come or consumption, but the condition of this method wasmore strict.
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Aims: Infant mortality rate (IMR) is not only used as a demographic measure, but also as an important health indicator of a society as well as a measure of its living standard worldwide. The Nigeria Demographic and Household Survey (NDHS) declared a wide difference in the IMR among geographical zones in Nigeria with widest gap between the North East (NE) and South West (SW). This study assessed the differences in IMR viz-a-viz socio-demographic, sexual and reproductive factors and also determined factors affecting the IMR in the two zones. Place of Study: Rural and Urbanlocations across the NE and SW Nigeria Study Design: We used a nationally representative cross sectional data from the NDHS 2008 survey.Our analysis was based on the 23,995 and 11,546 births during five years preceding data collection from women aged 15-49 years in NE and SW Nigeria respectively. Methods: We censored the children who have not had their first birthday as of the day of interview and estimated the IMR with Life tables using West Models. Other analysis were carried out with descriptive statistics, bivariate and multivariate cox regression models at 5% significance level. Results: About 3 of every four NE children are from rural areas compared with 47.4% in SW, while nearly 78% of NE children are from mothers without formal education the rate was 20.9% in the SW. The IMR among children from teenager mothers was 121 and 82 per 1000 live births in NE and SW respectively, 87 for urban NE, 52 for urban SW, 115 for rural NE, and 66 for rural SW. In the NE, children from rural areas were about 30% times more likely than children from urban areas to die before their first birthday (HR=1.3 95% CI:1.1-1.6)while in the SW they were 40% times more likely to die (HR=1.6 95% CI:1.1-2.4). Children from wealthiest homes in the NE had lower IMR than children from wealthiest homes in the SW (37 vs 55) but wealth quintiles were not significant to IMR in the SW. Conclusion: The prevailing trend of early marriage, non-education, delayed initiation of breastfeeding, unsafe drinking water, unemployment and poverty among others should be averted so as to improve child survival in the Nigeria especially in the North East.
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<B>Objectives:</B> In developing countries, measuring household income is difficult. The Wealth Index is an alternative to household income; however, it contains too many items making its use in a healt-related study difficult. Thus, we developed a shorter version of the index appropriate for rural areas in Cambodia and analyzed the relationship between economic status and maternal health knowledge and behavior using the index.<BR><B>Methods:</B> We conducted the study in four health center areas in Kampong Cham Province. We administered structured questionnaires to 640 women who had delivered babies within a year prior to the study. The development of the Cambodian Wealth Index-Rural version (CWI-R) followed the procedures of the Demographic and Health Survey (DHS) Wealth Index. Out of 69 items in the Cambodian DHS, we selected 18 items by assessing the distribution and correlation between the items and then performed principal component analysis. Those items that had principal component scores (PCS) below 0.4 were removed. As a result, we created an 11-item wealth index weighted by PCS; Cronbach’s <I>α</I> was 0.81. We tabulated economic status using quintiles and calculated health behavior and the women’s healt-related knowledge for each quintile.<BR><B>Results:</B> The mean age (SD) of the women was 27.0 (6.4) years. The rate of antenatal and postnatal care and skilled birth attendant increased as economic status improved. Knowledge of risk factors during pregnancy and delivery varied according to item. For prolonged labor and edema, knowledge increased as economic status improved; however, we observed no significant differences for vaginal bleeding. More women who had a higher economic status knew the benefits of Vitamin A and the causes of intestinal parasitic infections.<BR><B>Conclusion:</B> The pattern of maternal knowledge and behavior analyzed with the CWI-R was parallel to the original wealth index, indicating its usefulness as an alternative to the original wealth index.
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This study aimed to construct indices of living standards in rural Bangladesh that could be useful to study health outcomes or identify target populations for poverty-alleviation programmes. The indices were constructed using principal component analysis of data on household assets and house construction materials. Their robustness and use was tested and found to be internally consistent and correlated with maternal and infant health, nutritional and demographic indicators, and infant mortality. Indices derived from 9 or 10 household asset variables performed well; little was gained by adding more variables but problems emerged if fewer variables were used. A ranking of the most informative assets from this rural, South Asian context is provided. Living standards consistently and significantly improved over the six-year study period. It is concluded that simple household socioeconomic data, collected under field conditions, can be used for constructing reliable and useful indices of living standards in rural South Asian communities that can assist in the assessment of health, quality of life, and capabilities of households and their members.
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This paper explores the relationship between household wealth and nutritional status of pre-school children in Bangladesh using the nationally representative 2007 Bangladesh Demographic and Health Survey data. Chronic malnutrition was measured by z-score of height-for-age and the effect of household wealth on adverse childhood growth rate was assessed by multivariate logistic regression analyses. Overall, 43% of the children were stunted. The multivariate binary logistic regression analysis yielded significantly increased risk of stunting among the poorest (OR=2.26, 95% CI=1.77-2.89) as compared to the richest. The multivariate multinomial logistic regression produced elevated risk of moderate stunting (OR=1.98, 95% CI=1.50-2.61) and severe stunting (OR=2.88, 95% CI=2.00-4.14) of children in the poorest category compared to their richest counterparts. Children’s age, duration of breastfeeding, mother’s education, body mass index, mother’s working status and place of region were also identified as important determinants of children’s nutritional status. The findings suggest that apart from poverty reduction, maternal education, and strengthening of child and maternal health care services are important to improve health and nutritional status of the children.