Ethnic differences in metabolic syndrome in high-income countries: A systematic review and meta-analysis.

This review aimed to systematically quantify the differences in Metabolic Syndrome (MetS) prevalence across various ethnic groups in high-income countries by sex, and to evaluate the overall prevalence trends from 1996 to 2022. We conducted a systematic literature review using MEDLINE, Web of Science Core Collection, CINAHL, and the Cochrane Library, focusing on studies about MetS prevalence among ethnic groups in high-income countries. We pooled 23 studies that used NCEP-ATP III criteria and included 147,756 healthy participants aged 18 and above. We calculated pooled prevalence estimates and 95% confidence intervals (CI) using both fixed-effect and random-effect intercept logistic regression models. Data were analysed for 3 periods: 1996-2005, 2006-2009, and 2010-2021. The pooled prevalence of MetS in high-income countries, based on the NCEP-ATP III criteria, was 27.4% over the studied period, showing an increase from 24.2% in 1996-2005 to 31.9% in 2010-2021, with men and women having similar rates. When stratified by ethnicity and sex, ethnic minority women experienced the highest prevalence at 31.7%, while ethnic majority women had the lowest at 22.7%. Notably, MetS was more prevalent in ethnic minority women than men. Among ethnic minorities, women had a higher prevalence of MetS than men, and the difference was highest in Asians (about 15 percentage points). Among women, the prevalence of MetS was highest in Asians (41.2%) and lowest in Blacks/Africans (26.7%). Among men, it was highest in indigenous minority groups (34.3%) and lowest among in Blacks/Africans (19.8%). MetS is increasing at an alarming rate in high-income countries, particularly among ethnic minority women. The burden of MetS could be effectively reduced by tailoring interventions according to ethnic variations and risk profiles.

Associations between dietary behaviours and the mental and physical well-being of Swedish adolescents.

AIMS: This study aims to investigate the association between dietary behaviours, overweight/obesity, and mental health and well-being among Swedish adolescents. METHODS: Data from the 2017/2018 Health Behaviour in School-aged Children (HBSC) survey of 3692 adolescents aged ≈11, ≈13, and ≈15 years was analysed. We evaluated the prevalence and association of dietary behaviours, characterised by daily intake of fruits and vegetables, consumption of sugar-sweetened beverages (SSBs) and sweets once per week, and daily consumption of family meals and breakfast, with socioeconomic and demographic factors. Multivariate logistic regression models (adjusted and unadjusted) were then used to examine the relationship between dietary behaviours, overweight/obesity, and mental health and well-being including psychosomatic complaints, life satisfaction, and school-related pressure. RESULTS: Boys were more likely to eat breakfast and have meals together with their family than girls, but their fruit and vegetable intake was lower compared to girls. Adolescents with lower socioeconomic status (low family affluence, families perceived 'not well-off' and two unemployed parents), single-parent households and twoforeign born parents were more likely to engage in poorer dietary behaviours. Daily breakfast, family meals, fruit and vegetable intake were positively associated with mental health and well-being. Specifically, daily family meals were linked to higher life satisfaction, fewer psychosomatic complaints, and reduced school-related pressure. Breakfast emerged as a beneficial dietary habit, associated with higher life satisfaction, and a lower likelihood of psychosomatic complaints, school-related pressure, and overweight/obesity. Fruit and vegetable consumption was consistently associated with better mental health and well-being while associations between SSBs and sweets were mixed. CONCLUSIONS: Improving mental health and well-being, along with tackling the rising rates of mental illness and challenges related to overweight/obesity in adolescents constitute key public health priorities. Implementing policies that promote the intake of fruits and vegetables, reducing the consumption of SSBs and sweets, and emphasizing the value of having breakfast and sharing family meals could offer a cost-effective public health intervention.

Impact of poverty and adversity on perceived family support in adolescence: findings from the UK Millennium Cohort Study.

Emotional support from family members may have an important effect on adolescent health outcomes, and has been identified as a target for policy to protect against the impacts of poverty and other early life adversities. However, few studies have assessed the extent to which poverty and adversity themselves influence the nature of emotional support that parents can provide to adolescents. We, therefore, aimed to investigate the impact of trajectories of income poverty and family adversities, including parental mental ill health, alcohol misuse and domestic violence across childhood developmental stages on young people's relationships with their families and perceived emotional support received. We analysed longitudinal data on 10,976 children from the nationally representative UK Millennium Cohort study. Exposure trajectories of poverty and family adversities were characterised using group-based multi-trajectory models (age 9 months-14 years). The outcomes were perceived emotional support and quality of family relationships, measured by the three-item Short Social Provisions Scale (SPS-3) and levels of parent-adolescent closeness and conflict, measured at age 14. ORs and 95% CIs were estimated using multivariable logistic regression models, adjusting for potential confounding factors. At age 14, the overall prevalence of low perceived emotional support was 13% (95% CI: 12, 14). Children of mothers with lower socioeconomic status (SES) were more likely to report low emotional support, with a clear social gradient (education-degree plus: 10.3% vs. no qualifications: 15.4%). Compared with children exposed to low levels of poverty and adversity, children in the persistent adversity trajectory groups experienced higher odds of low emotional support and low-quality parent-adolescent relationship; those exposed to both persistent poverty and poor parental mental health were particularly at increased risk of experiencing poor family relationships and low perceived emotional support (adjusted odds ratio 2·2; 95% CI 1·7-2·9). Low perceived emotional support and poor family relationships in adolescence are more prevalent among socially disadvantaged children and adolescents and those experiencing social adversity. Policies to improve levels of family support for UK adolescents should focus on improving modifiable determinants such as child poverty and family mental health.

Impact of Parental Mental Health and Poverty on the Health of the Next Generation: A Multi-Trajectory Analysis Using the UK Millennium Cohort Study.

PURPOSE: Exposure to parental mental ill-health and poverty in childhood impact health across the lifecourse. Both maternal and paternal mental health may be important influences, but few studies have unpicked the complex interrelationships between these exposures and family poverty for later health. METHODS: We used longitudinal data on 10,500 children from the nationally representative UK millennium cohort study. Trajectories of poverty, maternal mental health, and secondary caregiver mental health were constructed from child age of 9 months through to 14 years. We assessed the associations of these trajectories with mental health outcomes at the age of 17 years. Population-attributable fractions were calculated to quantify the contribution of caregivers' mental health problems and poverty to adverse outcomes at the country level. RESULTS: We identified five distinct trajectories. Compared with children with low poverty and good parental mental health, those who experienced poverty and poor primary or secondary caregiver mental health (53%) had worse outcomes. Children exposed to both persistent poverty and poor caregiver mental health were at markedly increased risk of socioemotional behavioural problems (aOR 4.2; 95% CI 2.7-6.7), mental health problems (aOR 2.5; CI 1.6-3.9), and cognitive disability (aOR 1.7; CI 1.1-2.5). We estimate that 40% of socioemotional behavioural problems at the age of 17 were attributable to persistent parental caregivers' mental health problems and poverty. DISCUSSION: More than half of children growing up in the UK are persistently exposed to either one or both of poor caregiver mental health and family poverty. The combination of these exposures is strongly associated with adverse health outcomes in the next generation.

Interventions to Reduce Parental Substance Use, Domestic Violence and Mental Health Problems, and Their Impacts Upon Children's Well-Being: A Systematic Review of Reviews and Evidence Mapping.

INTRODUCTION: Children exposed to parental intimate partner violence and abuse, mental illness, and substance use experience a range of problems which may persist into adulthood. These risks often co-occur and interact with structural factors such as poverty. Despite increasing evidence, it remains unclear how best to improve outcomes for children and families experiencing these adversities and address the complex issues they face. AIMS AND METHODS: Systematic review of systematic reviews. We searched international literature databases for systematic reviews, from inception to 2021, to provide an evidence overview of the range and effectiveness of interventions to support children and families where these parental risk factors had been identified. RESULTS: Sixty-two systematic reviews were included. The majority (n = 59) focused on interventions designed to address single risk factors. Reviews mostly focused on parental mental health (n = 38) and included psychological interventions or parenting-training for mothers. Only two reviews assessed interventions to address all three risk factors in combination and assessed structural interventions. Evidence indicates that families affected by parental mental health problems may be best served by integrated interventions combining therapeutic interventions for parents with parent skills training. Upstream interventions such as income supplementation and welfare reform were demonstrated to reduce the impacts of family adversity. CONCLUSION: Most intervention approaches focus on mitigating individual psychological harms and seek to address risk factors in isolation, which presents potentially significant gaps in intervention evidence. These interventions may not address the cumulative impacts of co-occurring risks, or social factors that may compound adversities.

The clustering of multiple health and lifestyle behaviors among Swedish adolescents: a person-oriented analysis.

Background: Knowledge of the distribution, prevalence, and clustering of multiple health and lifestyle related behaviors (HLBs) among adolescents can inform the development of effective health-promoting policies and interventions. We assessed the clustering of multiple HLBs among 11, 13 and 15-year-old Swedish adolescents and examined the socioeconomic and demographic correlates for the identified clusters. Methods: We used data from the 2017/2018 Swedish Health Behaviour in School-aged children (HBSC) study to conduct sex and age-stratified latent class analysis (LCA). The LCA was based on five HLBs: eating behavior and habits (EBH), physical activity (PA), tobacco usage (TU), alcohol consumption (AC) and sleeping habits and patterns (SHPs). Multinomial logistic regression models were used to assess the associations between the identified clusters and the socioeconomic and demographic characteristics of adolescents and their parents. Results: Health behaviors varied by sex and age. Four distinct clusters were identified based on sex: cluster 1 (Mixed eating behaviors and habits, physical activity and low alcohol consumption), cluster 2 (Healthy lifestyle behaviors), cluster 3 (Unhealthy lifestyle behaviors), and cluster 4 (Breakfast, low alcohol consumption and tobacco usage). In the age-stratified analyzes, three clusters were identified: cluster 1 (Unhealthy lifestyle behaviors), cluster 2 (Moderately healthy lifestyle behaviors) and cluster 3 (Healthy lifestyle behaviors). The multinomial analysis showed that sex, age, family situation and perceived family wealth were strong predictors of health behaviors. Unhealthy behaviors were most commonly associated with socioeconomic disadvantage, having a migrant background, and living in reconstructed families or single-parent households. Conclusion: Health behaviors vary significantly based on socioeconomic and demographic circumstances. Targeted policies and intervention programs are necessary to improve HLBs among vulnerable and at-risk adolescents.

Contraceptive use pattern based on the number and composition of children among married women in sub-Saharan Africa: a multilevel analysis.

BACKGROUND: The relationship between composition of children and contraception use has received limited scholarly attention in sub-Saharan Africa. In this study, we examined the relationship between contraceptive methods, the number and composition of children in SSA. METHODS: Data on 21 countries in sub-Saharan Africa (SSA) countries that had a Demographic and Health Survey on or before 2015 were analysed. We applied a multilevel multinomial logistic regression model to assess the influence of family composition on contraceptive use. Adjusted relative risk ratio (aRRR) and 95% CI were estimated. The significant level was set at p < 0.05. All the analyses were conducted using weighted data. RESULTS: Women who had one son and two daughters (aRRR = 0.85, CI = 0.75, 0.95), two sons and one daughter (aRRR = 0.81 CI = 0.72, 0.92), one son and three daughters (aRRR = 0.66, CI = 0.54, 0.80), two sons and two daughters (aRRR = 0.59, CI = 0.50, 0.69), and three or more sons (aRRR = 0.75, CI = 0.63, 0.91) were less likely to use temporary modern contraceptive methods. Those with two sons and two daughters were less likely to use traditional methods (aRRR = 0.52, CI = 0.35, 0.78). Women in the older age group (35-49 years) were less likely to use temporary modern methods (aRRR = 0.60; 95%CI; 0.57, 0.63). However, this group of women were more likely to use permanent (sterilization) (aRRR = 1.71; 95%CI; 1.50, 1.91) and traditional methods (aRRR = 1.28; 95%CI; 1.14, 1.43). CONCLUSION: These findings suggest that contraception needs of women vary based on the composition of their children, hence a common approach or intervention will not fit. As a result, contraception interventions ought to be streamlined to meet the needs of different categories of women. The findings can inform policymakers and public health professionals in developing effective strategies to improve contraceptive use in SSA.

Trajectories of Child Cognitive and Socioemotional Development and Associations with Adolescent Health in the UK Millennium Cohort Study.

OBJECTIVE: To identify and describe distinct trajectories of cognitive and socioemotional development during childhood and to examine their relationships with adolescent health. STUDY DESIGN: We used group-based multitrajectory modeling applied to longitudinal data on 11 564 children up to age 14 years from the UK Millennium Cohort study to identify trajectories of cognitive and socioemotional development measured using validated instruments. We assessed associations between the derived trajectories and baseline socioeconomic, parental, and school factors using multinomial regression. Logistic regression was used to assess associations between trajectory groups and adolescent health at age 14 and 17 years. RESULTS: Four child development trajectories were identified: "no problems" (76.5%); "late socio-emotional problems" (10.1%); "early cognitive and socioemotional problems" (8.6%); and "persistent cognitive and socioemotional problems" (4.8%). Those in the problem trajectories were more socioeconomically disadvantaged. Compared with the "no problem" trajectory, the "late socioemotional problems" trajectory had increased odds of overweight and mental ill-health at age 14 years of 1.50 (95% CI 1.24-1.81) and 2.51 (2.03-3.10), respectively. For the "persistent problems" group, the OR for overweight was 1.41 (1.04-1.91), and for mental ill-health, 3.01 (2.10-3.30). For both groups, the associations persisted to age 17 years. CONCLUSIONS: In a representative UK cohort, groups of distinct trajectories of cognitive and socioemotional development were identified. Adverse development, if unresolved, can have a negative impact on weight and mental health in adolescence. Socioemotional development was the main driver of the impact on adolescent health and this requires emphasis in child health policy.

HIV testing among women of reproductive age in 28 sub-Saharan African countries: a multilevel modelling.

BACKGROUND: Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) remains one of the most significant public health challenges globally, particularly in sub-Saharan Africa (SSA). Although HIV testing is a vital step for both prevention and treatment, its uptake is still low in SSA. We therefore examined HIV testing in SSA and its individual/household and community factors among women of reproductive age groups (15-49 y). METHODS: Demographic and Health Survey data collected between 2010 and 2020 from 28 SSA countries were used for this analysis. We analysed the coverage of HIV testing and individual/household and community factors on 384 416 women in the reproductive age groups (15-49 y). Bivariate and multivariable multilevel binary logistic regression analysis were conducted to select candidate variables and to identify significant explanatory variables associated with HIV testing and the results were presented using adjusted odd ratios (AORs) at 95% confidence intervals (CIs). RESULTS: The pooled prevalence of HIV testing among women of reproductive age in SSA was 56.1% (95% CI 53.7 to 58.4), with the highest coverage found in Zambia (86.9%) and the lowest in Chad (6.1%). Age (45-49 y; AOR 0.30 [95% CI 0.15 to 0.62]), women's education level (secondary; AOR 1.97 [95% CI 1.36 to 2.84]) and economic status (richest; AOR 2.78 [95% CI 1.40 to 5.51]) were some of the individual/household factors associated with HIV testing. Similarly, religion (no religion; AOR 0.58 [95% CI 0.34 to 0.97]), marital status (married; AOR 0.69 [95% CI 0.50 to 0.95]) and comprehensive knowledge of HIV (yes; AOR 2.01 [95% CI 1.53 to 2.64]) were significantly associated individual/household factors for HIV testing. Meanwhile, place of residence (rural; AOR 0.65 [95% CI 0.45 to 0.94]) was found to be a significant community-level factor. CONCLUSION: More than half of married women in SSA have been tested for HIV, with between-country variations. Both individual/household factors were associated with HIV testing. Stakeholders should therefore consider all above-mentioned factors to plan an integrated approach to enhancing HIV testing through health education, sensitization, counselling and empowering older and married women, those with no formal education, those who do not have comprehensive HIV/AIDS knowledge and those in rural areas.

Association between women's household decision-making autonomy and health insurance enrollment in sub-saharan Africa.

BACKGROUND: Out of pocket payment for healthcare remains a barrier to accessing health care services in sub-Saharan Africa (SSA). Women's decision-making autonomy may be a strategy for healthcare access and utilization in the region. There is a dearth of evidence on the link between women's decision-making autonomy and health insurance enrollment. We, therefore, investigated the association between married women's household decision making autonomy and health insurance enrollment in SSA. METHODS: Demographic and Health Survey data of 29 countries in SSA conducted between 2010 and 2020 were analyzed. Both bivariate and multilevel logistic regression analyses were carried out to investigate the relationship between women's household decision-making autonomy and health insurance enrollment among married women. The results were presented as an adjusted odds ratio (AOR) and the 95% confidence interval (CI). RESULTS: The overall coverage of health insurance among married women was 21.3% (95% CI; 19.9-22.7%), with the highest and lowest coverage in Ghana (66.7%) and Burkina Faso (0.5%), respectively. The odds of health insurance enrollment was higher among women who had household decision-making autonomy (AOR = 1.33, 95% CI; 1.03-1.72) compared to women who had no household decision-making autonomy. Other covariates such as women's age, women's educational level, husband's educational level, wealth status, employment status, media exposure, and community socioeconomic status were found to be significantly associated with health insurance enrollment among married women. CONCLUSION: Health insurance coverage is commonly low among married women in SSA. Women's household decision-making autonomy was found to be significantly associated with health insurance enrollment. Health-related policies to improve health insurance coverage should emphasize socioeconomic empowerment of married women in SSA.

Time trends in socio-economic and geographic-based inequalities in childhood wasting in Guinea over 2 decades: a cross-sectional study.

BACKGROUND: Today, an estimated 7.3% (50 million) of all children <5 y of age suffer from wasting, with more burden in African countries including Guinea. Investigating inequalities in childhood wasting is essential for designing efficient programs and interventions, but no related evidence exists in Guinea. This study aimed to examine the trends in the prevalence of childhood wasting and the extent of sex, socio-economic and geographic-based disparities in Guinea. METHODS: Data from the 1999, 2005 and 2012 Guinea Demographic and Health Surveys and the 2016 Guinea Multiple Indicator Cluster Survey, with a total of 16 137 children <5 y of age were included for analysis. For inequality analysis, we used the 2019 updated World Health Organization Health Equity Assessment Toolkit (HEAT) software. Inequality was measured using four summary measures (difference [D], population attributable risk [PAR], ratio [R] and population attributable fraction [PAF]) for five equity stratifiers (economic status, education, place of residence, sex and subnational region). We computed 95% confidence intervals (CIs) around the points estimates to measure statistical significance. RESULTS: The findings revealed a pro-rich (R=1.68 [95% CI 1.11 to 2.24]), pro-urban (PAR=-1.04 [95% CI -1.90 to -0.18]) and subnational region (D=8.11 [95% CI 4.85 to 11.36]) inequalities in childhood wasting across all surveys. Except in 2005, education-based disparities (PAF=-18.2 [95% CI -36.10 to -0.26]) were observed across all survey years, but not sex-based disparities. An approximately constant inequality pattern was seen across all dimensions. CONCLUSIONS: This study showed inequalities in childhood wasting in Guinea with a disproportionately higher risk of wasting among children from disadvantaged subpopulations/mothers, including uneducated, poorest/poor, rural residents and regions. Policies that target disadvantaged populations need to be considered in order to ensure social protection, access to a wholesome diet and universal and quality health services.

Individual and community-level determinants of knowledge of ovulatory cycle among women of reproductive age in 29 African countries: a multilevel analysis.

BACKGROUND: Knowledge of the ovulatory cycle (KOC) can help reduce the chances of unwanted pregnancies and may improve a woman's reproductive health. However, little is known about the factors associated with knowledge of the ovulatory cycle across Africa. Therefore, we aimed to investigate the individual/household and community level determinants of KOC among women of childbearing age in 29 African countries. METHODS: We used data from the Demographic and Health Surveys of 29 African countries conducted between 2010 and 2020. Bivariate and multivariate multilevel logistic regressions were used to examine the association between women's correct knowledge of the ovulatory cycle and individual/household and community-level factors. The results were reported using adjusted odds ratios (AOR) with a 95% confidence interval (CI). RESULTS: The pooled results showed that correct KOC among women was 15.5% (95% CI 14.2-17.0%), varying from 11.5% in Liberia to 57.1% in the Democratic Republic of Congo. Regarding regional distribution, the highest prevalence of KOC was observed in West Africa (38.8%) followed by East Africa (21.3%) and was lowest in Southern Africa (15.6%) and Central Africa (15.5%). After adjusting for potential confounders, at the individual level, we found the odds of KOC to be higher among older women (40-44 years-aOR 3.57, 95% CI 1.90-6.67, 45-49 years-aOR 2.49, 95% CI 1.29-4.82), and women with higher educational level (aOR 2.58, 95% CI 1.40-4.75); at the community level, higher KOC was among women exposed to media (aOR 2.24, 95% CI 1.32-3.81). CONCLUSIONS: Knowledge of ovulatory cycle among women of reproductive age was found to be low in the region and varied by country. Women's age and educational level were the individual-level factors associated with increased knowledge of ovulatory cycle while community-level media exposure was found to be associated with increased knowledge of ovulatory cycle in this study. This finding highlights the need for appropriate strategies (possibly use of mass media) to increase knowledge of ovulatory cycle among women of reproductive age, especially among adolescents in Africa.

Investigating the associations between intimate partner violence and nutritional status of women in Zimbabwe.

BACKGROUND: Intimate partner violence (IPV) against women and poor nutritional status are growing health problems in low and middle-income countries (LMICs). Moreover, violence against women has been shown to be associated with poor nutrition. This study investigated the relationship between IPV and nutritional status (i.e., underweight, overweight, and obesity) among women of reproductive age (15-49 years) in Zimbabwe. METHODS: Pooled data from the 2005/2006, 2010/2011, and 2015 Zimbabwe Demographic Health Surveys (ZDHS) on 13,008 married/cohabiting women were analysed. Multinomial logistic regression models were used to examine the associations between the various forms of IPV and the nutritional status of women. We further estimated the prevalence of BMI ≥ 25.0 kg/m2 (overweight and obesity) by intimate partner violence type. RESULTS: The mean BMI of women was 24.3 kg/m2, more than one-fifth (24%) were overweight and about 12% were obese. Forty-three percent (43%) of women reported to have ever experienced at least one form of intimate partner violence. More than one-third (35%) of women who reported to have ever experienced at least one form of intimate partner violence had a BMI ≥ 25.0 kg/m2 (p< 0.01). Relative to normal weight, women who had ever experienced at least one form of IPV (i.e., physical, emotional, or sexual) were more likely to be obese (aOR = 2.59; 95% CI = 1.05-6.39). Women's exposure to any form of intimate partner violence was not significantly associated with the likelihood of being underweight or overweight relative to normal weight. CONCLUSIONS: The study findings show that women of reproductive age in Zimbabwe are at high risk of both IPV and excess weight. Moreover, we found a positive relationship between exposure to at least one form IPV and obesity. Public health interventions that target the well-being, empowerment and development of women are needed to address the complex issue of IPV and adverse health outcomes, including obesity.

Impact of poverty and family adversity on adolescent health: a multi-trajectory analysis using the UK Millennium Cohort Study.

BACKGROUND: Children exposed to poverty and family adversities including domestic violence, parental mental ill health and parental alcohol misuse may experience poor outcomes across the life course. However, the complex interrelationships between these exposures in childhood are unclear. We therefore assessed the clustering of trajectories of household poverty and family adversities and their impacts on adolescent health outcomes. METHODS: We used longitudinal data from the UK Millennium Cohort study on 11564 children followed to age 14 years. Family adversities included parent reported domestic violence and abuse, poor mental health and frequent alcohol use. We used a group-based multi-trajectory cluster model to identify trajectories of poverty and family adversity for children. We assessed associations of these trajectories with child physical, mental and behavioural outcomes at age 14 years using multivariable logistic regression, adjusting for confounders. FINDINGS: Six trajectories were identified: low poverty and family adversity (43·2%), persistent parental alcohol use (7·7%), persistent domestic violence and abuse (3·4%), persistent poor parental mental health (11·9%), persistent poverty (22·6%) and persistent poverty and poor parental mental health (11·1%). Compared with children exposed to low poverty and adversity, children in the persistent adversity trajectory groups experienced worse outcomes; those exposed to persistent poor parental mental health and poverty were particularly at increased risk of socioemotional behavioural problems (adjusted odds ratio 6·4; 95% CI 5·0 - 8·3), cognitive disability (aOR 2·1; CI 1·5 - 2·8), drug experimentation (aOR 2·8; CI 1·8 - 4·2) and obesity (aOR 1·8; CI 1·3 - 2·5). INTERPRETATION: In a contemporary UK cohort, persistent poverty and/or persistent poor parental mental health affects over four in ten children. The combination of both affects one in ten children and is strongly associated with adverse child outcomes, particularly poor child mental health. FUNDING: The National Institute for Health Research (NIHR) Policy Research Programme, NIHR Applied Research Collaboration South London (ARC South London) at King's College Hospital NHS Foundation Trust and the Medical Research Council (MRC).

Health behaviors and subsequent mental health problems during the COVID-19 pandemic: A longitudinal analysis of adults in the UK.

Introduction: Public health mitigation policies aimed at slowing the spread of COVID-19 led to an increase in mental health problems (MHPs). This study examines the association between multiple pre-pandemic health behaviors and MHPs prior to, and during, the COVID-19 pandemic. Methods: We analyzed a representative population sample of 11,256 adults (aged 20-65 years) from Understanding Society-The UK Household Longitudinal Study. Baseline data from participants interviewed in 2017/2019 (wave 9) were linked to web surveys conducted during the COVID-19 pandemic. We used latent class analysis (LCA) to identify mutually exclusive health behavior (physical activity, alcohol consumption, eating habits and smoking tobacco) clusters by gender, and examined the sociodemographic correlates of each cluster. We assessed how pre-pandemic latent classes of health behaviors were associated with changes in MHPs during the pandemic using fixed effects regression models. Results: Three health behavior clusters were identified: positive (33%), moderate (24%), and high risk (43%), where similar behaviors clustered within individuals and sociodemographic circumstances. In particular, gender, age, migrant status and ethnicity were found to have strong associations with each cluster. Our results also demonstrated a clear association in MHPs with health behaviors both prior to, and during the pandemic. There were significant increases in MHPs between 2017/2019 and January 2021, with fluctuations coinciding with changes in public health mitigation policies. Assessments across the three clusters showed about 25.2%, 16.9%, and 0.7% increases in MHPs in the positive, moderate and high risk health behavior clusters, respectively. Discussion: This study shows that pre-pandemic health behaviors were significantly associated with mental health before and during the pandemic. Holistic policy interventions and promotions targeting multiple health behaviors may be an effective strategy to improve mental health in the pandemic recovery period.

Pregnant women's decision-making capacity and adherence to iron supplementation in sub-Saharan Africa: a multi-country analysis of 25 countries.

BACKGROUND: Anaemia and related complications during pregnancy is a global problem but more prevalent in sub-Sahara Africa (SSA). Women's decision-making power has significantly been linked with maternal health service utilization but there is inadequate evidence about adherence to iron supplementation. This study therefore assessed the association between household decision-making power and iron supplementation adherence among pregnant married women in 25 sub-Saharan African countries. METHODS: We used data from the Demographic and Health Surveys (DHS) of 25 sub-Saharan African countries conducted between 2010 and 2019. Women's decision-making power was measured by three parameters; own health care, making large household purchases and visits to her family or relatives. The association between women's decision-making power and iron supplementation adherence was assessed using logistic regressions, adjusting for confounders. The results were presented as adjusted odds ratio (AOR) with 95% confidence intervals (CIs). RESULTS: Approximately 65.4% of pregnant married women had made decisions either alone or with husband in all three decisions making parameters (i.e., own health care, making large household purchases, visits to her family or relatives). The rate of adherence to iron medication during pregnancy was 51.7% (95% CI; 48.5-54.9%). Adherence to iron supplementation was found to be higher among pregnant married women who had decision-making power (AOR = 1.46, 95% CI; 1.16-1.83), secondary education (AOR = 1.45, 95% CI; 1.05-2.00) and antenatal care visit (AOR = 2.77, 95% CI; 2.19-3.51). Wealth quintiles and religion were significantly associated with adherence to iron supplementation. CONCLUSIONS: Adherence to iron supplementation is high among pregnant women in SSA. Decision making power, educational status and antenatal care visit were found to be significantly associated with adherence to these supplements. These findings highlight that there is a need to design interventions that enhance women's decision-making capacities, and empowering them through education to improve the coverage of antenatal iron supplementation.

Health care seeking behaviour for children with acute childhood illnesses and its relating factors in sub-Saharan Africa: evidence from 24 countries.

BACKGROUND: Childhood illnesses and mortality rates have declined over the past years in sub-Saharan African countries; however, under-five mortality is still high in the region. This study investigated the magnitude and factors associated with health care seeking behaviour for children with childhood illnesses in 24 sub-Saharan African countries. METHODS: We used secondary data from Demographic and Health Surveys (DHSs) conducted between 2013 and 2018 across the 24 sub-Saharan African countries. Binary logistic regression models were applied to identify the factors associated with health care seeking behaviour for children with acute childhood illnesses. The results were presented using adjusted odds ratios (aOR) with 95% confidence intervals (CIs). RESULTS: Overall, 45% of children under-5 years with acute childhood illnesses utilized health care facilities. The factors associated with health care seeking behaviour for children with acute illnesses were sex of child, number of living children, education, work status, wealth index, exposure to media and distance to a health facility. CONCLUSIONS: Over half of mothers did not seek appropriate health care for under-five childhood illnesses. Effective health policy interventions are needed to enhance health care seeking behaviour of mothers for childhood illnesses in sub-Saharan African countries.

Individual-, household-, and community-level factors associated with pregnant married women's discriminatory attitude towards people living with HIV in sub-Saharan Africa: A multicountry cross-sectional study.

BACKGROUND AND AIMS: Discriminatory attitude towards people living with human immunodeficiency virus (HIV) remains a major problem in the prevention and treatment of HIV in sub-Sahara Africa (SSA). Understanding the multiple factors linked to discriminatory attitude towards people living with HIV/AIDS (PLWHA) in SSA is necessary for developing appropriate interventions. This study aimed at investigating the individual, household, and community-level factors associated with pregnant married women's discriminatory attitude towards people living with HIV/AIDS. METHODS: We used data from the Demographic and Health Surveys of 12 sub-Saharan African countries conducted between 2015 and 2019. Data on 17 065 pregnant married women were analyzed. Bivariate (chi-squared test) and multivariable multilevel logistic regression analyses were applied to investigate the factors associated with discriminatory attitude towards PLWHA. The results were reported as adjusted odds ratio (aOR) at 95% confidence interval (CI). RESULTS: The mean age of participants was 31.2 ± 8.5. The prevalence of discriminatory attitude towards PLWHA was 36.2% (95% CI: 33.4%-39.1%). Individual/household-level factors associated with discriminatory attitude towards PLWHA were women's educational level (secondary school-aOR = 0.49, 95% CI: 0.26-0.93), husband's educational level (higher education-aOR = 0.35, 95% CI: 0.16-0.76), decision-making power (yes-aOR = 0.51, 95% CI: 0.38-0.69), wife-beating attitude (disagreement with wife beating-aOR = 0.58, 95% CI: 0.43-0.79), and religion (Muslim-aOR = 1.92, 95% CI: 1.22-3.04). Community socioeconomic status (medium-aOR = 0.61, 95% CI: 0.41-0.93) was the only community-level factor associated with discriminatory attitude towards PLWHA. CONCLUSION: More than one-third of pregnant married women in SSA had discriminatory attitude towards PLWHA. Women's educational level, husband's educational level, decision-making power, wife-beating attitude, religion, and community socio-economic status were associated with discriminatory attitude towards PLWHA. To lessen the prevalence of discriminatory attitude towards PLWHA, considering these significant factors is needed. Therefore, governments and other stakeholders in the respective countries need to increase education coverage. Moreover, empowering women through education and economy is crucial. Finally, working with religious leaders to increase awareness about HIV and discriminatory attitude towards PLWHA should also be a priority in SSA.

Does attitude towards wife beating determine infant feeding practices during diarrheal illness in sub-Saharan Africa?

BACKGROUND: Inappropriate feeding practices of children during illness remains a public health problem globally, particularly in sub-Saharan Africa (SSA). One strategy to improve child health outcomes is through women empowerment-measured by wife beating attitude. However, the role of attitude towards wife beating in child feeding practices has not been comprehensively studied. Therefore, we investigated the association between women's attitude towards wife beating and child feeding practices during childhood diarrhea in 28 countries in SSA. METHODS: We analyzed data from the Demographic and Health Survey on 40,720 children under 5 years. Bivariate and multivariate binary logistic regression analyses were applied to assess the association between women's attitude towards wife beating and child feeding practices. The results were presented using adjusted odds ratio (aOR) with 95% confidence intervals (CIs). RESULTS: The pooled results showed that appropriate feeding practices during diarrheal illness among under-five children was 9.3% in SSA, varying from 0.4% in Burkina Faso to 21.1% in Kenya. Regarding regional coverage, the highest coverage was observed in Central Africa (9.3%) followed by East Africa (5.5%), Southern Africa (4.8%), and West Africa (4.2%). Women who disagreed with wife-beating practices had higher odds of proper child feeding practices during childhood diarrhea compared to those who justified wife-beating practices (aOR = 2.02, 95% CI; 1.17-3.48). CONCLUSION: The findings suggest that women's disagreement with wife beating is strongly associated with proper child feeding practices during diarrheal illness in SSA. Proactive measures and interventions designed to change attitudes towards wife-beating practices are crucial to improving proper feeding practices in SSA.