Socioeconomic, sex and area related inequalities in childhood stunting in Mauritania: Evidence from the Mauritania Multiple Indicator Cluster Surveys (2007-2015).

INTRODUCTION: The prevalence of stunting in under five children is high in Mauritania. However, there is a paucity of evidence on the extent and the overtime alteration of inequality in stunting. To this end, we did this study to investigate stunting inequality and the change with time using three rounds of Mauritania Multiple Indicator Cluster Surveys. The evidence is important to inform implementation of equitable nutrition interventions to help narrow inequality in stunting between population groups. METHODS: World Health Organization's (WHO) Health Equity Assessment Toolkit (HEAT) was used in the analysis of stunting inequality. Following standard equity analysis methods recommended by the WHO, we performed disaggregated analysis of stunting across five equity stratfiers: Wealth, education, residence, sex and sub-national regions. Then, we summarized stunting inequality through four measures of inequality: Difference, Ratio, Population Attributable Fraction and Population Attributable Risk. The point estimates of stunting were accompanied by 95% confidence intervals to measure the statistical significance of the findings. RESULTS: The national average of childhood stunting in 2007, 2011 and 2015 was 31.3%, 29.7% and 28.2%, respectively. Glaring inequalities in stunting around the five equity stratifiers were observed in all the studied periods. In the most recent survey included in our study (2015), for instance, we recorded substantial wealth (PAF = -33.60; 95% CI: -39.79, -27.42) and education (PAF = -5.60; 95% CI: -9.68, -1.52) related stunting inequalities. Overall, no substantial improvement was documented in wealth and sex related inequality in stunting between 2007 and 2011 while region-based inequality worsened during the same time periods. CONCLUSIONS: The burden of stunting appeared to be heavily concentrated among children born to socioeconomically worse-off women, women who live in rural settings and certain subnational regions. Targeted nutrition interventions are required to address drivers of stunting embedded within geographic and socioeconomic contexts.

Observed magnitude and trends in socioeconomic and geographic area inequalities in obesity prevalence among non-pregnant women in Chad: evidence from three waves of Chad demographic and health surveys.

BACKGROUND: While the prevalence of obesity is increasing worldwide, the growing rates of overweight and obesity in developing countries are disquieting. Obesity is widely recognized as a risk factor for non-communicable diseases (NCDs), including diabetes, cancer and cardiovascular diseases. Available evidence on whether obesity has been more prevalent among higher or lower socioeconomic groups, across regions and urban-rural women's are inconsistent. This study examined magnitude of and trends in socioeconomic, urban-rural and sub-national region inequalities in obesity prevalence among non-pregnant women in Chad. METHOD: Using cross-sectional data from Chad Demographic and Health Surveys (DHSs) conducted in 1996, 2004 and 2014; we used the World Health Organization (WHO) Health Equity Assessment Toolkit (HEAT) to analyze socio-economic, urban-rural and regional inequalities in obesity prevalence among non-pregnant women aged 15-49 years. Inequalities were assessed using four equity stratifiers namely wealth index, educational level, place of residence and subnational region. We presented inequalities using simple and complex as well as relative and absolute summary measures such as Difference (D), Population Attributable Risk (PAR), Population Attributable Fraction (PAF) and Ratio (R). RESULTS: Though constant pattern overtime, both wealth-driven and place of residence inequality were observed in all three surveys by Difference measure and in the first and last surveys by Ratio measure. Similarly, including the recent survey (D = -2.80, 95% CI:-4.15, - 1.45, R = 0.37, 95% CI: 0.23, 0.50) absolute (in 1996 & 2014 survey) and relative (in all three surveys) educational status inequality with constant pattern were observed. Substantial absolute (PAR = -2.2, 95% CI: - 3.21, - 1.34) and relative (PAF = - 91.9, 95% CI: - 129.58, - 54.29) regional inequality was observed with increasing and constant pattern by simple (D) and complex (PAR, PAF) measures. CONCLUSION: The study showed socioeconomic and area-based obesity inequalities that disfavored women in higher socioeconomic status and residing in urban areas. Prevention of obesity prevalence should be government and stakeholders' priority through organizing the evidence, health promotion and prevention interventions for at risk population and general population.

Socioeconomic, urban-rural and sex-based inequality in infant mortality rate: evidence from 2013 Yemen demographic and health survey.

BACKGROUND: The occurrence of Infant Mortality Rate (IMR) varied globally with most of the cases coming from developing countries including Yemen. The disparity in IMR in Yemen however, has not been well dealt and therefore we examined the IMR inequality based on the most reliable methodology in order to generate evidence-based information for some program initiatives in Yemen. METHODS: Based on the World Health Organization (WHO) Health Equity Assessment Toolkit (HEAT) software, we analyzed the inequality across the different inequality dimensions in Yemen. The toolkit analyzes data stored in the WHO health equity monitor database. Simple and complex, and absolute and relative measures of inequality were calculated for the four dimensions of inequality (subpopulations) which included wealth, education, sex and residence. We computed a 95 % CI to assess statistical significance. RESULTS: The analysis included 31, 743 infants. Absolute and relative wealth-driven, education, urban-rural and sex-based inequalities were found in IMR. Higher concentration of IMR was observed among infants from the poorest/poor households (ACI=-4.68, 95 % CI; -6.57, -2.79, R = 1.61, 95 % CI; 1.18, 2.03), rural residents (D = 15.07, 95 % CI; 8.04, 22.09, PAF=-23.57, 95 % CI; -25.47, -21.68), mothers who had no formal education (ACI=-2.16, 95 % CI; -3.79, -0.54) and had male infants (PAF= -3.66, 95 % CI; -4.86, -2.45). CONCLUSIONS: Higher concentration of IMR was observed among male infants from disadvantaged subpopulations such as poorest/poor, uneducated and rural residents. To eliminate the observed inequalities, interventions are needed to target the poorest/poor households, rural residents, mothers with no formal education and male infants.

Prevention of Mother-to-Child HIV Transmission Service Utilization among Pregnant Women in Northeast Ethiopia: A Cross-Sectional Survey.

BACKGROUND: Targeting pregnant women attending antenatal care clinics provides a unique opportunity for implementing the Prevention of Mother-to-Child Transmission (PMTCT) programs against human immunodeficiency virus (HIV) infection of newborn babies. The objective of this study was to assess the PMTCT service utilization rate and to characterize its reasons among pregnant women attending antenatal care clinics at selected public health facilities in Debre Berhan Town, Northern Ethiopia. METHODS: A facility-based cross-sectional survey was conducted among 355 pregnant women from May 1 to June 15, 2019. The participants were selected by systematic random sampling technique, and data were collected using a pretested interviewer-administered structured questionnaire. Descriptive statistics like frequency, mean, and standard deviation were reported using text, table, and graphs. RESULTS: The mean ages of the respondents were 24 (±5.6) years, and the majority of the respondents (287 (80.8%)) were urban residents. In this study, prevention of mother-to-child HIV transmission service utilization rate was 86.8%. The most frequently mentioned reasons for not utilization of services were fear of stigma and discrimination (42.6%), fear of rejection by partner (19.1%), fear of positive test results (17.0%), lack of awareness (12.7%), and wastage of time (8.5%). Hence, continuous health education and comprehensive counseling are necessary to increase the awareness and reduce stigma, fear of the positive result, and partner rejection.

Knowledge of obstetric danger signs and its associated factors among pregnant women in Angolela Tera District, Northern Ethiopia.

OBJECTIVE: Knowledge of danger signs of obstetric complications is the first essential step in accepting appropriate and timely referral to maternal and newborn care units. The objective of this study was to assess the knowledge of obstetric danger signs and associated factors among pregnant women in Angolela Tera district, Northern Ethiopia. A community based cross sectional study was conducted among 563 pregnant women who were selected by multi-stage cluster sampling technique. Data were collected using a pre-tested and interviewer administered structured questionnaire. Descriptive statistics and binary logistic regression analysis were performed using statistical package for social sciences (SPSS) version 23. RESULTS: A total of 563 pregnant women were included in the study. About 211 (37.5%) women were knowledgeable about obstetric danger signs. Attending formal education, urban residence, time taken less than 20 min to reach health facility on foot, two or more history of pregnancies and receiving health education were found to be significantly associated with being knowledgeable about obstetric danger signs. A significant proportion of pregnant women in the study area were not knowledgeable about obstetric danger signs. Hence, continuous health education and appropriate counseling to pregnant mothers should be performed.