Urban-rural disparities in minimum acceptable diet intake among children aged 6-23 months in Ethiopia: A multivariable Decomposition analysis of Ethiopian demographic and health survey 2019.

Introduction: The achievement of the minimum acceptable diet intake (MAD) stands at 14% among urban and 10% among rural under-five children in Ethiopia. Consequently, identifying the determinants of the urban-rural gap is vital for advancing Sustainable Development Goals (SDGs), fostering healthier communities, and developing evidence-driven approaches to enhance health outcomes and address disparities. Objective: The objective of the study was to decompose the urban-rural disparities in minimum acceptable diet intake in Ethiopia using the Ethiopian Mini-Demographic and Health Survey 2019 data. Method: The study was conducted using the Ethiopian Demographic and Health Survey 2019 report. A total of 1,496 weighted children aged 6-23 months were included using stratified sampling techniques. The main outcome variable minimum acceptable diet was calculated as a combined proportion of minimum dietary diversity and minimum meal frequency. A decomposition analysis was used to analyze the factors associated with the urban-rural discrepancy of minimum acceptable diet intake, and the results were presented using tables and figures. Result: The magnitude of minimum acceptable diet among children aged 6-23 months in Ethiopia was 11.0%. There has been a significant disparity in the intake of minimum acceptable diet between urban and rural under-five children with 14 and 10%, respectively. Endowment factors were responsible for 70.2% of the discrepancy, followed by 45.1% with behavioral coefficients. Educational status of college and above was responsible for narrowing the gap between urban and rural residents by 23.9% (ß = 0.1313, 95% CI: 0.0332-0.245). The number of children in the household and the age of the child between 18 and 23 months were responsible for widening the gap in minimum acceptable diet intake discrepancy between urban and rural residents by 30.7% and 3.36%, respectively (ß = -0.002, 95% CI: -0.003 to -0.0011 and ß = -30.7, 95% CI: -0.025 - -0.0085). From the effect coefficients, the effect of institutional delivery was responsible for 1.99% of the widening of the gap between urban and rural residents in minimum acceptable diet intake (ß = -0.0862, 95% CI: -0.1711 - -0.0012). Conclusion: There is a significant variation between urban and rural residents in minimum acceptable diet. The larger portion of the discrepancy was explained by the endowment effect. Educational status of mothers with college and above, parity, age of child, and place of delivery were the significant factors contributing to the discrepancy of minimum acceptable diet intake between urban and rural residents.

Water and sanitation in urban India.

Two of the world's biggest sanitation initiatives are approaching their 10-year anniversaries, offering insights into challenges faced worldwide. Gary Humphreys reports.

A case study of inclusion of rural populations in research: Implications for science and health equity.

Prior research highlights that rural populations have been historically underrepresented/excluded from clinical research. The primary objective of this study was to describe the inclusion of rural populations within our research enterprise using Clinical Research Management System demographic information at a large academic medical center in the Southeast. This was a cross-sectional study using participant demographic information for all protocols entered into our Clinical Research Management System between May 2018 and March 2021. Descriptive statistics were used to analyze the representation of rural and non-rural participants and demographic breakdown by age, sex, race, and ethnicity for our entire enterprise and at the state level. We also compared Material Community Deprivation Index levels between urban and rural participants. Results indicated that 19% of the research population was classified as rural and 81% as non-rural for our entire sample, and 17.5% rural and 82.5% urban for our state-level sample. There were significant differences in race, sex, and age between rural and non-rural participants and Material Community Deprivation Indices between rural and non-rural participants. Lessons learned and recommendations for increasing the inclusion of rural populations in research are discussed.

Mechanism and empirical evidence on new-type urbanization to narrow the urban-rural income gap: Evidence from China's provincial data.

The main component of China's income gap is the urban-rural income gap, which is largely affected by urbanization. It is worth studying how new-type urbanization affects the income gap between urban and rural areas. Research mostly focuses on the urbanization rate as the core explanatory variable to explain the impact using one or two factors. This paper analyzes the mechanism of the effect using a comprehensive number of factors, with the quality of new-type urbanization development as the core explanatory variable. In terms of theoretical research, we believe that new-type urbanization affects the urban-rural income gap by promoting the transfer of labor, changing industrial structure, and policy tendency. Using both static and dynamic empirical analyses, we test the impact of new-type urbanization on the urban-rural income gap based on China's provincial data. We find that new-type urbanization is conducive to narrowing the income gap between urban and rural areas. The transfer of labor significantly reduces the urban-rural income gap. However, the upgrading of industrial structure will enlarge the gap. The impact of China's policy orientation is negligible. Policy should focus on promoting urbanization and improving the marginal rate of return of agriculture, improve the level of human capital, reverse the mismatch between employment structure and industrial structure, increase support for rural areas, and make substantial progress in promoting common prosperity.

Prevalence of Second Hand Smoke Exposure and Measures to Overcome: A Cross Sectional Study among Youth in Urban Hyderabad.

ABSTRACT: In India, the prevalence of secondhand smoke (SHS) exposure is 29.5% in general and 11.2% at home. The youth may expose themselves to SHS without knowing the risk factors and consequences involved. This study is intended to determine the prevalence of SHS exposure and the measures adopted by the youth to avoid exposure. A cross-sectional study was conducted among 338 youth in an urban area in Hyderabad. A modified Global Youth Tobacco Survey questionnaire was used for data collection on SHS exposure and avoidance. The total prevalence of SHS exposure was 35.21%. The mean days of SHS exposure/week were 1.419 (standard deviation -1.806) days. Belonging to the age group 18-21 years, and male gender were significant predictors of SHS exposure. Education of the head of family was a significant predictor of SHS avoidance behavior. Creating awareness among young adults regarding the deleterious effects and preventive strategies of SHS exposure, thereby making them responsible for the health of their family can be a protective long-term strategy.

Exploring the lived experiences of women with infertility using traditional healthcare services in Harare urban, Zimbabwe.

Infertility has a significant impact on the lives of women. Therefore, affected women often consider the treatment options available to deal with their condition, including traditional healthcare services (THS). The aim of this phenomenological study was to explore the lived experiences of women with infertility problems who sought help from traditional health practitioners in Harare, Zimbabwe. Data from interviews with five women with infertility was explicated using a simplified version of Hycner (1985) five step explication process. Two major themes and eight sub themes emerged from the findings. The major themes were traditional diagnosis experiences and traditional treatment experiences. Consultation and divination were the diagnosis methods experienced by the women with infertility. The THS offered comprehensive management of infertility through couples therapy, as well as pre- and post-natal therapies, which include lifestyle counselling. The findings also showed that women with infertility commonly receive concurrent treatment, including both allopathic and traditional medicine. This presents an opportunity to explore the convergence of traditional and allopathic approaches in the management of infertility in women.

L'infertilité a un impact significatif sur la vie des femmes. Par conséquent, les femmes affectées envisagent souvent les options de traitement disponibles pour faire face à leur maladie, y compris les services de santé traditionnels (THS). Le but de cette étude phénoménologique était d'explorer les expériences vécues de femmes souffrant de problèmes d'infertilité qui ont demandé l'aide de praticiens de santé traditionnels à Harare, au Zimbabwe. Les données provenant d'entretiens avec cinq femmes infertiles ont été expliquées à l'aide d'une version simplifiée du processus d'explication en cinq étapes de Hycner (1985). Deux thèmes majeurs et huit sous-thèmes ont émergé des résultats. Les thèmes principaux étaient les expériences de diagnostic traditionnel et les expériences de traitement traditionnel. La consultation et la divination étaient les méthodes de diagnostic expérimentées par les femmes infertiles. Le THS proposait une prise en charge complète de l'infertilité grâce à une thérapie de couple, ainsi que des thérapies prénatales et postnatales, qui comprennent des conseils sur le mode de vie. Les résultats ont également montré que les femmes souffrant d'infertilité reçoivent généralement un traitement concomitant, comprenant à la fois la médecine allopathique et la médecine traditionnelle. Cela présente l'occasion d'explorer la convergence des approches traditionnelles et allopathiques dans la gestion de l'infertilité chez la femme.

Overall health knowledge in the Philippines, multilevel confirmatory factor analysis of the Philippine National Demography Health Survey 2022 data.

A secondary data analysis of the 2022 Philippine National Demographic and Health Survey (PNDHS) was conducted to explore the underlying structure of knowledge regarding communicable and noncommunicable diseases using multilevel confirmatory factor analysis (CFA). The PNDHS data consist of two levels: level-1 represents within-household data (household questionnaire), and level-2 represents between-household data (primary sampling unit (PSU)). Therefore, a two-level CFA and two-level variance CFA were performed. Furthermore, a multigroup analysis assessed the structural differences between males/females and urban/rural groups. In the PNDHS survey, 30,372 household interviews were completed. Knowledge levels for cancer, heart disease, diabetes, dengue fever, TB, and COVID-19 were 96.7%, 94.9%, 97.8%, 98.4%, 96.7%, and 92.8%, respectively. The two-level CFA indicated that the coefficient loadings of each item for both levels were statistically significant (Z-test, P < 0.001). Regarding two-level variance CFA, the variance at level-1 was higher than that at level-2 (13 and 6.7, respectively). The multigroup analysis revealed that the model was non-invariant (not equal) across gender and residence (likelihood ratio test; P < 0.001, P < 0.001, respectively). In conclusion, level-1 has greater effect than does level-2 because the variance in level-1 is greater than that in level-2, the knowledge of COVID-19 has the lowest loading compared to other items, and rural/urban areas and females/males exhibit different levels of health knowledge.

The role of digital financial inclusion in China on urban-rural disparities in healthcare expenditures.

Introduction: The digital financial inclusion (DFI) provides opportunities to improve the relative capacity to pay for healthcare services by rural residents who are usually underserved by traditional finance in China. This paper provides empirical evidence on how the development of DFI affects the healthcare expenditure disparities between urban and rural residents. Methods: We employed the fixed effects model and instrumental variable method to estimate the impact of DFI on the Theil index of urban-rural disparities in healthcare expenditures, using panel data from 31 provinces (2011 ~ 2020) in China. We further adopted a moderating effect model to test whether the intensity of the impact would vary depending on the level of local government health expenditures. Results: The results suggest a negative association between the development level of DFI and the urban-rural healthcare expenditure disparities in China. For every 1% increase in the DFI index, the Theil index of urban-rural disparities in healthcare expenditures would fall by 0.0013. After changing the measurement method for the dependent variable and adjusting the sample, the results remain robust. Moreover, the result of the moderating effect model indicates that, a high level of government health expenditures is conducive to the impact of DFI. Discussion: Our research reveals that DFI plays an important role in bridging the urban-rural gap in healthcare expenditures. This finding provides new information for addressing the issue of urban-rural healthcare inequality in China. Chinese government needs to accelerate the construction of digital infrastructure and increase the penetration rate of digital tools in rural areas to promote the beneficial effects of DFI. Additionally, it is also necessary for local government to address the unbalanced allocation of medical resources between urban and rural areas, especially the shortage of rural human resources.

The silent epidemic: exploring the link between loneliness and chronic diseases in China's elderly.

BACKGROUND: Chronic diseases, such as heart disease, cancer, and diabetes, are the leading causes of death and disability. Loneliness is linked to a greater risk of chronic disease. However, the lack of loneliness may change this relationship. METHODS: The 4th Survey of the Aged Population in Urban and Rural China (SSAPUR) was performed. 222,179 people over 60 years old were recruited. Chronic disease was defined by self-reported tumble incidents using the fourth SSAPUR questionnaire. We found that the residuals were well normally distributed. Subsequently, we analyzed the association between each studied factor and chronic disease by univariate logistic regression analysis. Finally, we stratified the population by age, gender, and urban and rural. RESULTS: 77,448 individuals experienced loneliness, while 137,593 did not. Loneliness correlated significantly with urban-rural classification, age, and gender (P < 0.001). There was a significant association between chronic diseases and loneliness (P < 0.05). Compared to lonely individuals, those with low level of loneliness had a lower incidence of gastric diseases (OR = 0.752, 95% CI, 0.736-0.769, P < 0.001), osteoarthritis (OR = 0.685, 95% CI, 0.673-0.697, P < 0.001), chronic obstructive pulmonary disease (COPD) (OR = 0.678, 95% CI, 0.659-0.698, P < 0.001), asthma (OR = 0.608, 95% CI, 0.583-0.633, P < 0.001), malignant tumors (OR = 0.892, 95% CI, 0.822-0.968, P = 0.006), and reproductive system diseases (OR = 0.871, 95% CI, 0.826-0.918, P < 0.001). CONCLUSION: In summary, loneliness is an important risk factor in the occurrence and development of chronic diseases in the elderly in China, and it has adverse effects on hypertension, stomach disease, cataract or glaucoma, osteoarthrosis, chronic lung disease, asthma, malignant tumor, and reproductive system diseases.

Examining rurality and social determinants of health among women with GDM: a 15-year comprehensive population analysis.

BACKGROUND: Gestational diabetes mellitus (GDM) is a common pregnancy complication with long-term health consequences for mothers and their children. The escalating trends of GDM coupled with the growing prevalence of maternal obesity, a significant GDM risk factor projected to approach nearly 60% by 2030 in Kansas, has emerged as a pressing public health issue. METHODS: The aim of this study was to compare GDM and maternal obesity trends in rural and urban areas and investigate maternal demographic characteristics influencing the risk of GDM development over a 15-year period. Trend analyses and a binary logistic regression were employed utilizing 2005 to 2019 de-identified birth record vital statistics from the Kansas Department of Health and Environment (N = 589,605). RESULTS: Over the cumulative 15-year period, a higher prevalence of GDM was observed across age, race/ethnicity, education, and insurance source. Throughout this period, there was an increasing trend in both GDM and obese pre-pregnancy BMI age-adjusted prevalence, with noticeable rural-urban disparities. From 2005 to 2019, women, including Asians (OR: 2.73, 95% CI 2.58%-2.88%), American Indian or Alaskan Natives (OR: 1.58, 95%, CI 1.44-1.73%), Hispanics (OR: 1.42, 95% CI 1.37%-1.48%), women residing in rural areas (OR: 1.09, 95%, CI 1.06-1.12%), with advanced maternal age (35-39 years, OR: 4.83 95% CI 4.47%-5.22%; ≥40 years, OR: 6.36 95%, CI 5.80-6.98%), with lower educational status (less than high school, OR: 1.15, 95% CI 1.10%-1.20%; high school graduate, OR: 1.10, 95% CI 1.06%-1.13%), Medicaid users (OR: 1.10, 95% CI 1.06%-1.13%), or with an overweight (OR: 1.78, 95% CI 1.72%-1.84%) or obese (OR: 3.61, 95% CI 3.50%-3.72%) pre-pregnancy BMI were found to be at an increased risk of developing GDM. CONCLUSIONS: There are persistent rural-urban and racial/ethnic disparities present from 2005 to 2019 among pregnant women in Kansas with or at-risk of GDM. There are several socioeconomic factors that contribute to these health disparities affecting GDM development. These findings, alongside with prominent rising maternal obesity trends, highlight the need to expand GDM services in a predominantly rural state, and implement culturally-responsive interventions for at-risk women.

Nutritional status of HIV-infected children at Federal University Teaching Hospital, Owerri, Nigeria: A prospective analysis of rural and urban dwellers.

Malnutrition is a critical concern among children living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), particularly in regions heavily affected by the HIV epidemic, such as sub-Saharan Africa. In 2019, nearly 2.84 million children under 19 years of age were living with HIV globally, with over 90% residing in sub-Saharan Africa. Concurrently, malnutrition remains prevalent in the region, with approximately 49 million children under the age of 5 experiencing stunting and 149 million suffering from wasting in 2018. This burden of malnutrition is exacerbated by factors such as poverty, food insecurity, and HIV/AIDS, which collectively contribute to adverse health outcomes among affected children. The bidirectional relationship between HIV/AIDS and malnutrition is well-established, with HIV infection increasing the risk of malnutrition and malnutrition worsening the progression of HIV/AIDS. Studies have consistently demonstrated higher rates of stunting, underweight, and wasting among HIV-infected children compared to their uninfected counterparts. Moreover, malnutrition significantly impacts the disease progression, morbidity, and mortality of HIV-infected individuals, further underscoring the importance of addressing this issue in pediatric HIV care. A total of 99 HIV-infected children, aged 2 to 16 years, were consecutively recruited from the pediatric infectious disease clinic of the Federal University Teaching Hospital Owerri. Anthropometric measurements, including weight and height, were obtained using a stadiometer (RGZ-160 England). Weight status was categorized as normal, underweight, overweight, or obese, while height status was classified as stunted, normal, or tall stature. The study participants ranged in age from 2 to 16 years. Approximately 20.2% of the children were underweight, and 6.1% were classified as obese. Stunting was observed in 29.3% of the participants. Notably, all forms of malnutrition, including underweight and overweight, were more prevalent among children residing in rural areas. In addition, stunting was more common among rural dwellers. This study highlights the high prevalence of malnutrition among HIV-infected children attending the pediatric infectious disease clinic at the Federal University Teaching Hospital Owerri. The findings underscore the urgent need for targeted nutritional interventions, particularly in rural areas, to improve the health outcomes of HIV-infected children.

Dietary Knowledge, Attitudes, and Behaviors Related to Obesity and Highly Underweight Among Urban Chinese High School Students: A Cross-Sectional Study.

Objectives: This study aimed to identify dietary knowledge, attitudes, and behaviors related to obesity and highly underweight among urban Chinese high school students. Methods: Using the data of 403 high school students from a cross-sectional survey in 2022, multinomial logistic regression analysis was conducted with the body mass index as the objective variable (reference: normal weight), dietary knowledge, attitudes, and behaviors as the explanatory variables, adjusted for sex. Results: Both obesity and highly underweight were most strongly related to incorrect dietary knowledge of desirable types of diets. Additionally, obesity was related to inappropriate dietary attitudes regarding the importance of diet, eating at irregular meal-times, and eating without chewing well, while highly underweight was related to picky eating and not having three meals per day, but not related to attitudes. Conclusion: The incorrect knowledge of desirable type of diet was related to both obesity and highly underweight, while other risk factors of knowledge, attitudes, and behaviors related to obesity or highly underweight differed respectively. These findings should be useful in examining effective nutrition education for urban Chinese high school students.

To be visible yet remain unseen: An interpretative phenomenological analysis of embodied drug use and recovery of Filipinas.

The experience of drug use is a gendered and culturally embodied phenomenon. This qualitative study aims to unpack the lived experiences of 16 urban, poor, Filipina mothers who used drugs. In-depth interviews were conducted. Data was analyzed using interpretative phenomenological analysis (IPA). Their experiences were divided into drug initiation and recovery. Key findings show embodied experiences of initiation through starting use, losing control, and navigating through public and private spaces of drug use. Their experiences of drug recovery revolved around decoupling relations, avoiding drug use spaces, and healing their strained home. Theoretically, this study contributes to enriching the analytical underpinnings of IPA through a gendered and embodied perspective. In terms of practical implications, findings point to the need for a gender-conscious approach in intervention design and implementation in the community setting considering the life space of Filipinas who use drugs.

Population prevalence of aspergillus sensitization and allergic bronchopulmonary aspergillosis in COPD subjects in North India.

BACKGROUND: Sensitization to Aspergillus fumigatus (AS) has been recently described in chronic obstructive pulmonary disease (COPD) patients. However, there is no data on the community prevalence of AS in COPD. OBJECTIVES: To assess the prevalence of AS among COPD subjects. The secondary objectives were to (1) assess the prevalence of allergic bronchopulmonary aspergillosis (ABPA) in COPD and (2) compare the lung function in COPD subjects with and without AS. METHODS: We conducted a cross-sectional study in rural (29 villages) and urban (20 wards) communities in North India. We identified individuals with respiratory symptoms (IRS) through a house-to-house survey using a modified IUATLD questionnaire. We then diagnosed COPD through specialist assessment and spirometry using the GOLD criteria. We assayed A.fumigatus-specific IgE in COPD subjects. In those with A. fumigatus-specific IgE ≥0.35 kUA/L (AS), ABPA was diagnosed with raised serum total IgE and raised A.fumigatus-specific IgG or blood eosinophil count. RESULTS: We found 1315 (8.2%) IRS among 16,071 participants >40 years and diagnosed COPD in 355 (2.2%) subjects. 291 (82.0%) were men and 259 (73.0%) resided in rural areas. The prevalence of AS and ABPA was 17.7% (95% CI, 13.9-21.8) and 6.6% (95% CI, 4.4-8.8). We found a lower percentage predicted FEV1 in COPD subjects with AS than those without (p =.042). CONCLUSIONS: We found an 18% community prevalence of AS in COPD subjects in a specific area in North India. Studies from different geographical areas are required to confirm our findings. The impact of AS and ABPA on COPD requires further research.

Spatial non-equilibrium and distribution dynamic evolution of the development level of national physical fitness in China's provinces.

INTRODUCTION: Physical health is fundamental to a country's socio-economic advancement. An in-depth exploration of the spatial distribution and dynamic evolution of national physical fitness across China is crucial for enhancing the country's overall physical health. This study aims to provide valuable insights into the geographical and temporal patterns of physical fitness, informing strategies for national physical fitness improvement. METHODS: Employing data from China's national physical fitness monitoring of 31 provinces, cities, and districts for the years 2005, 2010, and 2015, this study utilizes the Gini coefficient, its decomposition, and nonparametric density estimation methods. These techniques are applied to analyze the spatial disparities and temporal trends in national physical fitness levels among different demographics, including the overall population, males, females, and urban and rural residents. RESULTS: The study reveals that the regional disparity in China's national physical fitness initially narrowed and then expanded across the general population, females, and in both urban and rural areas, while consistently increasing among males. In terms of geographical distribution, the East, Middle, and West regions show significant heterogeneity, with the East-West gap being the most pronounced (Gini coefficients of 0.0249, 0.0230, 0.0263). The contribution rate of regional gaps was highest (54.40% -64.69%), followed by regional disparities (24.78% -27.15%), and the contribution of hypervariable density difference was the smallest (10.53% -19.75%). Despite a slight improvement in overall national physical fitness, the absolute regional disparities have further widened. CONCLUSIONS: Provinces with lower levels of national physical fitness demonstrate a 'club convergence' trend, indicating regional clustering of similar fitness levels. Additionally, a 'catch-up effect' is evident in rural areas, particularly in provinces with historically lower levels of national physical fitness. These findings suggest the need for region-specific public health strategies to address the growing disparities in national physical fitness across China.

Point-of-care Testing HbA1c screening for type 2 diabetes in urban and rural areas of China: a cost-effectiveness analysis.

Background: Point-of-care Testing (POCT) glycosylated hemoglobin (HbA1c) is a convenient, cheap, effective and accessible screening method for type 2 diabetes in rural areas and community settings that is widely used in the European region and Japan, but not yet widespread in China. The study is the first to evaluate the cost-effectiveness of POCT HbA1c, fasting capillary glucose (FCG), and venous blood HbA1c to screen for type 2 diabetes in urban and rural areas of China, and to identify the best socio-economically beneficial screening strategy. Methods: Based on urban and rural areas in China, economic models for type 2 diabetes screening were constructed from a social perspective. The subjects of this study were adults aged 18-80 years with undiagnosed type 2 diabetes. Three screening strategies were established for venous blood HbA1c, FCG and POCT HbA1c, and cost-effectiveness analysis was performed by Markov models. One-way sensitivity analysis and probabilistic sensitivity analysis were performed on all parameters of the model to verify the stability of the results. Results: Compared with FCG, POCT HbA1c was cost-effective with an incremental cost-utility ratio (ICUR) of $500.06/quality-adjusted life year (QALY) in urban areas and an ICUR of $185.10/QALY in rural areas, within the willingness-to-pay threshold (WTP = $37,653). POCT HbA1c was cost-effective with lower cost and higher utility compared with venous blood HbA1c in both urban and rural areas. In the comparison of venous blood HbA1c and FCG, venous blood HbA1c was cost-effective (ICUR = $20,833/QALY) in urban areas but not in rural areas (ICUR = $41,858/QALY). Sensitivity analyses showed that the results of the study were stable and credible. Conclusions: POCT HbA1c was cost-effective for type 2 diabetes screening in both urban and rural areas of China, which could be considered for future clinical practice in China. Factors such as geographic location, local financial situation and resident compliance needed to be considered when making the choice of venous blood HbA1c or FCG.

Identifying pregnant and postpartum women's priorities for enhancing nutrition support through social needs programmes in a resource-constrained urban community in South Africa.

BACKGROUND: Malnutrition remains a pressing public health concern for mothers and children in South Africa. Despite the government's multisectoral response, unaddressed social needs prevent some mothers getting full benefit from interventions, spanning financial planning, income stability, housing, access to government services, social support, and provision of affordable, nutritious foods. Engaging with mothers and prioritising their concerns is important if we wish to overcome obstacles to women benefiting from government nutrition interventions. This study aimed to identify the programmes that women perceived as a priority in addressing the social needs of mothers of young infants and pregnant women to enhance nutrition in a resource-constrained urban township in South Africa. METHODS: A cross-sectional study employed a quantitative preference elicitation survey, administered to 210 mothers and pregnant women from five primary healthcare facilities in Soweto. The survey tool was developed with the community to identify unmet social needs and potential solutions, which were synthesised with findings from the literature. The survey described 15 programmes, grouped into three delivery levels: clinics, community, and government. Participants were required to rank programme options in two stages. First, they selected their top two programmes within each delivery level. Subsequently, they allocated stickers to indicate the strength of their preference among the top programmes across the levels. Rankings were analysed using descriptive statistics. RESULTS: The highest priority was given to five programmes. Two delivered at the community level: Women's economic empowerment groups and Job search assistance, two at the clinic level: Social needs assessment and referral, and Prescription-based food, and one at the government level: Free quality childcare. The lowest-ranked programmes were two clinic-based programmes, specifically Maternal nutrition groups and Couple antenatal education. CONCLUSION: Women expressed strong views about which programmes should be prioritised to support mothers and pregnant women in addressing their social needs and improving nutrition. Key areas included providing support with job searching and entrepreneurship, accessing childcare and the healthy foods recommended at clinics, as well as finding information on available community and government services. Leveraging multisectoral collaboration, aligned policy objectives, efficient public financing, and strengthened implementation capacity will be pivotal in delivering these programmes.

[Relationship between indoor and outdoor levels of black carbon in residential houses in urban areas of Beijing in 2016].

OBJECTIVE: To investigate the black carbon (BC) pollution in the indoor air of typical residential houses in urban areas of Beijing, and to explore the relationship between indoor and outdoor BC concentrations as well as the main influencing factors. METHODS: The indoor and outdoor PM_(2.5) samples were collected simultaneously from 33 apartments in the urban areas of Beijing during both the heating season (January to March) and the non-heating season (June to August) in 2016. Subsequently, optical method were employed to analyze BC concentrations in PM_(2.5)samples. The Spearman correlation coefficient (r_s) and the indoor/outdoor (I/O) ratio of BC concentrations were both calculated to characterize the relationship between indoor and outdoor BC concentrations. The factors may influence indoor BC pollution was collected through a questionnaire, including the basic characteristics of the residential buildings and households, smoking, cooking, window opening behavior, the use of air conditioner or air purifier and so on. Additionally, a linear mixed-effects model or multiple linear regression model was applied to identify the main factors influencing the I/O ratio. RESULTS: The(M(P25, P75)) concentrations of indoor and outdoor BC for season-pooled analysis were2.84 (2.59, 3.26)µg/m~3 and 3.08 (2.90, 3.63)µg/m~3, respectively. There were significant seasonal differences in both indoor and outdoor concentrations (P<0.05), with higher levels observed during the heating season compared to the non-heating season. There was a strong correlation between indoor and outdoor BC (r_s=0.74). The correlation during the heating season (r_s=0.78) was stronger than that during the non-heating season (r_s=0.44). The ■ of I/O ratio was 0.90±0.11, with 93.5%(29/31)and 86.7%(26/30) of I/O ratios being less than 1 during the heating season and non-heating season, respectively. Statistical analysis also showed that outdoor BCconcentrations were significantly higher than indoors (P<0.05). In season-pooled analysis, the result of the linear mixed-effects model showed that window opening duration was the most important factor affecting the I/O ratio, explaining 21.3%of the total variation. The I/O ratio increased with longer window opening duration. In season-specific analysis, the characteristics of residential buildings (including building age and floor level) and window opening duration were the main factors affecting the I/O ratio during the heating season and non-heating season, respectively in 2016. CONCLUSION: Residents in the urban areas of Beijing experienced relatively high indoor levels of BCpollution, but lower than the outdoor concentration during the same period in 2016. The window opening and the characteristics of residential buildings were the most important factors affecting the I/O ratio of BC.

Perspectives on telemedicine across urban, rural and remote areas in the Philippines during the COVID-19 pandemic.

OBJECTIVES: This study explored attitudes, subjective norms, and perceived behavioural control of participants across urban, rural and remote settings and examined intention-to-use telemedicine (defined in this study as remote patient-clinician consultations) during the COVID-19 pandemic. METHODS: This is a cross-sectional study. 12 focus group discussions were conducted with 60 diverse telemedicine user and non-user participants across 3 study settings. Analysis of responses was done to understand the attitudes, norms and perceived behavioural control of participants. This explored the relationship between the aforementioned factors and intention to use. RESULTS: Both users and non-users of telemedicine relayed that the benefits of telemedicine include protection from COVID-19 exposure, decreased out-of-pocket expenses and better work-life balance. Both groups also relayed perceived barriers to telemedicine. Users from the urban site relayed that the lack of preferred physicians discouraged use. Users from the rural and remote sites were concerned about spending on resources (ie, compatible smartphones) to access telemedicine. Non-users from all three sites mentioned that they would not try telemedicine if they felt overwhelmed prior to access. DISCUSSION: First-hand experiences, peer promotions, and maximising resource support instil hope that telemedicine can help people gain more access to healthcare. However, utilisation will remain low if patients feel overwhelmed by the behavioural modifications and material resources needed to access telemedicine. Boosting infrastructure must come with improving confidence and trust among people. CONCLUSION: Sustainable access beyond the pandemic requires an understanding of factors that prevent usage. Sufficient investment in infrastructure and other related resources is needed if telemedicine will be used to address inequities in healthcare access, especially in rural and remote areas.