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Socioeconomic and demographic factors and anaemia among children in the Democratic Republic of Congo, Uganda and Malawi
Ngianga II Shadrack Kandala, Amos Channon & Nyovani Madise, University of Southampton
Anaemia is one of the most common health problems in both developed and developing countries (Logan et al., 2001). In Africa more than 100 million children are thought to be anaemic and the excess mortality burden associated with anaemia is estimated at 174,000 - 190,000 deaths per year in children under the age of 5 years (Schellenberg et al., 2003). Anaemia affects the physical and cognitive development of children, the immune system and also increases children's susceptibility to infections. However, even though the direct biological causes of anaemia are well documented, the background socioeconomic factors related to the condition are less well understood, through a paucity of data. This has recently changed with the collection of haemoglobin measurements in Demographic and Health Surveys (DHS). In this study, the socioeconomic and demographic factors related to anaemia in children are investigated, focusing on community and household level similarities. DHS from the DRC (2007), Uganda (2006) and Malawi (2004) are used. Understanding these factors can then be used as a basis for policy formulation, planning and implementation. Multilevel ordinal logistic regression models are used to predict no anaemia, mild anaemia and moderate/severe anaemia in children under 5 years of age. The results suggested that age, sex, birth weight, household wealth status, source of drinking water, region, whether the mother is also anaemic and whether the child has had a recent fever are risk factors associated with anaemia in at least one of the three countries.
Email: nik1c08@soton.ac.uk
The double burden of child malnutrition: The international context and key socioeconomic determinants
Katie Bates, London School of Economics
The persistence of undernutrition and the increasing prevalence of overnutrition among 1 to 5 year olds worldwide have led to a 'double burden of child malnutrition' in rapidly developing low and middle income countries. This study aims to assess the macro socioeconomic factors associated with this emerging nutrition crisis. Using macro-data for 44 countries from the Demographic and Health Surveys Phase V and Human Development Reports (for the respective years), this paper explores the macro factors associated with the presence of a double burden of child malnutrition. Very few studies have tackled this relatively new phenomenon for child health and to the best of my knowledge none has looked at international comparisons. Logistic regression models are used to test the presence of a double burden of child malnutrition controlling for national-level socioeconomic conditions utilising independent variables for the countries' health, education, employment and economic characteristics. A binary dependent variable indicating the presence of a double burden of child malnutrition will be created based upon the prevalence of undernutrition and overnutrition among children utilising the 'cut-off' recommendations for medium to high prevalence of both stunting and overnutrition from the World Health Organisation. Results will show a clear picture of current trends in the double burden of child malnutrition internationally, and the key determinants at international level. This study is set within the wider contribution for the public health effort to tackle child malnutrition.
Email: k.m.bates@lse.ac.uk
The prevalence and predictors of low body mass index undergoing nutrition transition
Gobopamang Latamo, University of Botswana
Objective: The aim of this study was to estimate the prevalence and predictors of low body mass index (BMI) in a country undergoing nutrition transition. Design: A cross-sectional survey was conducted in 2007 using a multistage sampling method.
Setting: A middle-income country located in Southern Africa called Botswana
Subjects: A nationally representative sample of 4,107 men and 4,916 women aged 20 to 49 years was used for the analysis.
Main Outcome Measure: Low BMI was defined as <18.5 kg/m2
Results: Of the total sample, 19.5% of males and 10.1% of females were underweight (BMI < 18.5 kg.m2). Most of the underweight adult population was moderately thin. Most of the underweight adults were mildly thin, 13.7% and 6.2% men and women, respectively. 4.1% of men and 2.3% of women were moderately thin. The proportion of men and women who were severely thin were 1.7% and 1.6% respectively. Results from logistic regression analysis indicated that both adult men and women who were young, lived in rural areas, had never married, had no or little education, had no children, did not listen to a radio at least once a week and did not watch TV at least once a week were associated with high prevalence of underweight.
Conclusions: The problem of low BMI is predominantly more pronounced among men than women. Low socio-economic status appears to explain much of underweight as more of this phenomenon was more prevalent among the young, the rural area dwellers, the never married, those with no education or those who had not listened or watched television.
Email: letamog@mopipi.ub.bw
Social diseases (HIV and tuberculosis) and population health in Russia
Vladimir Kozlov, Moscow Lomonosov State University
The main goal of the paper is to analyze the impact of social diseases on healthy life expectancy in Russia and conduct an analysis of burden of these diseases. The main tasks: 1) Analyze tuberculosis (TB) and HIV prevalence rates in Russia by age and sex using medical and epidemiological research data. 2) Analyze and compare death rates from HIV and TB by age and sex using death registration data from these causes. 3) Compute life expectancy with and without TB, with and without HIV by age and sex. 4) Compute average number of years lost due to excess mortality and morbidity from TB and HIV in Russia. 5) Analyze particular qualities of HIV and TB spreading by different regions. The subject is topical, because according to the recent available data from WHO social deseases burden in Russia is sighnificantly higher than the burden in the Eastern european countries with the same level of economic development (for example, Eastern European countries).
Email: kozloww@gmail.com
The income gradient in health in England and the United States
Melissa L. Martinson, Princeton University
Population health is systematically worse in the United States (US) than England, despite the much higher level of healthcare spending in the US (Banks et al., 2006; Avendano et al., 2009; Martinson et al., 2011). Well-documented health differentials between the two countries exist for a wide variety of health measures and at all ages (Martinson et al., 2011). However, questions remain about the extent of cross-country differences in health disparities, in particular whether income inequalities in health are higher in the US than in England. This paper systematically examines income gradients in health in the England and the US across the life span (ages from 0 to 80 years), separately for females and males, for a number of health conditions. Using data from the Health Survey for England (n=69084) and the National Health and Nutrition Examination Survey for the United States (n=39849), weighted prevalence rates and risk ratios are calculated by income level for the following health risk factors or conditions: obesity, hypertension, diabetes, low high-density lipoprotein cholesterol, high cholesterol ratio, heart attack or angina, stroke, asthma, and cancer. The results demonstrate that the income gradients in health are very similar in the two countries across age, gender, and a number of health conditions. The gradients in both countries are robust to adjustments for health behaviors, body mass index (BMI), race/ethnicity, and health insurance.
Email: martinso@princeton.edu
Social inequalities in alcohol-related mortality by National Statistics Socio-economic Classification, England and Wales, 2001-03
Veronique Siegler, Alaa Al-Hamad, Brian Johnson, Claudoa Wells, Office for National Statistics; Nick Sheron, University of Southampton
Rates of alcohol-related mortality in the United Kingdom have increased significantly since the early 1990s. Excessive consumption of alcohol is a major preventable cause of premature mortality. In England and Wales, socio-economic class and deprivation have been identified as risk factors for alcohol-related mortality. This presentation is the first analysis of social inequalities in adult alcohol-related mortality at the start of the 21st century in England and Wales, which uses the National Statistics Socio-economic Classification (NS-SEC), based on the occupation and employment status of individuals. The study is restricted to the period 2001 to 2003 as a consequence of constraints on the availability of population data suitably classified by NS-SEC. Inequalities are measured using ratios of alcohol-related mortality rates between the least and the most advantaged classes for both men and women. The socio-economic patterns of alcohol-related mortality by age group, and its variation with gender are also dicussed. The geographical variation in inequalities in alcohol-related mortality are examined within the English regions and Wales.
Email:
veronique.siegler@ons.gsi.gov.uk
A good place for bringing up children? Mother's neighbourhood perceptions and children's social development
Anja Scheiwe, University College London; Yvonne Kelly, University of Essex; Mai Stafford, MRC Unit for Lifelong Health & Ageing; Richard Watt, University College London
Aim: To explore the associations between perceived quality of the neighbourhood environment, as reported by the mother, and children's social development. Design: Secondary analysis of longitudinal data from the UK Millennium Cohort Study. Participants: 8526 mother and child pairs with complete information across all four sweeps. Main outcome measure: Behavioural and emotional difficulties at age 7. Methods: Perceptions of the neighbourhood social environment were measured at sweeps 1-3. Items were combined to derive a "neighbourhood satisfaction" score. A dummy variable was created to differentiate between families who perceived their neighbourhood social environment as poor either never (reference category), at one sweep, at two sweeps or at three consecutive sweeps. The associations between low neighbourhood satisfaction across sweeps and children's behavioural and emotional difficulties were tested via multiple linear regression. Results: We found a positive linear relationship between exposure to perceived adverse neighbourhood conditions across sweeps 1-3 and children's behavioural and emotional difficulties at sweep 4 (age 7). The relationship was attenuated but remained statistically significant after individual characteristics, family socio-economic factors and indicators of maternal psychological distress were accounted for. Conclusions: The results suggest that children's social development is affected by maternal perceptions of the neighbourhood over and above individual socio-economic factors. Persistent exposure to perceived adverse neighbourhood conditions had the most detrimental effect. Part of the association appears to be mediated by the psychological well being of the mother.
Email: a.scheiwe@ucl.ac.uk
A comparative analysis of the black/white differential in the role of advanced maternal age
Alice Goisis, Wendy Sigle-Rushton, London School of Economics
It is well established that, across a range of countries, black women are more likely to have poorer birth outcomes than white women. Some, predominantly U.S., studies have also demonstrated that the excess risk of low birth weight for black women compared to white women tends to increase with the age of the mother. Researchers have suggested that this age pattern may be due to black women's greater risk of exposure to cumulative health disadvantages, something referred to as the "weathering hypothesis". If health disadvantages are the driving force behind these patterns, we might expect less evidence of an ethnic gradient in excess risk of poor birth outcomes with age in contexts where women are more protected from the detrimental effects of social inequality and poverty. In this paper, using data from the Millennium Cohort Study (U.K) and the Fragile Families (U.S.), we compare birth outcomes by ethnic group and age in both the U.S. and the U.K. Relative to the U.S., the U.K. has different social institutions and policies that reduce inequality. We therefore expect the gap in birth weight (our indicator of birth outcome) between white and black women to be smaller and to increase less steeply with maternal age in the U.K than in the U.S.
Email: A.Goisis@lse.ac.uk
Neonatal death and national income in developing countries: Will economic growth reduce deaths in the first month of life?
Sarah Neal, University of Southampton; Jane Falkingham, University of Southampton; John Micklewright, Institute of Education
The relationship between national income and child mortality has been understood for many years, but no studies have ever specifically looked at whether the association differs at different ages. At a household level there is some evidence to suggest that while a wealth gradient exists for neonatal mortality, it is weaker than for post neonatal deaths (Lawn et al., Titmuss 1943, cited in Loudon 1992). If this is extrapolated to the national level, a weaker association between income and levels of neonatal mortality may mean that economic growth has less impact on reducing neonatal deaths than those in older age groups. Our study extends knowledge by analysing the relationship between GDP and the three separate component rates of child mortality: neonatal, post-neonatal and early childhood mortality (NMR, PNMR and ECMR) using both cross-sectional and longitudinal data. It confirms that increases in GDP are indeed associated with smaller reductions in NMR than either PNMR or ECMR. This has potential implications for the degree to which economic growth can drive reductions in child mortality in countries where a high proportion of deaths occur in the first month of life.
Email: sn1c09@soton,ac.uk
Is there an urban advantage in child survival in sub-Saharan Africa? Evidence from 18 countries in the 1990s
Philippe Bocquier, Catholic University of Louvain; Nyovani Madise, University of Southampton; Eliya Zulu, African Institute for Development Policy
Evidence of higher child mortality of rural-to-urban migrants compared with urban nonmigrants is growing. However, less attention has been paid to comparing the situation of the same families before and after they migrate with the situation of urbanto-rural migrants. We use DHS data from 18 African countries to compare child mortality rates of six groups based on their mothers' migration status: rural nonmigrants; urban nonmigrants; rural-to-urban migrants before and after they migrate; and urban-to-rural migrants before and after they migrate. The results show that rural-to-urban migrants had, on average, lower child mortality before they migrated than rural nonmigrants, and that their mortality levels dropped further after they arrived in urban areas. We found no systematic evidence of higher child mortality for rural-to-urban migrants compared with urban nonmigrants. Urban-to-rural migrants had higher mortality in the urban areas, and their move to rural areas appeared advantageous because they experienced lower or similar child mortality after living in rural areas. After we control for known demographic and socioeconomic correlates of under-5 mortality, the urban advantage is greatly reduced and sometimes reversed. The results suggest that it may not be necessarily the place of residence that matters for child survival but, rather, access to services and economic opportunities.
Email: n.j.madise@soton.ac.uk
The treatment of child illness in Southern Africa: How has it changed over time?
Amos Channon, University of Southampton; Gobopamang Letamo, University of Botswana; Jesman Chintsanya, University of Malawi; Namuunda Mutumbo, University of Zambia; Isak Neema, University of Namibia
There have been massive changes in the health systems over time in most countries around the world, with deregulation and liberalisation of the health systems to private providers highlighted by the World Bank. Botswana, Malawi, Namibia and Zambia have all experienced this. It is not know what the effect on the care of children has been over this period. This paper studies these four countries and compares changes over time in the health system with the treatment of child illnesses – precisely where children are taken to when they have diarrhoea or acute respiratory infection. The focus is on looking at the quality of care but assessing the precise places of care. This will be done by using DHS in these countries (and the Botswana Family Health Survey) which have multiple rounds. The results indcate that in some countries more children are being taken to a shop for care, which is known to provide more rudimentary care and sometimes poor quality drugs. There have been an increase in children being taken to a formal health centre and a shop for the same illness - potentially highlighting that the costs are too high in the formal sector to purchase the care that is needed. The care of children has been greatly influenced by changes in the health systems. This paper looks at each country separately and as a whole to highlight some of the largest influences on child health.
Email: arc102@soton.ac.uk
Parental resources and children's health over the life-course and their consequences for educational outcomes: Evidence from Indonesia
Sarah Mohaupt, London School of Economics
Childhood health disadvantages can have long lasting effects over the life-course and even be transmitted over generations. Disadvantages in health are especially salient in developing countries. For instance, in Indonesia around 42% of children under five are stunted (indicator of malnourishment). Here, we use data from the Indonesian Family Life Survey (IFLS), a panel data set consisting of four waves of data over a period of 14 years. We study a cohort of 1,642 children who were less than five years old in the first wave of the IFLS for whom we can observe health and educational outcomes in all four waves. This paper addresses two questions. First, to what extent do parental resources influence children's health outcomes at different stages of their lifecourse? We investigate a range of parental socio-economic resources (education, consumption, assets, and occupation) and their association with children's health (height-for-age) at different stages of their life-course (early childhood, school-age, and young adulthood). Further, we study to what extent dynamics of stunting (e.g. reversal or chronic stunting) differ by parents' socio-economic background. Second, how do children's health dynamics affect their later educational outcomes? We investigate different dynamics of children's growth (e.g. reversal of stunting, chronic stunting, and never stunted) and how they are associated with educational outcomes (school enrolment and educational attainment). Specifically, we compare educational outcomes between children who experienced catch-up growth (reversal of stunting) with those who did not experience stunting (advantaged) and those who were chronically stunted (disadvantaged).
Email: S.Mohaupt@lse.ac.uk
Fathers and family health: Accounts of Zulu-speaking men in South Africa
Victoria Hosegood, University of Southampton & Africa Centre for Health & Population Studies; Lynda Clarke, London School of Hygiene & Tropical Medicine
The family environment itself, and involvement with families, influence the health and health behaviours of men. In South Africa, young men experience a high burden of morbidity and mortality, yet there is little research exploring the experience of men in the context of their families. We conducted 30 qualitative interviews and four focus group discussions with men in KwaZulu-Natal, South Africa in two locations. 10 men involved as fathers with at least one child (5-9 years) were interviewed twice. Analyses focused on men's narratives about the relationship between father identity and fatherhood experiences, and their own and families' health. Findings show that mens' characterisations of father identities were intimately interwoven with descriptions about health status and risk behaviours. Positive accounts of fathers were exemplified by mens' high health status linked to behaviours demonstrating a 'fitness of fatherhood' (controlled, moderate, respecting of the health of other family members). Fathers described involvement in a diverse range of activities and engagement with respect to the health of children and partners; emphasised de-traditionalising father roles and responsibilities, a strong sense of needing to know about, and making a positive contribution to, family health. We conclude that widely-held public and policy assumptions about limited at best, or negative at worst, influence of Black, particularly non-resident fathers' on family health is at odds with men's own understanding and desires. This tension needs to be addressed as part of efforts to develop effective interventions to engage men, especially fathers, positively in family and men's health programmes.
Email: v.hosegood@soton.ac.uk
The Facebook generation: youth's screen-based media use and well-being
Alexandra Skew, Yvonne Kelly, Amanda Sacker, University of Essex
Background. Previous studies suggest that screen based media use is associated with poor mental health. Here we examine which forms of screen based media use are related to better and worse well-being among youth. Gender, age and socioeconomic variation in these relationships are also explored. Methods. Self-completion questionnaires from 2163 youth aged 10-15 years were collected in wave 1 year 1 of Understanding Society, the UK Household Longitudinal Study. The Strengths and Difficulties questionnaire was used to measure low levels of well-being and items on happiness in different life domains were used to assess high well-being. Results. Gender differences in use of games consoles, the internet, social networking websites and computer based games were observed but there were no differences for TV viewing. Computer games, internet and social website use increased with age, while games console use became more polarised. Internet use, games console use and TV viewing were socially patterned. Highest levels of well-being were observed for those who used no or little screen based media. Lowest levels of well-being were seen among those youth who used any screen based media for four or more hours per day. Conclusions. The findings suggest that screen based media use in moderation is least harmful to well-being among young people. The mechanisms and processes at play require further elucidation.
Email: ajskew@essex.ac.uk
Body Mass Index, lifestyles, and health-related quality of life in Italian schoolchildren and adolescents
Elisabetta Petracci, University of Bologna; Giulia Cavrini, Free University of Bolzano
Background Childhood obesity is one of the most chronic disorders in childhood and its prevalence continues to increase rapidly. Although there is a growing awareness of the long-term health implications of obesity in children and adolescents, the more widespread psychosocial and Health-Related Quality of Life (HRQOL) effects of childhood obesity often go unaddressed by paediatricians. Objective To evaluate the relationship between body mass index (BMI) and other lifestyle factors and HRQOL as measured by the EQ-5D-Y questionnaire in two population-based samples of school children and adolescents. Methods Crosssectional data from a nutritional surveillance study aimed to assess eating habits in an Italian child population. Data on nutritional habits, BMI, physical activity and other lifestyle factors as well as information on how subjects perceive themselves and their body image were collected for 4,338 children and 2,406 adolescents. The Visual Analogue Scale (EQ-VAS) was used as outcome variable and a quantile regression was performed to evaluate its association with BMI and lifestyle factors. Results Overweight and obesity were associated with decreased Health Related Quality of Life in both children and adolescents as well as a low physical exercise, a low body self-acceptance and an incorrect body image perception. These associations were statistically significant especially in the lower tail of the VAS distribution. Conclusions Excess of weight and undesirable lifestyles have been found positively associated with impaired HRQOL. Given the scarce literature related to these relationships we believe that further studies will be helpful in the programming of intervention and preventive strategies.
Email: elisabetta.petracci2@unibo.it
Life expectancy variation across local authorities in Greece in 2001 and associations with socioeconomic conditions and population density of localities
Cleon Tsimbos, University of Piraeus; Stamatis Kalogirou, Harokopio University of Athens; Georgia Verropoulou, University of Piraeus & Institute of Education, University of London
Aim: In the absence of life expectancy estimates for local authorities in Greece, we construct abridged life tables for the 325 Municipalities of the country using vital registration and census data. We also calculate Poverty Indices at local authority level to examine socioeconomic differentials in expectation of life at birth (e0). Effects of population density and size of localities on longevity are explored, too. Data: The analysis is based on census population data and death registration statistics for the 5-year period around the 2001 census. The statistical information is classified by local authority, sex and 5-year age groups. The material used is restricted access. Data on socioeconomic characteristics of the population come from census counts and records of the Ministry of Economy. Methods: For areas with population 5,000 or more (n=276) conventional techniques of constructing an abridged life table are used; for the remaining localities (n=49) life expectancy is estimated through regression model using SMR as predictor. Mapping techniques are employed to display regional life expectancy variations. OLS regression models are used to estimate the effect of socioeconomic conditions and population density on e0. Geographically Weighted Regression (GWR) models are applied to explore spatial life expectancy patterns. Results: Islands and small size localities exhibit relatively high life expectancy. Poor socioeconomic conditions and high population density are inversely associated with e0 and their effect is statistically significant. The application of GWR indicates that the relationship between the dependent and independent variables does not remain stationary over the local authorities of the country.
Email: cleon@unipi.gr
The scale of health inequalities in England: from region to local authority district, 2006-2008
Michael P. Smith, Olugbenga Olatunde, Chris White, Office for National Statistics
Background The health inequalities across England carry enormous social and economic costs. Assessing the impact of policies aimed at reducing these inequalities requires timely measurement of health outcomes such as health expectancies (HEs) at useful geographical scales. However, inter-censal analyses of HEs at such scales are restricted by the availability of sufficiently large survey datasets. Here we explore the potential of the ONS Annual Population Survey (APS) to provide benchmark estimates of disability-free life expectancy (DFLE) across a range of geographies in England– regions, local authority districts and clusters of Lower Super Output Areas defined by the Index of Multiple deprivation 2007– in the period 2006–2008. Methods The prevalence of limiting long-standing illness and/or disability across English regions, local authority districts and quintiles of Lower Super Output Areas grouped according to the IMD 2007 was derived from the APS during 2006–2008. These data were combined with mortality and population data to calculate DFLE according to the Sullivan method. Results Restricted until 24 May 2011. Conclusions Restricted until 24 May 2011
Email: Olugbenga.Olatunde@ons.gsi.gov.uk
Exploring the impact of local trends in self-reported morbidity (1991-2001) on spatial health inequalities
Alan Marshall, University of Leeds
A wide body of research demonstrates that people who live in the most disadvantaged circumstances have more illness, disability and shorter lives than those who are more affluent. One consequence of the health inequalities between rich and poor people is the strong spatial inequalities in morbidity, disability and mortality in the UK. Research has demonstrated the existence of a health gradient (from poor to good health) between urban and rural areas, between the North and the South of England as well as pockets of especially poor health in very deprived, former industrial and coalfield areas. Both compositional (population) and contextual (area) factors are though to be responsible for these spatial patterns.. This paper presents projections of limiting long term illness (LLTI) that quantify the consequences of a continuation of district trends in age and sex specific LLTI rates between 1991 and 2001. A relational model (Brass 1973) is used to adjust rates of LLTI in the 1991 census to overcome inconsistencies with the 2001 census measure that result from changes to the LLTI question. A relational model is then used to capture district trends in LLTI schedules between 1991 and 2001 and to project these forwards. Analysis of the projections suggests that the spatial patterns observed in 1991 and 2001 are remarkably similar and correlate strongly with the National Statistics 2001 Area Classification. Continuation of local trends in the LLTI projections reveals widening spatial inequalities in self-assessed health. Brass, W. (1971). Biological aspects of demography. On the scale of mortality. Brass, W. London, Taylor Francis: 69-110.
Email: a.d.marshall@leeds.ac.uk