Prioritizing child health interventions in ethiopia: modeling impact on child mortality, life expectancy and inequality in age at death

Background

The fourth Millennium Development Goal calls for a two-thirds reduction in under-5 mortality between 1990 and 2015. Under-5 mortality rate is declining, but many countries are still far from achieving the goal. Effective child health interventions that could reduce child mortality exist, but national decision-makers lack contextual information for priority setting in their respective resource-constrained settings. We estimate the potential health impact of increasing coverage of 14 selected health interventions on child mortality in Ethiopia (2011–2015). We also explore the impact on life expectancy and inequality in the age of death (Gini_health).

Methods and Findings

We used the Lives Saved Tool to estimate potential impact of scaling-up 14 health interventions in Ethiopia (2011–2015). Interventions are scaled-up to 1) government target levels, 2) 90% coverage and 3) 90% coverage of the five interventions with the highest impact. Under-5 mortality rate, neonatal mortality rate and deaths averted are primary outcome measures. We used modified life tables to estimate impact on life expectancy at birth and inequality in the age of death (Gini_health). Under-5 mortality rate declines from 101.0 in 2011 to 68.8, 42.1 and 56.7 per 1000 live births under these three scenarios. Prioritizing child health would also increase life expectancy at birth from expected 60.5 years in 2015 to 62.5, 64.2 and 63.4 years and reduce inequality in age of death (Gini_health) substantially from 0.24 to 0.21, 0.18 and 0.19.

Conclusions

The Millennium Development Goal for child health is reachable in Ethiopia. Prioritizing child health would also increase total life expectancy at birth and reduce inequality in age of death substantially (Gini_health).     

Racial and ethnic differences in diurnal cortisol rhythms in preadolescents: the role of parental psychosocial risk and monitoring

Racial/ethnic minorities experience persistent health disparities due in part to their exposure to chronic SES and psychosocial risk. The hypothalamic-pituitary-adrenal axis and its hormonal end product, cortisol, are believed to mediate the associations between chronic stress and poor health. In this study, racial/ethnic differences in diurnal salivary cortisol rhythms in 179 preadolescent youths and the contributing roles of SES risk, psychosocial risk, perceived discrimination, harsh parenting, and parental monitoring were examined. The analyses revealed racial/ethnic differences in diurnal cortisol rhythms, with African Americans having significantly flatter morning-to-evening cortisol slopes than Caucasians and with Latinos having significantly lower evening cortisol levels than Caucasians. Greater psychosocial risk and less parental monitoring were associated with flatter cortisol slopes. Racial/ethnic differences on the cortisol measures persisted when controlling for SES, psychosocial risk, and parenting quality. The need to assess chronic risk across the lifespan and disentangle possible genetic from environmental contributors is discussed.     

Reconstructing relationships among mortality, status, and gender at the Medieval Gilbertine Priory of St. Andrew, Fishergate, York

The varied relationships among status, gender, and mortality are complex, historically produced phenomena that shape people's lives and deaths in socially meaningful ways. Paleodemographic analysis coupled with acute sensitivity to site-specific context has the potential to move us toward a greater understanding of these experiences in the past. After considering the potential effects of migration and fertility on the age-at-death profiles of adult individuals interred at the Gilbertine Priory of St. Andrew, Fishergate, York (n = 200), it is asserted that these profiles primarily reveal expected and unexpected relationships among status, gender, and mortality in this Medieval context. Collectively, the long lives of religious-status males compared to other composite and gendered status groups suggest that they experienced a relatively comfortable existence despite periodic complaints of destitution. The postulated demographic advantage of high-status males did not materialize in the analysis, and a reevaluation of the skeletal evidence indicates that nearly 20% of these individuals died violently. Unexpectedly, moderate-status females shared a mortality profile similar to that of religious-status males and retained a demographic advantage over all other secular status groups. In contrast to the experiences of moderate-status females, low-status females had, on average, the shortest lives at St. Andrew's. This pattern is intimately linked to their restriction from crucial social and economic resources, and provides further evidence of their marginalization in York's wage-labor economy. Overall, these relationships suggest that traditional, highly stratified and gendered notions of Medieval status and mortality are not adequate for understanding the intricacies of everyday life and death at St. Andrew's.     

Obesity and impairment in psychosocial functioning in women: the mediating role of eating disorder features

Objective: The objective was to test the hypothesis that, in women, the association between obesity and impairment in psychosocial functioning is mediated by levels of weight and shape concerns and/or binge‐eating frequency. Research Methods and Procedures: Self‐report measures of eating disorder psychopathology, mental health functioning, subjective quality of life in the psychological and social domains, and days “out‐of‐role” associated with any (physical or mental) health problem, were completed by a community sample of women classified as obese (BMI ≥30 kg/m², n = 639) or non‐obese (BMI <30 kg/m², n = 4253). For each of the dependent measures, regression models were used to test the hypothesis of mediation by comparing the strength of the relationship between independent and dependent variables with and without inclusion of the putative mediator in the regression model. Results: On each measure, the conditions for perfect mediation were satisfied when weight or shape concerns acted as the putative mediator, indicating that there was no association between obesity and functional impairment after controlling for weight or shape concerns. In contrast, associations between obesity and impairment in psychosocial functioning remained highly significant when binge‐eating frequency was the putative mediator. Discussion: The findings suggest that in women, weight and shape concerns are an important mediator of the relationship between obesity and impairment in psychosocial functioning, whereas binge eating may not be of primary importance. A greater focus on body acceptance in obesity treatment may be indicated.     

Demographic and health status risk factors in childbearing among Indian women. Evidence from hospital data for the later stages of fertility decline

Indirect estimates of maternal mortality in India indicate that fertility decline has reduced maternal deaths by reducing the frequency of pregnancy and childbirth. The earlier stages of fertility decline are also likely to have lowered maternal mortality by reducing the risk of pregnancy and childbirth as the proportion of births among risky multiparous, older women declines. However, further fertility decline may well be associated with some increase in risk. Risk will also remain high if the health status of Indian girls and women remains poor. This study uses a sample of maternal deaths and deliveries among patients who survived which occurred in Civil Hospital, Ahmedabad, Gujarat during 1982-1993 to investigate these issues further. The women in the sample have relatively low fertility and represent a fairly late stage of fertility decline. They also have persistently poor health status. Logit regression analysis reveals that although fertility decline is associated with some increase in risk, poor health status is the more important maternal mortality risk factor. Without attention to female health, even childbearing among expectant mothers with low fertility continues to be hazardous.     

A biosocial model of medication use among older women and men in Ismailia, Egypt

In Western industrialized countries, women report using health services, and certain medications, more often than do men. Often, analyses are based on data that exclude objective measures of morbidity and that come from cross-sectional surveys, which precludes the use of socioeconomic covariates that are endogenous to seeking care. Here, differences in objective cognitive and physical function, as well as differences in reporting on illness, propensity to seek care, and socioeconomic resources are expected to account for differences in care-seeking behaviour among women and men. This model is applied to the question of medication use in Ismailia, Egypt, using two waves of survey data and in-home tests of physical function from 896 adults aged 50 years and older. The results show that women use "modern" medications more often than do men, and that differences between women and men in reported morbidity and disability, observed cognitive and physical function, and economic resources account for women's greater use of medication. The findings underline a need for biosocial models to understand differences in women's and men's care-seeking behaviour in later life.     

Density-dependent mortality,growth and size inequality in roadside populations of the annual herbGalium aparine L.

Biomass, plant size, plant density and the inequality of sizes were assessed for autumn-emerging roadside populations dominated byGalium aparine during early stages of growth in two independent studies. A third data set dealt with the survival of labelled seedlings belonging to different cohorts of emergence. One data set showed that the slope of the log-log size/density relationship for all plant species present in the samples was closer to −1.5 and that forG. aparine was closer to −1.0 in five separate populations. Biomass increase and density decrease was not found to take place in any of these simultaneously. The size inequality ofG. aparine tended to increase or to remain constant during periods of high mortality, and in the early harvests it was negatively related to population density. The second data set revealed simultaneous decreases of both biomass and density ofG. aparine and of all plant species during a period of a month soon after emergence, and a higher size inequality ofG. aparine in those patches where plant density (and that ofG. aparine) was lower. The labelling of seedlings indicated density-dependent mortality and a higher probability of survival for seedlings emerging very early. The size/density relationship of roadside populations dominated byG. aparine may follow a trajectory over time similar to that predicted by the 3/2 power law of self-thinning, but this species seems to have a weak size hierarchy development and limited individual growth at high population densities. The importance of plant architecture in relation to this response is discussed.     

Contraceptive knowledge,attitudes and use among women attending health clinics in St. Petersburg,Russian Federation

This study describes women's knowledge, attitudes, and use of contraception in Russia. Data were obtained from a sample of 917 women attending 44 women's consulting centers in St. Petersburg during January 15-30, 1995. Findings indicate that 68% were married; 21% were single. 56.1% worked full-time, 7.2% worked part-time, and 9.4% were students. 50.9% reported having received sex education, of whom 73.8% learned about birth control methods and 70.7% learned about abortion. Over 90% of the entire sample knew about condoms, IUDs, and oral contraceptives. About 60-70% knew about rhythm, withdrawal, and female sterilization. 49-56% were aware of vaginal suppositories and vasectomy. Under 23% were aware of the diaphragm, sponge, jelly, and foam. People talked about family planning with doctors and partners. 58.7% preferred joint responsibility for family planning. 909 women responded to the question about the current method being used: 41% reported using condoms; 33.8%, IUDs; 32.8%, pills; 23.7%, the rhythm method; and 17.2%, withdrawal. Many women used multiple methods, but the questions did not clearly distinguish single from concurrent multiple method use or switching between a few methods. 20.6% report nonuse. 115 of 187 were pregnant or desiring a pregnancy. Nonusers were concerned about side effects. Method choice was based on effectiveness and ease of use. Few were dissatisfied with their method choice. About 75% reported method switching over time. Most of the 452 oral contraceptive users knew 2-3 side effects. 25.1% of the 319 condom users were usual users.     

The change of life,the sorrow of life: Menopause,bad blood and cancer among Italian-Australian working class women

This paper explores the discourse of menopause, health and illness among 20 middle aged Italo-Australian working class women living in Melbourne. Using the methods of interpretative anthropology and the perspectives of critical feminist theory, I argue that women's discourse about health and illness is one way in which they express feelings of loss over the fertility of their youth, ambivalences about their lives in Australia, and grief over a life left behind in Italy. These losses are experienced physically and expressed metaphorically through conditions of bad blood and nerves and are perceived to contribute to their vulnerability to a range of diseases including cancer. For these women, the change of life is experienced as the end of life and their fear of cancer is representative of their fears of social and physical death. Cancer is also seen to be a disease more common in Australia and is used as a metaphor for expressing anxieties relating to feelings of placelessness, of being disconnected from one's roots, and anxieties about becoming old and dying far from “home.”     

Sexual initiation among Canadian youth: A model comparison approach of evolutionary hypotheses shows greatest support for extrinsic mortality cues,intergenerational conflict,and early life psychosocial stressors

Early life factors are associated with the timing of reproductive events in adolescence, but a variety of hypotheses (such as psychosocial acceleration theory, paternal investment theory, extrinsic mortality, internal prediction, and intergenerational conflict) propose different explanations for why this may occur. To compare between these theories, we use the National Longitudinal Survey of Children and Youth, an extensive, longitudinal survey of Canadian male and female youth (aged 14-15 in last wave) to identify variables that uniquely support these different models (n≈1200). We identify the best predictors of sexual initiation for each hypothesis and then use a model selection procedure to determine which set of variables has the most support. Results show that variables representing extrinsic mortality cues, intergenerational conflict, early life psychosocial stressors, and prenatal factors are included in the top models, while variables representing social support and unpredictability are represented in some of the top models. Variables representing the paternal investment theory were not included in any of the top models, suggesting limited support for this hypothesis. These results support many of the hypotheses that have been previously presented in the literature, suggesting that timing of sexual initiation may have multiple causal pathways.