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.     

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.     

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.     

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.     

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.”     

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.     

BMI, all-cause and cause-specific mortality in Chinese Singaporean men and women: the Singapore Chinese health study

Background

The optimal range of relative weight for morbidity and mortality in Asian populations is an important question in need of more thorough investigation, especially as obesity rates increase. We aimed to examine the association between body mass index (BMI), all cause and cause-specific mortality to determine the optimal range of BMI in relation to mortality in Chinese men and women in Singapore.

Methodology/Principal Findings

We analyzed data from a prospective cohort study of 51,251 middle-aged or older (45–74) Chinese men and women in the Singapore Chinese Health Study. Participants were enrolled and data on body weight and covariates were collected in 1993–1998 and participants were followed through 2008. The analysis accounted for potential methodological issues through stratification on smoking and age, thorough adjustment of demographic and lifestyle confounders and exclusion of deaths early in the follow-up.

Conclusions/Significance

Increased risk of mortality was apparent in underweight (<18.5) and obese BMI categories (≥27.5) independent of age and smoking. Regardless of age or BMI, smoking considerably increased the rate of mortality and modified the association between BMI and mortality. The most favorable range of BMI for mortality rates and risk in non-smoking persons below age 65 was 18.5–21.4 kg/m², and for non-smoking persons aged 65 and above was 21.5–24.4 kg/m².     

Age variations in adiposity and body fat composition among older Bengalee Hindu women of Calcutta, India

A cross-sectional study of 279 older (50+ years) urban Bengalee Hindu women was undertaken to study age variations in adiposity, body composition, obesity and central fat distribution. The women were divided into three groups: Group I (G I, 50-59 years), Group II (G II, 60-69 years) and Group III (G III, 70+ years). A significant decreasing age trend was observed in adiposity and body fat composition measures. Women in G I had significantly higher means compared with those in G III. Individuals in G II had intermediate values. However, there was no significant age trend in muscle measures and indices of central body fat distribution. The results revealed that significantly more women in G III (45.8%) were malnourished (BMI < 18.5), while significantly more women in G I (28.7%) were obese (BMI > or = 25). The levels of malnourishment (21.6%) and obesity (24.5%) in G II were intermediate between G I and G III. Age had significant negative correlations with measures of adiposity and body fat composition. Regression analysis revealed that age had significant negative effect on these anthropometric measures. This significant negative impact of age remained even after controlling for the effect of BMI. In conclusion, the present investigation revealed that among older Bengalee Hindu women, there is a significant inverse age trend in adiposity and body fat composition, which is independent of overall adiposity (BMI). However, with ageing, muscle and central body fat distribution remain the same. Furthermore, with increasing age, there is a trend of increasing levels of malnourishment and decreasing levels of obesity.     

Offspring dependence on parental care and the role of parental transfer of oral fluids in burying beetles

Background

Immature stages of many animals can forage and feed on their own, whereas others depend on their parents’ assistance to obtain or process food. But how does such dependency evolve, and which offspring and parental traits are involved? Burying beetles (Nicrophorus) provide extensive biparental care, including food provisioning to their offspring. Interestingly, there is substantial variation in the reliance of offspring on post-hatching care among species. Here, we examine the proximate mechanisms underlying offspring dependence, focusing on the larvae of N. orbicollis, which are not able to survive in the absence of parents. We specifically asked whether the high offspring dependence is caused by (1) a low starvation tolerance, (2) a low ability to self-feed or (3) the need to obtain parental oral fluids. Finally, we determined how much care (i.e. duration of care) they require to be able to survive.

Results

We demonstrate that N. orbicollis larvae are not characterized by a lower starvation tolerance than larvae of the more independent species. Hatchlings of N. orbicollis are generally able to self-feed, but the efficiency depends on the kind of food presented and differs from the more independent species. Further, we show that even when providing highly dependent N. orbicollis larvae with easy ingestible liquefied mice carrion, only few of them survived to pupation. However, adding parental oral fluids significantly increased their survival rate. Finally, we demonstrate that survival and growth of dependent N. orbicollis larvae is increased greatly by only a few hours of parental care.

Conclusions

Considering the fact that larvae of other burying beetle species are able to survive in the absence of care, the high dependence of N. orbicollis larvae is puzzling. Even though they have not lost the ability to self-feed, an easily digestible, liquefied carrion meal is not sufficient to ensure their survival. However, our results indicate that the transfer of parental oral fluids is an essential component of care. In the majority of mammals, offspring rely on the exchange of fluids (i.e. milk) to survive, and our findings suggest that even in subsocial insects, such as burying beetles, parental fluids can significantly affect offspring survival.