Economic Impact of Maternal Death on Households in Rural China: A Prospective Cohort Study

Objective

To assess the economic impact of maternal death on rural Chinese households during the year after maternal death.

Methods

A prospective cohort study matched 183 households who had suffered a maternal death to 346 households that experienced childbirth without maternal death in rural areas of three provinces in China. Surveys were conducted at baseline (1–3 months after maternal death or childbirth) and one year after baseline using the quantitative questionnaire. We investigated household income, expenditure, accumulated debts, and self-reported household economic status. Difference-in-Difference (DID), linear regression, and logistic regression analyses were used to compare the economic status between households with and without maternal death.

Findings

The households with maternal death had a higher risk of self-reported “household economy became worse” during the follow-up period (adjusted OR = 6.04, p<0.001). During the follow-up period, at the household level, DID estimator of income and expenditure showed that households with maternal death had a significant relative reduction of US$ 869 and US$ 650, compared to those households that experienced childbirth with no adverse event (p<0.001). Converted to proportions of change, an average of 32.0% reduction of annual income and 24.9% reduction of annual expenditure were observed in households with a maternal death. The mean increase of accumulated debts in households with a maternal death was 3.2 times as high as that in households without maternal death (p = 0.024). Expenditure pattern of households with maternal death changed, with lower consumption on food (p = 0.037), clothes and commodity (p = 0.003), traffic and communication (p = 0.022) and higher consumption on cigarette or alcohol (p = 0.014).

Conclusion

Compared with childbirth, maternal death had adverse impact on household economy, including higher risk of self-reported “household economy became worse”, decreased income and expenditure, increased debts and changed expenditure pattern.     

Income differences in COVID-19 incidence and severity in Finland among people with foreign and native background: A population-based cohort study of individuals nested within households

BackgroundAlthough intrahousehold transmission is a key source of Coronavirus Disease 2019 (COVID-19) infections, studies to date have not analysed socioeconomic risk factors on the household level or household clustering of severe COVID-19. We quantify household income differences and household clustering of COVID-19 incidence and severity.Methods and findingsWe used register-based cohort data with individual-level linkage across various administrative registers for the total Finnish population living in working-age private households (N = 4,315,342). Incident COVID-19 cases (N = 38,467) were identified from the National Infectious Diseases Register from 1 July 2020 to 22 February 2021. Severe cases (N = 625) were defined as having at least 3 consecutive days of inpatient care with a COVID-19 diagnosis and identified from the Care Register for Health Care between 1 July 2020 and 31 December 2020. We used 2-level logistic regression with individuals nested within households to estimate COVID-19 incidence and case severity among those infected.Adjusted for age, sex, and regional characteristics, the incidence of COVID-19 was higher (odds ratio [OR] 1.67, 95% CI 1.58 to 1.77, p < 0.001, 28.4% of infections) among individuals in the lowest household income quintile than among those in the highest quintile (18.9%). The difference attenuated (OR 1.23, 1.16 to 1.30, p < 0.001) when controlling for foreign background but not when controlling for other household-level risk factors. In fact, we found a clear income gradient in incidence only among people with foreign background but none among those with native background. The odds of severe illness among those infected were also higher in the lowest income quintile (OR 1.97, 1.52 to 2.56, p < 0.001, 28.0% versus 21.6% in the highest quintile), but this difference was fully attenuated (OR 1.08, 0.77 to 1.52, p = 0.64) when controlling for other individual-level risk factors—comorbidities, occupational status, and foreign background. Both incidence and severity were strongly clustered within households: Around 77% of the variation in incidence and 20% in severity were attributable to differences between households. The main limitation of our study was that the test uptake for COVID-19 may have differed between population subgroups.ConclusionsLow household income appears to be a strong risk factor for both COVID-19 incidence and case severity, but the income differences are largely driven by having foreign background. The strong household clustering of incidence and severity highlights the importance of household context in the prevention and mitigation of COVID-19 outcomes.

Sanni Saarinen and colleagues explore the association between income differences and COVID-19 incidence and severity among people with foreign and native background in Finland.     

Impact of Maternal Death on Household Economy in Rural China: A Prospective Path Analysis

Objectives

The present study aimed to explore the inter-relationships among maternal death, household economic status after the event, and potential influencing factors.

Methods

We conducted a prospective cohort study of households that had experienced maternal death (n = 195) and those that experienced childbirth without maternal death (n = 384) in rural China. All the households were interviewed after the event occurred and were followed up 12 months later. Structural equation modeling was used to test the relationship model, utilizing income and expenditure per capita in the following year after the event as the main outcome variables, maternal death as the predictor, and direct costs, the amount of money offset by positive and negative coping strategies, whether the husband remarried, and whether the newborn was alive as the mediators.

Results

In the following year after the event, the path analysis revealed a direct effect from maternal death to lower income per capita (standardized coefficient = -0.43, p = 0.041) and to lower expenditure per capita (standardized coefficient = -0.51, p<0.001). A significant indirect effect was found from maternal death to lower income and expenditure per capita mediated by the influencing factors of higher direct costs, less money from positive coping methods, more money from negative coping, and the survival of the newborn.

Conclusion

This study analyzed the direct and indirect effects of maternal death on a household economy. The results provided evidence for better understanding the mechanism of how this event affects a household economy and provided a reference for social welfare policies to target the most vulnerable households that have suffered from maternal deaths.     

Environmental Contamination as a Risk Factor for Intra-Household Staphylococcus aureus Transmission

Background

The household is a recognized community reservoir for Staphylococcus aureus. This study investigated potential risk factors for intra-household S. aureus transmission, including the contribution of environmental contamination.

Methods

We investigated intra-household S. aureus transmission using a sample of multiple member households from a community-based case-control study examining risk factors for CA-MRSA infection conducted in Northern Manhattan. During a home visit, index subjects completed a questionnaire. All consenting household members were swabbed, as were standardized environmental household items. Swabs were cultured for S. aureus. Positive isolates underwent further molecular characterization. Intra-household transmission was defined as having identical strains among two or more household members. Multiple logistic regression was used to identify independent risk factors for transmission.

Results

We enrolled 291 households: 146 index cases, 145 index controls and 687 of their household contacts. The majority of indexes were Hispanic (85%), low income (74%), and female (67%), with a mean age of 31 (range 1–79). The average size of case and control households was 4 people. S. aureus colonized individuals in 62% of households and contaminated the environment in 54% of households. USA300 was the predominant clinical infection, colonizing and environmental strain. Eighty-one households had evidence of intra-household transmission: 55 (38%) case and 26 (18%) control households (P<.01). Environmental contamination with a colonizing or clinical infection strain (aOR: 5.4 [2.9–10.3] P<.01) and the presence of a child under 5 (aOR: 2.3 [1.2–4.5] P = .02) were independently associated with transmission. In separate multivariable models, environmental contamination was associated with transmission among case (aOR 3.3, p<.01) and control households (aOR 27.2, p<.01).

Conclusions

Environmental contamination with a colonizing or clinical infection strain was significantly and independently associated with transmission in a large community-based sample. Environmental contamination should be considered when treating S. aureus infections, particularly among households with multiple infected members.     

Variation in Indigenous Forest Resource Use in Central Guyana

Sustainable forest conservation strategies should be based on local as well as landscape-scale forest resource use data. Using ecological and sociological techniques, we test the hypotheses that (1) forest resource use differs between ethnic and socioeconomic indigenous groups and (2) that this difference results in differing spatial patterns of resource use, with implications for forest diversity and for conservation planning. In the North Rupununi Guyana, three adjacent indigenous communities (differing in their indigenous/immigrant balance) were recorded using 73 animal and 164 plant species (plus several unidentified ethno-species). Farm sites formed important foci for most forest based activities and ex-farm sites supported similar floristic diversity to surrounding forest. Resource usage differences between communities could be attributed to socio-cultural drivers, e.g. mammal meat consumption and the use of the fruits from the palm tree A. maripa were higher in more traditional households. When extracting household construction timber, lower income groups created small scattered felling sites akin to tree fall gaps whereas higher income groups created larger gaps. Lower income (indigenous) households tended to clear larger but more contained sites for farming while mixed or non-Amerindian household tended to clear smaller but more widely dispersed farm sites. These variations resulted in different patterns of forest disturbance originating from agriculture and timber extraction.     

Farmers' management of cabbage and cauliflower pests in India and their approaches to crop protection

Cabbage (Brassica olearaceae var. capitata) and cauliflower (Brassica oleracea var. botrytis) are two major vegetables produced and consumed in India. Over the years, they have been cultivated more intensively. This has resulted in higher rates of pest infestation, especially by the diamondback moth (Plutella xylostella) and higher pesticide use. This, in turn, has contributed to insecticide resistance, environmental degradation, and human health impacts, which have triggered a growing interest in alternative management techniques. There is a dearth of knowledge on current pest management practices in cabbage and crucifer. Knowledge about pest management practices is necessary to develop appropriate strategies such as Integrated Pest Management. The main purpose of this study was to obtain comprehensive information on pest management practices among farmers growing cabbage and cauliflower in India.A survey was conducted in the states of Gujarat, West Bengal, and Karnataka from October 2006 through January 2007. Three hundred farmers were interviewed to obtain information on pesticide use in cabbage and cauliflower production, the cost of pesticide use, and socioeconomic characters that influence cabbage and cauliflower production.Farmers relied on pesticides as the major and often exclusive crop protection strategy. Ten of the active ingredients (16.4% of all pesticides reported by all farmers in this survey) were listed as extremely or highly hazardous (classes Ia and Ib) by the World Health Organization. The results confirmed that pesticide use differs between states of India, but that location alone does not determine pesticide spraying pattern. A regression model was used to identify determinants of pesticide application frequency and pesticide cost per hectare. After controlling for location, individual level variables, such as age, education and experience, had significant effects on how often farmers sprayed. Farmers also spent more for pesticides, and sprayed more frequently on cauliflower than on cabbage and on open-pollinated varieties than on hybrid varieties.Our findings highlight the excessive use of pesticides in cabbage and cauliflower, and the reliance on pesticides as the only pest management strategy. The results confirm the need for alternative management strategies. Bt vegetables may be one of these alternative strategies. However, it is questionable whether cultivation of Bt vegetables will reduce the strong reliance on pesticides. Small-scale farmers will need training in the identification of pests, natural enemies, basic ecology, and integrated pest management strategies to ensure sustainable and safe vegetable production.     

Contribution of “Women’s Gold” to West African Livelihoods: The Case of Shea (<Emphasis Type="Italic">Vitellaria paradoxa</Emphasis>) in Burkina Faso

Contribution of “Women’s Gold” to West African Livelihoods: The Case of Shea ( Vitellaria paradoxa ) in Burkina Faso. This paper (i) quantifies the contribution that Vitellaria paradoxa makes to the total income of rural households belonging to different economic groups in two areas of Burkina Faso; (ii) quantifies the involvement of women in shea nuts and fruits collection and processing; and (iii) empirically verifies the “gap filling” function of shea products in Burkina Faso by quantifying the commercialization and subsistence use of shea fruits, nuts, and butter between agricultural seasons. Based on data collected from structured household surveys used on a quarterly basis during a one-year period on 536 households, we demonstrate that the reliance on shea is generally high in the sampled populations, and is at its highest for the poorest households, for which it contributes 12 % of total household income. Moreover, shea nut collection and processing was found to provide a valuable source of cash income to female household members who otherwise have very few income possibilities. Finally, due to its ecology, shea fills in an income gap during a period where human activities are at their highest while income is at its lowest. Although shea is crucial for poor people’s livelihoods and for the generation of income for women, its harvesting and processing are time-consuming activities that generate low returns per unit of labor. We argue that shea collection and processing should therefore not be considered as a remedy to poverty but instead as a way for households to diversify their livelihood strategy and decrease their vulnerability to food insecurity and climate variability.     

Acute human lethal toxicity of agricultural pesticides: a prospective cohort study

Background

Agricultural pesticide poisoning is a major public health problem in the developing world, killing at least 250,000–370,000 people each year. Targeted pesticide restrictions in Sri Lanka over the last 20 years have reduced pesticide deaths by 50% without decreasing agricultural output. However, regulatory decisions have thus far not been based on the human toxicity of formulated agricultural pesticides but on the surrogate of rat toxicity using pure unformulated pesticides. We aimed to determine the relative human toxicity of formulated agricultural pesticides to improve the effectiveness of regulatory policy.

Methods and Findings

We examined the case fatality of different agricultural pesticides in a prospective cohort of patients presenting with pesticide self-poisoning to two clinical trial centers from April 2002 to November 2008. Identification of the pesticide ingested was based on history or positive identification of the container. A single pesticide was ingested by 9,302 patients. A specific pesticide was identified in 7,461 patients; 1,841 ingested an unknown pesticide. In a subset of 808 patients, the history of ingestion was confirmed by laboratory analysis in 95% of patients. There was a large variation in case fatality between pesticides—from 0% to 42%. This marked variation in lethality was observed for compounds within the same chemical and/or WHO toxicity classification of pesticides and for those used for similar agricultural indications.

Conclusion

The human data provided toxicity rankings for some pesticides that contrasted strongly with the WHO toxicity classification based on rat toxicity. Basing regulation on human toxicity will make pesticide poisoning less hazardous, preventing hundreds of thousands of deaths globally without compromising agricultural needs. Ongoing monitoring of patterns of use and clinical toxicity for new pesticides is needed to identify highly toxic pesticides in a timely manner. Please see later in the article for the Editors'' Summary     

Adverse Respiratory Health and Hematological Alterations among Agricultural Workers Occupationally Exposed to Organophosphate Pesticides: A Cross-Sectional Study in North India

Background

Non-protective work practices followed by farm workers during spraying of pesticides lead to occupational exposure among them.

Objective

This study is designed to explore the respiratory health and hematological profile of agricultural workers occupationally exposed to OP pesticides.

Materials and Methods

A cross sectional study was undertaken among 166 pesticide sprayers working in mango orchards of Lucknow district in North India compared with 77 controls to assess the respiratory illness, lung functions, cholinesterase levels and hematological profile. A questionnaire based survey and clinical examination for respiratory health were conducted among study subjects. Lung function test was conducted among study subjects by using spirometer. Cholinesterase level as biomarker of OP pesticides and hematological profile of study subjects were investigated in the laboratory by following the standard protocols.

Results

Overall respiratory morbidity observed among exposed subjects was 36.75%. Symptoms for respiratory illness like dry cough, productive cough, wheezing, irritation of throat and blood stained sputum were found to be significantly more (p<0.05) among pesticide sprayers than controls. Lung function parameters viz. PEFR, FEV₁, %PEFR predicted, %FEV₁ predicted and FEV₁/FVC were found to be significantly decreased (p<0.05) among pesticide sprayers as compared to controls. Exposure wise distribution of respiratory illness and lung functions among pesticide sprayers show that the exposure duration significantly elevates (p<0.05) the respiratory problems and significantly decreases (p<0.001) lung functions among pesticide sprayers. Activities of acetylcholinesterase and butyrylcholinesterase were found to be significantly depleted (p<0.001) among pesticide sprayers as compared to controls which show the exposure of OP pesticides among them. The hematological profile viz. RBC, WBC, monocytes, neutrophils, MCV, MCH, MCHC and platelet count were significantly altered (p<0.001) in pesticide sprayers than controls.

Conclusion

This study shows that the unsafe occupational exposure of OP pesticides causes respiratory illness, decreased lung functions and hematological alterations among pesticide sprayers.     

Household Determinants of Liquified Petroleum Gas (LPG) as a Cooking Fuel in SW Cameroon

Currently 70% of the population in Cameroon are reliant on solid fuel for cooking (90% in rural communities) and the associated household air pollution contributes to significant mortality and morbidity in the country. To address the problems of energy security, deforestation and pollution the government has developed a strategy (Masterplan) to increase use of liquified petroleum gas (LPG) as a cooking fuel from 12% to 58% by 2030. As a clean fuel scaled adoption of LPG has the potential to make significant positive impacts on population health. The LPG Adoption in Cameroon Evaluation (LACE) studies are assessing in the community (i) barriers and enablers for and (ii) local interventions to support, adoption and sustained use of LPG. A census survey conducted for LACE in rural and peri-urban regions of SW Cameroon provided an opportunity to investigate current fuel use patterns and factors associated with primary and exclusive use of LPG. A cross-sectional survey of 1577 households (1334 peri-urban and 243 rural) was conducted in March 2016 using standardised fuel use and household socio-demographic questions, administered by trained fieldworkers. Wood (40.7%) and LPG (51.1%) were the most frequently reported fuels, although the dominant fuels in rural and peri-urban communities were wood (81%) and LPG (58%) respectively. Fuel stacking was observed for the majority of LPG using households (91% of peri-urban and 99% of rural households). In rural homes, a higher level of education, access to sanitation and piped water and household wealth (income and asset ownership) were all significantly associated with LPG use (p < 0.05). In peri-urban homes, younger age, access to sanitation and piped water and increasing education were significantly associated with both any and exclusive use of LPG (p < 0.05). However, whilst household wealth was related to any LPG use, there was no relationship with exclusive use. Results from this census survey of a relatively well-established LPG market with lower levels of poverty and high levels of education than Cameroon as a whole, find LPG usage well below target levels set by the Cameroon government (58% by 2030). Fuel stacking is an issue for the majority of LPG using households. Whilst, as observed here, education, household wealth and socio-economic status are well recognised predictors of adoption and sustained use of clean modern fuels, it is important to consider factors across the whole LPG eco-system when developing policies to support their scaled expansion. A comprehensive approach is therefore required to ensure implementation of the Cameroon LPG Masterplan achieves its aspirational adoption target within its stated timeframe.     

Staphylococcus aureus in the Community: Colonization Versus Infection

Background

Antibiotic-resistant Staphylococcus aureus infections have increased dramatically in the community, yet S. aureus nasal colonization has remained stable. The objectives of this study were to determine if S. aureus colonization is a useful proxy measure to study disease transmission and infection in community settings, and to identify potential community reservoirs.

Methodology/Principal Findings

Randomly selected households in Northern Manhattan, completed a structured social network questionnaire and provided nasal swabs that were typed by pulsed field gel electrophoresis to identify S. aureus colonizing strains. The main outcome measures were: 1) colonization with S. aureus; and 2) recent serious skin infection. Risk factor analyses were conducted at both the individual and the household levels; logistic regression models identified independent risks for household colonization and infection.

Results

321 surveyed households contained 914 members. The S. aureus prevalence was 25% and MRSA was 0.4%. More than 40% of households were colonized. Recent antibiotic use was the only significant correlate for household colonization (p = .002). Seventy-eight (24%) households reported serious skin infection. In contrast with colonization, five of the six risk factors that increased the risk of skin infection in the household at the univariate level remained independently significant in multivariable analysis: international travel, sports participation, surgery, antibiotic use and towel sharing. S. aureus colonization was not significantly associated with serious skin infection in any analysis. Among multiperson households with more than one person colonized, 50% carried the same strain.

Conclusions/Significance

The lack of association between S. aureus nasal colonization and serious skin infection underscores the need to explore alternative venues or body sites that may be crucial to transmission. Moreover, the magnitude of colonization and infection within the household suggests that households are an underappreciated and substantial community reservoir.     

The Economic Burden Attributable to a Child’s Inpatient Admission for Diarrheal Disease in Rwanda

Background

Diarrhea is one of the leading causes of childhood morbidity and mortality. Hospitalization for diarrhea can pose a significant burden to health systems and households. The objective of this study was to estimate the economic burden attributable to hospitalization for diarrhea among children less than five years old in Rwanda. These data can be used by decision-makers to assess the impact of interventions that reduce diarrhea morbidity, including rotavirus vaccine introduction.

Methods

This was a prospective costing study where medical records and hospital bills for children admitted with diarrhea at three hospitals were collected to estimate resource use and costs. Hospital length of stay was calculated from medical records. Costs incurred during the hospitalization were abstracted from the hospital bills. Interviews with the child’s caregivers provided data to estimate household costs which included transport costs and lost income. The portion of medical costs borne by insurance and household were reported separately. Annual economic burden before and after rotavirus vaccine introduction was estimated by multiplying the reported number of diarrhea hospitalizations in public health centers and district hospitals by the estimated economic burden per hospitalization. All costs are presented in 2014 US$.

Results

Costs for 203 children were analyzed. Approximately 93% of the children had health insurance coverage. Average hospital length of stay was 5.3 ± 3.9 days. Average medical costs for each child for the illness resulting in a hospitalization were $44.22 ± $23.74 and the total economic burden was $101, of which 65% was borne by the household. For households in the lowest income quintile, the household costs were 110% of their monthly income. The annual economic burden to Rwanda attributable to diarrhea hospitalizations ranged from $1.3 million to $1.7 million before rotavirus vaccine introduction.

Conclusion

Households often bear the largest share of the economic burden attributable to diarrhea hospitalization and the burden can be substantial, especially for households in the lowest income quintile.     

Impacts of Cash Transfer Programs on Rural Livelihoods: a Case Study in the Brazilian Amazon Estuary

We conducted a large household survey in a region of the Amazon estuary in Brazil to investigate the dependence of small farming households on government cash transfers and to identify the main factors that lead to better livelihood outcomes. The study examined the factors that contribute to heterogeneous household livelihoods and patterns of dependence on cash transfer programs. Multinomial logistic regression was used to evaluate household attributes affecting the level of dependence on cash transfers. Results indicate that households engage in a diversity of livelihood strategies, and vary in dependence on cash transfers. Lower levels of dependency are associated with higher levels of education and income from off-farm activities as well as larger property sizes and holdings in the várzea. Recognition of the causes and potential range of dependence on cash transfer programs adds decision-making capacity for policy makers seeking avenues to reduce dependence and increase program effectiveness.     

Capturing the context of maternal deaths from verbal autopsies: a reliability study of the maternal data extraction tool (M-DET)

Background

The availability of quality data to inform policy is essential to reduce maternal deaths. To characterize maternal deaths in settings without complete vital registration systems, we designed and assessed the inter-rater reliability of a tool to systematically extract data and characterize the events that precede a nationally representative sample of maternal deaths in India.

Method/Principal Findings

Of 1017 nationally representative pregnancy-related deaths, which occurred between 2001 and 2003, we randomly selected 105 reports. Two independent coders used the maternal data extraction tool (questions with coding guidelines) to collect information on antenatal care access, final pregnancy outcome; planned place of birth and care provider; community consultation, transport, admission, hospital referral; and verification of cause of death assignment. Kappa estimated inter-rater agreement was calculated and classified as poor (K≤0.4), moderate (K = 0.4-≤0.6), substantial (K = 0.6-≤0.8) and high (K>0.8) using the criteria from Landis & Koch. The data extraction tool had high agreement for gestational age, pregnancy outcome, transport, death en route and admission to hospital; substantial agreement for receipt of antenatal care, planned place of birth, readmission and referral to higher level hospital, and whether or not death occurred in the intrapartum period; moderate to substantial agreement for classification of deaths as direct or indirect obstetric deaths or incidental deaths; moderate agreement for classification of community healthcare consultation and total number of healthcare contacts; and poor agreement for the classification of deaths as sudden deaths and other/unknown cause of death. The ability of the tool to identify the most-responsible-person in labour varied from moderate agreement to high agreement.

Conclusions

This data extraction tool achieved good inter-rater reliability and can be used to collect data on events surrounding maternal deaths and for verification/improvement of underlying cause of death.     

Comparative analysis of energy intake and physical activity according to household type and presence of metabolic syndrome in middle-aged men based on data from the 7th Korea national health and nutrition examination survey (KNHANES) (2016-2018)

[Purpose] This study analyzed data from the 7^th Korean National Health and Nutrition Examination Survey (2016‒2018) to compare the differences in energy intake and physical activity (PA) levels in middle-aged Korean men aged 40-59 years according to household type and the presence of metabolic syndrome (MetS).[Methods] Data from 2,266 young adults (aged >39 years and <60 years) were obtained from the KNHANES. We analyzed the differences in energy intake and PA levels according to household type and MetS. The presence or absence of MetS was determined by measuring waist circumference, blood pressure, fasting blood glucose, triglyceride, and HDL-C levels.[Results] Regarding total nutritional intake, no relationship with MetS was observed regardless of household type (interaction between MetS and household type: p = 0.875). No differences in total PA were observed between multiple- and single-person households (interaction between MetS and household type: p = 0.122). The relationship between MetS and MetS components according to nutritional intake showed that participants with a higher energy intake had a 27% lower prevalence of low high-density lipoprotein cholesterol (HDL-C) (p < 0.05) and a 36% higher prevalence of high blood pressure (p < 0.01). The relationship between MetS and MetS components according to the PA level showed significantly reduced prevalence of MetS by approximately 39%, 35%, and 43% (p < 0.01, 0.01, and 0.001) in subjects who were somewhat active, active, and very active, respectively, compared to inactivity.[Conclusion] Middle-aged men showed no difference in nutritional intake and PA between multiple- and single-person households. However, the risk of MetS was significantly higher in participants with approximately 1.5 times the energy intake compared to the group with the lowest energy intake. Moreover, higher levels of PA had a marked positive effect on the risk factors and prevalence of MetS. Therefore, we suggest that reducing the total energy intake and increasing total PA are important for preventing MetS in middle-aged men regardless of household type.     

Diversity of Medicinal and Food Plants as Non-timber Forest Products in Naban River Watershed National Nature Reserve (China): Implications for Livelihood Improvement and Biodiversity Conservation

Diversity of Medicinal and Food Plants as Non-timber Forest Products in Naban River Watershed National Nature Reserve (China): Implications for Livelihood Improvement and Biodiversity Conservation. Non-timber forest products (NTFPs) play an important role in rural livelihoods. People living in and around forests are dependent on a variety of NTFPs for their subsistence and for income generation. This paper gives a general overview on the diversity of NTFPs in the Naban River Watershed National Nature Reserve, with a focus on medicinal and food plants. Data on NTFPs use were gathered through an ethnobotanical inventory with semistructured, free-listing, and household socioeconomic interviews. Interviews were supplemented with voucher collections. Bamboo shoots were analyzed further as proxy NTPF. It was hypothesized that there is no significant difference between collection amounts of bamboo shoots and their contribution to the household income between the villages studied. A rapid vulnerability assessment (RVA) was conducted to identify vulnerable and threatened species. A total of 480 plant species (25% of recorded flora) from 117 families and 334 genera are used as NTFPs by the local people. Results revealed that there is a significant difference in the collection and contribution of bamboo shoots to household income among the villages. However, their contribution to per-capita income is very low, and they are mainly used in households. Vulnerability assessment showed that most of the medicinal species have moderate vulnerable status and that most of the food species have less vulnerable status. Some medicinal plants, such as Paris polyphylla var. yunnanensis, are overexploited and getting scarce. Sustainable harvest and management strategies should be implemented to prevent overexploitation of these species.     

Efficiency of chemical and organic pesticides for Conogethes punctiferalis (Lepidoptera: Crambidae) in commercial chestnut and walnut fields

Chestnuts and walnuts are ones of most important forest products in Korea. However, Conogethes punctiferalis has been increasingly causing economic damages to chestnuts and walnuts. Currently, its management is mainly relayed on aerial application of pesticides. To select pesticides of C. punctiferalis for aerial application, damage rate of chestnut and walnut fruits and death rate of C. punctiferalis were analyzed according to selected pesticides. Experiments were conducted during two years by randomly applying chemical pesticide (i.e., Chlorfluazuron 5 % in 2018 and Thiacloprid 10 % in 2019), organic pesticide (i.e., paraffin oil 8 % + plant extracts (90 %) from Styphnolobium japonicum, Melia azedarach, and Dysphania ambrosioides), and no treatment (i.e., control) into an area which were divided into three from a whole commercial field. All pesticides used in this study could suppress damages of walnuts and chestnuts by C. punctiferalis. However, these pesticides could not kill their larvae inside of fruits. Thus, aerial spraying these pesticides for C. punctiferalis should be applied at optimal timing or slightly earlier than optimal timing. By considering honeybee toxicity, cost, and management efficiency, Chlorfluazuron 5 % was the best as an aerial application pesticide among these three pesticide in this study.     

Analysis of Binary Multivariate Longitudinal Data via 2-Dimensional Orbits: An Application to the Agincourt Health and Socio-Demographic Surveillance System in South Africa

We analyse demographic longitudinal survey data of South African (SA) and Mozambican (MOZ) rural households from the Agincourt Health and Socio-Demographic Surveillance System in South Africa. In particular, we determine whether absolute poverty status (APS) is associated with selected household variables pertaining to socio-economic determination, namely household head age, household size, cumulative death, adults to minor ratio, and influx. For comparative purposes, households are classified according to household head nationality (SA or MOZ) and APS (rich or poor). The longitudinal data of each of the four subpopulations (SA rich, SA poor, MOZ rich, and MOZ poor) is a five-dimensional space defined by binary variables (questions), subjects, and time. We use the orbit method to represent binary multivariate longitudinal data (BMLD) of each household as a two-dimensional orbit and to visualise dynamics and behaviour of the population. At each time step, a point (x, y) from the orbit of a household corresponds to the observation of the household, where x is a binary sequence of responses and y is an ordering of variables. The ordering of variables is dynamically rearranged such that clusters and holes associated to least and frequently changing variables in the state space respectively, are exposed. Analysis of orbits reveals information of change at both individual- and population-level, change patterns in the data, capacity of states in the state space, and density of state transitions in the orbits. Analysis of household orbits of the four subpopulations show association between (i) households headed by older adults and rich households, (ii) large household size and poor households, and (iii) households with more minors than adults and poor households. Our results are compared to other methods of BMLD analysis.     

Nontimber forest product gathering in Ritigala forest (Sri Lanka): Household strategies and community differentiation

Sri Lanka has a long tradition of forest product use. The relationship of people with a dry zone forest was studied using a sample of 48 households in two villages that varied in distance to the forest and access to the market. All households interviewed collected subsistence forest products and a majority of them also collected commercial products. The daily peak-season income from commercial gathering was 4.5 to 7.7 times the daily labor wage. There is a strong gender specialization, with commercial gathering dominated by men whereas subsistence gathering is almost exclusively the task of women. The average forest-derived household income in the village closer to the forest and with better market access was nearly double that of the other village. Family size as a proxy of labor availability was the main discriminating factor between those households who did and those who did not gather commercial products. A small inverse relationship between forest gathering and size of household agricultural land (particularly paddy rice) was observed. No clear relationship was found between total household income and forest derived income, contradicting the view that commercial forest gathering is an exclusive activity of the poorest households.     

Geospatial analysis of the associations between environmental contamination with livestock feces and children with chronic fascioliasis in the Anta province of Cusco,Peru

Fasciola hepatica is a neglected parasitic infection with significant human health and livestock industry impact. The Andean Altiplano harbors an estimated 50% of the Fasciola’s world infection burden. There is scarce data regarding the spatial associations between different Fasciola hosts. In this project, we aimed to determine the geospatial relationships between Fasciola eggs passed in feces of different livestock species and the risk of infection among each household as a unit. We used data from a cross-sectional study evaluating children and livestock feces for Fasciola infection around households in three districts of Anta province, in the Cusco region of Peru. Each sample was geographically tagged and evaluated for fascioliasis using microscopy methods. A total of 2070 households were included, the median age was 9.1 years (6.7–11.8), 49.5% were female, and 7.2% of the households had at least one infected child. A total of 2420 livestock feces samples were evaluated. The infection rate in livestock samples was 30.9%. The highest infection rate was found in sheep with 40.8%, followed by cattle (33.8%), and swine (26.4%). The median distance between a household with an infected child to a positive animal sample was 44.6 meters (IQR 14.7–112.8) and the distance between a household with no infected children to a positive animal sample was 62.2 meters (IQR 18.3–158.6) (p = 0.025). The multivariable logistic regression adjusted by presence of poor sanitation, unsafe water consumption, altitude, and presence of multiple infected children per household demonstrated an association between household infection and any cattle feces at a 50 meters radius (Uninfected: OR 1.42 (95%CI 1.07–1.89), p = 0.017. Infected: OR 1.89 (95%CI 1.31–2.73), p = 0.001), positive cattle feces at a 100 meters radius (OR 1.35 (95% CI 1.08–1.69), p = 0.008), and negative cattle feces at a 200 meters radius (OR 1.08 (95% CI 1.01–1.15), p = 0.022). We identified potential hot and cold spots for fascioliasis in the Anta province. An association between environmental contamination with feces from different livestock species and infected children in rural households was found in our study. Local health authorities may apply this strategy to estimate the risk of infection in human populations and apply targeted interventions.