Place and Child Health: The Interaction of Population Density and Sanitation in Developing Countries

A long literature in demography has debated the importance of place for health, especially children’s health. In this study, we assess whether the importance of dense settlement for infant mortality and child height is moderated by exposure to local sanitation behavior. Is open defecation (i.e., without a toilet or latrine) worse for infant mortality and child height where population density is greater? Is poor sanitation is an important mechanism by which population density influences child health outcomes? We present two complementary analyses using newly assembled data sets, which represent two points in a trade-off between external and internal validity. First, we concentrate on external validity by studying infant mortality and child height in a large, international child-level data set of 172 Demographic and Health Surveys, matched to census population density data for 1,800 subnational regions. Second, we concentrate on internal validity by studying child height in Bangladeshi districts, using a new data set constructed with GIS techniques that allows us to control for fixed effects at a high level of geographic resolution. We find a statistically robust and quantitatively comparable interaction between sanitation and population density with both approaches: open defecation externalities are more important for child health outcomes where people live more closely together.     

Major Socioeconomic Driving Forces of Improving Population Health in China: 1978–2018

China's post-Cultural-Revolution reform generated rapid economic growth. But it also brought about major negative changes, especially in the early stage, which jeopardized population health and mortality gains. Nonetheless, improvements continued. China had achieved the Millennium Development Goal target 4 of reducing under-5 mortality by two-thirds well before the target year of 2015. Life expectancy continued to rise and reached 76.6 years by 2018, notably higher than the world average and that recorded in many countries with similar per capita GDP. By describing China's recent economic growth, the rebuilding of nationwide health insurance systems, the development of medical financial assistance, and poverty alleviation programs, this paper shows how these improvements were achieved. Vulnerability to health and mortality risks has been reduced; the availability of, and people's access to, health insurance have increased; and better medical treatments and health services have become available and accessible. These macro-socioeconomic determinants have played the central role in achieving further population health and mortality progress in China in the past four decades.     

COVID Health Structure Index: The Vulnerability of Brazilian Microregions

Social Indicators Research - Many developing countries have highly unequal health systems across their regions. The pandemic of COVID-19 brought an additional challenge, as hospital structures...     

Change point detection for COVID-19 excess deaths in Belgium

Journal of Population Research - Emerging at the end of 2019, COVID-19 has become a public health threat to people worldwide. Apart from deaths with a positive COVID-19 test, many others have died...     

Asia's population and development in retrospect and prospect

By 1989 Asia's population will reach 3 billion. That Asia's countries can change the course of population development has been shown by China, whose population growth rate has decreased to 1.2%. 58% of the world's population in 1985 was Asian, and 53% of it was concentrated in 11 Asian countries, of which 37.6% was accounted for by India and China. Asia's population density is 3 times the world average, and the number of persons sustained by a square kilometer of land in Asia is 2.5 times the world average. Asia's population is young (median age 20.3), which means a high dependency burden, a large number of women of childbearing age, and low quality of life, as measured by infant mortality, life expectancy, and literacy. Rapid population growth ensures a low rate of development. Asia's goals are to achieve a 1% growth rate by year 2000, zero population growth and replacement level by 2015 for East Asia and 2020 for South Asia. The World Bank estimates that Asia's population will not stabilize until the end of the 21st century, by which time it will have reached 6 billion. Asia must find a way of achieving both population control and economic development. 5 recommendations are made to the Asian Forum of Parliamentarians on Population and Development (AFPPD): 1) that the AFPPD sponsor the activities of "the Day of 3 billion"; 2) that seminars and conferences on population be held among Asian nations; 3) that high-fertility countries adopt late marriages, few births, and programs for maternal and child health; 4) that organizations for family planning be strengthened and given the resources to upgrade the status of women; and 5) that international cooperation in the area of population be intensified.     

The impact of COVID-19 on the provision of respectful maternity care: Findings from a global survey of health workers

BackgroundSignificant adjustments to maternity care in response to the COVID-19 pandemic and the direct impacts of COVID-19 can compromise the quality of maternal and newborn care.AimTo explore how the COVID-19 pandemic negatively affected frontline health workers’ ability to provide respectful maternity care globally.MethodsWe conducted a global online survey of health workers to assess the provision of maternal and newborn healthcare during the COVID-19 pandemic. We collected qualitative data between July and December 2020 among a subset of respondents and conducted a qualitative content analysis to explore open-ended responses.FindingsHealth workers (n = 1127) from 71 countries participated; and 120 participants from 33 countries provided qualitative data. The COVID-19 pandemic negatively affected the provision of respectful maternity care in multiple ways. Six central themes were identified: less family involvement, reduced emotional and physical support for women, compromised standards of care, increased exposure to medically unjustified caesarean section, and staff overwhelmed by rapidly changing guidelines and enhanced infection prevention measures. Further, respectful care provided to women and newborns with suspected or confirmed COVID-19 infection was severely affected due to health workers’ fear of getting infected and measures taken to minimise COVID-19 transmission.DiscussionMultidimensional and contextually-adapted actions are urgently needed to mitigate the impacts of the COVID-19 pandemic on the provision and continued promotion of respectful maternity care globally in the long-term.ConclusionsThe measures taken during the COVID-19 pandemic had the capacity to disrupt the provision of respectful maternity care and therefore the quality of maternity care.     

Ethnic Diversity and Health Outcomes

This study hypothesizes a relationship between ethnic diversity and health outcomes. We explore the effects of ethnic and linguistic heterogeneity (measured by indices of ethnic and linguistic fractionalization) on various health outcomes in a cross-section of 91 countries. We explore outcomes relating to four major categories of health: (1) immunization rates, (2) prevalence of diseases, (3) life expectancy and mortality rates, and (4) health related infrastructure and staff. Across all dimensions examined, evidence suggests that higher heterogeneity is bad for health outcomes. We explore several potential mechanisms which could explain the observed negative effects of ethnic and linguistic diversity on health.     

Effect of COVID-19 on Household Food Insecurity and Poverty: Evidence from Ghana

Social Indicators Research - Following the outbreak of COVID-19 and its heavy toll on the global community and humanity, a fierce debate on the pandemic and Sustainable Development Goals (SDGs)...     

The United Kingdom and the Netherlands maternity care responses to COVID-19: A comparative study

BackgroundThe national health care response to coronavirus (COVID-19) has varied between countries. The United Kingdom (UK) and the Netherlands (NL) have comparable maternity and neonatal care systems, and experienced similar numbers of COVID-19 infections, but had different organisational responses to the pandemic. Understanding why and how similarities and differences occurred in these two contexts could inform optimal care in normal circumstances, and during future crises.AimTo compare the UK and Dutch COVID-19 maternity and neonatal care responses in three key domains: choice of birthplace, companionship, and families in vulnerable situations.MethodA multi-method study, including documentary analysis of national organisation policy and guidance on COVID-19, and interviews with national and regional stakeholders.FindingsBoth countries had an infection control focus, with less emphasis on the impact of restrictions, especially for families in vulnerable situations. Differences included care providers’ fear of contracting COVID-19; the extent to which community- and personalised care was embedded in the care system before the pandemic; and how far multidisciplinary collaboration and service-user involvement were prioritised.ConclusionWe recommend that countries should 1) make a systematic plan for crisis decision-making before a serious event occurs, and that this must include authentic service-user involvement, multidisciplinary collaboration, and protection of staff wellbeing 2) integrate women’s and families’ values into the maternity and neonatal care system, ensuring equitable inclusion of the most vulnerable and 3) strengthen community provision to ensure system wide resilience to future shocks from pandemics, or other unexpected large-scale events.     

政府支出对医疗服务健康公平影响的比较和启示

医疗服务公平和人民的健康是各国卫生系统向其国家居民提供医疗服务所应实现的两个重要目标。但以英美日为例的发达国家根据世界卫生统计年鉴中的医疗服务公平性排名确有明显差距，因此，高收入和高政府医疗卫生支出与医疗卫生服务公平和健康公平性并没有必然关系。本文通过比较分析美日英国的政府间医疗卫生支出责任划分的结构发现高政府医疗卫生支出比例是提高医疗服务筹资公平性的前提，中央承担社会医疗保险责任是实现医疗服务筹资公平性的保证，政府特别是中央政府出资的长期护理有助于提高国民健康水平，地方政府的参与更有助于提高一国医疗系统机构数量特别是医院的数量。     

Prime-age adult mortality in sub-Saharan Africa: examining trends in Demographic and Health Surveys conducted between 1990 and 2014

Adult mortality rate is a critical indicator used to assess the level of national development in most sub-Saharan African countries. However, estimation of adult mortality rates requires comprehensive and accurate reporting of adult deaths, which is one of the challenges faced by most sub-Saharan African countries. Using data from Demographic and Health Surveys conducted between 1990 and 2014 in 25 countries in sub-Saharan Africa, we examine trends in all-cause prime adult mortality (measured by the probability of dying between exact ages 15 and 50) and sex differences in adult mortality by region. Our paper provides a basis for tracking progress in reducing adult mortality and improving overall health. The median probability of dying was 173 per 1000 for women in the latest surveys, an increase from 166 per 1000 during the initial surveys. The median value for men was 177 per 1000; a decrease from the initial surveys which was 202 per 1000. Across all countries, the average annual increase in the probability of dying was higher for women (1.08%) than men (0.49%). Intensive efforts are needed to improve adult survival and ensure that sub-Saharan Africa achieves the Sustainable Development Goals by 2030. In particular, efforts to mitigate the premature risk of dying among women need to be intensified.     

The challenge of world health

2 development specialists have expounded on the demands world health has placed on public health. Striking declines in infant and child mortality occurred with the advent of biomedical and technical interventions in developing countries after World War II. At the same time, these interventions promoted longer lives by curing and/or treating chronic diseases in developed countries. In the 1970s, however, it was apparent that the hospital based, curative approach could not meet health needs and was very costly. In developed countries, biomedical and social sciences showed that chronic diseases did not occur due to modernization but from unhealthy behaviors, diet, and lifestyle. In fact, in 1975, the US Centers for Disease Control announced that unhealthy lifestyles contributed to 50% of all deaths while the medical system was responsible for only 11%. The US and other developed countries then began to promote healthy lifestyles, and in the 1980s, considerable improvements in health occurred, especially among adults. Developing countries which depended on the Western medical model did not experience health gains in the 1970s. Yet developing countries where health systems concentrated on carrying essential services to all people and promoted basic hygiene and sound dietary practices continued to achieve considerable health gains. In 1978, WHO an UNICEF hosted the International Conference on Primary Health Care in Alma Ata, the Soviet Union to hold these developing countries with community based health systems as models of primary health care (PHC). The 1980s witnessed the spread of PHC especially in the form of child survival which focused on oral rehydration therapy and breast feeding. The biomedical and social sciences are needed to move this health policy and program strategy forward. Governments must see to policies that promote healthy people. Political will is needed to make human welfare a high priority.     

The effect of COVID-19 lockdowns on women's perinatal mental health: a systematic review

BackgroundRisk factors for poor maternal perinatal mental health include a previous mental health diagnosis, reduced access to perinatal services, economic concerns and decreased levels of social support. Adverse maternal perinatal mental health can negatively influence the psychological wellbeing of infants. The outbreak of the COVID-19 pandemic presented an additional stressor. While literature on the impact of COVID-19 on perinatal mental health exists, no systematic review has focused specifically on maternal perinatal mental health during periods of COVID-19 lockdown.AimsThis systematic review explores how periods of COVID-19 lockdown impacted women’s perinatal mental health.MethodsSearches of CINAHL, PsycARTICLES, PsycINFO, PubMed, Scopus and Web of Science were conducted for literature from 1st January 2020–25th May 2021. Quantitative, peer-reviewed, cross-sectional studies published in English with perinatal women as participants, and data collected during a period of lockdown, were included. Data was assessed for quality and narratively synthesized.FindingsSixteen articles from nine countries met the inclusion criteria. COVID-19 lockdowns negatively impacted perinatal mental health. Risk factors for negative perinatal mental health noted in previous literature were confirmed. In addition, resilience, educational attainment, trimester, and ethnicity were identified as other variables which may influence mental health during perinatal periods experienced during lockdown. Understanding nuance in experience and harnessing intra and interpersonal support could advance options for intervention.ConclusionDeveloping resources for perinatal women that integrate informal sources of support may aid them when normal routine is challenged, and may mediate potential long-term impacts of poor perinatal maternal health on infants.     

Is prenatal sex selection associated with lower female child mortality?

I examine whether prenatal sex selection has substituted postnatal excess female mortality by analysing the dynamics of child sex ratios between 1980 and 2015 using country-level life table data. I decompose changes in child sex ratios into a ‘fertility’ component attributable to prenatal sex selection and a ‘mortality’ component attributable to sex differentials in postnatal survival. Although reductions in numbers of excess female deaths have accompanied increases in missing female births in all countries experiencing the emergence of prenatal sex selection, relative excess female mortality has persisted in some countries but not others. In South Korea, Armenia, and Azerbaijan, mortality reductions favouring girls accompanied increases in prenatal sex selection. In India, excess female mortality was much higher and largely stable as prenatal sex selection emerged, but slight reductions were seen in the 2000s. In China, although absolute measures showed reductions, relative excess female mortality persisted as prenatal sex selection increased.     

Infant Mortality Rate as a Measure of a Country’s Health: A Robust Method to Improve Reliability and Comparability

Researchers and policymakers often rely on the infant mortality rate as an indicator of a country’s health. Despite arguments about its relevance, uniform measurement of infant mortality is necessary to guarantee its use as a valid measure of population health. Using important socioeconomic indicators, we develop a novel method to adjust country-specific reported infant mortality figures. We conclude that an augmented measure of mortality that includes both infant and late fetal deaths should be considered when assessing levels of social welfare in a country. In addition, mortality statistics that exhibit a substantially high ratio of late fetal to early neonatal deaths should be more closely scrutinized.     

Religion and Health in Early Childhood: Evidence from South Asia

This article studies early childhood health in India, Bangladesh, and Nepal, focusing on inequalities in anthropometric outcomes by religious adherence. India and Nepal have Hindu majorities, while Bangladesh is predominantly Muslim. The results suggest that Muslim infants have an advantage over Hindu infants in height‐for‐age in India (for boys and girls) and in Bangladesh (for boys). However, this advantage disappears beyond 12 months of age, at which point Hindu children in all three countries are found to have significantly better anthropometric outcomes than Muslim children. We report tests that rule out mortality selection and undertake falsification and robustness exercises that confirm these findings. Further results suggest that exposure to Ramadan fasting in utero may lead to positive selection of Muslim male infants, partially explaining the Muslim infant health advantage, but this does not fully explain the shift from Muslim advantage in infancy to Hindu advantage in childhood in all three countries.     

Neo-natal and post-neo-natal mortality in a rural area of Bangladesh

Abstract An analysis of neo-natal and post-neo-natal mortality in 132 villages (population of 117,000) of Matlab thana indicates the following: (i) Neo-natal deaths accounted for 60% of the infant mortality rate of 125. This proportion was unexpectedly high since previous research had maintained that in countries with infant mortality rates over 100, neo-natal deaths account for less than one-third of all infant deaths. Since the present findings on the proportions of neo-natal deaths correspond exactly with results from an earlier registration system in East Pakistan, it is suggested that the long-accepted proposition, 'less developed' areas are characterized by lower proportions of neo-natal deaths than 'more developed' areas, be re-examined. (2) The infant death rate accounts for 36% of all deaths in the population. If the infant death rate were reduced by half the result would be a decrease in the current crude death rate from 16 to 13. Although this reduction would appear to be small, in the context of a current high growth rate of 3% (from 1966-67 to 1968-69) it exerts a sizeable impact. For example, it would take a reduction of eight points in the crude birth rate of 46 just to achieve a growth rate 2·5% under these circumstances. Obviously, continued efforts in death control without an effective birth control programme will perpetuate high rates of growth. (3) Neo-natal and post-neo-natal mortality exhibited the -expected 'U' shaped pattern with parity, and generally varied as expected with age and family size, except in the oldest age group and largest family size where the risk was smaller than in the preceding groups. An explanation for these findings is presented, based on the effect that births to high-parity women with low child mortality have upon the total neo-natal and post-neo-natal mortality rates. It was found that these births exhibit a much lower mortality risk than births to women of comparable parities and higher child mortality, and that their numbers account for the lower risk to the births in the oldest age group and largest family size. It was concluded that women with a combination of high parity and low child mortality most probably represent a group with superior socio-economic and or health conditions which contribute to the lower risk of neo-natal and post-neo-natal death.     

Data for the Sustainable Development Goals: Metrics for Evaluating Civil Registration and Vital Statistics Systems Data Relevance and Production Capacity,Illustrations with Nigeria

Three issues impinging on the potential use of Civil Registration and Vital Statistics (CRVS) data for the Sustainable Development Goals (SDGs) are analysed in the paper. These include CRVS data relevance, content and data production capacity of CRVS systems. The paper adopts a ‘data type’ approach to relevance and capacity and proposes two metrics based on a graded qualitative evaluation (GQE) methodology. One is a data-relevance metric for evaluating the relevance of CRVS data types to the SDGs. The second is a National Statistical Systems (NSS) data type production capacity metric used for evaluating the data production capacity of CRVS systems. CRVS data instrument analysis and the CRVS data production capacity are exemplified with the Nigerian CRVS system. Relevance assessment results suggest that CRVS systems can provide data relevant to 25% of the SDGs. However the SDG data contribution of CRVS depends on the ‘data type’ capacity of National CRVS systems. As the capacity assessment shows, the Nigerian CRVS system has ‘nominal’ capacity to produce all CRVS data types (fertility, mortality, migration, nuptiality and socio-economic) and ‘active’ and ‘latent’ capacities to provide data for some 21 SDG targets. However, it currently lacks ‘effective’ capacity to produce any of the data types for the SDGs. The paper has implications for goal setting and prioritization in evolving strategies to enhance the development of CRVS/NSS systems’ data capacities, especially in developing countries.     

Trust in Government Actions During the COVID-19 Crisis

The worldwide COVID-19 pandemic puts countries and their governments in an unprecedented situation. Strong countermeasures have been implemented in most places, but how much do people trust their governments in handling this crisis? Using data from a worldwide survey, conducted between March 20th and April 22nd, 2020, with more than 100,000 participants, we study people’s perceptions of government reactions in 57 countries. We find that media freedom reduces government trust directly as well as indirectly via a more negative assessment of government reactions as either insufficient or too strict. Higher level of education is associated with higher government trust and lower tendency to judge government reactions as too extreme. We also find different predictors of perceived insufficient reactions vs. too-extreme reactions. In particular, number of COVID-19 deaths significantly predicts perceived insufficient reactions but is not related to perceived too-extreme reactions. Further survey evidence suggests that conspiracy theory believers tend to perceive government countermeasures as too strict.