Research Article
Clustering of hypertension, diabetes and overweight/obesity according to socioeconomic status among Bangladeshi adults
- Gulam Muhammed Al Kibria, Mohammad Rashidul Hashan, Md Mahbub Hossain, Sojib Bin Zaman, Christina A. Stennett
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- Published online by Cambridge University Press:
- 09 March 2020, pp. 157-166
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The prevalences of hypertension, diabetes and overweight/obesity are increasing in most developing countries, including Bangladesh. Although earlier studies have investigated the factors associated with these three conditions, little is known about whether socioeconomic status is associated with their co-existence. This cross-sectional study analysed data from the 2011 Bangladesh Demographic and Health Survey. An individual was considered hypertensive, diabetic and overweight/obese if their systolic/diastolic blood pressure, fasting plasma glucose concentration, and body mass index were ≥130/80 mmHg, ≥7 mmol/l and ≥23 kg/m2, respectively. Furthermore, individuals who reported taking anti-hypertensive and anti-diabetic drugs were also considered as hypertensive and diabetic, respectively. Two socioeconomic variables were investigated: education level and household wealth quintile. Descriptive analyses and multilevel logistic regression were conducted. Among the 7932 respondents (50.5% female) aged ≥35 years, the prevalences of hypertension, diabetes, overweight/obesity, any one condition and the co-existence of the three conditions were 48.0%, 11.0%, 25.3%, 60.9% and 3.6%, respectively. In adjusted analysis, individuals with secondary (adjusted odds ratio [AOR]: 1.8, 95% confidence interval [CI]: 1.2–2.8) and college or above (AOR: 3.6; 95% CI: 2.2–5.7) education levels had higher odds of the co-existence of all three conditions compared with those with no formal education. Similarly, compared with the poorest wealth quintile, the richer (AOR: 4.6; 95% CI: 2.2–9.4) and richest (AOR: 11.8; 95% CI: 5.8–24.1) wealth quintiles had higher odds of co-existence of these three conditions. Education and wealth quintile also showed significant relationships with each of the three conditions separately. In conclusion, in Bangladesh, hypertension, diabetes and overweight/obesity are associated with indicators of higher socioeconomic status. These findings highlight the importance of developing healthy lifestyle interventions (e.g. physical exercise and dietary modification) targeting individuals of higher socioeconomic status to minimize the burden of these non-communicable diseases.
Increasing role of abstinence and infecundity in non-use of contraceptive methods in India
- Preeti Dhillon, Govind Singh, Faujdar Ram, Pradeep Kumar, Niranjan Saggurti
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- Published online by Cambridge University Press:
- 09 March 2020, pp. 167-182
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This paper assesses the reasons for non-use of contraceptive methods, and the possible complexity of reported data on women in India. The study used recent data from two successive rounds of the National Family Health Survey (NFHS) (2005–06: N=37,296; 2015–16: N=247,024), which surveyed currently married women aged 15–49 years. The reporting on non-use of contraceptives and the changing pattern of the reasons for non-use were analysed, classified into fertility and other cited reasons. The self-reported reasons for non-use of contraception were verified with other related information captured in the survey. Bivariate and logistic regression analyses were conducted. Sexual abstinence (not having sex: 10%; infrequent sex: 3%) and infecundity (menopausal/hysterectomy: 12%; subfecund/infecund: 10%) were the most commonly reported reasons for non-use of contraceptive methods in 2015–16, followed by refusal to use (10%). The proportion of non-users who wanted to have a child soon (25% to 21%), were pregnant (16% to 13%), in postpartum amenorrhoea (68% to 40%) and who had method-related reasons (10% to 6%) declined over time (from 2005–06 to 2015–16, respectively). A higher proportion of less-educated women reported abstinence (6%) and menopause/hysterectomy (19%) than educated women. Abstinence was more commonly reported in states with low prevalence of modern contraceptive use. The findings suggest that the increasing trend of abstinence and infecundity among non-users of contraception may be a concern for future research and reproductive health programmes, as it questions both the quality of data and sexual health of married couples.
An invincible memory: what surname analysis tells us about history, health and population medical genetics in the Brazilian Northeast
- Augusto César Cardoso-dos-Santos, Virginia Ramallo, Marcelo Zagonel-Oliveira, Maurício Roberto Veronez, Pablo Navarro, Isabella L. Monlleó, Victor Hugo Valiati, José Edgardo Dipierri, Lavinia Schuler-Faccini
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- Published online by Cambridge University Press:
- 16 March 2020, pp. 183-198
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Several studies have shown that the Brazilian Northeast is a region with high rates of inbreeding as well as a high incidence of autosomal recessive diseases. The elaboration of public health policies focused on the epidemiological surveillance of congenital anomalies and rare genetic diseases in this region is urgently needed. However, the vast territory, socio-demographic heterogeneity, economic difficulties and low number of professionals with expertise in medical genetics make strategic planning a challenging task. Surnames can be compared to a genetic system with multiple neutral alleles and allow some approximation of population structure. Here, surname analysis of more than 37 million people was combined with health and socio-demographic indicators covering all 1794 municipalities of the nine states of the region. The data distribution showed a heterogeneous spatial pattern (Global Moran Index, GMI = 0.58; p < 0.001), with higher isonymy rates in the east of the region and the highest rates in the Quilombo dos Palmares region – the largest conglomerate of escaped slaves in Latin America. A positive correlation was found between the isonymy index and the frequency of live births with congenital anomalies (r = 0.268; p < 0.001), and the two indicators were spatially correlated (GMI = 0.50; p < 0.001). With this approach, quantitative information on the genetic structure of the Brazilian Northeast population was obtained, which may represent an economical and useful tool for decision-making in the medical field.
Culture and domestic violence amongst ever-married women in Malawi: an analysis of emotional, sexual, less-severe physical and severe physical violence
- Lana Clara Chikhungu, Tamsin Bradley, Monica Jamali, Ottis Mubaiwa
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- 06 April 2020, pp. 199-213
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Nearly 42% of ever-married women in Malawi have experienced some form of physical, sexual or emotional violence perpetrated by their current or most recent spouse – higher than the global estimate of 35%. This study used national-level data for ever-married women aged 15–49 years from the 2015 Malawi Demographic and Health Survey to explore the association between cultural factors and the likelihood of women experiencing sexual, physical and emotional violence after controlling for socioeconomic factors using multilevel logistic regression modelling. Key cultural factors found to be associated with violence against ever-married women in Malawi were type of marriage (polygynous or monogamous), age at marriage, religion and ethnicity. Husband's consumption of alcohol also emerged as a very important factor in violence against married women. Interventions to tackle violence against married women in Malawi should aim at promoting monogamous marriages and discouraging polygynous marriages, and address the culture of heavy alcohol consumption amongst husbands. Future studies could explore further if there are key lessons that families can learn from Muslim families and across ethnic groups.
Nationally representative surveys show gradual shifting of overweight and obesity towards poor and less-educated women of reproductive age in Nepal
- Ipsita Sutradhar, Tahmina Akter, Mehedi Hasan, Rajat Das Gupta, Hemraj Joshi, Mohammad Rifat Haider, Malabika Sarker
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- 27 March 2020, pp. 214-232
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Overweight and obesity are considered major public health concerns all over the world. They have the potential to increase the risk of developing non-communicable diseases in reproductive age women, increasing their risk of pregnancy related complications and adverse birth outcome. This study was carried out to identify the trend of prevalence of overweight and obesity, along with their determinants, among reproductive age women (15–49 years) in Nepal. Data were taken from the nationally representative 2006, 2011 and 2016 Nepal Demographic and Health Surveys (NDHSs). Women were considered to be overweight or obese when their BMI was 23.0–27.5 kg/m2 or ≥27.5 kg/m2, respectively. Univariate, bivariate and multivariate analyses were performed, with significance taken at p<0.05. The prevalences of overweight and obesity both showed rising trends in women of reproductive age in Nepal from 2006 to 2016, particularly among those with no education, only primary education and poor women. The presence of overweight and obesity was found to be significantly associated with the sample women’s age, educational status, wealth index, place of residence, ecological zone, developmental region, number of household members, marital status and ethnicity. In 2016 one in every three women of reproductive age in Nepal was either overweight or obese. As overweight and obesity have detrimental effects on women’s health, the Government of Nepal, in collaboration with other government and non-government organizations, should take action to halt the rising trends in overweight and obesity in the country.
Analysing the seasonality of births in mainland China
- Yuxiang Yang
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- 06 April 2020, pp. 233-246
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The seasonality of human births varies in different countries and regions. Explanations for this variation have been divided into biological and behavioural factors. This paper documents birth seasonality in mainland China using data for a large sample from Chinaʼs Fifth National Population Census (FNPC) conducted in 2000. The main method used was the decomposition of monthly time series birth data into annual, seasonal and random trends. The results show large seasonal birth fluctuations, with a salient peak of October births. The study hypothesis is that this seasonal birth pattern is partially due to a home-bound wave of movement of people after the annual Spring Festival. Subsequent analysis of the calculated de-trended monthly births provided supportive evidence for this hypothesis. Further in-depth analysis showed that the magnitude of births varied with location and family characteristics. This result should inform researchers in the field of economics, where seasonality of births has been previously regarded as exogenous.
Body mass index of women in Bangladesh: comparing Multiple Linear Regression and Quantile Regression
- Sorif Hossain, Raaj Kishore Biswas, Md Amir Hossain
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- Published online by Cambridge University Press:
- 07 April 2020, pp. 247-265
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This study explored the association between socio-demographic factors and the body mass index (BMI) of women of reproductive age (15–49 years) in Bangladesh. Data from the 2014 Bangladesh Demographic and Health Survey (BDHS-14) were analysed using Multiple Linear Regression (MLR) and Quantile Regression (QR) analyses. The study sample comprised 15,636 non-pregnant women aged 15–49. The mean BMI of the women was 22.35±4.12 kg/m2. Over half (56.75%) had a BMI in the normal range (18<BMI<25 kg/m2), and 18.50%, 20.00% and 4.75% were underweight (BMI≤18 kg/m2), overweight (25≤BMI<30 kg/m2) and obese (BMI≥30 kg/m2), respectively. The results of the MLR found that age, wealth index, urban/rural place of residence, geographical division, womenʼs educational status, husbandʼs educational status, womenʼs working status and total number of children ever born were significantly (p<0.001) associated with respondents’ mean BMI. The QR results showed different associations between socio-demographic factors and mean BMI, as well as a different conditional distribution of mean BMI. Overall, the results indicated that women with uneducated husbands, with little or no education and from less-affluent households from rural areas tended to be more underweight compared with women in other groups. The inter-relationship between the study womenʼs mean BMI and associated socio-demographic factors was assessed using QR analysis to identify the most vulnerable cohorts of women in Bangladesh.
Does the preference for location of childbirth change for successive births? Evidence from the states and regions of India
- Bidyadhar Dehury, Mithlesh Chourase
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- 16 April 2020, pp. 266-289
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Universal health coverage is central to the development agenda to achieve maternal and neonatal health goals. Although there is evidence of a growing preference for institutional births in India, it is important to understand the pattern of switching location of childbirth and the factors associated with it. This study used data from the fourth round of the National Family and Health Survey (NFHS-4) conducted in India in 2015–16. The study sample comprised 59,629 women who had had at least two births in the five years preceding the survey. Bivariate and multivariate logistic regression analyses were applied to the data. About 16.4% of the women switched their location of childbirth between successive births; 9.1% switched to a health facility contributing to a net increment of 1.9% in institutional delivery, varying greatly across states and regions. There was at least a 4 percentage point net increment in institutional births in Chhattisgarh, Bihar, Punjab and Haryana, but the shift was more in favour of home births in Madhya Pradesh, Odisha and West Bengal. Women with high parity and a large birth interval had higher odds of switching their place of childbirth, and this was in favour of a health facility, while women with higher education, from lower social groups, living in urban areas, who had not received four antenatal care visits, and who belonged to a higher wealth quintile had higher odds of switching their place of childbirth to a health facility, despite having lower odds of switching their childbirth location. The study provides evidence of women in India switching their location of childbirth for successive births, and this was more prevalent in areas where the rate of institutional delivery was low. Only a few states showed a higher net increment in favour of a health facility. This suggests that there is a need for action in specific states and regions of India to achieve universal health coverage.
Disability-free life expectancy at old ages in Egypt
- Soha Metwally
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- 06 May 2020, pp. 290-304
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This study aimed to estimate among the older population in Egypt (aged 60 years and over): 1) disability prevalence rates, their levels of severity and the common types and 2) disability-free life expectancy (DFLE) by sex, age and disability type. Data were from the nationally representative 2016 Household Observatory Survey (HOS-2016), with 4658 persons aged 60+ constituting the study sample population. To identify individuals with disabilities, the HOS asked respondents a short set of questions on functional difficulties, as suggested by the United Nations Washington Group on Disability Statistics. The DFLE was estimated using the Sullivan method. Older (60+) women reported a higher prevalence of disability than older men. Women had longer DFLEs and longer disabled life expectancies (DLEs) than men but had lower proportions of DFLE to their total lifetime. The findings suggest that, at age 60, around 30% of life expectancy in Egypt can be expected to be with limitations in mobility and vision. Men, although they live for fewer years than women, can expect to have a greater proportion of their life expectancy free of disability. The findings of the study suggest that the contextual differences in how the process of ageing is experienced need to be considered by decision-makers when designing gender-responsive health policies.
Religion and fertility patterns: comparison of life history traits in Catholics and Protestants, Hallstatt (Austria) 1733–1908
- Alina Gavrus-Ion, Torstein Sjøvold, Miguel Hernández, Rolando González-José, Neus Martínez-Abadías, María Esther Esteban Torné, Mireia Esparza
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- Published online by Cambridge University Press:
- 09 June 2020, pp. 305-318
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Catholicism and Protestantism have different ways of promoting the family unit that could influence survival and fertility at a population level. Parish records in the Austrian village of Hallstatt allowed the reconstruction of Catholic and Protestant genealogies over a period of 175 years (1733–1908) to evaluate how religion and social changes affected reproduction and survival. Life history traits such as lifespan beyond 15 years, number of offspring, reproductive span, children born out of wedlock and child mortality were estimated in 5678 Catholic and 3282 Protestant individuals. The interaction of sex, time and religion was checked through non-parametric factorial ANOVAs. Religion and time showed statistically significant interactions with lifespan >15 years, number of offspring and age at birth of first child. Protestants lived longer, had a larger reproductive span and an earlier age at birth of first child. Before the famine crisis of 1845–1850, Protestants showed lower values of childhood mortality than Catholics. Comparison of the number of children born out of wedlock revealed small differences between the two religions. Religion influenced reproduction and survival, as significant differences were found between Catholics and Protestants. This influence could be explained in part by differential socioeconomic characteristics, since Protestants may have enjoyed better living and sanitary conditions in Hallstatt.