Worldwide, children from less affluent backgrounds suffer from more stressful life events and greater distress compared with those from wealthier backgrounds. Despite these stark disparities, how a sufferer's wealth status influences perceptions of their distress is an understudied yet important question. The present research explored early intuitions regarding the connection between wealth and psychological pain in 4- to 9-year-old children. In Study 1 (N = 122), children saw two gender-matched White children who varied in their wealth status but experienced identical stressful events. Children perceived the low-wealth individuals as more distressed than their affluent counterparts, and this tendency increased as children grew older. Study 2 (N = 120, preregistered) extended this to judgments of Black individuals' psychological pain. Children's tendency to attribute greater distress to the less wealthy was predicted by their belief that the less wealthy have less control over their lives. Study 3 (N = 144, preregistered) provided a causal test of this mechanism. Information about an individual's control in life rendered their wealth status irrelevant, such that children perceived the less wealthy as experiencing more distress only when the less wealthy had lower control in life. Across all three studies, children's wealth-based pain perceptions prompted greater sympathy and increased support for individuals with less wealth compared with those with more wealth. These findings advance our understanding of the early beliefs children hold about wealth status and psychological pain, revealing its development, underlying mechanism, and potential impact on subsequent social support. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
The universal prevalence of cooperation is puzzling, as defection typically yields higher payoffs than cooperation, motivating searches for hidden pathways to cooperation. Here we study a game-theoretic model on a lattice structured population in which interaction payoffs are scaled by the minimum of participants' accumulated wealth, reflecting real-world heterogeneity and incorporating the influence of past strategic choices. This wealth scaling allows frequent cooperators to surpass defectors in payoffs through their greater wealth even at high cooperation costs where defection would otherwise dominate. At the elevated critical cost-benefit ratio, the wealth gradient at the cooperator-defector boundary in one dimension exhibits a discontinuous transition. We show that slowing and effective stalling of the boundary trigger an explosive buildup of the wealth gradient, driving the dominance of cooperation below the critical ratio. Remarkably, this promotion of cooperation is stronger at higher temperatures, revealing a constructive role of fluctuations.
Malaria remains a leading cause of morbidity and mortality among children under five in Uganda. Despite national control efforts, significant disparities and inequalities in prevalence persist across regions, residences, and mean socio-economic status. This study examines the socio-demographic factors and wealth-related inequalities associated with malaria among children under five in Uganda. A secondary analysis of data from the Uganda Malaria Indicator Survey (UMIS) 2018-2019 was conducted. A sample of 4,600 children with malaria test results was included in the study. The distribution of malaria prevalence across socio-demographic factors was analysed using cross-tabulations and a chi-squared test. Malaria-related inequalities were measured using equity plots and the concentration index (CIX). A multilevel logistic regression model was used to examine the relationship between malaria prevalence and associated factors. The results are presented as adjusted odds ratios (aORs) with 95% confidence intervals (CI). Almost twenty-three in every 100 children under five had malaria infection (95% CI: 19.2-27.0). Regional variations in malaria prevalence and wealth-related inequalities were observed. The multilevel model identified several significant independent factors: older child age (aOR = 2.12, 95% CI: 1.51-2.96, P < 0.001), child's anemia (aOR = 3.16, 95% CI: 2.33-4.29, P < 0.001), and larger household size (aOR = 1.98, 95% CI: 1.13-3.45, P < 0.05) were positively associated with malaria in children under five years in Uganda. A negative concentration index (CIX = - 0.334, P < 0.001) was also observed, indicating that higher malaria prevalence is concentrated among children in the poorest wealth quintile. Malaria prevalence in Uganda is associated with a complex interplay of socioeconomic and geographic factors. The substantial disparities observed highlight the need for tailored public health strategies designed for high-burden regions and vulnerable communities to reduce disease burden effectively.
Public health nutrition lacks scalable, objective tools for real-time dietary surveillance. We developed FoodSeq-FLOW (Food Landscape Observation in Wastewater), a genomic platform that sequences chloroplast trnL and mitochondrial 12SV5 DNA in municipal wastewater. Across 183 samples from 21 North Carolina wastewater treatment plants serving 2.1 million people, we detected 184 plant and 116 animal food taxa at a cost of <US $0.01 per person. Wastewater-derived dietary profiles correlated with paired individual stool dietary data (Spearman ρ = 0.64), and 98% of animal-derived sequences mapped to known food taxa. Temporal sampling revealed seasonal shifts in food taxa consistent with regional food availability patterns. Spatial analysis revealed community-level dietary signatures associated with per capita income and education, beer ingredient abundance with discretionary income, tropical fruits and pulses with foreign-born population size, and local seafood with coastal geography. FoodSeq-FLOW extends wastewater-based epidemiology from pathogens to diet, providing a scalable platform that existing global wastewater surveillance networks can deploy to inform nutrition policy and market analytics.
For a sustainable circular economy, the processing of substantial agrarian waste into valuable materials would be an excellent strategy. This minimizes the cost of discarding waste while simultaneously reducing pollution and CO2 emissions. Herein, we synthesize cotton shell-derived nitrogen-doped graphene quantum dots (CS-N-GQDs) through hydrothermal synthesis. The structural, optical, morphological, and compositional properties of CS-N-GQDs are analysed using various analytical tools. The theoretical insights of CS-N-GQDs are corroborated through density functional theory (DFT) studies at the ωB97XD/6-31G(d,p) level of theory. Further, the nanomolar detection of H2O2 through optical and electrochemical sensing is performed for applications in environmental monitoring, food quality assessment, and biomedical analysis. Importantly, optical and electrochemical sensing show limits of detection of 5.34 ± 2 nM and 5.96 ± 1 nM, respectively, at a broad linear range of 10 nM to 1 mM. The possibility of detecting H2O2 using CS-N-GQDs in real-time analysis is also tested in commercial juice and beverage samples. This work reveals that cotton shells are useful in producing green and economic dual-mode optical and electrochemical sensor probes for the rapid, sensitive, and selective sensing of H2O2. Combined spectroscopic, electrochemical, and theoretical analyses provide mechanistic insights, revealing dynamic photoinduced electron-transfer quenching for optical sensing and diffusion-controlled electrocatalytic reduction for electrochemical sensing.
The increasing demand for natural and sustainable colorants has accelerated interest in microbial pigments as alternatives to synthetic dyes. Diverse microorganisms, including bacteria, fungi, yeasts, microalgae, and actinomycetes, produce pigments such as carotenoids, melanins, prodigiosin, violacein, and phycobiliproteins with applications in food, pharmaceuticals, cosmetics, textiles, and biomedicine. Despite their potential, large-scale microbial pigment production remains constrained by high costs, refined substrate dependency, and downstream processing challenges. This review summarizes recent advances in microbial pigment production using agro-industrial residues, food processing wastes, lignocellulosic biomass, and other organic waste streams within a circular bioeconomy framework. Key microbial sources, waste-derived substrates, and bioprocess strategies are discussed alongside techno-economic, environmental, and regulatory considerations. Current bottlenecks and emerging approaches, including metabolic engineering, synthetic biology, and integrated biorefinery concepts, are highlighted as future directions to enhance sustainability and industrial scalability.
Catastrophic health expenditure (CHE) remains a central challenge to achieving financial protection and equity in health systems. While extensive evidence shows that CHE remains disproportionately concentrated among socioeconomically disadvantaged households, most studies adopt a static perspective and provide limited insights into how CHE inequality evolves over time and through which mechanisms. This study aims to examine changes in socioeconomic inequality in CHE in China and disentangle the underlying channels from a household mobility perspective. Using nationally representative longitudinal data from the 2010 and 2020 waves of the China Family Panel Studies, socioeconomic-related CHE inequality was measured using Erreygers' corrected concentration index, with household per capita wealth as the ranking variable. An integrated mobility-determinant decomposition framework was employed to quantify the contributions of both mobility processes and socioeconomic, demographic, and health system-related factors to changes in CHE inequality. Robustness analyses were performed using alternative CHE definitions, different specifications of household socioeconomic status, and an alternative decomposition approach. CHE remained disproportionately concentrated among lower-wealth households in both waves, although the magnitude of inequality declined significantly between 2010 and 2020. This reduction was primarily driven by progressive contribution of wealth-related CHE mobility, indicating larger improvements in financial protection among initially poorer households, while the regressive contribution of CHE-related wealth mobility partially offset these gains. Lower wealth quintiles, urban residence, and social health insurance coverage were associated with the reduction in CHE inequality, whereas higher wealth quintiles and household ageing were associated with attenuating the inequality reduction, reflecting heterogenous contributions through distinct mobility channels. Robustness checks confirmed the stability of the main findings. Socioeconomic inequality in CHE in China has narrowed over the past decade, primarily due to progressive improvements in financial protection. However, persistent wealth stratification and population ageing continue to constrain further reductions in CHE inequality. Monitoring progress toward universal health coverage requires attention not only to aggregate CHE incidence but also to the underlying mobility processes and structural determinants that influence distributional change.
In low- and middle-income countries like Ghana, older adults with health conditions face a double burden of managing illness while simultaneously mitigating the financial toxicity of healthcare, which may negatively impact household food insecurity (FI). However, a critical gap exists in the literature regarding the direct effect of catastrophic health expenditure (CHE) on household food insecurity (FI) in this demographic, despite its policy significance. Thus, this study investigates the association between CHE and household FI among older adults with health conditions in Ghana. A cross-sectional analysis was conducted among 6,804 adults aged 50 + with an illness, injury, or disability from the 2022 Annual Household Income and Expenditure Survey (AHIES). FI was measured using a hybrid indicator consolidating expenditure-based (> 60% of income spent on food) and experience-based metrics. CHE was defined as occurring when a household's out-of-pocket health payments exceeded 40% of its capacity to pay for healthcare (income remaining after meeting basic food needs). Multivariable logistic regression was used to estimate the association between CHE and FI and effect modification by wealth, adjusting for key sociodemographic factors, including age, sex, wealth quintile, marital status, occupation, and place of residence. The overall prevalence of FI was 50.2% among the sample. CHE was a strong predictor of household FI. After adjusting for covariates, the association remained strong and significant; incurring CHE was associated with a 5.88-fold increase in the odds of FI (AOR = 5.88, 95% CI: 2.31-14.93). The association of CHE with FI was significantly stronger among those in the 'poorer' wealth quintile (AOR for interaction = 2.38, p = 0.007) compared to the poorest, identifying this near-poor group-the 'missing middle'-as disproportionately vulnerable. CHE is a significant driver of FI among older, unwell Ghanaians, with effects disproportionately affecting those in the poorer wealth quintile. Policy efforts must advance beyond expanding health insurance enrollment to strengthen financial protection and integrate nutritional support for at-risk older adults, particularly those in the 'poorer' wealth quintile (the 'missing middle') who face the highest vulnerability to health-induced food insecurity.
Adults born very preterm and/or with very low birth weight (VP or VLBW; <32 weeks' gestation and/or <1500 g birth weight) are at increased risk of experiencing wealth and social relationship difficulties, yet many achieve positive outcomes in these domains. Following the bioecological framework, early factors relating to person, process, and context may shape long-term positive functioning, but few studies capture this heterogeneity in VP or VLBW individuals, and little is known about the childhood factors promoting positive functioning in adulthood. To identify distinct positive functioning profiles at 34 years in VP or VLBW and term-born adults across the domains of risk avoidance, wealth, and social relationships with parents, partners, and peers and to investigate whether identified profiles based on objective domains align with subjective life satisfaction at 34 years and are associated with childhood factors. This longitudinal cohort study was conducted among VP/VLBW and healthy term-born infants born between January 1985 and March 1986 in a geographically defined area (Bavaria, Germany) from birth until 34 years of age. Data were analyzed from February 2025 through April 2026. Person factors: VP or VLBW, sex at birth, effortful control at 8 years, and IQ at 8 years; process factors: parenting at 6 and 8 years and peer relationship quality at 8 years; and context factors: family socioeconomic status at birth, normative-authoritative family climate at 6 years, and interparental relationship quality at 8 years. Positive functioning across risk avoidance, wealth, and social relationship domains was assessed with a standard Life Course Interview, and life satisfaction was assessed with the Satisfaction with Life Scale. Of 715 eligible adults, 416 (214 born VP or VLBW; 217 female [52.2%]) were assessed at age 34 years. Three profiles were distinguished: (1) optimal functioning (261 [63%] in total; 119 [56%] VP or VLBW individuals) across domains; (2) moderate functioning (106 [26%] in total; 56 [26%] VP or VLBW individuals) with low partner relationship scores; and (3) low economic and social functioning (49 [12%] in total; 39 [18%] VP or VLBW individuals), with the lowest wealth, partner, and peer relationship scores. Individuals with the optimal-functioning profile had substantially higher mean scores of life satisfaction than those in the low-functioning profile (mean difference = 7.71; 95% CI, 5.17-10.24; d = 1.46). After adjustment for childhood factors and multiple testing, a 1-SD increase in IQ was associated with decreased odds for low economic and social functioning compared to optimal functioning (odds ratio = 0.21; 95% CI, 0.13-0.34). Per the results of this cohort study, a substantial subgroup of adults born VP or VLBW are at increased risk for lower positive functioning and lower life satisfaction in adulthood. Improving children's cognitive functioning may help improve adult positive functioning.
We present a numerical study of several inequality measures across two kinetic wealth-exchange models with extreme inequality features (namely the Banerjee model, and the Chakraborti or yard-sale model) and two earthquake simulating models (namely the Chakrabarti-Stinchcombe two-fractal overlap model and the nonlinear dynamical Burridge-Knopoff model). For each model we compute numerically the Lorenz function for the respective models' wealth, overlap magnitude or avalanche distributions. We then estimate the variations of Gini (g), Pietra (p), and Kolkata (k) indices in these models with systematic variations of saving propensity (for the two wealth-exchange models), with systematic variations of generation or block numbers (for the two earthquake simulating models). We find that for appropriate values of the respective model parameters, the inequality indices g and k in corresponding the distributions (of "wealth" or "avalanche") show quantitatively similar behavior, namely g=k≃0.86, which was identified earlier to correspond to the precursor point of criticality in self-organized critical models (k=0.80 corresponds to that for Pareto's 80-20 law). The values of p/(2k-1) in all these (wealth exchange and earthquake) models remain a little above unity, as was predicted theoretically. These observations for the inequality indices g, k, and p across the socioeconomic and geophysical models indicate the presence of unifying subtle features in the statistics of such disparate dynamical systems.
Early marriage remains a significant public health and social issue in Lesotho, with profound implications for women's health, education, and economic empowerment. Despite legal frameworks aimed at curbing the practice, a substantial proportion of women continue to marry before the age of 18, driven by sociocultural norms, economic constraints, and limited access to opportunities. This study investigates the timing and factors associated with first marriage among women in Lesotho using advanced multilevel survival analysis to inform targeted interventions. We analyzed retrospective time-to-event data from the nationally representative, cross-sectional 2023-24 Lesotho Demographic and Health Survey (LDHS), employing a log-logistic accelerated failure time (AFT) model within a multilevel framework to account for individual, household, and community-level factors. The analysis included 6,413 women aged 15-49, with 48.76% having experienced first marriage (events) and 51.24% right-censored. Statistical computations were performed using R statistical software (version 4.4.3), incorporating survey weights to ensure representativeness. The median age at first marriage was 24 years (95% CI: 24-25), with significant variation across socioeconomic and contextual factors. Employment (TR = 1.072, 95% CI: 1.043-1.103), middle wealth quintile (TR = 1.060, 95% CI: 1.012-1.110), low community poverty (TR = 1.094, 95% CI: 1.045-1.145), and urban residence (TR = 1.079, 95% CI: 1.033-1.126) were statistically associated with later age at first marriage (p < 0.05). In contrast, primary education (TR = 0.856, 95% CI: 0.749-0.979), younger birth cohorts (1979-2003: TR range 0.774-0.907), richest wealth quintile (TR = 0.927, 95% CI: 0.875-0.981), and rural residence (TR = 0.927, 95% CI: 0.888-0.967) were associated with earlier age at first marriage. The intraclass correlation coefficient (ICC = 0.0029) indicated that only 0.3% of the variation in age at first marriage was attributable to community-level differences. Although statistically significant, the magnitude of these associations is modest. The findings show that employment, middle wealth status, low community poverty, and urban residence are associated with a later age at first marriage, while primary education, younger birth cohorts, richest wealth quintile, and rural residence are associated with earlier marriage. The minimal community-level variation suggests that individual and household-level factors are more important determinants of marriage timing. Policymakers could consider prioritizing multisectoral interventions, including expanded educational access, economic empowerment programs, and poverty reduction strategies, with particular attention to rural-urban disparities. Addressing these structural factors may be relevant to achieving sustainable development goals related to gender equality and women's empowerment in Lesotho.
Climate change increasingly poses a threat to psychological health. The Domain-Specific Climate Change Distress Scale (DCCDS) was developed to capture climate-related distress across six thematic (ecology, existence, food supply, future generations, society, and wealth) and one generic domain. Building on its theoretical foundation, the present study extends initial validation efforts by providing large-scale psychometric data and normative values, drawing on a large, diverse sample to further substantiate the scale's psychometric properties and practical utility. We pooled data from seven independent German-speaking samples (N = 894; Mage = 39.2, SD = 13.5; 53% women). We replicated the bifactor S-1 model using confirmatory factor analysis (CFA), tested measurement invariance across gender, and estimated a regularized network. Exploratory graph analysis (EGA) served as a dimensionality check. Bootstrap stability analyses and a network comparison test (NCT) assessed the robustness of network indices and gender differences. CFA confirmed acceptable fit of the bifactor S-1 model. Metric invariance across gender was fully supported; partial scalar invariance was established after freeing intercepts for three items. In the regularized network, items related to food supply, future generations, and generic climate anxiety showed the highest centrality. EGA identified six stable empirical dimensions, with society and wealth items loading onto a single community. NCT revealed equivalent global network structure across gender. Gender-stratified and age-stratified normative percentiles are provided. The DCCDS demonstrates robust psychometric properties across independent samples and is largely measurement-equivalent across gender. Findings support its use for individual diagnostics and group comparisons in climate psychology research and clinical settings. The empirical identification of six rather than seven dimensions further invites reconsideration of the Society and Wealth domain distinction. Normative data facilitate score interpretation in applied settings.
Demographic and health surveys are a major source of information for monitoring oral health conditions among vulnerable populations. To assess the association between socioeconomic inequality, measured by the wealth index, and time elapsed since the last dental visit among Peruvian children and older adults from 2013 to 2023. A repeated cross-sectional analytical study was conducted using secondary data from the Demographic and Family Health Survey (ENDES) from 2013 to 2023. The dependent variable was time since the last dental visit (years), and the independent variable was the wealth index. Additional variables included survey year, place of last dental care, region, area and place of residence, altitude, health insurance coverage, sex, and age. Descriptive statistics and Mann-Whitney U and Kruskal-Wallis tests were applied. After logarithmic transformation of the dependent variable, hierarchical linear regression was performed with a 95% confidence level and p < 0.05. Among children, the longest mean time since the last dental visit was observed in 2020 (6.65 years, SD = 4.90), and among older adults in 2016 (8.54 years, SD = 9.10). The wealth index was significant among children in 2021 (p = 0.017) and 2022 (p = 0.005), whereas among older adults it was significant from 2016 to 2023 (p < 0.05). These findings suggest persistent socioeconomic inequalities in timely access to dental care, particularly among older adults and in specific years among children. Further formal trend analyses are needed to determine whether these inequalities have widened over time.
Menstrual health is a critical yet under-prioritized component of women's sexual and reproductive health, with persistent inequities in access to menstrual products across socioeconomic and geographic contexts. In Ghana, these disparities are influenced by a combination of individual, household, and community-level factors. This study examined the determinants of menstrual product use and quantified the relative contributions of compositional and structural factors to residence-related disparities using nationally representative data. Data were derived from the 2022 Ghana Demographic and Health Survey among a weighted sample of 12,497 women aged 15-49 years. Single-and multilevel logistic and ordered logistic regression models were fitted to identify determinants of menstrual product use, adjusting for intra-cluster correlations and complex survey design. Predictive performance and model fit were evaluated using AIC/BIC, McFadden's pseudo-R², C-index, and ROC AUC. Non-linear multivariate decomposition analysis was conducted to disentangle the contributions of compositional differences (endowments) and differential effects (coefficients) to disparities by urban-rural residence. Use of modern menstrual products was strongly associated with higher individual educational attainment, household wealth, urban residence, younger age, self-reported good health, and greater media exposure. At the community level, higher average education and media exposure within clusters were also positively associated with uptake. Multilevel modelling revealed that 13%-15% of the variance in product use was attributable to between-cluster differences, highlighting the influence of contextual factors. Predictive models exhibited excellent discrimination (C-index ≥ 0.82; ROC AUC = 0.87). Decomposition analyses indicated that compositional factors, particularly household wealth and education, accounted for the majority of rural-urban (63%) inequalities, while differences in the effects of these determinants further contributed to disparities. Structural inequities in wealth, education, and community resources are major determinants of menstrual product use in Ghana. Policy interventions that subsidize menstrual products, expand school-and community-based distribution programs, enhance mass media outreach, and improve rural WASH infrastructure are critical to reducing disparities. Integrating menstrual health into national health and gender equity strategies is essential to advancing Sustainable Development Goals related to health, education, and gender equality.
Decision theories commonly model human behavior as maximizing the expected value of a utility function. This function may vary from one person to another but is assumed to be stable over time. Recent theoretical developments demonstrate that these assumptions are generally incompatible with growing wealth at the fastest rate. Growth optimality requires utility functions to mirror ergodicity transformations and adapt to the dynamic environment. We exposed human participants to different wealth dynamics in a consequential risky decision-making experiment. Via Bayesian modelling, we estimated utility functions separately for each dynamic. Pre-registered analyses revealed strong evidence supporting the quantitative predictions of the ergodicity model. Our study provides evidence that human risk-taking can adapt quickly to the dynamical context, in ways that align closely to the theoretical optimum for maximizing wealth over time.
Health facility delivery is a critical intervention to reduce maternal and neonatal mortality. Ghana has achieved substantial gains in facility deliveries over the past three decades, yet disparities persist across socioeconomic and demographic dimensions. This study describes trends and inequalities in health facility deliveries among women of reproductive age in Ghana from 1993 to 2022 across wealth, education, place of residence, age, and region. Data were extracted from the WHO Health Equity Assessment Toolkit (HEAT), which provides weighted, age-standardised estimates from Ghana Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) for the years 1993, 1998, 2003, 2006, 2008, 2011, 2014, 2017, and 2022. The outcome was the percentage of live births occurring in a health facility (WHO HEAT indicator code: MNCH7). Inequality was measured using the absolute difference (D), ratio (R), population attributable fraction (PAF), and population attributable risk (PAR) for each dimension, with 95% confidence intervals. National health facility delivery prevalence increased from 42.3% (95% CI: 39.5-45.1) in 1993 to 85.4% (95% CI: 84.1-86.7) in 2022. In 2022, marked disparities remained: richest vs. poorest quintile (97.1% vs. 71.1%; D = 25.7 percentage points); higher education vs. no education (98.0% vs. 72.3%; D = 25.7 percentage points); urban vs. rural (93.7% vs. 77.9%; D = 15.8 percentage points); and Upper East vs. Northern region (97.7% vs. 69.0%; D = 28.7 percentage points). Absolute economic inequality (D) declined from 60.6 percentage points in 1993 to 25.7 in 2022; educational inequality fell from 53.6 to 17.8; and rural-urban inequality declined from 35.8 to 9.7. Age-related inequality was negligible throughout. While Ghana has achieved substantial gains in health facility deliveries, marked inequalities by wealth, education, place of residence, and region persist. These patterns coincide temporally with policy reforms including the Free Maternal Health Policy and the National Health Insurance Scheme; however, this descriptive analysis cannot establish causality. Targeted interventions for women in poorer, less educated, and rural settings are needed to achieve equitable maternal healthcare.
The Composite Index of Anthropometric Failure (CIAF) and its extensions-the Composite Index of Severe Anthropometric Failure (CISAF) and extended CIAF (eCIAF)-capture overlapping forms of child undernutrition but remain under-reported at global and regional levels. We aimed to estimate the prevalence of CIAF, CISAF and eCIAF among children under 5 years and assess inequalities by sex, residence, household wealth and maternal education. We systematically searched major databases, including Embase, MEDLINE (PubMed), Scopus, CINAHL, ProQuest, Global Index Medicus and the Cochrane Library, without language or geographic restrictions. Random-effects meta-analyses estimated pooled prevalence. Heterogeneity was assessed using Cochran's Q and I² statistics. Subgroup analyses, meta-regression, sensitivity analyses and publication bias assessments were conducted. Inequalities were quantified using prevalence ratios (PRs), prevalence differences, the Concentration Index and the Slope Index of Inequality (SII). We included 107 studies from 18 countries, predominantly low- and middle-income countries in South Asia and Africa (notably India, n=54), comprising over 2.6 million under-5 children for CIAF, 590 744 for eCIAF and 29 905 for CISAF. The pooled prevalence of CIAF was 49.07% (95% CI 46.00% to 52.14%), declining from 59.8% in 2005 to 45.9% in 2024. The pooled prevalence of CISAF and eCIAF was 12.77% and 40.41%, respectively. CIAF prevalence did not differ significantly by sex (pooled PR: 1.04, 95% CI 0.99 to 1.09) but was higher in rural than in urban settings (pooled PR: 1.18, 95% CI 1.10 to 1.27). Substantial socioeconomic inequalities were observed, with higher prevalence among children from the poorest households (pooled PR: 1.71, 95% CI 1.42 to 2.05) and among those whose mothers had no formal education (pooled PR: 1.55, 95% CI 1.26 to 1.90). Absolute inequalities were further confirmed by SII estimates for wealth (-31.28%) and maternal education (-26.60%). CIAF prevalence remains alarmingly high in low-income settings, disproportionately affecting children in rural areas, poorer households and those born to mothers with limited education.
Achieving universal health coverage (UHC) in Laos requires a financing system that supports equitable access to essential services, especially for underserved groups. The National Health Insurance (NHI) scheme, integrating prior social and community-based programs, provides coverage for essential services and reduces out-of-pocket costs. Understanding socioeconomic factors shaping enrollment is critical to avoid policies that unintentionally reinforce inequities. We conducted a secondary analysis of cross-sectional survey data from 2,138 women with children aged 0-23 months across five Laos provinces. Multivariable logistic regression models estimated associations between sociodemographic factors and health insurance coverage, including an interaction term to examine provincial variations in the effect of education. One-third of women had health insurance. Adjusted odds ratios (aORs) with 95% confidence intervals (CI) were estimated using multivariable logistic regression. Coverage was higher among older women, those with secondary education or above (aOR = 2.00, 95% CI: 1.57-2.54), employed women (aOR = 1.71, 95% CI: 1.30-2.24), women exposed to health messages (aOR = 2.03, 95% CI: 1.62-2.54), and those from wealthier households (highest vs. lowest quintile: aOR = 1.91, 95% CI: 1.23-2.91). Rural residence (aOR = 0.65, 95% CI: 0.48-0.87) and larger households (7-8 members: aOR = 0.68, 95% CI: 0.37-0.91) were associated with lower coverage. Provincial variation in maternal education showed Savannakhet and Oudomxay had relatively high coverage even among less educated women, whereas Phongsaly, Salavan, and Sekong displayed marked socioeconomic disparities. Health insurance enrollment is driven by a multidimensional set of factors, including education, household wealth, and geographic location. While provincial disparities and education are critical determinants, they interact with broader socioeconomic constraints. Achieving UHC coverage requires holistic interventions that not only target specific disadvantaged regions but also address the underlying social and financial barriers impeding access for vulnerable women.
Access to safe water, sanitation, and hygiene (WASH) remains a critical global public health challenge, with an estimated 2 billion people lacking safe drinking water and basic hygiene services. In Bangladesh, disparities in WASH access persist across regions and socioeconomic groups. This study assesses decade-long changes in WASH coverage, examines its distribution across socio-demographic groups, identifies key associated factors, and highlights underserved regions and population subgroups. Data from four rounds of the Bangladesh Demographic and Health Survey (BDHS) (2011-2022) were analyzed. WASH indicators were classified as improved or unimproved based on WHO-UNICEF Joint Monitoring Programme (JMP) 2017 guidelines and applied consistently across all survey rounds. Spatial mapping was used to assess regional disparities, while regression models identified factors associated with WASH facilities. A classification tree approach was used to explore interactions among predictors. Over the decade (2011-2022), access to improved drinking water remained high (above 98%), with improvements in sanitation (22 percentage points), hygiene (30.5 percentage points), and overall WASH facilities (28 percentage points). Classification tree analysis identified wealth index as the most important determinant. Regional disparities were evident, with higher coverage in Dhaka, Rajshahi, and Chattogram, and lower coverage in Barishal and Mymensingh. Wealthier households had higher odds of improved WASH facilities (AOR: 8.72 [6.74, 11.3] in 2011; 9.35 [8.31, 10.5] in 2022) compared to poorer households. Households with more higher educated heads also had higher odds (AOR: 7.10 [5.80, 8.69] in 2011; 3.44 [2.99, 3.96] in 2022) compared to those with no formal education. Other associated factors included family size, region, media access, and mobile ownership. Key determinants of WASH access, including wealth, education, and regional disparities, remained largely unchanged over time. Achieving SDG 6 requires targeted subsidies for socioeconomically disadvantaged households, region-specific interventions in underserved areas such as Barishal and Mymensingh, and strengthened awareness programs.
Acute respiratory infections (ARIs) are the leading cause of morbidity and mortality among children under 5 years of age, particularly in sub-Saharan Africa. Although several individual- and household-level factors have been associated with ARI, previous studies in the region have largely been limited to single-country analyses, older datasets, or conventional regression approaches that did not account for the hierarchical structure of Demographic and Health Surveys (DHS) data. Furthermore, evidence based on recent multicountry data collected after COVID-19 pandemic remains limited. To assess the prevalence of ARI and associated factors among children under 5 years of age in sub-Saharan Africa. A cross-sectional study was conducted using nationally representative DHS data collected between 2021 and 2024 from 11 sub-Saharan African countries. A weighted sample of 67,134 children aged 0-59 months with complete information on ARI was included in the analysis. Missing data were handled using multiple imputation. Given the hierarchical structure of DHS data, a multilevel modified Poisson regression model with robust variance estimation was employed to identify individual- and community-level factors associated with ARI. Adjusted prevalence ratios (APRs) with 95% confidence intervals (CIs) were reported. The prevalence of ARI among under-five children in sub-Saharan Africa was 31.0% (95% CI: 30.6-31.5). ARI prevalence was higher among children of mothers aged 35-49 years (APR = 1.13; 95% CI: 1.02-1.25) and wasted children (APR = 1.23; 95% CI: 1.05-1.50), and in households using polluted cooking fuels (APR = 1.22; 95% CI: 1.05-1.42). Lower prevalence was observed among children from rich households (APR = 0.86; 95% CI: 0.75-0.98), with household media exposure (APR = 0.85; 95% CI: 0.78-0.93), delivered in health institutions (APR = 0.89; 95% CI: 0.79-0.99), and residing in communities with high media exposure (APR = 0.90; 95% CI: 0.83-0.98). ARI remains highly prevalent among children under five in sub-Saharan Africa. Individual and household factors, including maternal age, child nutritional status, household wealth, type of cooking fuel, place of delivery, and media exposure, are significantly associated with ARI, highlighting the need for targeted interventions to reduce its burden. Not applicable. Why many young children in Sub-Saharan Africa get lung infections and what increases their risk Acute respiratory infections (such as cough, cold, and pneumonia) are common illnesses that affect the lungs and airways. These infections are a major cause of sickness and death among children under five years old in Sub-Saharan Africa. Understanding why these infections occur can help families, communities, and policymakers take steps to prevent them. This study looked at recent survey data collected between 2021 and 2024 from 11 countries in Sub-Saharan Africa. It included information on over 67,000 children under the age of five. The aim was to find out how common these infections are and what factors increase or reduce the risk. The study found that about 31 out of every 100 children had symptoms of a respiratory infection. Children were more likely to get sick if they were undernourished, if their mothers were older, or if their households used polluting fuels such as wood or charcoal for cooking. These fuels produce smoke that can harm children’s lungs. On the other hand, children were less likely to have respiratory infections if they lived in wealthier households, had access to media (such as radio or television), were born in health facilities, or lived in communities where people were more exposed to health information through media. In conclusion, respiratory infections remain a serious health problem for young children in Sub-Saharan Africa. Improving nutrition, promoting cleaner cooking methods, increasing access to health information, and encouraging facility-based childbirth could help reduce these infections and improve child health.