Journal of biosocial science
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This paper analyses the levels and trends of childhood mortality in urban Bangladesh, and examines whether children's survival chances are poorer among the urban migrants and urban poor. It also examines the determinants of child survival in urban Bangladesh. Data come from the 1999-2000 Bangladesh Demographic and Health Survey. ⋯ The study findings indicate that rapid growth of the urban population in recent years due to rural-to-urban migration, coupled with higher risk of mortality among migrant's children, may be considered as one of the major explanations for slower decline in under-five mortality in urban Bangladesh, thus diminishing urban-rural differentials in childhood mortality in Bangladesh. The study demonstrates that housing conditions and access to safe drinking water and hygienic toilet facilities are the most critical determinants of child survival in urban areas, even after controlling for migration status. The findings of the study may have important policy implications for urban planning, highlighting the need to target migrant groups and the urban poor within urban areas in the provision of health care services.
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Using pooled children data from the 1998 and 2003 Ghana Demographic and Health Surveys, this study examines religious differences in child survival in Ghana. Guided by the particularized theology and selectivity theses, a piecewise constant hazard model with gamma-shared frailty is used to explore if there are denominational differences in child mortality, and whether these could be explained through other characteristics. ⋯ In the multivariate models, however, the religious differences disappeared after the mediating and confounding influence of socioeconomic factors were controlled. The findings provide support for the selectivity hypothesis, which is based on the notion that religious variations mainly reflect differential access to social and human capital rather than religious theology per se.
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While a country's health policy aims to provide health services to all who need them, very little in known about unmet need for additional medical care from users' perspectives in Bangladesh. This study examined unmet medical need (defined as whether a mother felt that, to manage sickness, her child had required medical care that was not available, regardless of reasons and medical care sought) of 2123 under-15 sick children by illness and child's socioeconomic characteristics in rural Bangladesh. The 1996 Health and Socioeconomic Survey conducted in Matlab recorded children's chronic (a disease or a condition lasting 3 months or more) and acute (a disease or a condition with a rapid onset and a short, severe course) morbidity, medical care sought to combat illness and unmet needs for additional medical services in mothers' views to manage the illness. ⋯ For chronic illnesses, seeking medical care to manage illness from any health provider outside the home reduced unmet medical needs. Economic inequalities existed for both acute and chronic illnesses: the odds ratio of unmet medical needs for sick children of the least poor households was 0.42 (95% CI: 0.28-0.64) times that for sick children of the very poor households. The critically high unmet needs for children's chronic morbidity reveal that the chronic disease control programme in Bangladesh needs urgent revisiting and strengthening.
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A fundamental public health strategy to reduce the risk of HIV/AIDS is to increase levels of awareness and knowledge about the disease. Although knowledge about HIV/AIDS and protective sexual behaviour are linked theoretically, relatively little is known about their empirical relationship. Using Demographic and Health Survey data from 23 low- and middle-income countries, this study used multilevel logistic regression models: to examine cross-national variability in the relationship between HIV/AIDS knowledge and protective behaviour (condom use and restricted sex); to investigate the moderating influences of women's educational attainment on this relationship; and to test the extent to which severity of the HIV/AIDS epidemic accounts for cross-national variability in the association between HIV/AIDS knowledge and protective behaviour. ⋯ Finally, this study indicates that protective sexual practices are disturbingly low. In eight of 23 countries, overall levels of condom use to prevent STDs and HIV/AIDS were less than 5.0%. Waiting for the spread of HIV/AIDS infection to change sexual practices in low- and middle-income countries will result in dramatic unnecessary suffering.
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The objective of this study was to analyse the association between socioeconomic indicators and cardiovascular disease risk factors in adult residents of Rio de Janeiro city, Brazil. Data were obtained by direct interview and physical examination in a population-based cross-sectional study in the city of Rio de Janeiro, 1995-96. Subjects were selected by two-stage random sampling and information was collected on socioeconomic, anthropometric and demographic characteristics, as well as on existing risk factors for cardiovascular disease. ⋯ For males, the socioeconomic and demographic indicators retained in the logistic model were age (OR 1.01, 95% CI 1.00-1.01), level of schooling (1.77, 95% CI 1.39-2.26) and per capita income (OR 0.77, 95% CI 0.61-0.97). For females, the indicators retained were age (OR 1.02, 95% CI 1.01-1.02) and level of schooling (OR 2.26, 95% CI 1.84-2.77). The findings indicate that cardiovascular disease risk is already an alarming problem in the urban populations of developing countries, and that educational level is the most important socioeconomic factor associated with its presence.