This paper compares the knowledge and utilization of health services among rural residents, urban residents, rural migrants and urban migrants in a large Chinese city. Data were obtained from a questionnaire survey of 2765 individuals (1951 heads of households and 814 spouses) in Guandu district, Kunming, in 2005. The determinants of their knowledge and utilization of health services were analysed using multivariate logistic regression. First, the migrant population was less likely to know of, or utilize, high-level hospitals and township hospitals than residents. Migrants were more likely to utilize private rather than public services for general health care and delivery care. Second, there was a difference between rural migrants and urban migrants in terms of knowledge and utilization of health services. Rural migrants utilized more low-cost private clinics, but had less knowledge about sources of condoms than urban migrants. Finally, rural residents had more knowledge and utilization of township hospitals than urban residents. This latter group were more likely to utilize high-level hospitals. Migrants' access to health care in urban China is understood better using a dual rural–urban and migrant–resident analytical framework. Rural migrants are the most disadvantaged in their access to urban health care. Further reform of the registered residence system and urban public financing system is recommended. Better information on services and their utilization should be provided to migrants and residents.

This study examined the underlying demographic and socioeconomic determinants of child nutritional status in Egypt using data from the most recent round of the Demographic and Health Survey. The height-for-age Z-score (HAZ) was used as a measure of child growth. A quantile regression approach was used to allow for a heterogeneous effect of each determinant along different percentiles of the conditional distribution of the HAZ. A nationally representative sample of 13,682 children aged 0–4 years was drawn from the 2014 Egypt DHS. The multivariate analyses included a set of HAZ determinants commonly used in the literature. The conditional and unconditional analyses revealed a socioeconomic gradient in child nutritional status, in which children of low income/education households have a worse HAZ than those from high income/education households. The results also showed significant disparities in child nutritional status by demographic and social characteristics. The quantile regression results showed that the association between the demographic and socioeconomic factors and HAZ differed along the conditional HAZ distribution. Intervention measures need to consider the heterogeneous effect of the determinants of child nutritional status along the different percentiles of the HAZ distribution. There is no one-size-fits-all policy to combat child malnutrition; a multifaceted approach and targeted policy interventions are required to address this problem effectively.

An analysis of the monthly distribution of births in two areas of Matlab Thana, East Pakistan, indicates that there is a seasonal variation in births different from what would be expected by chance. The highest proportion of births occur in the last three months of a year and the lowest proportion between May and July. Investigation into some of the environmental and social factors which might contribute to the seasonal pattern revealed the following: mean minimum monthly temperature 9 months before birth was inversely related to the number of births; all occupations had seasonal patterns different from what would be expected by chance and the business and mill-and-office occupations had distributions significantly different from each other; the distribution of births for all pregnancy orders was different from chance and the distribution for first order pregnancies was significantly different from those for third and fourth or higher orders.

This study aimed to explore pregnant women's attitudes towards the inclusion of a lay companion as a source of social support during labour and delivery in rural central Ghana. Quantitative demographic and pregnancy-related data were collected from 50 pregnant women presenting for antenatal care at a rural district hospital and analysed using STATA/IC 11.1. Qualitative attitudinal questions were collected from the same women through semi-structured interviews; data were analysed using NVivo 9.0. Twenty-nine out of 50 women (58%) preferred to have a lay companion during facility-based labour and delivery, whereas 21 (42%) preferred to deliver alone with the nurses in a facility. Women desiring a companion were younger, had more antenatal care visits, had greater educational attainment and were likely to be experiencing their first delivery. Women varied in the type of companion they prefer (male partner vs female relative). What was expected in terms of social support differed based upon the type of companion. Male companions were expected to provide emotional support and to ‘witness her pain’. Female companions were expected to provide emotional support as well as instrumental, informational and appraisal support. Three qualitative themes were identified that run counter to the inclusion of a lay helper: fear of an evil-spirited companion, a companion not being necessary or helpful, and being ‘too shy’ of a companion. This research challenges the assumption of a unilateral desire for social support during labour and delivery, and suggests that women differ in the type of companion and type of support they prefer during facility deliveries. Future research is needed to determine the direction of the relationship – whether women desire certain types of support and thus choose companions they believe can meet those needs, or whether women desire a certain companion and adjust their expectations accordingly.

The term ‘neglected tropical diseases’ (NTDs) points to the need for a biosocial perspective. Although ‘diseases’ are widely understood as biological phenomena, ‘neglect’ is inherently social. Social priorities, social relations and social behaviour profoundly influence the design, implementation and evaluation of control programmes. Yet, these dimensions of neglect are, themselves, neglected. Instead, emphasis is being placed on preventive chemotherapy – a technical, context-free approach which relies almost entirely on the mass distribution of drugs, at regular intervals, to populations living in endemic areas. This article reflects on the processes which have enabled an NTD ‘brand’ identity to emerge, and it comments on a disquieting disengagement with some of the more critical insights about the consequences of mass drug administration. Building on the work of biosocial scholars studying other aspects of health and disease, a more adequate, evidence-based approach is delineated. Developing such an approach is an iterative process, requiring on-going engagement with both biological and social insights as they emerge. Considerable theoretical, methodological and political challenges lie ahead, but it is essential they are overcome, if the sustainable control of NTDs is to become a reality.

Due to their effect on maternal testosterone levels, sons are said to have reduced maternal longevity in pre-industrial humans. This analysis, using information from a Flemish agricultural village in the 18th–20th centuries, confirms the presence of a negative effect of sons on maternal longevity. However, the effect is mainly observed for mothers belonging to the least privileged social group and for sons surviving their fifth birthday. Both findings make the above-mentioned biological explanation relative. However, a plausible alternative, social interpretation is male-dominated intra-household resource competition. It is reasonable to assume that only sons above a certain age are able to claim a serious amount of resources and that competition is strongest within the least privileged social group.

This paper analyses mass media exposure and its effect on family planning in Bangladesh using data from the Bangladesh Demographic and Health Survey (BDHS) 1993–94. The findings indicate that radio and television are two important mass media for disseminating family planning information in Bangladesh. However, access to them and exposure to family planning through them are still limited. Slightly more than 40% (42·1%) of respondents reported that they had heard family planning messages via radio, while 17·2% said television, 8·4% said poster and 5·4% said billboard. Respondent’s place of residence, education, economic status, geographical region and number of living children appeared to be the most important variable determining mass media exposure to family planning. Multivariate analysis shows that both radio and TV exposure to family planning messages and ownership of a radio and TV have a significant effect on current use of family planning methods. These factors remain significant determinants of contraceptive use, even after controlling socioeconomic and demographic factors. The study reveals that both socioeconomic development policies and family planning programmes with a special emphasis on mass media, especially radio, may have a significant effect on contraceptive use in Bangladesh. The principal policy challenge is to design communications strategies that will reach the less privileged, rural and illiterate people who are by far the majority in Bangladesh.

The effects of war-induced anxiety and mental distress on individuals and groups can either be mitigated or exacerbated by ‘humanitarian action’. This paper focuses on two key factors that protect the mental well-being of war-affected populations: organized displacement or assisted relocation; and coordinated humanitarian aid operations that are responsive to local needs. Qualitative data from two internally displaced person (IDP) camps in Eritrea are presented. Analysis of these data serves to substantiate and refine a working hypothesis: that social support of the right type, provided at the right time and level, can mitigate the worst effects of war and displacement on victims/survivors. An integrated model of psychosocial transition is suggested. The implications of this approach for humanitarian policy and practice are discussed in the wider context of current debates and lamentations of the ‘humanitarian idea’.

There is some evidence, mostly of an epidemiological nature, that coital rates may be positively associated with dizygotic twinning. It is suggested that this link is causal, in which case an explanation becomes available for some curious—and hitherto unexplained—features of dizygotic twinning rates by maternal age and legitimacy.

This paper uses retrospective event-history data covering a four-year period to examine the timing of exposure to HIV/AIDS education and social marketing condom promotion campaigns, relative to the timing of changes in sexual risk behaviour in Tanzania. Analysis of the event-history data shows that the process of exposure to AIDS education messages and exposure to brand advertising for Salama brand condoms was very different. While exposure to AIDS education was early and gradual, exposure to Salama brand condoms started later, but was much more rapid. After one year of advertising, over half of the target population had been reached by the Salama advertising campaign, mostly through newspapers, radio and television. During the study period, condom use increased from 15% at the beginning of 1993 to 42% at the end of 1996. Increases in condom use were driven both by men who became sexually active, and by men who were not yet protected, or not fully protected. The results further show that it is uncommon for men who adopted condom use to return to more risky behaviour, which suggests that behaviour change in the study population is permanent.

This paper examines the association between family structure and child health in India using the third round of the National Family Health Survey, conducted during 2005–06. Two important child health indicators – underweight and full immunization – are used as dependent variables. Descriptive and multivariate statistics are deployed to establish the relationship between family structure and child health. The results of the descriptive statistics show that children who belong to a non-nuclear family have better nutritional status and higher immunization coverage than those in nuclear families. Children living with siblings have worse health status than those living without siblings for both the outcomes. Multivariate analysis shows that family structure has a small effect on the two child health outcomes, which is no longer significant after adjusting for socioeconomic measures and region. However, number of siblings is significantly and negatively associated with the nutritional status of children and full immunization coverage, even after other socio-demographic and geographic factors are controlled for. Along with family structure, parent's educational attainment, age of the mother and household economic status are significant determinants of underweight and full immunization.

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. There was an association between increased knowledge of HIV/AIDS and condom use that varied in strength and form cross-nationally. This cross-national variation was accounted for partially by the socioeconomic characteristics of women resident in the study countries and between-country differences in the severity of the HIV epidemic. While education modified the association between HIV/AIDS knowledge and protective behaviour – stronger associations at lower levels of education – epidemic severity exerted a stronger influence on behaviour than any other characteristic. 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.

In a medieval population of Stockholm only three cases of maternal deaths were proved out of 330 burials of adult females, and only in one of the cases was a contracted pelvis found. However, life table analysis indicates a shorter life expectancy of females in the reproductive ages. This suggests a higher maternal mortality in the Middle Ages than in the 18th and 19th centuries in Sweden.

Anthropometric and sociodemographic variables were taken from 4320 children in a baseline survey carried out in March–April 1988 in the district of Mbarara, south-west Uganda. After 12 months a follow-up survey assessed the mortality of the children during the preceding year. Lack of ownership of cattle, recent arrival in the village, using candles for lighting, being of birth order higher than 5 and having a father with less than 8 years of schooling were significantly associated with child mortality. The addition of mid-upper arm circumference significantly improved the logistic model of socioeconomic variables and mortality and did not diminish the predictive power of socioeconomic variables in relation to increased mortality. This suggests that nutritional status and specific socioeconomic factors are both, independently, important predictors of child mortality.

Among the Kipsigis, a population of south-western Kenya who do not use contraception, age at menarche and age at last live birth could be determined for a cohort of post-menopausal women, through reference to clitoridectomy ceremonies that can easily be dated. While a woman's age at last live birth was strongly associated with the length of her reproductive lifespan, completed family size was better predicted by age at menarche. The demographic implications of variation in menarcheal age are discussed.

In 2008 in Morogoro region, Tanzania, mass drug administration (MDA) to school-aged children to treat two neglected tropical diseases (NTDs) – urinary schistosomiasis and soil-transmitted helminths – was suspended by the Ministry of Health and Social Welfare after riots broke out in schools where drugs were being administered. This article discusses why this biomedical intervention was so vehemently rejected, including an eyewitness account. As the protest spread to the village where I was conducting fieldwork, villagers accused me of bringing medicine into the village with which to ‘poison’ the children and it was necessary for me to leave immediately under the protection of the Tanzanian police. The article examines the considerable differences between biomedical and local understandings of one of these diseases, urinary schistosomiasis. Such a disjuncture was fuelled further by the apparent rapidity of rolling out MDA and subsequent failures in communication between programme staff and local people. Rumours of child fatalities as well as children’s fainting episodes and illnesses following treatment brought about considerable conjecture both locally and nationally that the drugs had been either faulty, counterfeit, hitherto untested on humans or part of a covert sterilization campaign. The compelling arguments by advocates of MDA for the treatment of NTDs rest on the assumption that people suffering from these diseases will be willing to swallow the medicine. However, as this article documents, this is not always the case. For treatment of NTDs to be successful it is not enough for programmes to focus on economic and biomedical aspects of treatment, rolling out ‘one size fits all’ programmes in resource-poor settings. It is imperative to develop a biosocial approach: to consider the local social, biological, historical, economic and political contexts in which these programmes are taking place and in which the intended recipients of treatment live their lives. If this is not done, the world’s poor will continue to be neglected.

This study examined men's justification of wife beating in relation to their perceived rights and autonomy using a nationally representative sample of 18,047 men in India with childhood exposure to parental violence. Five reasons for wife beating justification, four items of men's perceived rights, and five items of household autonomy were analysed using χ2 test and logistic regression. Among 18,047 participants, 67% justified wife beating. Low education, economic stress and being unmarried were generally more associated with justifying wife beating for all five reasons. Wife's refusal of sex and husband's final say on household autonomy are risk factors. Joint autonomy on household decision making and wife's autonomy on managing her own earnings are protective factors. Perceived relationship rights and autonomy are highly predictive of wife-beating justification for the men who have been exposed to parental violence during childhood. The study has significant implications for public health planners and education strategies.

A study was conducted in Dakar, Senegal, to measure reproductive health knowledge and contraceptive use among young adults, and access to family planning services. A household survey was conducted with 1973 single and married women aged 15–24 and 936 single men aged 15–19. Two focus groups and a simulated client study were also conducted. The survey and focus groups noted gaps in knowledge of family planning methods and reproductive health. There were misconceptions about methods and only one-third of men and women aged 15–19 correctly identified the time of the menstrual cycle when a women is most likely to get pregnant. Contraceptive use at time of first premarital sexual experience was less than 30%. The simulated client study noted many barriers to services. ‘Clients’ felt uncomfortable in the clinics and felt that providers were reluctant to take care of them. None of the ‘clients’ who requested contraception received it.

Over the past century, the population of Korea has aged rapidly as a result of decreasing fertility and mortality. Furthermore, the percentage of the population aged 65 and older is expected to double from 7% to 14% within 18 years, a much shorter doubling period than in most other developed countries. As Korean society ages, interest in healthy and successful ageing has increased. However, although previous studies have examined various determinants of successful ageing, such as socioeconomic status, gender differences have been neglected. This study investigated gender differences as factors in successful ageing among elderly men and women. Successful ageing has been defined as having high levels of physical and social functioning. Physical functioning includes having no difficulties with activities of daily living (ADL) or instrumental activities of daily living (IADL). Social functioning is defined as participation in at least one of the following social activities: paid work, religious gatherings or volunteer service. Data for this study were obtained from a representative sample of 761 community-living individuals aged 65–84 years (340 males, 421 females); the respondents were interviewed face-to-face as part of the third wave of the Hallym Ageing Study (2007). Socioeconomic status appears to have a greater gender-specific effect on physical functioning than on social functioning. Especially for elderly men, a higher monthly individual income was significantly related to a higher level of physical functioning. Among elderly women, a higher level of education was associated with a higher level of physical functioning. In a major metropolis, elderly men had low social functioning and elderly women had low physical functioning. As Korea's population ages, successful ageing has received much attention. This study shows that policies promoting successful ageing must consider gender differences and associated socioeconomic factors.

A study has been made in a group of rural Oxfordshire villages of levels of similarity between husbands and wives for IQ, personality and some anthropometric characteristics. Significant levels of assortative marriage have been found in both verbal and performance IQ, personality ‘inconsistency’, stature, weight and some other bodily dimensions. Their nature has been analysed by time of marriage, birthplace and social class, all of which appear to have marked effects. On the other hand, length of courtship and distance apart of the partners' residences at marriage seem to be more or less inconsequential.