During the pandemic period, the use of health services by disadvantaged groups such as immigrants has deteriorated. The study aims to evaluate the use of antenatal care services by Syrian pregnant women during the pandemic. It is a cross-sectional type of study. The population consisted of 495 pregnant women who applied to the Extended Migrant Health Center (EMHC) between August 2020 and December 2022. Demographic data and pregnancy-related health records were examined through the system records, without any contact with the pregnant women. The percentage of pregnant women who had timely follow-up for each antenatal visit were 11.5% (n=56), 17.2% (n=80), 20.0% (n=88), and 17.4% (n=73), respectively. Only 17.7% (n=87) of the pregnant women made the recommended number of visits during their pregnancy period. The recommended number of follow-ups was statistically significantly higher in women with high-risk pregnancies (p=0.045). Of the pregnant women, 27.4% had anaemia and 2.4% had hypertension. The use of antenatal care in immigrant pregnant women is very low. Interventions are needed in this regard. Increasing the utilization of antenatal care services by immigrant pregnant women is extremely important for both the health of the pregnant woman and the health of the baby.

Low birth weight (LBW) is an important public health indicator that is associated with various negative health outcomes in infants. To effectively implement interventions that would improve health outcomes in children, it is important to understand both the historical trends and current levels of LBW rates. In this study, trends and regional differences in LBW rates in Saskatchewan from 2002/2003 to 2021/2022 were assessed. A joinpoint regression analysis was conducted using historical LBW rates, obtained from the Canadian Institute for Health Information database. Data were analysed using average percent change and average annual percent change. Spatial patterns and trends were identified using a choropleth map. From a provincial and national rate of 5.2% in 2002/2003, the LBW rate in Saskatchewan increased to 6.5% in 2021/2022, approaching the national rate of 6.8%. Over the 20-year period, average annual changes for Canada were 1.4% and 1.0% for Saskatchewan. There was a turning point in the study: 2004/2005 for Canada and 2011/2012 for Saskatchewan. Initially, Saskatchewan had stable LBW rates, increasing yearly by 0.1%, while the national rate was 5.7%. However, in recent years, Saskatchewan’s rate increased to 1.8% annually, surpassing the national rate of 0.9%. Geographical differences were also observed within Saskatchewan, with the Far North region having the highest LBW rate (9.2%), and the Central West region having the lowest rate (4.3%) in 2021/2022. The Central East, Regina Qu’Appelle, and southern Saskatchewan saw significant upwards trends in LBW rates between 2015/2016 and 2021/2022. There is an increasing trend in LBW rates in Canada and Saskatchewan, as well as geographical disparities within the province. The geographical disparities in LBW rates underscore the need for tailored interventions in high-risk regions in the province.

This study aimed to investigate the factors contributing to the gap in the use of hygienic materials during menstruation to collect blood among adolescent women between Aspirational and the remaining districts of India. The study sample consisted of 114805 adolescent women (20835 women from 112 Aspirational districts and 93970 women from 595 remaining districts) from the National Family Health Survey-5. Fairlie decomposition was used to identify and measure the factors contributing to the gap in the use of hygienic materials between Aspirational and the remaining districts of India. This study determined that the use of hygienic materials during menstruation varied significantly between Aspirational and the remaining districts. While only 37% of adolescent women used hygienic materials in Aspirational districts, almost 52% did so in the remaining districts. Seventy-five per cent of Aspirational districts (84 of 112 districts) reported less than 50% use of hygienic materials, which is lower than the national average and the average of the remaining districts. It was revealed that nearly 90% of the total explained gap between the two groups was accounted for by household wealth, place of residence, exposure to mass media, and education level. Wealth was the main contributor to the gap, explaining about 46% of the difference in hygienic materials use between Aspirational and the remaining districts, followed by the place of residence (18%), exposure to mass media (15%), and education level (11%). Findings suggest that targeted interventions to improve access to hygienic materials among adolescent women in Aspirational districts, particularly those in the northern states of Uttar Pradesh, Bihar, and Chhattisgarh, are necessary. Policy efforts should focus on women from poor households, improving access to education, and expanding mass media exposure in Aspirational districts to reduce the gap in menstrual hygiene practices among adolescent women in India.

Contraceptive side effects are consistently given as the main reason why women are dissatisfied with contraception or choose not to use it. However, why some women suffer more from side effects remains unknown. Through inductive analysis of in-depth interviews and focus group discussions with 40 contraceptive users and 3 key informants in Central Oromia, Ethiopia, we explored women’s rationales for variation in side-effect experiences. The data first reveal the wide diversity in type and severity of side-effect experiences reported by users of contraception. Second, we found that women’s rationales for why some individuals suffer more side effects from contraception invoke economic and physical hardship (food insecurity and heavy workloads), as well as interindividual differences in biology (one’s blood must ‘fit’ with contraception). Finally, the analysis revealed the tension many women face in trying to negotiate the trade-off between the consequences of these side effects and those of an unwanted pregnancy. The results show the value of using a biosocial approach, which centres women’s voices and experiences, for informing the measurement of contraceptive side effects within population health surveys and clinical trials. Additionally, the findings help gain an understanding of how an individual’s social, biological, and cultural contexts drive variation in when and why different side effects manifest.

Bangladesh is experiencing a rapid increase in hypertension prevalence, particularly in socio-economically disadvantaged communities. The higher use of solid fuel in these communities could be one of the significant factors contributing to this trend, but evidence supporting this hypothesis is limited in Bangladesh. Therefore, this study aims to investigate the associations of household solid fuel use and its exposure level with systolic and diastolic blood pressure (DBP) and hypertension. We analysed 7,320 women’s data from 2017/18 Bangladesh Demographic and Health Survey. We considered three outcome variables: (i) systolic blood pressure (BP) (continuous response), (ii) DBP (continuous response), and (iii) hypertension status (yes, no). Our primary exposures of interest were fuel type (clean vs solid) and the potential level of household air pollution exposure through solid fuel use (unexposed, moderately exposed, and highly exposed). We used a multilevel mixed-effects Poisson regression model with robust variance to determine association between exposure and outcome variables while adjusting for confounders. Of the total respondents analysed, approximately 82% used solid fuel for cooking. The age-standardised prevalence of hypertension was 28%. Respondents using solid fuel were found to be 1.44 times (95% confidence interval [CI], 1.04–1.89) more likely to develop hypertension compared to clean fuel users. Compared to women using clean fuel, the likelihood of hypertension was found to be 1.61 times (95% CI, 1.07–2.20) higher among the moderately exposed group and 1.80 times (95% CI, 1.27–2.32) higher among the highly exposed group. Similar associations were reported for systolic and DBP. The use of solid fuel increases the risk of becoming hypertensive and elevates systolic and DBP. Policies and programmes are necessary to increase awareness of the adverse effects of solid fuel use on health, including hypertension. Efforts should be made to reduce solid fuel use and ensure proper ventilation systems in households where solid fuel is used.

This study was conducted to provide empirical evidence of geographical variations of neonatal mortality and its associated social determinants with a view to improving neonatal survival at the subnational level in Nigeria. With a combination of spatial analysis and artificial intelligence techniques, this study analysed data from the 2016/2017 Nigeria Multiple Indicator Cluster Survey. The analysis focused on the neonatal period of a weighted national representative population of 30,924 live births delivered five years before the survey commencement. Global Moran’s I index and local indicator of spatial autocorrelation cluster maps were used to determine hot and cold spots. A multilayer perceptron neural network was used to identify the key determinants of neonatal mortality across the states and geopolitical zones in Nigeria. The overall neonatal mortality rate was 38 deaths per 1000 live births. There is evidence of geographic clustering of neonatal mortality across Nigeria (worse in the North-Central and North-West zones), majorly driven by poor maternal access to mass media (which plays a critical role in promoting positive health behaviours), short birth interval, a higher position in a family birth order, and young maternal age at child’s birth. This study highlights the need for a policy shift towards implementing state and region-specific strategies in Nigeria. Gender-responsive, culturally, and regionally appropriate reproductive, maternal, and child health-targeted interventions may address geographical inequity in neonatal survival.

Governments in sub-Saharan African countries aim to increase married women’s household decision-making autonomy as it remains a critical determinant of desirable health behaviours such as healthcare utilisation, antenatal care visits, and safer sex negotiation. However, very few studies explore how household structure (i.e., monogamous or polygamous) is associated with married women’s household decision-making autonomy. Our paper seeks to address this gap. Using the 2019–20 Mauritania Demographic and Health Survey, a nationally representative dataset, and applying logistic regression analysis, we explore how married women’s household structure is associated with their household decision-making autonomy. We find that 9% of married women are in polygamous marriages, while 63% and 65% are involved in decision-making about their health and large household purchases, respectively. Additionally, 76% and 56% are involved in decision-making about visiting family or relatives and household expenditures. After accounting for socio-economic and demographic factors, we find that compared to women from monogamous households, those from polygamous households are less likely to participate in decision-making about their health (OR=0.65, p < 0.001), making large household purchases (OR=0.65, p < 0.001), visiting family or relatives (OR=0.72, p < 0.001), and household expenditure (OR=0.58, p < 0.001). Based on our findings, we recommend the urgent need to review and re-evaluate policies and approaches seeking to promote gender equality and women’s autonomy in Mauritania. Specifically, it may be critical for intervention programmes to work around reducing power imbalances in polygamous household structures that continue to impact married women’s household decision-making autonomy adversely. Such interventions should centre married women’s socio-economic status as a central component of their empowerment strategies in Mauritania.

This paper compares community responses to Ebola and Covid-19 in two regions of southern and eastern Sierra Leone with reference to the theory of institutional dynamics proposed by the anthropologist Mary Douglas. Institutions, Douglas argued, are conveyed by styles of thought, shaped by the ways human communities, through everyday practices, reinforce systems of classification and denotation. Pandemic advice to ‘follow the science’ proved problematic, since there is no single institution of science, and institutions never stand alone but are bundled with other institutions, reflecting the manifold and intertwined practices of human social life. The paper explores some of the ways a traumatic epidemic of Ebola Virus Disease in Sierra Leone shaped a distinctive local response to this deadly infectious disease in the absence of an effective vaccine. This local approach emphasised social rules based on ideas about sequestration and testing. Communities then proposed to continue this rules-based approach to the pandemic of Covid-19 and showed little initial enthusiasm for vaccination. With Ebola, the adoption of rules resulted in dramatic drops in infection rates. But Covid-19 spreads in different ways, and good results from the application of social rules were much less apparent. The paper shows how communities began to grapple with this new situation. In some cases, vaccine hesitation was overcome by treating the requirement for vaccination as a new form of social discipline. More generally, it is concluded that epidemiologists need to pay specific attention to institutions and institutional dynamics in order to better understand and anticipate public reactions to new disease threats.

Persons with mental illnesses may experience stigma from their immediate family members in addition to other forms of stigma. Using semi-structured interviews, we investigated experiences of familial mental illness stigma among 15 people diagnosed with mental illnesses in a mid-sized city in Canada. We identified five themes that speak to participants’ experiences of familial mental illness stigma and ways to reduce it. The themes include the following: diagnosis as a ‘double-edged sword,’ potential familial isolation, familial stigma as societal stigma localized, stories of acceptance, and confronting potential familial mental illness stigma. Participants’ narratives indicate that familial mental illness stigma is rooted in the broader social or public stigma, which sees its way into familial relations as well. This stigma takes various forms, including relationship bias or unfair treatment, breakdown in romantic relationships, loss of status, verbal and emotional abuse, exclusion from decision-making, and alienation within their immediate and extended families. Familial mental illness stigma experiences negatively impact participant’s psychological well-being and personal empowerment. However, participants also shared ways that family members create supportive environments or actively confront or prevent stigma. Overall, this study has contributed to knowledge on mental illness stigma, particularly familial mental illness stigma from the perspective of participants living with a mental illness in a high-income country. Suggestions for future research include a focus on strategies to prevent ongoing familial mental illness stigma and large-scale studies to explore familial mental illness stigma to understand why families might perpetrate stigma.

Around half of the population of Suriname, who are mainly of African and South Asian descent, migrated to the Netherlands at the end of the previous century, where they face higher perinatal and maternal mortality and up to 5 years lower life expectancy than European-Dutch. Analyses by ancestry are needed to address these inequalities, but the law prohibits registration by ancestry. Therefore, a list of Surinamese surnames was compiled and validated to identify the largest groups, African-Surinamese or South Asian-Surinamese ancestry in health research. A complete database of Surinamese surnames was provided by the National Population Registry of Suriname. Surname recognition by researchers of Surinamese ancestry was used. Disagreement was resolved using historical registers and through discussion. The list was further validated against contemporary lists of Surinamese surnames with self-defined ancestry, obtained during population and clinical studies in Suriname and the Netherlands. All 71,529 Surinamese surnames were encoded, as African-Surinamese (34%), South Asian-Surinamese (18%), Brazilian or other Iberian (17%), Indonesian-Surinamese (13%), Chinese-Surinamese (5%), First Nation (2%), and other (10%). Compared to self-defined ancestry, South Asian-Surinamese surname coding had 100% sensitivity, 99.8% specificity, and 99.9% accuracy. For African-Surinamese, who may have Dutch surnames, these values depended on geocoding. With a known Surinamese origin, sensitivity, specificity, and accuracy were, respectively, 97.3%, 100%, and 98.6%, but without this information, there was interference of African-Surinamese with European-Dutch surnames in the Dutch validation sample. In conclusion, the Surinamese Surname List has a high accuracy in identifying persons of Surinamese ancestry. This quick, inexpensive, and nonintrusive method, which is unaffected by response bias, might be a valuable tool in public health research to help address the profound health disparities by ancestry.

Vaccination is one of the most recognised strategies in public health for preventing the spread of epidemics, and the availability of a vaccine is often expected by health actors to be a ‘game-changer’. However, the COVID-19 (coronavirus disease 2019) vaccine in Senegal was not the magic bullet that the international community expected. A very low vaccination coverage rate (less than 10% by April 2023) was observed in this country, once considered a model in West Africa for its epidemic response. Beyond the population’s alleged hesitancy to be vaccinated, was a lack of preparedness to blame? Previous analyses show that outbreak preparation limited to standard interventions is not sufficient in the face of the social, cultural, and political configurations of each epidemic context and that uncertainty limits response capacity. This paper examines the social life of the COVID-19 vaccine to identify the forms and contextual dimensions of uncertainty related to immunisation in Senegal. The authors explore how vaccination was implemented and compare experiences with the preparedness process, to offer insight on uncertainties. Using Stirling’s theoretical model that defines various expressions of incertitude, the authors identify four nexuses at various stages of the social life of COVID-19 vaccine in Senegal: (1) material uncertainty related to vaccine availability, (2) ambiguity of the population about the purpose of vaccination and the risks of the disease, (3) uncertainty related to side effects, and (4) uncertainty about vaccination strategies shared by scientific and health authorities. These uncertainties were only partly considered in the preparedness process, for they are related to systemic structural dimensions and reflect the impact of global/regional powers on the local level. The findings of this research are relevant not only to support better communication around vaccines in Senegal but also more generally to the prevention of emerging epidemics shaped by human behaviours.

Assisted reproductive technologies (ARTs) such as in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI) are still discussed critically, as there is no consensus on whether these treatments could be the cause of risk factors for obstetric problems such as breech presentation. The aim of this study was to test the association between ART and breech presentation among 11920 singleton term births taking place in Vienna from 2010 to 2020. In this single-centre medical record-based study, data concerning the conception mode (spontaneous versus IVF or ICSI), child presentation, birth mode, newborn sex and size as well as age, height, weight, and reproductive history of the mother were included. Three hundred twenty-six newborns (2.7%) were conceived by IVF or ICSI, and 527 newborns (4.4%) were delivered in breech presentation. Breech presentation occurred in 7.6% of IVF/ICSI children but only in 4.3% of spontaneously conceived children (P = 0.019). ART increased the crude risk of breech presentation significantly (OR = 1.67; 95% CI 1.71 – 2.38). After adjusting for maternal age, height, number of previous births, smoking, and newborn sex, however, ART had no longer a significant impact on the risk of breech presentation. In contrast, breech presentation was significantly associated with higher maternal age as well as a lower number of previous births, but not with ART. This study shows that the adverse outcomes of IVF and ICSI pregnancies may not be due to the ART treatment alone but might also be due to the mostly higher age and lower parity of the mothers using ART.

Uganda has received praise for its success in dealing with the COVID-19 pandemic. This opinion piece uses publically available data from Johns Hopkins University to suggest that it is far from clear whether the Public Health and Social Measures (PHSM) introduced in Uganda influenced the course of the first outbreak. In addition, the analysis of data from the second and third waves in Uganda suggest that government action had little or no effect on these outbreaks. The dominant narrative of successful PHSM, therefore, needs to be reconsidered, and alternative explanations for the low rates of COVID-19-related mortality in the country need to be further understood.

This study analyses the arrival-cohort effects on the newborn birthweight of Latina women residing in Spain. First, it has been tested whether women of Latin American origin in Spain have an advantage in terms of birth outcomes, a pattern previously documented in the United States and referred to as the ‘Latin American paradox’. Second, it has been examined whether this health advantage of Latina mothers varies by arrival cohort.

A novel database provided by the Spanish National Statistics Office that links the 2011 Census with Natural Movement of the Population records from January 2011 to December 2015 has been used. Poisson regression models were applied to test for differences in the incidence rates of low birthweight (LBW) and high birthweight (HBW) among children of Latina and native mothers, controlling for various demographic, socio-economic, and birth characteristics.

Two distinct arrival-cohort effects on perinatal health were observed. On one hand, first-generation Latina women were found to be at a lower risk of giving birth to LBW infants; however, they experienced a higher incidence of HBW during the study period. Second, Latina women of 1.5 generation, likely stressed by increased exposure to the receiving country, exhibited adverse birthweight results.

Despite the global decrease over the last two decades, stunting, also called ‘chronic malnutrition’, remains a public health issue affecting almost 150 million children under the age of 5 years globally. Defined by height-for-age, stunting is the consequence of poor nutrition, repeated infection, and inadequate psychosocial stimulation. Programmes and policies target undernutrition globally, and humanitarian and development actors invest great efforts to prevent stunting. This study uses multivariate analysis to examine the impact of financial assistance on the reduction of stunting in a refugee context, focusing on Syrian refugee children under the age of 5 years in Türkiye. Using a unique dataset, the 2018 Turkey Demographic and Health Survey Syrian Migrant Sample (2018 TDHS-SR), the findings indicate that financial assistance significantly reduces the incidence of stunting among refugee children under the control of economic, mother and children, environmental, health-related and nutritional and breastfeeding characteristics. However, having household members generate income is found to be another stronger predictor to reduce stunting. The paper also argues that the nutritional well-being of refugee children might improve if forced migration occurs towards a stable host country/region. In addition, adaptation over time also seems to have a positive influence.

The fertility gap, which indicates the difference between the planned and actual number of children born, can be explained by the shift in parenthood to older ages and is associated with the non-attainment of one’s intended reproductive plans. This paper focuses on the gap in the timing of entry into parenthood, i.e. between the planned and actual age at the birth of the first child. The study is based on data from the Women 2016 survey which re-interviewed women of fertile age from the second wave of the Czech Generations & Gender Survey conducted in 2008. At the population level, the fertility timing gap differs across generations. While for Czech women born between 1966 and 1971 the planned age exceeded the actual observed age by one year, the realisation of fertility occurred two years later than planned for the youngest generation (1983–1990) included in the study. At the individual level, the later-than-planned realisation of fertility was found to be related primarily to partner-related factors.

Vaccines for COVID-19 began to be available in Africa from mid-2021. This paper reports on local reactions to the possibility of vaccination in one West African country, Sierra Leone. We show that the history of institutionalisation of vaccine is highly relevant to understanding these reactions. Given lack of testing for the disease, medical authorities could not be sure whether there was a hidden epidemic. In addition, many people associate vaccination with care of children under 5 years, and not adults, and an emphasis on vaccinating the old at first seemed strange and worrying. This paper examines evidence from ethnographic studies in two rural areas selected for varying exposure to Ebola Virus Disease (EVD), supplemented by some interviews in two provincial urban centres, Bo and Kenema. We describe local ideas about vaccination (maklet) and body marking with leaf medicine (tεwi). We asked about attitudes to the idea of COVID-19 vaccination both before and after vaccines were available. A number of reasons were given for scepticism and hesitation. These included lack of experience with vaccines for adults and lack of experience of COVID-19 as a severe disease. Medical evidence suggests the vaccination protects against serious illness, but local people had their own views about control of infection, based both recent experience (notably EVD) and the history and institutionalisation of vaccination and public health measures in Sierra Leone more broadly.

While social determinants of health have been perennially linked to child survival in resource-limited countries, the precise and tested pathways to effect are not clearly understood. The objective of this study was therefore to identify the critical pathways as posited a priori in a model through which social factors (at maternal, household, and community levels) determine neonatal, infant, and under-five mortalities in Nigeria. Using a novel analytic approach (hierarchical path modelling for predicting accelerated failure time) to estimate (in)direct and total effects of social determinants of child survival, we analysed 30,960 live births (weighted data for representativeness), obtained from the 2016/2017 Nigeria Multiple Indicator Cluster Survey. There were three outcome variables: time until occurrence of neonatal, infant, and under-five mortalities. The independent variables were layered factors related to child, maternal, household and community. Geographical region, rurality of residence, infrastructural development, maternal education, contraceptive use, marital status, and maternal age at birth were found to operate more indirectly on neonatal, infant, and under-five survival. Child survival is due to direct effects of child’s sex (female), gestational type (singleton), birth spacing (children whose mothers delivered at least two years apart), and maternal age at delivery (20–34 years). According to the path coefficients, the indirect effects of geographical regions are the most influential determinants of child survival, accounting for 30% (neonatal), 37.1% (infant) and 39.9% (under-five) of the total effects. This study offers comprehensive set of factors, and linked pathways, at the maternal, household, and community levels that are associated with child survival in Nigeria. To accelerate progress towards Sustainable Development Goal targets for child survival and reduce geographical inequities, stakeholders should implement more impactful policies that promote maternal education, contraceptive use and improve living conditions of women (especially in rural areas of northern Nigeria). Future research should focus on identifying the most effective interventions for addressing these social determinants of child survival in Nigeria.