The Role of Social Determinants of Health in Cardiovascular Diseases: An Umbrella Review

Cardiovascular disease (CVD) is the leading cause of mortality worldwide. Addressing social determinants of health (SDoH) may be the next forefront of reducing the enormous burden of CVD. SDoH can be defined as any social, economic, or environmental factor that influences a health outcome. Comprehensive evidence of the role of SDoH in CVD is lacking, nevertheless. This umbrella review aims to give a comprehensive overview of the role of SDoH in CVD. We searched systematic reviews (with or without meta-analyses) using 8 databases and included review reference lists. Four themes (economic circumstances, social/community context, early childhood development, and neighbourhood/built environment) and health literacy in the health/health care theme were considered. Seventy reviews were eligible. Despite the quality of the included reviews being low or critically low, there was consistent evidence that factors relating to economic circumstances and early childhood development themes were associated with an increased risk of CVD and CVD mortality. We also found evidence that factors in the social/community context and neighbourhood/built environment themes, such as social isolation, fewer social roles, loneliness, discrimination, ethnicity, neighborhood socioeconomic status, violence, and environmental attributes, had a role in CVD. SDoH factors without (or with minimal) evidence synthesis for CVD were also identified. In sum, this umbrella review offers evidence that SDoH, especially economic circumstance and early childhood development, play a significant role in CVD. This calls for the strengthening of nonmedical interventions that address multiple factors simultaneously and the inclusion of SDoH in future CVD risk prediction models. Registration URL: https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42022346994

Determinants of births protected against neonatal tetanus in Ethiopia: A multilevel analysis using EDHS 2016 data.

BackgroundEven though there is low coverage of maternal health services such as antenatal care and skilled birth attendant delivery as well as poor sanitary practice during delivery in Ethiopia, the proportion of births protected by the tetanus vaccine is low. Thus, this study aimed to investigate the determinants of births protected against neonatal tetanus in Ethiopia.ObjectiveTo assess the determinants of births protected against neonatal tetanus in Ethiopia.MethodThe study was based on secondary data analysis of the Ethiopian Demographic and Health Survey 2016 data. A weighted sample of 7590 women who gave birth within five years preceding the survey was used for analysis. We conducted a multilevel analysis, due to the hierarchical nature of the data. Variables with p-value ResultIn this study, mothers with primary education [adjusted odds ratio (AOR) = 1.23; 95%CI: 1.04, 1.44] and secondary and above education [AOR = 1.36; 95%CI: 1.06, 1.73], media exposure [AOR = 1.35; 95%CI: 1.15, 1.58], not perceiving distance from the health facility as a big problem [AOR = 1.24; 95%CI: 1.08,1.42], one antenatal care (ANC) visit [AOR = 1.56; 95%CI: 2.71, 4.68], two to three ANC visit [AOR = 11.82; 95%CI: 9.94,14.06], and four and more ANC visit [AOR = 15.25; 95%CI: 12.74, 18.26], being in Amhara [AOR = 0.59; 95%CI: 0.38,0.92], Afar [AO = 0.41; 95%CI: 0.25,0.66], and Harari [AOR = 1.88; 95%CI: 1.15,3.07] regions, being in communities with higher level of women education [AOR = 1.25; 95%CI: 1.03,1.52], and higher level of media exposure [AOR = 1.22; 95%CI: 1.01,1.48] were significant predictors of having a protected birth against neonatal tetanus.ConclusionIn this study, both individual level and community level factors were associated with having protected birth against neonatal tetanus. Therefore, strengthening maternal health services such as ANC visits and interventions related to increasing media campaigns regarding tetanus could increase the immunization against tetanus among reproductive-age women. In addition, it is also better to give attention to those reproductive age group women from remote areas and also better to distribute maternal services fairly and equally between regions

SaTScan analysis of non-uptake of MCV2 in Ethiopia, Map produced using Arc GIS version 10.7 and SaTScan version 9.6.

SaTScan analysis of non-uptake of MCV2 in Ethiopia, Map produced using Arc GIS version 10.7 and SaTScan version 9.6.</p

Kriging interpolation of non-uptake of MCV2 in Ethiopia, Map produced using Arc GIS version 10.7.

Kriging interpolation of non-uptake of MCV2 in Ethiopia, Map produced using Arc GIS version 10.7.</p

Proportion of the uptake of measles-containing second dose vaccine among children aged 24 to 35 months in Ethiopia.

Proportion of the uptake of measles-containing second dose vaccine among children aged 24 to 35 months in Ethiopia.</p

Characteristics of study participants.

Characteristics of study participants.</p

Multilevel analysis for assessing factors associated with uptake of MCV2 in Ethiopia.

Multilevel analysis for assessing factors associated with uptake of MCV2 in Ethiopia.</p

Variability (random effect analysis) of uptake of MCV2 in Ethiopia.

Variability (random effect analysis) of uptake of MCV2 in Ethiopia.</p

Spatial autocorrelation showing the clustering of MCV2 uptake, Map produced using Arc GIS version 10.7.

Spatial autocorrelation showing the clustering of MCV2 uptake, Map produced using Arc GIS version 10.7.</p

Hot spot and cold spot analysis of non-uptake of MCV2 in Ethiopia, Map produced using Arc GIS version 10.7.

Hot spot and cold spot analysis of non-uptake of MCV2 in Ethiopia, Map produced using Arc GIS version 10.7.</p