Como as mudanças na posse de bens afetam o Indicador Econômico Nacional em 10 anos?

OBJECTIVE Our main objective was to analyse how the evolution of household assets ownership affected the Indicador Econômico Nacional (IEN – National Wealth index) and to point out the most stable assets and which lost importance more quickly. METHODS We analysed the trend of the ownership of each IEN variable and the distribution of the households’ scores. We calculated the correlation coefficients of each variable separately with the IEN score and the household income. We also evaluated how the changes of the score distribution over time affected the validity of the published reference cut-points. We used data from consortium surveys conducted every two years from 2002 to 2014 in the city of Pelotas, Brazil. RESULTS An increase in the educational level of household heads and in the ownership of all IEN assets, except radio and telephone, was observed in the study period. In general, the correlation of the assets with the IEN scores decreased over time. There was an increase in the score, with a consequent increase in the quintiles cut-points, but the distance between these cut-points had no significant variation. Thus, the reference cut-points for Pelotas, quickly became outdated. CONCLUSIONS Some assets showed greatly reduction on its importance for the indicator, and the reference cut-points became obsolete very quickly. It is essential for a standardized wealth (or asset) index with research purposes to be updated frequently, especially the cut-points of reference distribution.OBJETIVO Analisar como a evolução temporal da posse de bens domésticos afetou o Indicador Econômico Nacional e como essas mudanças afetaram o poder discriminatório do indicador. MÉTODOS Analisou-se a evolução temporal da posse de cada uma das variáveis do Indicador Econômico Nacional, bem como da distribuição do escore dos domicílios. Utilizamos dados de inquéritos populacionais realizados bienalmente no município de Pelotas, RS, de 2002 a 2014. Foi calculado o coeficiente de correlação de cada variável isoladamente com o escore do Indicador Econômico Nacional e com a renda familiar. Avaliamos também como a variação da distribuição do escore ao longo do tempo afetou a validade da utilização dos pontos de corte de referência publicados. RESULTADOS Houve aumento da escolaridade dos chefes das famílias e da posse de todos os bens, exceto rádio e linha telefônica no período. A correlação dos bens com o Indicador Econômico Nacional reduziu com o tempo. O escore aumentou, com consequente incremento nos pontos de corte dos quintis, mas a distância entre os pontos não teve variação importante. Assim, os pontos de corte de referência publicados para Pelotas rapidamente ficaram desatualizados. CONCLUSÕES Alguns bens perderam a capacidade discriminatória e os pontos de corte ficaram obsoletos rapidamente. É essencial um indicador de bens padronizado para uso em pesquisa, que seja atualizado com frequência, em especial os pontos de corte da distribuição de referência

The SWPER index for women’s empowerment in Africa: development and validation of an index based on survey data

Background The Sustainable Development Goals strongly focus on equity. Goal 5 explicitly aims to empower all women and girls, reinforcing the need to have a reliable indicator to track progress. Our objective was to develop a novel women's empowerment indicator from widely available data sources, broadening opportunities for monitoring and research on women's empowerment. Methods We used Demographic and Health Survey data from 34 African countries, targeting currently partnered women. We identified items related to women's empowerment present in most surveys, and used principal component analysis to extract the components. We carried out a convergent validation process using coverage of three health interventions as outcomes; and an external validation process by analysing correlations with the Gender Development Index. Findings 15 items related to women's empowerment were selected. We retained three components (50% of total variation) which, after rotation, were identified as three dimensions of empowerment: attitude to violence, social independence, and decision making. All dimensions had moderate to high correlation with the Gender Development Index. Social independence was associated with higher coverage of maternal and child interventions; attitude to violence and decision making were more consistently associated with the use of modern contraception. Interpretation The index, named Survey-based Women's emPowERment index (SWPER), has potential to widen the research on women's empowerment and to give a better estimate of its effect on health interventions and outcomes. It allows within-country and between-country comparison, as well as time trend analysis, which no other survey-based index provides

Association between availability of children's book and the literacy-numeracy skills of children aged 36 to 59 months: secondary analysis of the UNICEF Multiple-Indicator Cluster Surveys covering 35 countries.

BACKGROUND: Stimulating home environments that have children's books, pictures and play toys facilitate caregiver-child interactions and enhance children's development. Although this has been demonstrated in small-scale intervention studies, it is important to document whether book ownership is beneficial at large scale in low and middle-income settings. METHODS: We conducted a secondary analysis using data from the multiple-indicator cluster survey, covering 100 012 children aged 36-59 months, from 35 countries. The outcome was children being on-track for a literacy-numeracy index (LNI) constructed from three questions assessing children's ability to identify/name at least 10 letters of the alphabet, read at least four simple popular words and know the names and symbols of all numbers from 1-10. The main exposure was availability of children's book to the child within household. Analysis considered the survey design, assessed and ranked risk ratios of being on track, adjusting for potential confounders such as child's age (in months), maternal education, household wealth index quintile and area of residence (rural/urban). Ecological analysis was performed using meta-regression after grouping countries by World Bank income groups (low- to high-income). RESULTS: Only half (51.8%) of children from all the countries analysed have at least one children's book at home and less than one-third (29.9%; 95% confidence interval (CI) = 23.5%, 36.3%) are on track for literacy-numeracy. After adjusting for confounders, the likelihood of being on track in literacy-numeracy almost doubled if at least one book was available at home compared to when there was none: RR = 1.89 (95% CI = 1.75, 2.03). There was an economic gradient showing that the likelihood of children being on track for LNI decreased with the country's income group: adjusted-RR ranged from 1.65 in upper middle income to 2.23 in LIC (F-test P-value <0.0001). Only three high-income countries were included, and children's books were universally available resulting in wide confidence intervals for the effect. CONCLUSIONS: These findings are policy-relevant, as they corroborate the results from small scale experiments. Making children's book available to children is a cheap and feasible intervention that could change home dynamics to improve the future economic fortunes of children especially in the poorest countries

The Role of Gender Inequality and Health Expenditure on the Coverage of Demand for Family Planning Satisfied by Modern Contraceptives: A Multilevel Analysis of Cross-Sectional Studies in 14 LAC Countries

BACKGROUND: Despite international efforts to improve reproductive health indicators, little attention is paid to the contributions of contextual factors to modern contraceptive coverage, especially in the Latin America and the Caribbean (LAC) region. This study aimed to identify the association between country-level Gender Inequality and Health Expenditure with demand for family planning satisfied by modern contraceptive methods (DFPSm) in Latin American sexually active women. METHODS: Our analyses included data from the most recent (post-2010) Demographic and Health Survey or Multiple Indicator Cluster Survey from 14 LAC countries. Descriptive analyses and multilevel logistic regressions were performed. Six individual-level factors were included. The effect of the country-level factors Gender Inequality Index (GII) and Current Health Expenditure on DFPSm was investigated. FINDINGS: DFPSm ranged from 41.8% (95% CI: 40.2-43.5) in Haiti to 85.6% (95% CI: 84.9-86.3) in Colombia, with an overall median coverage of 77.8%. A direct association between the odds of DFPSm and woman\u27s education, wealth index, and the number of children was identified. Women from countries in the highest GII tertile were less likely (OR: 0.32, 95% CI: 0.13-0.76) to have DFPSm than those living in countries in the lowest tertile. INTERPRETATION: Understanding the contribution of country-level factors to modern contraception may allow macro-level actions focused on the population\u27s reproductive needs. In this sense, country-level gender inequalities play an important role, as well as individual factors such as wealth and education. FUNDING: Bill and Melinda Gates Foundation and Associação Brasileira de Saúde Coletiva (ABRASCO)

Countdown to 2030 : tracking progress towards universal coverage for reproductive, maternal, newborn, and child health

Building upon the successes of Countdown to 2015, Countdown to 2030 aims to support the monitoring and measurement of women's, children's, and adolescents' health in the 81 countries that account for 95% of maternal and 90% of all child deaths worldwide. To achieve the Sustainable Development Goals by 2030, the rate of decline in prevalence of maternal and child mortality, stillbirths, and stunting among children younger than 5 years of age needs to accelerate considerably compared with progress since 2000. Such accelerations are only possible with a rapid scale-up of effective interventions to all population groups within countries (particularly in countries with the highest mortality and in those affected by conflict), supported by improvements in underlying socioeconomic conditions, including women's empowerment. Three main conclusions emerge from our analysis of intervention coverage, equity, and drivers of reproductive, maternal, newborn, and child health (RMNCH) in the 81 Countdown countries. First, even though strong progress was made in the coverage of many essential RMNCH interventions during the past decade, many countries are still a long way from universal coverage for most essential interventions. Furthermore, a growing body of evidence suggests that available services in many countries are of poor quality, limiting the potential effect on RMNCH outcomes. Second, within-country inequalities in intervention coverage are reducing in most countries (and are now almost non-existent in a few countries), but the pace is too slow. Third, health-sector (eg, weak country health systems) and non-health-sector drivers (eg, conflict settings) are major impediments to delivering high-quality services to all populations. Although more data for RMNCH interventions are available now, major data gaps still preclude the use of evidence to drive decision making and accountability. Countdown to 2030 is investing in improvements in measurement in several areas, such as quality of care and effective coverage, nutrition programmes, adolescent health, early childhood development, and evidence for conflict settings, and is prioritising its regional networks to enhance local analytic capacity and evidence for RMNCH

Measuring women’s empowerment and its impact on child development in African countries: an analysis of national surveys

The Sustainable Development Goals strongly focus on equity. Goal 5 explicitly aims to empower all women and girls, reinforcing the need to have a reliable indicator to track progress. Women’s empowerment has a strong potential to improve health and economic outcomes both in the households and communities. The first objective of this thesis was to develop a novel women’s empowerment indicator using Demographic and Health Survey (DHS) data from 34 African countries, broadening opportunities for monitoring and research on women’s empowerment in the region (paper 1). The proposed indicator, named Survey-based Women’s empowerment (SWPER), composed by 15 items, allows the assessment of three empowerment domains: attitude to violence, social independence and decision making. It allows withincountry and between-country comparison, as well as time trend analysis, which no other survey-based index provides. This indicator was then used to evaluate the association between women’s empowerment and the Composite Coverage Index (CCI), a weighted average of coverage with eight interventions in reproductive, maternal, newborn and child health (paper 2). We also assessed whether these effects are modified by wealth. Using DHS data for 36 countries, we found a positive association between the three SWPER domains and the CCI at country level. One standard deviation change in empowerment increased the CCI by 15 (attitude to violence and decision-making domains) and 23 percentage points (social independence). For the latter, the association was modified by wealth: each additional standard deviation was associated with 39.0 (95% CI: 26.2 – 51.9) percentage points increase in the CCI among the poorest and 9.7 (95% CI: 5.1 – 14.3) percentage points among the richest quintile. Also using the SWPER, we evaluated the effect of the mothers’ empowerment on the development on the child (paper 3). To do so, we used the Early Childhood Development Index, which allows the assessment of four developmental domains, namely literacynumeracy, physical, learning and socioemotional. On average, 14.3%, 92.0%, 80.4% and 65,7% of the children were on track for literacy-numeracy, physical, learning and socioemotional developmental domains, respectively. Overall, for each standard deviation increase in attitude to violence, social independence and decision-making scores, the odds for the child being on track on literacy-numeracy increased 31%, 90% and 31%, respectively. However, the mothers’ empowerment overall effects on the physical, learning and socialemotional development of the child was very small or null, which may be related to the low variability in these outcomes. Overall, our findings suggest that efforts toward the achievement of SDG5 (Achieve gender equality and empower all women and girls) may have an important impact on both maternal and child health, as well as on the development of the child in literacynumeracy on the African continent.Os objetivos de desenvolvimento sustentável apresentam um grande enfoque na redução de iniquidades. O objetivo 5, especificamente, visa a eliminação das desigualdades de gênero e o empoderamento de todas as mulheres e meninas, reforçando a necessidade de ter um indicador que possibilite a mensuração do progresso dos países com relação a esta meta. O empoderamento das mulheres tem potencial para gerar mudanças que podem impactar positivamente a economia e os indicadores de saúde, tanto nos núcleos familiares quanto nas comunidades. O primeiro objetivo desta tese foi desenvolver um indicador de empoderamento feminino utilizando dados de inquéritos DHS (do inglês Demographic and Health Surveys) de 34 países africanos, possibilitando assim o monitoramento do empoderamento das mulheres na região (artigo 1). O indicador proposto, denominado SWPER (em inglês, Survey-based Women’s emPowERment), é composto por 15 itens e permite a avaliação de três domínios de empoderamento: postura com relação à violência, independência social e tomada de decisão. O SWPER possibilita a comparações dentro do país (entre indivíduos ou subgrupos) entre países, bem como a análise de tendências temporais. Nenhum outro índice baseado em inquéritos permite comparações entre países ou ao longo do tempo. Utilizando o SWPER, foi avaliada a associação entre o empoderamento das mulheres e um indicador composto de cobertura de intervenções de saúde (Composite Coverage Index, CCI). O CCI é calculado como uma média ponderada da cobertura de oito intervenções em saúde reprodutiva, materna, neonatal e infantil (artigo 2). Também foi avaliado se esse efeito seria modificado pelo nível de riqueza. Utilizando dados do DHS para 36 países da África, encontramos uma associação positiva entre os três domínios do SWPER e o CCI em nível do país. Uma mudança de um desvio padrão no empoderamento feminino aumentou o CCI em 15 (postura com relação à violência e tomada de decisão) e 23 pontos percentuais (independência social). Para este último, a associação foi modificada pela riqueza: cada desvio padrão adicional mostrou-se associado com 39,0 (IC 95%: 26,2 - 51,9) pontos percentuais de aumento no CCI entre os mais pobres e 9,7 (IC95%: 5,1 - 14,3) pontos percentuais entre o quintil mais rico. Também usando o SWPER, avaliamos o efeito do empoderamento da mãe no desenvolvimento da criança (artigo 3). Para isso, foi utilizado um indicador de desenvolvimento infantil desenvolvido pela UNICEF (ECDI, em inglês Early Childhood Development Index), que permite a avaliação de quatro domínios do desenvolvimento, a saber: alfabetização (originalmente denominado literacy-numeracy), físico, aprendizagem e socioemocional. Em média, 14,3%, 92,0%, 80,4% e 65,7% das crianças encontravam-se com desenvolvimento adequado nos domínios de alfabetização, físico, aprendizagem e socioemocional, respectivamente. Para cada aumento de um desvio padrão no empoderamento da mãe nos domínios de postura com relação à violência, independência social e tomada de decisão, as chances de a criança estar com desenvolvimento adequado em alfabetização aumentou em 31%, 90% e 31%, respectivamente. No entanto, o efeito do empoderamento da mãe sobre o desenvolvimento físico, de aprendizagem e socioemocional da criança foram muito pequenos ou nulos, o que pode estar relacionado à baixa variabilidade desses desfechos. No geral, nossos resultados sugerem que os esforços para alcançar o quinto objetivo de desenvolvimento sustentável (Alcançar a igualdade de gênero e empoderar todas as mulheres e meninas) no continente africano podem ter um impacto importante na saúde materna e infantil, bem como no desenvolvimento da criança, em especial no domínio da alfabetização

An analysis of the temporal evolution of possession of the goods that make up the National Economic Indicator (IEN)

Objectives: This study aims to analyze the temporal evolution of the households’ consumption profile in order to indicate which are the best goods and households’ characteristics to include in asset indexes, considering their stability and identifying those that rapidly lose importance. Methods: We analyzed the temporal evolution of the ownership of each one of the variables that compose the IEN, as well as the household’s scores, using descriptive statistics and graphic analysis. We also calculated the correlation coefficients of each component of the index with the household’s scores of IEN. We used data from the consortiums of research from 2002 to 2014, an inquiry realized every two year in Pelotas/RS, in the analysis. Results: We have found an increase in the schooling of the head of the family and in the ownership of all the assets analyzed, except radio and landline. We also observed that in general the Pearson’s correlation of the goods with the score of IEN tends to decrease over the year. The quintiles cut points showed a consistent increase, however, the distance between the points did not show an important variation. The ownership of all goods increased in the higher quintiles of IEN, with different grow tendencies, but very similar for a few groups of goods. Conclusion: We considered that the best goods to include in wealth indexes as IEN as those that are capable of distinguish the households according to its socioeconomic position and that have a high correlation with the index (or with income), without suffering much variation in this correlation over the years. This all taking into account that it is advisable not to include items with similar tendency of grow of the ownership through the quintiles. Besides, the reference cut points published with the IEN rapidly loose its functionality. Thus, it should be updated in every 1-2 years.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPESObjetivo: Estudar a evolução temporal do perfil de consumo dos domicílios apontando quais os melhores tipos de bens e características dos domicílios a serem incluídos em indicadores de bens, considerando as variáveis mais estáveis e identificando aquelas que perdem a importância mais rapidamente. Métodos: Avaliamos a evolução temporal da posse de cada uma das variáveis componentes do IEN, bem como do escore obtido pelos domicílios através do exame de suas estatísticas descritivas e de análises gráficas. Também calculamos os coeficientes de correlação de cada componente do Indicador com o escore de IEN dos domicílios. Utilizamos na análise dados dos consórcios de pesquisa de 2002 a 2014, inquéritos realizados bianualmente em Pelotas/RS. Resultados: Houve no período um aumento da escolaridade dos chefes das famílias e da posse de todos os bens, exceto rádio e linha telefônica. Também se observa que, salvo exceções, a correlação dos bens com o IEN tende a cair com o passar dos anos. Os pontos de corte dos quintis apresentaram um aumento consistente, no entanto a distância entre estes pontos não teve um variação importante. A posse de todos os bens cresce nos quintis mais altos do IEN, com tendências distintas de crescimento, mas muito similares para alguns grupos de bens. Conclusões: Considerou-se que os melhores bens para incluir em indicadores de bens como o IEN são aqueles que conseguem classificar os domicílios de acordo com sua posição socioeconômica, e que têm uma alta correlação com o índice (ou com a renda), sem sofrer muita variação na sua correlação ao longo do tempo, levando-se em conta que não se aconselha incluir itens com tendência semelhante de crescimento da posse entre os quintis. Além disso, os pontos de corte de referência publicados com o IEN rapidamente perdem a sua funcionalidade, devendo ser atualizados a cada 1-2 anos

After 10 years, how do changes in asset ownership affect the Indicador Econômico Nacional?

ABSTRACT OBJECTIVE Our main objective was to analyse how the evolution of household assets ownership affected the Indicador Econômico Nacional (IEN – National Wealth index) and to point out the most stable assets and which lost importance more quickly. METHODS We analysed the trend of the ownership of each IEN variable and the distribution of the households’ scores. We calculated the correlation coefficients of each variable separately with the IEN score and the household income. We also evaluated how the changes of the score distribution over time affected the validity of the published reference cut-points. We used data from consortium surveys conducted every two years from 2002 to 2014 in the city of Pelotas, Brazil. RESULTS An increase in the educational level of household heads and in the ownership of all IEN assets, except radio and telephone, was observed in the study period. In general, the correlation of the assets with the IEN scores decreased over time. There was an increase in the score, with a consequent increase in the quintiles cut-points, but the distance between these cut-points had no significant variation. Thus, the reference cut-points for Pelotas, quickly became outdated. CONCLUSIONS Some assets showed greatly reduction on its importance for the indicator, and the reference cut-points became obsolete very quickly. It is essential for a standardized wealth (or asset) index with research purposes to be updated frequently, especially the cut-points of reference distribution

Os Determinantes Socioeconômicos do Estado de Saúde das Crianças do Brasil Rural

This study aims to analyze the socioeconomic determinants of children’s individual health state in the countryside of Brazil, using data from PNAD 2008. Probit and ordered probit were used in the analysis. Main results show that elements, such as better health of parents, higher income, higher information levels, access to high quality water, besides governmental policies, such as ProgramaSaúde da Família,are positively related with children’s health. Besides the negative effect of the poor socioeconomic conditions on health in childhood, it is known that worse health in childhood can generate, in the future, new poor socioeconomic conditions forthese children. Thus, this circle could be a mechanism of poverty perpetuation. Therefore, governmental policies which affect children’s health in a positive way can promote favorable resultsfor the population

Os Determinantes Socioeconômicos do Estado de Saúde das Crianças do Brasil Rural

This study aims to analyze the socioeconomic determinants of children’s individual health state in the countryside of Brazil, using data from PNAD 2008. Probit and ordered probit were used in the analysis. Main results show that elements, such as better health of parents, higher income, higher information levels, access to high quality water, besides governmental policies, such as ProgramaSaúde da Família,are positively related with children’s health. Besides the negative effect of the poor socioeconomic conditions on health in childhood, it is known that worse health in childhood can generate, in the future, new poor socioeconomic conditions forthese children. Thus, this circle could be a mechanism of poverty perpetuation. Therefore, governmental policies which affect children’s health in a positive way can promote favorable resultsfor the population