Relationship between household wealth inequality and chronic childhood under-nutrition in Bangladesh

BACKGROUND: Household food insecurity and under-nutrition remain critically important in developing countries struggling to emerge from the scourge of poverty, where historically, improvements in economic conditions have benefited only certain privileged groups, causing growing inequality in health and healthcare among the population. METHODS: Utilizing information from 5,977 children aged 0-59 months included in the 2004 Bangladesh Demographic and Health Survey , this study examined the relationship between household wealth inequality and chronic childhood under-nutrition. A child is defined as being chronically undernourished or whose growth rate is adversely stunted, if his or her z-score of height-for-age is more than two standard deviations below the median of international reference. Household wealth status is measured by an established index based on household ownership of durable assets. This study utilized multivariate logistic regressions to estimate the effect of household wealth status on adverse childhood growth rate. RESULTS: The results indicate that children in the poorest 20% of households are more than three time as likely to suffer from adverse growth rate stunting as children from the wealthiest 20% of households (OR=3.6; 95% CI: 3.0, 4.3). The effect of household wealth status remain significantly large when the analysis was adjusted for a child's multiple birth status, age, gender, antenatal care, delivery assistance, birth order, and duration that the child was breastfed; mother's age at childbirth, nutritional status, education; household access to safe drinking water, arsenic in drinking water, access to a hygienic toilet facility, cooking fuel cleanliness, residence, and geographic location (OR=2.4; 95% CI: 1.8, 3.2). CONCLUSION: This study concludes that household wealth inequality is strongly associated with childhood adverse growth rate stunting. Reducing poverty and making services more available and accessible to the poor are essential to improving overall childhood health and nutritional status in Bangladesh

Cost-effectiveness of early detection of breast cancer in Catalonia (Spain)

<p>Abstract</p> <p>Background</p> <p>Breast cancer (BC) causes more deaths than any other cancer among women in Catalonia. Early detection has contributed to the observed decline in BC mortality. However, there is debate on the optimal screening strategy. We performed an economic evaluation of 20 screening strategies taking into account the cost over time of screening and subsequent medical costs, including diagnostic confirmation, initial treatment, follow-up and advanced care.</p> <p>Methods</p> <p>We used a probabilistic model to estimate the effect and costs over time of each scenario. The effect was measured as years of life (YL), quality-adjusted life years (QALY), and lives extended (LE). Costs of screening and treatment were obtained from the Early Detection Program and hospital databases of the IMAS-Hospital del Mar in Barcelona. The incremental cost-effectiveness ratio (ICER) was used to compare the relative costs and outcomes of different scenarios.</p> <p>Results</p> <p>Strategies that start at ages 40 or 45 and end at 69 predominate when the effect is measured as YL or QALYs. Biennial strategies 50-69, 45-69 or annual 45-69, 40-69 and 40-74 were selected as cost-effective for both effect measures (YL or QALYs). The ICER increases considerably when moving from biennial to annual scenarios. Moving from no screening to biennial 50-69 years represented an ICER of 4,469€ per QALY.</p> <p>Conclusions</p> <p>A reduced number of screening strategies have been selected for consideration by researchers, decision makers and policy planners. Mathematical models are useful to assess the impact and costs of BC screening in a specific geographical area.</p

The oral health of street-recruited injecting drug users: Prevalence and correlates of problems

Aims: To examine the effects of a series of injecting drug users' (IDU) characteristics and drug use behaviours upon the self-reported oral health of a sample of IDU. Design: Cross-sectional survey. Setting: Melbourne, Australia. Participants: A total of 285 IDU recruited through needle and syringe programmes, snowballing and outreach across six sites. Measurements: Structured survey that collected information on current drug use patterns, self-reported blood-borne virus status and general health factors, including open-ended questions on past-year dental health problems. Findings: Sixty-eight per cent of the sample reported dental problems that were commonly severe and caused dental pain. Despite these reported problems, almost half the sample had not visited the dentist in the 12 months prior to the survey. Participants who were older, and reported homelessness, not eating every day and more common injection of amphetamines rather than heroin in the previous month, were more likely to report having a past-year dental problem. Conclusions: Dental problems in IDUs are common but few receive treatment. Further, those using amphetamines, with poor housing, hygiene and poor nutrition, are most at risk. Programmes designed to improve the oral health of IDU need to be developed and implemented in a manner amenable to the varying social circumstances of this marginalized group in the community. © 2008 The Authors