Socio-economic determinants of child nutritional status in Armenia: The analysis of 2000 and 2005 demographic and health surveys

Objectives: The study examined the association between an index of household wealth and key nutritional status indicators in children under age five in Armenia. The study compared the distribution of the child nutritional status indicators across socio-economic groups in 2000 and 2005. It also examined the correlation between the Wealth Index and subjective measures of socio-economic status (SES), as well as the relationship between all of those SES measures and child nutritional status in Armenia in 2005. Methods: Data were from the Armenia Demographic and Health Survey (DHS) conducted in 2000 and 2005. The analyses accounted for sampling features, including the stratification of the sample by regions and urban/rural areas and the primary sampling units, as well as the clustering of children within households. Three measures of undernutrition were examined: stunting (low height-for-age), wasting (low weight-for- age), and underweight (low weight-for-height). Analyses included chi-square, the Kappa statistic, unadjusted and adjusted logistic regression, and calculation of poor/rich odds ratios and concentration indices. Independent variables included the Wealth Index, an objective SES measure, and three subjective SES measures, respondents’ perceptions about: “having enough money to meet needs,” “making ends meet in the household,” and “satisfaction with living space.” Covariates included urban/rural residence, region, education in years for mothers and fathers, marital status of mothers, work status of mothers, mother’s age in years at the time of the child’s birth, mother’s body mass index, child’s age in months, child gender, birth weight in kilograms, and the number of months the child was breastfed. Results: The prevalence of stunting in the combined and weighted DHS populations for 2000 and 2005 was 17.4%, using the 2006 World Health Organization standards for child growth. The prevalence of wasting was 3.3%, and for being underweight 2.9%. In bivariate results, children in the second wealth quintile, those who were “poorer” but not the most poor, had lower rates of wasting and underweight than those in most of the richer quintiles. In adjusted analyses, none of the associations for the Wealth Index and child undernutrition indicators were statistically significant. Each additional year of a father’s or partner’s education was associated with significantly lower adjusted odds of stunting (OR 0.93, 95% CI 0.88-0.98) and underweight (OR 0.85, 95% CI 0.76-0.95). Each additional kilogram of the child’s birth weight was associated with 53% lower odds of stunting (OR 0.47, 95% CI 0.35-0.63) and 72% lower odds of being underweight (OR 0.28, 95% CI 0.17-0.46). Armenian regions that had less favorable nutritional indicators were Gegharkunik (children had higher risk of stunting and underweight), Shirak (children had higher risk of wasting and underweight), and Vayots Dzor (children had higher risk of wasting and underweight). Residents in these three regions have poorer SES compared to those living in other Armenian regions. The calculation of poor/rich odds ratios showed a significant differential in the risk for stunting in 2000 (poor/rich OR 2.12; 95% CI 1.29-3.50), but no significant difference in 2005. The analysis of concentration curves and indices indicated a higher concentration of stunting and underweight in poorer households in 2000, and a slightly higher concentration in the richer quintiles in 2005. The “making ends meet in the household” indicator might be a better predictor of child undernutrition than the Wealth Index or the other two subjective indicators examined. Discussion: Findings suggest that the Wealth Index has limited ability to predict nutritional status of children in Armenia. Region and paternal education had highly significant associations with undernutrition; these results suggest that they are important independent socio-economic determinants of nutritional outcomes for Armenian children. The regional variation in malnutrition rates and malnutrition inequalities show the importance of examining community and regional level socio-economic variables in addition to individual and household level factors, and of targeting selected regions for further studies and public health interventions designed to improve child nutrition

Identifying priority healthcare trainings in frozen conflict situations: The case of Nagorno Karabagh

<p>Abstract</p> <p>Introduction</p> <p>Health care in post-war situations, where the system's human and fixed capital are depleted, is challenging. The addition of a frozen conflict situation, where international recognition of boundaries and authorities are lacking, introduces further complexities.</p> <p>Case description</p> <p>Nagorno Karabagh (NK) is an ethnically Armenian territory locked within post-Soviet Azerbaijan and one such frozen conflict situation. This article highlights the use of evidence-based practice and community engagement to determine priority areas for health care training in NK. Drawing on the precepts of APEXPH (Assessment Protocol for Excellence in Public Health) and MAPP (Mobilizing for Action through Planning and Partnerships), this first-of-its-kind assessment in NK relied on in-depth interviews and focus group discussions supplemented with expert assessments and field observations. Training options were evaluated against a series of ethical and pragmatic principles.</p> <p>Discussion and Evaluation</p> <p>A unique factor among the ethical and pragmatic considerations when prioritizing among alternatives was NK's ambiguous political status and consequent sponsor constraints. Training priorities differed across the region and by type of provider, but consensus prioritization emerged for first aid, clinical Integrated Management of Childhood Illnesses, and Adult Disease Management. These priorities were then incorporated into the training programs funded by the sponsor.</p> <p>Conclusions</p> <p>Programming responsive to both the evidence-base and stakeholder priorities is always desirable and provides a foundation for long-term planning and response. In frozen conflict, low resource settings, such an approach is critical to balancing the community's immediate humanitarian needs with sponsor concerns and constraints.</p

Self-efficacy predicts the outcome of smoking cessation attempts

Background Despite well-established advantages of smoking cessation in the prevention and treatment of myocardial infarction (MI) many patients continue smoking after a diagnosis of MI. Recent evidence suggests that higher self-efficacy (SE), or confidence in one's ability to abstain from smoking, is positively associated with successful smoking cessation attempts. This study aimed to investigate the association between SE and smoking cessation outcome at 6 to 12 months after MI in Armenia. Methods Cross-sectional survey was conducted among smoker adult MI patients who were hospitalized at the largest cardiac hospital in Armenia (Nork-Marash Medical Center). Data collection was done at 6 to 12 months after MI through medical chart review and interviewer administered telephone survey. SE at the time of MI was measured through widely used and validated Self-Efficacy Questionnaire (SEQ-12). SEQ-12 consists of two six-item subscales which measure confidence in aptitude to abstain from smoking when facing internal stimuli (e.g. feeling nervous) and external stimuli (e.g. being with a smoker). Logistic regression analysis was performed to reveal the association between SE and quitting outcome. Results About half (54.37%) of 103 surveyed participants quitted smoking after MI. The mean SE score was 33.55 (SD: 16.49) (out of possible 60) which was significantly higher among quitters compared to non-quitters (45.55 vs. 19.26, p< 0.001). Likewise, the difference between was significant in terms of both internal and external subscale scores. Adjusted logistic regression elucidated that each unit increase in SE score was associated with 1.3 times higher odds of quitting (95% CI: 1.17-1.44; p< 0.001). Conclusions The results illustrated that SE is an independent predictor of smoking cessation after MI suggesting that increase in patients' confidence in ability to abstain from smoking will contribute to successful cessation outcomes. This emphasized the importance of behavioral interventions in encouraging and assisting smoking cessation attempts among MI patients

Contraceptive practices in Armenia: Panel evaluation of an Information-Education-Communication Campaign

Induced abortion remains the major form of birth control among Armenian women, contributing to their excess mortality and preventable morbidity. Reliance on abortion is attributed to limited access to information concerning modern methods of contraception and to widely held misinformation among women regarding family planning and reproductive health. Based on the Steps to Behavior Change model, the Green Path Campaign for Family Health, an information-education-communication (IEC) campaign, was launched in June 2000. This multimedia campaign promoted greater awareness, knowledge, acceptance, and adoption of modern contraception through increased utilization of counseling and related services provided at underutilized family planning centers. A representative panel of 1088 married women aged 18-35 were surveyed on reproductive health/family planning knowledge, attitudes, and practices immediately prior to and immediately following the 6-month national campaign. Exposure to the campaign was associated with significant increases in factors associated with contraceptive behavior change: knowledge, favorable attitudes toward modern methods, favorable attitudes toward family planning services, and information seeking and utilization of family planning services. Women who were more educated, more affluent, and slightly older were more likely to use family planning services as well as modern contraceptive methods. New visits to family planning centers increased by 84%. Despite the usual 25% turnover among those using modern methods at the start of the study, use of modern contraceptive methods increased by 4.6%, significantly exceeding the projected 3% increase. The results document changes in underlying behavioral predictors consistent with the Steps to Behavior Change model and highlight the relatively untapped potential of media-based health promotion efforts in post-Soviet Republics.Armenia Behavior change Family planning Program evaluation Health communication

Predicting COVID-19 vaccination uptake in Armenia using the Health Belief Model: Results from a nationwide survey

Health behavior theories have been effectively used for studying populations’ awareness, attitudes, and beliefs related to COVID-19 preventative behaviors. The aim of this study was to explore the factors associated with the intention to get vaccinated against COVID-19 in the Armenian population using the Health Belief Model (HBM) as a framework. We applied stratified two-stage random sampling to conduct a telephone survey of 3,483 adults in 2021. The multi-domain survey instrument included questions on socio-demographic characteristics, COVID-19-related knowledge, COVID-19 susceptibility, severity and self-efficacy beliefs, sources of information on COVID-19, COVID-19 vaccination practice, and its benefits and barriers. We performed bivariate and hierarchical multivariate regression analysis with the entry of variables in blocks. In total, about 12% of the sample (n = 393) was vaccinated against COVID-19. Of 2,838 unvaccinated participants, about 53% (n = 1516) had an intention to get vaccinated. The final hierarchical logistic regression model containing socio-demographic characteristics, knowledge about COVID-19, and HBM constructs explained 43% of the variance in the intention to get vaccinated against COVID-19. Participants’ age, employment status, average monthly expenditures, perceived threat, benefits, perceived barriers, self-efficacy, and cues to action were significant and independent predictors of the intention to get COVID-19 vaccination. This study confirmed the utility of the HBM in highlighting drivers of an important health-protective behavior in the context of pandemics. Health policy makers, communication specialists, and healthcare providers should particularly stress the effectiveness and safety of the vaccines in their efforts to increase vaccination rates and focus on unemployed and low-income population groups