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Poverty is not only an economic problem but also a social problem, and there are certain limitations of objective poverty based on the population's income. It does not reflect the residents' true feelings regarding education opportunities, pension and medical security, and participation in decision-making. Researchers have studied it intensively in different objective dimensions of Chinese poverty, and little attention has been paid to subjective poverty. This study analyzes how public services supply, livelihood capital, and livelihood strategies affect subjective perceptions of poverty. The results show that public services supply, livelihood capital, and livelihood strategies significantly correlate with subjective poverty. Physical capital and social capital have the greatest effects on the occurrence of subjective poverty. The probability of subjective poverty decreases by 0.149 and 0.107 for each unit change in physical and social capital, respectively. What's more, public services supply, physical capital, financial capital, and human capital affect the subjective poverty of urban and rural residents at different significance levels. It means that the formation of subjective poverty results from the superposition of multiple factors. [ABSTRACT FROM AUTHOR]

According to the national population Census of Colombia, 4.1 per cent of the population lives with a disability. Although information is available on the number of persons with disabilities in the country, little information exists on their levels of multidimensional poverty and deprivation, especially at the province of local level. Aiming to contribute to the analysis of the levels of poverty of persons with disabilities living at the municipal/province level, this study computes and analyses the levels of multidimensional poverty in households with and without members with disabilities in the 1.101 municipalities of Colombia. Using the 2018 national population census, we computed the percentage of people living with disabilities in each of the municipalities of the country, then we computed their levels of poverty and deprivation and analysed the difference between households with and without members with disabilities. We also analysed the availability of teachers and schools providing services for children living with disabilities and deprivations in terms of school attendance. The results reveal that households with members with disabilities are poorer than households without members with disabilities, These households present higher deprivations according to most indicators, and the intensity of their poverty is higher. In addition, households with members with disabilities usually present higher levels of deprivation in school attendance and live in municipalities where there is no provision of inclusive schools. These results highlight the importance of implementing specific policies designed to reduce the levels of poverty of persons with disabilities and their families and to guarantee their access to basic opportunities and services. [ABSTRACT FROM AUTHOR]

Poverty is a big threat to prosperity in developing countries like Pakistan. Alleviating poverty needs concerted efforts including how to measure and analyze poverty. Therefore, this paper employs synthetic panel technique and uses repeated cross-sections household survey dataset (Household Integrated and Economic Survey (HIES)) of Pakistan for 2010–11 and 2015–16, to derive poverty bounds for Pakistan. The findings of the paper suggest that 17% of population still remains in poverty in 2015–16 as they were in 2010–11. They don't move in or out of poverty. In the same periods 19% population affected by poverty. The 2.5% poor's of 2010–11 moves out of poverty in 2015–16. This constitutes the first attempt to provide an insight into poverty dynamics in Pakistan using the available survey data. [ABSTRACT FROM AUTHOR]

Neighbourhood effects studies typically investigate the negative effects on individual outcomes of living in areas with concentrated poverty. The literature rarely pays attention to the potential beneficial effects of living in areas with concentrated affluence. This poverty paradigm might hinder our understanding of spatial context effects. Our paper uses individual geocoded data from the Netherlands to compare the effects of exposure to neighbourhood affluence and poverty on educational attainment within the same statistical models. Using bespoke neighbourhoods, we create individual neighbourhood histories which allow us to distinguish exposure effects from early childhood and adolescence. We follow an entire cohort born in 1995 and we measure their educational level in 2018. The results show that, in the Netherlands, neighbourhood affluence has a stronger effect on educational attainment than neighbourhood poverty for all the time periods studied. Additionally, interactions with parental education indicate that children with higher educated parents are not affected by neighbourhood poverty. These results highlight the need for more studies on the effects of concentrated affluence and can inspire anti-segregation policies. [ABSTRACT FROM AUTHOR]

Poverty is multifaceted. The global poverty profile shows 41% of multidimensionally poor people living in South Asian countries. Though castes and tribes are a more prevalent line of social stratification in India, and their socio-economic characteristics also vary remarkably, hardly any study has explored these dimensions while analysing multidimensional poverty in India. Hence, this study attempts to assess the multidimensional status of poverty among the social groups in India. National Family Health Survey, 2015–16 (NFHS-4) is a source of rich information on 579,698 households' well-being for this analysis. Alkire- Foster technique was applied to decompose the Multidimensional Poverty Index (M0) across its dimensions and indicators for all the social groups. Three broad dimensions of deprivation–Health, Education and Standard of Living–include 12 indicators, guided by the poverty literature, data availability and the country's sustainable Development Goals (SDGs). There were three main findings in this study: (1) Scheduled Tribes (STs) are the most disadvantaged subgroup in India with remarkably high values of headcount (H = 0.444;), intensity (A = 0.486), and M0 (0.216), followed by Scheduled Castes (SCs) (H = 0.292; A = 0.473; M0 = 0.138), and Other Backward Classes (OBCs) (H = 0.245; A = 0.465; M0 = 0.114); and Others category is the most privileged with very low values of H = 0.149, A = 0.463, and M0 = 0.069; (2) STs contribute nearly twice their population share for both H and M0, and the SCs contribution is also noticeably higher than their population share; (3) States located in the central and eastern regions of India have the higher H, A and M0 for all the social groups. This suggests that there is a need for a thorough assessment of poverty at specific levels to uncover the poverty situation in society, improve the effectiveness of evidence-based planning and effective policymaking. [ABSTRACT FROM AUTHOR]

Background: The menstrual needs of girls and women are important to health, education, and well-being. Unmet need and harm from poor menstrual health in low-and- middle-income countries have been documented, but with little empirical research undertaken in high income countries. Continuing austerity in the UK suggests menstruators are likely more vulnerable to 'period poverty' than previously, with the COVID-19 pandemic assumed to exacerbate the situation. Aim: To explore the menstrual experiences and perceptions of women in the UK who are living under circumstances of deprivation, alongside views of staff working in organisations supporting these women, to understand whether women's menstrual needs are met. Methods: A qualitative study was conducted in an inner-city in NW England. Three focus group discussions and 14 in-depth interviews were conducted across three study sites supporting impoverished women. Data was analysed thematically. Results: Themes were: reflections on menstruation; affordability of products; access to public facilities; organisational support; potential solutions. Many women perceived menstruation as a burden in three aspects: physical discomfort and pain; psychological anxiety; and shame and stigma. Managing menstruation was difficult due to cost relative to low incomes, with food, heating and lighting prioritised, leaving women improvising with materials or wearing products for longer than desired. Most suggested that products should be free, often remarking if men required similar items this would happen. Most women were unaware supporting organisations provided free products. Staff felt the small range of products offered did not meet client needs and were ill-prepared to have conversations on products and clients' menstrual needs. Conclusion: Impoverished women lack the necessary resources to manage their menses well which negatively impacts their health and brings stress, embarrassment, and shame. Support, including access to free products, is needed at both local and national level to help impoverished women manage their menstrual hygiene. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has changed the course of human development. In this manuscript we analyze the long-term effect of COVID-19 on poverty at the country-level across various income thresholds to 2050. We do this by introducing eight quantitative scenarios that model the future of Sustainable Development Goal 1 (SDG1) achievement using alternative assumptions about COVID-19 effects on both economic growth and inequality in the International Futures model. Relative to a scenario without the pandemic (the No COVID scenario), the COVID Base scenario increases global extreme poverty by 73.9 million in 2020 (the range across all scenarios: 43.5 to 155.0 million), 63.6 million in 2030 (range: 9.8 to 167.2 million) and 57.1 million in 2050 (range: 3.1 to 163.0 million). The COVID Base results in seven more countries not meeting the SDG1 target by 2030 that would have achieved the target in a No COVID scenario. The most pessimistic scenario results in 17 more countries not achieving SDG1 compared with a No COVID scenario. The greatest pandemic driven increases in poverty occur in South Asia and sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

Foreign aid and remittances augment the income of economies. The present study examines the relationship between economic growth, poverty, inequality, remittances, and foreign aid in the Middle East and North Africa (MENA) countries using panel data methods from 1991 to 2019. The study focuses on the MENA region due to the rise in labor immigration and significant foreign aid. The empirical findings reveal that remittances, foreign aid, and economic growth play a significant role in bringing down the MENA region's poverty levels. Besides, a rise in income share accruing to the lowest quintile is observed despite the negative income growth, which indicates that on average, the income increased more rapidly of the poor in comparison to the non-poor households. Thus, the study finds evidence supporting the hypothesis that remittances and foreign aid augment per capita income and income share in the MENA member countries. [ABSTRACT FROM AUTHOR]

Introduction: Narrow, unidimensional measures of poverty often fail to measure true poverty and inadequately capture its drivers. Multidimensional indices of poverty more accurately capture the diversity of poverty. There is little research regarding the association between multidimensional poverty and depression. Methods: A cross-sectional survey was administered in five sub-locations in Migori County, Kenya. A total of 4,765 heads of household were surveyed. Multidimensional poverty indices were used to determine the association of poverty with depression using the Patient Health Questionnaire (PHQ-8) depression screening tool. Results: Across the geographic areas surveyed, the overall prevalence of household poverty (deprivation headcount) was 19.4%, ranging from a low of 13.6% in Central Kamagambo to a high of 24.6% in North Kamagambo. Overall multidimensional poverty index varied from 0.053 in Central Kamagambo to 0.098 in North Kamagambo. Of the 3,939 participants with depression data available, 481 (12.2%) met the criteria for depression based on a PHQ-8 depression score ≥10. Poverty showed a dose-response association with depression. Conclusions: Multidimensional poverty indices can be used to accurately capture poverty in rural Kenya and to characterize differences in poverty across areas. There is a clear association between multidimensional poverty and depressive symptoms, including a dose effect with increasing poverty intensity. This supports the importance of multifaceted poverty policies and interventions to improve wellbeing and reduce depression. [ABSTRACT FROM AUTHOR]

The recent methodological development has entirely shifted the identification of poor in the multidimensional spectrum; thereby addressing the multiple health spheres. The present research primarily examines the dynamics of multidimensional health poverty on the basis of HIES & PSLM nationwide survey data from 2013–14 to 2018–19. The study employed Alkire & Foster Alkire, S (2007) Multidimensional Poverty Index to estimate the seven distinct dimensions of health aspects to identify the poor. The results of health poverty demonstrate a declining trend over time at national, provincial and regional level in Pakistan. Interestingly, the regional statistics indicated the poverty as a rural phenomenon of Pakistan. Comparative measures of provinces reveal that Baluchistan has been a severe victim of health poverty at overall as well as regional level during the study period. The population decomposition elaborates that individuals residing in two most populated provinces Punjab & Sindh, were the major contributor to overall profile of health poverty. Findings of dimensional decomposition exposes that five key dimensions i.e. use of health services, quality of health services, maternal health, child health and malnutrition have contributed to the overall profile of multidimensional health poverty. [ABSTRACT FROM AUTHOR]

Introduction: An estimated 1 billion people with disabilities live in low and middle income countries, a population that includes people with communication disabilities (PwCD). PwCD are a heterogenous group with a wide range of abilities who may be underrepresented in research due to the communication demands involved in research participation. Methods: A critical analysis of 145 studies from a previously published systematic review was undertaken with the aim of documenting the opportunities for direct participation of PwCD in research on poverty and disability in low- and middle- income countries. Results: The key finding was the high risk of underrepresentation of PwCD in research on poverty and disability in LMICs, despite low rates of explicit exclusion (n = 8; 5.5%). A total of 366 uses of data collection tools were analysed (255 unique tools). The majority of data collection tools had high communication demands (92.9%), including those measuring disability (88.6%) and those assessing poverty (100%). Only 22 studies (15.2%) specifically included PwCD. A subset of these studies (n = 14) presented disaggregated data in a way that allowed for analysis of outcomes for PwCD, suggesting a clear intersection between poverty and communication disability, with findings related to general poverty indicators, reduced access to education, low levels of employment, and additional expenditure. Conclusions: The findings suggest a systematic underrepresentation of PwCD in research on poverty and disability with substantial implications for future policy and program planning, directly affecting the availability and provision of services and resources for this population. A failure to provide adequate opportunity for participation of PwCD in research risks leaving those with communication disabilities behind in the pursuit of global poverty eradication. [ABSTRACT FROM AUTHOR]

Advances in remote sensing and machine learning enable increasingly accurate, inexpensive, and timely estimation of poverty and malnutrition indicators to guide development and humanitarian agencies' programming. However, state of the art models often rely on proprietary data and/or deep or transfer learning methods whose underlying mechanics may be challenging to interpret. We demonstrate how interpretable random forest models can produce estimates of a set of (potentially correlated) malnutrition and poverty prevalence measures using free, open access, regularly updated, georeferenced data. We demonstrate two use cases: contemporaneous prediction, which might be used for poverty mapping, geographic targeting, or monitoring and evaluation tasks, and a sequential nowcasting task that can inform early warning systems. Applied to data from 11 low and lower-middle income countries, we find predictive accuracy broadly comparable for both tasks to prior studies that use proprietary data and/or deep or transfer learning methods. [ABSTRACT FROM AUTHOR]

The Multidimensional Poverty Index (MPI) is an income-based poverty index which measures multiple deprivations alongside other relevant factors to determine and classify poverty. The implementation of a reliable MPI is one of the significant efforts by the Malaysian government to improve measures in alleviating poverty, in line with the recent policy for Bottom 40 Percent (B40) group. However, using this measurement, only 0.86% of Malaysians are regarded as multidimensionally poor, and this measurement was claimed to be irrelevant for Malaysia as a country that has rapid economic development. Therefore, this study proposes a B40 clustering-based K-Means with cosine similarity architecture to identify the right indicators and dimensions that will provide data driven MPI measurement. In order to evaluate the approach, this study conducted extensive experiments on the Malaysian Census dataset. A series of data preprocessing steps were implemented, including data integration, attribute generation, data filtering, data cleaning, data transformation and attribute selection. The clustering model produced eight clusters of B40 group. The study included a comprehensive clustering analysis to meaningfully understand each of the clusters. The analysis discovered seven indicators of multidimensional poverty from three dimensions encompassing education, living standard and employment. Out of the seven indicators, this study proposed six indicators to be added to the current MPI to establish a more meaningful scenario of the current poverty trend in Malaysia. The outcomes from this study may help the government in properly identifying the B40 group who suffers from financial burden, which could have been currently misclassified. [ABSTRACT FROM AUTHOR]

A quantitative analysis of the panel data of 21 districts in Chongqing City in the Three Gorges Reservoir region from 1998 to 2015 was conducted to determine the influence of China's focused poverty reduction policy in terms of causal inference. Specifically, the effects of this policy at the initial phase of execution through break-point regression; the impacts of this policy during the implementation period by using an instrumental variable panel regression; and comparative studies of the policy impacts by using the generalized synthetic control method. The outcomes showed that: (1) China's state policy for specific poverty mitigation has a substantial impact on reducing poverty, which has been observed from the start of the enactment, namely, peasants' net income per capita from 2011 to 2013 increased by 13.9%, as compared to that during 2008–2010. Meanwhile, the net earnings of each farmer grew by 22% from 2011 to 2015 throughout the implementation phase of the policy, as opposed to that in 1998–2010. (2) Economic behavior in the marketplace and agricultural output figure of impoverished regions has significantly improved farmers' individual net income. (3) The comparative study further proves that the poverty mitigation policy has the effect of reducing poverty. Based on these findings, it is proposed that China should increase investment to consolidate its poverty alleviation policy in the most poverty-stricken areas, activate rural markets and develop agricultural production at the local level to accelerate poverty reduction in the region. The method of causal inference was utilized as an innovative method to study China's focused poverty reduction policy for both immediate and permanent effects. It is the first time to use the generalized integrated control method, which is a causal inference frontier method, to further verify the effectiveness of poverty reduction policies. [ABSTRACT FROM AUTHOR]

A widening evidence base across low- and middle-income countries (LMICs) points towards mutually reinforcing linkages between poverty and mental health problems. The use of validated and culturally relevant measures of mental health outcomes is crucial to the expansion of evidence. At present, there is a paucity of measures that have been tested and validated in contexts of extreme poverty. Using data from adult women living in extreme poverty in rural Haiti this study assesses the cross-cultural validity of the widely used Rosenberg Self-Esteem Scale (RSES) and its applicability in assessing linkages between poverty and mental health outcomes. We find no evidence for a one-dimensional 10-factor structure of the RSES within our data and agree with other authors that the standard self-esteem model does not fit well in this cultural context. Comparisons with another widely used measure of mental health–the K6 measure–indicate that the RSES cannot be used as a proxy for mental health outcomes. We conclude that the use of the RSES in different cultural contexts and with samples with different socioeconomic characteristics should be undertaken with caution; and that greater consideration of the validity of psychosocial constructs and their measurement is vital for gaining robust and replicable insights into breaking the cycle between poverty and mental health problems. [ABSTRACT FROM AUTHOR]

We create a network model to study the spread of an epidemic through physically proximate and accidental daily human contacts in a city, and simulate outcomes for two kinds of agents—poor and non-poor. Under non-intervention, peak caseload is maximised, but no differences are observed in infection rates across poor and non-poor. Introducing interventions to control spread, peak caseloads are reduced, but both cumulative infection rates and current infection rates are systematically higher for the poor than for non-poor, across all scenarios. Larger populations, higher fractions of poor, and longer durations of intervention are found to progressively worsen outcomes for the poor; and these are of particular concern for economically vulnerable populations in cities of the developing world. Addressing these challenges requires a deeper, more rigorous understanding of the relationships between structural poverty and epidemy, as well as effective utilization of extant community level infrastructure for primary care in developing cities. Finally, improving iniquitous outcomes for the poor creates better outcomes for the whole population, including the non-poor. [ABSTRACT FROM AUTHOR]

In the global context, the health and quality of life of people are adversely affected by either one or more types of chronic diseases. The chronic pain associated with diagnosed patients may include heavy medical expenditure along with the physical and mental suffering they undergo. Usually, unbearable amounts of medical expenses are incurred, to improve or sustain the health condition of the patient. Consequently, the heavy financial burden tends to push households from a comfortable or secure life, or even from bad to worse, towards the probability of becoming poor. Hence, this study is conducted to identify the impact chronic illnesses have on poverty using data from a national survey referred as the Household Income and Expenditure Survey (HIES), with data gathered by the Department of Census and Statistics (DCS) of Sri Lanka in 2016. As such, this study is the first of its kind in Sri Lanka, declaring the originality of the study based on data collected from the local arena. Accordingly, the study discovered that married females who do not engage in any type of economic activity, in the age category of 40–65, having an educational level of tertiary level or below and living in the urban sector have a higher likelihood of suffering from chronic diseases. Moreover, it was inferred that, if a person is deprived from access to basic education in the level of education, lives in the rural or estate sector, or suffers from a brain disease, cancer, heart disease or kidney disease, he is highly likely to be poor. Some insights concluded from this Sri Lankan case study can also be applied in the context of other developing countries, to minimise chronic illnesses and thereby the probability of falling into poverty. [ABSTRACT FROM AUTHOR]

Socioeconomic status (SES), living in poverty, and other social determinants of health contribute to health disparities in the United States. African American (AA) men living below poverty in Baltimore City have a higher incidence of mortality when compared to either white males or AA females living below poverty. Previous studies in our laboratory and elsewhere suggest that environmental conditions are associated with differential gene expression (DGE) patterns in peripheral blood mononuclear cells (PBMCs). DGE have also been associated with hypertension and cardiovascular disease (CVD) and correlate with race and sex. However, no studies have investigated how poverty status associates with DGE between male and female AAs and whites living in Baltimore City. We examined DGE in 52 AA and white participants of the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) cohort, who were living above or below 125% of the 2004 federal poverty line at time of sample collection. We performed a microarray to assess DGE patterns in PBMCs from these participants. AA males and females living in poverty had the most genes differentially-expressed compared with above poverty controls. Gene ontology (GO) analysis identified unique and overlapping pathways related to the endosome, single-stranded RNA binding, long-chain fatty-acyl-CoA biosynthesis, toll-like receptor signaling, and others within AA males and females living in poverty and compared with their above poverty controls. We performed RT-qPCR to validate top differentially-expressed genes in AA males. We found that KLF6, DUSP2, RBM34, and CD19 are expressed at significantly lower levels in AA males in poverty and KCTD12 is higher compared to above poverty controls. This study serves as an additional link to better understand the gene expression response in peripheral blood mononuclear cells in those living in poverty. [ABSTRACT FROM AUTHOR]

Resource-based livelihoods are uncertain and potentially unstable due to variability over time, including seasonal variation: this instability threatens marginalised populations who may fall into poverty. However, empirical understanding of trajectories of household well-being and poverty is limited. Here, we present a new household-level model of poverty dynamics based on agents and coping strategies–the Household Economy And Poverty trajectory (HEAP) model. HEAP is based on established economic and social insights into poverty dynamics, with a demonstration of the model calibrated with a qualitative and quantitative household survey in coastal Bangladesh. Economic activity in Bangladesh is highly dependent on natural resources; poverty is widespread; and there is high variability in ecosystem services at multiple temporal scales. The results show that long-term decreases in poverty are predicated more on the stability of, and returns from, livelihoods rather than their diversification. Access to natural resources and ecosystem service benefits are positively correlated with stable income and multidimensional well-being. Households that remain in poverty are those who experience high seasonality of income and are involved in small scale enterprises. Hence, seasonal variability in income places significant limits on natural resources providing routes out of poverty. Further, projected economic trends to 2030 lead to an increase in well-being and a reduction in poverty for most simulated household types. [ABSTRACT FROM AUTHOR]

Environmental conditions that contribute to childhood lead exposure are spatially patterned. Socioeconomic and racial inequities in childhood lead exposure have been well documented, however childhood lead exposure in Milwaukee is understudied. As a segregated rustbelt metropolitan area with childhood lead exposure concerns, Milwaukee is uniquely positioned to evaluate the synergistic effects of racial and economic drivers of childhood lead exposure. Using surveillance data from the Wisconsin Department of Health Services, Division of Public Health and the US Census Bureau, this cross-sectional study determined the intersectional effect of poverty, home ownership, and racial/ethnic composition on childhood lead exposure in Milwaukee County neighborhoods using linear regression adjusting for average census tract housing age and number of children. The final analytical sample consisted of 48,393 individual childhood blood lead levels aggregated to 215 Milwaukee County census tracts. Census tracts with mean childhood blood lead levels greater than or equal to 5 μg/dL were predominantly low home ownership, high poverty, and majority non-White census tracts. The effects of low home ownership, high poverty, and majority non-White census tracts were synergistic, producing 1.78 (95% CI: 1.44, 2.11) μg/dL higher mean childhood blood lead level than high home ownership, low poverty, and majority White census tracts (referent). This research reveals that social determinants at the neighborhood level co-occur and interact to produce inequities in childhood lead exposure. Lead prevention efforts should align with equity-focused housing and economic policies that target primary prevention in neighborhoods disproportionately burdened by childhood lead exposure. [ABSTRACT FROM AUTHOR]

Income inequality is blamed for being the main driver of violent crime by the majority of the literature. However, earlier work on the topic largely neglects the role of poverty and income levels as opposed to income inequality. The current paper uses all court verdicts for homicide cases in China between 2014 and 2016, as well as various inequality measures calculated from 2005 mini census data together with a host of control variables to shed light on the relationship at the detailed Chinese prefecture-level. The results suggest that it is the poverty and low income level, rather than income inequality, that is positively related to homicide rates. We show that the internal rural-urban migration from more violent localities contributes to the destination cities' homicide rates. The poverty-homicide association implies that instead of "relative deprivation", "absolute deprivation" is mainly responsible for violent crime. Poverty is the mother of crime. —Marcus Aurelius (121-180AD), Emperor of the Roman Empire. [ABSTRACT FROM AUTHOR]

Over the last two decades, private renting has undergone a major revival in the UK, more than doubling its share within the housing system. Young adults increasingly remain in the sector into their 30s, giving rise to the term 'Generation Rent'. Using data from the UK's Family Resources Survey, this article shows how reliance on the sector varies by poverty status, particularly for young adults and children. In 2017/18, 42 per cent of adults under 40 in low-income poverty lived in private renting, compared with just 26 per cent of non-poor. This is almost double the proportion of 20 years earlier. Private renting is now home to more poor adults under 40 than owner occupation and social renting combined. In addition, one in three children in poverty (36 per cent) now lives in private renting, three times the level of 20 years ago. For both adults and children, rates are even higher in London and the South. Although rates of increase have slowed in recent years, this dramatic shift in the housing circumstances of those in poverty has a number of implications for housing and social policy which have not yet been sufficiently recognised. [ABSTRACT FROM AUTHOR]

Background: The provision of health care in low-income and middle-income countries (LMICs) is recognized as a significant contributor to economic growth and also impacts individual families at a microeconomic level. The primary goal of our study was to examine the relationship between surgical conditions in children and the poverty trajectories of either falling into or coming out of poverty of families across Somaliland. Methods: This work used the Surgeons OverSeas Assessment of Surgical Need (SOSAS) tool, a validated household, cross-sectional survey designed to determine the burden of surgical conditions within a community. We collected information on household demographic characteristics, including financial information, and surgical condition history on children younger than 16 years of age. To assess poverty trajectories over time, we measured household assets using the Stages of Progress framework. Results: We found there were substantial fluxes in poverty across Somaliland over the study period. We confirmed our study hypothesis and found that the presence of a surgical condition in a child itself, regardless of whether surgical care was provided, either reduced the chances of moving out of poverty or increased the chances of moving towards poverty. Conclusion: Our study shows that the presence of a surgical condition in a child is a strong singular predictor of poverty descent rather than upward mobility, suggesting that this stressor can limit the capacity of a family to improve its economic status. Our findings further support many existing macroeconomic and microeconomic analyses that surgical care in LMICs offers financial risk protection against impoverishment. [ABSTRACT FROM AUTHOR]

Background: Youth with disability contribute to a high burden of disease but are often neglected. This study aims to estimate the prevalence of disability and its association with poverty among Chinese youth aged 15–24 years. Methods: Data were obtained from a nationally representative population-based cross-sectional survey in 2006 and its follow-up investigations from 2007 to 2013 in 31 provinces of mainland China. A total of 357 856 non-institutionalized youth at age of 15–24 years were investigated. Population weighted numbers and prevalence rates with 95% CI of various types and causes of disabilities for the overall youth were estimated where appropriate. Univariate and multivariate logistic regressions were used to identify the association between poverty and each type of and cause-specific disability. Results: A weighted number of 3 633 838 youth were living with disability in China, with a prevalence rate of 19.7 per thousand Chinese youth. Youth living in poor households were 3.84 times more likely to be with disability than those living in affluent households (95% CI: 3.56–4.14). Associations were similar for most types of and cause-specific disabilities. Among youth with disability, those from poor households had less healthcare service use (OR: 0.71, 95% CI: 0.61–0.82) than those from affluent households. Conclusion: A significant number of Chinese youth were living with disability, and poverty is significant associated with the disability among youth. Investment in health and disability prevention are essential to the development of youth, as well as their families and communities. [ABSTRACT FROM AUTHOR]

In Spain, the issue of unemployment or precarious employment worsen with globalization, leading to an expansion of the so-called working poor in the labour market. According to previous literature, the economic poverty that is characteristic of this group may accompany poverty competency. In particular, the working poor resort to informal and poorly developed job-search strategies. This study addresses the job search methods used by people at risk of poverty and social exclusion. It provides evidence on the subject and serves as a basis for the adaptation of socio-labour intermediation programmes to this group. The hypothesis of this study is that people at high risk will predominantly use informal strategies that require a low level of job-search skills. A survey-based correlational study is conducted using a questionnaire completed by 279 people participating in socio-labour intermediation programmes developed by the Action against Hunger Foundation (AaHF) in Spain. Information on poverty indicators and on job-search strategies is collected. Data are analysed through cluster analysis, which distinguish two groups of people at risk of poverty and social exclusion (high risk and low risk), followed by a comparison of means (t-test) with a subsequent calculation of effect size using Cohen's d. Results show statistically significant differences with a medium effect size (between 0.45 and 0.50) for the typology of job-search strategies used, confirming the initial hypothesis. These results offer relevant information that should be considered when developing programmes aimed at improving social and labour issues for people at risk of poverty and social exclusion. [ABSTRACT FROM AUTHOR]

Introduction: Poverty is a well-known risk factor for a child’s health and development. This paper aimed to establish whether poverty negatively affected both intra-uterine growth and early childhood growth, i.e., whether children facing poverty were at a double disadvantage. Methods: For this study, we made use of routinely collected data on child development throughout early childhood from the 2006–2009 birth cohorts in Kind & Gezin’s Ikaros database collected during 2,605,975 consultations with 273,935 children from birth to 730 days old. Indicators for child development at birth were gestational age and height-at-birth. A standardized height-for-age indicator captured height development throughout early childhood. A multidimensional indicator measured the risk of poverty. For the analysis of development at birth, we used linear and logistic regression; for the analysis of height development during early childhood, we estimated linear and logistic growth curve models. Results: The risk of poverty negatively affected both gestational age and height-at-birth. Throughout early childhood, we observed a negative relation between the risk of poverty and height-for-age indicators. However, the effect varied throughout childhood. Children at risk of poverty (over)compensated for their smaller stature at birth, and between ages 6 and 18 months, approximately, the negative effects of risk of poverty decreased substantially or disappeared. However, towards the end of the period studied, children born in households at risk of poverty started to lag again in height development. Conclusion: This study found that the risk of poverty indeed negatively affected a child’s growth, both in utero and in early childhood. However, the results suggest that developmental lags later in childhood were not merely an extension of such lags at birth. [ABSTRACT FROM AUTHOR]

Background: Climate change and extreme temperatures pose increasing challenges to individuals and their health with older adults being one of the most vulnerable groups. The aim of this paper is to better understand the roles that tangible assets (e.g., physical or financial) and intangible assets (e.g., human or social) play in the way older adults adapt to extreme temperatures, the types of adaptive responses they implement, limits and constraints, as well opportunities for better adaptation. Rather than focusing exclusively on extremes of heat, or considering each type of asset in isolation, the important and novel contribution of this paper is to take an integrated and multi-seasonal qualitative and quantitative approach, that conjointly investigates all categories of assets in relation to the adaptations that independently-living older adults make to both extreme heat and extreme cold. Methods and findings: The paper examines the contribution of assets to adaptation to extreme temperatures among older adults living independently in their homes. An innovative mixed methods study with an inter-seasonal approach was implemented in Lisbon, Portugal with interviews and surveys during summer for extreme heat and winter for extreme cold. The ability of participants to adapt to extreme temperatures was found to be dependent on asset context and diversity, and the dynamics through which extreme temperatures enhanced or reduced the stock of assets available. As a result, participants engaged in activities of assets replacement, exchange or substitutions. Despite this, many participants recognised many constraints and limits to their ability to adapt and protect their health and well-being ranging from reduced income, high energy costs and lack of social networks. Opportunities for improving older adults’ adaptation were found to exist and strategies, action and investment have been identified by older adults which included life-long education, incentives to improve insulation and local activities. Conclusions: The paper suggests that the implementation of the proposed asset-based approach linking assets and adaptation to extreme temperatures, illustrates the key pathway that individuals, their families and carers, governments, policymakers, researchers and practitioners can follow to ensure effective adaptation and promote health and well-being. Supporting older adults’ adaptation to extreme temperatures is possible and can be complemented with efforts to reduce older adults’ vulnerability and building resilience to extreme temperatures. These findings pose concrete implications for policy and practice, including for example the need for implementation of measures and actions to reduce poverty, reduce energy costs, improve the quality of the housing stock and improve older adults’ social networks. [ABSTRACT FROM AUTHOR]

Background: The majority of women suffering from maternal morbidities live in resource-constrained settings with diverse barriers preventing access to quality biomedical health care services. This study aims to highlight the dynamics between the public health system and alternative healing through an exploration of the experiences of health care seeking among women living with severe symptomatic pelvic organ prolapse in an impoverished setting. Methods: The data were collected through ethnographic fieldwork at the hospital and community levels in the Amhara region of Ethiopia. The fieldwork included participant observation, 42 semi-structured interviews and two focus group discussions over a period of one year. A group of 24 women with severe symptomatic pelvic organ prolapse served as the study’s main informants. Other central groups of informants included health care providers, local healers and actors from the health authorities and non-governmental organisations. Results: Three case stories were chosen to illustrate the key findings related to health care seeking among the informants. The women strove to find remedies for their aggravating ailment, and many navigated between and combined various available healing options both within and beyond the health care sector. Their choices were strongly influenced by poverty, by lack of knowledge about the condition, by their religious and spiritual beliefs and by the shame and embarrassment related to the condition. An ongoing health campaign in the study area providing free surgical treatment for pelvic organ prolapse enabled a study of the experiences related to the introduction of free health services targeting maternal morbidity. Conclusions: This study highlights how structural barriers prevent women living in a resource-constrained setting from receiving health care for a highly prevalent and readily treatable maternal morbidity such as pelvic organ prolapse. Our results illustrate that the provision of free quality services may dramatically alter both health-and illness-related perceptions and conduct in an extremely vulnerable population. [ABSTRACT FROM AUTHOR]

Despite global health improvements, substantial challenges in social determinants of health and poverty remain in rural communities in low-income countries. Public health theorists suggest that communities with high social capital are less vulnerable to such challenges and more likely to participate in community development. This research examines levels of social capital amongst rural communities in southern Malawi through data gathered as part of a participatory needs assessment for a Healthy Settings project, and discusses the potential benefits of having access to such data before project implementation. Social capital data was collected during 108 focus group discussions in 18 communities (split by gender, age, status) by adapting an existing mixed methods measurement tool, the Schutte tool. Five indicators were measured: sense of belonging, friendship, reliance, ability to work together and influence. Mean results showed all 18 communities had medium-high levels of social capital. Means from each group in the 18 communities highlighted the lowest social capital among the youth groups and the highest with the leaders. A more detailed breakdown highlighted that all groups had a strong sense of belonging to the community, while youth and women had lower social capital levels in terms of influence over local decisions and ability to rely on other community members. Incorporating social capital tools into community health needs assessments in low-income settings provides a valuable overview of community dynamics before project implementation, and Monitoring & Evaluation indicators which allow changes in social capital to be measured at different stages of the project. [ABSTRACT FROM AUTHOR]

Each year, evidence-based clinical guidelines gain more space in the health professionals’ practice and in services organization. Due to the scarcity of scientific publications focused on diseases of poverty, the development of well-founded clinical guidelines becomes more and more important. In view of that, this paper aims to evaluate the quality of Brazilian guidelines for those diseases. The AGREE II method was used to evaluate 16 guidelines for poverty-related diseases (PRD) and 16 guidelines for global diseases whose treatment require high-cost technologies (HCD), with the ultimate aim of comparing the results. It was found that, in general, the guideline development quality standard is higher for the HCD guidelines than for the PRD guidelines, with emphasis on the "rigour of development" (48% and 7%) and "editorial independence" (43% and 1%) domains, respectively, which had the greatest discrepancies. The HCD guidelines showed results close to or above international averages, whereas the PRD guidelines showed lower results in the 6 domains evaluated. It can be concluded that clinical protocol development priorities need some redirecting in order to qualify the guidelines that define the healthcare organization and the care of vulnerable populations. [ABSTRACT FROM AUTHOR]

Background: Food insecurity and poverty rates in Ghana are highest in the districts from latitude 8° N upwards. These have motivated several interventions aimed at addressing the food insecurity via promoting agricultural growth. An assessment of the overall impact of these interventions on food security is necessary to guide policy design and future interventions. Methods and findings: A systematic review was used to assess the cumulative evidence of the effect of development interventions, implemented from 2006 to 2016 on food security, especially in Northern Ghana. Information were retrieved from over 20 Government and non-Governmental organisations through online search and actual visits. The number of studies included in systematic review was 22. The study showed that a large number of interventions have been implemented in Northern Ghana over the study period. Access to quality extension services, training and capacity building was a major intervention strategy. About 82% of studies considered increasing production but only 14% of the studies reported on changes in yield. About 42% of the included studies used market access as a strategy but about 44% reported increase in incomes of beneficiaries (with only seven studies providing numerical evidence for this claim). The ranking of frequency of intervention strategies was in the order extension and capacity building > production > postharvest value addition > water and irrigation facilities > storage facilities > input supply. A substantial number of the studies had no counterfactuals, weakening confidence in attributing impacts on food security for even the beneficiaries. Conclusions: It is concluded that evidence for impacts of the interventions on food security was weak, or largely assumed. A logical recommendation is the need for development partners to synchronise their measurement and indicators of food security outcomes. It is also recommended that some food security indicators are explicitly incorporated into intervention design while bearing in mind the potential need for counterfactuals. [ABSTRACT FROM AUTHOR]

Background: The incidence of canine rabies cases in El Salvador has decreased in the last decade since the establishment of intense control programs, such as massive vaccination campaigns implemented by the Ministry of Health. Socioeconomic crises in recent years have limited the access to certain areas across the country and have impacted surveillance and prevention campaigns, which places the country at risk for a resurgence of canine rabies.We aimedto describe the spatiotemporal patterns of canine rabies and its association with critical social factors in El Salvador from 2005 to 2014. Method: We included 459 cases of canine rabies. Several socioeconomic, demographic, and surveillance variables were modeled using a Poisson regression to evaluate their associations with the incidence of canine rabies. Spatial scan statistics were adjusted or unadjusted with covariates and applied to identify statistically significant clusters of canine rabies. Finally, a canine rabies risk map was created. Results: A positive association and higher risk of canine rabies were found for low poverty zones, where it is suspected that urban slums contribute to ongoing rabies transmission (RR = 7.74). Violence had a negative association with rabies (RR = 0.663), which is likely due to reporting bias. Significant clusters were identified in all five epidemiological regions, and the Eastern region had the highest risk (RR = 50.62). The influences of the selected variables in cluster detection were confirmed by the adjusted analysis. Higher-risk townships were distributed from the Western to the Eastern regions of the country. Conclusion: Social factors are determinants of rabies in El Salvador and play a major role in national spatial patterns of the disease. There are high-risk areas for canine rabies across the country, and there were two persistent rabies foci during the study period. Examining the role of social factors can provide better insight into rabies in vulnerable countries, and socioeconomic factors can be key elements in developing better policies and interventions for rabies control. [ABSTRACT FROM AUTHOR]

Lesbian, gay, bisexual, trans, and/or queer (LGBTQ) people face barriers to accessing mental health care; however, we know little about service experiences of low income LGBTQ people. In this qualitatively-driven mixed methods study, over 700 women and/or trans people completed an internet survey, of whom 12 LGBTQ individuals living in poverty participated in interviews. Low income LGBTQ respondents saw more mental health professionals and had more unmet need for care than all other LGBTQ/income groups. Narrative analysis illustrated the work required to take care of oneself in the context of extreme financial constraints. These findings highlight the mechanisms through which inadequate public sector mental health services can serve to reproduce and sustain both poverty and health inequities. [ABSTRACT FROM AUTHOR]

Several scholars have concluded that ethnic diversity has negative consequences for social trust. However, recent research has called into question whether ethnic diversity per se has detrimental effects, or whether lower levels of trust in diverse communities simply reflect a higher concentration of less trusting groups, such as poor people, minorities, or immigrants. Drawing upon a nationally representative sample of the German population (GSOEP), we make two contributions to this debate. First, we examine how ethnic diversity at the neighborhood level–specifically the proportion of immigrants in the neighborhood–is linked to social trust focusing on the compositional effect of poverty. Second, in contrast to the majority of current research on ethnic diversity, we use a behavioral measure of trust in combination with fine-grained (zip-code level) contextual measures of ethnic composition and poverty. Furthermore, we are also able to compare the behavioral measure to a standard attitudinal trust question. We find that household poverty partially accounts for lower levels of trust, and that after controlling for income, German and non-German respondents are equally trusting. However, being surrounded by neighbors with immigrant background is also associated with lower levels of social trust. [ABSTRACT FROM AUTHOR]

Background: Poverty and human capital development are inextricably linked and therefore research on human capital typically incorporates measures of economic well-being. In the context of randomized trials of health interventions, for example, such measures are used to: 1) assess baseline balance; 2) estimate covariate-adjusted analyses; and 3) conduct subgroup analyses. Many factors characterize economic well-being, however, and analysts often generate summary measures such as indices of household socio-economic status or wealth. In this paper, a household wealth index is developed and tested for participants in the cluster-randomized Sanitation, Hygiene, Infant Nutrition Efficacy (SHINE) trial in rural Zimbabwe. Methods: Building on the approach used in the Zimbabwe Demographic and Health Survey (ZDHS), we combined a set of housing characteristics, ownership of assets and agricultural resources into a wealth index using principal component analysis (PCA) on binary variables. The index was assessed for internal and external validity. Its sensitivity was examined considering an expanded set of variables and an alternative statistical approach of polychoric PCA. Correlation between indices was determined using the Spearman’s rank correlation coefficient and agreement between quintiles using a linear weighted Kappa statistic. Using the 2015 ZDHS data, we constructed a separate index and applied the loadings resulting from that analysis to the SHINE study population, to compare the wealth distribution in the SHINE study with rural Zimbabwe. Results: The derived indices using the different methods were highly correlated (r>0.9), and the wealth quintiles derived from the different indices had substantial to near perfect agreement (linear weighted Kappa>0.7). The indices were strongly associated with a range of assets and other wealth measures, indicating both internal and external validity. Households in SHINE were modestly wealthier than the overall population of households in rural Zimbabwe. Conclusion: The SHINE wealth index developed here is a valid and robust measure of wealth in the sample. [ABSTRACT FROM AUTHOR]

Poverty affects many people, but the ramifications and impacts affect all aspects of society. Information about the incidence of poverty is therefore an important parameter of the population for policy analysis and decision making. In order to provide specific, targeted solutions when addressing poverty disadvantage small area statistics are needed. Surveys are typically designed and planned to produce reliable estimates of population characteristics of interest mainly at higher geographic area such as national and state level. Sample sizes are usually not large enough to provide reliable estimates for disaggregated analysis. In many instances estimates are required for areas of the population for which the survey providing the data was unplanned. Then, for areas with small sample sizes, direct survey estimation of population characteristics based only on the data available from the particular area tends to be unreliable. This paper describes an application of small area estimation (SAE) approach to improve the precision of estimates of poverty incidence at district level in the State of Bihar in India by linking data from the Household Consumer Expenditure Survey 2011–12 of NSSO and the Population Census 2011. The results show that the district level estimates generated by SAE method are more precise and representative. In contrast, the direct survey estimates based on survey data alone are less stable. [ABSTRACT FROM AUTHOR]

Recent studies have examined the risk of poverty throughout the life course, but few have considered how transitioning in and out of poverty shape the dynamic heterogeneity and mortality disparities of a cohort at each age. Here we use state-by-age modeling to capture individual heterogeneity in crossing one of three different poverty thresholds (defined as 1×, 2× or 3× the “official” poverty threshold) at each age. We examine age-specific state structure, the remaining life expectancy, its variance, and cohort simulations for those above and below each threshold. Survival and transitioning probabilities are statistically estimated by regression analyses of data from the Health and Retirement Survey RAND data-set, and the National Longitudinal Survey of Youth. Using the results of these regression analyses, we parameterize discrete state, discrete age matrix models. We found that individuals above all three thresholds have higher annual survival than those in poverty, especially for mid-ages to about age 80. The advantage is greatest when we classify individuals based on 1× the “official” poverty threshold. The greatest discrepancy in average remaining life expectancy and its variance between those above and in poverty occurs at mid-ages for all three thresholds. And fewer individuals are in poverty between ages 40-60 for all three thresholds. Our findings are consistent with results based on other data sets, but also suggest that dynamic heterogeneity in poverty and the transience of the poverty state is associated with income-related mortality disparities (less transience, especially of those above poverty, more disparities). This paper applies the approach of age-by-stage matrix models to human demography and individual poverty dynamics. In so doing we extend the literature on individual poverty dynamics across the life course. [ABSTRACT FROM AUTHOR]

Proven links between disability and poverty suggest that development programmes and policies that are not disability-inclusive will leave persons with disabilities behind. Despite this, there is limited quantitative evidence on livelihood opportunities amongst adults with disabilities in Low and Middle Income Countries. This study adds to the limited evidence base, contributing data from one African and one Asian Setting. We undertook a population-based case–control study of adults (18+) with and without disabilities in North-West Cameroon and in Telangana State, India. We found that adults with disabilities were five times less likely to be working compared to age-sex matched controls in both settings. Amongst adults with disabilities, current age, marital status and disability type were key predictors of working. Inclusive programmes are therefore needed to provide adequate opportunities to participate in livelihood prospects for adults with disabilities in Cameroon and India, on an equal basis as others. These findings are of crucial importance at this stage of the Sustainable Development Agenda, to ensure that the mandate of inclusive development is achieved. [ABSTRACT FROM AUTHOR]

In recent years, entrepreneurship has been gaining more prominence as a potential tool for solving poverty in developing countries. This paper mainly examines the relationship between farmer entrepreneurship and rural poverty alleviation in China by assessing the contribution of farm entrepreneurs towards overcoming poverty. Data were collected from 309 employees of farmer entrepreneurships in Guangxi Province through survey questionnaires. Structural equation modeling was used to conduct an analysis of the effects of three identified capabilities of farm entrepreneurs—economic, educational and knowledge, and socio-cultural capabilities—on attitude towards farmer entrepreneurship growth and the qualitative growth of farmer entrepreneurship and how these in turn affect rural poverty, using AMOS 21. The findings show that socio-cultural capability has the greatest influence on farmer entrepreneurship growth (β = 0.50, p<0.001). The qualitative growth of farmer entrepreneurship also more significantly impacts rural poverty (β = 0.69, p<0.001) than attitude towards farmer entrepreneurship growth. This study suggests that policy makers in China should involve more rural farmers in the targeted poverty alleviation strategies of the government by equipping rural farmers with entrepreneurial skills. This can serve as a sustainable, bottom-up approach to alleviating rural poverty in remote areas of the country. The study also extends the literature on the farmer entrepreneurship-rural poverty alleviation nexus in China, and this can serve as a lesson for other developing countries in the fight against rural poverty. [ABSTRACT FROM AUTHOR]

Background: Children exposed to family poverty have been found to have higher morbidity and mortality rates, poorer mental health and cognitive outcomes and reduced life chances across a wide range of life domains. There is, however, very little known about the extent to which poverty is experienced by children over their early life course, particularly in community samples. This study tracks changes in family poverty and the main factors that predict family poverty (adverse life experiences) over a 30-year period since the birth of the study child. Methods: Data are from a prospective, longitudinal, birth cohort study conducted in Brisbane, Australia. Consecutive families were recruited at the mothers’ first obstetrical visit at one of two major obstetrical hospitals in Brisbane. Data are available for 2087 families with complete data at the 30-year follow-up. Poverty was measured using family income at each time point (adjusted for inflation). Findings: Poverty affects about 20% of families at any time point. It is common for families to move in and out of poverty, as their circumstances are affected by such adversities as unemployment and marital breakdown. Over the period of the study about half the families in the study experienced poverty on at least one occasion. Only a very small minority of families experienced persistent poverty over the 30-year duration of the study. Logistic regressions with time lag show that family poverty predicts subsequent adversities and adverse events predict subsequent poverty. Conclusions: Experiences of poverty and adversity are common and may vary greatly over the child’s early life course. In assessing the health consequences of poverty, it is important to distinguish the timing and chronicity of early life course experiences of poverty and adversity. [ABSTRACT FROM AUTHOR]

Introduction: Disability and poverty are believed to operate in a cycle, with each reinforcing the other. While agreement on the existence of a link is strong, robust empirical evidence substantiating and describing this potential association is lacking. Consequently, a systematic review was undertaken to explore the relationship between disability and economic poverty, with a focus on the situation in low and middle income countries (LMICs). Methods: Ten electronic databases were searched to retrieve studies of any epidemiological design, published between 1990-March 2016 with data comparing the level of poverty between people with and without disabilities in LMICs (World Bank classifications). Poverty was defined using economic measures (e.g. assets, income), while disability included both broad assessments (e.g. self-reported functional or activity limitations) and specific impairments/disorders. Data extracted included: measures of association between disability and poverty, population characteristics and study characteristics. Proportions of studies finding positive, negative, null or mixed associations between poverty and disability were then disaggregated by population and study characteristics. Results: From the 15,500 records retrieved and screened, 150 studies were included in the final sample. Almost half of included studies were conducted in China, India or Brazil (n = 70, 47%). Most studies were cross-sectional in design (n = 124, 83%), focussed on specific impairment types (n = 115, 77%) and used income as the measure for economic poverty (n = 82, 55%). 122 studies (81%) found evidence of a positive association between disability and a poverty marker. This relationship persisted when results were disaggregated by gender, measure of poverty used and impairment types. By country income group at the time of data collection, the proportion of country-level analyses with a positive association increased with the rising income level, with 59% of low-income, 67% of lower-middle and 72% of upper-middle income countries finding a positive relationship. By age group, the proportion of studies reporting a positive association between disability and poverty was lowest for older adults and highest for working-age adults (69% vs. 86%). Conclusions: There is strong evidence for a link between disability and poverty in LMICs and an urgent need for further research and programmatic/policy action to break the cycle. [ABSTRACT FROM AUTHOR]

The Centers for Medicare and Medicaid Services recently released a five star rating system as part of ‘Dialysis Facility Compare’ to help patients identify and choose high performing clinics in the US. Eight dialysis-related measures determine ratings. Little is known about the association between surrounding community sociodemographic characteristics and star ratings. Using data from the U.S. Census and over 6000 dialysis clinics across the country, we examined the association between dialysis clinic star ratings and characteristics of the local population: 1) proportion of population below the federal poverty level (FPL); 2) proportion of black individuals; and 3) proportion of Hispanic individuals, by correlation and regression analyses. Secondary analyses with Quality Incentive Program (QIP) scores and population characteristics were also performed. We observed a negligible correlation between star ratings and the proportion of local individuals below FPL; Spearman coefficient, R = -0.09 (p<0.0001), and a stronger correlation between star ratings and the proportion of black individuals; R = -0.21 (p<0.0001). Ordered logistic regression analyses yielded adjusted odds ratio of 0.91 (95% confidence interval [0.80–1.30], p = 0.12) and 0.55 ([0.48–0.63], p<0.0001) for high vs. low level of proportion below FPL and proportion of black individuals, respectively. In contrast, a near-zero correlation was observed between star ratings and the proportion of Hispanic individuals. Correlations varied substantially by country region, clinic profit status and clinic size. Analyses using clinic QIP scores provided similar results. Sociodemographic characteristics of the surrounding community, factors typically outside of providers’ direct control, have varying levels of association with clinic dialysis star ratings. [ABSTRACT FROM AUTHOR]

The developing region of SAARC (South Asian Association for Regional Cooperation) is home to a large number of people living below the poverty line. In future, providing affordable, universally accessible, reliable, low to zero carbon electricity in this region will be the main aim. A cost optimal 100% renewable energy system is simulated for SAARC for the year 2030 on an hourly resolved basis. The region was divided into 16 sub-regions and three different scenarios were set up based on the level of high voltage direct current (HVDC) grid connections. The results obtained for a total system levelised cost of electricity (LCOE) showed a decrease from 71.6 €/MWh in a decentralized to 67.2 €/MWh for a centralized grid connected scenario. An additional scenario was simulated to show the benefits of integrating industrial gas production and seawater reverse osmosis desalination demand, and showed the system cost decreased by 5% and total electricity generation decreased by 1%. The results show that a 100% renewable energy system could be a reality in the SAARC region with the cost assumptions used in this research and it may be more cost competitive than nuclear and fossil carbon capture and storage (CCS) alternatives. One of the limitations of this study is the cost of land for installation of renewables which is not included in the LCOE calculations, but regarded as a minor contribution. [ABSTRACT FROM AUTHOR]

Background: Globally, food insecurity is a major public health concern. In North America, it is particularly prevalent in certain sub-groups, including Indigenous communities. Although many Indigenous and remote communities harvest and share food, most food security assessment tools focus on economic access. This study describes the psychometric evaluation of a modified Household Food Insecurity Access Scale (HFIAS), developed for mixed economies, to assess food insecurity among pregnant Inuit women. Methods: The HFIAS was administered to 130 pregnant women in Nunavik (Arctic region of Quebec), Canada. Data were fit to a Rasch Rating Scale Model (RSM) to determine the discrimination ability of the HFIAS. Person parameter (Theta) estimates were calculated based on the RSM to provide a more accurate scoring system of the modified HFIAS for this population. Theta values were compared to known correlates of food insecurity. Results: Comparative fit indices showed preference for a modified version of the HFIAS over the original. Theta values displayed a continuum of severity estimates and those values indicating greater food insecurity were consistently linked to known correlates of food insecurity. Participants living in households with more than 1 hunter (Theta = -.45) or more than 1 fisher (Theta = -.43) experienced less food insecurity than those with no hunters (Theta = .48) or fishers (Theta = .49) in their household. The RSM indicated the scale showed good discriminatory ability. Subsequent analyses indicated that most scale items pertain to the classification of a household as moderately food insecure. Conclusions: The modified HFIAS shows potential for measuring food insecurity among pregnant women in Nunavik. This is an efficient instrument that can inform interventions targeting health conditions impacting groups that obtain food through both monetary and non-monetary means. [ABSTRACT FROM AUTHOR]

Drip irrigation is a means of distributing the exact amount of water a plant needs by dripping water directly onto the root zone. It can produce up to 90% more crops than rain-fed irrigation, and reduce water consumption by 70% compared to conventional flood irrigation. Drip irrigation may enable millions of poor farmers to rise out of poverty by growing more and higher value crops, while not contributing to overconsumption of water. Achieving this impact will require broadening the engineering knowledge required to design new, low-cost, low-power drip irrigation technology, particularly for poor, off-grid communities in developing countries. For more than 50 years, pressure compensating (PC) drip emitters—which can maintain a constant flow rate under variations in pressure, to ensure uniform water distribution on a field—have been designed and optimized empirically. This study presents a parametric model that describes the fluid and solid mechanics that govern the behavior of a common PC emitter architecture, which uses a flexible diaphragm to limit flow. The model was validated by testing nine prototypes with geometric variations, all of which matched predicted performance to within R2 = 0.85. This parametric model will enable irrigation engineers to design new drip emitters with attributes that improve performance and lower cost, which will promote the use of drip irrigation throughout the world. [ABSTRACT FROM AUTHOR]

Gun violence in the United States of America is a large public health problem that disproportionately affects urban areas. The epidemiology of gun violence reflects various aspects of an infectious disease including spatial and temporal clustering. We examined the spatial and temporal trends of gun violence in Syracuse, New York, a city of 145,000. We used a spatial scan statistic to reveal spatio-temporal clusters of gunshots investigated and corroborated by Syracuse City Police Department for the years 2009–2015. We also examined predictors of areas with increased gun violence using a multi-level zero-inflated Poisson regression with data from the 2010 census. Two space-time clusters of gun violence were revealed in the city. Higher rates of segregation, poverty and the summer months were all associated with increased risk of gun violence. Previous gunshots in the area were associated with a 26.8% increase in the risk of gun violence. Gun violence in Syracuse, NY is both spatially and temporally stable, with some neighborhoods of the city greatly afflicted. [ABSTRACT FROM AUTHOR]

Objectives: Severe acute malnutrition (SAM) is an important risk factor for illness and death globally, contributing to more than half of deaths in children worldwide. We hypothesized that SAM is positively correlated to poverty, low educational attainment, major crime and higher mean soil concentrations of lead, cadmium and arsenic. Methods: We reviewed admission records of infants admitted with a diagnosis of SAM over 14 years (2000–2013) in Jamaica. Poverty index, educational attainment, major crime and environmental heavy metal exposure were represented in a Geographic Information System (GIS). Cases of SAM were grouped by community and the number of cases per community/year correlated to socioeconomic variables and geochemistry data for the relevant year. Results: 375 cases of SAM were mapped across 204 urban and rural communities in Jamaica. The mean age at admission was 9 months (range 1–45 months) and 57% were male. SAM had a positive correlation with major crime (r = 0.53; P < 0.001), but not with educational attainment or the poverty index. For every one unit increase in the number of crimes reported, the rate of occurrence of SAM cases increased by 1.01% [Incidence rate ratio (IRR) = 1.01 (95% CI = 1.006–1.014); P P<0.001]. The geochemistry data yielded no correlation between levels of heavy metals and the prevalence of malnutrition. Conclusion: Major crime has an independent positive association with severe acute malnutrition in Jamaican infants. This could suggest that SAM and major crime might have similar sociological origins or that criminality at the community level may be indicative of reduced income opportunities with the attendant increase in poor nutrition in the home. [ABSTRACT FROM AUTHOR]

Background: Social isolation is an important determinant of all-cause mortality, with evidence suggesting an association with cancer-specific mortality as well. In this study, we examined the associations between social isolation and neighborhood poverty (independently and jointly) on cancer mortality in a population-based sample of US adults. Methods: Using data from the Third National Health and Nutrition Examination Survey (NHANES III; 1988–1994), NHANES III Linked Mortality File (through 2011) and 1990 Census, we estimated the relationship between social isolation and high neighborhood poverty and time-to-cancer death using multivariable-adjusted Cox proportional hazards models. We examined the associations of each factor independently and explored the multiplicative and additive interaction effects on cancer mortality risk and also analyzed these associations by sex. Results: Among 16 044 US adults with 17–23 years of follow-up, there were 1133 cancer deaths. Social isolation (HR 1.25, 95% CI: 1.01–1.54) and high neighborhood poverty (HR 1.31, 95% CI: 1.08–1.60) were associated with increased risk of cancer mortality adjusting for age, sex, and race/ethnicity; in sex-specific estimates this increase in risk was evident among females only (HR 1.39, 95% CI: 1.04–1.86). These associations were attenuated upon further adjustment for socioeconomic status. There was no evidence of joint effects of social isolation and high neighborhood poverty on cancer mortality overall or in the sex-stratified models. Conclusions: These findings suggest that social isolation and higher neighborhood poverty are independently associated with increased risk of cancer mortality, although there is no evidence to support our a priori hypothesis of a joint effect. [ABSTRACT FROM AUTHOR]

Background: Quality of healthcare is an important determinant of future progress in global health. However, the distributional aspects of quality of care have received inadequate attention. We assessed whether high quality maternal care is equitably distributed by (1) mapping the quality of maternal care in facilities located in poorer versus wealthier areas of Kenya; and (2) comparing the quality of maternal care available to Kenyans in and not in poverty. Methods: We assessed three measures of maternal care quality: facility infrastructure and clinical quality of antenatal care and delivery care, using indicators from the 2010 Kenya Service Provision Assessment (SPA), a standardized facility survey with direct observation of maternal care provision. We calculated poverty of the area served by antenatal or delivery care facilities using the Multidimensional Poverty Index. We used regression analyses and non-parametric tests to assess differences in maternal care quality in facilities located in more and less impoverished areas. We estimated effective coverage with a minimum standard of care for the full population and those in poverty. Results: A total of 564 facilities offering at least one maternal care service were included in this analysis. Quality of maternal care was low, particularly clinical quality of antenatal and delivery care, which averaged 0.52 and 0.58 out of 1 respectively, compared to 0.68 for structural inputs to care. Maternal healthcare quality varied by poverty level: at the facility level, all quality metrics were lowest for the most impoverished areas and increased significantly with greater wealth. Population access to a minimum standard (≥0.75 of 1.00) of quality maternal care was both low and inequitable: only 17% of all women and 8% of impoverished women had access to minimally adequate delivery care. Conclusion: The quality of maternal care is low in Kenya, and care available to the impoverished is significantly worse than that for the better off. To achieve the national targets of maternal and neonatal mortality reduction, policy initiatives need to tackle low quality of care, starting with high-poverty areas. [ABSTRACT FROM AUTHOR]