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The number of cesarean deliveries has increased sharply worldwide over the last 3 decades. The World Health Organization recommends using the Robson classification as the best tool for monitoring and auditing cesarean delivery rates and to safely reduce the rate of avoidable cesarean deliveries.This study aimed to identify the association between the Robson classification groups and cesarean delivery in 2008 and 2018 at the Urguu Maternity Hospital, Ulaanbaatar, Mongolia, and to examine the changes in this association over 10 years.This cross-sectional study was conducted using 21,225 participants' electronic birth records (9544 in 2008 and 11,681 in 2018) from the Urguu Maternity Hospital. Birth records were categorized into 10 groups using the Robson classification report table. Multiple logistic regressions were conducted to examine the association between the Robson classification group and the cesarean delivery rate for 2008 and 2018. The same regression analysis was subsequently conducted using a pooled data set to capture the changes in the association among the Robson classification group, a birth-year dummy, and the cesarean delivery rate.The odds of having a cesarean delivery when classified in group 1 in 2018 (adjusted odds ratio, 3.02; 95% confidence interval, 1.85-4.94;The high percentage of mothers classified as group 5 who gave birth via cesarean delivery suggests that healthcare providers should work with mothers in group 5 to increase their willingness to give birth vaginally after a previous cesarean delivery in an attempt to reduce the overall cesarean delivery rates. Further research is needed to better understand the factors that may influence the increasing rates of birth through cesarean delivery.

Background People who inject drugs (PWID) suffer from a high burden of infectious disease. At the same time, they often have poor access to health care. As in other East African countries, the population of PWID is growing in Tanzania, but little is known about their contact with health care services. In this paper we examine patterns of health care use among PWID in Dar es Salaam and identify what factors are associated with regular contact with clinicians during illness. Methods We conducted a baseline cross-sectional study as part of a prospective cohort study involving PWID. We recruited 578 PWID, of whom 273 were newly enrolled on an integrated methadone-assisted treatment (MAT) program and 305 were community-recruited. At baseline, we interviewed the MAT program enrollees before they received services at the program clinics. We used bivariate and multiple logistic regression analyses to identify the factors associated with seeking medical care when ill. Results Only 25.4% of 578 participants reported seeing clinicians regularly when they needed medical care. Participants were more likely to see clinicians regularly if they were employed, (OR: 2.25, 95% CI: 1.28–3.98), had higher income levels (OR: 1.10, 95% CI: 1.00–1.22), were parents (OR: 1.71, 95% CI: 1.09–2.68), or knew where to seek affordable care (OR: 3.42, 95% CI: 2.12–5.52). Conclusion PWID in Dar es Salaam generally did not seek health care when needed. To improve their health care seeking behaviour, it is important to advise PWID about where to seek affordable health care and to increase their income-generating skills.

OBJECTIVES: The double burden of malnutrition (DBM) is a major public health problem in the world. Overweight and obesity with concurrent stunting (called stuntingoverweight) is one of the specific forms of DBM at the individual level, and it has been documented in several low- and middle-income countries (LMICs). However, the changes in country-level prevalence of stuntingoverweight has not been known. The impact of socioeconomic inequalities on the prevalence of stuntingoverweight also have not been done across LMICs. Thus, this study aimed to investigate the changes of stuntingoverweight prevalence among children under five-years, and to assess socioeconomic inequality in the prevalence in LMICs. METHODS: Secondary data analysis was conducted in 58 LMICs between 2006 and 2018, comprising 692,704 children under five years old by using the Demographic and Health Surveys (DHS). For stuntingoverweight, the following values were estimated: rate ratio, mean difference, the slope index of inequality (SII), and the relative index of inequality (RII). RESULTS: The range of the prevalence of stuntingoverweight was lower than the ranges in the country-level prevalence of stunting and overweight. The relative index of inequality (RII) by wealth status ranged from 0.16 (Peru) to 2.31 (Nepal). RII by maternal education ranged from 0.06 (Kyrgyz Republic) to 15.11 (Tajikistan). Stuntingoverweight was found more in the poorest households. Among 31 LMICs, 27 countries reduced the prevalence of stuntingoverweight except four countries. However, to what extent the prevalence of stuntingoverweight reduced varied between countries. CONCLUSIONS: The prevalence of stuntingoverweight had been reduced in most countries, and socioeconomic inequalities existed in the prevalence and its change. Governments require health policies in addition to preventing stunting to ensure that children who are already stunted have a healthy life without becoming overweight concurrently. FUNDING SOURCES: N/A.