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Generalisation of sexual behaviour, including early sexual initiation, does not provide comprehensive knowledge of young people's sexual attitudes, behaviours and challenges, given the high sociocultural diversity and economic inequalities within countries. This study examines geographical hotspots of early sexual initiation, at the district level in Ghana and the factors associated with the observed spatial patterns.Data was derived from the 2017 Ghana Maternal Health Survey, covering 21,392 women aged 15-49 years. Early sexual debut denotes first sexual intercourse before attaining the legal age of sexual consent, which in Ghana, is 16 years. The Bayesian geoadditive semiparametric regression technique was used to examine geographical hotspots and correlates of the observed spatial patterns, classified into demographic, socioeconomic and pregnancy outcome factors.The results show that 26.7% (95% CI = 26.1-27.3) of women had their first sexual intercourse before attaining the age of 16 years. Hotspots of early sexual debut was observed predominantly among districts along the mainstream of the Volta Lake, which are also reported hotspots of child trafficking, labour and slavery. Demographic, socioeconomic and pregnancy related factors were identified to be correlated with the observed spatial clustering.Policies and interventions such as sexual and reproductive health education should target at-risk population, simultaneously addressing other child abuses perpetuating the practice.Ghana operates a decentralised health system, where health policies and interventions, including those for sexual and reproductive health are implemented at the district level. Yet, there are no studies that systematically identify districts where sexual behaviours, such as early sexual debut, require attention. This study uses spatial models and data from the 2017 Ghana Maternal Health Survey to identify areas (districts) with high concentration of women who initiated sex before the legal age of consent. Early sexual debut refers to first sexual intercourse before attainment of the legal age (16 years) of sexual consent. Early sexual initiation has been associated with adverse sexual and reproductive health outcomes such as unwanted pregnancies and STIs. The results show that about one in four women reported having early sexual intercourse. High early sexual intercourse was observed to be particularly concentrated among districts along the mainstream of the Volta Lake. With regards to the spatial correlates, for the districts in the Oti region, high early sexual debut was associated with low educational attainment and inability to read. For those in the Bono East and Eastern regions, women who had early sexual debut were more likely to have had a miscarriage, abortion or stillbirth. Younger women, those in co-habiting relationships and those not in union were more likely to have had early sexual debut in the districts in the Ashanti, Central and Northern regions. The findings call for intensification of sexual and reproductive health education in districts along the mainstream of the Volta Lake.

Through the Anthropocene, growing populations and economic assets have intensified risk. Within deltas, the concurrence of high human populations and economic assets with climatic events, physical and biophysical processes, and natural hazards generate ‘hotspots’ of societal risk. Identification of these hotspots requires combining hazards, exposure, and vulnerability data and information on a spatial basis. However, changing human activities over both time and space affect the nature and location of these hotspots. Analysis of the distribution and change in risk components identifies vulnerable areas and communities and where changes in hotspots may occur in the future. This can inform other analysis, such as the design of surveys and data collection, as well as identify policy needs and indicate where adaptation actions are likely to be required.

The Ganges–Brahmaputra–Meghna delta of Bangladesh is one of the most populous deltas in the world, supporting as many as 140 million people. The delta is threatened by diverse environmental stressors including salinity intrusion, with adverse consequences for livelihood and health. Shrimp farming is recognised as one of the few economic adaptations to the impacts of the rapidly salinizing delta. Although salinity intrusion and shrimp farming are geographically co-located in the delta, there has been no systematic study to examine their geospatial associations with poverty. In this study, we use multiple data sources including Census, Landsat Satellite Imagery and soil salinity survey data to examine the extent of geospatial clustering of poverty within the delta and their associative relationships with salinity intensity and shrimp farming. The analysis was conducted at the union level, which is the lowest local government administrative unit in Bangladesh. The findings show a strong clustering of poverty in the delta, and whilst different intensities of salinization are significantly associated with increasing poverty, neither saline nor freshwater shrimp farming has a significant association with poverty. These findings suggest that whilst shrimp farming may produce economic growth, in its present form it has not been an effective adaptation for the poor and marginalised areas of the delta. The study demonstrates that there are a series of drivers of poverty in the delta, including salinization, water logging, wetland/mudflats, employment, education and access to roads, amongst others that are discernible spatially, indicating that poverty alleviation programmes in the delta require strengthening with area-specific targeted interventions. Electronic supplementary material The online version of this article (doi:10.1007/s11625-016-0356-6) contains supplementary material, which is available to authorized users.

A flexible meta-model, the Delta Dynamic Integrated Emulator Model (ΔDIEM), is developed to capture the socio-biophysical system of coastal Bangladesh as simply and efficiently as possible. Operating at the local scale, calculations occur efficiently using a variety of methods, including linear statistical emulators, which capture the behaviour of more complex models, internal process-based models and statistical associations. All components are tightly coupled, tested and validated, and their behaviour is explored with sensitivity tests. Using input data, the integrated model approximates the spatial and temporal change in ecosystem services and a number of livelihood, well-being, poverty and health indicators of archetypal households. Through the use of climate, socio-economic and governance scenarios plausible trajectories and futures of coastal Bangladesh can be explored.

Census and spatial data are used to analyse geographical variations in poverty and identify the key socio-economic and environmental drivers of poverty. Results show a strong clustering of poverty within the study area with multivariate analysis indicating a significant association with environmental predictors. However, whilst increasing intensity of salinity intrusion is significantly associated with poverty, neither large shrimp nor freshwater prawn farms impact on poverty. The strong association identified between salinity intrusion and poverty could be attributed to loss of arable land, reduced agricultural productivity and income, food insecurity, rural unemployment, social unrest, conflicts and forced migration. This analysis provides important inputs to the integrated analysis of coastal Bangladesh and the delta.

Climate‐dependent subsistence agriculture remains the main livelihood for most populations in Ghana. The spatiotemporal variations in rainfall and temperature have influence particularly in poorly‐developed agrarian regions with limited or no irrigation infrastructure. Therefore, a systematic understanding of climate patterns across space and time is important for mitigating against food insecurity and household poverty. Using over a century of high‐spatial resolution data, this study examines the spatiotemporal variations in rainfall and temperature across Ghana to identify climate‐stressed locations with potential effect on the production of major staple crops. The data for the analysis were drawn from the University of Delaware's Gridded Precipitation and Temperature Monthly Climatology version 4.01. The analysis was restricted to the main crop‐growing periods (March to December). The Mann‐Kendall nonparametric regression test was used to examine significant changes in rainfall variability and temperature at the district level. The results show that Ghana's climate has become progressively drier over the last century and prone to drought conditions. The most climate‐stressed districts are clustered within the three northern regions (Upper West, Upper East, and Northern) and the Western region. The most recent census in Ghana shows that the three northern regions also have the highest prevalence of subsistence agriculture. The findings from this study have implications for targeted interventions such as the Ghanaian government's recent policy initiative aimed at alleviating rural poverty by encouraging youth participation in agriculture along with efforts to intensifying crop production using modern farming techniques.

Land cover and land use (LCLU) analysis is a central determinant of the current and future relationship between people and local ecosystem services. It provides the spatial basis for the integrated analysis of the study area. Historical change (1989–2010) is identified using classification techniques based on available satellite imagery supported by other data. Nine categories of LULC are identified; water, Bagda (brackish shrimp farming), Galda (freshwater prawn farming), agriculture (non-waterlogged), agriculture (waterlogged), wetlands and mudflats, mangrove, rural settlements and major urban areas. The analysis shows an increase in aquaculture (mainly replacing rice fields), with agriculture becoming more intermixed with settlements. Future LULC scenarios are determined based on stakeholder narratives.

Background Nepal has a distinct topography that makes reproductive health and family planning services difficult to access, particularly in remote mountain and hill regions where over a quarter of modern contraceptive users rely exclusively on vasectomy. Study design A three-level random intercept logistic regression analysis was applied on data from the 2011 Nepal Demographic and Health Survey to investigate the extent of influence of mobile family planning clinics on the odds of a male or a female sterilization, adjusting for relevant characteristics including ecological differences and random effects. The analyses included a sample of 2014 sterilization users, considering responses from currently married women of reproductive ages. Results The odds of a male sterilization were significantly higher in a mobile clinic than those in a government hospital (odds ratio, 1.65; 95% confidence interval, 1.21–2.25). The effects remained unaltered and statistically significant after adjusting for sociodemographic and clustering effects. Random effects were highly significant, which suggest the extent of heterogeneity in vasectomy use at the community and district levels. The odds of vasectomy use in mobile clinics were significantly higher among couples residing in hill and mountain regions and among those with three or more sons or those with only daughters. Conclusion Mobile clinics significantly increase the uptake of vasectomy in hard-to-reach areas of Nepal. Reproductive health interventions should consider mobile clinics as an effective strategy to improve access to male-based modern methods and enhance gender equity in family planning. Implications Family planning interventions in hard-to-reach communities could consider mobile clinic as an effective strategy to promote male-based modern methods. Improving access to vasectomy could substantially reduce unmet need for family planning in countries experiencing rapid fertility transition.

Background: Many low and middle income countries have initiated maternity fee exemption and removal policies to promote use of skilled maternity care. After two and a half decades of these policies, uptake of skilled birth care remains low and inequalities continue to exist in many low and middle income countries. This study uses 2 decades of birth histories data to examine four maternity fee paying policies enacted in Ghana over the past 3 decades and their geospatial impacts on uptake of skilled delivery care.Methods: Bayesian Geoadditive Semiparametric regression techniques were applied on four conservative rounds of Demographic and Health Surveys in Ghana to examine the extent of geospatial dependence in skilled birth care use at the district level and their associative relationships with maternity fee paying policies focusing on the temporal trends when the policies were functional.Results: The results show that at the country-level, the policies had a positive influence on use of skilled delivery care; however their impacts on reducing between-district inequalities were trivial.Conclusions: The findings suggest that targeted interventions at the district level are essential to strengthen maternal health programmes in Ghana.

Although recent studies show that human wellbeing on global and national scales is improving, it is important to monitor the regional progress of human wellbeing and Millennium Development Goals (MDGs). Here we provide an assessment of human wellbeing in the south-west coastal part of Bangladesh by analysing Household Expenditure Survey (HIES) and Demographic Health Survey (DHS) data from 1995 to 2010. Indicators have been selected based on the five dimensions of human wellbeing, including health, material condition, personal security and freedom of choice and actions. This study shows that the south-west coastal region has made commendable progress in meeting the target MGDs goal for ‘child and maternal health’. However, the areas of ‘personal security’ and ‘freedom of choice and action’ have not achieved the target MDGs despite showing substantial progress for ‘poverty alleviation’ (17%), ‘sanitation coverage’ (40%) and ‘education’ (23%). Incomes from fishery and ‘non-ecosystem’ based livelihood have increased 76% and 8% respectively, whereas income from shrimp and agriculture show declining trends. Production costs have increased substantially since 1995 in response to a rise in GDP. At a household level, proxy indicators of provisioning services, such as crop production, are positively correlated with poverty alleviation. Overall, greater attention on education and sustainable land use is required if Sustainable Development Goals (SDGs) are to be achieved by 2030.

The Upper Brahmaputra River Basin is prone to natural disasters and environmental stresses (floods, droughts and bank erosion, delayed rainfall, among others) creating an environment of uncertainty and setting the basin back in terms of socio-economic development. The climate change literature shows that agriculture and ecosystems and their services are highly climate sensitive, yet they are the main sources of livelihood that supports a large proportion of residents of the tributaries of the Brahmaputra River Basin. The continuous depletion of ecosystems and loss of agricultural outputs resulting from environmental stressors has a substantial impact on the socio-economic wellbeing of the basins residents, particularly the vulnerable rural poor. This paper uses spatially explicit data from Census, Household Surveys and Earth Observation to develop a transferable methodological approach which investigates the extent of dependence on agriculture and ecosystems as a source of livelihood in the contrasting sub-basins of the Brahmaputra River in the State of Assam, India and Bhutan, and the risk to these livelihood dependencies in these sub-basins due to potential environmental impacts of climate change. The results from this study constitute a case study in the development of a systematic and spatially explicit set of tools that inform and assist policy makers in the appropriate interventions to secure the livelihood benefits of sustainably managed agriculture in the face of environmental change.

Background: The efforts and commitments to accelerate progress towards the Millennium Development Goals for maternal and newborn health (MDGs 4 and 5) in low and middle income countries have focused primarily on providing key medical interventions at maternity facilities to save the lives of women at the time of childbirth, as well as their babies. However, in most rural communities in sub-Saharan, access to maternal and newborn care services is still limited and even where services are available they often lack the infrastructural prerequisites to function at the very basic level in providing essential routine health care services, let alone emergency care. Lists of essential interventions for normal and complicated childbirth, do not take into account these prerequisites, thus the needs of most health facilities in rural communities are ignored, although there is enough evidence that maternal and newborn deaths continue to remain unacceptably high in these areas.Methods: This study uses data gathered through qualitative interviews in Kitonyoni and Mwania sub-locations of Makueni County in Eastern Kenya to understand community and provider perceptions of the obstacles faced in providing and accessing maternal and newborn care at health facilities in their localities.Results: The study finds that the community perceives various challenges, most of which are infrastructural, including lack of electricity, water and poor roads that adversely impact the provision and access to essential life-saving maternal and newborn care services in the two sub-locations.Conclusions: The findings and recommendations from this study are important for the attention of policy makers and programme managers in order to improve the state of lower-tier health facilities serving rural communities and to strengthen infrastructure with the aim of making basic routine and emergency obstetric and newborn care services more accessible.

Unintended childbearing in Ghana is estimated to be about 0.7 births per woman, thus contributing to the high total fertility rate of more than 4 births. About one-third of women of reproductive age have an unmet need for family planning and there are strong geographic differences between and within ecological zones. Spatial analysis of risk of unintended pregnancies planning can reveal differences in the provision and usage of contraceptive commodities, thereby providing information of areas where programmes should be strengthened. This study uses data from the 1998 and 2003 Ghana Demographic and Health Surveys to examine geographical variation in the risk of unintended pregnancies among women in the three ecological zones of Ghana (Savannah, Forest, and Coastal). The data was analysed using multilevel logistic regression. Approximately 55% of Ghanaian women (married or in union) are at risk of unintended pregnancies and there are differences between urban and rural women, with rural women more likely to have their demand for contraception unmet. After adjusting for the socio-economic and demographic factors, the results show little differences between ecological zones in the levels of women exposed to the risk of unintended pregnancy, but they demonstrate significant within community effects, which influence the risk of unintended pregnancies for women within the community. Communities, therefore, can be used as units for targeting services aimed at increasing coverage of contraceptive commodities.

SummaryAfter a decade of fertility decline, Ghana’s fertility and the level of unmet need for contraception stalled in mid-transition in the late 1990s. Although the literature acknowledges this, the geographical patterns in unmet need have not been adequately documented. Spatial analysis of unmet need can reveal differences in usage and provision of contraceptive commodities, thereby pointing to geographical areas where contraceptive programmes should be strengthened. This study examines the geographical variation of the risk of mistimed and unwanted pregnancies between rural communities and also between urban communities of the three ecological zones of Ghana. The study also investigates if geographical differences in the risks of mistimed and unwanted pregnancies changed during the period when unmet need stalled at the national level. A multilevel regression model was applied to pooled data from the 1998 and 2003 Ghana Demographic and Health Surveys to examine the determinants of the risk of unintended pregnancies, while controlling for clustering of outcomes within communities. The results show that between the two surveys, there was no significant change in the levels of risk of mistimed and unwanted pregnancy. However, geographical heterogeneity in the risk of mistimed and unwanted pregnancy was observed, after controlling for relevant predictors. This showed concentration of mistimed pregnancies in some rural communities relative to others, and variation in the risk of unwanted pregnancies between urban communities. The results give a clear indication that bridging the inequality gap in contraceptive use requires programmes that are area-specific.

Spatial inequalities related to the choice of delivery care have not been studied systematically in Sub-Saharan Africa where maternal and perinatal health outcomes continue to worsen despite a range of safe motherhood interventions. Using retrospective data from the 1998 and 2003 Demographic and Health Surveys, this paper investigates the extent of changes in spatial inequalities associated with type of delivery care in Ghana with a focus on rural-urban differentials within and across the three ecological zones (Savannah, Forest and Coastal). More than one-half of births in Ghana continue to occur outside health institutions without any skilled obstetric care. While this is already known, we present evidence from multilevel analyses that there exist considerable and growing inequalities, with regard to birth settings between communities, within rural and urban areas and across the ecological zones. The results show evidence of poor and disproportionate use of institutional care at birth; the inequalities remained high and unchanged in both urban and rural communities within the Savannah zone and widening in urban communities of the Forest and Coastal zones. The key policy challenges in Ghana, therefore, include both increasing the uptake of institutional delivery care and ensuring equity in access to both public and private health institutions.

Objective: To investigate the impact of maternity-related fee payment policies on the uptake of skilled birth care amongst the poor in Ghana. Methods: Population data representing 12,288 births between November 1990 and October 2008 from four consecutive rounds of the Ghana Demographic and Health Surveys were used to examine the impact of four major maternity-related payment policies: the full-cost recovery cash and carry scheme; antenatal care fee exemption; delivery care fee exemption and the National Health Insurance Scheme. Concentration curves were used to analyse the rich-poor gap in the use of skilled birth care by the four policy interventions. Multilevel logistic regression was used to examine the effect of the policies on the uptake of skilled birth care, adjusting for relevant predictors and clustering within communities and districts. Findings: The uptake of skilled birth care over the policy periods for the poorest women was trivial when compared to their non-poor counterparts. The rich-poor gap in skilled birth care use was highly pronounced during the ?cash and carry ?and free antenatal care policies period. The benefits during the free delivery care and ?National ?Health Insurance Scheme policy periods accrued more for the rich than the poor. ?There exist significant differences in skilled birth care use between and within communities and districts, even after adjusting for policy effects and other relevant predictors. Conclusion: The maternal care fee exemption policies specifically targeted towards the poorest women had limited impact on the uptake of skilled birth care.

Background: the Community-based Health Planning and Services (CHPS) initiative is a major government policy to improve maternal and child health and accelerate progress in the reduction of maternal mortality in Ghana. However, strategic intelligence on the impact of the initiative is lacking, given the persistent ?problems of patchy geographical access to care for rural women. This study investigates the impact of proximity to CHPS on facilitating uptake of skilled ?birth care in rural areas.Methods and findings: data from the ?2003 and 2008 Demographic and Health Survey, ? on 4,349 births from 463 rural communities were linked to georeferenced data on health facilities, CHPS and topographic data on national road-networks. Distance to nearest health facility and CHPS was computed using the closest facility functionality in ArcGIS 10.1. Multilevel logistic regression was used to examine the effect of proximity to health facilities and CHPS on use of skilled care at birth, adjusting for relevant predictors and clustering within ?communities.? The results show that a substantial proportion of births continue to occur in communities more than 8 km from both ?health facilities and CHPS. Increases in uptake of skilled birth care are more pronounced where both health ?facilities and CHPS compounds are within 8 km, but not in communities within 8 km of CHPS but lack access to health facilities. Where both health facilities and CHPS are within 8 km, the odds of skilled ?birth care is 16% higher than ?where there is only a health facility within 8km. Conclusion: where CHPS compounds are set up near health facilities, there is improved access to care, demonstrating the facilitatory role of CHPS in stimulating access to better care at birth, in areas where health facilities are accessible.

This chapter provides an overview of the assessment of socio-economic vulnerability to floods in the context of climate change in the Salzach catchment (UDRB) as well as for the floodplains in Assam (UBRB). The assessment adapts a conceptual framework of the IPCC defining vulnerability. Within both assessments spatially-explicit and expert-based approaches are applied to provide an integrative assessment linking to ILWRM. Next to the assessment of present-day conditions, future scenarios of socio-economic vulnerability are provided building on the SRES framework. Socio-economic issues are major drivers and subjects of climate change and it is inevitable to analyse them within an integrative assessment through the application of a vulnerability approach.

Background: Intersectoral integration is acknowledged to be essential for improving provision of health care and outcomes, yet it remains one of the main primary health care strategic challenges. Although this is well articulated in the literature, the factors that explain differentials in levels of intersectoral integration have not been systematically studied, particularly in low and middle-income countries. In this study, we examine the levels and determinants of intersectoral integration amongst institutions engaged in malaria control programmes in an urban (Kumasi Metropolitan) district and a rural (Ahafo Ano South) district in Ghana.Methods: Interviews were conducted with representatives of 32 institutions engaged in promoting malaria prevention and control. The averaging technique proposed by Brown et al. and a two-level multinomial multilevel ordinal logistic regression were used to examine the levels of integration and the factors that explain the differentials.Results: The results show high disparity in levels of integration amongst institutions in the two districts. Integration was higher in the rural district compared to the urban district. The multivariate analysis revealed that the district effect explained 25% of the variations in integration. The type of institution, level of focus on malaria and source of funding are important predictors of intersectoral integration.Conclusion: Although not causal, integrated malaria control programmes could be important for improving malaria-related health outcomes in less developed regions as evident from the rapid decline in malaria fatality rates observed in the Ahafo Ano South district. Harmonisation of programmes should be encouraged amongst institutions and the public and private sectors should be motivated to work in partnership.

BackgroundAlthough there is evidence to tracking progress towards facility births within the UN Millennium Development Goals framework, we do not know whether women are deciding against home birth over their reproductive lives. Using Demographic and Health Surveys (DHS) data from 44 countries, this study aims to investigate the patterns and shifts in childbirth locations and to determine whether these shifts are in favour of home or health settings.Methods and FindingsThe analyses considered 108,777 women who had at least two births in the five years preceding the most recent DHS over the period 2000–2010. The vast majority of women opted for the same place of childbirth for their successive births. However, about 14% did switch their place and not all these decisions favoured health facility over home setting. In 24 of the 44 countries analysed, a higher proportion of women switched from a health facility to home. Multilevel regression analyses show significantly higher odds of switching from home to a facility for high parity women, those with frequent antenatal visits and more wealth. However, in countries with high infant mortality rates, low parity women had an increased probability of switching from home to a health facility.ConclusionsThere is clear evidence that women do change their childbirth locations over successive births in low and middle income countries. After two decades of efforts to improve maternal health, it might be expected that a higher proportion of women will be deciding against home births in favour of facility births. The results from this analysis show that is not the case.

OBJECTIVES: First, our objective was to estimate socio-economic inequalities in the use of postnatal care (PNC) compared with those in the use of care at birth and antenatal care. Second, we wanted to compare inequalities in the use of PNC between facility births and home births and to determine inequalities in the use of PNC among mothers with high-risk births. METHODS AND FINDINGS: Rich-poor ratios and concentration indices for maternity care were estimated using the third round of the District Level Household Survey conducted in India in 2007-08. Binary logistic regression models were used to examine the socio-economic inequalities associated with use of PNC after adjusting for relevant socio-economic and demographic characteristics. PNC for both mothers and newborns was substantially lower than the care received during pregnancy and child birth. Only 44% of mothers in India at the time of survey received any care within 48 hours after birth. Likewise, only 45% of newborns received check-up within 24 hours of birth. Mothers who had home births were significantly less likely to have received PNC than those who had facility births, with significant differences across the socio-economic strata. Moreover, the rich-poor gap in PNC use was significantly wider for mothers with birth complications. CONCLUSIONS: PNC use has been unacceptably low in India given the risks of mortality for mothers and babies shortly after birth. However, there is evidence to suggest that effective use of pregnancy and childbirth care in health facilities led to better PNC. There are also significant socio-economic inequalities in access to PNC even for those accessing facility-based care. The coverage of essential PNC is inadequate, especially for mothers from economically disadvantaged households. The findings suggest the need for strengthening PNC services to keep pace with advances in coverage for care at birth and prenatal services in India through targeted policy interventions.

The importance of meeting the unmet need for contraception is nowhere more urgent than in the countries of sub-Saharan Africa, where the fertility decline is stalling and total unmet need exceeds 30 per cent among married women. In Ghana, where fertility levels vary considerably, demographic information at sub-national level is essential for building effective family planning programmes. We used small-area estimation techniques, linking data from the 2003 Ghana Demographic and Health Survey to the 2000 Ghana Population and Housing Census, to derive district-level estimates of contraceptive use and unmet need for contraception. The results show considerable variation between districts in contraceptive use and unmet need. The prevalence of contraceptive use varies from 4.1 to 41.7 per cent, while that of the use of modern methods varies from 4.0 to 34.8 per cent. The findings identify districts where family planning programmes need to be strengthened.

The HIV epidemic in sub-Saharan Africa has caused many children to become orphaned and vulnerable. Recent studies show that orphaned and vulnerable children (OVC) lack the basic necessities for survival and development. These children are particularly at high risk of poor health and poverty. Although the poor health outcomes of these children are well documented, the complexities of the factors that mediate their health outcomes have not been systematically studied. The aim of this paper is to examine how the complex relationships between and within the proximate and socio-economic determinants mediate the poor health outcomes of children through their OVC status. The analyses considered graphical chain modelling of morbidity data from a sample of 3745 children aged below five years from the 2005 Rwandan Demographic and Health Survey. The results show that OVC status influences the risk of childhood morbidity both directly and indirectly and also as a conduit through which other significant proximate factors and socio-economic factors operate.

The authors present an assessment of risk from river bank erosion in the Brahmaputra river basin. The concept of risk is conceptualised in the context of socio-economic vulnerability, and the potential for exposure to hazard. By addressing both the physical hazard and the variations across the socio-economic surface the approach presented attempts to spatially combine these parameters to provide a risk surface for use by policy makers and decision makers at a number of administrative levels. The concept of vulnerability and risk as a description of the status of a society with respect to an imposed hazard such as flooding or the associated bank erosion exacerbated by climate change is deep rooted in a very broad research effort and its associated publications. In part, this reflects the complex evolution of the underlying notion of hazard - which itself shows the concurrent evolution of a series of strands each representing one disciplinary tradition. The concept of vulnerability has been very widely treated in the literature, and For present purposes an acceptable approach to vulnerability may be to start with an influential (but still controversial) established model by IPCC (2001) who have developed working definition - and then explore its ramifications in order to develop a set of working definitions and operational indicators for the project. This provides a pragmatic route towards a realistic target. It also offers a possible buffer against the common experience that the more sophisticated indices of vulnerability are strongly sensitive to contingent local/historical circumstances. This approach is explored within this chapter. The hazard posed by unabated bank erosion has been analysed with the help of satellite imagery based data and through adoption of Plan Form Index along with its threshold values develop for the Brahmaputra. The land loss to erosion is depicting a significantly rising trend which has obviously contributed to the impoverishment of the riverine population. The attendant uncertainties of climate change of hydrological and hydraulic river behaviour may exacerbate the channel instability of the Brahmaputra.

SummaryThe association between maternal smoking and adverse child health outcomes has not been systematically explored in less developed countries, especially in Nepal where over a quarter of women of reproductive age smoke tobacco products. This study aims to quantify the effect of maternal smoking on acute respiratory infection (ARI) symptoms among children aged below five years, using the 2001 Nepal Demographic and Health Survey. It is hypothesized that children born to mothers who smoke frequently are at higher risk of developing ARI symptoms. Four-level random intercept logistic regression models were used to disentangle the independent effect of maternal smoking on children's ARI symptoms, controlling for potential biological, socioeconomic, seasonal and spatial variables. Maternal smoking status had a significant effect on children's ARI symptoms; the effects were significantly higher (adjusted OR 1.41; 95% CI 1.02–1.96) among those born to mothers who smoked more frequently than their counterparts. Furthermore, a strong spatial pattern was evident in the prevalence of ARI symptoms, after adjusting for maternal smoking and relevant control variables. The findings underscore the importance of designing exclusive public health intervention measures to prevent tobacco smoking within households, for example through awareness campaigns highlighting the adverse effect of maternal smoking on child health.

The precipitation of oxygen in silicon and the resulting defect formation have been studied in bulk n-type wafers with varying oxygen content subjected to CMOS processing. The results are consistent with the previously reported existence of a threshold initial oxygen concentration for the occurrence of substantial oxygen precipitation during typical CMOS processing. Processed wafers from the sample set with the lower initial oxygen content exhibited marked radial nonuniformity of precipitation. Through the use of a combination of Fourier-transform infrared microspectroscopy, X-ray topography, chemical etching and TEM it has been possible to demonstrate a direct, quantitative correlation between the spatial variation of oxygen loss from solution and the associated defect formation, along with an analysis of the precipitate morphology. In the near-edge region of these wafers the precipitate number density changes by more than two orders of magnitude over a few millimetres, with a linearly related increase in the number of oxygen atoms lost from solution. Both these parameters are quantitatively correlated with changes in X-ray topographic image contrast, thereby defining useful detection limits for the application of X-ray topography to oxygen precipitation studies under the specific conditions employed.

We have been engaged in a systematic and careful study of the early stages of oxygen precipitation at temperatures up to 850°C which involved transmission electron microscopy correlated with diffraction, optical and IR spectroscopy. We have simultaneously made a detailed study of macroscopic defects induced in Czochralski silicon wafers after repeated heat cycling during the fabrication of circuits. Even though there have been a number of such studies there remain many questions about the effects which are observed, such as why do stacking faults sometimes occur while on other occasions prismatic loop punching predominates? Variable precipitate morphologies are also observed such as {100} plates or octahedra without any general agreement on the reasons for such differences. The question of how precipitates nucleated at lower temperatures grow and develop after repeated high temperature cycles has also not often been addressed. Further questions exist over the heterogeneous or homogeneous nucleation of precipitates, the involvement of transition metals, the unfaulting of stacking fault loops. Answers to many of these questions arise out of our work which seeks to provide an over-view of the variety of oxygen precipitation routes in silicon.

Transmission electron microscopy at 300kV has been used in a thorough examination of CMO3 and bipolar processed wafers of Czochralski silicon. Diffraction contrast and tilting experiments have been performed on the defects which were observed and a number of new observations have been made on stacking faults and {001} platelets induced by oxygen precipitation.

The concept of complex social-ecological systems (SES) as a means for capturing system dynamics properties (e.g. interactions and feedbacks) has gained attention in policymaking and advancing evidence in understanding complex systems. In contexts with limited data, conceptual system dynamic models offer a promising entry point to overcome challenges in understanding SES dynamics, which is essential for managing the long-term sustainability of SES and human wellbeing. Here, we build on previous work focused on agricultural production and use participatory approaches to develop a conceptual System Dynamics (SD) model for the south-west coastal SES in Bangladesh encompassing multiple forms of livelihood (fisheries, shrimp farming and forests, as well as agriculture). Using qualitative methods, including focus group discussions with farmers, fishermen, shrimp farmers and forest people, as well as expert consultations, we identified interactions, feedback loops and thresholds for the SES. The conceptual system model developed independently by stakeholders is consistent with a model developed using an empirical approach and literature review. Feedback loops are identified for the ecological (e.g. climate and water, mangrove and salinity) and social (e.g. shrimp farming and mangrove, agricultural (e.g. crops) production and subsidy) sub-systems in the Bangladesh delta. The biophysical thresholds that impact social conditions include river water discharge (1500 to 2000 m3 s−1), climate (28 °C) and soil salinity (~4 to ~10 dS m−1). Exceeding these thresholds suggests that SES may lose resilience in the near future and increase the likelihood of regime shifts. Findings of this study contribute to the management of the deltaic ecosystem and provide specific policy recommendations for improving environmental sustainability and human well-being in the Bangladesh delta and can be further used as inputs into system dynamic modelling to simulate changes in this SES.

As the deadline for the millennium development goals approaches, it has become clear that the goals linked to maternal and newborn health are the least likely to be achieved by 2015. It is therefore critical to ensure that all possible data, tools and methods are fully exploited to help address this gap. Among the methods that are under-used, mapping has always represented a powerful way to ‘tell the story’ of a health problem in an easily understood way. In addition to this, the advanced analytical methods and models now being embedded into Geographic Information Systems allow a more in-depth analysis of the causes behind adverse maternal and newborn health (MNH) outcomes. This paper examines the current state of the art in mapping the geography of MNH as a starting point to unleashing the potential of these under-used approaches. Using a rapid literature review and the description of the work currently in progress, this paper allows the identification of methods in use and describes a framework for methodological approaches to inform improved decision-making. The paper is aimed at health metrics and geography of health specialists, the MNH community, as well as policy-makers in developing countries and international donor agencies.