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Previous studies of inequality in health and mortality have largely focused on income-based inequality. Maternal education plays an important role in determining access to water and sanitation, and inequalities in child mortality arising due to differential access, especially in low- and middle-income countries such as Peru. This article aims to explain education-related inequalities in child mortality in Peru using a regression-based decomposition of the concentration index of child mortality. The analysis combines a concentration index created along a cumulative distribution of the Demographic and Health Surveys sample ranked according to maternal education, and decomposition measures the contribution of water and sanitation to educational inequalities in child mortality. We observed a large education-related inequality in child mortality and access to water and sanitation. There is a need for programs and policies in child health to focus on ensuring equity and to consider the educational stratification of the population to target the most disadvantaged segments of the population.

Introduction: Public health concerns over the impact of social media use (SMU) on adolescent health are growing. We investigated the relationship between SMU and sleep health in adolescents in Canada aged 11 to 17 years. Methods: Data from the 2017-2018 Health Behaviour in School-aged Children study were available for 12 557 participants (55.2% female). SMU was categorized by frequency of use (non-active, active and intense) and the presence of addiction-like symptoms (problematic). Mixed effects logistic regression models identified associations between SMU and seven sleep health indicators (insomnia symptoms, daytime wakefulness problems, screen time before bed, meeting sleep duration recommendations, sleep variability and late bedtime on school and non-school days). Results: Compared to active SMU, non-active SMU was associated with better sleep indicators, except for insomnia symptoms. Intense SMU was associated with greater odds of having poor sleep health indicators (adjusted odds ratio [aORs] from 1.09 to 2.24) and problematic SMU with the highest odds (aORs from 1.67 to 3.24). Associations with problematic SMU were greater among girls than boys, including having a later bedtime on school days (aOR = 3.74 vs. 1.84) and on non-school days (aOR = 4.13 vs. 2.18). Associations between SMU and sleep outcomes did not differ by age group. Conclusion: Intense and problematic SMU were associated with greater odds of poor sleep health among adolescents in Canada, with stronger associations among girls than boys. Further research is needed to understand the mechanisms underlying associations between SMU and sleep to inform public health recommendations. [ABSTRACT FROM AUTHOR]

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Objective To estimate the association between legal age of consent and coverage of human immunodeficiency virus (HIV) testing among adolescents in countries with high HIV-burden. Methods We analysed data from adolescents aged 15-18 years, who participated in Demographic and Health Surveys or AIDS Indicator Surveys between 2011 and 2016, in 15 sub-Saharan African countries. To improve balance in the distribution of measured individual- and country-level characteristics, we used propensity score matching between adolescents in countries with more versus less restrictive age-of-consent laws ([less than or equal to] 15 years versus > 16 years). We estimated the percentage of individuals who self-reported that they have done an HIV test in the past 12 months and compared the differences in such testing rates among adolescents exposed to lower versus higher age-of-consent laws. We also investigated effect modifications by sex and age. Findings Legal age of consent below 16 years was associated with an 11.0 percentage points higher coverage of HIV testing (95% confidence interval, CI: 7.2 to 14.8), corresponding to a rate ratio of 1.74 (95% CI: 1.35 to 2.13). HIV testing rate had a stronger association with lower age of consent among females than males. The testing rates differences were 14.0 percentage points (95% CI: 8.6 to 19.4) for females and 6.9 percentage points (95% CI: 1.6 to 12.2) for males (P-value for homogeneity = 0.07). Conclusion This study provides evidence to support the recent World Health Organization's recommendations that countries should examine current laws and address age-related barriers to uptake of sexual and reproductive health services. [phrase omitted] [phrase omitted] Objectif Determiner le lien entre l'age legal de consentement et la couverture du depistage du virus de l'immunodeficience humaine (VIH) chez les adolescents dans des pays a forte prevalence d'infection au VIH. Methodes Nous avons analyse les donnees fournies par des adolescents ages de 15 a 18 ans dans le cadre de leur participation a une enquete demographique et de sante ou a une enquete sur l'indicateur du sida entre 2011 et 2016 dans 15 pays d'Afrique subsaharienne. Afin d'obtenir une repartition plus equilibree des caracteristiques mesurees au niveau des individus et des pays, nous avons utilise un appariement des coefficients de propension entre les adolescents des pays oU les lois relatives a l'age de consentement etaient plus restrictives par opposition aux pays oU elles etaient moins restrictives ([less than or equal to] 15 ans contre [greater than or equal to] 16 ans). Nous avons estime le pourcentage des individus qui avaient declare avoir beneficie d'un depistage du VIH au cours des 12 derniers mois et compare les ecarts entre ces taux de depistage chez les adolescents exposes a des lois relatives a l'age de consentement moins restrictives par opposition aux adolescents exposes a des lois relatives a l'age de consentement plus restrictives. Nous avons egalement etudie les modifications des effets en fonction du sexe et de l'age. Resultats Lage legal de consentement inferieur a 16 ans a ete associe a une couverture du depistage du VIH superieure de 11,0 points de pourcentage (intervalle de confiance, IC, a 95%: 7,2-14,8), soit un rapport de taux de 1,74 (IC a 95%: 1,35-2,13). Le taux de depistage du VIH a ete plus fortement associe a un age de consentement plus bas chez les femmes que chez les hommes. L'ecart des taux de depistage etait de 14,0 points de pourcentage (IC a 95%: 8,6-19,4) chez les femmes et de 6,9 points de pourcentage (IC a 95%: 1,6-12,2) chez les hommes (valeur Ppour l'homogeneite = 0,07). Conclusion Cette etude fournit des donnees pour soutenir les recentes recommandations de l'Organisation mondiale de la Sante preconisant que les pays examinent leurs lois actuelles et prennent des mesures a l'egard des obstacles lies a l'age qui freinent le recours a des services de soins de sante sexuelle et procreative. [phrase omitted] Objetivo Estimar la asociacion entre la edad legal de consentimiento y la cobertura de las pruebas del virus de la inmunodeficiencia humana (VIH) en los adolescentes de paises con una alta carga de VIH. Metodos Se analizaron datos de adolescentes de 15 a 18 anos que participaron en encuestas demograficas y de salud o encuestas de indicadores de SIDA entre 2011 y 2016, en 15 paises de Africa subsahariana. Para mejorar el equilibrio en la distribucion de las caracteristicas medidas a nivel individual y nacional, se utilizo la comparacion de puntuacion de propension entre adolescentes de paises con leyes de edad de consentimiento mas restrictivas y menos restrictivas ([less than or equal to] 15 anos frente a [greater than or equal to] 16 anos). Se calculo el porcentaje de individuos que declararon haberse hecho la prueba del VIH en los ultimos 12 meses y se compararon las diferencias en las tasas de pruebas entre los adolescentes expuestos a leyes de edad de consentimiento mas bajas o mas altas. Tambien se investigaron las modificaciones de los efectos por sexo y edad. Resultados La edad legal de consentimiento por debajo de los 16 anos se asocio con una cobertura de 11,0 puntos porcentuales mas alta de pruebas de VIH (intervalo de confianza del 95 %, IC: 7,21 a 4,8), lo que corresponde a una relacion de tasas del 1,74 (IC del 95 %: 1,35 a 2,13). La tasa de pruebas de VIH tenia una asociacion mas fuerte con la edad de consentimiento mas baja entre las mujeres que entre los hombres. Las diferencias en las tasas de pruebas fueron de 14,0 puntos porcentuales (IC del 95 %): 8,6 a 19,4) para las mujeres y de 6,9 puntos porcentuales (IC del 95 %: 1,6 a 12,2) para los hombres (Valor P para la homogeneidad = 0,07). Conclusion Este estudio proporciona pruebas que respaldan las recientes recomendaciones de la Organizacion Mundial de la Salud de que los paises deben revisar las leyes vigentes y abordar los obstaculos relacionados con la edad que impiden el acceso a los servicios de salud sexual y reproductiva., Abstracts in [phrase omitted] Francais, [phrase omitted] and Espanol at the end of each article. Introduction In 2017, an estimated 1.8 million adolescents were living with human immunodeficiency virus (HIV)/acquired [...]

Objective To estimate prevalence of suicidal ideation and suicidal ideation with a plan in each Surveyed country and to examine cross-national differences in associated risk factors. Methods We analysed data of students aged 13-17 years who participated in the 2003-2012 Global School-based Health Surveys in 32 countries, of which 29 are low- and middle-income. We used random effects meta-analysis to generate regional and overall pooled estimates. Multivariable logistic regression was used to estimate risk ratios for the associated risk factors. Population attributable fractions were estimated based on adjusted risk ratios and the prevalence of the determinants within each exposure level. Findings Across all countries, the pooled 12-month prevalence of suicide ideation were 16.2% (95% confidence Interval, CI: 15.6 to 16.7) among females and 12.2% (95% CI: 11.7 to 12.7) among males and ideation with a plan were 8.3% (95% CI: 7.9 to 8.7) among females and 5.8% (95% CI: 5.5 to 6.1) among males. Suicide Ideation In the WHO Region of the Americas was higher in females than males, with an estimated prevalence ratio of 1.70 (95% CI: 1.60 to 1.81), while this ratio was 1.04 (95% CI: 0.98 to 1.10) in the WHO African Region. Factors associated with suicidal ideation in most countries Included experiences of bullying and physical violence, loneliness, limited parental support and alcohol and tobacco use. Conclusion The prevalence of adolescent suicidal behaviours varies across countries, yet a consistent set of risk factors of suicidal behaviours emerged across all regions and most countries. Objectif Estimer la prevalence de l'ideation suicidaire et de l'ideation suicidaire avec un plan dans chacun des pays etudies et examiner les differences entre les pays concernant les facteurs de risque associes. Methodes Nous avons analyse des donnees recueillies aupres d'eleves ages de 13 a 17 ans ayant participe aux Enquetes mondiales realisees en milieu scolaire sur la sante des eleves entre 2003 et 2012 dans 32 pays, dont 29 a revenu faible et intermediaire. Nous avons utilise une metaanalyse a effets randomises pour produire des estimations globales au niveau regional et general. Une regression logistique multivariee a ete utilisee pour estimer les risques relatifs pour les facteurs de risque associes. Des fractions attribuables en population ont ete estimees a partir des risques relatifs ajustes et de la prevalence des determinants pour chaque niveau d'exposition. Resultats Dans tous les pays, la prevalence globale de l'ideation suicidaire sur 12 mois etait de 16,2% (intervalle de confiance, IC, a 95%: 15,6-16,7) pour les filles et de 12,2% (IC a 95%: 11,7-12,7) pour les garcons et la prevalence de l'ideation avec un plan etait de 8,3% (IC a 95%: 7,9-8,7) pour les filles et de 5,8% (IC a 95%: 5,5-6,1) pour les garcons. Dans la Region OMS des Ameriques, l'ideation suicidaire etait plus importante chez les filles que chez les garcons, le taux de prevalence etant estime a 1,70 (IC a 95%: 1,60-1,81) dans cette region contre 1,04 (IC a 95%: 0,98-1,10) dans la Region OMS de l'Afrique. Dans la plupart des pays, les facteurs associes a l'ideation suicidaire incluaient des cas de harcelement et de violence physique, la solitude, un soutien parental limite et une consommation d'alcool et de tabac. Conclusion Si la prevalence des comportements suicidaires des adolescents varie selon les pays, un ensemble coherent de facteurs de risque associes aux comportements suicidaires est ressorti dans toutes les regions et dans la plupart des pays. Objetivo Estimar la prevalencia de pensamientos suicidas y de pensamientos suicidas con un plan en los paises encuestados y analizar las diferencias transversales de los factores de riesgo relacionados. Metodos Se analizaron datos de estudiantes de edades comprendidas entre los 13 y 17 anos que participaron en las Encuestas Mundiales de Salud a Escolares de 2003-2012 en 32 paises, de los cuales 29 tienen ingresos bajos y medios. Se utilizo un metaanalisis de efectos aleatorios para generar estimaciones agrupadas generales y regionales. Se uso una regresion logistica multivariable para calcular los coeficientes de riesgo relacionados con los factores de riesgo. Se calcularon fracciones atribuibles a la poblacion segun los coeficientes de riesgo ajustados y la prevalencia de los determinantes de cada nivel de exposicion. Resultados En todos los paises, los resultados de la recopilacion durante 12 meses de datos sobre la prevalencia de pensamientos suicidas fueron del 16,2% (intervalo de confianza, IC, del 95%: 15,6 a 16,7) entre las mujeres y del 12,2% (IC del 95%: 11,7 a 12,7) entre los hombres, y las cifras de pensamientos suicidas con un plan fueron del 8,3% (IC del 95%: 7,9 a 8,7) entre las mujeres y del 5,8% (IC del 95%: 5,5 a 6,1) entre los hombres. En la region de America de la OMS, las cifras de pensamientos suicidas eran mayores en mujeres que en hombres, con un coeficiente de prevalencia calculado del 1,70 (IC del 95%: 1,60 a 1,81), mientras que el mismo coeficiente fue del 1,04 (IC del 95%: 0,98 a 1,10) en la region africana de la OMS. En la mayoria delos paises, los factores relacionados con los pensamientos suicidas incluian experiencias de acoso y violencia fisica, soledad, escaso apoyo de los padres y consumo de alcohol y tabaco. Conclusion La prevalencia de las conductas suicidas de los adolescentes es diferente segun el pais, aunque ha surgido un conjunto de factores de riesgo de conducta suicida similares en todas las regiones y en la mayoria de los paises., Introduction Worldwide, suicide accounts for an estimated 6% of all deaths among young people. (1) As the second leading cause of mortality among females and the third leading cause among [...]

Objectives To examine socioeconomic and health system determinants of wealth-related inequalities in neonatal mortality rates (NMR) across 48 low- and middle-income countries. Methods We used data from Demographic and Health Surveys conducted between 2006 and 2012. Absolute and relative inequalities for NMR and coverage of antenatal care, facility-based delivery, and Caesarean delivery were measured using the Slope Index of Inequality and Relative Index of Inequality, respectively. Meta-regression was used to assess whether variation in the magnitude of NMR inequalities was associated with inequalities in coverage of maternal health services, and whether country-level economic and health system factors were associated with mean NMR and socioeconomic inequality in NMR. Results Of the three maternal health service indicators examined, the magnitude of socioeconomic inequality in NMR was most strongly related to inequalities in antenatal care. NMR inequality was greatest in countries with higher out-of-pocket health expenditures, more doctors per capita, and a higher adolescent fertility rate. Determinants of lower mean NMR (e.g., higher government health expenditures and a greater number of nurses/midwives per capita) differed from factors associated with lower NMR inequality. Conclusions Reducing the financial burden of maternal health services and achieving universal coverage of antenatal care may contribute to a reduction in socioeconomic differences in NMR. Further investigation of the mechanisms contributing to these cross-national associations seems warranted., Author(s): Britt McKinnon[sup.1] [sup.2] , Sam Harper[sup.2] , Jay S. Kaufman[sup.1] [sup.2] Author Affiliations: (1) Institute for Health and Social Policy, 1030 Pine Avenue West, H3A 1A2, Montreal, QC, Canada [...]