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Background This exploratory study aimed to investigate factors related to infant deaths using a conceptual framework that explains the risk factors of infant deaths in developing countries. Methods The study adopted a cross-sectional study design and used data from the 2012 and 2017 Indonesia Demographic and Health Surveys, with a sample of 3694 singleton live births in 2012 and 3413 in 2017. Results Female infants had a lower chance of mortality compared to male infants [adjusted odds ratio (aOR) = 0.51; 95% confidence interval (CI) = 0.34–0.77]. Infants with a smaller birth size had a higher risk of infant death compared to those with an average size (aOR = 5.66; 95% CI = 3.66–8.77). The risk of infant death with a preceding birth interval of ≥24 months was lower than that with a preceding birth interval of Conclusions A higher infant death risk was associated with male babies and a shorter birth interval (

Mercury (Hg) is a well-known toxicant that can affect children's neurodevelopment. This study attempted to evaluate the internal dose of Hg in hair and fingernails and external Hg exposure from dietary consumption in 283 pairs of mothers and their children aged under 6 years in Taiwan. Mean Hg levels in hair and fingernail samples were 1.07 ± 0.67 and 0.42 ± 0.34 μg/g for mothers, and 1.11 ± 1.22 and 0.36 ± 0.26 μg/g for children, respectively. Our results showed that 42% of mothers and 41% of children had hair Hg levels exceeding the US Environmental Protection Agency recommended value of 1 μg/g. Hg exposure in children was greater than that of their mothers. Estimated daily intake (EDI) levels of Hg among preschool children were 3.3-times higher than those of their mothers. A sensitivity analysis indicated that fish consumption was the main potential factor of Hg exposure among both mothers and their children. External Hg exposure using estimated daily dietary ingestion by mothers was a surrogate for internal hair Hg concentrations. However, poor correlations were found between EDI Hg levels and hair Hg levels among children aged 4-6 years. Exposure sources from food and other media, such as soil and dust, need to be considered to arrive at more-valid risk assessments for younger children's exposure to Hg. Children of mothers who did not have food safety-related risk perceptions or protective behaviors had significantly higher hair Hg concentrations compared to children whose mothers had risk perceptions and protective behaviors. Hg exposure of women of childbearing age and preschool children in Taiwan is still an area of great concern. Providing food safety information and risk-benefits of fish consumption for mothers may avoid harm to the developing nervous systems of their children.

The province of Nusa Tenggara Timur (NTT) in the eastern part of Indonesia is known for high maternal mortality ratios (MMRs) and neonatal mortality eates (NMRs). Sister Hospital is a multicenter program, which aims to lower MMRs and NMRs in the deprived areas of Indonesia by providing comprehensive emergency services for maternal and newborn care. In this study, we evaluated the impact of the Sister Hospital program on MMRs and NMRs in 2009–17. We used linear mixed-effects models to analyze the program’s effects. Study results suggested that in general, the Sister Hospital program reduced MMRs by 1.14/100 000 live births after adjusting for other sociodemographic factors. This study also found that the program effects varied by island, and the highest reduction in MMRs, were found on Sumba Island in which the log of MMRs decreased from 2.23 in 2009 to 2.01 in 2017. However, no effects on NMR outcomes by the program were found. These findings suggest that the Sister Hospital program can be a practical solution for lowering MMRs in rural Indonesia.

Background:\ud \ud Despite malaria control programmes having successfully increased the number of households owning insecticide-treated nets (ITNs) in Malawi, the population of people with ITN access but still not using them fluctuated from 13% in 2010, 5% in 2012 and then 12% in 2015. This study aimed to compare the rate and factors associated with ITN usage among children under 5 years of age, living in household with at least one ITN, in Malawi between 2010 and 2015.\ud \ud Methods:\ud \ud The 2010 and 2015-2016 Malawi Demographic and Health Surveys (MDHSs) were utilized. Only children from households that owned at least one ITN were selected. Multivariate logistic regression analyses were performed to examine associations of child, maternal and household factors with ITN usage.\ud \ud Results:\ud \ud In total, 12,378 and 10,196 children under 5 years of age were examined from 2010 and 2015-2016, respectively. ITN usage increased from 57.8% (95% Confidence interval (CI): 56.1%-59.4%) in 2010 to 69.0% (95% CI 67.4%-70.5%) in 2015. The multivariate analysis revealed that, among others, being aged ≥ 24 months, having mothers with no formal education or with primary education, residing in a female-headed household, and residing in households that had poor household ITN supply were significantly associated with reduced odds of ITN usage.\ud \ud Conclusions:\ud \ud ITNs are a key vector control intervention in malaria prevention. This study revealed increased ITN usage among children under 5 years old in the 5-year period, suggesting that considerable improvements have been made. However, continued efforts to increase awareness of the importance of using ITNs in malaria prevention in Malawi are necessary. Findings from this research provide some policy implications, especially for improving household ITN supply, to improve ITN utilization in Malawi.

Objectives The aim of this study was to determine whether gender impacts potential associations between social relationships, sociodemographic, health and behavioural factors with resilience among older Taiwanese adults. Methods High and low resilience of older adults was determined based on the median value of the Friborg’s Resilience Scale. An independent sample t-test, χ2, and multivariate logistic regression were used to examine predictors for resilience which were then stratified by gender. Results Older women were less likely to be resilient than older men. Marital status, age, financial stress, and satisfaction with one's living environment were only significant in women. Traditional gender roles in the wider Taiwanese context can be attributed to these differences. Conclusions The relationships between gender, sociodemographics, health, and social and behavioural factors with resilience provide unique insights into how culture shapes trends in data.

Background The use of contraceptives is an essential public health concept that improves overall safe motherhood and infant health. Women empowerment has been reported to influence health behaviors in women. With recent efforts to increase access to contraceptive methods, uptake of the same remains a challenge in Cambodia. There are limited studies that have examined the role of women’s empowerment at both individual- and community- level on contraceptive use in Cambodia. This study examined the individual- and community-level factors associated with contraceptive use among Cambodian married women between 2005 and 2014. Methods Data from 2005, 2010, and 2014 Cambodia Demographic and Health Surveys were used to analyze 2211; 10,505; and 10,849 women, respectively. Multilevel binary and multinomial logistic regression models were applied to assess the association between individual- and community- level factors, and the use of contraceptive methods. Results The prevalence of using modern contraceptive methods increased over time (i.e., 29.0, 38.1, and 42.3% in 2005, 2010, and 2014, respectively). At the individual level, women who attained secondary and higher education were more likely to use any contraceptives [adjusted odds ratio (aOR) = 1.43, 95% confidence interval (CI) = 1.22–1.68, and aOR = 1.23, 95% CI = 1.05–1.44 in 2010 and 2014, respectively] compared with those with no formal education. Similarly, having a high workforce participation level was significantly associated with increased likelihood of using any contraceptive methods [aOR = 1.12, 95% CI = 1.00–1.26, aOR = 1.44, 95% CI = 1.29–1.60 and in 2010 and 2014, respectively]. Other factors such as age at first marriage, residence, and having a health insurance were associated with contraceptive use. The proportional change in variance showed that about 14.3% of total variations in the odds of contraceptive use across the communities were explained by both individual- and community-level factors. Moreover, the intraclass correlation showed that about 5.2% of the total variation remained unexplained even after adjustments. Conclusion Both individual- and community- level factors influenced contraceptive use in Cambodia. When designing programs to improve contraceptive use, contextual influences should be taken into account for the effectiveness of the programs.

Background Identifying risk factors of incomplete immunization among children is crucial to developing relevant policies to improve immunization coverage. In this study, we investigated factors associated with incomplete immunization among children in Indonesia and elucidated differences in risk factors between urban and rural areas. Methods The data came from a national-wide survey, the 2017 Indonesia Demographic Health Surveys. In total, 3,264 children aged 12∼23 months were included in the study. An incomplete immunization status was defined as a child who did not complete the ten doses of basic vaccinations, consisting of one dose of bacille Calmette-Guerin, one dose of hepatitis B, three doses of pentavalent vaccine (diphtheria, pertussis, tetanus, hemophilus influenza type B, and hepatitis B vaccine), four doses of polio vaccine, and one dose of measles vaccine. Generalized linear mixed models were constructed to examine the effects of different levels of risk factors on the incomplete immunization status. We further conducted stratified analyses by urban and rural areas. Results About 40% of the 3,264 children were incompletely immunized, among whom 45.3% were in urban areas and 54.7% were in rural areas. Eight of the 34 provinces had incomplete immunization rates exceeding 50%, and the Papua and Maluku regions had the highest rates of incomplete child immunization. The multivariate analyses showed that when women attended fewer than four antenatal care sessions and resided outside the Nusa Tenggara region, their children were more likely to have incomplete immunization in both urban and rural areas. On the other hand, having no health insurance was positively associated with incomplete immunization in urban areas, whereas having received a tetanus vaccination during pregnancy was negatively associated with incomplete immunization in rural areas. Conclusions Results of this study suggest that tailored interventions should be developed to address significant risk factors in rural and urban areas.

Background Signs associated with the onset of disability can be useful in disability projection and have significant implications in elderly care policy. Objective To explored the associations between biometric screening indicators and declines in activities of daily life (ADLs) functioning among the Indonesian elderly. Methods This is a prospective longitudinal cohort study. The Indonesian Family Life Survey (IFLS) 4 conducted in 2007–2008, and IFLS 5 conducted in 2014–2015 were used to assess the association between biometric indicators and ADLs at baseline and follow-up. Results Findings revealed that 22.3% of participants surveyed in 2007–2014 had become disabled in terms of ADLs. Anemia status, stage 2 hypertension, lung capacity, and a longer sit-to-stand time were associated with ADLs. Conclusion These findings are important to help early detection and potentially help the prevention of ADLs in elderly people in the future. Accuracy of disability estimation could possibly be improved if including biometric parameters.

Supplemental material, supplement_11_12 for Multilevel Factors Associated With Pregnancy-Related Health Behaviors in Indonesia: Evidence From the 2007, 2012, and 2017 Indonesian Demographic Health Surveys by Muhammad Hardhantyo and Ying-Chih Chuang in Asia Pacific Journal of Public Health

Background Elderly people tend to have greater healthcare utilization because of their health status. However, with the 4th largest population in the world, little is known concerning the use of services among the Indonesian elderly. Hence, this study aimed to identify factors related to the use of outpatient services among the Indonesian elderly. Methods This is cross sectional study using data from the Indonesian Family Life Survey 5 (IFLS 5), conducted in 2014 and 2015. Only those who were 60 years or older were included in the analyses. We used a logistic regression analysis to determine factors associated with use of outpatient services. Results Among 2912 participants, only 22.7% of respondents had visited health workers or doctors within the previous 4 weeks before the survey. After controlling for other variables, factors associated with the use of outpatient services were socioeconomic status, insurance status, regions of residence, self-rated health, and the number of chronic conditions. Conclusion Inequality in outpatient services was observed among the elderly in Indonesia. More effort is need to expand insurance coverage for the elderly, particularly for those in the lower economic status, and to improve access to outpatient services in rural regions by allocating the needed resources.

Background: Undernutrition is a major global public health problem among children under the age of 5 years. We aimed to untangle the effects of a wide range of individual- and community-level socioeconomic factors on the risks of childhood undernutrition in Malawi. Methods: We analyzed 6384 women-infant pairs from the 2004 and 2010 Malawi Demographic and Health Surveys (MDHSs). The undernutrition status was assessed by three domains of stunted (height-for-age), wasted (weight-for-height), and underweight (weight-for-age). We constructed generalized estimating equation logistic models to analyze associations of individual- and community-level characteristics with childhood undernutrition. Results: About 48.4% of the children were stunted, 4.5% were wasted, and 14.4% were underweight. At the individual level, the risk of childhood undernutrition was significantly higher in males, children with a small birth size, children with a diarrheal episode in the last 2 weeks, children that were a product of multiple births, children born to mothers with either a low socioeconomic status, or a poor education, or who were underweight, and children born in the year 2004. At community level, children born in communities with low and medium wealth, and in communities with low and medium female educational attainment were more likely to be undernourished. Unexpectedly, the maternal HIV status was not associated with childhood undernutrition at either the individual or community level. Conclusion: This study provides evidence of the importance of both individual- and community-level factors in determining childhood undernutrition. Interventions against childhood undernutrition should consider the various predictors discussed in this study in order to reduce undernutrition in children and contribute to their well-being. Key Words: childhood nutritional status, Malawi, stunting, underweight, wasting

Allergic diseases are prevalent worldwide and may result from exposure to various substances. Exposure to ambient bioaerosols is a potential risk factor for allergic diseases; however, accurate exposure assessment is challenging due to the limited number of outdoor monitoring stations. In this study, the relationships between ambient bioaerosol exposure and allergic diseases (viz., acute conjunctivitis, allergic rhinitis, and asthma) were evaluated using validated land-use regression (LUR) models to estimate the exposure levels. Data on the daily outpatient visits were retrieved from the Taiwan National Health Insurance Research Database. The total fungal spore count was associated with acute conjunctivitis in males at the second and third quartiles with relative risks (RRs) of 1.75 (95% confidence interval [CI] = 1.24, 2.48) and 1.32 (95% CI = 1.03, 1.70), respectively. It was also associated with asthma in both sexes when the concentration ≥ 95^(th) percentile with RRs = 3.06 (95% CI = 1.89, 4.95) in males and 1.73 (95% CI = 1.08, 2.76) in females. Cladosporium was correlated with acute conjunctivitis in females at a concentration ≥ 95^(th) percentile with RR = 2.90 (95% CI = 1.40, 6.04). Basidiospores were associated with allergic rhinitis in males at the third and fourth quartiles with RRs = 1.88 (95% CI = 1.44, 2.45) and 1.49 (95% CI = 1.20, 1.84), respectively. Meteorological parameters, including relative humidity and rainfall, were also crucial factors associated with the number of outpatient visits. Our results revealed that ambient fungal spores are critical determinants of allergic diseases. In addition, using LUR models to assess exposure to ambient bioaerosols is feasible.

The influences of HCO3 −, Cl−, and other components on the UV/TiO2 degradation of the antineoplastic agents ifosfamide (IFO) and cyclophosphamide (CP) were studied in this work. The results indicated that the presence of HCO3 −, Cl−, NO3 −, and SO4 2− in water bodies resulted in lower degradation efficiencies. The half-lives of IFO and CP were 1.2 and 1.1 min and increased 2.3–7.3 and 3.2–6.3 times, respectively, in the presence of the four anions (initial compound concentration = 100 μg/L, TiO2 loading =100 mg/L, anion concentration = 1000 mg/L, and pH = 8). Although the presence of HCO3 − in the UV/TiO2/HCO3 − system resulted in a lower degradation rate and less byproduct formation for IFO and CP, two newly identified byproducts, P11 (M.W. = 197) and P12 (M.W. = 101), were formed and detected, suggesting that additional pathways occurred during the reaction of •CO3 − in the system. The results also showed that •CO3 − likely induces a preferred ketonization pathway. Besides the inorganic anions HCO3 −, Cl−, NO3 −, and SO4 2−, the existence of dissolved organic matter in the water has a significant effect and inhibits CP degradation. Toxicity tests showed that higher toxicity occurred in the presence of HCO3 − or Cl− during UV/TiO2 treatment and within 6 h of reaction time, implying that the effects of these two anions should not be ignored when photocatalytic treatment is applied to treat real wastewater.

Highlights • This review summarizes current knowledge on the norovirus RdRp. • Multiple X-ray structures of norovirus RdRp show important conformational changes. • Norovirus RdRp recognizes specific promotor sequences to initiate RNA synthesis. • Anti-HCV nucleoside analogs such as 2CM-C also inhibit Norovirus RdRp. • Suramin and its analogs act as allosteric non-nucleoside polymerase inhibitors., Noroviruses belong to the Caliciviridae family of single-stranded positive-sense RNA viruses. The genus Norovirus includes seven genogroups (designated GI-GVII), of which GI, GII and GIV infect humans. Human noroviruses are responsible for widespread outbreaks of acute gastroenteritis and represent one of the most common causes of foodborne illness. No vaccine or antiviral treatment options are available for norovirus infection. The RNA-dependent RNA polymerase (RdRp) of noroviruses is a key enzyme responsible for transcription and replication of the viral genome. Here, we review the progress made in understanding the structures and functions of norovirus RdRp and its use as a target for small molecule inhibitors. Crystal structures of the RdRp at different stages of substrate interaction have been determined, which shed light on its multi-step catalytic cycle. The in vitro assays and in vivo animal models that have been developed to identify and characterize inhibitors of norovirus RdRp are also summarized, followed by an update on the current antiviral research targeting different regions of norovirus RdRp. In the future, structure-based drug design and rational optimization of known nucleoside and non-nucleoside inhibitors of norovirus RdRp may pave the way towards the next generation of direct-acting antivirals.

Background:\ud \ud Approximately 45% of all children's deaths are associated with malnutrition, and sub-Saharan Africa is hardest hit by this phenomenon. However, information on geographical variations of malnutrition in developing countries is limited. This study examined the geographical distribution and community characteristics associated with child malnutrition in Burkina Faso.\ud \ud Design:\ud \ud Data from the 2011 Burkina Faso Demographic Health Survey were analyzed. A general Kriging interpolation method was used to generate spatial malnutrition patterns. The global Moran's I test was used to identify significant malnutrition spatial patterns. Generalized estimating equations (GEEs) were fitted to examine the association between community level factors and malnutrition.\ud \ud Results:\ud \ud Average rates of stunting and wasting in the communities were 32.48% and 15.05%, respectively. Stunting hotspots were observed in the eastern and northeastern parts of Burkina Faso (i.e. Oudolan, Séno and Yagha, among others), while high rates of wasting were observed in the north-central part. The GEE results revealed lower stunting rates in communities with a higher percentage of households with improved sanitation. Communities with higher rates of professionally assisted births were associated with low wasting rates, while communities with higher rates of households with a low wealth index reported higher rates of wasting.\ud \ud Conclusions:\ud \ud Spatial statistical models of malnutrition prevalence are useful for indicating hotspots over wide areas and hence, for guiding intervention strategies. This study revealed significant geographical patterns and community factors associated with childhood malnutrition. These factors should be considered in future programs aimed at reducing malnutrition in Burkina Faso.

Supplemental material, supplement for Multilevel Factors Associated With Pregnancy-Related Health Behaviors in Indonesia: Evidence From the 2007, 2012, and 2017 Indonesian Demographic Health Surveys by Muhammad Hardhantyo and Ying-Chih Chuang in Asia Pacific Journal of Public Health

Allergic skin diseases may result from various types of chemical and biological allergens. This study investigated the association between ambient bioaerosol exposure and allergic skin diseases by using the exposure data obtained from land use regression models and interpolated data. Data on daily average outpatient visits for atopic dermatitis (ICD-9-CM 691.8) and contact dermatitis and other eczema (ICD-9-CM 692.9) between November 2011 and August 2012 were obtained from the National Health Insurance Research Database. A generalized estimating equation was used to analyze the associations between the skin diseases and ambient bioaerosol levels. The results indicated that during the study period, contact dermatitis and other eczema were more prevalent than atopic dermatitis in the study area. Most cases were observed in districts of Taipei City and 3 major districts of New Taipei City, namely Xinzhuang, Banqiao, and Xindian. In univariate analysis, most bioaerosols were positively associated with both skin diseases. After adjustment for air pollution and sociodemographic factors, exposure to total fungal spores was significantly associated with atopic dermatitis in males (relative risk [RR] = 1.12; 95% confidence interval [CI] = 1.05-1.19). Contact dermatitis and other eczema had significant relationships with Cladosporium in males (RR = 1.07; 95% CI = 1.02-1.14) and with Aspergillus/Penicillium in females (RR = 1.04; 95% CI = 1.02-1.07). Meteorological parameters, namely wind speed, temperature, and rainfall, were also significantly associated with skin diseases. Our findings reveal that exposure to ambient bioaerosols is a significant and independent risk factor for allergic skin diseases.

Lack of knowledge regarding brucellosis may lead to highly risky practices. Among herders in Mongolia, little research was conducted assessing the extent of knowledge related to brucellosis, the type of preventive behaviours that were practiced, and the relationship between knowledge and behaviour regarding brucellosis. A cross-sectional study was conducted in two provinces of Mongolia where herders were randomly selected to participate in the study. Face-to-face interviews were conducted using a structured questionnaire. In total, 485 herders participated in the study. The results indicated that brucellosis preventive practices were significantly associated with sex, location, use of veterinary services, exposure to TV programs and knowledge of brucellosis. Regional disparities in knowledge and behaviour were observed in this research. Herders were more likely to engage in preventive practices if they had a higher level of knowledge of brucellosis. Findings from this research indicated that the effectiveness of incorporating health education through TV programs, as well as the importance of ensuring access to veterinary services in brucellosis prevention.

Geographical variations in teen birth rates (TBR) still persist despite controlling for contextual factors. The aim of this research was to identify spatial patterns of TBR in Taiwan and to examine spatial relationships among different contextual factors. Using townships as the unit of analysis (N=359), this research used social and demographic variables for the years 1995, 2000, 2005 and 2010 and conducted spatial modelling of TBR. Geographical maps of TBR were presented, and Local Indicator of Spatial Autocorrelations was used to identify TBR clustering. Comparisons were made between ordinary least-squares models and spatial lag models, in which township-level TBRs were regressed on other township-level contextual characteristics. Our study found that townships with a high TBR were mostly in eastern, central and some southern regions of Taiwan, while townships with a low TBR were in the vicinity of metropolitan areas. The significant spatial lag indicated that townships would have a higher expected prevalence rate if adjacent townships have had higher rates. Results also indicated that the percentage of aborigines and the percentage of college-educated people were consistently associated with TBR over the years. Interventions aimed at reducing TBR in Taiwan should consider the presence of spatial correlations and should incorporate neighbouring townships.

The Democratic Republic of the Congo (DRC) has one of the highest rates of violence against women in the world; however, few studies have focused on this issue. In this study, we assessed the interrelationship among intimate partner violence (IPV), unintended pregnancy, pregnancy loss, and other sociodemographic factors in the DRC. Our analyses were based on data from the DRC demographic and health survey, conducted from November 2013 to February 2014. We constructed generalized estimating equation models to analyze the data from a sample of 5,120 married women. Our results showed that having a husband or partner who exhibited controlling behaviors, women who justified wife-beating, having a mother who had experienced IPV, and having a husband or partner who consumed alcohol were positively associated with IPV, whereas decision-making autonomy among women was negatively associated with IPV. In the community, the proportion of women who had experienced IPV and that of those who had completed secondary or higher education were positively and negatively associated with any IPV type, respectively. In addition, emotional IPV and any IPV type were positively associated with pregnancy loss. Our results indicate the necessity of implementing programs targeting gender equality at both individual and community levels.

Airborne fungal spores, a type of bioaerosols, are significant air pollutants. We conducted a study to determine the spatiotemporal distributions of ambient fungi in the Greater Taipei area and develop land use regression (LUR) models for total and major fungal taxa. Four seasonal sampling campaigns were conducted over a year at 44 representative sites. Multiple regressions were performed to construct the LUR models. Ascospores were the most prevalent category, followed by Aspergillus/Penicillium, basidiospores, and Cladosporium. The highest fungal concentrations were found in spring. According to the LUR models, higher concentrations of Aspergillus/Penicillium and basidiospores were respectively present in residential/commercial areas and in areas with shorter road lengths. Various meteorological factors, particulates with aerodynamic diameters of ≤10 μm, and elevation also had significant relationships with fungal concentrations. The LUR models developed in this study can be used to assess spatiotemporal fungal distribution in the Greater Taipei area.

Family planning has improved the well-being of families by preventing high-risk pregnancies and abortions and reducing unplanned pregnancies. However, the effectiveness of family planning efforts has not been consistent across countries. This study examined factors associated with contraceptive use among married women in Ethiopia. Data were from the 2011 Ethiopian Demographic and Health Survey. The sample comprised 10,204 married women (aged 15-49 years). Logistic regression models were used to analyze the data. Among married women in Ethiopia, 29.2% used contraceptive methods. About 44.1% of women who were not current users of contraceptives reported that they intended to use contraceptives in the future. Age at first marriage, being educated, number of living children, exposure to mass media, being employed, having educated partners, and having been informed about contraceptive use at health facilities were positively associated with current contraceptive use. By contrast, older age, a rural resident, or Muslim; belonging to the Afar or Somali ethnic groups; desiring numerous children; having husbands who desired additional children; and abortion experience were negatively associated with current contraceptive use. Our findings indicated that improving education, providing employment opportunities for women, and providing training to family planning providers are essential to increasing contraceptive use.

Ambient bacteria and endotoxins are components of bioaerosols, which are abundant in ambient air. Exposure to ambient bacteria and endotoxins has been associated with respiratory symptoms. We monitored the spatiotemporal distributions of ambient bioaerosols in the Greater Taipei area by using multisite sampling and developed regression models for ambient bacterial and endotoxin concentrations. Forty-four representative sampling sites were selected from the Greater Taipei area. Samples were collected in 4 seasons throughout a 1-y study period. Ambient bacteria were quantified using acridine orange staining, and endotoxins were analyzed using Limulus amebocyte lysate assays. Land-use types and major determinants of the bioaerosols were used to develop regression models. Ambient bacteria ranged from < limit of detection (LOD) to 1.68 × 105 cells/m3, whereas endotoxins ranged from < LOD to 20.62 EU/m3. Significant seasonal variations were observed for both bioaerosols, with the highest concentrations observed in spring. Regression analyses revealed temperature, relative humidity, and particulate matter as the major predictors of ambient bacteria and endotoxins. No land-use type was correlated with any of the bioaerosols. The number of schools and gas stations was positively associated with both bioaerosols. The leave-one-out cross-validation R2 of the final models for ambient bacteria and endotoxins were 0.11 and 0.31, respectively. The results of this study revealed high spatiotemporal variations in the distributions of ambient bacteria and endotoxins in the Greater Taipei area. Additional potential predictors should be included in future studies to develop better predictive models for ambient bacteria and endotoxins.

Background Most previous studies on healthcare service utilization in low-income countries have not used a multilevel study design to address the importance of community-level women’s autonomy. We assessed whether women’s autonomy, measured at both individual and community levels, is associated with maternal healthcare service utilization in Ethiopia. Methods We analyzed data from the 2005 and 2011 Ethiopia Demographic and Health Surveys (N = 6058 and 7043, respectively) for measuring women’s decision-making power and permissive gender norms associated with wife beating. We used Spearman’s correlation and the chi-squared test for bivariate analyses and constructed generalized estimating equation logistic regression models to analyze the associations between women’s autonomy indicators and maternal healthcare service utilization with control for other socioeconomic characteristics. Results Our multivariate analysis showed that women living in communities with a higher percentage of opposing attitudes toward wife beating were more likely to use all three types of maternal healthcare services in 2011 (adjusted odds ratios = 1.21, 1.23, and 1.18 for four or more antenatal care visits, health facility delivery, and postnatal care visits, respectively). In 2005, the adjusted odds ratios were 1.16 and 1.17 for four or more antenatal care visits and health facility delivery, respectively. In 2011, the percentage of women in the community with high decision-making power was positively associated with the likelihood of four or more antenatal care visits (adjusted odds ratio = 1.14). The association of individual-level autonomy on maternal healthcare service utilization was less profound after we controlled for other individual-level and community-level characteristics. Conclusions Our study shows that women’s autonomy was positively associated with maternal healthcare service utilization in Ethiopia. We suggest addressing woman empowerment in national policies and programs would be the optimal solution. Electronic supplementary material The online version of this article (10.1186/s12913-017-2670-9) contains supplementary material, which is available to authorized users.

Background Studies on the determinants of cervical cancer screening in sub-Saharan Africa have focused mostly on individual-level characteristics of cervical cancer screening. Therefore, in this study, we included both individual- and community-level indicators to examine the determinants of cervical cancer screening among Kenyan women. Methods We analyzed data from the 2014 Kenya Demographic and Health Surveys. Our analysis focused on 9016 married women of reproductive age (15–49 years). We conducted multilevel analyses using generalized linear mixed models with the log-binomial function to simultaneously analyze the association of individual- and community-level factors with cervical cancer screening. Results About 72.1% of women (n = 6498) knew about cervical cancer. Of these women, only 19.4% had undergone cervical cancer screening [58.24% Papanicolaou (Pap) test and 41.76% visual inspection]. Our multivariate analysis results indicated that the prevalence of cervical cancer screening was higher among women aged 35-49 years than women aged 15-24 years. The prevalence was also higher among women residing in the Central, Nyanza, and Nairobi regions than women residing in the Coastal region. Cervical cancer screening was more prevalent among women who had media exposure, had higher household wealth index, were employed, were insured, and had visit a health facility in 12 months than did their counterparts. The prevalence of Pap test history was 19% higher among women who had sexual autonomy than women who did not have sexual autonomy. The prevalence of Pap test history was also higher among communities comprised of higher proportions of women with sexual autonomy and higher education. Conclusions Policies should emphasize increasing gender equality, improving education at the community level, providing employment opportunities for women, and increasing universal health insurance coverage. These focal points can ensure equity in access to health care services and further increase the prevalence of cervical cancer screening in Kenya.

Effects of Individual-Level and Community-Level Characteristics on Maternal Healthcare Service Utilization (2-year pooled data, 2005 and 2011). Description of data: Results of multivariate analyses about the relationships among individual-level characteristics, community-level characteristics, and interaction effects of womenâ s empowerment and year on maternal healthcare service utilization. (DOCX 16Â kb)

Objective Despite the large reduction in infant mortality rates in the last two decades, the burden of infant mortality is still high in Malawi. Because few studies have specifically addressed the determinants of infant mortality in Malawi, this exploratory study identified a series of distal, intermediate, and proximal factors related to infant mortality using a conceptual framework that explains the risk in developing countries. The objective of this study was to examine the effects of family and socioeconomic factors on the risk of an infant dying before the age of 12 months. Methods In this study, we analyzed the 2004 and 2010 data of the Malawi Demographic and Health Surveys. This study adopted a cross-sectional study design involving 4,698 and 12,174 singleton births in the years 2004 and 2010, respectively. Multiple logistic regression models were used to estimate the effects of selected variables on infant mortality. Results In the multivariate logistic regression analyses, women who resided in wealthy urban areas were 58% less likely to report infant deaths than those in rural areas [odds ratio (OR) = 0.48]. Infants who were second or third in birth order were less likely to die before 12 months. However, cesarean section delivery was found to be a risk factor associated with infant mortality in the year 2004 (OR = 1.95). By contrast, women who were in the highest 20% of household wealth, who resided in the northern region, and were in the 20–29 age group were less likely to report infant deaths. However, cesarean section delivery (OR = 1.42), male infants (OR = 1.26), and small size at birth (OR = 1.63) were the significant predictors of infant mortality in the year 2010. Furthermore, the mother's education and household wealth were not significant predictors of infant mortality in Malawi. Conclusion The present study shows that improving the quality of life in rural areas, evenly distributing health care delivery services and other social economic factors across the nation, and improving maternal health care, neonatal care, and nutrient intake could decrease infant mortality in Malawi.

Background Empirical evidence regarding the relationship between childhood immunization and individual- and community-level factors in low-income countries has received little attention. We compared the trends and the effects of a wide range of individual- and community-level socioeconomic factors on the likelihood of a child being immunized between 2004 and 2010 in Malawi. Methods We used data from the 2004 and 2010 Malawi Demographic and Health Survey and applied generalized estimating logistic regression equation to analyze data respectively on 2042 and 3496 children aged 12–23 months. We compared the relationship between individual- and community-level socioeconomic factors and a child's vaccination status for four basic vaccines recommended by the World Health Organization: bacillus Calmette-Guerin (BCG) vaccine, diphtheria-tetanus-pertussis (DPT3) vaccine, oral polio vaccine (OPV3), and measles-containing vaccine 1 (MCV1). Results The trends of vaccination had a similar pattern in 2004 and 2010. The coverage of the four vaccinations was highest for BCG and lowest for OPV3 and complete immunization was higher in 2010. The multivariate analyses show that mother’s low education, having one or none antenatal visits, having no immunization card, having immunization card but not seen, residing in poor households, and living in central region were the most significant factors associated with decreased odds of achieving vaccination coverage and complete vaccination in both 2004 and 2010. However, maternal education was more likely to be associated with children’s immunization in 2010, while the geographical region was more likely to be associated with children’s immunization in 2004. Conclusions There were marked improvements in the national immunization coverage from 2004 to 2010. In order to achieve complete immunization, to further enhance the national immunization coverage as well as to lessen the gaps and disparities in childhood vaccination in Malawi, policy makers should design interventions based on the factors addressed in this study.

Indonesia has one of the highest maternal mortality rates among Southeast Asia countries. Mothers’ pregnancy-related behaviors were proven to be the major determinants of maternal mortality. This study attempted to measure individual- and community-level factors that contribute to pregnancy-related health behaviors among Indonesian women. This study used representative nationwide survey samples among women aged 15 to 49 years from the Indonesian Demographic Health Survey in the years 2007 (N = 15 314), 2012 (N = 15 197), and 2017 (N = 15 300). Generalized linear mixed models were constructed to simultaneously analyze relationships of pregnancy-related health behaviors with other individual- and community-level explanatory factors. We found that women’s educational level, household wealth index, insurance status, access to health facilities, geographic location, general health condition, pregnancy intentions, and community-level socioeconomic status were significantly associated with different outcome behaviors. The findings of this study suggest that future policies should focus on both individual- and community-level factors to improve women’s pregnancy-related behaviors.

The collective excitations in AA-stacked bilayer graphene for a perpendicular electric field are investigated analytically within the tight-binding model and the random-phase approximation. Such a field destroys the uniform probability distribution of the four sublattices. This drives a symmetry breaking between the intralayer and interlayer polarization intensities from the intrapair band excitations. A field-induced acoustic plasmon thus emerges in addition to the strongly field-tunable intrinsic acoustic and optical plasmons. At long wavelengths, the three modes show different dispersions and field dependence. The definite physical mechanism of the electrically inducible and tunable mode can be expected to also be present in other AA-stacked few-layer graphenes.

This study used a longitudinal dataset and lagged dependent-variable panel regression models to examine whether political and economic characteristics directly predict under-5-year mortality rates (U5MR), and moderate the effects of health services and environment on U5MR. We used a sample of 46 less-developed countries from 1980 to 2009. Our results showed that the effects of political and economic characteristics on U5MR varied by non-sub-Saharan and sub-Saharan countries. After controlling for baseline U5MR and other socioeconomic variables, while foreign investment and health services were negatively associated U5MR, democracy was positively associated with U5MR in nonsub-Saharan countries. In contrast, debt was positively associated with and democracy and foreign investment were negatively associated with U5MR in sub-Saharan countries. The interaction analyses indicated that for sub-Saharan countries, the effects of health services on U5MR only existed for countries with low foreign investment.

Background The theory of ecological unequal exchange explains how trade and various forms of economic activity create the problem of environmental degradation, and lead to the deterioration of population health. Based on this theory, the present study examined the interrelationships among economic characteristics, ecological footprints, CO2 emissions, infant mortality rates, and under-five mortality rates in low-income countries. Methods …

This study was conducted to evaluate the effects of transported Asian dust and other environmental parameters on the levels and compositions of ambient fungi in the atmosphere of northern Taiwan. We monitored Asian dust events in Taipei County, Taiwan from January 2003 to June 2004. We used duplicate Burkard portable air samplers to collect ambient fungi before, during, and after dust events. Six transported Asian dust events were monitored during the study period. Elevated concentrations of Aspergillus (A. niger, specifically), Coelomycetes, Rhinocladiella, Sporothrix and Verticillium were noted (p 0.05) during Asian dust periods. Botryosporium and Trichothecium were only recovered during dust event days. Multiple regression analysis showed that fungal levels were positively associated with temperature, wind speed, rainfall, non-methane hydrocarbons and particulates with aerodynamic diameters ≤10 μm (PM(10)), and negatively correlated with relative humidity and ozone. Our results demonstrated that Asian dust events affected ambient fungal concentrations and compositions in northern Taiwan. Ambient fungi also had complex dynamics with air pollutants and meteorological factors. Future studies should explore the health impacts of ambient fungi during Asian dust events, adjusting for the synergistic/antagonistic effects of weather and air pollutants.