Objective: This study examined the associations between the adequacy ofchildcare provided by adult caretakers and childhood undernutrition in rural Yemen,independent of household wealth and food consumption.

Methods: We analyzed data of 3,549 children under the age of 5 years livingin rural areas of Yemen based on the 2013 Yemen Baseline Survey of Mother and ChildHealth. Nutritional status was evaluated by the presence of underweight, stunting, andwasting according to the World Health Organization child growth standards. The impact ofchildcare including leaving children alone, putting older children into labor force, andthe use of antenatal care while pregnant on child undernutrition was assessed and adjustedfor food consumption by children, household composition, demographic and educationalbackground of caretakers, and household wealth.

Results: The prevalence of underweight, stunting, and wasting was 46.2%,62.6%, and 11.1%, respectively. Not leaving children alone, keeping children out of thelabor force, and use of antenatal care were associated with a lower risk of underweight(odds ratio [OR] = 0.84, P = 0.016; OR = 0.84, P = 0.036; and OR = 0.85, P = 0.042) andstunting (OR = 0.80, P = 0.004; OR = 0.82, P = 0.024; and OR = 0.78, P = 0.003). Afterfurther adjustment for food consumption, the associations between adequate childcareindicators and lower odds of stunting remained significant (OR = 0.73, P = 0.025; OR =0.72, P = 0.046; and OR = 0.76, P = 0.038).

Conclusions: A marked prevalence of stunting among rural children in Yemenwas observed. Adequate childcare by adult caretakers in families is associated with alower incidence of underweight and stunting among children under 5 years of age. Promotingadequate childcare by adult household members is a feasible option for reducingundernutrition among children in rural Yemen.

Objectives: This study was performed to evaluate the use of individual components of antenatal care (ANC) services by pregnant women across India in addition to counting of ANC visits and then analyze differences according to state, socioeconomic condition, and access to health care services.Methods: The study used a nationally representative sample of 36,850 women from the National Family Health Survey (2005–2006) of India. Outcome measurements were medication, number of ANC visits, and components of ANC, including physical examination and measurements, laboratory examination, and advice about pregnancy. Differences in these outcomes according to 29 states, socioeconomic conditions, and access to health care services were examined. Independent associations between outcome measures and social and health care factors were analyzed.Results: The percentages of women who used ANC at least once and four times or more were 81.5% (ranges by states: 38.0 –99.9%) and 46.1% (15.2–97.9%), respectively. Among those who used ANC four times or more, 86.4% (54.2–98.9%) received a blood examination, and 85.8% (70.3–96.3%) were advised to deliver in a hospital. Greater wealth (OR=3.38; 95%CI 2.58–4.42) and higher education level (OR=3.19; 95%CI 2.49–4.14) were associated with receiving a blood examination during ANC. Rural residence was negatively associated with using ANC four times or more (OR=0.64; 95%CI 0.59–0.67) and receiving a blood examination (OR=0.67; 95%CI 0.59–0.76). Those who received ANC at community health centers were less likely to receive a blood pressure examination, blood and urine examination, and advice to deliver in a hospital compared with those who received ANC at public hospitals.Conclusion: This study showed substantial inequalities in use of ANC and service components of ANC received in India across geographic areas, socioeconomic conditions, and levels of access to health care services. In addition to reducing socioeconomic inequalities, it is necessary to provide quality services to those with limited access to health care services.

Objective: The aim of this study was to elucidate the roles of knowledge related to lymphatic filariasis (LF), contributions of taking roles in community activities to eradicate LF and participation in traditional village forums in adherence to mass drug administration (MDA) in a preventive chemotherapy program targeted at the community residents.
Materials and Methods: A survey on ingestion of diethylcarbamazine (DEC) and albendazole (ALB), knowledge related to LF, taking roles in community activities and participation in traditional village forums was carried out for 400 adult subjects randomly selected from the Central Division of Fiji within three months after the MDA campaign in 2010 in the respective communities. Multilevel logistic regression analysis and multilevel linear regression analysis were performed to examine relationships between knowledge, community activities, traditional village forums and ingestion of anti-filarial drugs. The LF knowledge score was defined as a factor score of five knowledge variables.
Results: Among 324 respondents, 40.4% of them ingested both DEC and ALB. Participation in traditional village forums was independently and significantly related to ingestion of DEC and ALB (OR=1.78, 95% CI=1.04-3.05) and taking roles in community activities for MDA (OR=1.87, 95% CI=1.18-2.94), regardless of the subject’s gender, education, knowledge and taking roles in community activities. Taking roles in community activities for MDA was independently related to the LF knowledge score (β=0.24, 95% CI=0.15-0.33).
Conclusion: Participation in traditional village forums in Fiji was related to taking roles in community activities for MDA and associated with adherence to MDA regimen regardless of the educational attainment of the individual residents.

Objectives: This study was performed to evaluate the use of individual components of antenatal care (ANC) services by pregnant women across India in addition to counting of ANC visits and then analyze differences according to state, socioeconomic condition, and access to health care services.
Methods: The study used a nationally representative sample of 36,850 women from the National Family Health Survey (2005–2006) of India. Outcome measurements were medication, number of ANC visits, and components of ANC, including physical examination and measurements, laboratory examination, and advice about pregnancy. Differences in these outcomes according to 29 states, socioeconomic conditions, and access to health care services were examined. Independent associations between outcome measures and social and health care factors were analyzed.
Results: The percentages of women who used ANC at least once and four times or more were 81.5% (ranges by states: 38.0 –99.9%) and 46.1% (15.2–97.9%), respectively. Among those who used ANC four times or more, 86.4% (54.2–98.9%) received a blood examination, and 85.8% (70.3–96.3%) were advised to deliver in a hospital. Greater wealth (OR=3.38; 95%CI 2.58–4.42) and higher education level (OR=3.19; 95%CI 2.49–4.14) were associated with receiving a blood examination during ANC. Rural residence was negatively associated with using ANC four times or more (OR=0.64; 95%CI 0.59–0.67) and receiving a blood examination (OR=0.67; 95%CI 0.59–0.76). Those who received ANC at community health centers were less likely to receive a blood pressure examination, blood and urine examination, and advice to deliver in a hospital compared with those who received ANC at public hospitals.
Conclusion: This study showed substantial inequalities in use of ANC and service components of ANC received in India across geographic areas, socioeconomic conditions, and levels of access to health care services. In addition to reducing socioeconomic inequalities, it is necessary to provide quality services to those withlimited access to health care services.

Objective: The aim of this study was to assess the economic burden of disability of school-aged children and to evaluate the association between disabilities and household socioeconomic status, as well as the economic burden of disability and household socioeconomic status in Vietnam.
Materials and Methods: Nationally representative data for 9,882 children aged 6 to 17 years from the Vietnam Household Living Standard Survey 2006 were used. Disabilities were measured in six basic functional domains, including vision, hearing, remembering or concentrating, mobility, self-care, and communication. We evaluated the association between area, household income, educational attainment, or occupation of household head, and each difficulty. The ratio of health-care expenditure to per capita household income was compared by presence of a disability as well as household socioeconomic status.
Results: The prevalence of difficulty was 1.9% for vision and 2.3% for at least one of the other five domains. Difficulty in vision was more prevalent in the richer households (p=0.001), whereas difficulty in the other five domains was more prevalent in the poorer households (p=0.002). The ratio of health-care expenditure to per capita household income was greater than 0.05 in 4.6% of children. The adjusted odds ratio of children with difficulty in vision having a health-care expenditure share greater than 0.05 compared with children without difficulty was 4.78 (95% CI: 2.95, 7.73; p<0.001), and that for difficulty in the other five domains was 3.13 (95% CI: 2.04, 4.80; p<0.001). Among children with difficulty in at least one of the five domains other than vision, the proportion of children with a health-care expenditure share greater than 0.05 was higher among children from the poorer households (p=0.033).
Conclusions: Children with a disability spent more on health care relative to their income than those without. Visual disability was more prevalent among children from the richer households, whereas other disabilities were more prevalent among children from the poorer households.

OBJECTIVESThe aim of this study is to examine the utilities of antenatal care with comprehensive health education qualified in Phnom Penh for the health of mothers and infants during perinatal and postpartum periods. Attention was given to the existing socioeconomic disparties among women in this urban area, and the utilities were discussed irrespective of socioeconomic status.

METHODSA total of 436 pregnant women in an urban area in Phnom Penh were selected using a complete survey in randomly sampled villages and were followed up. Participating in antenatal care with comprehensive health education at least three time was regarded as the use of "qualified antenatal care" during pregnancy. In this study, we investigated the independent associations of the use of qualified antenatal care with the following outcome variables after the adjustment for the influence of socieconomic variables: postpartum maternal health knowledge, postpartum maternal anemia, low birth weight, and infant immunization.

RESULTSOf the 314 subjects who completed the follow-up examination, 66.8% used qualified antenatal care during pregnancy. The use of qualified antenatal care was positively associated with postpartum maternal health knowledge (OR=2.38, 95% CI: 1.12-5.05). and reductions in the incidences of postpartum anemia (OR=0.22,95% CI: 0.05-0.95) and low birth weight (OR=0.05,95% CI: 0.01-0.39) after the adjustment of the influence of socioeconomic status. The infants born to mothers who used qualified antenatal care had significantly higher coverage of BCG, DPT(1), and DTP(3) immunizations (P<0.001,P<0.001, andP<0.01, respectively), independent of their socioeconomic conditions.

CONCLUSIONThis study shows the solid utilities of qualified antenatal care in Phnom Penh for perinatal health.

Aim: To evaluate the costs associated with healthcare and long-term care during the last 24 months before death according to major disease groups.Methods: Individual data regarding healthcare and long-term care costs according to public insurance schemes during the last 24 months before death among all decedents older than 75 years reported in a city in Japan between April 1, 2010 and March 31, 2014 were identified; the data for nine major diseases were then analyzed.Results: For the 2149 decedents studied, the average healthcare costs per capita in the last 24 months of life for moderately-old (75 to 84 years) and extremely-old (85 years and older) decedents was 4,135,467 JPY and 2,493,001 JPY, respectively, while the average long-term care costs per capita for 24 months was 1,300,710 JPY and 2,723,239 JPY, respectively. The total costs (healthcare and long-term care combined) ranged from 9,169,547 JPY for chronic kidney disease to 5,023,762 JPY for ischemic heart disease. In all the diseases studied, the moderately-old decedents incurred higher healthcare costs while the extremely-old decedents incurred higher long-term care costs. However, for the care costs of chronic lower respiratory diseases, this pattern was not observed.Conclusion: A shift in expenditure from healthcare to long-term care as the decedents’ age increased was observed in major diseases, with some exceptions.