What is the most appropriate measure of impaired fertility for understanding its social consequences in sub-Saharan Africa? The dearth of subjective measures in surveys in the region has prevented comparisons of subjective and objective measures. Perceived difficulties conceiving may have a greater impact than objective measures for social outcomes such as divorce, stigmatization and distress. This study compares 12- (clinical) and 24- (epidemiological) month measures from biomedicine and 5- and 7-year measures from demography with a subjective measure of impaired fertility using correlations, random effects models and test–retest models to assess relationships between measures, their association with sociodemographic characteristics and the stability of measures across time. Secondary panel data (1998–2004) from 1350 Ghanaian women aged 15–49 of all marital statuses are used. Longer waiting times to identification of impaired fertility required by demographic measures result in more stable measures, but perceived difficulties conceiving are most closely aligned with clinical infertility (r=0.61; p<0.05). Epidemiological infertility is also closely aligned with the subjective measure. A large proportion of those identified as having impaired fertility based purely on waiting times are successful contraceptors. Where subjective measures are not available, epidemiological (24-month) measures may be most appropriate for studies of the social consequences of impaired fertility. Accounting for contraceptive use is important in order to avoid false positives. Future research should consider a variety of measures of perceived difficulties conceiving and self-identified infertility to assess which is most valid; in order to accomplish this, it is imperative that subjective measures of infertility be included in social surveys in sub-Saharan Africa.

Early life disparity – defined as the average life years lost due to death by the age of 60 years – can be used to assess more systematically the effect of savings from death at a young age. In addition, it can give valuable insight into the consequences of death in the early stages of life. Early life disparity can further be categorized into child life disparity (0–14 years) and adult life disparity (15–60 years). This study estimated early life disparity using complete life tables for the period 1970–1975 to 2006–2010, which were constructed from abridged life tables and death rates provided by the Sample Registration System (SRS) in India. The contribution of premature deaths to the difference in life disparity was estimated using a replacement algorithm. The findings clearly indicated an overall declining trend in early life disparity in India, with a notable reduction in child life disparity, and a deceleration of adult life disparity during the period 1970–1975 to 2006–2010. Interstate variations in early life disparity were seen to converge with time. Decomposition analysis suggested that these variations could be minimized further by averting death during childhood.

Uttar Pradesh is India’s most populous state with a population of 200 million. Any change in its fertility and mortality is bound to bring change at the national level. This study analysed the burden of disease in the state by calculating the disability-adjusted life year (DALY) for infectious and non-communicable diseases. Data were from two rounds (52nd and 60th) of the National Sample Survey Organization (NSSO) survey conducted in 1995–96 and 2004, respectively, and the Million Deaths Study (MDS) of 2001–03. Descriptive and multivariate analyses were carried out to identify the determinants of different types of self-reported morbidity and DALY. The results show that in Uttar Pradesh the prevalence of all selected self-reported infectious and non-communicable diseases increased over the study period from 1995 to 2004, and in most cases by more than two times. The highest observed increase in prevalence was in non-communicable diseases excluding CVDs, which increased from 7% in 1995 to 19% in 2004. The prevalence was higher for those aged 60 and above, females, those who were illiterate and rich across the time period and for all selected morbidities. The results were significant at p<0.001. The estimation of the DALY revealed that the burden of infectious diseases was higher during infancy, noticeably among males than females in 2002. However, females aged 1–5 years were more likely to report infectious diseases than corresponding males. The age distribution of the DALY indicated that individuals aged below 5 years and above 60 years were more susceptible to ill health. The growing incidence of non-communicable diseases, especially among the older generation, puts an additional burden on the health system in the state. Uttar Pradesh has to grapple with the unresolved problem of preventable infectious diseases on the one hand and the growth in non-communicable disease on the other.

In sub-Saharan Africa, nutrition research has primarily focused on under-nutrition, particularly among vulnerable children. However, there is increasing evidence of an emerging nutrition transition with extremely high rates of obesity, and malnutrition in women may be a problem that is insufficiently recognized and inadequately documented. This analysis was based on the 2008 Nigerian Demographic and Health Survey (NDHS), which included 27,967 women aged 15–49 years. Individual-level data were collected for socio-demographic characteristics and aggregated to the country’s 37 states. A Bayesian geo-additive mixed model was used to map the geographic distribution of under-nutrition at the state level, accounting for individual-level risk factors. The results reveal that 12.0% of the population were underweight, while 20.9% were either overweight or obese, based on BMI. The northern states of Sokoto and Yobe/Borno and the southern state of Delta had the highest prevalence of underweight, while states in the centre had the lowest underweight prevalence. Underweight women were more likely to be from poorer households compared with their counterparts from the richest wealth index, which were consistently associated with lower odds of being underweight (posterior odds ratio (POR) and 95% credible region (CR): 0.56 [0.46, 0.70]). On the other hand Muslim women (1.61 [1.10, 2.23]), those of traditional religion (2.12 [1.44, 3.00]), those from the Fulani ethnic group (2.90 [1.64, 5.55]) and those living in Yobe state were all consistently associated with higher odds of being underweight. This study demonstrates that underweight is a major public health problem in Nigeria affecting adult females in the northern states of Nigeria. Identifying risk factors and the need to account for sex, spatial and socio-cultural issues are crucial to develop and implement evidence-informed strategies and interventions for lifestyle health promotion.

The aim of the study was to reveal the ethnic and socioeconomic factors associated with height and body mass index (BMI) of children during the period of political and social transition in Lithuania in 1990–2008. Data were derived from the personal health records of 1491 children (762 boys and 729 girls) born in 1990 in Vilnius city and region. Height and BMI from birth up to the age of 18 years were investigated. Children were divided into groups according to their ethnicity, place of residence, father’s and mother’s occupation and birth order. Height and BMI were compared between the groups; a Bonferroni correction was applied. A multiple linear regression model was used to measure the effects of the independent variables on height and BMI. Girls living in Vilnius city were significantly taller in later life at the ages of 8 and 11 years. Sons of mothers employed as office workers appeared to be significantly taller at the ages of 7, 12, 14 and 15 years compared with the sons of labourers. First-born girls were taller at the age of 7 years than later-born girls of the same age (124.48±5.11 cm and 122.92±5.14 cm, respectively, p<0.001). Later-born children of both sexes had higher BMIs at birth compared with first-borns; however, first-born girls had higher BMIs at the age of 11 years compared with their later-born peers (17.78±2.87 kg/m² and 16.79±2.14 kg/m² respectively, p<0.001). In the multiple linear regression model, the five tested independent variables explained only up to 18% of total variability. Boys were more sensitive to ethnic and socioeconomic factors: ethnicity appeared to be a significant predictor of boys’ height at the age of 5 years (p<0.001), while birth order (p<0.001) predicted boys’ BMI at birth. In general, ethnicity, place of residence, father’s and mother’s occupation and birth order were not associated with children’s height and BMI in most age groups.

Many Bangladeshi women marry early, and many marry before the legal age of 18 years. This practice has been associated with a higher risk of health and medical morbidities, and also early pregnancy with higher pre- and postnatal complications. The aim of this study was to determine the prevalence, and factors associated with, child marriage among Bangladeshi women using multiple binary logistic regression analysis of data from the BDHS-2011. Further analysis on the trend of age at first marriage was performed with additional data sets from previous surveys. The mean and median of ages at first marriage of Bangladeshi women in 2011 were 15.69±2.97 and 15.00 years, respectively. A remarkably high percentage (78.2%) married before the age of 18; of these, 5.5% married at a very early age (before 13 years of age). Binary logistic regression analysis demonstrated that uneducated women were more likely to be married early (p<0.001) than those with secondary and higher education. Child marriage was especially pronounced among women with uneducated husbands, Muslims, those with poor economic backgrounds and those living in rural areas. Further analysis including data from previous BDHS surveys showed that child marriage among Bangladeshi women had a decreasing trend from 1993–94 to 2011. These results show that child marriage was very common in Bangladesh, and closely associated with low level of education and low economic status. The decreasing trend in child marriage indicates an improvement over the past two decades but more effort is needed to further reduce and eventually eliminate the practice.

Female sex workers (FSWs) are vulnerable to HIV infection. Their socioeconomic and behavioural vulnerabilities are crucial push factors for movement for sex work. This paper assesses the factors associated with the likelihood of movement of sex workers from their current place of work. Data were derived from a cross-sectional survey conducted among 5498 mobile FSWs in 22 districts of high in-migration across four states in southern India. A multinomial logit model was constructed to predict the likelihood of FSWs moving from their current place of work. Ten per cent of the sampled mobile FSWs were planning to move from their current place of sex work. Educational attainment, marital status, income at current place of work, debt, sexual coercion, experience of violence and having tested for HIV and collected the results were found to be significant predictors of the likelihood of movement from the current place of work. Consistent condom use with different clients was significantly low among those planning to move. Likewise, the likelihood of movement was significantly higher among those who had any STI symptom in the last six months and those who had a high self-perceived risk of HIV. The findings highlight the need to address factors associated with movement among mobile FSWs as part of HIV prevention and access to care interventions.

This study used US National Longitudinal Study of Youth data to explore how exposure to different socioeconomic conditions (proxied by maternal education) before birth can shape child weight. Using endogenous selection regression models, the findings suggest that educational selectivity affects weight gain. Mothers whose mothers graduated from high school were more likely to complete high school, and mothers reared in an intact family had higher levels of education. However, mothers who had given birth as a teenager had the same educational outcomes as mothers who gave birth in their post-teenage years. Based on this intergenerational educational selectivity, caretaking (e.g. breast-feeding) was found to be associated with a lower child body mass index (BMI), while negative maternal characteristics (e.g. mothers with high BMIs) were associated with higher child BMIs. Thus, educational selectivity influences child health through values passed on to the child and the lifestyle in which the child is reared. Maternal education may be tied to parenting, which relates to child obesity risk.