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Solid fuel use and early child development disparities in Ghana: analyses by gender and urbanicity.

ABSTRACT: In Ghana, more than 77% of the population depends on biomass fuels for cooking. Previous studies show that solid fuel use (SFU) has adverse effects on pregnancy and child health outcomes. Yet, no previous study considered potential effects on early child development indicators (ECDI), nor how SFU effects may vary by gender, and rural and urban areas. We investigated the associations of SFU with ECDI measures, and whether these associations exhibited sex and urban/rural differences. We used the 2011-2012 Ghana's Multiple Indicator Cluster Surveys-UNICEF (N = 3326 children; 3-4 years). We derived a binary ECDI measure reflecting whether the child is developmentally on track or not from a caregiver-report of ten yes/no/do not know questions designed specifically to assess four domains of early child development: learning-cognition, literacy-numeracy, socio-emotional, and physical. We used multilevel Poisson regressions adjusting for neighborhood, household, mother, and child's characteristics to estimate covariate-adjusted prevalence ratios (PRs) of the associations between SFU and ECDI and its four dimensions. We run stratified analyses and used z-score tests of differences to evaluate effect modification by sex and urbanicity. Overall, 85% of children were exposed to SFU and 28% of children were not developmentally on track. After adjustment for confounders, children exposed to SFU were more likely to be not developmentally on track in comparison with nonexposed children (PR = 1.16; 95% confidence interval, [95% CI]: 1.10,1.22). These associations were stronger in girls (PR = 1.36; 95% CI: 1.03,1.79) in comparison with boys (PR = 0.87; 95% CI: 0.73,1.04). No difference in associations was observed between urban and rural children. Overall, these associations were mainly driven by the literacy-numeracy dimension. In this study, we show that SFU was associated with developmental delays in Ghanaian girls. Policy efforts which tackle SFU should be mindful of gender disparities in susceptibility to indoor pollution.

SUBMITTER: Nazif-Munoz JI

PROVIDER: S-EPMC8075970 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundThis paper examines seemingly contradictory evidence from extant research that son preference is high, but male disadvantage in mortality is increasing in Nepal. To do so, we documented the timing, geographic patterning, and extent of gendered patterns in mortality and feeding practices for children under-five.MethodsWe applied pooled multilevel regression models and survival analysis to five rounds of data from Nepal's nationally representative Demographic and Health Surveys (1996-2016). We controlled for potential sociodemographic confounders, including child, maternal, household, and regional correlates, and disaggregated findings by birth order and sibling gender.ResultsWe found evidence of regional variation in mortality, with girls in wealthy urban areas faring the worst in terms of mortality rates. Girls' comparative mortality advantage compared to boys in the neonatal period masks their mortality disadvantage in later periods. Mortality has fallen at a faster rate for boys than girls in most cases, leading to widening of gender inequalities. We also found evidence of female disadvantage in breastfeeding duration, which was linked to higher mortality risks, but no gender disparities in the consumption of other food items. Sibling gender and birth order also mattered for breastfeeding duration: Young girls with older sisters but with no brothers were most disadvantaged.ConclusionWhile we did not find evidence of postnatal discrimination in access to solid and semi-solid foods, girls in Nepal face a disadvantage in breastfeeding duration. Girls with older sisters but no older brothers facing the greatest disadvantage, with risks being particularly concentrated for girls aged 1-4 years. This disadvantage is linked to an increased risk of mortality. To address this, community-based health programs could be expanded to continue targeted healthcare for children beyond 12 months of age, with particular focus on nutrition monitoring and health service provision for girls.

Project description:IntroductionExposure to violence victimization may help explain disparities of substance use among gender-nonconforming youth (i.e., those whose gender expression differs from societal expectations).MethodsIn 2015, three large urban school districts (2 in California and 1 in Florida) conducted a Youth Risk Behavior Survey that included the assessment of gender expression among a racially/ethnically diverse population-based sample of 6,082 high school students. Five categories of violence victimization were assessed (felt unsafe at school, threatened or injured with a weapon at school, bullied at school, electronically bullied, and forced sexual intercourse). In 2019, the effect of violence victimization on substance use disparities was examined by calculating sex-stratified prevalence ratios by gender nonconformity, adjusted for sexual identity, race/ethnicity, and grade (adjusted prevalence ratio 1 [APR1]), and comparing these with prevalence ratios adjusted for those variables plus violence victimization (adjusted prevalence ratio 2 [APR2]).ResultsAmong female students, only being threatened or injured with a weapon was significantly (p<0.05) associated with gender nonconformity and there were no substance use disparities by gender nonconformity. Among male students, every category of violence victimization was more prevalent among gender-nonconforming than among gender-conforming students and most substance use categories demonstrated significant gender nonconformity disparities. After controlling for violence victimization, these disparities decreased but remained statistically significant for the use of cocaine (APR1=2.84 vs APR2=1.99), methamphetamine (APR1=4.47 vs APR2=2.86), heroin (APR1=4.55 vs APR2=2.96), and injection drug use (APR1=7.90 vs APR2=4.72).ConclusionsSchool-based substance use prevention programs may benefit from strategies that support gender diversity and reduce violence victimizations experienced by gender-nonconforming students, by providing a safe and supportive school environment.

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Solid fuel use and early child development disparities in Ghana: analyses by gender and urbanicity.

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