International Journal of Environmental Research and Public Health

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12 pages, 2042 KiB

Open AccessArticle

Inequalities of Infant Mortality in Ethiopia

by Nasser B. Ebrahim and Madhu S. Atteraya

Int. J. Environ. Res. Public Health 2023, 20(12), 6068; https://doi.org/10.3390/ijerph20126068 - 06 Jun 2023

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Abstract

(1) Background: Infant mortality is viewed as a core health indicator of overall community health. Although globally child survival has improved significantly over the years, Sub-Saharan Africa is still the region with the highest infant mortality in the world. In Ethiopia, infant mortality [...] Read more.

(1) Background: Infant mortality is viewed as a core health indicator of overall community health. Although globally child survival has improved significantly over the years, Sub-Saharan Africa is still the region with the highest infant mortality in the world. In Ethiopia, infant mortality is still high, albeit substantial progress has been made in the last few decades. However, there is significant inequalities in infant mortalities in Ethiopia. Understanding the main sources of inequalities in infant mortalities would help identify disadvantaged groups, and develop equity-directed policies. Thus, the purpose of the study was to provide a diagnosis of inequalities of infant mortalities in Ethiopia from four dimensions of inequalities (sex, residence type, mother’s education, and household wealth). (2) Methods: Data disaggregated by infant mortalities and infant mortality inequality dimensions (sex, residence type, mother’s education, and household wealth) from the WHO Health Equity Monitor Database were used. Data were based on Ethiopia’s Demographic and Health Surveys (EDHS) of 2000 (n = 14,072), 2005 (n = 14,500), 2011 (n = 17,817), and 2016 (n = 16,650) households. We used the WHO Health Equity Assessment Toolkit (HEAT) software to find estimates of infant mortalities along with inequality measures. (3) Results: Inequalities related to sex, residence type, mother’s education, and household wealth still exist; however, differences in infant mortalities arising from residence type, mother’s education, and household wealth were narrowing with the exception of sex-related inequality where male infants were markedly at a disadvantage. (4) Conclusions: Although inequalities of infant mortalities related to social groups still exist, there is a substantial sex related infant mortality inequality with disproportional deaths of male infants. Efforts directed at reducing infant mortality in Ethiopia should focus on improving the survival of male infants. Full article

(This article belongs to the Special Issue Child, Health and Equity)

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10 pages, 836 KiB

Open AccessArticle

Interdisciplinary Children’s Behavioral Health Workforce Development for Social Work and Nursing

by Elizabeth Palley, Chireau White, Chrisann Newransky and Marissa Abram

Int. J. Environ. Res. Public Health 2023, 20(8), 5601; https://doi.org/10.3390/ijerph20085601 - 20 Apr 2023

Viewed by 1644

Abstract

This paper will begin with a review of child health inequities globally, in the United States and in the State of New York. It will then describe a model training program that was designed to educate social workers and nurse practitioners to create [...] Read more.

This paper will begin with a review of child health inequities globally, in the United States and in the State of New York. It will then describe a model training program that was designed to educate social workers and nurse practitioners to create a workforce able to address child behavioral health inequities in the United States (US), specifically New York State. Behavioral health care refers to prevention, care and treatment for mental health and substance abuse conditions as well as physical conditions caused by stress and life crises. This project uses an interdisciplinary training program for nurse practitioner and Master of Social Work students to address workforce shortages in underserved communities in New York State. It will present process evaluation findings to highlight the program’s initial success and will conclude with a discussion of the data that are still needed and the challenges of obtaining this data. Full article

(This article belongs to the Special Issue Child, Health and Equity)

11 pages, 3271 KiB

Open AccessArticle

Trends of Incidence, Mortality, and Risk Factors for Lower Respiratory Infections among Children under 5 Years in China from 2000 to 2019

by Xuezhong Shi, Meina Wu, Xiaocan Jia, Junzhe Bao, Yuping Wang, Chaojun Yang, Mengdie Yu and Yongli Yang

Int. J. Environ. Res. Public Health 2023, 20(4), 3547; https://doi.org/10.3390/ijerph20043547 - 17 Feb 2023

Viewed by 2014

Abstract

Background: Understanding the temporal trends in the burden of lower respiratory tract infections (LRI) and their attributable risk factors in children under 5 years is important for effective prevention strategies. Methods: We used incidence, mortality, and attributable risk factors of LRI among children [...] Read more.

Background: Understanding the temporal trends in the burden of lower respiratory tract infections (LRI) and their attributable risk factors in children under 5 years is important for effective prevention strategies. Methods: We used incidence, mortality, and attributable risk factors of LRI among children under 5 years from the Global Burden of Diseases database to analyze health patterns in 33 provincial administrative units in China from 2000 to 2019. Trends were examined using the annual average percentage change (AAPC) by the joinpoint regression method. Results: The rates of incidence and mortality for under-5 LRI in China were 18.1 and 4134.3 per 100,000 children in 2019, with an AAPC decrease of 4.1% and 11.0% from 2000, respectively. In recent years, the under-5 LRI incidence rate has decreased significantly in 11 provinces (Guangdong, Guangxi, Guizhou, Hainan, Heilongjiang, Jiangxi, Qinghai, Sichuan, Xinjiang, Xizang, and Zhejiang) and remained stable in the other 22 provinces. The case fatality ratio was associated with the Human Development Index and the Health Resource Density Index. The largest decline in risk factors of deaths was household air pollution from solid fuels. Conclusions: The burden of under-5 LRI in China and the provinces has declined significantly, with variation across provinces. Further efforts are needed to promote child health through the development of measures to control major risk factors. Full article

(This article belongs to the Special Issue Child, Health and Equity)

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11 pages, 611 KiB

Open AccessArticle

Inequalities in Childhood Immunisation in South Asia

by Madhu Sudhan Atteraya, In Han Song, Nasser B. Ebrahim, Shreejana Gnawali, Eungi Kim and Thakur Dhakal

Int. J. Environ. Res. Public Health 2023, 20(3), 1755; https://doi.org/10.3390/ijerph20031755 - 18 Jan 2023

Cited by 2 | Viewed by 1684

Abstract

Identifying the inequalities associated with immunisation coverage among children is crucial. We investigated the factors associated with complete immunisation among 12- to 23-month-old children in five South Asian countries: Afghanistan, Bangladesh, India, Nepal, and Pakistan, using nationally representative data sets from the Demographic [...] Read more.

Identifying the inequalities associated with immunisation coverage among children is crucial. We investigated the factors associated with complete immunisation among 12- to 23-month-old children in five South Asian countries: Afghanistan, Bangladesh, India, Nepal, and Pakistan, using nationally representative data sets from the Demographic and Health Survey (DHS). Descriptive statistics, bivariate association, and logistic regression analyses were employed to identify the prevalence and the factors in each country that affect the likelihood of full childhood immunisation coverage. The complete childhood immunisation coverage varied significantly within each country in South Asia. Afghanistan had the lowest immunisation rates (42.6%), whereas Bangladesh ranked the highest in complete childhood immunisation rates, at 88.2%. Similarly, 77.1% of Indian children, 79.2% of Nepali children, and 62.2% of Pakistani children were completely immunised. Household wealth status strongly correlated with full childhood immunisation in Afghanistan, India, and Pakistan at the bivariate level. The results from the logistic regression showed that a higher maternal educational level had a statistically significant association with complete childhood immunisation in all countries compared to mothers who did not attend any school. In conclusion, the study revealed the inequalities of complete childhood immunisation within South Asia. Governments must be proactive in their endeavours to address universal and equitable vaccine coverage in collaboration with national and international stakeholders and in line with the relevant Sustainable Development Goals. Full article

(This article belongs to the Special Issue Child, Health and Equity)

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9 pages, 316 KiB

Open AccessArticle

The Association between Types of COVID-19 Information Source and the Avoidance of Child Health Checkups in Japan: Findings from the JACSIS 2021 Study

by Masafumi Ojio, Yuto Maeda, Takahiro Tabuchi and Takeo Fujiwara

Int. J. Environ. Res. Public Health 2022, 19(15), 9720; https://doi.org/10.3390/ijerph19159720 - 07 Aug 2022

Cited by 1 | Viewed by 1658

Abstract

The coronavirus disease 2019 (COVID-19) pandemic can affect children’s well-being through mothers’ avoidance of health checkups for children due to media portrayal of the disease. This study investigated the association between the type of information source for COVID-19 received by mothers and the [...] Read more.

The coronavirus disease 2019 (COVID-19) pandemic can affect children’s well-being through mothers’ avoidance of health checkups for children due to media portrayal of the disease. This study investigated the association between the type of information source for COVID-19 received by mothers and the avoidance of their children’s health checkups. The study was an online-based survey, and the participants comprised 5667 postpartum women with children aged under 2 years during the study period. We analyzed the analytic sample and three groups of women with children aged 0–3 months, 4–6 months, and 6 months or older according to the timing of children’s health checkups in Japan. Among the participants, 382 women (6.7%) avoided their children’s health checkups. Multivariate logistic regression analysis revealed that mothers with children over 6 months who used magazines as an information source about COVID-19 tended to avoid their children’s health checkups (adjusted odds ratio (aOR): 3.19; 95% confidence interval (CI): 1.68–6.05) compared with those who did not. In contrast, those using public websites were less likely to avoid their children’s health checkups (aOR 0.58, 95% CI 0.43–0.77). This study showed that specific types of information source on COVID-19 could have varying effects on mothers’ decisions about their children’s health checkups. Full article

(This article belongs to the Special Issue Child, Health and Equity)

16 pages, 365 KiB

Open AccessArticle

Impact of Parental Beliefs on Child Developmental Outcomes: A Quasi-Experiment in Rural China

by Lei Wang, Conghong Yang, Dingjing Jiang, Siqi Zhang, Qi Jiang and Scott Rozelle

Int. J. Environ. Res. Public Health 2022, 19(12), 7240; https://doi.org/10.3390/ijerph19127240 - 13 Jun 2022

Cited by 1 | Viewed by 1924

Abstract

This paper examines the impact of parental beliefs on child development outcomes (for both cognitive and social–emotional skills) based on a three-wave longitudinal survey in rural China. The survey waves were conducted when the sample children were 18–30 months, 22–36 months, and 49–65 [...] Read more.

This paper examines the impact of parental beliefs on child development outcomes (for both cognitive and social–emotional skills) based on a three-wave longitudinal survey in rural China. The survey waves were conducted when the sample children were 18–30 months, 22–36 months, and 49–65 months, respectively. A total of 815 children and their primary caregivers who participated in all three wave surveys were enrolled in this study. Using difference-in-differences and propensity score matching approaches, the results indicate that strengthened parental beliefs have a positive and significant impact on child social–emotional development. Specifically, between the periods of the Wave 1 survey (when children were 18–30 months old) and the Wave 3 survey (when children were 49–65 months old), and between the Wave 2 survey (when children were 22–36 months old) and the Wave 3 survey, strengthened parental beliefs were causally associated with more favorable child social–emotional scores by 0.44 SD (p < 0.01) and 0.49 SD (p < 0.01), respectively. No significant impact, however, was found between the period of the Wave 1 survey and the Wave 2 survey. In contrast, weakened parental beliefs had a negative and significant impact on child social–emotional development. Specifically, weakened parental beliefs were causally associated with worse child social–emotional abilities by 0.35 SD (p < 0.01), 0.30 SD (p < 0.01), and 0.22 (p < 0.05) for the time period of the Wave 1 to Wave 2, Wave 1 to Wave 3, and Wave 2 to Wave 3, respectively. No significant impact of parental beliefs, however, was found on child cognitive development. In addition, the findings of the mediation analysis show that only a marginal impact of parental beliefs on child social–emotional development can be indirectly explained by parental beliefs through parenting practices. This study calls on policy makers to improve parental beliefs and parenting practices in the hope that it will lead to better child development in rural China. Full article

(This article belongs to the Special Issue Child, Health and Equity)

28 pages, 3685 KiB

Open AccessArticle

Where There’s a Will, There’s a Way? Social and Mental Forces of Successful Adaptation of Immigrant Children in Young Adulthood

by Jerf W. K. Yeung, Hui-Fang Chen, Zhuoni Zhang, Andrew Yiu Tsang Low and Herman H. M. Lo

Int. J. Environ. Res. Public Health 2022, 19(11), 6433; https://doi.org/10.3390/ijerph19116433 - 25 May 2022

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Abstract

Although the twenty-first century is deemed as a new era of globalization, waves of immigration continue, due to disparities between politically and economically unstable regions and Western democratized and developed countries. Immigration research has therefore reignited its attention on the successful adaptation of [...] Read more.

Although the twenty-first century is deemed as a new era of globalization, waves of immigration continue, due to disparities between politically and economically unstable regions and Western democratized and developed countries. Immigration research has therefore reignited its attention on the successful adaptation of immigrants’ offspring, which has profound implications for Western immigrant-receiving countries, as well as worldwide stability. Although immigration research mainly informed by the conventional assimilation theory and/or segmented assimilation perspective accentuates the importance of structural factors, termed as social forces here, in relation to immigrant children’s successful adaptation in adolescence, an argument of determinism and tenability keeps on and the contribution of human mental resources and determination, termed as mental forces here, in shaping life trajectories of immigrant children should be not ignored. For this, with a representative sample of 3344 immigrant children from the Children of Immigrants Longitudinal Study (CILS), we examined and compared both the effects of social and mental forces measured in adolescence of immigrant children on their multiple adaptation outcomes in terms of college graduation, engagement in postgraduate study, and first and current job attainments in young adulthood with a Bayesian multilevel modeling framework. The results found that both social forces of segmented assimilation theory and mental forces of immigrant children in adolescence were significantly predictive of immigrant children’s successful adaptation in young adulthood (OR = 1.088–2.959 and β = 0.050–0.639 for social forces; OR = 11.290–18.119 and β = 0.293–0.297 for mental forces), in which, although the latter showed stronger effects than the former, the effects of mental forces on adaptation of immigrant children were conditionally shaped by the contexts of the social forces informed by segmented assimilation theory. The findings of the current study highlight the significance of the organism–environment interaction perspective on immigration research and provide an insight to consider a context-driven response thesis proposed. Full article

(This article belongs to the Special Issue Child, Health and Equity)

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12 pages, 366 KiB

Open AccessArticle

Examining School and Neighborhood Effects of Socioeconomic Status on Childhood Obesity in the U.S.

by Christian E. Vazquez, Megan J. McBride, Katherine E. Hess, Catherine Cubbin, Sarah Kate Bearman and Esther J. Calzada

Int. J. Environ. Res. Public Health 2022, 19(10), 5831; https://doi.org/10.3390/ijerph19105831 - 10 May 2022

Cited by 3 | Viewed by 2948

Abstract

Obesity amongst Kindergartners in Texas is above the national average, particularly among Hispanic students. Research on the impact of school and neighborhood-level SES on obesity in childhood using multilevel models is lacking. Survey data were collected from Hispanic caregivers of pre-kindergarten students in [...] Read more.

Obesity amongst Kindergartners in Texas is above the national average, particularly among Hispanic students. Research on the impact of school and neighborhood-level SES on obesity in childhood using multilevel models is lacking. Survey data were collected from Hispanic caregivers of pre-kindergarten students in Fall 2019 (n = 237). Students were clustered in thirty-two neighborhoods and twelve schools. The dependent variable was the child’s body mass index z-score (BMIz). Covariates included the child’s sex, primary caregiver’s marital status, education level, relationship to the child, and family income. Level-two variables included neighborhood poverty and school SES. CTableross-classified multilevel linear regression models were conducted to examine the unique associations of neighborhood poverty and school SES with individual student BMIz, and how they interact. Twenty-four percent of students were classified as overweight, and five percent were classified as obese. The models resulted in a significant association between school SES and BMIz (B = −0.13; SE = 0.06; p < 0.05) and between neighborhood poverty and BMIz (B = −1.41; SE = 0.49; p < 0.01). Individual students’ BMIz decreased as school SES increased and decreased as neighborhood poverty increased. Neighborhood poverty and school SES appear to play a role in the development of obesity in childhood, although in differing directions. Full article

(This article belongs to the Special Issue Child, Health and Equity)

10 pages, 1331 KiB

Open AccessArticle

Too Many Treats or Not Enough to Eat? The Impact of Caregiving Grandparents on Child Food Security and Nutrition

by Rahel Mathews and Danielle Nadorff

Int. J. Environ. Res. Public Health 2022, 19(10), 5796; https://doi.org/10.3390/ijerph19105796 - 10 May 2022

Cited by 1 | Viewed by 1759

Abstract

With the number of grandparent-headed households on the rise, the influence of grandparents needs to be considered in the fight to reduce child obesity. The current study investigated the influence of caregiver type (i.e., grandparents only, parents only, or multi-generational households) on children’s [...] Read more.

With the number of grandparent-headed households on the rise, the influence of grandparents needs to be considered in the fight to reduce child obesity. The current study investigated the influence of caregiver type (i.e., grandparents only, parents only, or multi-generational households) on children’s nutrition, food security, and BMI. This was a cross-sectional, secondary analysis based on the 2009–2010 wave of the Health Behavior in School-Aged Children (HBSC) survey in collaboration with the World Health Organization. This sample included 12,181 students from 10,837 families with only parents present in the household, 238 with only grandparents present, and 1106 multi-generational families. One-way analyses of covariance (ANCOVAs) were conducted using caregiver type as the independent variable, controlling for SES, on items assessing frequency of breakfast consumption, nutrition intake, hunger, snacking frequency and location, and BMI. Children reported more unhealthy snacking in households with only grandparents. Hunger was reported more often in multi-generational households. These results support that caregiver type, especially caregiving grandparents, is a significant predictor of children’s BMI, nutrition, and food security. Tailoring nutrition education to the needs of grandparents could help both the health of grandparents and the reduction of child obesity. Full article

(This article belongs to the Special Issue Child, Health and Equity)

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18 pages, 790 KiB

Open AccessFeature PaperArticle

Examining the Relation between Caregiver Mental Health and Student Outcomes in Rural China

by Huan Wang, Claire Cousineau, Yuwei Adeline Hu, Grace Hu, Sunny Qi, Adrian Sun, Helen Wu, Scott Rozelle and Manpreet Singh

Int. J. Environ. Res. Public Health 2021, 18(23), 12613; https://doi.org/10.3390/ijerph182312613 - 30 Nov 2021

Cited by 1 | Viewed by 3007

Abstract

Research continues to highlight the central relationship between caregivers’ mental health and their children’s development. This study examined the relation between primary caregivers’ mental health and school-aged children’s outcomes, including student mental health, resilience, and academic performance, in rural China. Using cross-sectional data [...] Read more.

Research continues to highlight the central relationship between caregivers’ mental health and their children’s development. This study examined the relation between primary caregivers’ mental health and school-aged children’s outcomes, including student mental health, resilience, and academic performance, in rural China. Using cross-sectional data from economically poor areas in the Gansu province, 2989 students (mean age = 11.51, 53.33% male, 46.67% female) and their primary caregivers (74.2% female) completed the 21-item, self-report Depression Anxiety Stress Scale. Students also completed the 25-item Connor-Davidson Resilience Scale and a standardized math test. The results indicated a high prevalence of caregiver depression (31%), stress (39%), and anxiety (24%). Characteristics that were significantly correlated with caregiver mental health issues included being a grandparent, having a low socioeconomic status and low education level, and living in a household with at least one migrant worker. Apart from caregiver stress and student resilience, caregiver mental health issues were negatively correlated with all student outcomes, including student mental health, resilience, and academic performance. Although additional empirical research is needed to investigate the associations between caregiver mental health and student outcomes, our results suggest that rural communities could benefit greatly from programs focused on improving the mental health of caregivers and this, in turn, may have a positive impact on student outcomes. Full article

(This article belongs to the Special Issue Child, Health and Equity)

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15 pages, 1114 KiB

Open AccessArticle

Poor Adherence to the WHO Guidelines on Feeding Practices Increases the Risk for Respiratory Infections in Surinamese Preschool Children

by Jill R. Wormer, Arti Shankar, Michael Boele Van Hensbroek, Ashna D. Hindori-Mohangoo, Hannah Covert, Maureen Y. Lichtveld and Wilco C. W. R. Zijlmans

Int. J. Environ. Res. Public Health 2021, 18(20), 10739; https://doi.org/10.3390/ijerph182010739 - 13 Oct 2021

Cited by 1 | Viewed by 2766

Abstract

Poor feeding practices in infants and young children may lead to malnutrition, which, in turn, is associated with an increased risk of infectious diseases, such as respiratory tract infections (RTIs), a leading cause of under-five mortality. We explored the association between RTIs and [...] Read more.

Poor feeding practices in infants and young children may lead to malnutrition, which, in turn, is associated with an increased risk of infectious diseases, such as respiratory tract infections (RTIs), a leading cause of under-five mortality. We explored the association between RTIs and the WHO infant and young child feeding (IYCF) indicators: minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD), among infants and preschool children in Suriname. A validated pediatric food frequency questionnaire was used and data on RTIs, defined as clinical care for fever with respiratory symptoms, bronchitis, or pneumonia were obtained. Associations between feeding indicators and RTIs were explored using hierarchical logistic regression. Of 763 children aged 10–33 months, 51.7% achieved the MDD, 88.5% the MMF, and 46.5% the MAD. Furthermore, 73% of all children experienced at least one upper and/or lower RTI. Children meeting the MDD and MAD had significantly lower odds on RTIs (OR 0.53; 95%CI: 0.37–0.74, p < 0.001; OR 0.55; 95%CI: 0.39–0.78, p < 0.001, respectively). The covariates parity and household income were independently associated with RTIs. In conclusion, MDD and MAD were associated with (upper) RTIs. Whether these indicators can be used as predictors for increased risk for RTIs should be assessed in future prospective studies. Full article

(This article belongs to the Special Issue Child, Health and Equity)

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16 pages, 1239 KiB

Open AccessArticle

Women’s Media Use and Preferences of Media-Based Interventions on Lifestyle-Related Risk Factors in Gynecological and Obstetric Care: A Cross-Sectional Multi-Center Study in Germany

by Manuela Bombana, Maren Wittek, Gerhard Müller, Monika Heinzel-Gutenbrunner and Michel Wensing

Int. J. Environ. Res. Public Health 2021, 18(18), 9840; https://doi.org/10.3390/ijerph18189840 - 18 Sep 2021

Cited by 1 | Viewed by 3133

Abstract

This study aimed to investigate factors affecting (1) women’s media use regarding health-related behaviors during pregnancy and lactation, (2) women’s preferences for media format, and (3) the content of media-based interventions on lifestyle-related risk factors during pregnancy and lactation. A cross-sectional observational multi-center [...] Read more.

This study aimed to investigate factors affecting (1) women’s media use regarding health-related behaviors during pregnancy and lactation, (2) women’s preferences for media format, and (3) the content of media-based interventions on lifestyle-related risk factors during pregnancy and lactation. A cross-sectional observational multi-center study of pregnant and lactating women and women of childbearing age was carried out in 14 randomly selected obstetric and gynecologic care settings in the 12 most populated cities in Baden-Wuerttemberg, South-West Germany. Data from 219 surveyed women showed that older women, pregnant women, and lactating women have a higher probability of using media during pregnancy and lactation, respectively. The majority of women preferred a combination of analog and digital media-based interventions in gynecological (46.9%) and obstetric (47.1%) care settings and at home (73.0%). Women would like to see information brochures and flyers on health-related behaviors during pregnancy and lactation for use in gynecological and obstetric care settings, and for media use at home, they would like to have books. The probability of preferring the favored media formats in gynecological and obstetric care settings and at home were associated with pregnancy status, relationship status, socioeconomic status (SES), ethnicity, and health insurance status. About 80% of the surveyed women preferred media content regarding recommendations for a healthy lifestyle and healthy behavior during pregnancy and lactation. All of the independent variables were associated with the probability of preferring a specific media content. The SES was found to play a major role in the probability of preferring a specific media content, followed by pregnancy status, ethnicity, and health insurance status. The results from our study provide a basis for tailored preventive interventions in gynecological and obstetric care settings and for use at home. The results imply that a woman can be reached before conception, during pregnancy, or during lactation with preventive measures tailored to their requirements; however, acceptance may vary across personal attributes, such as SES, ethnicity, and others. Full article

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9 pages, 340 KiB

Open AccessArticle

Acculturation Stressors and Academic Adjustment among Nepalese Students in South Korean Higher Education Institutions

by Madhu Sudhan Atteraya

Int. J. Environ. Res. Public Health 2021, 18(12), 6529; https://doi.org/10.3390/ijerph18126529 - 17 Jun 2021

Cited by 6 | Viewed by 3611

Abstract

International students are steadily increasing in South Korean higher education institutions. How well international students are adjusted academically and the relationship between acculturation stressors and academic adjustment has not yet been determined. This study aimed to fill this research gap by examining the [...] Read more.

International students are steadily increasing in South Korean higher education institutions. How well international students are adjusted academically and the relationship between acculturation stressors and academic adjustment has not yet been determined. This study aimed to fill this research gap by examining the relationship between acculturation stressors and academic adjustment among Nepalese international students in South Korean higher education institutions. The sample of the study consisted of Nepalese students who enrolled in 36 universities in South Korea. Students’ background characteristics and acculturation stressors were selected to examine the association between acculturation stressors and academic adjustment. Pearson correlation and hierarchical multiple regression were utilized. The results from the Pearson correlation revealed the negative correlation of perceived discrimination (r = −0.23, p < 0.01), perceived hate/rejection (r = −0.18, p < 0.05), perceived fear (r = −0.24, p < 0.01), and perceived cultural shock (r = −0.17, p < 0.05) with academic adjustment. Further, the hierarchical regression model revealed that perceived fear (β = −0.220, p < 0.05) had a negative association with academic adjustment. Addressing acculturation stressors among international students is essential to facilitate a positive academic environment. Mainly, perceived fear has negatively affected students’ academic adjustment. Based on these findings, tailored programs must be developed to curtail international students’ perceived fear. Full article

(This article belongs to the Special Issue Child, Health and Equity)

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12 pages, 787 KiB

Open AccessReview

Structural Determinants of Child Health in Rural China: The Challenge of Creating Health Equity

by Yunwei Chen, Sean Sylvia, Sarah-Eve Dill and Scott Rozelle

Int. J. Environ. Res. Public Health 2022, 19(21), 13845; https://doi.org/10.3390/ijerph192113845 - 25 Oct 2022

Cited by 4 | Viewed by 1994

Abstract

Over the past two decades, the literature has shown a clear gradient between child health and wealth. The same health–wealth gradient is also observed among children in China, with a large gap in health between rural and urban children. However, there are still [...] Read more.

Over the past two decades, the literature has shown a clear gradient between child health and wealth. The same health–wealth gradient is also observed among children in China, with a large gap in health between rural and urban children. However, there are still unanswered questions about the main causes of China’s rural–urban child health inequality. This paper aims to review the major factors that have led to the relatively poor levels of health among China’s rural children. In addition to the direct income effect on children’s health, children in rural areas face disadvantages compared with their urban counterparts from the beginning of life: Prenatal care and infant health outcomes are worse in rural areas; rural caregivers have poor health outcomes and lack knowledge and support to provide adequate nurturing care to young children; there are large disparities in access to quality health care between rural and urban areas; and rural families are more likely to lack access to clean water and sanitation. In order to inform policies that improve health outcomes for the poor, there is a critical need for research that identifies the causal drivers of health outcomes among children. Strengthening the pediatric training and workforce in rural areas is essential to delivering quality health care for rural children. Other potential interventions include addressing the health needs of mothers and grandparent caregivers, improving parenting knowledge and nurturing care, improving access to clean water and sanitation for remote families, and most importantly, targeting poverty itself. Full article

(This article belongs to the Special Issue Child, Health and Equity)

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11 pages, 608 KiB

Open AccessProtocol

Improving Innovation and Access to Combination Vaccines for Childhood Immunization in China

by Jiyan Ma, Zhuo Li, Yinuo Sun, Zuokun Liu, Yuan Dang and Yangmu Huang

Int. J. Environ. Res. Public Health 2022, 19(23), 15557; https://doi.org/10.3390/ijerph192315557 - 23 Nov 2022

Cited by 2 | Viewed by 1615

Abstract

Background: combination vaccines can improve timely vaccination coverage and mitigate the social and economic burdens of both caregivers and health systems. Compared to other countries with high immunization performance, China remains behind the curve in promoting the inclusion of new combination vaccines into [...] Read more.

Background: combination vaccines can improve timely vaccination coverage and mitigate the social and economic burdens of both caregivers and health systems. Compared to other countries with high immunization performance, China remains behind the curve in promoting the inclusion of new combination vaccines into national vaccination schedules. The domestic research and development pipeline faces many technical obstacles, regulatory pressures, and competitive opposition. In addition to this, health disparities regarding combination vaccines exist in each dimension of access and their determinants, including availability, accessibility, acceptability, and quality. Our study aims to provide a cross-disciplinary analysis of China’s combination vaccines (from innovation to access) and identify the main factors that affect the attitudes and behavior choices for combination vaccines. Method: systematic reviews and secondary data analysis will be conducted to map the landscape of combination vaccines in China and the determinants influencing their innovation and access. A cross-sectional survey will be performed in seven provinces of China based on geo-economic representativeness among caregivers with children that are between 2 and 24 months old and are registered in the national immunization system. Questionnaires will be used to examine the relationship between each dimension of access and their determinants. These questionnaires will cover the caregivers’ knowledge, attitude, and willingness to pay for combination vaccines, as well as their perceptions about vaccination services. Semi-structured interviews with the suppliers (public and private) and healthcare providers will help identify research gaps and the key challenges they face when developing and introducing combination vaccines in China. Discussion: using a combined approach, with cross-country and multi-disciplinary support from experts, our research is designed to fill the information gaps in China’s combination vaccine industry across the innovation-access spectrum. It will lead to evidence-based recommendations which will foster greater access to innovation-enhancing combination vaccines for childhood immunization in China. Moreover, the multi-dimensional approach could also be adapted beyond combination vaccines to assess innovation and other public goods for health among disadvantaged groups in the future. Full article

(This article belongs to the Special Issue Child, Health and Equity)

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