Effects of social determinants on children’s health in informal settlements in Bangladesh and Kenya through an intersectionality lens: a study protocol

Kibuchi, Eliud; Barua, Proloy; Chumo, Ivy; Filha, Noêmia Teixeira de Siqueira; Phillips-Howard, Penelope A.; Mithu, Imran Hossain; Kabaria, Caroline; Quayyum, Zahidul; Whittaker, Lana; Dean, Laura; Forsyth, Ross; Selim, Tasmiah; Aktar, Bachera; Sai, Varun; Garimella, Surekha; Saidu, Samuel; Gandi, Ibrahim; Josyula, Lakshmi K.; Mberu, Blessing; Elsey, Helen; Leyland, Alastair H.; Gray, Linsay

doi:10.1136/bmjopen-2021-056494

Cited by 3 publications

(7 citation statements)

References 35 publications

(80 reference statements)

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“…Unlike common measures of average association, MAIHDA allows for a better understanding of the heterogeneity of individual effects and inter-individual heterogeneity around group averages [23]. This method involves defining a number of intersectional strata based on combinations of social attributes such as a set of SDoH associated with their intersectional social identities and individual characteristics [31,39].…”

Section: Methodsmentioning

confidence: 99%

“…A residual of zero indicates that a social stratum represents exactly the mean outcome predicted by the additive main effects [48]. Further details on the application of MAIHDA for these analyses are described in the protocol document [31]. The statistical details can be found in the S1 File.…”

Section: Methodsmentioning

confidence: 99%

“…Similarly, we retrieved 3,183 records for fever and ARI in U5y without any missing data. Further details can be found in Kibuchi et al [31].…”

Section: Data Sources Participants and Settingsmentioning

confidence: 99%

“…We have used the wealth index variable already developed and available in the data set [33]. Further details on the choice of variables can be found in Kibuchi et al [31]. The wealth index quintiles were constructed using Principal Components Analysis (PCA) [34].…”

Section: Plos Global Public Healthmentioning

confidence: 99%

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The effects of social determinants on children’s health outcomes in Bangladesh slums through an intersectionality lens: An application of multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA)

Barua

Kibuchi²,

Aktar³

et al. 2023

PLOS Glob Public Health

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Empirical evidence suggests that the health outcomes of children living in slums are poorer than those living in non-slums and other urban areas. Improving health especially among children under five years old (U5y) living in slums, requires a better understanding of the social determinants of health (SDoH) that drive their health outcomes. Therefore, we aim to investigate how SDoH collectively affects health outcomes of U5y living in Bangladesh slums through an intersectionality lens. We used data from the most recent national Urban Health Survey (UHS) 2013 covering urban populations in Dhaka, Chittagong, Khulna, Rajshahi, Barisal, Sylhet, and Rangpur divisions. We applied multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) to estimate the Discriminatory Accuracy (DA) of the intersectional effects estimates using Variance Partition Coefficient (VPC) and the Area Under the Receiver Operating Characteristic Curve (AUC-ROC). We also assessed the Proportional Change in Variance (PCV) to calculate intersectional effects. We considered three health outcomes: cough, fever, and acute respiratory infections (ARI) in U5y.We found a low DA for cough (VPC = 0.77%, AUC-ROC = 61.90%), fever (VPC = 0.87%, AUC-ROC = 61.89%) and ARI (VPC = 1.32%, AUC-ROC = 66.36%) of intersectional strata suggesting that SDoH considered do not collectively differentiate U5y with a health outcome from those with and without a health outcome. The PCV for cough (85.90%), fever (78.42%) and ARI (69.77%) indicates the existence of moderate intersectional effects. We also found that SDoH factors such as slum location, mother’s employment, age of household head, and household’s garbage disposal system are associated with U5y health outcomes. The variables used in this analysis have low ability to distinguish between those with and without health outcomes. However, the existence of moderate intersectional effect estimates indicates that U5y in some social groups have worse health outcomes compared to others. Therefore, policymakers need to consider different social groups when designing intervention policies aimed to improve U5y health outcomes in Bangladesh slums.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…Similarly, we retrieved 3,183 records for fever and ARI in U5y without any missing data. Further details can be found in Kibuchi et al [31].…”

Section: Data Sources Participants and Settingsmentioning

confidence: 99%

Section: Plos Global Public Healthmentioning

confidence: 99%

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The effects of social determinants on children’s health outcomes in Bangladesh slums through an intersectionality lens: An application of multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA)

Barua

Kibuchi²,

Aktar³

et al. 2023

PLOS Glob Public Health

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“…On the other hand, societies, communities and individuals can promote change that will reduce vulnerable situations, yet societies, communities, and individuals factors are undervalued and understudied (Ahmad, 2008;Butler et al, 2020). A Lack of data in slums across cities has been identified as a major hindrance to answering questions critical to the health and wellbeing needs of the slum residents (3-D Commission, 2021;Kibuchi et al, 2022), more so data on drivers of vulnerability among the most marginalized populations (Rohwerder, 2014). We therefore used CLUVA social vulnerability framework to explore and uncover determinant factors and drivers of vulnerability to health and wellbeing inequities among the vulnerable and marginalized populations in informal settlements using governance diaries approach.…”

mentioning

confidence: 99%

Drivers of vulnerability to health and wellbeing challenges in informal settlements

Chumo

Kabaria

Shankland

et al. 2023

Front. Sustain. Cities

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IntroductionIt is widely acknowledged that vulnerable populations are hit very hard, both in the short and long term, when their health and wellbeing needs are not met. Despite the efforts at different levels to protect and promote their health and wellbeing, older persons, people with disabilities and children heads of households, continue to face significant social, economic and cultural difficulties in relation to health and wellbeing inequities. While rights to health and wellbeing are constitutionally guaranteed, and strategies can be advanced to reduce vulnerable situations, challenges persists and yet societies, communities, and individual factors that engender vulnerability are understudied and remain poorly understood. Situating our findings and understandings within CLUVA social vulnerability framework, allows us to adapt a conceptual framework for understanding vulnerability to health and wellbeing challenges across different groups in informal urban space. We used CLUVA social vulnerability framework to explore and uncover drivers of vulnerability to health and wellbeing challenges among the vulnerable and marginalized groups using the governance diaries approach.MethodsThis was an ethnographic study, using governance diaries with 24 participants in Korogocho and Viwandani informal settlements in Nairobi, Kenya. The governance diaries approach involved bi-weekly governance in-depth interviews (IDIs) with study participants for 4 months, complemented with observations, reflections, participant diaries and informal discussions. We used framework analysis methodology.ResultsWe identified several interlinked drivers and grouped them as individual, community, societal and structural level factors.DiscussionA comprehensive view of drivers at different levels will help actors engage in more expansive and collaborative thinking about strategies that can effectively reduce health and wellbeing challenges.ConclusionThe factors identified come together to shape functioning and capabilities of vulnerable groups in informal settlements. Beyond applying a more comprehensive concept of understanding health and wellbeing challenges, It is important to understand the drivers of vulnerability to health and wellbeing challenges from the perspective of marginalized and vulnerable populations. Particularly for local urban planning, the information should blend routine data with participatory assessment within different areas and groups in the city.

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Reporting of Social Determinants of Health in Pediatric Sepsis Studies*

Menon

Sorce²,

Argent

et al. 2023

Pediatric Critical Care Medicine

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OBJECTIVE:Standardized, consistent reporting of social determinants of health (SDOH) in studies on children with sepsis would allow for: 1) understanding the association of SDOH with illness severity and outcomes, 2) comparing populations and extrapolating study results, and 3) identification of potentially modifiable socioeconomic factors for policy makers. We, therefore, sought to determine how frequently data on SDOH were reported, which factors were collected and how these factors were defined in studies of sepsis in children. DATA SOURCES AND SELECTION:We reviewed 106 articles (published between 2005 and 2020) utilized in a recent systematic review on physiologic criteria for pediatric sepsis.DATA EXTRACTION: Data were extracted by two reviewers on variables that fell within the World Health Organization's SDOH categories.DATA SYNTHESIS: SDOH were not the primary outcome in any of the included studies. Seventeen percent of articles (18/106) did not report on any SDOH, and a further 36.8% (39/106) only reported on gender/sex. Of the remaining 46.2% of articles, the most reported SDOH categories were preadmission nutritional status (35.8%, 38/106) and race/ethnicity (18.9%, 20/106). However, no two studies used the same definition of the variables reported within each of these categories. Six studies reported on socioeconomic status (3.8%, 6/106), including two from upper-middle-income and four from lower middle-income countries. Only three studies reported on parental education levels (2.8%, 3/106). No study reported on parental job security or structural conflict. CONCLUSIONS:We found overall low reporting of SDOH and marked variability in categorizations and definitions of SDOH variables. Consistent and standardized reporting of SDOH in pediatric sepsis studies is needed to understand the role these factors play in the development and severity of sepsis, to compare and extrapolate study results between settings and to implement policies aimed at improving socioeconomic conditions related to sepsis.

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Effects of social determinants on children’s health in informal settlements in Bangladesh and Kenya through an intersectionality lens: a study protocol

Cited by 3 publications

References 35 publications

The effects of social determinants on children’s health outcomes in Bangladesh slums through an intersectionality lens: An application of multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA)

The effects of social determinants on children’s health outcomes in Bangladesh slums through an intersectionality lens: An application of multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA)

Drivers of vulnerability to health and wellbeing challenges in informal settlements

Reporting of Social Determinants of Health in Pediatric Sepsis Studies*

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