In order to understand current and changing patterns of population health, there is a clear need for high-quality health indicators. The World Health Organization Study on Global AGEing and Adult Health (SAGE) survey platform and the International Network for the Demographic Evaluation of Populations and Their Health in developing countries (INDEPTH) generated data for this study. A total of 4300 people aged 50 years or older were selected randomly from the Matlab Health and Demographic Surveillance System of the International Centre for Diarrhoeal Disease Research, Bangladesh. The health indicators derived from these survey data are self-rated general health, overall health state, quality of life and disability levels. The outcome of the study is mortality over a 2-year follow-up since the survey. Among the four health indicators, only self-rated health was significantly associated with subsequent mortality irrespective of sex: those who reported bad health had higher mortality than those who reported good health, even after controlling for socio-demographic factors. For all other three health indicators, such associations exist but are significant only for males, while for females it is significant only for ‘quality of life’.

Women's social networks and social power are increasingly seen as important factors modulating their health in sub-Saharan Africa. Polygyny, a common marital structure in many societies, mediates important intra-household relationships by requiring both competition and co-operation among co-wives. Using mixed methods, semi-structured questionnaires were administered to 298 women aged 15–84 living in the Kolondiéba region of rural Mali in 1999, and supplemented by detailed interviews with 40 women. Three categories of outcome were explored: illness experience, therapeutic itinerary and social support received. Quantitative data were analysed using regression analysis and qualitative data using a grounded theory approach. In quantitative analyses, controlling for age and household wealth index, senior wives were less likely to be escorted to a healer by their husbands during illness than were junior wives or monogamous women. Polygynous women were also less likely to obtain a treatment for which there was a monetary fee. Fewer than one-third of polygynous women reported the assistance of a co-wife during illness in any given task. In qualitative analyses, women further related varied mechanisms through which polygyny impacted their health trajectories. These ranged from strongly supportive relationships, to jealousy because of unequal health or fertility, bias in emotional and material support provided by husbands, and accusations of wrong-doing and witchcraft. This study highlights the need for more prospective mixed methods analyses to further clarify the impact of polygyny on women's health-related experiences and behaviours in sub-Saharan Africa.

HIV prevalence in China is less than one per cent, but the absolute number of people living with HIV/AIDS is large and growing. Given the limited scope of any potential cure for HIV, prevention plays a crucial role in controlling the epidemic. This paper examines the evolution of HIV awareness among women in China between 1997 and 2005. A regression decomposition analysis technique was used to disentangle the two main components driving a change in HIV awareness. The results show that HIV awareness has increased over time in China. The gaps between groups are narrowing over time and lower HIV awareness groups are catching up with the higher awareness groups. In 2005 education remained one of the main factors associated with HIV awareness, the other main factors being ethnicity, exposure to TV and newspapers. The increases in HIV awareness observed between 1997 and 2001 are similar between groups of women with different demographic characteristics, whereas between 2003 and 2005 increases are more pronounced among specific groups of women such as women from rural areas, women from Western parts of the country, women who belong to ethnic minorities and those with no education or with only primary education. The results suggest that the main driver of the observed change in HIV awareness over time in China is change in the environment such as in political commitment, interventions and campaigns rather than change in population structure.

Casual heterosexual sex remains a significant contributor to HIV transmissions in Ghana. The study used data from the 2008 Ghana Demographic and Health Survey (GDHS) to assess the socio-demographic, economic and spatial factors influencing unprotected casual heterosexual sex among men and women. The results of the binary logistic regression models revealed that women aged 35–44 had significantly higher odds of engaging in unprotected casual heterosexual sex than those aged 15–24, unlike the men. There were significantly lower odds of unprotected casual heterosexual sex for women and men with exposure to print media compared with those without exposure. Compared with men residing in the Western Region, unprotected casual heterosexual sex was significantly less likely among those in the Upper East Region. There is the need for behavioural change campaigns in Ghana that take into consideration the multiplicity of factors that determine unprotected casual heterosexual sex.

Negotiating safer sex among married women has been identified as an important determinant of vulnerability or resilience to new HIV infections. Using the Cambodia Demographic and Health Survey data of 2010, this paper examined negotiation for safer sex among 11,218 married women in the context of Cambodia's highly touted reduction in HIV/AIDS prevalence. The results from a complementary log-log regression model indicate that wealthier and highly educated married women were more likely to report that they can refuse sexual intercourse and ask their husbands to use a condom. Interestingly, while women who were fully involved in decision-making on their own health care were 19% more likely to refuse sex, they were 14% less likely to be able to ask their husbands to use a condom, compared with their counterparts who were not involved in this decision-making. Women who were partially involved in decision-making on family visits were 17% less likely to be able to ask their husbands to use a condom compared with those who were not involved. In this context, involvement in decision-making may have translated into trust and risk compensation. Those who believed in HIV transmission myths were less likely to negotiate safer sex relative to their counterparts who did not hold such myths to be true. Women's ability to negotiate for safer sex is, therefore, a function of their autonomy in terms of their full participation in decision-making in health care, household expenditure and mobility. Policy implications of the capacity of women to negotiate for safer sex are delineated.

It is anticipated that the demand for contraceptives in Iran will increase in the near future as the number of women of reproductive age increases and with women wanting smaller families. The aim of this paper was to study the demand for long-acting and permanent contraceptive methods (LAPCMs), and its determinants, among Kurdish women in Mahabad city, Iran. Data were taken from the Mahabad Fertility Survey (MFS) conducted on a sample of over 700 households in April 2012. The results show that the demand for LAPCMs was 71.35% at the time of survey, although only 27.7% of women were using these methods. Thus, the number of unintended pregnancies is likely to increase in the future if this gap is not reduced. The multivariate analysis showed significant impacts on the dependent variables of the number of children ever born, perceived contraceptive costs and childbearing intentions. Moreover, women at the end of their reproductive lives and those with higher education were more likely to desire LAPCMs. It is concluded that despite a growing use of contraceptive methods in Iran in recent decades, the development of reproductive health services and promotion of the quality of family planning services remains a necessity.

According to human capital theory, individual competences and personality attributes are relevant for individual productivity and income. Within human capital, intelligence is crucial. To study engineering and work successfully as an engineer, high cognitive abilities are necessary, especially for work in research and development. In a study of 30 German and 30 Emirati engineering students (mean age: 22 years), both groups were tested with mathematical and figural intelligence scales (CogAT). German engineering students achieved a mean IQ of 116, and Emirati students 104 (in converted UK norms). In both groups male students achieved better results than females (2 to 4 IQ point difference). The results are compared with those from PISA and TIMSS. The possible causes of these results, their consequences and strategies for improvement are discussed.

The epidemiological paradox and ‘healthy migrant effect’ refer to the favourable health outcomes in unprivileged groups under unfavourable socioeconomic conditions. Weight at birth is associated with the epidemiological paradox. However, differences in fertility structure (mainly mother's age and first maternity) might be the cause of the difference in weight at birth between children of immigrant and non-immigrant mothers. This paper aims to analyse the impact of the epidemiologic paradox by distinguishing between the factors related to fertility structure, in addition to other socio-cultural factors. The importance of fertility structure as the cause of weight-at-birth differences of the newborns of immigrant and non-immigrant women, and between those of subgroups of immigrant mothers, is tested. Based on data from birth registries for the period 1998–2009, a variance analysis was performed for Spanish mothers and for those of five major immigrant subgroups living in the region of Valencia, Spain, which experienced significant migrant inflows within a short period of time. A Scheffé test between pairs of nationalities was carried out. Finally, linear regression models were built. The results suggest that the most relevant factors are those related to fertility structure, and that consequently the epidemiological paradox does not apply for immigrant mothers as a whole, although Bolivian immigrant offspring may be an exception. This unexpected result requires further research to test to what extent this is due to the special adaptation of multigenerational high-altitude populations in pregnancy. The factors associated with fertility structure must be controlled when trying to relate birth weight differences between ethnic groups to socioeconomic factors.

This study provides evidence on the principal determinants of pregnancy and abortion in India using a large country-wide district-level data set (DLHS 2007). The paper provides an economic framework for the analysis of pregnancy and abortion. The study distinguishes between induced and spontaneous abortion and compares the effects of their determinants. The results show that there are wide differences between induced and spontaneous abortions in terms of the sign and magnitude of the estimated effects of several of their determinants, most notably wealth, the woman's age and her desire for children. The study makes a methodological contribution by proposing a trivariate probit estimation framework that recognizes the joint dependence of pregnancy and induced and spontaneous abortion, and provides evidence in support of this joint dependence. The study reports an inverted U-shaped effect of a woman's age on her pregnancy and both forms of abortion. The turning point in each case is quite robust to the estimation framework. A significant effect of contextual variables, at the village level, constructed from the individual responses, on a woman's pregnancy is found. The effects are weaker in the case of induced abortion, and insignificant in the case of spontaneous abortion. The results are shown to be fairly robust. This paper extends the literature on the relation between son preference and fertility by examining the link between mother's son preference and desire for more children with abortion rates.

Studies on the causes of maternal mortality in India have focused on institutional deliveries, and the association of socioeconomic and demographic factors with the decline in maternal mortality has not been sufficiently investigated. By using both time series and cross-sectional data, this paper examines the factors associated with the decline in maternal mortality in India. Relative effects estimated by OLS regression analysis reveal that per capita state net domestic product (−1.49611, p<0.05), poverty ratio (0.02426, p<0.05), female literacy rate (−0.05905, p<0.10), infant mortality rate and total fertility rate (0.11755, p<0.05) show statistically significant association with the decline in the maternal mortality ratio in India. The Barro-regression estimate reveals that improvements in economic and demographic conditions such as growth in state income (β=0.35020, p<0.05) and reduction in poverty (β=0.01867, p<0.01) and fertility (β=0.02598, p<0.05) have a greater association with the decline in the maternal mortality ratio in India than institutional deliveries (β=0.00305). The negative β-coefficient (β=−0.69578, p<0.05), showing the effect of the initial maternal mortality ratio on change in maternal mortality ratio in the Barro-regression model, indicates a greater decline in maternal mortality ratio in laggard states compared with advanced states. Overall, comparing the estimates of relative effects, the socioeconomic and demographic factors have a stronger statistically significant association with the maternal mortality ratio than institutional deliveries. Interestingly, the weak association between ‘increase in institutional deliveries' and ‘decline in maternal mortality ratio’ suggests that merely increasing deliveries alone will not help in ensuring maternal survival in India. Quality of services provided by the health facility, birth preparedness and avoiding delay in reaching health facility are also important. Deliveries in health facilities will not necessarily translate into increased survival chances of mothers unless women receive full antenatal care services and delays in reaching health facility are avoided.

Young adults in sub-Saharan Africa most often state ‘I trust my partner’ as the reason for not using condoms consistently. This study assesses the extent to which young adults in Dar es Salaam, Tanzania, trust their partners, how trust influences condom use and whether certain relationship characteristics influence the relationship between trust and condom use. Data were taken from the 2003 Tanzania Trust Survey, and the level of trust reported by 509 male and female young adults aged 15–24 who were in relationships was examined. The analysis showed that reported trust in a partner has the expected negative relationship with consistent condom use. However, this negative association differs by relationship characteristics. To facilitate the interpretation of interactions between marriage and trust, the predicted probabilities of consistent condom use by level of trust were calculated for males and for females by marital status, showing that the negative association is strong among those who are not married, but that there is no association between trust and condom use among young married adults.

This study examines the knowledge of sexually transmitted diseases (STDs) among male youths in Malaysia. A self-administered survey was carried out on a sample of 952 never-married males aged 15–24 years. The respondents were asked about their knowledge of STDs, how these diseases get transmitted and their sexual behaviours. The data showed that 92% of the respondents knew of at least one STD (syphilis, gonorrhoea, chlamydia, herpes, genital warts, yeast infection, trichomoniasis or HIV/AIDS). About 95% of them knew of at least one method of STD transmission. Urban and tertiary-educated male youths showed a substantially higher proportion of awareness of STDs and transmission methods compared with their rural and less-educated counterparts. The data also indicated that 10% of the study sample admitted to having had sexual experiences. There were still a large proportion of the respondents who were not aware of STDs other than syphilis and HIV/AIDS and the means of transmission, such as multiple sex partners, including those who claimed to be sexually active. Thus there is a need for more concerted efforts to disseminate information on STDs and transmission methods to a wider audience in Malaysia, especially youths in rural areas.

Human height is a heritable trait that is known to be influenced by environmental factors and general standard of living. Individual and population stature is correlated with health, education and economic achievement. Strong sexual selection pressures for stature have been observed in multiple diverse populations, however; there is significant global variance in gender equality and prohibitions on female mate selection. This paper explores the contribution of general standard of living and gender inequality to the variance in global female population heights. Female population heights of 96 nations were culled from previously published sources and public access databases. Factor analysis with United Nations international data on education rates, life expectancy, incomes, maternal and childhood mortality rates, ratios of gender participation in education and politics, the Human Development Index (HDI) and the Gender Inequality Index (GII) was run. Results indicate that population heights vary more closely with gender inequality than with population health, income or education.

The study investigates the complex relationships between sex-selective abortion and family composition in two countries of the Southern Caucasus: Armenia and Azerbaijan. Data were drawn from maternity histories recorded in Demographic and Health Surveys (DHSs). In both countries, the relationship between the sex ratio of the next birth and the number of girls already born changed from negative to positive after 1992, when sex-selective abortion became prevalent. In Azerbaijan, but not in Armenia, a similar change was noticed for the relationship between the sex ratio of the next birth and the number of boys already born, this time from positive to negative. All changes in slopes were highly statistically significant. These findings indicate that sex-selective abortion was prevalent in both countries, and could work both ways in Azerbaijan. The results are interpreted in terms of ‘gender saturation’, that is a desire of families to better balance the composition of the family when too many children of the same sex are already born, which is consistent with opinion surveys indicating a preference for balanced families.

The aim of this study was to examine differences in several aspects of health between Kuwaiti men and women aged 60 years and over across three age categories (60–69, 70–79, 80+ years). The relationships between several social support variables, somatic symptoms and systolic and diastolic blood pressures were examined. A total of 1427 adult men (472) and women (955) aged 60 years and over representing all six governorates were selected. Data were collected during 2008–2009 by interview and completion of a questionnaire by participants in their own homes, after obtaining their informed consent. The Social Support Scale (SSS), Frequency of Contact Scale (FOC), Strength of Relations (SOR), Somatic Symptoms Inventory (SSI) and self-rated scales of general health were included. Systolic and diastolic blood pressures were measured. The data show that self-rated health and health in the last year differ significantly across age groups. Glycaemia differed significantly across the three age groups for the total sample. Systolic and diastolic blood pressure were higher in older respondents than younger ones, but no significant differences were observed between men and women. No significant differences in somatic symptoms were observed across the three age groups. Strength of relationship, frequency of contact, social support and children living with an elderly adult were all associated with fewer somatic symptoms, and all, except social support, were associated with lower systolic and diastolic blood pressure. Having children, the perception of social support, frequency of contact with, and strength of, relationships with kin are important modulators of somatic symptoms and blood pressure among elderly Kuwaitis.

This study examines the association between age cohort and utilization of maternal health care services in India, before and after adjusting for individual, household and contextual factors. Using data from the Demographic and Health Survey 2005–06, women were classified into three distinct age cohorts based on their age at childbirth: 15–24, 25–34 and 35–49 years. Binary logistic regression models were applied to assess the influence of women's age cohort on receiving full antenatal care (ANC) and skilled birth attendance (SBA). The analytical sample included the women who delivered their most recent birth at any time in the 5 years preceding the survey. Women belonging to the younger age cohort were found to be disadvantaged in receiving full ANC, whereas increasing age of women was negatively associated with receiving SBA. Low level of education, low mass media exposure, low autonomy, belonging to deprived social groups, poor economic status and residence in the central region were found to be major constraining factors in receiving full ANC and SBA for women in India. The findings support the need for ‘age-sensitive’ interventions that tailor programmes and incentives to women's health care needs through the reproductive life-stage. Urgent efforts are needed to ensure that women who are illiterate and those belonging to low autonomy and low socioeconomic groups receive the recommended maternal health care benefits.

Obesity is pandemic, but no consensus has yet emerged regarding appropriate tools for measuring it. Medical research based on populations in the developed world has largely dismissed body mass index (BMI) because it is a weak predictor of some health outcomes. In contrast, social science research still relies on it for its simplicity and ready availability in surveys. This paper uses consistent definitions and measures to select sufficiently good predictors of health and economic outcomes from among the anthropometrics that are considered alternatives to BMI. The results from the Indonesian Family Life Survey indicate that BMI and waist circumference are better predictors than waist-to-height ratio and waist-to-hip ratio. This paper argues that given its advantages, BMI is an adequate measure of obesity for Indonesia and possibly for the developing world. Further, if BMI is to be replaced, waist circumference is preferable to other anthropometrics.

The aim of the study was to assess the relationship between adverse life events, a tendency to respond with a high level of anxiety, and height and adiposity of adolescents. The sample included 575 persons (309 girls and 266 boys) aged 10–15 (mean 12.73) from the Wielkopolska region of Poland. The influence of adverse events during the 6 months before the examination and anxiety trait, as assessed with a STAIC questionnaire, on body height and BMI was analysed. Also sex, age, chronic diseases and socioeconomic status indicators were assessed. One-way and two-way ANOVA was used for assessment of relationships. Adverse events had no influence on body height and BMI. Subjects with a high level of anxiety trait (>34 score) were shorter (difference z=0.21) than subjects with a normal level of anxiety trait (≤34 score). The association of anxiety trait and body height was significant after adjustment for sex, age, chronic diseases and history of adverse life events. The analysis showed no statistically significant influence of adverse life events on height and BMI and a significant relationship between the general tendency to respond with anxiety and body height of adolescents. This suggests that psychological characteristics associated with the cognitive tendency to interpret events as threatening, and consequently, to respond with stress, may be involved in the variability of biological traits regardless of the objective harmfulness of the situation.

China's one-child policy has been quite successful in bringing down the country's fertility level but has produced a large number of one-child families. The risk of one-child families losing their only child has not received enough attention. In this paper, using an extension of Goldman & Lord (1983)'s method to measure widowhood, period life-table data from China's 2000 population census are used to examine age-specific and cumulative probabilities of mothers losing their only child. It is found that a mother faces a 14.94% probability of losing a son, and 12.21% probability of losing a daughter. As the age of first-time mothers increases, the probability of losing a child declines. Urban and rural mothers have different indices regarding the loss of children. Based on these findings the prospects for China's one-child policy are discussed.

As a leading indicator of child health, under-five mortality was incorporated in the United Nations Millennium Development Goals with the aim of reducing the rate by two-thirds between 1990 and 2015. Under-five mortality in Nigeria is alarmingly high, and many of the diseases that result in mortality are vaccine preventable. This study evaluates the uptake of childhood immunization in Nigeria from 1990 to 2008. A multi-year trend analysis was carried out using Alternating Logistic Regression on 46,130 children nested within 17,380 mothers in 1938 communities from the Nigerian Demographic and Health Surveys from 1990 to 2008. The findings reveal that mother-level and community-level variability are significantly associated with immunization uptake in Nigeria. The model also indicates that children delivered at private hospitals have a higher chance of being immunized than children who are delivered at home. Children from the poorest families (who are more likely to be delivered at home) have a lower chance of being immunized than those from the richest families (OR=0.712; 95% CI, 0.641–0.792). Similarly, the chance of children with a mother with no education being immunized is decreased by 17% compared with children whose mother has at least a primary education. In the same way, children of mothers who are gainfully employed and those of older mothers have statistically significantly higher odds of being immunized. Children of households with a female head are less likely to be immunized than those from male-headed households. The statistical significance of the community–survey year interaction term suggests an increase in the odds of a child being immunized over the years and spread over communities. Evidence-based policy should lay more emphasis on mother- and community-level risk factors in order to increase immunization coverage among Nigerian children.