Biomedical subjects

Kath Moser

Publications and source records attributed to Kath Moser.

5 recordsLinked to original sources

PubMed2006

Rising under-5 mortality in Africa: who bears the brunt?

OBJECTIVES: To identify the socioeconomic and geographical groups in which the recent under-5 mortality increase observed in several African countries was most pronounced, and to explore the contribution of a number of proximate determinants of under-5 mortality. METHODS: Time trends in under-5 mortality were assessed with Cox Proportional Hazards regression analysis, using Demographic and Health Surveys data for Burkina Faso, Cameroon, Côte d'lvoire, Kenya and Zimbabwe for the late 1980s - 1990s. We tested for differences in time trends between socioeconomic and rural/urban subgroups, and described the inequalities in time trends in living conditions, malnutrition and health care use. RESULTS: Under-5 mortality increased substantially (ranging from 25% to 71% in 10 years) within the five countries. In Kenya, the increase was the largest among children born to less educated mothers (test for difference between educational groups: P = 0.074) and in rural areas (P = 0.090). In Cameroon, the increase was the largest among the higher educated (P = 0.013), and in Zimbabwe among the higher educated (P = 0.098) and in urban areas (P = 0.093). For Burkina Faso and Côte d'Ivoire, we did not observe statistically significant differences between educational and rural/urban subgroups. The decline in skilled delivery attendance in Zimbabwe and Kenya was similar among the less and higher educated. The decline in immunization coverage during the mid-1990s in Zimbabwe was the largest in the group with the highest mortality increase, but in Kenya it was as large among the less and higher educated. Whereas in Kenya the increase in malnutrition was the largest in the group with the highest mortality increase, this was not the case in Zimbabwe. CONCLUSIONS: The recent increase in under-5 mortality in some African countries was highly concentrated in specific population subgroups. Exactly which groups were most affected was highly variable. It cannot be assumed that lower socioeconomic groups are always most vulnerable. Strategies to halt the under-5 mortality increase should be based on disaggregate information for individual countries.

Africa South of the Sahara↗

PubMed2006

Household wealth and the metabolic syndrome in the Whitehall II study.

OBJECTIVE: The metabolic syndrome is more common in socially disadvantaged groups. Inequalities in household wealth are currently widening and may contribute to the increasing prevalence of the metabolic syndrome. RESEARCH DESIGN AND METHODS: This was a cross-sectional analysis of 1,509 women and 4,090 men (aged 45.2-68.9 years) of an occupational cohort study of 20 civil service departments located in London, U.K. Components of the metabolic syndrome were measured in 1997-1999 and defined using a modified World Health Organization definition. RESULTS: Own income, household income, and wealth were each strongly and inversely associated with the metabolic syndrome in both sexes (P(trend) < 0.001). Within each group of household wealth, the prevalence of the metabolic syndrome was higher in men than in women. Sex differences became smaller with decreasing household wealth, with the prevalence of the metabolic syndrome rising from 12.0 and 5.7% in the wealthiest men and women, respectively, to corresponding values of 23.6 and 20.1% in the poorest group. The odds ratio (95% CI) associated with each decrease of one category in household wealth was 1.25 (1.03-1.50) in men and 1.69 (1.18-2.41) in women, adjusting for age, household members, occupational grade, education, father's social class, personal and household income, ethnic group, smoking, alcohol intake, diet, and physical activity. CONCLUSIONS: Household wealth, a measure of assets accumulated over decades and generations, is strongly and inversely associated with the metabolic syndrome. Future research should explore the potential mechanisms by which wealth inequalities are associated with the metabolic syndrome.

Adult↗

PubMed2005

Strengthening health information systems to address health equity challenges.

Special studies and isolated initiatives over the past several decades in low-, middle- and high-income countries have consistently shown inequalities in health among socioeconomic groups and by gender, race or ethnicity, geographical area and other measures associated with social advantage. Significant health inequalities linked to social (dis)advantage rather than to inherent biological differences are generally considered unfair or inequitable. Such health inequities are the main object of health development efforts, including global targets such as the Millennium Development Goals, which require monitoring to evaluate progress. However, most national health information systems (HIS) lack key information needed to assess and address health inequities, namely, reliable, longitudinal and representative data linking measures of health with measures of social status or advantage at the individual or small-area level. Without empirical documentation and monitoring of such inequities, as well as country-level capacity to use this information for effective planning and monitoring of progress in response to interventions, movement towards equity is unlikely to occur. This paper reviews core information requirements and potential databases and proposes short-term and longer term strategies for strengthening the capabilities of HIS for the analysis of health equity and discusses HIS-related entry points for supporting a culture of equity-oriented decision-making and policy development.

Developing Countries↗

PubMed2005

World mortality 1950-2000: divergence replaces convergence from the late 1980s.

OBJECTIVE: We sought to investigate to what extent worldwide improvements in mortality over the past 50 years have been accompanied by convergence in the mortality experience of the world's population. METHODS: We have adopted a novel approach to the objective measurement of global mortality convergence. The global mortality distribution at a point in time is quantified using a dispersion measure of mortality (DMM). Trends in the DMM indicate global mortality convergence and divergence. The analysis uses United Nations data for 1950-2000 for all 152 countries with populations of at least 1 million in 2000 (99.7% of the world's population in 2000). FINDINGS: The DMM for life expectancy at birth declined until the late 1980s but has since increased, signalling a shift from global convergence to divergence in life expectancy at birth. In contrast, the DMM for infant mortality indicates continued convergence since 1950. CONCLUSION: The switch in the late 1980s from the global convergence of life expectancy at birth to divergence indicates that progress in reducing mortality differences between many populations is now more than offset by the scale of reversals in adult mortality in others. Global progress needs to be judged on whether mortality convergence can be re-established and indeed accelerated.

Global Health↗

PubMed2002

Consultation rates from the general practice research database.

An analysis was undertaken of consultation rates in 226 UK general practices contributing to the General Practice Research Database. Over the period 1992-1998 the mean age-standard-ised consultation rate per person year at risk was 3.85 (3.01 for males and 4.71 for females). In contrast with younger ages, consultation rates among those aged 65years and over showed an upward trend over the seven-year period. Consultation rates were higher in areas of low population density as compared with higher density areas.

Adolescent↗