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Who leaves school prematurely in Uganda: Do predictors vary by place of residence?
No full textThis paper examined the predictors for school dropouts in Uganda following the introduction of universal primary education close to 30 years ago. We used 10 % of the 2014 Uganda Population and Housing Census dataset (albeit relatively old) to examine the predictors of school dropouts in; i) Rural Uganda ii) Kampala (the capital) and iii) other urban areas. We specifically applied the logistic regression model to predict the probability that a child aged 6–16 dropped out of school (versus not) in 2014. While the socioeconomic status of households, household size, composition and age of the child were the strongest predictors for dropouts, the latter were found to vary by place of residence, due to variations in; geography, population composition, nature of economic activity, supply of education and levels of commitment of local government authorities in school supervision. Action points to redress dropouts in Uganda cannot be implemented ubiquitously but ought to take into consideration peculiar circumstances pertaining in; i) Rural areas ii) Kampala and iii) other urban areas. Policy should especially engender fiscal reforms to increase local revenue and redress the various predictors for dropouts in the differing rural and urban spaces
Transition de la mortalité, transition épidémiologique et transition nutritionnelle chez les adultes vivant en milieu rural au Sénégal
No full textThis thesis explores the mortality transition, the epidemiological transition and the nutritional transition in rural Senegal. The mortality transition, a pillar of the demographic transition, is reflected in a general decline in mortality.The epidemiological transition explains this phenomenon by the transition from a mortality structure dominated by communicable diseases, undernutrition and maternal and neonatal deaths, to a system in which the majority of deaths are caused by non-communicable diseases, favoured by environmental and behavioural factors. The nutrition transition explains part of the epidemiological transition. It describes the
changes in diet and the decline in physical activity associated with urbanisation. In terms of mortality, the nutrition transition is reflected in a fall in deaths linked to undernutrition, followed by an increase in deaths associated with non-transmissible diseases linked to nutritional imbalance. In rural areas of low- and middle-income countries, the nutrition transition has long been overlooked, because it is thought to be associated with urban lifestyles and affluent environments. The health of adults, in particular, has been little studied in these countries, owing to a lack of available longitudinal data. While reductions in mortality due to transitions are more apparent in young children, the increase in non-communicable diseases and associated deaths is more likely to be observed in adults. A growing body of work tends to demonstrate the rapid nutritional and epidemiological changes occurring in low- and middle-income countries, including sub-Saharan Africa, even in poor and peripheral environments. This thesis studies three rural Senegalese areas, Bandafassi, Mlomp and Niakhar, covered by a demographic observatory. The aim is to look for evidence of ongoing transitions in demographic data, but also in local perceptions. An initial demographic analysis using 35 years of mortality data shows that changes in mortality trends and structure in these three areas are compatible with the hypothesis of an epidemiological transition, one of the driving forces of which may be the nutrition transition. Secondly, an anthropological analysis using data from focus groups conducted in Niakhar and Bandafassi highlights the reality of the nutrition transition phenomenon for the people we met. The final section discusses the discrepancies between perceptions of the nutrition transition and the theoretical model
Prenatal Exposure to Ambient Particulate Matter and Autism Spectrum Disorder in Children, a Case Control Study in France
No full textA series of epidemiological studies conducted in the United States have consistently shown an increased risk of autism spectrum disorder (ASD) in children associated with pre- and postnatal exposure to ambient particulate matter (PM). In Europe, studies are scarce and results are inconsistent. We aimed to investigate the association between prenatal exposure to PM and the risk of ASD in France. ASD cases were participants from the ELENA cohort. Controls children from the ELFE cohort were matched by sex, year (± 2) and region of birth. Prenatal exposures to PM10 and to PM2.5 were estimated between 2008 and 2013 using innovative hybrid spatio-temporal models developed for France. Conditional logistic regression models adjusted for birth season, parent’s age at the child birth and parental education level were run. We included 125 ASD cases and 500 controls. Prenatal PM2.5 and PM10 median (IQR) concentration estimates were respectively 16.3 (3.9) µg/m3 and 22.9 (6.6) µg/m3 in the whole sample. The conditional logistic regression models showed Odds Ratios (ORs) (Confidence Interval 95%) for ASD risk of 0.72 (0.52–1.01) and 0.84 (0.58–1.22) for an IQR increase in PM2.5 and PM10 prenatal levels, respectively. When restricting population of ASD cases to children born the same year of controls, ORs were 1.79 (0.80–4.01) and 2.23 (0.71–9.04), respectively. Our results did not show that prenatal exposures to PM2.5 and PM10 were associated with the risk of ASD in children in France
Uptake of and willingness to pay for health insurance in rural Senegal: a reinforcement effect
No full textIntroduction: Expanding health insurance is viewed as a core strategy for achieving universal health coverage. In Senegal, as in many other developing countries, this strategy has been implemented by creating community-based health insurance (CBHI) schemes with voluntary enrolment and a fixed premium paid by enrollees. Yet little is known about how the individuals’ experience of CBHI enrolment further influences their willingness to pay (WTP). In this paper, we test the existence of a reinforcement effect between effective enrolment in a CBHI and WTP for health insurance by analysing their mutual relationship.
Methods: We rely on primary survey data collected in 2019–2020 in the rural area of Niakhar in Senegal. We use an econometric methodology involving: (1) Heckman-type selection models to estimate the determinants of CBHI membership conditioned on awareness of health insurance, addressing the issue of sample selection due to differential awareness and (2) a simultaneous equation model to jointly estimate the uptake and WTP for health insurance, addressing the issue of endogeneity due to reverse causality between both variables. We also focus on the roles that informational and geographical barriers, as well as individual risk preference and trust, play in both outcomes.
Results: The final sample includes 1607 individuals. Results show that WTP further increases with the individuals’ direct experience in a CBHI scheme, despite an environment characterised by low enrolment rates. We also provide evidence for a U‐shaped relationship between risk tolerance and WTP for health insurance.
Conclusion: We provide novel evidence on a reinforcement effect of enrolment in a CBHI on WTP for health insurance, with the presence of a substantial consumer surplus among enrolled individuals at the actual premium. Our findings suggest that policies aiming at improving health insurance awareness should foster the demand for health insurance in rural Senegal
Profiles of the maternal occupational exposome during pregnancy and associations with intrauterine growth: Analysis of the French Longitudinal Study of Children – ELFE study
No full textBackground: Numerous agents in the workplace are suspected of impairing fetal growth. To date, no epidemiological studies have specifically described the occupational exposome during pregnancy.
Objective: The objectives were to determine maternal occupational exposome profiles and study their associations with intrauterine growth characteristics measured by small for gestational age (SGA), birthweight (BW), and head circumference (HC).
Methods: We used data from the French national ELFE cohort. Occupational exposures to 47 agents (chemical, physical, biological, biomechanical, organizational and psychosocial), were identified using job exposure matrices. Mothers were classified as occupationally not exposed, uncertainly exposed, or exposed depending on their probability of exposure. Outcomes of interest were BW, SGA and HC. Maternal profiles of the occupational exposome were determined using hierarchical clustering of principal components. Associations between profiles and intrauterine growth outcomes were studied using linear or logistic regression models adjusted for potential confounders. Analyses were carried out depending on whether mothers stopped working during pregnancy.
Results: The 12,851 included women were exposed to a median of 6 factors. Four occupational exposome profiles were identified, characterized by “low exposure, stress at work”; “strenuous, high organization, low decision”; “postural constraints, psychosocial factors”, “postural and strength constraints, chemical and biological factors”. In multivariate analyses, and among women who stopped working during the third trimester of pregnancy, analyses found associations between the profile “postural constraints, psychosocial factor” and SGA, and HC. None of the other exposure profiles were statistically significantly associated with foetal growth outcomes.
Conclusion: The results show that the specific profile “postural constraints, psychosocial factors” may increase the risk of foetal growth retardation. Although these results need to be replicated, this study provides a first better understanding of the exposome of pregnant women at the workplace which may help to better adapt prevention strategies
Life expectancy losses in the Gaza Strip during the period October, 2023, to September, 2024
No full textBackground: In the context of the ongoing war in the Gaza Strip, the Gaza Health Ministry (GHM) has reported 45 936 fatalities and more than 10 000 individuals missing or under the rubble for the period Oct 7, 2023, to Jan 8, 2025. The scope of this death count is difficult to fully interpret because it does not account for the size and age distribution of the Gaza Strip population. Moreover, the quality of this death count has been questioned. In this study, we evaluated the quality of the GHM death count by comparing GHM data against register data, and we estimated life expectancy losses in the Gaza Strip for the period October, 2023, to September, 2024, ie, the first 12 months of the war.
Methods: We matched individuals included in the GHM nominative list of killed individuals for the period Oct 7, 2023, to Aug 30, 2024, with individuals included in the refugee register maintained by the UN Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), which covers about 66% of the Gaza Strip population. We compared proportions of matched fatalities with proportions of registered refugees in the 2017 census. We then used census data, vital registration data, and GHM fatality information since Oct 7, 2023, to produce estimates of life expectancy losses in the Gaza Strip for the first 12 months of the war. We used three scenarios for these life expectancy estimates, based on the different types of counts provided by GHM. These scenarios did not account for the indirect effect of the war.
Findings: 21 953 (63·9%) of 34 344 individuals in the GHM list of killed individuals (and 19 744 [64·4%] of 30 673 excluding those who were not yet born at the time of the 2017 census) were matched with individuals included in the UNRWA refugee register. This proportion is similar to the proportion of registered refugees in the 2017 census (65·7%), providing additional evidence regarding the reliability of the GHM data. In the central variant, life expectancy in the Gaza Strip decreased by 34·9 years during the first 12 months of the war, about half (–46·3%) the prewar level of 75·5 years. Life expectancy losses were larger for males (–38·0 years [–51·6%]) than for females, but nonetheless, females also suffered large losses (–29·9 years [–38·6%]). Losses between the low and high variants ranged between –31·1 years (–41·1%) and –39·4 years (–52·2%) for both sexes combined.
Interpretation: Our approach to estimating life expectancy losses in this study is conservative as it ignores the indirect effect of the war on mortality. Even ignoring this indirect effect, results show that the ongoing war in the Gaza Strip generated a life expectancy loss of more than 30 years during the first 12 months of the war, nearly halving prewar levels. Actual losses are likely to be higher
Collecter, classer et décrire les familles au prisme des statistiques. Une lecture démographique des configurations familiales et de l’organisation des solidarités en Polynésie française
No full textCette thèse propose une description systématique de l’organisation des familles en Polynésie française, au sein du ménage et au-delà. Celle-ci éclaire les pratiques d’entraide familiales et leur rôle structurant sur le territoire.
Un premier axe fait l’état de l’art des manières dont les familles sont collectées dans les enquêtes statistiques. Il s’agit notamment d’interroger les potentialités et les limites des données de recensement pour la description des familles et en particulier la manière dont ceux-ci classent les structures familiales. Cette analyse montre la prédominance du modèle de la famille nucléaire dans ces typologies. L’une de ses conséquences est l’agrégation de tous les autres modes de cohabitation dans la catégorie hétérogène des ménages complexes, laquelle nécessite d’être précisée lorsqu’elle ne se réduit pas à une minorité des ménages. C’est le cas de la Polynésie française, où en 2017, on dénombre un quart de ménages complexes. Pourtant la catégorie n’est pas détaillée. La suite de cette thèse propose une méthodologie adaptable et reproductible pour en construire des sous-catégories. Pour ce faire, nous chercherons d’abord à mieux comprendre ces données, à partir d’une observation de terrain menée lors de la collecte du recensement en août 2022.
L’examen des modes de classification permet aussi de dégager un certain nombre de critères déterminants dans l’élaboration des typologies de ménages. La deuxième partie met en application ces critères afin de constituer une typologie consolidée des ménages complexes polynésiens. Des méthodes de classification non supervisée nous permettent, d’explorer l’hétérogénéité de cette catégorie. Les résultats quantitatifs ont ensuite été complétés par une revue des modes de corésidence historiquement présents sur le territoire et des processus socio-historiques qui ont amené aux formes familiales actuellement observées. Tout cela permet de construire une typologie qui éclaire les configurations des familles corésidentes.
Enfin, la dernière partie mobilise cette typologie ainsi que les résultats de l’enquête Feti’i e fenua (ISPF-Ined, 2020) pour montrer comment les familles organisent l’accès aux ressources sur le territoire. Elle complète les observations sur la corésidence, en tenant compte des membres qui vivent à proximité, ainsi que de la dispersion spatiale des familles polynésiennes, qui se répartissent bien souvent sur plusieurs archipels. Tout cela permet d’une part de mettre en lumière comment les familles, organisent l’accès aux ressources sur le territoire, à proximité comme à distance, et d’autre part en quoi ces modes d’organisation résultent des pratiques d’entraide intrafamiliales
