Household Microenvironment and Under-Fives Health Outcomes in Uganda: Focusing on Multidimensional Energy Poverty and Women Empowerment Indices
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Source
2.2. Description of Health Outcomes and Predictors
2.2.1. Health Outcomes
2.2.2. Independent Variables
2.2.3. Multidimensional Energy Poverty Index (MEPI)
2.2.4. Water, Sanitation, and Hygiene Facilities
2.2.5. Women Empowerment Index
2.3. Statistical Analyses
3. Results
4. Discussion
5. Conclusions
6. Limitations
Supplementary Materials
Author Contributions
Funding
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
References
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Dimensions | Indicator (Weight) | Variables | Deprivation Cut-Off (Energy Poor if…) |
---|---|---|---|
Cooking | Modern Cooking fuel (0.2) | Type of cooking fuel | any fuel use besides electricity, LPG, kerosene, natural gas, or biogas |
Indoor pollution (0.2) | Food cooked on stove or open fire (no hood/chimney), indoor, if using any fuel besides electricity, LPG, natural gas or biogas | True | |
Lighting | Electricity access (0.2) | Has access to electricity | False |
Services provided by means of household appliances | Household appliance ownership (0.13) | Has a refrigerator | False |
Entertainment/education | Entertainment/education appliance ownership (0.13) | Has a radio OR television | False |
Communication | Telecommunication means (0.13) | Has a phone landline OR mobile phone | False |
Variables | Descriptions |
---|---|
Multidimensionally energy poverty | Categorized into acute (MEPI exceed 0.7) and moderate (MEPI ≤ 0.7) |
Women empowerment | Scores of the empowerment dimensions (attitude to domestic violence, social independence, and decision making) estimated from components of dimensions and their weight |
Source of drinking water | Categorized into improved and unimproved |
Unimproved | Drinking water directly from a river, dam, lake, pond, stream, canal, or irrigation canal and drinking water from an unprotected dug well or unprotected spring |
Improved | Drinking water located in the premises or not, from piped water, protected dug wells, protected springs, rainwater, and packaged water. This category also includes drinking water from boreholes or tube wells. |
Sanitation facility | Categorized into poor, improved, and safely managed |
No facility | No toilet facility |
Unimproved | Use of pit latrines without a slab or platform, hanging latrines or bucket latrines |
Improved | Sanitation facilities including flush/pour flush to piped sewer systems, septic tanks, or pit latrines; ventilated improved pit latrines, composting toilets or pit latrines with slabs |
Hygiene facility | Categorised as no facility, limited, and basic |
No facility | No handwashing facility on premises |
Limited | Availability of a handwashing facility on premises without soap and water |
Basic | Availability of a handwashing facility on premises with soap and water |
Characteristics | n (Percentage) or Mean (SD) |
---|---|
Child demographic characteristics, n (%) | |
Child is female | 7326 (49.8) |
Child age is 0–11 months | 2622 (21.5) |
Child age is 12–35 months | 4796 (39.3) |
Child age is 36–59 months | 4795 (39.3) |
Parental characteristics | |
Mother’s age, mean (SD) | 28.42 (6.75) |
Mother no education, n (%) | 1937 (13.17) |
Mother Primary education, n (%) | 9187 (62.45) |
Mother Secondary or higher education, n (%) | 3586 (24.38) |
Partner’s age, mean (SD) | 44.92 (24.8) |
Husband no education, n (%) | 837 (7.03) |
Husband Primary education, n (%) | 6572 (55.21) |
Husband Secondary or higher education, n (%) | 4495 (37.76) |
Household characteristics | |
Rural resident | 11,398 (78.65) |
Household size, mean (SD) | 6.18 (2.75) |
Children under 5 in the household, mean (SD) | 1.91 (0.94) |
Source of drinking Water, n (%) | |
Unimproved | 3305 (22.81) |
Improved | 11,187 (77.19) |
Sanitation facility, n (%) | |
No toilet facility | 1031 (7.11) |
Unimproved | 8498 (58.64) |
Improved | 4963 (34.25) |
Hygiene facility, n (%) | |
No facility | 6137 (42.34) |
Limited | 4915 (33.92) |
Basic | 3441 (23.74) |
Household multidimensional energy poverty, n (%) | |
Multidimensionally acute energy poverty | 3822 (26.39) |
Moderate energy poverty | 10,660 (73.61) |
Wealth Index, n (%) | |
Poorest | 3251 (22.43) |
Poorer | 3038 (20.96) |
Middle | 2799 (17.31) |
Richer | 2579 (17.79) |
Richest | 2826 (19.50) |
Child health outcomes, n (%) | |
ARI | 1354 (9.34) |
Diarrhoea | 2832 (19.54) |
Stunted | 1479 (28.9) |
Characteristics | Child Health Outcome, (%) | ||
---|---|---|---|
ARI | Diarrhoea | Stunted | |
Age of child | |||
0–11 months | 10.71 | 29.43 | 14.10 |
12–35 months | 10.65 | 24.44 | 36.26 |
36–59 months | 7.63 | 9.36 | 27.71 |
χ2 | 43.90 *** | 722.61 *** | 180.41 *** |
Sex of child | |||
Female | 9.10 | 18.09 | 26.88 |
Male | 9.70 | 20.99 | 30.90 |
χ2 | 2.28 | 20.85 *** | 7.44 ** |
Mother’s education | |||
No education | 11.81 | 18.62 | 37.81 |
Primary | 9.60 | 19.95 | 30.10 |
Secondary or higher | 7.83 | 19.00 | 19.82 |
χ2 | 24.31 *** | 2.71 | 81.74 *** |
Household drinking water quality | |||
Unimproved | 9.97 | 19.2 | 32.76 |
Improved | 9.16 | 19.64 | 26.79 |
χ2 | 2.1 | 0.34 | 16.34 *** |
Household Sanitation facility | |||
No facility | 15.75 | 23.29 | 33.63 |
Unimproved facility | 9.27 | 19.78 | 31.61 |
Improved facility | 8.15 | 18.35 | 21.53 |
χ2 | 62.38 *** | 14.70 ** | 64.39 *** |
Household Hygiene facility | |||
No facility | 11.15 | 22.21 | 28.01 |
Limited | 8.78 | 17.94 | 29.98 |
Basic | 6.91 | 17.05 | 26.18 |
χ2 | 53.01 *** | 52.99 *** | 5.63 |
Multidimensional energy poverty | |||
Moderate energy poverty | 6.96 | 17.46 | 23.85 |
Acute energy poverty | 10.38 | 20.36 | 29.95 |
χ2 | 50.71 *** | 18.16 ** | 22.10 *** |
Residence | |||
Rural | 7.07 | 20.23 | 29.63 |
Urban | 9.96 | 16.99 | 22.39 |
χ2 | 25.78 *** | 17.37 *** | 21.93 *** |
Wealth Index | |||
Poorest | 12.74 | 22.18 | 32.51 |
Poorer | 10.46 | 21.32 | 32.31 |
Middle | 8.86 | 18.7 | 31.59 |
Richer | 8.31 | 18.47 | 26.56 |
Richest | 5.9 | 16.55 | 16.63 |
χ2 | 108.32 *** | 42.53 *** | 93.98 *** |
Variables (Base Category) | Odds Ratios (ORs) and 95% Confidence Intervals (CI) | ||
---|---|---|---|
ARI | Diarrhoea | Stunted | |
Multidimensional energy poverty (moderate) | |||
Multidimensionally Acute Energy Poor | 1.32 *** (1.10 to 1.58) | 0.98 (0.86 to 1.11) | 1.12 (0.92 to 1.37) |
Drinking water quality (unimproved) | |||
Improved | 0.99 (0.85 to 1.5) | 1.08 (0.97 to 1.20) | 0.83 ** (0.70 to 0.99) |
Sanitation facility (No facility) | |||
Unimproved | 0.55 *** (0.47 to 0.65) | 0.83 ** (0.71 to 0.96) | 0.89 (0.70 to 1.14) |
Improved | 0.55 *** (0.45 to 0.68) | 0.91 (0.76 to 1.08) | 0.64 *** (0.49 to 0.86) |
Hygiene facility (No facility) | |||
Limited | 0.87 * (0.77 to 1.01) | 0.84 *** (0.75 to 0.93) | 1.05 (0.88 to 1.25) |
Basic | 0.75 *** (0.63 to 0.89) | 0.80 *** (0.70 to 0.91) | 1.01 (0.83 to 1.23) |
Scores for the three women empowerment domains | |||
Score for attitude to violence | 0.88 *** (0.82 to 0.93) | 0.89 *** (0.84 to 0.93) | 1.06 (0.97 to 1.16) |
Score for social independence | 0.91 ** (0.84 to 0.98) | 0.93 ** (0.88 to 0.99) | 0.83 *** (0.75 to 0.92) |
Score for decision making | 1.05 (0.98 to 1.12) | 1.00 (0.95 to 1.05) | 0.95 (0.87 to 1.03) |
Sex of child (Male) | |||
Female | 0.93 (0.82 to 1.04) | 0.86 *** (0.79 to 0.94) | 0.78 *** (0.68 to 0.91) |
Child age category (0–11months) | |||
12–35 months | 1.001 (0.86 to 1.17) | 0.79 *** (0.71 to 0.88) | 3.65 *** (2.90 to 4.61) |
36–59 months | 0.67 *** (0.57 to 0.79) | 0.25 *** (0.22 to 0.29) | 2.54 *** (2.00 to 3.23) |
Place of residence (Urban) | |||
Rural | 1.12 (0.92 to 1.36) | 1.14 * (0.99 to 1.32) | 1.10 (0.86 to 1.42) |
Mother’s height in meter (<14.5) | |||
≥14.5 | 0.28 *** (0.21 to 0.38) | ||
Mother’s BMI (<18.5 Kg/m2) | |||
18.5 to 24.9 Kg/m2 | 0.87 (0.67 to 1.12) | ||
≥25 Kg/m2 | 0.61 *** (0.45 to 0.82) | ||
Child’s birth order (first) | |||
Second | 1.09 (0.84 to 1.41) | ||
Third | 1.32 ** (1.02 to 1.72) | ||
Fourth and above | 1.02 (0.82 to 1.28) | ||
Constant | 0.17 *** (0.13 to 0.24) | 0.49 (0.38 to 0.63) | 0.73 (0.42 to 1.30) |
Number of observations | 12,095 | 12,095 | 3694 |
203.81 (p < 0.01) | 572.15 (p < 0.01) | 263.12 (p < 0.01) | |
McFadden’s or the Pseudo R2 | 0.025 | 0.06 | 0.07 |
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Terfa, Z.G.; Ahmed, S.; Khan, J.; Niessen, L.W.; on behalf of the IMPALA Consortium. Household Microenvironment and Under-Fives Health Outcomes in Uganda: Focusing on Multidimensional Energy Poverty and Women Empowerment Indices. Int. J. Environ. Res. Public Health 2022, 19, 6684. https://doi.org/10.3390/ijerph19116684
Terfa ZG, Ahmed S, Khan J, Niessen LW, on behalf of the IMPALA Consortium. Household Microenvironment and Under-Fives Health Outcomes in Uganda: Focusing on Multidimensional Energy Poverty and Women Empowerment Indices. International Journal of Environmental Research and Public Health. 2022; 19(11):6684. https://doi.org/10.3390/ijerph19116684
Chicago/Turabian StyleTerfa, Zelalem G., Sayem Ahmed, Jahangir Khan, Louis W. Niessen, and on behalf of the IMPALA Consortium. 2022. "Household Microenvironment and Under-Fives Health Outcomes in Uganda: Focusing on Multidimensional Energy Poverty and Women Empowerment Indices" International Journal of Environmental Research and Public Health 19, no. 11: 6684. https://doi.org/10.3390/ijerph19116684