Hypertension is a significant contributor to the global burden of cardiovascular and related target organ diseases such as heart failure, coronary heart disease, stroke and kidney failure, and their associated premature morbidity, mortality and disability. Marital status is an important social characteristic known to predict a range of health outcomes including cardiovascular disease. However, little is known about its impact on hypertension in sub-Saharan Africa. This study explored the relationship between marital status and hypertension among women and men in Ghana. Drawing on data from the 2014 Ghana Demographic and Health Survey (GDHS), descriptive statistics and binary logistic regression models were used to analyse the link between marital status and hypertension. About 13% of women aged 15–49 and 15% of men aged 15–59 were found to be hypertensive. After controlling for lifestyle and socio-demographic covariates, the logistic regression models showed significantly higher odds of hypertension for married (OR=2.14, 95% CI=1.30–3.53), cohabiting (OR=1.94, 95% CI=1.16–3.23) and previously married (OR=2.23, 95% CI=1.29–3.84) women. In contrast, no significant association was found between any of the marital status cohorts and hypertension for men. Other significant predictors of hypertension were age, body mass index and wealth status. The results demonstrate that marital status is an independent risk factor for hypertension in Ghana for women, rather than men. This could have immediate and far-reaching consequences for cardiovascular health policy in Ghana. In particular, the findings could lead to better targeted public health interventions, including more effective risk factor assessment and patient education in clinical settings, which could lead to more effective patient management and improved cardiovascular outcomes.

The Sustainable Development Goals (SDGs) are increasingly being used to measure developmental progress among and within countries. Achieving the health-related SDGs remains a primary concern of many developing countries. This study measured the progress in selected health-related indicators of SDGs in the states of India by social and economic groups, and predicted their likely progress by 2030. The health indicators analysed included health outcomes, nutrition, health care utilization and determinants of health. Data from the Census of India, Sample Registration System (SRS), National Family and Health Surveys (NFHSs) and National Sample Survey Organization (NSSO) were used in the analysis. Annual rate of progress (ARP) and the required rate of progress (RRP) were computed for selected indicators over the period 2005–06 to 2015–16. A Composite Index of Health (CIH) was used to understand the state of health of populations. The ARP was higher than the RRP in maternal care and reduction of under-five mortality, while ARP was lower than the RRP in undernutrition and sanitation. The ARP for health-related indicators showed a mixed pattern across religion and caste groups. The ARP for medical assistance at birth and immunization was highest among Scheduled Castes and that for reduction of under-five mortality was highest among Scheduled Tribes. The CIH was lowest in Uttar Pradesh (0.26) and highest in Goa (0.81). The association between the CIH and the Human Development Index (HDI) was significant, suggesting interlinkage between health and development. Notable improvements were observed in maternal and child health and maternal health care utilization across social groups in India over the period 2005–06 to 2015–16, and if the trends continue the country can achieve the SDG target in maternal health by 2030. However, progress in nutrition and other health indicators has been slow and uneven.

Dowry practice, women’s autonomy to use dowry (‘dowry autonomy’) and the association of these with domestic violence were examined among young married women in India. Data were taken from the ‘Youth in India: Situation and Needs Study’ carried out in six Indian states during 2006–07. A total of 13,912 women aged 15–24 years were included in the study. About three-quarters of the women reported receiving a dowry at their marriage, and about 66% reported having the ability to exercise autonomy over the use of it – ‘dowry autonomy’. Dowry given without ‘dowry autonomy’ was found to have had no protective value against young women experiencing physical domestic violence in India. While women’s participation in paid employment increased the odds of them experiencing physical domestic violence, women’s education and marrying after the age of 18 years reduced the likelihood of experiencing physical domestic violence.

Despite the significant health benefits of breastfeeding for the mother and the infant, economic class and race disparities in breastfeeding rates persist. Support for breastfeeding from the father of the infant is associated with higher rates of breastfeeding initiation. However, little is known about the factors that may promote or deter father support of breastfeeding, especially in fathers exposed to contextual adversity such as poverty and violence. Using a mixed methods approach, the primary aims of the current work were to (1) elicit, using qualitative methodology, the worries, barriers and promotive factors for breastfeeding that expectant mothers and fathers identify as they prepare to parent a new infant, and (2) to examine factors that influence the parental breastfeeding intentions of both mothers and fathers using quantitative methodology. A sample (N=95) of expectant, third trimester mothers and fathers living in a low-income, urban environment in Midwestern USA, were interviewed from October 2013 to February 2015 about their infant feeding intentions. Compared with fathers, mothers more often identified the benefits of breastfeeding for the infant’s health and the economic advantage of breastfeeding. Mothers also identified more personal and community breastfeeding support resources. Fathers viewed their own support of breastfeeding as important but expressed a lack of knowledge about the breastfeeding process and often excluded themselves from discussions about infant feeding. The results point to important targets for interventions that aim to increase breastfeeding initiation rates in vulnerable populations in the US by increasing father support for breastfeeding.

A woman’s decision to continue or terminate an unplanned pregnancy is affected by a broad range of contextual and cognitive factors. The identification of women’s perceptions of unplanned pregnancy is crucial for health care providers to be able to offer supportive care and counselling. The aim of this study was to develop an instrument to accurately measure women’s perceptions of unplanned pregnancy: the Women’s Perceptions of Unplanned Pregnancy Questionnaire. The instrument was developed using a methodological framework guided by Waltz et al. (2010). A conceptual model of the designed instrument emerged from the qualitative study using a content analysis approach conducted in Tabriz, Iran. Participants were recruited using convenience sampling method between June 2016 and July 2017. Participants were a sample of married Iranian women between the ages of 15 and 49 who had experienced an unplanned pregnancy, either unwanted or mistimed, within the last 3 months. Women with an established diagnosis of a psychological disorder were excluded from the study. The psychometric properties of the instrument were assessed using face, content, concurrent and construct validations. To evaluate face validity, qualitative and quantitative (item impact score) methods were used. The content validity was assessed by fifteen panel experts. In addition, concurrent validity of the designed instrument was tested using the Persian version of the Cambridge Worry Scale and the Spielberger State-Trait Anxiety Inventory. The construct validity was calculated by using the exploratory factor analysis method. Data were collected from questionnaires completed by 310 eligible women. Analysis of the data using exploratory factor analysis yielded 31 items in a unique six-factor structure. The instrument was found to have high internal consistency (Cronbach’s α=0.88) and adequate reliability (Intraclass Correlation Coefficient=0.89). A clearer understanding of women’s perceptions of unplanned pregnancy may enhance reproductive services and interventions.

Tuberculosis (TB) remains a major global public health problem that has become a crisis fuelled by HIV and the increasing occurrence of antimicrobial resistance. What has been termed the biosocial nature of TB challenges effective control of the disease. Yet, biosocial interactions involved in the persistence of TB in diverse settings are difficult to systematically account for. The recently developed framework of syndemics provides a way to capture how complex health problems result from the interactions between diseases such as HIV and TB, and harmful social conditions such as unemployment, malnutrition and substance abuse. This article advances the syndemics scholarship by examining health conditions that cluster together with TB in the Russian Federation, by eliciting a set of social processes that precipitate this clustering and exacerbate health outcomes, and by analysing interactions between these health conditions and social processes. To provide an account of this complexity, the article takes a qualitative approach and draws on the perspectives and experiences of people with TB. The results demonstrate emergence of a syndemic of stress, substance abuse, TB and HIV that is sustained by poverty, occupational insecurity, marginalization and isolation. Frictions between the narrow focus of the health care system on TB and the wider syndemic processes in which the lives of many persons with TB are embedded, contribute to poorer health outcomes and increase the risks of developing drug resistance. Finally, the article argues that the large-scale and impersonal forces become embodied as individual pathology through the crucial interface of the ways in which persons experience and make sense of these forces and pathologies. Qualitative research is needed for the adequate analysis of this biosocial complexity in order to provide a solid basis for responses to TB-centred syndemics in various settings.

The effects of marriage between biological relatives on the incidence of childhood genetic illness and mortality are of major policy significance, as rates of consanguinity exceed 50% in various countries. Empirical research on this question is complicated by the fact that consanguinity is often correlated with poverty and other unobserved characteristics of households, which may have independent effects on mortality. This study has developed an instrumental variables empirical strategy to re-examine this question, based on the concept that the availability of unmarried cousins of the opposite gender at the time of marriage creates quasi-random variation in the propensity to marry consanguineously. Using primary data collected in Bangladesh in 2006–07 and Pakistan in 2009–10, the study found that previous estimates of the impact of consanguinity on child health were biased and falsely precise. The study also empirically investigated the social and economic causes of consanguinity (including marital quality) and concludes that marrying a cousin can have positive economic effects for one’s natal family, by allowing deferral of dowry payments until after marriage.

Bio-Detection Dogs (BDDs) are used in some high-income countries as a diagnostic intervention, yet little is known about their potential in low/middle-income countries with limited diagnostic resources. This exploratory study investigated the opportunities and implications of deploying BDDs as a mobile diagnostic intervention to identify people with asymptomatic malaria, particularly at ports of entry, as an important step to malaria elimination in a population. A qualitative study design consisting of participant observation, five focus group discussions and informal conversations was employed in The Gambia in April–May 2017. A disciplined German Shepherd companion dog (not trained as a BDD) was introduced to research participants and their perceptions recorded. Field-notes and discussions were transcribed, translated and analysed thematically. Most research participants viewed positively the possibility of using BDDs to detect malaria, with the major advantage of being non-invasive. Some concerns, however, were raised regarding safety and efficacy, as well as cultural issues around the place of dogs within human society. The Gambia is a rabies-endemic country, and unfamiliar dogs are not usually approached, with implications for how research participants perceived BDDs. Understanding such concerns and working with local people to address such issues must be part of any successful strategy to deploy BDDs in new settings. Bio-Detection Dogs represent a potentially non-invasive diagnostic tool for the detection of asymptomatic or chronic malaria infections, particularly in areas with very low parasite rates. However, it is important to understand local concerns and work closely with communities to address those concerns. Wider deployment of BDDs will also require careful planning and sustained financial support.

This paper reports on the association between early marriage, age at first reproduction and height, as an indicator of childhood environment, and maternal health outcomes among traditional Roma women in Serbia. Demographic data, marital and reproductive histories, height, weight and self-rated health were collected from 414 Roma women living in rural settlements in Serbia in 2015–2017. Data analysis showed that higher age and weight were associated with a greater risk of poor health, greater height contributed to reduced risk of poor health while reproductive variables were insignificant. The study provides evidence that the long-term effects of early childbearing may not always be associated with poorer health status. As indicated by the differences in height, it is likely that women who were capable of reproducing very early on and staying healthy in later life were probably very healthy to begin with. The results probably reflect both the biological and social differences of early childhood. Aside from height, the traditional Roma marriage pattern and social benefits may have an additional protective effect on the health of women.

Many factors influence the male:female birth ratio (number of male births divided by total births, M/T). Studies have suggested that this ratio may be positively correlated with the education levels of mothers. This study assessed the effect of maternal education on M/T in the US population overall and by racial group. Number of live births by sex of the child, maternal educational level reached and race were obtained from the Centres for Disease Control (CDC Wonder) for the period 2007–2015. The total study sample comprised 28,268,183 live births. Overall, for the four available recorded racial groups (Asian/Pacific Islander, White, American Indian/Alaska Native and Black/African American), M/T rose significantly with increasing education levels (p<0.0001). When analysed by race, this relationship was only found for White births (p<0.0001). The M/T of Black births rose with increasing maternal education level up to associate degree level (p=ns), then fell significantly with higher levels of education (χ2=4.5, p=0.03). No significant trends were present for Asian/Pacific Islander or American Indian/Alaska Native births. Socioeconomic indicators are generally indicators of better condition and in this study educational attainment was overall found to be positively correlated with M/T, supporting the Trivers–Willard hypothesis.