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BACKGROUND: Foodborne diseases are a growing public health concern worldwide and households are a common setting. This study aimed to explore the epidemiological characteristics of household foodborne disease outbreaks in Zhejiang Province and propose targeted prevention and control measures. METHODS: Descriptive statistical methods were used to analyze household foodborne disease outbreak data collected from the Foodborne Disease Outbreaks Surveillance System in Zhejiang Province from 2010 to 2022. RESULTS: Household foodborne disease outbreaks showed an upward trend during the study period (Cox-Staurt trend test, p = 0.01563 < 0.05). These outbreaks mainly occurred from June to September, with 62.08% (352/567) of all reported outbreaks. The number of reported outbreaks varied in 11 prefectures, with a maximum of 100 and a minimum of only 7. Household foodborne disease outbreaks had a wide spectrum of etiologic factors. Mushroom toxins accounted for the largest proportion of all etiologies (43.39 %) and caused the highest proportion of hospitalization (54.18%) and death (78.26%). Such outbreaks are caused by accidently eating wild poisonous mushrooms. Bacterial infection (16.23%) was the second most common etiology, with Salmonella spp. and Vibrio parahaemolyticus being the primary pathogens. These outbreaks were caused by improper storage, improper processing or a combination of factors, and the foods involved were mainly aquatic animals, eggs and cooked meat. Other identified etiologies included plant toxins (9.52%), chemicals (7.23%), animal toxins (3.70%), and viruses (1.76%). Among the above-mentioned etiologies, mushroom toxins, bacteria, and animal toxins had seasonal characteristics. Analysis of regions and etiologies revealed that the proportion of various etiologies was different in 11 prefectures. Wild mushrooms (43.39%), aquatic animals (9.88%), and toxic plants (8.47%) were the top three foods involved in these outbreaks. The most common factors contributing to household foodborne disease outbreaks were inedibility and misuse (59.08%), followed by multiple factors (7.58%), improper storage (7.41%), and improper processing (7.41%). CONCLUSIONS: Household foodborne disease outbreaks were closely related to the lack of knowledge regarding foodborne disease prevention. Therefore, public health agencies should strengthen residents' surveillance and health education to improve food safety awareness and effectively reduce foodborne diseases in households. In addition, timely publicity and early warning by relevant government departments, the introduction of standards to control the contamination of pathogenic bacteria in raw materials, and strengthened supervision of the sale of substances that may cause health hazards, such as poisonous mushrooms and nitrites, will also help reduce such outbreaks.

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IMPORTANCE: Understanding the susceptibility and infectiousness of children and adolescents in comparison to adults is important to appreciate their role in the COVID-19 pandemic. OBJECTIVE: To determine SARS-CoV-2 susceptibility and infectiousness of children and adolescents with adults as comparator for three variants (wild-type, alpha, delta) in the household setting. We aimed to identify the effects independent of vaccination or prior infection. DATA SOURCES: We searched EMBASE, PubMed and medRxiv up to January 2022. STUDY SELECTION: Two reviewers independently identified studies providing secondary household attack rates (SAR) for SARS-CoV-2 infection in children (0-9 years), adolescents (10-19 years) or both compared with adults (20 years and older). DATA EXTRACTION AND SYNTHESIS: Two reviewers independently extracted data, assessed risk of bias and performed a random-effects meta-analysis model. MAIN OUTCOMES AND MEASURES: Odds ratio (OR) for SARS-CoV-2 infection comparing children and adolescents with adults stratified by wild-type (ancestral type), alpha, and delta variant, respectively. Susceptibility was defined as the secondary attack rate (SAR) among susceptible household contacts irrespective of the age of the index case. Infectiousness was defined as the SAR irrespective of the age of household contacts when children/adolescents/adults were the index case. RESULTS: Susceptibility analysis: We included 27 studies (308,681 contacts), for delta only one (large) study was available. Compared to adults, children and adolescents were less susceptible to the wild-type and delta, but equally susceptible to alpha. Infectiousness analysis: We included 21 studies (201,199 index cases). Compared to adults, children and adolescents were less infectious when infected with the wild-type and delta. Alpha -related infectiousness remained unclear, 0-9 year old children were at least as infectious as adults. Overall SAR among household contacts varied between the variants. CONCLUSIONS AND RELEVANCE: When considering the potential role of children and adolescents, variant-specific susceptibility, infectiousness, age group and overall transmissibility need to be assessed.

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BACKGROUND: The impact of migration on HIV risk among non-migrating household members is poorly understood. We measured HIV incidence among non-migrants living in households with and without migrants in Uganda. METHODS: We used four survey rounds of data collected from July 2011 to May 2018 from non-migrant participants aged 15-49 years in the Rakai Community Cohort Study. Non-migrants were individuals with no-migration between surveys or at the prior survey. Household migration was defined as ≥1 household member migrating into or out of the house from another community between surveys (∼18 months). Incident HIV was defined as testing HIV seropositive following a negative result. Incidence rate ratios (IRRs) were estimated using Poisson regression with generalized estimating equations. Analyses were stratified by gender, migration into or out of the household and the relationship between non-migrants and migrants (e.g. spouse, child). RESULTS: About 11 318 non-migrants (5674 women) were followed for 37 320 person-years. Twenty-eight percent (6059/21 370) of non-migrant person-visits had recent migration into or out of the household, and 240 HIV incident cases were identified. Overall, non-migrants in migrant households were not at greater risk of acquiring HIV than non-migrants in households without any migration. However, men were significantly more likely to acquire HIV if their spouse had recently migrated in [adjusted IRR: 2.12; 95% confidence interval (CI): 1.05-4.27] or out (adjusted IRR: 4.01; 95% CI, 2.16-7.44) compared with men with no spousal migration. CONCLUSIONS: HIV incidence is higher among non-migrant men with migrant spouses. Targeted HIV testing and prevention interventions like pre-exposure prophylaxis could be considered for men with migrant spouses.

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Objective: This paper utilizes data from the China Family Panel Studies (CFPS) to evaluate the impact of the "4 + 7" National Centralized Drug Procurement (NCDP) on Per Capita Household Health Care Expenditure (PCHHCE). Methods: The study applies the Differences-in-Differences (DID) methodology to analyze the effects of NCDP. Various robustness tests were conducted, including the Permutation test, Propensity Score Matching, alterations in regression methodologies, and consideration of individual fixed effects. Results: Research indicates that the implementation of NCDP led to a reduction of 10.6% in PCHHCE. The results remained consistent across all robustness tests. Additionally, the research identifies diversity in NCDP effects among various household characteristics, with a more significant impact on households residing in rural regions of China, enrolled in Basic Medical Insurance for urban and rural residents and urban workers, and having an income bracket of 25-75%. Conclusion: These findings carry policy implications for the future expansion and advancement of NCDP in China. The study highlights the effectiveness of NCDP in reducing healthcare expenditures and suggests potential areas for policy improvement and further research.

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Background: Higher education is widely recognized as a strategy to mitigate food insecurity. However, marginalized and racialized groups, especially Latinos, often do not experience the same economic and health benefits from their educational achievements as non-Latino Whites, highlighting a pattern of diminished returns within these communities. Aims: This study aims to explore the disparities in how educational attainment influences marital status and employment, and subsequently, food insecurity among Latino and non-Latino adults. Methods: Utilizing data from the 2022 National Health Interview Survey (NHIS), which encompassed 27,648 adults from both Latino and non-Latino backgrounds, this research applied a structural equation model to examine the relationship between educational attainment, ethnicity, and food insecurity. The study specifically focused on the mediating roles of marital status and employment. Results: Findings reveal significant interactions between education and ethnicity affecting marital status and employment, both of which serve as protective factors against food insecurity. These results indicate that higher levels of unemployment and lower marriage rates may disproportionately escalate food insecurity among Latinos, irrespective of educational attainment. Conclusion: The study highlights profound societal and environmental obstacles that prevent Latinos from leveraging educational achievements to improve their marital and employment statuses, and thereby, their food security. Addressing these disparities demands targeted interventions directed at Latino communities to bridge gaps in employment and marriage rates stemming from educational disparities. A holistic strategy that transcends mere access to education is essential to dismantle the societal barriers that undermine the educational dividends for Latino communities.

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This study examines the impact of financial literacy and social security on healthcare cost anxiety in China using data from the 2021 Global Financial Inclusion database. Employing an ordered logit model and its marginal effects, we analyse how these factors influence varying levels of healthcare cost anxiety (worried, somewhat worried, and not worried at all) across total, female-headed and male-headed households. Financial literacy and social security both demonstrate significant negative effects on healthcare cost anxiety across all household types. It implied that individuals who save for old age and those with social security coverage are less likely to experience high levels of healthcare cost anxiety. The ordered logit results show consistent negative coefficients for financial literacy and social security across all household categories. Marginal effects analysis further illustrates how these factors affect the probability of falling into each category of healthcare cost anxiety. These findings underscore the importance of promoting financial literacy and expanding social security coverage as potential strategies to alleviate healthcare cost anxiety in China.

Cette étude examine l'impact de la littératie financière et de la sécurité sociale sur l'anxiété liée aux coûts des soins de santé en Chine à l'aide des données de la base de données mondiale sur l'inclusion financière 2021. En utilisant un modèle logit ordonné et ses effets marginaux, nous analysons comment ces facteurs influencent différents niveaux d'anxiété liée aux coûts de santé (inquiet, quelque peu inquiet et pas du tout inquiet) dans l'ensemble des ménages dirigés par une femme ou un homme. La littératie financière et la sécurité sociale démontrent toutes deux des effets négatifs significatifs sur l'anxiété liée aux coûts des soins de santé dans tous les types de ménages. Cela implique que les personnes qui épargnent pour leur vieillesse et celles qui bénéficient d'une couverture de sécurité sociale sont moins susceptibles de ressentir des niveaux élevés d'anxiété liée aux coûts des soins de santé. Les résultats du logit ordonné montrent des coefficients négatifs cohérents pour la culture financière et la sécurité sociale dans toutes les catégories de ménages. L'analyse des effets marginaux illustre en outre comment ces facteurs affectent la probabilité d'appartenir à chaque catégorie d'anxiété liée aux coûts des soins de santé. Ces résultats soulignent l'importance de promouvoir la culture financière et d'élargir la couverture de sécurité sociale en tant que stratégies potentielles pour atténuer l'anxiété liée aux coûts des soins de santé en Chine.

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This paper presents findings on groundwater physiochemical composition and radioactivity levels in households in Bac Lieu province, Vietnam. Through discriminant analysis, it was observed that groundwater quality exhibits spatial variations corresponding to saline intrusion zones. The paired-samples T-tests revealed significantly different ratios of Ra-224, Ra-226, and Ra-228 isotopes between Na-Cl and Ca-Na-HCO3 water types. All three water types had a ratio of Ra-226/Ra-228 of approximately one, indicating the presence of groundwater aquifers beneath the crust and fluvial marine sediment. Furthermore, strong associations between sulfate and calcium suggest that CO2 enrichment in groundwater aquifers indicates anoxic aquatic environments. Twenty-five of the thirty-three evaluated samples exceeded the national technical regulations for domestic water quality with parameters such as chloride, sulfate, sodium, gross alpha, or total dissolved solids. Fifteen samples exceeded gross alpha's allowable contamination threshold of 0.1 Bq/L. The combination of Ra-226 and Ra-228 did not surpass the U.S. Environmental Protection Agency's recommended limit of 0.185 Bq/L. However, nineteen samples exhibited annual committed effective doses of radium isotopes for infants that exceeded the WHO recommendation of 0.1 mSv/year.

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Solid waste refers to the material that is discarded because of human activity. In developing countries like Ethiopia, rapid urbanization leads to the production of large amounts of solid waste in towns. As a consequence, it causes severe problems to human health, aesthetics, and the environment, particularly in Dangila Town. Therefore, this study aimed to assess household solid waste characteristics, quantity, and management practices. Data was collected for seven days in January 2020 from 73 households, which were divided into three income groups. Observations, interviews, field measurements, sorting, and open-ended questionnaires were used as data collection tools. The research showed that food waste and ash and dust were the most dominant fractions, comprising 41.04% and 26.18%, respectively. It was also revealed that 77.88%, 12.74%, and 9.38% of household solid waste was decomposable, recyclable, and disposable waste, respectively. Furthermore, the waste components showed a significant statistical difference among income groups, except for the metal and miscellaneous groups. The quantification result indicated that the per capita household generation rate was 0.26 kg/day. The management practice assessment found that most households did not practice integrated solid waste management options. They disposed of waste indiscriminately, leading to environmental pollution. The results of this study suggest that the municipality needs to create awareness among households regarding proper solid waste management practices. It is crucial to apply appropriate solid waste management mechanisms and establish a well-organized institution that will collect solid waste in the town and achieve a circular economy.

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BACKGROUND: Ensuring the availability of safe drinking water remains a critical challenge in developing countries, including Ethiopia. Therefore, this paper aimed to investigate the prevalence of fecal coliform and E. coli bacteria and, geographical, children availability, and seasonal exposure assessment through a meta-analysis. METHODS: Two independent review groups extensively searched internet databases for English-language research articles published between 2013 and 2023. This systematic review and meta-analysis followed PRISMA guidelines. The methodological quality of each included study was evaluated using the STROBE guidelines. Publication bias was assessed by visual inspection of a funnel plot and then tested by the Egger regression test, and meta-analysis was performed using DerSimonian and Laird random-effects models with inverse variance weighting. Subgroup analyses were also conducted to explore heterogeneity. RESULTS: Out of 48 potentially relevant studies, only 21 fulfilled the inclusion criteria and were considered for meta-analysis. The pooled prevalence of fecal coliform and E. coli was 64% (95% CI: 56.0-71.0%, I2 = 95.8%) and 54% (95% CI: 45.7-62.3%, I2 = 94.2%), respectively. Subgroup analysis revealed that the prevalence of fecal coliform bacteria increased during the wet season (70%) compared to the dry season (60%), particularly in households with under-five children (74%) compared to all households (61%), in rural (68%) versus urban (66%) areas, and in regions with high prevalence such as Amhara (71%), Gambela (71%), and Oromia (70%). Similarly, the prevalence of E. coli was higher in households with under-five children (66%) than in all households (46%). CONCLUSIONS: The analysis highlights the higher prevalence of fecal coliform and E. coli within households drinking water, indicating that these bacteria are a significant public health concern. Moreover, these findings emphasize the critical need for targeted interventions aimed at improving drinking water quality to reduce the risk of fecal contamination and enhance public health outcomes for susceptible groups, including households with under-five children, in particular geographical areas such as the Amhara, Gambela, and Oromia regions, as well as rural areas, at point-of-use, and during the rainy season. REGISTRATION: This review was registered on PROSPERO (registration ID - CRD42023448812).

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Introduction: coronavirus disease 2019 (COVID-19) transmission dynamics in the communities of low- and middle-income countries, particularly sub-Saharan African countries, are still not fully understood. This study aimed to determine the characteristics of COVID-19 secondary transmission during the first wave of the epidemic (March-October 2020) in Lusaka, Zambia. Methods: we conducted an observational study on COVID-19 secondary transmission among residents in Lusaka City, between March 18 and October 30, 2020. We compared the secondary attack rate (SAR) among different environmental settings of contacts and characteristics of primary cases (e.g, demographics, medical conditions) by logistic regression analysis. Results: out of 1862 confirmed cases of COVID-19, 272 primary cases generated 422 secondary cases through 216 secondary transmission events. More contacts and secondary transmissions were reported in planned residential areas than in unplanned residential areas. Households were the most common environmental settings of secondary transmission, representing 76.4% (165/216) of secondary transmission events. The SAR in households was higher than the overall events. None of the environmental settings or host factors of primary cases showed a statistically significant relationship with SAR. Conclusion: of the settings considered, households had the highest incidence of secondary transmission during the first wave in Lusaka, Zambia. The smaller proportion of contacts and secondary transmission in unplanned residential areas might have been due to underreporting of cases, given that those areas are reported to be vulnerable to infectious disease outbreaks. Continuous efforts are warranted to establish measures to suppress COVID-19 transmission in those high-risk environments.

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Objective: This paper aims to examine the gendered differences in the subjective wellbeing of older adults and underlying determinant factors which contribute to these differences in China where the unique social and cultural systems, the consequent concept of filial piety and the perceptions towards different living arrangements in later life provide an excellent laboratory for studying the topic. Methods: Hierarchical linear models are employed to analyze the impacts of household structure and built environment on the subjective wellbeing of older adults based on a survey conducted in Nanjing in 2021. Results: There are significant gender differences in the subjective wellbeing of older adults, with older women reporting higher levels of subjective wellbeing (4.95 vs.4.69). Gender differences also exist in how the built environment affects the subjective wellbeing of older adults, with a greater impact on older adult women (33.68% vs. 28.50%). Household structure impacts the subjective wellbeing of older adults through the division of housework and the company of family members. Conclusion: There are three major mechanisms through which gender affects the subjective wellbeing of older adults, including structural mechanisms, socio-cultural mechanisms, and physiological mechanisms. Targeted environmental interventions and urban planning policies are recommended to promote the subjective wellbeing of older adults.

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Human rabies transmitted by dogs still kills thousands of people each year worldwide. Dog bites are common in the city of Beni (Democratic Republic of Congo), which shows low rabies vaccination coverage. This study aimed to determine the factors associated with the rabies vaccination status of dogs. A cross-sectional analytical study was conducted in the town of Beni among dog owners, during a household survey selected using a multistage sampling. The information sought concerned the knowledge and characteristics of the dog owners as well as the vaccination status of these dogs. Logistic regression was used to investigate associations between the vaccination status of the dogs and the main independent factors. Rabies vaccination coverage in Beni was 26% (95% confidence interval [CI]: 22% - 30%). The main factors associated with the rabies vaccination status of the dog were primary education level of household head (adjusted odds ratio [aOR]:4.8; 95% CI: 1.2- 19.8); university education level of household head (aOR: 5.9; 95% CI: 1.6-22); perceived rabies severity (aOR: 44. 4; 95% CI: 10.4-188), having more than one dog in the household (aOR: 2.6; 95% CI: 1.6-4.3); age range 7-12 months (aOR: 0.2; 95% CI: 0.1-0.6) and confined dog breeding (aOR: 3.9; 95% CI: 1.1-14.9). The low vaccination coverage in Beni requires mass vaccination campaigns against canine rabies targeting the dog owners with low education levels, those raising more than one dog, with stray dogs or dogs less than 12 months old.

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Improvement of water and sanitation conditions may reduce infant mortality, particularly in countries like India where open defecation is highly prevalent. We conducted a quasi-experimental study to investigate the association between the Swachh Bharat Mission (SBM)-a national sanitation program initiated in 2014-and infant (IMR) and under five mortality rates (U5MR) in India. We analyzed data from thirty-five Indian states and 640 districts spanning 10 years (2011-2020), with IMR and U5MR per thousand live births as the outcomes. Our main exposure was the district-level annual percentage of households that received a constructed toilet under SBM. We mapped changes in IMR and U5MR and toilet access at the district level over time. We fit two-way fixed effects regression models controlling for sociodemographic, wealth, and healthcare-related confounders at the district-level to estimate the association between toilets constructed and child mortality. Toilet access and child mortality have a historically robust inverse association in India. Toilets constructed increased dramatically across India following the implementation of SBM in 2014. Results from panel data regression models show that districts with > 30% toilets constructed under SBM corresponds with 5.3 lower IMR (p < 0.05), and 6.8 lower U5MR (p < 0.05). Placebo, falsification tests and robustness checks support our main findings. The post-SBM period in India exhibited accelerated reductions in infant and child mortality compared to the pre-SBM years. Based on our regression estimates, the provision of toilets at-scale may have contributed to averting approximately 60,000-70,000 infant deaths annually. Our findings show that the implementation of transformative sanitation programs can deliver population health benefits in low- and middle-income countries.

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BACKGROUND: Endemic African malaria vectors are poorly adapted to typical urban ecologies. However, Anopheles stephensi, an urban malaria vector formerly confined to South Asia and the Persian Gulf, was recently detected in Africa and may change the epidemiology of malaria across the continent. Little is known about the public health implications of An. stephensi in Africa. This study is designed to assess the relative importance of household exposure to An. stephensi and endemic malaria vectors for malaria risk in urban Sudan and Ethiopia. METHODS: Case-control studies will be conducted in 3 urban settings (2 in Sudan, 1 in Ethiopia) to assess the association between presence of An. stephensi in and around households and malaria. Cases, defined as individuals positive for Plasmodium falciparum and/or P. vivax by microscopy/rapid diagnostic test (RDT), and controls, defined as age-matched individuals negative for P. falciparum and/or P. vivax by microscopy/RDT, will be recruited from public health facilities. Both household surveys and entomological surveillance for adult and immature mosquitoes will be conducted at participant homes within 48 hours of enrolment. Adult and immature mosquitoes will be identified by polymerase chain reaction (PCR). Conditional logistic regression will be used to estimate the association between presence of An. stephensi and malaria status, adjusted for co-occurrence of other malaria vectors and participant gender. CONCLUSIONS: Findings from this study will provide evidence of the relative importance of An. stephensi for malaria burden in urban African settings, shedding light on the need for future intervention planning and policy development.

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BACKGROUND: Despite persistent concerns about only children's disadvantage relative to individuals with siblings, existing health-related evidence is inconsistent. Recent evidence from Nordic countries about only children having poorer health outcomes may not apply elsewhere because selection processes differ across contexts. We investigate the midlife health of only children in the UK where one-child families tend to be socio-economically advantaged relative to large families. METHODS: Using the 1946, 1958 and 1970 British birth cohort studies, we examine various biomarkers and self-reported measures of chronic disease by sibship size when respondents are aged in their mid-40s, mid-50s and mid-60s. We estimate separate linear probability models for each cohort, age and outcome, adjusting for childhood and early adulthood circumstances. RESULTS: We found no evidence of only children differing from those with one, two or three or more siblings, at any age, in any of the cohorts, on: heart problems, hypertension, high triglycerides, high glycated haemoglobin or high C-reactive protein. However, compared with only children, the probability for cancer (0.019, 95% confidence interval [CI]: 0.002, 0.035; age 46/1970) and poor general health (0.060, CI: 0.015, 0.127; age 55/1958; and 0.110, CI: 0.052, 0.168; age 63/1946) was higher among those with three or more siblings. CONCLUSIONS: There is no consistent pattern of only child health disadvantage for midlife chronic disease outcomes across ages or cohorts in the UK. Research should focus on better understanding how sibship size differentials are contingent on context.

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The incidence of mental health problems is increasing in the United Kingdom and may be associated with lower dietary quality. Food expenditure is a marker of food insecurity with potential implications for mental health. This analysis considers data collected as part of the United Kingdom Household Longitudinal Survey (UKHLS), also known as 'Understanding Society' (2009-2021) (N = 388,944) to determine the extent to which food expenditure within and outside the household, is associated with mental health, whilst controlling for demographic factors. Mental health was measured using the General Health Questionnaire (GHQ-12) for which responses were on a 4-point scale and reverse-scored so that a higher score represented more favourable mental health. Household food expenditure and food expenditure outside the home were the outcomes. Controlling for socioeconomic and demographic factors, fixed-effects models indicated that better mental health was associated with greater household food expenditure and with greater food expenditure outside the home and that this association persisted post-lockdown. Among those on lower incomes better mental health was associated with lower food expenditure. When people who identified as white and non-white were modelled separately, better mental health was associated with lower food expenditure within and beyond the household only in those who identified as white. These findings imply that the mental health of people residing in the UK, particularly those on lower incomes and those who identify as white, may benefit from spending less of the household budget on food. In achieving United Nations General Assembly (2012) Sustainable Development Goals related to poverty, hunger and in promoting mental health, policies are needed to render food more affordable and to reduce other aspects of expenditure that impact upon food budgeting.

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This study explores how the Household Dietary Diversity Score (HDDS) and spatial visualization can inform food governance in Chile, focusing on socio-demographic and geographical determinants affecting food consumption patterns. A national household database (n = 4047), including households from 2019 (n = 3967; 98.02%) and 2020 (n = 80; 1.98%), provided by the "Family Support Program of Food Self-Sufficiency" (FSPFS) of the Ministry of Social Development and Family, was analyzed. The findings revealed that Chilean vulnerable households were led mostly by women (86.6%), with an age average of 55.9 ± 15.6 years old, versus 68.9 ± 12.9 years in the case of men. The intake frequency analysis showed that dairy, fruits, and vegetables were below the recommended values in at least half of the households, and that fats and sugars were above recommended levels. Regarding the HDDS (0-189), the national average was 91.4 ± 20.6 and was significantly influenced by the number of minors in the households, water access, food access issues, and residing in the Zona Sur. Finally, the spatial visualization showed that the Zona Central had higher consumption of fruits and vegetables, while the extreme zones Norte Grande and Zona Austral showed higher intakes of fats and sugars. These findings emphasize the importance of leveraging data insights like the HDDS and spatial visualization to enhance food security and inform food governance strategies.

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BACKGROUND: One of the key functions and ultimate goals of health systems is to provide financial protection for individuals when using health services. This study sought to evaluate the level of financial protection and its inequality among individuals covered by the Social Security Organization (SSO) health insurance between September and December 2023 in Iran. METHODS: We collected data on 1691 households in five provinces using multistage sampling to examine the prevalence of catastrophic healthcare expenditure (CHE) at four different thresholds (10%, 20%, 30%, and 40%) of the household's capacity to pay (CTP). Additionally, we explored the prevalence of impoverishment due to health costs and assessed socioeconomic-related inequality in OOP payments for healthcare using the concentration index and concentration curve. To measure equity in out-of-pocket (OOP) payments for healthcare, we utilized the Kakwani progressivity index (KPI). Furthermore, we employed multiple logistic regression to identify the main factors contributing to households experiencing CHE. FINDINGS: The study revealed that households in our sample allocated approximately 11% of their budgets to healthcare services. The prevalence of CHE at the thresholds of 10%, 20%, 30%, and 40% was found to be 47.1%, 30.1%, 20.1%, and 15.7%, respectively. Additionally, we observed that about 7.9% of the households experienced impoverishment due to health costs. Multiple logistic regression analysis indicated that the age of the head of the household, place of residence, socioeconomic status, utilization of dental services, utilization of medicine, and province of residence were the main factors influencing CHE. Furthermore, the study demonstrated that while wealthy households spend more money on healthcare, poorer households spend a larger proportion of their total income to healthcare costs. The KPI showed that households with lower total expenditures had higher OOP payments relative to their CTP. CONCLUSION: The study findings underscore the need for targeted interventions to improve financial protection in healthcare and mitigate inequalities among individuals covered by SSO. It is recommended that these interventions prioritize the expansion of coverage for dental services and medication expenses, particularly for lower socioeconomic status household.

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Scholars have focused on the digital transformation of commercial banks, yet there remains a lack of systematic and integrative research at the micro-level of household finance. This article uses data from the China Household Finance Survey (CHFS) and the Digital Transformation Index of Chinese Commercial Banks from Peking University. It employs empirical methods such as mechanism analysis and heterogeneity analysis to explore the impact of the digital transformation of commercial banks on household income. The findings indicate that the digital transformation of commercial banks significantly enhances household income. Second, increasing credit availability, fostering the development of digital inclusive finance, enhancing entrepreneurial possibilities, and increasing the purchase of wealth management products are key pathways through which digital transformation affects household income. Third, heterogeneity analysis reveals that the positive effects of digital transformation on household income are more pronounced in the central and western regions, areas with lower financial industry competition, regions with underdeveloped inclusive finance, rural areas, and among low-income families. This study highlights the significant role that the digital transformation of commercial banks plays in enhancing the welfare of the resident sector.

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Agricultural mechanization is a crucial indicator of modernization in agriculture. It improves productivity and underpins the evolution of a modern state. This study scrutinizes the enduring effects of government subsidies on farm machinery acquisition, income growth, and capital accumulation in rural households. It is based on policies about targeted poverty alleviation and rural revitalization. Research findings indicate that government subsidies have significantly increased the per capita net income of rural households. However, in the post-poverty alleviation era, for households that already possess agricultural machinery, the benefits brought by government subsidies in the early stages of the policy cycle tend to diminish over time. From 2016 to 2020, government subsidies continued to enhance the value of agricultural machinery in rural households. Their impact on ownership rates first slightly declined and then increased again. The promotional effect in 2020 was not significantly better than in 2016. When China is fighting against poverty, it is essential to encourage rural households to use their income and government subsidies to accumulate production capital. A long-term mechanism has been established to protect the achievements of poverty alleviation, promote agricultural mechanization and rural modernization, and support rural revitalization.

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