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The 30 MOCHA (Models of Child Health Appraised) countries are diverse socially, culturally and economically, and differences exist in their healthcare systems and in the scope and role of primary care. An economic analysis was undertaken that sought to explain differences in child health outcomes between countries. The conceptual framework was that of a production function for health, whereby health outputs (or outcomes) are assumed affected by several ‘inputs’. In the case of health, inputs include personal (genes, health behaviours) and socio-economic (income, living standards) factors and the structure, organisation and workforce of the healthcare system. Random effects regression modelling was used, based on countries as the unit of analysis, with data from 2004 to 2016 from international sources and published categorisations of healthcare system. The chapter describes the data deficiencies and measurement conundrums faced, and how these were addressed. In the absence of consistent indicators of child health outcomes across countries, five mortality measures were used: neonatal, infant, under five years, diabetes (0–19 years) and epilepsy (0–19 years). Factors found associated with reductions in mortality were as follows: gross domestic product per capita growth (neonatal, infant, under five years), higher density of paediatricians (neonatal, infant, under five years), less out-of-pocket expenditure (neonatal, diabetes 0–19), state-based service provision (epilepsy 0–19) and lower proportions of children in the population, a proxy for family size (all outcomes). Findings should be interpreted with caution due to the ecological nature of the analysis and the limitations presented by the data and measures employed.

The differences in the distribution of factors associated with under-five mortality (UFM) can help explain the rural-urban inequities in UFM. The determinants contributing to UFM in rural and urban areas have not been previously explored in Bhutan. This study examined the factors associated with UFM in rural and urban Bhutan and the role of the factors in explaining UFM disparity.

The dataset of 6,398 single births (4,999 in rural and 1,399 in urban areas) from the 2012 Bhutan National Health Survey was analyzed. Logistic regression analysis accounting for the complex survey design was performed to investigate the determinants.

The UFM rate was 2.75 times higher in rural than in urban Bhutan. In rural communities, children of younger mothers, born in households without safe sanitation and electricity, and central and eastern regions had increased UFM odds. Whereas, children born to working mothers and educated fathers, and born in households with non-working household heads had lower UFM odds in urban areas. A higher number of births and smaller household size was associated with an increased UFM odds irrespective of rural-urban residence. Environmental factors were attributable for the largest portion of rural UFM disadvantage.

This study helps to understand the rural-urban differences in the factors influencing UFM in Bhutan. The findings suggest that policies aimed to improve environmental and socioeconomic conditions, women empowerment, and those aimed to enhance health utilization can help reduce the rural-urban child survival disparity and accelerate the achievement of the Sustainable Development Goal target.

In order to assess the state of health of Europe’s children, or to appraise the systems and models of healthcare delivery, data about children are essential, with as much precision and accuracy as possible by small group characteristic. Unfortunately, the experience of the Models of Child Health Appraised (MOCHA) project and its scientists shows that this ideal is seldom met, and thus the accuracy of appraisal or planning work is compromised. In the project, we explored the data collected on children by a number of databases used in Europe and globally, to find that although the four quinquennial age bands are common, it is impossible to represent children aged 0–17 years as a legally defined group in statistical analysis. Adolescents, in particular, are the most invisible age group despite this being a time of life when they are rapidly changing and facing increasing challenges. In terms of measurement and monitoring, there is little progress from work of nearly two decades ago that recommended an information system, and no focus on the creation of a policy and ethical framework to allow collaborative analysis of the rich anonymised databases that hold real-world people-based data. In respect of data systems and surveillance, nearly all systems in European society pay lip service to the importance of children, but do not accommodate them in a practical and statistical sense.

This study aims to empirically examine how the Khmer Rouge regime (1975–1979) in Cambodia continues to affect the health of the second generation.

The 2000 and 2005 Cambodia Demographic and Health Surveys were used in the analysis. The study sample were women with a child/children in 2000/2005. The sample population was identified according to whether the person was in utero “91 months or earlier before the Khmer Rouge regime,” “46–90 months before the Khmer Rouge regime” and “1–45 months before the Khmer Rouge regime” and during the Khmer Rouge regime. The authors then regressed the size of babies of the targeted population on the timing of the mothers being in utero.

Mothers who were in utero during the regime had a higher likelihood of giving birth to smaller-than-average babies. Additionally, mothers born in the areas that had a higher probability of death of children aged five or under during the regime were at risk of giving birth to smaller-than-average babies if they were in utero during that time.

This is the first paper to assess the impact of the Khmer Rouge regime on the health of the second generation.

Cambodia has one of the highest death rates for children under five years of age in Southeast Asia. The high mortality rate of children under five years of age, especially the neonate is 35 per 1,000 for the period zero to four years. There are no neonatal nursing standards of practice to guide nurses providing neonatal nursing care. Some general guidelines are currently being implemented for both doctors and nurses. The Minister for Health officially launched the Cambodian Council of Nurses’ Guideline for the Standard of Nursing Care in December 2015. In the absence of specific neonatal nursing standards of practice, the purpose of this paper is to develop the Neonatal Nursing Standard of Practice for Cambodia.

The Delphi technique was selected as being appropriate for this study. The snowball with purposive sampling was used. The identified experts were located across Cambodia so the e-Delphi approach was considered appropriate and applicable according to the study context. Four experts preferred to be interviewed face-to-face, while 16 experts were confident to use e-mail to respond to the questionnaire in Round 1. In total, 19 experts provided responses via e-mail to the Rounds 2 and 3 questionnaires.

A Standard for Neonatal Nursing Practice for Cambodia which consists of ten standards was found as a result of this study: assessment, nursing diagnosis, planning, implementation, evaluation, ethics, evidence-based practice and research, health teaching and health promotion, continuing education, and communication.

All items and sub-items achieved consensus as either being at the most significant level and therefore, could be key indicators for neonatal nursing standards of practice. The results of this study can be incorporated into a focused discussion led by the Nursing and Midwifery Bureau of the Ministry of Health to develop national standards of practice for neonatal nurses in Cambodia.

The paper investigates whether cultural lineage mediates gender gaps in child nutrition. It captures nutrition using height-for-age and stunting. The analysis uses the 2014 Malawi Millennium Development Goals Endline Survey data. We find evidence of male child nutrition deprivation in matrilineal cultural lineage. The gender of the household head does not relate to the mediating role of lineage on gendered nutrition gaps. As such, the analysis of gendered nutrition should account for the potential impact of culture to produce policy relevant estimates. Furthermore, deficiencies in male nutrition remains a strong health problem, particularly in cultures that benefit most from returns on female children. In these cultures, lineage dominates personal parental preferences. Therefore, there is a need to revisit received wisdom that providing more resources to female heads eliminates gender gaps by provision of culture-tailored nutritional interventions.

This study aims to explore whether there is an association between women's empowerment and the utilization of maternal healthcare facilities.

This study considered four indices for measuring women's empowerment – labor force participation index (LFPI), decision-making power index (DMPI), attitude toward partner’s violence index (ATPVI) and knowledge level index (KLI) – and three healthcare facilities – number of antenatal visits, delivery with healthcare facilities and postnatal checkup after delivery. Data extracted for this study were from the Bangladesh Demographic and Health Survey 2011 and 2014. A chi-square test was used for bivariate analysis, and a three-level logistic regression model was applied for multivariate analysis.

An increment was observed in the practice of all considered healthcare facilities, and the percentage of highly empowered women in DMPI decreased from 2011 to 2014. This study found that higher empowerment of women in DMPI, KLI and ATPVI significantly (p-value < 0.05) increases the utilization of healthcare facilities. High empowerment of mothers in LFPI was found negatively associated with facility delivery and positively associated with the postnatal checkup.

Women's empowerment was found significantly associated with the utilization of maternal healthcare facilities. This study is seeking the attention of corresponding authority to come up with a more effective intervention program to empower women to utilize maternal healthcare facilities.

The extraction of natural resources has long been part of economic development in small islands. The damage to environment and health is extensive, even rendering once productive islands virtually uninhabitable. Rather than providing long-term benefits to the population or to the environment, the culture of “extractivism” – a nonreciprocal approach where resources are removed and used with little care or regard to consequences – has instead left many in far more fragile circumstances, increasingly dependent on external income. The purpose of this paper is to show how continued extractivism in small islands is contributing to global climate change and increasing climate risks to the local communities.

Through a series of case studies, this paper examines the history of extractivism in small islands in Oceania, its contribution to environmental degradation locally and its impacts on health.

It examines how extractivism continues today, with local impacts on environment, health and wellbeing and its much more far-reaching consequences for global climate change and human health. At the same time, these island countries have heightened sensitivity to climate change due to their isolation, poverty and already variable climate, whereas the damage to natural resources, the disruption, economic dependence and adverse health impacts caused by extractivism impart reduced resilience to the new climate hazards in those communities.

This paper proposes alternatives to resource extractivism with options for climate compatible development in small islands that are health-promoting and build community resilience in the face of increasing threats from climate change.

Extractivism is a new concept that has not previously been applied to understanding health implications of resource exploitation thorough the conduit of climate change. Small-island countries are simultaneously exposed to widespread extractivism, including of materials contributing to global climate change, and are among the most vulnerable to the hazards that climate change brings.

The under-5 mortality rate in Nepal remains high in comparison to neighboring countries and developed nations. The result of this problem on Nepal’s social, economic, political and cultural development makes it an urgent priority requiring the Nepalese Government to address this issue. The purpose of this paper is to find out if Nepal’s high female labor force participation (FLFP), the caste system and no paid maternity leave are contributing factors to under-5 deaths in Nepal.

Data for this study were taken from Nepal’s cross-sectional demographic health survey 2016–2017. The study sample included 5,060 children born to 3,074 mothers in the five years preceding the survey. Data were collected by interviewing respondents via a structured questionnaire selected through stratified random sampling methods.

The study found that the hazard ratio for FLFP, the caste of the mother and paid maternity were 1.145, 1.485 and 0.556, respectively, with a p-value <0.001. Therefore, the risk of death in children under-5 years for a working mother, a Terai caste mother and a mother who did not get paid maternity was 14, 45 and 48 percent, respectively, higher than for non-working mothers, mothers from other castes and mothers who got paid maternity.

This research demonstrated that FLFP, the caste of the mother and paid maternity leave are important factors for determining the risk of death in children under the age of 5.

This paper explores the relationship between married women's intrahousehold decision-making participation and marital gender roles, next to factors suggested in the household bargaining literature. Additionally, the authors investigate whether women's employment carries the same importance for decision-making participation as contributions to household incomes.

Using 2011/2012 Nicaraguan Demographic and Health Survey (DHS), the authors estimate multinomial logistic regressions for eight decision-making domains, analyzing three levels of decision-making: wife-dominant or sole decisions, joint decision-making (with the partner) and decision-making by someone else. The authors create an additive index for measuring internalized marital gender roles.

Women's intrahousehold decision-making participation is explained differently depending on the decision-making area and level of participation. Women with a better relative position vis-à-vis partners and not following patriarchal gender roles are more likely to make decisions jointly with their partners, but not alone. Women's age and educational level are the strongest predictors in the analysis. Women's employment reduces their decision-making participation in children's disciplining and daily cooking-related decisions.

It focuses on married women only, while marital status might be a determinant of decision-making itself and left out the contribution of unearned incomes.

Interventions aimed at increasing women's intrahousehold decision-making participation should not only focus on economic endowments but also comprehend the gendered dynamics governing intrahousehold allocation.

The study incorporates quantitative measures of marital gender roles in the study of intrahousehold decision-making. It also contributes to the literature with insights from contexts where women's involvement in employment increased against a background of patriarchal gender roles.