The under-five mortality rate (U5MR) is a critical and widely available population health indicator. Both the MDGs and SDGs define targets for improvement in the U5MR, and the SDGs require spatial disaggregation of indicators. We estimate trends in the U5MR for Admin-1 subnational areas using 122 DHS surveys in 35 countries in Africa and assess progress toward the MDG target reductions for each subnational region and each country as a whole. In each country, direct weighted estimates of the U5MR from each survey are calculated and combined into a single estimate for each Admin-1 region across five-year periods. Our method fully accounts for the sample design of each survey. The region-time-specific estimates are smoothed using a Bayesian, space-time model that produces more precise estimates (when compared to the direct estimates) at a one-year scale that are consistent with each other in both space and time. The resulting estimated distributions of the U5MR are summarized and used to assess subnational progress toward the MDG 4 target of two-thirds reduction in the U5MR during 1990–2015. Our space-time modeling approach is tractable and can be readily applied to a large collection of sample survey data. Subnational, regional spatial heterogeneity in the levels and trends in the U5MR vary considerably across Africa. There is no generalizable pattern between spatial heterogeneity and levels or trends in the U5MR. Subnational, small-area estimates of the U5MR: (i) identify subnational regions where interventions are still necessary and those where improvement is well under way; and (ii) countries where there is very little spatial variation and others where there are important differences between subregions in both levels and trends. More work is necessary to improve both the data sources and methods necessary to adequately measure subnational progress toward the SDG child survival targets.

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Many have observed that a new political generation of digital natives has heavily used social media as means of facilitating street protests. Nevertheless, the mechanisms by which social media affects protest participation are not completely understood due to the shortage of psychological explanations. This study employs a uniquely designed survey on a massive demonstration to address such concerns. Social media activity triggers the psychological incentives of anger, social incentives, identification, and individual efficacy. In particular, individual efficacy directly mediates the relationship between social media activity and protest participation. The findings substantiate new theories of connective action and suggest that social media may be a new mobilization structure via changing the decision-making processes of individuals. Theoretical implications on understanding digital natives and deliberative democracy are discussed.

This article analyzes Martin Luther’s role in spreading the early Reformation, one of the most important episodes of radical institutional change in the last millennium. We argue that social relations played a key role in its diffusion because the spread of heterodox ideologies and their eventual institutionalization relied not only on private “infection” through exposure to innovation but also on active conversion and promotion of that new faith through personal ties. We conceive of that process as leader-to-follower directional influence originating with Luther and flowing to local elites through personal ties. Based on novel data on Luther’s correspondence, Luther’s visits, and student enrollments in Luther’s city of Wittenberg, we reconstruct Luther’s influence network to examine whether local connections to him increased the odds of adopting Protestantism. Using regression analyses and simulations based on empirical network data, we find that the combination of personal/relational diffusion via Luther’s multiplex ties and spatial/structural diffusion via trade routes fostered cities’ adoption of the Reformation, making possible Protestantism’s early breakthrough from a regional movement to a general rebellion against the Roman Catholic Church.

Background: In 2015, a 7.8 magnitude earthquake struck Nepal, causing unprecedented damage and loss in the mountain and hill regions of central Nepal. The aim of this study was to investigate the association between healthcare access and utilization, and post-disaster mental health symptoms. Methods: A cross-sectional study conducted with 750 disaster-affected individuals in six districts in central Nepal 15 months post-earthquake. Anxiety and depression were measured through the Depression, Anxiety and Stress Scale (DASS-21). Healthcare utilization questions examined types of healthcare in the communities, utilization, and approachability of care providers. Univariate analyses, ANOVAs and Tobit regression were used. Results: Depression and anxiety symptoms were significantly higher for females and individuals between 40–50 years old. Those who utilized a district hospital had the lowest anxiety and depression scores. Participants who indicated medical shops were the most important source of health-related information had more anxiety and depression than those who used other services. Higher quality of healthcare was significantly associated with fewer anxiety and depressive symptoms. Conclusions: Mental health symptoms can last long after a disaster occurs. Access to quality mental health care in the primary health care settings is critical to help individuals and communities recover immediately and during the long-term recovery.