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Within country inequalities in caesarean section rates: Observational study of 72 low and middle income countries
Authors: Boatin AA, Schlotheuber A, Betran AP, Moller AB, Barros AJD, Boerma T, Torloni MR, Victora CG, and Hosseinpoor AR
Source: BMJ Open, 360(k55); DOI: 10.1136/bmj.k55
Topic(s): Cesarean section
Inequality
Country: More than one region
  Multiple Regions
Published: JAN 2018
Abstract: Objective To provide an update on economic related inequalities in caesarean section rates within countries. Design Secondary analysis of demographic and health surveys and multiple indicator cluster surveys. Setting 72 low and middle income countries with a survey conducted between 2010 and 2014 for analysis of the latest situation of inequality, and 28 countries with a survey also conducted between 2000 and 2004 for analysis of the change in inequality over time. Participants Women aged 15-49 years with a live birth during the two or three years preceding the survey. Main outcome measures Data on caesarean section were disaggregated by asset based household wealth status and presented separately for five subgroups, ranging from the poorest to the richest fifth. Absolute and relative inequalities were measured using difference and ratio measures. The pace of change in the poorest and richest fifths was compared using a measure of excess change. Results National caesarean section rates ranged from 0.6% in South Sudan to 58.9% in the Dominican Republic. Within countries, caesarean section rates were lowest in the poorest fifth (median 3.7%) and highest in the richest fifth (median 18.4%). 18 out of 72 study countries reported a difference of 20 percentage points or higher between the richest and poorest fifth. The highest caesarean section rates and greatest levels of absolute inequality were observed in countries from the region of the Americas, whereas countries from the African region had low levels of caesarean use and comparatively lower levels of absolute inequality, although relative inequality was quite high in some countries. 26 out of 28 countries reported increases in caesarean section rates over time. Rates tended to increase faster in the richest fifth (median 0.9 percentage points per year) compared with the poorest fifth (median 0.2 percentage points per year), indicating an increase in inequality over time in most of these countries. Conclusions Substantial within country economic inequalities in caesarean deliveries remain. These inequalities might be due to a combination of inadequate access to emergency obstetric care among the poorest subgroups and high levels of caesarean use without medical indication in the richest subgroups, especially in middle income countries. Country specific strategies should address these inequalities to improve maternal and newborn health. Design Secondary analysis of demographic and health surveys and multiple indicator cluster surveys. Setting 72 low and middle income countries with a survey conducted between 2010 and 2014 for analysis of the latest situation of inequality, and 28 countries with a survey also conducted between 2000 and 2004 for analysis of the change in inequality over time. Participants Women aged 15-49 years with a live birth during the two or three years preceding the survey. Main outcome measures Data on caesarean section were disaggregated by asset based household wealth status and presented separately for five subgroups, ranging from the poorest to the richest fifth. Absolute and relative inequalities were measured using difference and ratio measures. The pace of change in the poorest and richest fifths was compared using a measure of excess change. Results National caesarean section rates ranged from 0.6% in South Sudan to 58.9% in the Dominican Republic. Within countries, caesarean section rates were lowest in the poorest fifth (median 3.7%) and highest in the richest fifth (median 18.4%). 18 out of 72 study countries reported a difference of 20 percentage points or higher between the richest and poorest fifth. The highest caesarean section rates and greatest levels of absolute inequality were observed in countries from the region of the Americas, whereas countries from the African region had low levels of caesarean use and comparatively lower levels of absolute inequality, although relative inequality was quite high in some countries. 26 out of 28 countries reported increases in caesarean section rates over time. Rates tended to increase faster in the richest fifth (median 0.9 percentage points per year) compared with the poorest fifth (median 0.2 percentage points per year), indicating an increase in inequality over time in most of these countries. Conclusions Substantial within country economic inequalities in caesarean deliveries remain. These inequalities might be due to a combination of inadequate access to emergency obstetric care among the poorest subgroups and high levels of caesarean use without medical indication in the richest subgroups, especially in middle income countries. Country specific strategies should address these inequalities to improve maternal and newborn health.
Web: https://www.bmj.com/content/360/bmj.k55


Debugging Information
ColdFusion Server Developer 2018,0,19,330149
Template /Publications/journal-details.cfm
Time Stamp 30-Jun-24 07:17 PM
Locale English (US)
User Agent Mozilla/5.0 AppleWebKit/537.36 (KHTML, like Gecko; compatible; ClaudeBot/1.0; +claudebot@anthropic.com)
Remote IP 10.0.0.149
Host Name 10.0.0.149


Execution Time

Total Time Avg Time Count Template
501 ms 21 ms 24 C:/inetpub/wwwroot/commonspot/utilities/ct-render-element.cfm
486 ms 20 ms 24 C:/inetpub/wwwroot/commonspot/utilities/ct-render-element-core.cfm
359 ms 359 ms 1 C:/inetpub/wwwroot/commonspot/master.cfm
359 ms 359 ms 1 C:/inetpub/wwwroot/dhs/Publications/journal-details.cfm
312 ms 312 ms 1 C:/inetpub/wwwroot/commonspot/uncached-master.cfm
312 ms 312 ms 1 C:/inetpub/wwwroot/commonspot/utilities/cached-page-render.cfm
296 ms 296 ms 1 C:/inetpub/wwwroot/commonspot/master-render.cfm
296 ms 296 ms 1 C:/inetpub/wwwroot/commonspot/render-page-meat.cfm
296 ms 296 ms 1 C:/inetpub/wwwroot/commonspot/render-page.cfm
266 ms 27 ms 10 C:/inetpub/wwwroot/commonspot/utilities/ct-render-named-element.cfm
266 ms 266 ms 1 C:/inetpub/wwwroot/dhs/templates/template-basepage.cfm
203 ms 203 ms 1 C:/commonspot-data/customers/commonspot-users/sites/commonspot-site-dhs/mapped/cache/2/p9706-c1378-l70-t51-dAny.read
188 ms 188 ms 1 C:/inetpub/wwwroot/commonspot/utilities/run-element.cfm
47 ms 47 ms 1 C:/inetpub/wwwroot/commonspot/controls/customcf/cpe-customcf.cfm
16 ms 16 ms 1 C:/commonspot-data/customers/commonspot-users/sites/commonspot-site-dhs/mapped/cache/2/p9706-c19154-l70-t51-dAny.read
16 ms 16 ms 1 C:/commonspot-data/customers/commonspot-users/sites/commonspot-site-dhs/mapped/cache/2/p9706-c19174-l70-t51-dAny.read
16 ms 16 ms 1 C:/inetpub/wwwroot/commonspot/set-page-vars.cfm
16 ms 16 ms 1 C:/inetpub/wwwroot/commonspot/site-application.cfm
16 ms 16 ms 1 C:/inetpub/wwwroot/commonspot/startup/core-application-meat.cfm
16 ms 16 ms 1 C:/inetpub/wwwroot/commonspot/startup/site-application-meat.cfm
16 ms 16 ms 1 C:/inetpub/wwwroot/dhs/Publications/Application.cfm
16 ms 16 ms 1 C:/inetpub/wwwroot/dhs/customcf/legacy/journal/detail_article_summary.cfm
16 ms 8 ms 2 CFC[ C:/inetpub/wwwroot/commonspot/public_api/cache.cfc | getElementCacheSettings(9706, 4304) ] from C:/inetpub/wwwroot/commonspot/public_api/cache.cfc
15 ms 15 ms 1 C:/inetpub/wwwroot/commonspot/controls/control-setup.cfm
15 ms 8 ms 2 C:/inetpub/wwwroot/commonspot/controls/ct-include-once.cfm
15 ms 15 ms 1 C:/inetpub/wwwroot/commonspot/render-head.cfm
15 ms 15 ms 1 C:/inetpub/wwwroot/commonspot/security/security-page.cfm
15 ms 8 ms 2 C:/inetpub/wwwroot/commonspot/utilities/newwindow-js.cfm
0 ms 0 ms 1 C:/commonspot-data/customers/commonspot-users/sites/commonspot-site-dhs/mapped/cache/2/p9706-c1432-l70-t51-dAny.read
0 ms 0 ms 1 C:/commonspot-data/customers/commonspot-users/sites/commonspot-site-dhs/mapped/cache/2/p9706-c19152-l70-t51-dAny.read
0 ms 0 ms 1 C:/commonspot-data/customers/commonspot-users/sites/commonspot-site-dhs/mapped/cache/2/p9706-c19153-l70-t51-dAny.read
0 ms 0 ms 1 C:/commonspot-data/customers/commonspot-users/sites/commonspot-site-dhs/mapped/cache/2/p9706-c19155-l70-t51-dAny.read
0 ms 0 ms 1 C:/commonspot-data/customers/commonspot-users/sites/commonspot-site-dhs/mapped/cache/2/p9706-c19169-l70-t51-dAny.read
0 ms 0 ms 1 C:/commonspot-data/customers/commonspot-users/sites/commonspot-site-dhs/mapped/cache/2/p9706-c19172-l70-t51-dAny.read
0 ms 0 ms 1 C:/commonspot-data/customers/commonspot-users/sites/commonspot-site-dhs/mapped/cache/2/p9706-c19177-l70-t51-dAny.read
0 ms 0 ms 1 C:/inetpub/wwwroot/ADF/core/load_site_adf.cfm
0 ms 0 ms 1 C:/inetpub/wwwroot/commonspot/controls/dhtmlmenu/menu-output-display.cfm
0 ms 0 ms 1 C:/inetpub/wwwroot/commonspot/controls/handle-styles.cfm
0 ms 0 ms 1 C:/inetpub/wwwroot/commonspot/controls/upfront-generic.cfm
0 ms 0 ms 1 C:/inetpub/wwwroot/commonspot/lview-contribute-mode-redirect-check.cfm
0 ms 0 ms 1 C:/inetpub/wwwroot/commonspot/non-dashboard-include.cfm
0 ms 0 ms 1 C:/inetpub/wwwroot/commonspot/pagemode/pagemodeui.cfm
0 ms 0 ms 1 C:/inetpub/wwwroot/commonspot/render-body-tag.cfm
0 ms 0 ms 1 C:/inetpub/wwwroot/commonspot/render-foot.cfm
0 ms 0 ms 1 C:/inetpub/wwwroot/commonspot/render-metatags.cfm
0 ms 0 ms 1 C:/inetpub/wwwroot/commonspot/render-tracking-code.cfm
0 ms 0 ms 1 C:/inetpub/wwwroot/commonspot/startup/browser-detect-methods.cfm
0 ms 0 ms 1 C:/inetpub/wwwroot/commonspot/startup/build-request-params.cfm
0 ms 0 ms 1 C:/inetpub/wwwroot/commonspot/startup/handle-head-request.cfm
0 ms 0 ms 1 C:/inetpub/wwwroot/commonspot/startup/handle-request-timeout.cfm
0 ms 0 ms 1 C:/inetpub/wwwroot/commonspot/startup/init-customer-scope.cfm
0 ms 0 ms 1 C:/inetpub/wwwroot/commonspot/startup/init-server-scope.cfm
0 ms 0 ms 1 C:/inetpub/wwwroot/commonspot/startup/session-first-global.cfm
0 ms 0 ms 1 C:/inetpub/wwwroot/commonspot/startup/session-first-site.cfm
0 ms 0 ms 1 C:/inetpub/wwwroot/commonspot/utilities/add-resource-request.cfm
0 ms 0 ms 6 C:/inetpub/wwwroot/commonspot/utilities/add-unregistered-resource-request.cfm
0 ms 0 ms 1 C:/inetpub/wwwroot/commonspot/utilities/append-to-resource-group.cfm
0 ms 0 ms 1 C:/inetpub/wwwroot/commonspot/utilities/build-user-struct.cfm
0 ms 0 ms 3 C:/inetpub/wwwroot/commonspot/utilities/cp-cfheader.cfm
0 ms 0 ms 1 C:/inetpub/wwwroot/commonspot/utilities/cp-cfmail-request-queue.cfm
0 ms 0 ms 2 C:/inetpub/wwwroot/commonspot/utilities/define-upfront-vars.cfm
0 ms 0 ms 1 C:/inetpub/wwwroot/commonspot/utilities/flush-cache-db-queue.cfm
0 ms 0 ms 4 C:/inetpub/wwwroot/commonspot/utilities/handle-in-list.cfm
0 ms 0 ms 1 C:/inetpub/wwwroot/commonspot/utilities/load-template-properties.cfm
0 ms 0 ms 1 C:/inetpub/wwwroot/commonspot/utilities/newwindow-js-meat.cfm
0 ms 0 ms 1 C:/inetpub/wwwroot/commonspot/utilities/nocache-headers.cfm
0 ms 0 ms 1 C:/inetpub/wwwroot/commonspot/utilities/update-page-cache-status.cfm
0 ms 0 ms 3 C:/inetpub/wwwroot/commonspot/utilities/validate-date-string.cfm
0 ms 0 ms 1 C:/inetpub/wwwroot/commonspot/utilities/verify-stub-data.cfm
0 ms 0 ms 1 C:/inetpub/wwwroot/dhs/custom-application.cfm
0 ms 0 ms 1 C:/inetpub/wwwroot/dhs/custom-search/inc-custom-application-search-vars.cfm
0 ms 0 ms 1 C:/inetpub/wwwroot/dhs/templates/template-basepage.head
0 ms 0 ms 2 CFC[ C:/inetpub/wwwroot/commonspot/components/cache/cache-settings-cache.cfc | getPageSettings(1) ] from C:/inetpub/wwwroot/commonspot/components/cache/cache-settings-cache.cfc
0 ms 0 ms 2 CFC[ C:/inetpub/wwwroot/commonspot/components/cache/cache-settings-cache.cfc | getPageSettings(1652) ] from C:/inetpub/wwwroot/commonspot/components/cache/cache-settings-cache.cfc
0 ms 0 ms 2 CFC[ C:/inetpub/wwwroot/commonspot/components/cache/cache-settings-cache.cfc | getPageSettings(2) ] from C:/inetpub/wwwroot/commonspot/components/cache/cache-settings-cache.cfc
0 ms 0 ms 2 CFC[ C:/inetpub/wwwroot/commonspot/components/cache/cache-settings-cache.cfc | getPageSettings(9706) ] from C:/inetpub/wwwroot/commonspot/components/cache/cache-settings-cache.cfc
0 ms 0 ms 1 CFC[ C:/inetpub/wwwroot/commonspot/components/cache/cache-status.cfc | DBQueue_Count() ] from C:/inetpub/wwwroot/commonspot/components/cache/cache-status.cfc
0 ms 0 ms 1 CFC[ C:/inetpub/wwwroot/commonspot/components/cache/cache-status.cfc | GetPageCacheStatus(1652, 2, 2, 0) ] from C:/inetpub/wwwroot/commonspot/components/cache/cache-status.cfc
0 ms 0 ms 2 CFC[ C:/inetpub/wwwroot/commonspot/components/cache/cache-status.cfc | GetPageCacheStatus(9706, 2, 1652, 0) ] from C:/inetpub/wwwroot/commonspot/components/cache/cache-status.cfc
0 ms 0 ms 1 CFC[ C:/inetpub/wwwroot/commonspot/components/cache/cache-status.cfc | UpdateStatus(argumentCollection = [complex value]) ] from C:/inetpub/wwwroot/commonspot/components/cache/cache-status.cfc
0 ms 0 ms 1 CFC[ C:/inetpub/wwwroot/commonspot/components/cache/custom-module-cache.cfc | getCustomAppPath(2) ] from C:/inetpub/wwwroot/commonspot/components/cache/custom-module-cache.cfc
0 ms 0 ms 1 CFC[ C:/inetpub/wwwroot/commonspot/components/cache/custom-module-cache.cfc | getCustomModulePath(post-page-render, 2) ] from C:/inetpub/wwwroot/commonspot/components/cache/custom-module-cache.cfc
0 ms 0 ms 1 CFC[ C:/inetpub/wwwroot/commonspot/components/cache/item-security-cache.cfc | GetEntry(9706) ] from C:/inetpub/wwwroot/commonspot/components/cache/item-security-cache.cfc
0 ms 0 ms 1 CFC[ C:/inetpub/wwwroot/commonspot/components/cache/rewrite-rules-cache.cfc | getRewriteSettings(2) ] from C:/inetpub/wwwroot/commonspot/components/cache/rewrite-rules-cache.cfc
0 ms 0 ms 1 CFC[ C:/inetpub/wwwroot/commonspot/components/cache/subsite-cache-manager.cfc | getLatest() ] from C:/inetpub/wwwroot/commonspot/components/cache/subsite-cache-manager.cfc
0 ms 0 ms 1 CFC[ C:/inetpub/wwwroot/commonspot/components/cache/subsite-cache-manager.cfc | getSecurityPageIDMap([complex value]) ] from C:/inetpub/wwwroot/commonspot/components/cache/subsite-cache-manager.cfc
0 ms 0 ms 1 CFC[ C:/inetpub/wwwroot/commonspot/components/cache/template-cache.cfc | LoadTemplateProperties(publication-template.cfm, 1652, 2) ] from C:/inetpub/wwwroot/commonspot/components/cache/template-cache.cfc
0 ms 0 ms 1 CFC[ C:/inetpub/wwwroot/commonspot/components/custom-application-framework/handle-applications.cfc | executeFunction(handleRequestStart) ] from C:/inetpub/wwwroot/commonspot/components/custom-application-framework/handle-applications.cfc
0 ms 0 ms 1 CFC[ C:/inetpub/wwwroot/commonspot/components/engine/ACF/utilities.cfc | checkFileExists(C:/inetpub/wwwroot/dhs/templates/template-basepage.cfm, 0, false) ] from C:/inetpub/wwwroot/commonspot/components/engine/ACF/utilities.cfc
0 ms 0 ms 1 CFC[ C:/inetpub/wwwroot/commonspot/components/engine/ACF/utilities.cfc | queryRowToStruct(ArgumentCollection = [complex value]) ] from C:/inetpub/wwwroot/commonspot/components/engine/ACF/utilities.cfc
0 ms 0 ms 1 CFC[ C:/inetpub/wwwroot/commonspot/components/util/commonspot-context.cfc | getDSN(site) ] from C:/inetpub/wwwroot/commonspot/components/util/commonspot-context.cfc
0 ms 0 ms 1 CFC[ C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc | addEvent('head' request check) ] from C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc
0 ms 0 ms 1 CFC[ C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc | addEvent(CGI variable processing) ] from C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc
0 ms 0 ms 1 CFC[ C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc | addEvent(New (global) session initialized) ] from C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc
0 ms 0 ms 1 CFC[ C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc | addEvent(Request object updates) ] from C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc
0 ms 0 ms 1 CFC[ C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc | addEvent(Request.Params initialized) ] from C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc
0 ms 0 ms 1 CFC[ C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc | addEvent(RequestTimeout check) ] from C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc
0 ms 0 ms 1 CFC[ C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc | addEvent(Server-level remote requests checked) ] from C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc
0 ms 0 ms 1 CFC[ C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc | addEvent(Subsite context updated (ID=2)) ] from C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc
0 ms 0 ms 1 CFC[ C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc | addEvent(authoring suspended check) ] from C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc
0 ms 0 ms 1 CFC[ C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc | addEvent(basic setup) ] from C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc
0 ms 0 ms 1 CFC[ C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc | addEvent(check for server property changes) ] from C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc
0 ms 0 ms 1 CFC[ C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc | addEvent(core cleanup) ] from C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc
0 ms 0 ms 1 CFC[ C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc | addEvent(core initialization) ] from C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc
0 ms 0 ms 1 CFC[ C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc | addEvent(core variables) ] from C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc
0 ms 0 ms 1 CFC[ C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc | addEvent(custom-application.cfm) ] from C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc
0 ms 0 ms 1 CFC[ C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc | addEvent(customerScope object initialized) ] from C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc
0 ms 0 ms 1 CFC[ C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc | addEvent(handleRequestStart) ] from C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc
0 ms 0 ms 1 CFC[ C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc | addEvent(init-server-scope loaded) ] from C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc
0 ms 0 ms 1 CFC[ C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc | addEvent(lock checks/updates) ] from C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc
0 ms 0 ms 1 CFC[ C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc | addEvent(site environment initialization) ] from C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc
0 ms 0 ms 1 CFC[ C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc | addEvent(site session check) ] from C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc
0 ms 0 ms 1 CFC[ C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc | addEvent(subsite context refreshed) ] from C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc
0 ms 0 ms 1 CFC[ C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc | addEvent(user object created) ] from C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc
0 ms 0 ms 1 CFC[ C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc | addEvent(user session initialized) ] from C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc
0 ms 0 ms 1 CFC[ C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc | addEvent(wait for lock: CommonSpot_Server_Scope (read)) ] from C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc
0 ms 0 ms 1 CFC[ C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc | addEvent(wait for lock: CommonSpot_Site1_Core (exclusive)) ] from C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc
0 ms 0 ms 1 CFC[ C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc | init() ] from C:/inetpub/wwwroot/commonspot/components/util/debug-timing.cfc
0 ms 0 ms 2 CFC[ C:/inetpub/wwwroot/commonspot/components/util/object-factory.cfc | getObject(Cache) ] from C:/inetpub/wwwroot/commonspot/components/util/object-factory.cfc
0 ms 0 ms 1 CFC[ C:/inetpub/wwwroot/commonspot/components/util/object-factory.cfc | getObject(Element) ] from C:/inetpub/wwwroot/commonspot/components/util/object-factory.cfc
0 ms 0 ms 1 CFC[ C:/inetpub/wwwroot/commonspot/components/util/object-factory.cfc | getObject(Keywords) ] from C:/inetpub/wwwroot/commonspot/components/util/object-factory.cfc
0 ms 0 ms 1 CFC[ C:/inetpub/wwwroot/commonspot/components/util/object-factory.cfc | getObject(LiveBookmarks) ] from C:/inetpub/wwwroot/commonspot/components/util/object-factory.cfc
0 ms 0 ms 1 CFC[ C:/inetpub/wwwroot/commonspot/components/util/visitor-context-rule-actions.cfc | onPageVisit(9706, 2) ] from C:/inetpub/wwwroot/commonspot/components/util/visitor-context-rule-actions.cfc
0 ms 0 ms 1 CFC[ C:/inetpub/wwwroot/commonspot/public_api/element.cfc | getInfo(elementTypeID = 26) ] from C:/inetpub/wwwroot/commonspot/public_api/element.cfc
0 ms 0 ms 1 CFC[ C:/inetpub/wwwroot/commonspot/public_api/keywords.cfc | appendEnforced(subsiteIDOrURL = , keywordList = Journal Details) ] from C:/inetpub/wwwroot/commonspot/public_api/keywords.cfc
0 ms 0 ms 1 CFC[ C:/inetpub/wwwroot/commonspot/public_api/livebookmarks.cfc | getTags(9706) ] from C:/inetpub/wwwroot/commonspot/public_api/livebookmarks.cfc
0 ms 0 ms 1 CFC[ C:/inetpub/wwwroot/commonspot/udf/database.cfc | getUDF(commonspot-site-dhs) ] from C:/inetpub/wwwroot/commonspot/udf/database.cfc
0 ms  STARTUP, PARSING, COMPILING, LOADING, & SHUTDOWN
375 ms  TOTAL EXECUTION TIME
red = over 250 ms average execution time


SQL Queries

get (Datasource=dhs_legacy_live, Time=0ms, Records=217) in C:\inetpub\wwwroot\dhs\custom-application.cfm @ 19:17:33.033
    	SELECT lang_text_var, lang_text_en
        FROM dataset_lang_dictionary
    
SelectedCustomRenderElements (Datasource=commonspot-site-dhs, Time=16ms, Records=2117) in C:\inetpub\wwwroot\commonspot\set-page-vars.cfm @ 19:17:33.033
		SELECT dcr.*
		  FROM Data_Custom_Render dcr, CustomElementModules cem
		 WHERE (dcr.PageID IN (?,?,?,?)) 
			AND dcr.VersionState=?
			AND (dcr.ModuleID = cem.ID OR dcr.ModuleID <= 0)
	 ORDER BY dcr.ControlID, dcr.PageID DESC, dcr.VersionID DESC
	
Query Parameter Value(s) -
Parameter #1(CF_SQL_INTEGER) = 1
Parameter #2(CF_SQL_INTEGER) = 2
Parameter #3(CF_SQL_INTEGER) = 1652
Parameter #4(CF_SQL_INTEGER) = 9706
Parameter #5(CF_SQL_INTEGER) = 2

Request.PageData.PageParams (Datasource=commonspot-site-dhs, Time=0ms, Records=1) in C:\inetpub\wwwroot\commonspot\render-page-meat.cfm @ 19:17:33.033
			SELECT *
			  FROM Param_Page
			 WHERE (PageID=9706 OR (PageID IN (1652,2,1) AND (VersionState = 2)))
			   AND VersionState=2
			 ORDER BY PageID DESC
		
qry (Datasource=commonspot-site-dhs, Time=0ms, Records=1) in C:\inetpub\wwwroot\commonspot\udf\validation\core.cfm @ 19:17:33.033
					SELECT SubsiteID
					  FROM SitePages
					 WHERE ID = ? 
Query Parameter Value(s) -
Parameter #1(CF_SQL_INTEGER) = 9706

testQuery (Datasource=commonspot-site-dhs, Time=0ms, Records=1) in C:\inetpub\wwwroot\commonspot\udf\validation\generated-validators.cfm @ 19:17:33.033
		SELECT ID
		  FROM SitePages
		 WHERE ID = ?
			AND (PageType IN (0,1) AND Uploaded=0)
	
Query Parameter Value(s) -
Parameter #1(CF_SQL_INTEGER) = 9706

qry (Datasource=commonspot-site-dhs, Time=0ms, Records=0) in C:\inetpub\wwwroot\commonspot\commands\livebookmarks.cfc @ 19:17:33.033
		SELECT Data_SeeAlso.ID, SubSites.SubSiteURL, SitePages.filename as pagename,
				 XMLPublications.name as feedname, XMLPublicationFormat.name as feedformat,
				 XMLPublications.description,
				 CASE
					 	WHEN XMLPublicationFormat.IsSyndication = 0 THEN 0
						ELSE 1
				 END AS IsSyndicationFeed
		  FROM Data_SeeAlso, XMLPublications, XMLPublicationFormat, SitePages, SubSites
		 WHERE Data_SeeAlso.PageID = ?
		 	AND Data_SeeAlso.Action = ?
		 	AND Data_SeeAlso.ItemID = XMLPublicationFormat.XMLPublicationFormatID
		 	AND Data_SeeAlso.TargetPageID = XMLPublications.XMLPublicationID
		 	AND XMLPublications.XMLPublicationFormatID = XMLPublicationFormat.XMLPublicationFormatID
		 	AND XMLPublications.PageID = SitePages.ID
		 	AND SitePages.SubSiteID = SubSites.ID
	
Query Parameter Value(s) -
Parameter #1(CF_SQL_INTEGER) = 9706
Parameter #2(CF_SQL_INTEGER) = 11

ControlInstanceData (Datasource=commonspot-site-dhs, Time=0ms, Records=76) in C:\inetpub\wwwroot\commonspot\controls\control-setup.cfm @ 19:17:33.033
		SELECT ControlID, ControlName, ControlType, ParentControlID, ParentControlType, pageID
		  FROM ControlInstance
		 WHERE (PageID IN (?,?,?,?)) 
	 ORDER BY ControlID, PageID DESC
	
Query Parameter Value(s) -
Parameter #1(CF_SQL_INTEGER) = 1
Parameter #2(CF_SQL_INTEGER) = 2
Parameter #3(CF_SQL_INTEGER) = 1652
Parameter #4(CF_SQL_INTEGER) = 9706

qInfo (Datasource=commonspot-site-dhs, Time=0ms, Records=1) in C:\inetpub\wwwroot\commonspot\commands\element.cfc @ 19:17:33.033
		SELECT ac.ShortDesc AS Name, CustomRenderSupport AS SupportsCustomLayouts,
				 CASE
					WHEN ac.ID <?
					 THEN 'Standard'
					WHEN (ac.Name is NULL or ac.Name = '')
					 THEN 'Saved'
					WHEN fcm.ClassID = 1
					 THEN 'Global'
					ELSE 'Local'
				 END AS ElementType,
				 CASE WHEN ac.Name = 'custom' THEN 'custom/ce' ELSE ac.ControlPrefix END AS ElementURLPrefix,
				 CASE WHEN (ac.ID IN (?,?,?,?,?,?,?,?,?,?,?,?))  THEN 0 ELSE 1 END AS HasFontColorProperties,
				 CASE WHEN (ac.ID IN (?,?,?,?,?,?,?))  THEN 0 ELSE 1 END AS HasLayoutProperties,
				 1 AS HasStyleProperties
		  FROM AvailableControls ac
		  LEFT OUTER JOIN FormControlMap fcm ON fcm.FormID = ac.ID
		 WHERE ac.ID = ? 
Query Parameter Value(s) -
Parameter #1(cf_sql_integer) = 400
Parameter #2(CF_SQL_INTEGER) = 22
Parameter #3(CF_SQL_INTEGER) = 44
Parameter #4(CF_SQL_INTEGER) = 55
Parameter #5(CF_SQL_INTEGER) = 1
Parameter #6(CF_SQL_INTEGER) = 56
Parameter #7(CF_SQL_INTEGER) = 47
Parameter #8(CF_SQL_INTEGER) = 26
Parameter #9(CF_SQL_INTEGER) = 48
Parameter #10(CF_SQL_INTEGER) = 27
Parameter #11(CF_SQL_INTEGER) = 28
Parameter #12(CF_SQL_INTEGER) = 51
Parameter #13(CF_SQL_INTEGER) = 31
Parameter #14(CF_SQL_INTEGER) = 33
Parameter #15(CF_SQL_INTEGER) = 26
Parameter #16(CF_SQL_INTEGER) = 48
Parameter #17(CF_SQL_INTEGER) = 37
Parameter #18(CF_SQL_INTEGER) = 27
Parameter #19(CF_SQL_INTEGER) = 38
Parameter #20(CF_SQL_INTEGER) = 28
Parameter #21(cf_sql_integer) = 26

Request.customCFUpfront (Datasource=commonspot-site-dhs, Time=0ms, Records=1) in C:\inetpub\wwwroot\commonspot\controls\upfront-generic.cfm @ 19:17:33.033
	SELECT *
	  FROM Data_CustomCF
	 WHERE (PageID=9706 OR (PageID IN (1652,2,1) AND (VersionState = 2)))
		AND (VersionState = 2) 
 ORDER BY ControlID, PageID DESC, VersionID DESC 
testQuery (Datasource=commonspot-site-dhs, Time=0ms, Records=1) in C:\inetpub\wwwroot\commonspot\udf\validation\generated-validators.cfm @ 19:17:33.033
		SELECT ID
		  FROM SitePages
		 WHERE ID = ?
			AND (PageType IN (0,1,2) AND Uploaded=0)
	
Query Parameter Value(s) -
Parameter #1(CF_SQL_INTEGER) = 9706

qry (Datasource=commonspot-site-dhs, Time=16ms, Records=1) in C:\inetpub\wwwroot\commonspot\commands\cache.cfc @ 19:17:33.033
		SELECT SubsiteID, InheritedTemplateList
		  FROM SitePages
		 WHERE ID=? 
Query Parameter Value(s) -
Parameter #1(CF_SQL_INTEGER) = 9706

testQuery (Datasource=commonspot-site-dhs, Time=0ms, Records=1) in C:\inetpub\wwwroot\commonspot\udf\validation\generated-validators.cfm @ 19:17:33.033
		SELECT ID
		  FROM SitePages
		 WHERE ID = ?
			AND (PageType IN (0,1,2) AND Uploaded=0)
	
Query Parameter Value(s) -
Parameter #1(CF_SQL_INTEGER) = 1652

testQuery (Datasource=commonspot-site-dhs, Time=0ms, Records=1) in C:\inetpub\wwwroot\commonspot\udf\validation\generated-validators.cfm @ 19:17:33.033
		SELECT ID
		  FROM SitePages
		 WHERE ID = ?
			AND (PageType IN (0,1,2) AND Uploaded=0)
	
Query Parameter Value(s) -
Parameter #1(CF_SQL_INTEGER) = 2

testQuery (Datasource=commonspot-site-dhs, Time=0ms, Records=1) in C:\inetpub\wwwroot\commonspot\udf\validation\generated-validators.cfm @ 19:17:33.033
		SELECT ID
		  FROM SitePages
		 WHERE ID = ?
			AND (PageType IN (0,1,2) AND Uploaded=0)
	
Query Parameter Value(s) -
Parameter #1(CF_SQL_INTEGER) = 1

getArticlesDetails (Datasource=dhs_legacy_live, Time=0ms, Records=1) in C:\inetpub\wwwroot\dhs\customcf\legacy\journal\detail_article_summary.cfm @ 19:17:33.033
SELECT distinct(a.article_id),p.pub_id,tp.article_type_id,title,authors,article_date,article_year,
vol,link,active,source,pub_name,article_type_name,
abstract as abstractText
FROM dhs_articles a
INNER JOIN  Dhs_article_pub p ON a.pub_id = p.pub_id
INNER JOIN   Dhs_article_type Tp ON a.article_type_id = Tp.Article_type_Id

WHERE active=1	and tp.article_type_id=1

AND a.article_id =? 
Order By title
Query Parameter Value(s) -
Parameter #1(cf_sql_integer) = 2925

getart_topic (Datasource=dhs_legacy_live, Time=0ms, Records=2) in C:\inetpub\wwwroot\dhs\customcf\legacy\journal\detail_article_summary.cfm @ 19:17:33.033
				select * from dhs_article_topics_lnk l, dhs_article_topics t 
				where article_id=?
				and l.topic_id=t.topic_id
				order by topic_name
			 
Query Parameter Value(s) -
Parameter #1(cf_sql_integer) = 2925

getart_Ctry (Datasource=dhs_legacy_live, Time=0ms, Records=1) in C:\inetpub\wwwroot\dhs\customcf\legacy\journal\detail_article_summary.cfm @ 19:17:33.033
				select * from dhs_article_ctry_lnk l, dhs_article_ctry c ,dhs_article_rgn r
				where article_id=? and l.country_id=c.country_id
				and R.Rgn_id = c.country_rgn_id	
			 
Query Parameter Value(s) -
Parameter #1(cf_sql_integer) = 2925

testQuery (Datasource=commonspot-site-dhs, Time=0ms, Records=1) in C:\inetpub\wwwroot\commonspot\udf\validation\generated-validators.cfm @ 19:17:33.033
		SELECT ID
		  FROM SitePages
		 WHERE ID = ?
			AND (PageType IN (0,1,2) AND Uploaded=0)
	
Query Parameter Value(s) -
Parameter #1(CF_SQL_INTEGER) = 9706

qry (Datasource=commonspot-site-dhs, Time=0ms, Records=1) in C:\inetpub\wwwroot\commonspot\commands\cache.cfc @ 19:17:33.033
		SELECT SubsiteID, InheritedTemplateList
		  FROM SitePages
		 WHERE ID=? 
Query Parameter Value(s) -
Parameter #1(CF_SQL_INTEGER) = 9706

testQuery (Datasource=commonspot-site-dhs, Time=0ms, Records=1) in C:\inetpub\wwwroot\commonspot\udf\validation\generated-validators.cfm @ 19:17:33.033
		SELECT ID
		  FROM SitePages
		 WHERE ID = ?
			AND (PageType IN (0,1,2) AND Uploaded=0)
	
Query Parameter Value(s) -
Parameter #1(CF_SQL_INTEGER) = 1652

testQuery (Datasource=commonspot-site-dhs, Time=0ms, Records=1) in C:\inetpub\wwwroot\commonspot\udf\validation\generated-validators.cfm @ 19:17:33.033
		SELECT ID
		  FROM SitePages
		 WHERE ID = ?
			AND (PageType IN (0,1,2) AND Uploaded=0)
	
Query Parameter Value(s) -
Parameter #1(CF_SQL_INTEGER) = 2

testQuery (Datasource=commonspot-site-dhs, Time=0ms, Records=1) in C:\inetpub\wwwroot\commonspot\udf\validation\generated-validators.cfm @ 19:17:33.033
		SELECT ID
		  FROM SitePages
		 WHERE ID = ?
			AND (PageType IN (0,1,2) AND Uploaded=0)
	
Query Parameter Value(s) -
Parameter #1(CF_SQL_INTEGER) = 1


Scope Variables

Application Variables:
activesubsites=1,2,5,6,8,17,18,19,20,21,22,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58
adf=Struct (89)
adfscheduler=Struct (0)
applicationname=site1
assocpubdocs=Struct (4)
blogcache=Struct (4)
cachedimages=Struct (32)
cacheinfocache=Struct (53)
confidentiality=Array (5)
controlinstance_toplevel_cache=Struct (126)
covid_articlecount=10
covid_newsarticlecount=49
covid_pressreleasecount=4
covid_pubcount=3
cs_elementcache=Struct (10)
cs_resourcesmissing=Struct (0)
cs_rewriterulescache=Struct (21)
cs_subsitecachemanager=Struct (28)
customerinfo=Complex type
customerscope=Struct (21)
custommodulecache=Struct (21)
defaultconfidentiality=2
dhspagesyncdata=Struct (1)
itemsecuritycache=Struct (31)
languagenames=Struct (51)
languages=Struct (51)
lastknownchange=Struct (18)
lastupdate=Struct (14)
metadatacache=Struct (4)
pendingstubrequests=Struct (0)
rsscache=Struct (2)
search_archive_next_clean=2024-07-01 11:48:40
serverstatus=Struct (1)
site=Struct (74)
sitescope=Struct (9)
styleids=Struct (248)
stylenames=Struct (248)
subsitecache=Struct (46)
subsitecachebysecuritypageid=Struct (46)
templatecache=Struct (28)
templatedefaultsecuritycache=Struct (60)
templateenforcedsecuritycache=Struct (60)
treecache=Struct (25)
twittercache=Struct (2)
typefactory=Complex type
youtubecache=Struct (3)
CGI Variables:
AUTH_PASSWORD=
AUTH_TYPE=
AUTH_USER=
CERT_COOKIE=
CERT_FLAGS=
CERT_ISSUER=
CERT_KEYSIZE=
CERT_SECRETKEYSIZE=
CERT_SERIALNUMBER=
CERT_SERVER_ISSUER=
CERT_SERVER_SUBJECT=
CERT_SUBJECT=
CF_TEMPLATE_PATH=C:\inetpub\wwwroot\dhs\Publications\journal-details.cfm
CONTENT_LENGTH=0
CONTENT_TYPE=
CONTEXT_PATH=
GATEWAY_INTERFACE=CGI/1.1
HTTPS=off
HTTPS_KEYSIZE=
HTTPS_SECRETKEYSIZE=
HTTPS_SERVER_ISSUER=
HTTPS_SERVER_SUBJECT=
HTTP_ACCEPT=*/*
HTTP_ACCEPT_ENCODING=gzip, br, zstd, deflate
HTTP_ACCEPT_LANGUAGE=
HTTP_CONNECTION=
HTTP_COOKIE=
HTTP_HOST=preview.dhsprogram.com
HTTP_REFERER=
HTTP_URL=/Publications/journal-details.cfm?C_id=0&P_ID=0&T_ID=0&article_id=2925&r_id=0
HTTP_USER_AGENT=Mozilla/5.0 AppleWebKit/537.36 (KHTML, like Gecko; compatible; ClaudeBot/1.0; +claudebot@anthropic.com)
LOCAL_ADDR=10.0.0.111
PATH_INFO=
PATH_TRANSLATED=C:\inetpub\wwwroot\dhs\Publications\journal-details.cfm
QUERY_STRING=C_id=0&P_ID=0&T_ID=0&article_id=2925&r_id=0
REMOTE_ADDR=10.0.0.149
REMOTE_HOST=10.0.0.149
REMOTE_USER=
REQUEST_METHOD=GET
SCRIPT_NAME=/Publications/journal-details.cfm
SERVER_NAME=preview.dhsprogram.com
SERVER_PORT=80
SERVER_PORT_SECURE=0
SERVER_PROTOCOL=HTTP/1.1
SERVER_SOFTWARE=Microsoft-IIS/10.0
WEB_SERVER_API=
Cookie Variables:
CSRFTOKEN=253D1AF43A14782B930C0C76CA812E3419B6CAC8
Request Parameters:
anonnoreadelements=
applockname=CS_App_Site1_1
archiveemail=archive@dhsprogram.com
assetsdir=/assets/
author_approve_whereclause=(VersionState = 2)
authormode=0
authorok=1
blupfront=
browser=Struct (13)
browserallincluded=1
cachefilesused=22
cachestatus=Complex type
cfflushcount=0
cgivars=Struct (49)
cloudfrontkeypairid=K3LSHNFSZFMIUC
cloudfronturl=d1vyaiefsqy4pf
constants=Complex type
cors.isCorsRequest=NO
cp=Struct (123)
cs_includedobjects=nwjs
cs_init_timings=Struct (23)
cs_isdashboardcmd=0
cs_request_start_memory=2407895040
cs_runningdashboardcmdcode=0
csrftoken=253D1AF43A14782B930C0C76CA812E3419B6CAC8
ctrl_data=Struct (64)
customcf_data=Struct (2)
customcfupfront=Query (1)
customerinfo=Complex type
customhead=1
customrenderhandlerpairs=
customsearch=Struct (11)
dbdsn=measure_db
debugstate=Struct (1)
dhspagesyncdata=Struct (1)
dhtmlmenuitemsprefetch=
disablehideformenus=0
dsource=dhs_legacy_live
editmode=0
element=Struct (42)
elementrundetail=Struct (1)
elementsrun=1
environment=Struct (5)
finalreportids=5,26,21,10,18,30,39
finalreportna=139,315,445,488,107,138,459,518
formattedtimestamp=2024-06-30 19:17:33
getghost=
hivbold=1,3,8,9
imageupfront=
imgdir=/images/
includerootdir=/
initialsiteid=1
initticks=1719775053440
jswarnmessage=
linkdataupfront_itempos=
linkdataupfront_itemtitle=
lockid=0
mainpage=Struct (84)
master_cfm_used=1
maxperms=Complex type
modeorderbyclause=VersionID Desc
modewhereclause=(VersionState = 2)
modewhereclause_page=(VersionState = 2)
multisectionupfront=
noauthorreason=
nocacheelementtypes=
nocacheheaderincluded=1
nondashboardincludedone=1
obcountires=EG,ZM
package=Struct (0)
page=Struct (84)
pagedata=Struct (1)
pagedhtmlitems=
pagedhtmlmenus=
pageperms=Complex type
pagesync=Struct (4)
params=Struct (9)
params_formfields=
params_urlfields=T_ID,C_id,article_id,r_id,P_ID
previewmode=0
readmodewhereclause=(VersionState = 2)
renderedelements=Struct (0)
renderelementdata=Struct (0)
renderfordiff=0
renderforprint=0
renderstate=Struct (73)
req_cam_callcount=1
req_inittimestamp=2024-06-30 19:17:33.440
req_sequenceid=30209
req_startticks=1719775053440
rootdir=/
rootpath=
rooturldatasetadmin=https://preview.dhsprogram.com/data/dataset_admin
samesite_value=
scheduleupfront=
serverdatasource=commonspot-sites
sessionlockname=Session_1_AC16A6A919A5E3F42C6F81F13F2E8718.cfusion
sessionstring=1_AC16A6A919A5E3F42C6F81F13F2E8718.cfusion
sicupfront=
sicupfrontparam=
site=Struct (74)
siteid=1
standardrenderhandlers=
styleids=Struct (248)
stylenames=Struct (248)
subsite=Struct (0)
subsitecache=Struct (46)
subsitecachebysecuritypageid=Struct (46)
subsiteid=2
taiupfrontparam=
tbupfront=
tbupfrontparam=
templatecachestatus=Struct (0)
templaterootdir=/
timestamp={ts '2024-06-30 19:17:33'}
trustcachestatus=1
typefactory=Complex type
udslockname=CS_Customer_commonspot-users
updatingschemas=0
user=Struct (30)
usersdatasource=commonspot-users
wanterrorsrethrown=0
warnmessage=
xmlbrowser=Struct (13)
Server Variables:
ADF=Struct (15)
COMMONSPOT=Struct (44)
EMAILALERTKEY=BSu0cRa8xSWdSrClnnGvpA==
coldfusion=Struct (10)
os=Struct (5)
system=Struct (2)
Session Variables:
_csrf_token=253D1AF43A14782B930C0C76CA812E3419B6CAC8
adf=Struct (0)
authormode=0
contributemode=read
currentpageid=9706
debugmode=0
debugstate=Struct (1)
editmode=0
environment=Struct (5)
hasusertempfiles=0
language=Struct (216)
lastupdate=Struct (2)
lastuserupdate=1719775053456
lockid=0
lockobjectid=0
lockobjecttype=
locktype=
logintime=
ownedobjecttypes=
pendingapprovalpages=
pendingapprovals=
previewmode=0
requestedversioncounter=
requestedversiontimestamp=
sessionid=AC16A6A919A5E3F42C6F81F13F2E8718.cfusion
sessionstring=1_AC16A6A919A5E3F42C6F81F13F2E8718.cfusion
urltoken=CFID=2156126&CFTOKEN=faa529c45dc78253-29CF857F-9D41-64CA-422D33034E913396&jsessionid=AC16A6A919A5E3F42C6F81F13F2E8718.cfusion
usagelist=
user=Struct (30)
xmlbrowser=Struct (13)
xmlenvironment=Struct (5)
URL Parameters:
C_id=0
P_ID=0
T_ID=0
article_id=2925
r_id=0
Debug Rendering Time: 31 ms