Advances in Public Health The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Infection and Foot Care in Diabetics Seeking Treatment in a Tertiary Care Hospital, Bhubaneswar, Odisha State, India Tue, 04 Aug 2015 13:08:18 +0000 Diabetes mellitus is a major public health problem that can cause a number of serious complications. Foot ulceration is one of its most common complications. Poor foot care knowledge and practices are important risk factors for foot problems among diabetics. The present study was undertaken in the diabetes outpatient department of a tertiary care hospital to assess the practices regarding foot care in diabetes, find out the determinants of foot ulcer in diabetics, and offer suggestions to improve care. After informed consent, a total of 124 diabetics were interviewed to collect all relevant information. The diabetic foot care practice responses were converted into scores and for the sake of analysis were inferred as poor (0–5), fair (6-7), and good (>7) practices. Of the study population, 68.5% (85/124) consisted of men. The disease was diagnosed within the last 5 years for 66% (81/124) of the study participants. Of the study subjects, 83% (103/124) were on oral hypoglycemic agents (OHAs), 15.3% (19) on insulin, and 2 on diet control only. Among them about 18.5% had a history of foot ulcer. 37.9% reported using special slippers, 12% diabetics used slippers indoors, and 66.9% used slippers while using toilet. Of the study subjects, 67.8% said that feet should be inspected daily. 27.4% said they regularly applied oil/moisturizer on their feet. There is a need on part of the primary or secondary physician and an active participation of the patient to receive education about foot care as well as awareness regarding risk factors, recognition, clinical evaluation, and thus prevention of the complications of diabetes. Sonali Kar, Shalini Ray, and Dayanidhi Meher Copyright © 2015 Sonali Kar et al. All rights reserved. A Tool to Improve Accuracy of Parental Measurements of Preschool Child Height Tue, 04 Aug 2015 11:13:59 +0000 Background. Parent-reported measurement of child height is common in public health research but may be inaccurate, especially for preschoolers. A standardized protocol and tools to improve measurement accuracy are needed. The purpose of this study was to develop and test materials to improve parents’ accuracy when measuring their preschooler’s height. Methods. In Phase A, 24 parents were observed measuring child height using written instructions and an easy-to-read tape measure; after each of 3 testing rounds, instructions were refined based on observed errors and parent versus researcher measurements. In Phase B, a video replaced written instructions and was refined over 4 rounds with 37 parents. Results. The height kit with written instructions, tape measure, plumb line, and explanatory video helped parents accurately measure child height. Compared to written instructions alone, parents rated the video as having significantly greater clarity and likelihood of improving measurements. Although no significant differences in accuracy were found between paper and video instructions, observations indicated written instructions were more difficult for parents with less education to use with fidelity. Conclusions. The kit may improve parent measurement of preschooler height, thereby improving accuracy of body mass index calculations, tracking of obesity prevalence, and obesity prevention and treatment. Meredith Yorkin, Kim Spaccarotella, Jennifer Martin-Biggers, Carolina Lozada, Nobuko Hongu, Virginia Quick, and Carol Byrd-Bredbenner Copyright © 2015 Meredith Yorkin et al. All rights reserved. Severity of Burn Injury and the Relationship to Socioeconomic Status in Nova Scotia, Canada Wed, 22 Jul 2015 11:23:42 +0000 Objective. Few Canadian studies have examined the relationship between socioeconomic status (SES) and incidence of burn injury. We seek to evaluate this relationship using median income as a measure of SES in Nova Scotia, Canada. Methods. Nova Scotia residents admitted to the Queen Elizabeth II burn unit in Halifax, Nova Scotia, from 1995 to 2012, were included in the study. SES was estimated by linking the subject’s postal code to median family household income via Canadian population census data at the level of dissemination areas. Four equal income groups ranging from lowest to highest income quartile were compared (average total burn percentage). Likelihood ratio was calculated to evaluate the effect of median family income burn injury in each income quartile. Results. 302 patients were included in the analysis. Average percent total burn surface area was 19%, 15%, 15%, and 14% () per income quartile (Q1: lowest, Q4: highest), respectively. Likelihood ratios for income quartile Q1–Q4 were 1.3 (0.8–1.6), 1.2 (0.6–1.4), and 0.7 (0.6–1.2), respectively. Conclusion. Contrary to findings in other geographic regions of the world, severity or incidence of burn injury in Nova Scotia, Canada, does not change in relation to SES when using family median income as a surrogate. Jeffrey Le, Sarah Alyouha, Lihui Liu, Michael Bezuhly, and Jason Williams Copyright © 2015 Jeffrey Le et al. All rights reserved. Prevalence of Stunting among Children Aged 6–23 Months in Kemba Woreda, Southern Ethiopia: A Community Based Cross-Sectional Study Tue, 26 May 2015 11:47:01 +0000 Background. Stunting is a public health problem in developing countries. Stunting (HAZ < −2 Z-score) is a major cause of disability preventing children who survive from reaching their full developmental potential. Objective. To assess stunting and associated factors among children aged 6–23 months in Southern Ethiopia. Methods. Community based cross-sectional study was carried out among 562 mothers who have children from 6 to 23 months in 2014/15 in Kemba district. Multivariate analyses were applied to identify predictor variables and control effect of confounding. Results. The study revealed that out of 562 children, 18.7% (95% CI (15.6–22.1)) of children were stunted. In multiple logistic regressions, boys [AOR: 2.50; 95% CI (1.60–4.01)], older mothers [AOR: 2.60; 95% CI (1.07–6.35)], mothers who have no formal education [AOR: 2.76; 95% CI (1.63–4.69)], mothers who work as daily workers [AOR: 3.06; 95% CI (1.03–9.12)] and have private work activity [AOR: 2.39; 95% CI (1.61–3.53)], mothers who have no postnatal follow-up [AOR: 1.64; 95% CI (1.05–2.55)], and maternal illness encountered after delivery [AOR: 1.56; 95% CI (1.05–2.32)] were identified as significant independent predictors of childhood stunting. Conclusion and Recommendation. A significant number of children had chronic undernutrition in critical periods. An organized effort should be made at all levels to solve the problems of chronic undernutrition (stunting) in children. Eskezyiaw Agedew and Tefera Chane Copyright © 2015 Eskezyiaw Agedew and Tefera Chane. All rights reserved. Effect of Physical Activity on Blood Pressure Distribution among School Children Mon, 09 Mar 2015 14:05:33 +0000 The present study analyzed the relationship between physical activity and blood pressure in 701 school children aged 12–16 years (girls = 338, boys = 363). During the baseline examination, systolic blood pressure (SBP) and diastolic blood pressure (DBP), height, weight, and 24-hour recall of the working day activity with duration were recorded. Total activity score and type of activity were calculated by weighing the activity level. Mean, standard deviation, and correlation coefficient were calculated by using SPSS 12.0 version. The results revealed that rise in blood pressure was directly proportional to the increase in age. The range of systolic blood pressure was found to be high in low risk blood pressure (LBP) group than in elevated blood pressure (EBP) group showing direct association of activity level and systolic blood pressure. Physical activity score was found to be more in LBP group than in EBP group. Our results support the hypothesis that SBP is independently related to the level of habitual physical activity in children. Anisa M. Durrani and Waseem Fatima Copyright © 2015 Anisa M. Durrani and Waseem Fatima. All rights reserved. Factors Associated with Home Delivery in West Pokot County of Kenya Wed, 04 Mar 2015 09:28:08 +0000 Background. This paper sought to estimate the percentage of women who deliver at home in West Pokot County and establish the factors associated with home delivery in the area. Design and Methods. The cross-sectional survey targeted 18,174 households between the months of April and July 2013. Six hundred mothers participated in the study. Association between predictors and the place where the delivery took place was analysed by chi-square test () at 95% confidence interval. Factors with value < 0.05 were considered statistically significant. These factors were entered into multivariate logistic regression model after controlling for confounding to ascertain how each one influenced home delivery. Odds ratio was used to determine the extent of association. Results. Based on the mother’s most recent births, 200 (33.3%) women delivered in a health facility while 400 (66.7%) delivered at home. Factors associated with home delivering were housewives (OR: 4.5, 95% CI: 2.1–9.5; ) and low socioeconomic status of 10 km (OR: 0.5, 9.5% CI: 0.3–0.7; ). Conclusions. The findings of this study provide novel information for stakeholders responsible for maternal and child health in West Pokot County. Jared Otieno Ogolla Copyright © 2015 Jared Otieno Ogolla. All rights reserved. Diabetic Complications among Adult Diabetic Patients of a Tertiary Hospital in Northeast Ethiopia Wed, 04 Feb 2015 08:06:12 +0000 Background. The diabetic complications are becoming common community problems. The outcomes of diabetic complications are increased hospitalization, increased direct patient costs, and mortality. In Dessie, the prevalence of the diabetic complications is not well studied so far. Thus, the aim of this study is to assess prevalence of diabetic complications and associated factors among adult diabetic patients of Dessie Referral Hospital, Northeast Ethiopia. Methods. Cross-sectional study was conducted in the diabetic clinic of Dessie Referral Hospital from April to May 31, 2013. All diabetic patients who visited the clinic during the study period were included. Data was collected using interview guided self-administered questionnaire. Presence of complications and the type of medications the patient was on were identified through review of patient records. Data were cleaned, coded, and entered into SPSS for Windows version 17.0. Descriptive statistics and chi-square tests were carried out to meet the stated objective. The Results. Overall 129 (59.7%) of the patients were found to have been affected by one or more of the diabetic complications. Complications were identified mainly among type II diabetic patients. The age of patients ( value-0.048), type of diabetes (P value-0.00), and medication (P value-0.00) were strongly associated with the occurrence of diabetic complication but self-reported adherence, attitude, and knowledge level of patients and the family history were not associated with the presence of complication. Conclusion. The prevalence of complications among diabetic patients in Dessie Referral Hospital was high. Targeted counseling and health information provision to the patients by the clinical staff will be helpful in reducing avoidable morbidity and mortality in the patients. Asrat Agalu Abejew, Abebe Zeleke Belay, and Mirkuzie Woldie Kerie Copyright © 2015 Asrat Agalu Abejew et al. All rights reserved. Patients’ Compliance with Tuberculosis Medication in Ghana: Evidence from a Periurban Community Sun, 01 Feb 2015 13:53:07 +0000 Globally, an estimated 2 million deaths occur every year as a result of tuberculosis. Ghana records over 46,000 new cases annually despite numerous efforts to curb the disease. One major challenge associated with the control of the disease is patients’ noncompliance with medication. Despite the noncompliance setback, not much information is available on the issue. This paper, therefore, examines patients’ compliance with medication at the Suhum Kraboa Coaltar District in Ghana. A cross-sectional descriptive study was carried out using interview schedules. Data were primarily retrieved from 40 treatment supporters, in addition to 110 previously treated persons registered in 2010 and 2011 with cases of pulmonary tuberculosis. Evidence from the study indicates that 63 percent of the previously treated persons complied with medication which is below the expected national target of at least 85 percent. However, those with treatment supporters significantly complied with medication. Depression, substance abuse, financial problems, and long duration of treatment were other issues that discouraged patients’ adherence to medication. Some patients also attributed supernatural explanations to the source of the disease which negatively affected compliance. Conclusively, future approaches aimed at controlling/eradicating tuberculosis in the district should consider counselling, economic empowerment packages, and detailed education for patients. Evans Danso, Isaac Yeboah Addo, and Irene Gyamfuah Ampomah Copyright © 2015 Evans Danso et al. All rights reserved. Prevalence of Cardiovascular Disease and Associated Risk Factors among Adult Population in the Gulf Region: A Systematic Review Tue, 27 Jan 2015 09:47:18 +0000 Background. CVD is a principal cause of mortality and disability globally. Objective. To analyse the epidemiological data on CHD, strokes, and the associated risk factors among adult population in the Gulf countries. Methods. A systematic review of published articles between 1990 and 2014 was conducted. Results. The analysis included 62 relevant studies. The prevalence of CHD was reported to be 5.5% in Saudi Arabia. The annual incidence of strokes ranged from 27.6 to 57 per 100 000 in the Gulf countries with ischaemic stroke being the most common subtype and hypertension and diabetes being the most common risk factors among stroke and ACS patients. The prevalence of overweight and obesity ranged from 31.2% to 43.3% and 22% to 34.1% in males and from 28% to 34.3% and 26.1% to 44% in females, respectively. In males, the prevalence of hypertension and diabetes ranged from 26.0% to 50.7% and 9.3% to 46.8%, respectively; in females these ranged from 20.9% to 57.2% and 6% to 53.2%, respectively. The prevalence of inactivity was from 24.3% to 93.9% and 56.7% to 98.1% in males and females, respectively. Relatively more males (13.4% to 37.4%) than females (0.5% to 20.7%) were current smokers. Available data indicate poor dietary habits with high consumption of snacks, fatty foods, sugar, and fast food. Conclusion. Effective preventative strategies and education programs are crucial in the Gulf region to reduce the risk of CVD mortality and morbidity in the coming years. Najlaa Aljefree and Faruk Ahmed Copyright © 2015 Najlaa Aljefree and Faruk Ahmed. All rights reserved. Seroprevalence of Leptospiral Antibodies among Healthy Municipal Service Workers in Selangor Wed, 14 Jan 2015 11:54:48 +0000 Introduction. Municipal service workers have been found to have an occupational risk of leptospirosis. Study among municipality workers shows high seropositivity of leptospiral antibodies detected among town cleaners and garbage collectors. Objective. Aims of this study were to determine seroprevalence of leptospiral antibodies and distribution of serovars detected in samples among municipal service workers. Methodology. Cross-sectional study involved 89 municipal service workers in Selangor. Blood samples were taken and serological test was done using MAT following standard procedures. Results. Seropositivity of leptospiral antibodies among municipal service workers was 34.8%. Serovars identified were strains of Sarawak, Copenhageni, Hardjobovis, Lai, Bataviae, Patoc, Celledoni, Hardjoprajitno, Tarrasovi, and Pomona. There were 31 workers with positive leptospiral antibodies. All of them were frequently exposed towards leptospirosis. Significant associations have been reported between seropositivity of leptospiral antibodies with job category () and worker’s nationality () among municipal service workers. Conclusion. High seropositivity of leptospiral antibodies detected among municipal service workers which was associated with job category and nationality of workers. The significant findings from this study suggest that health education programs and safe work practice should be considered to prevent leptospirosis among municipal service workers in future. Suhailah Samsudin, Siti Norbaya Masri, Tengku Zetty Maztura Tengku Jamaluddin, Siti Nor Sakinah Saudi, Umi Kalsom Md Ariffin, Fairuz Amran, and Malina Osman Copyright © 2015 Suhailah Samsudin et al. All rights reserved. Children’s Oral Health: The Opportunity for Improvement Using the WHO Health Promoting School Model Thu, 08 Jan 2015 12:14:54 +0000 The health and quality of life of a large proportion of the world’s children are compromised by dental caries and periodontal disease. Those in developing countries and from disadvantaged populations suffer disproportionately from these forms of poor oral health; however, much of the primary disease and secondary pathology is preventable by simple and inexpensive measures that children can readily learn. WHO health promoting schools (HPS) are an established model for addressing public health issues through education of children in a manner that achieves acquisition of knowledge and health practices that promote behaviours that positively impact determinants of health. HPS programs that address poor oral health have achieved improvement in oral health practices and reduction in caries rates among disadvantaged populations of children. WHO has called for more programs to address the “epidemic” of poor oral health worldwide, and the WHO HPS model appears to be a relevant and applicable way forward. Health care professionals and educators who want to improve the health and quality of life of children related to caries and periodontal disease now have an opportunity to collaborate to initiate, deliver, and evaluate community-based HPS interventions using proven concepts, content, and process. Andrew J. Macnab Copyright © 2015 Andrew J. Macnab. All rights reserved. Neighborhood Social Environment and Health Communication at Prepregnancy and Maternal Stages among Caucasian and Asian Women: Findings from the Los Angeles Mommy and Baby Survey Mon, 29 Dec 2014 00:10:09 +0000 Introduction. We study whether the relationship between neighborhood social environment and maternal communication with healthcare providers differs between Asians and Caucasians. Method and Materials. Using the 2007 Los Angeles Mommy and Baby (LAMB) survey, we measure new mother’s neighborhood social environment by four key variables: (1) instrumental/emotional support during pregnancy, (2) neighborhood social cohesion, (3) neighborhood social exchange, and (4) neighborhood services. Logistic regressions were applied for data analysis. Neighborhood social exchange predicts less chance of lacking communication about sensitive issues in preconception visits among Caucasians (logged odds: −0.045; ) and Asians (L.O.: −0.081; ) and predicts less chance of lacking communication during preconception visits among Asians (L.O.: −0.092; ). Neighborhood social cohesion predicts more chance for lacking communication about preparation for pregnancy only among Asians (L.O.: 0.065; ). Neighborhood services predict less chance of lacking communication about stigmatized issues in the prenatal visit among Asians (L.O.: −0.036; ). Discussion. Caucasians and Asians with more neighborhood social exchange are more likely to discuss sensitive issues during preconception visits. Neighborhood service significantly predicts maternal discussion of stigmatized issues with health care providers, but only among Asians. Lu Shi and Yuping Mao Copyright © 2014 Lu Shi and Yuping Mao. All rights reserved. Sociodemographic Correlates of Choice of Health Care Services in Six Rural Communities in North Central Nigeria Mon, 22 Dec 2014 07:32:18 +0000 Household expenditure on health has increasingly remained a major source of health care financing in Nigeria despite the introduction of several social health scheme policies provided by the government for meeting the health care costs of patients. Recognizing these limitations, this study assessed the type of health care services people commonly use in various illnesses and the sociodemographic correlates of the preferred health care services by household heads in six rural communities of North Central Nigeria. A cross-sectional community-based descriptive study design was used to study 154 household heads in the settlements using a multistage sampling method. Multiple logistic regressions were performed to investigate independent predictors that had significant chi-square at . The leading causes of illness experienced by respondents were medical conditions (42.0%) and 41.7% of them sought treatment from patent medicine vendors. The dominant reasons for health-seeking preferences were financial access (53.7%) and proximity (48.6%). Age had a higher impact (Beta = 0.892) on the health-seeking preferences of the respondents as compared to their occupation and religion (Beta = 0.368 and −0.746, resp.). Therefore, in order to meet the health care of patients, it is pertinent that the unmet needs of patients are properly addressed by appropriate agencies. Onyemocho Audu, Ishaku Bako Ara, Abdujalil Abdullahi Umar, Victoria Nanben Omole, and Solomon Avidime Copyright © 2014 Onyemocho Audu et al. All rights reserved. Changing Smoking Behavior of Staff at Dr. Zainoel Abidin Provincial General Hospital, Banda Aceh Wed, 17 Dec 2014 06:22:25 +0000 Smoking tobacco is a habit of individuals. Determinants of smoking behavior are multiple factors both within the individual and in the social environment around the individual. Staff smoking has been an undesirable phenomenon at Dr. Zainoel Abidin Provincial General Hospital in Banda Aceh. Health promotion efforts are a strategy that has resulted in behavioral changes with reductions in smoking by staff. This action research was designed to analyze changes in smoking behavior of hospital staff. The sample for this research was all 152 male staff who were smokers. The results of this research showed that Health Promotion Interventions (HPI) consisting of personal empowerment plus social support and advocacy to improve employee knowledge and attitudes influenced staff to stop or to significantly. HPI employed included counseling programs, distribution of antismoking leaflets, putting up antismoking posters, and installation of no smoking signs. These HPI proved effective to increase knowledge and create a positive attitude to nonsmoking that resulted in major reductions in smoking by staff when offsite and complete cessation of smoking whilst in the hospital. Continuous evaluation, monitoring, and strengthening of policies banning smoking should be maintained in all hospitals. Said Usman, Soekidjo Notoadmodjo, Kintoko Rochadi, and Fikarwin Zuska Copyright © 2014 Said Usman et al. All rights reserved. Sexual Coercion and Associated Factors among Female Students of Madawalabu University, Southeast Ethiopia Tue, 16 Dec 2014 06:58:34 +0000 Introduction. Violence against women, in its various forms, is an important social and public health problem in different communities around the world. Although violence against women is against the inalienable human right and resulted in physical, sexual, and psychological harm or suffering to women, little has been documented regarding its factors and distribution among youth population such as university students. Therefore, the objective of this study was to assess factors associated with sexual coercion among female students at Madawalabu University. Methods. This was a cross-sectional institution based study conducted on 411 female students which were selected by systematic random sampling from the list of female students. Data were collected in April 2012 using structured-interview administered questionnaire. Descriptive, binary, and multivariable logistic regression analysis were carried out using SPSS version 16. Result. In this study, the mean (±SD) age at first sex was 18.19 (+1.83) years. Lifetime and coercion in last twelve months were 163 (41.1%) and 101 (25.4%), respectively. Twenty-one (5.9%) of the respondents were raped. Being influenced/forced into unwanted sexual act 74 (18.6%) and having their genitalia/breast unwillingly touched 44 (11.1%) were reported as the commonest mechanisms of coercion. Age at first sex (17–19 years) (AOR = 0.241, 95% CI: 0.074, 0.765) and occasional alcohol use (AOR = 4.161, 95% CI: 1.386, 12.658) were significantly associated with coercion in the last twelve months. Conclusion. The overall lifetime sexual coercion was found to be 41.1%. In this study 6.8% of female students were raped and majority have had trial of rape. But 93.75% did not report to any legal body. With the existing prevalence and identified factors, the university should work towards minimizing the risk of sexual coercion through intensifying life skill peer education and assertiveness trainings. Abulie Takele and Tesfaye Setegn Copyright © 2014 Abulie Takele and Tesfaye Setegn. All rights reserved. Body Mass Index in Clinic Attenders: Patient Self-Perception versus Actual Measurements Mon, 24 Nov 2014 13:43:18 +0000 Objectives. The objectives of the study were to measure actual BMI in patients attending chronic disease clinics in health centres and to relate this to the patients’ own perceptions of their body image and the need to lose weight. Study Design. A cross sectional study. Methods. The actual BMIs in patients who attended chronic disease clinics in 14 health centres were measured. All participants were asked to state where they thought they were on a visual body image scale and were also asked if they thought they needed to lose weight. Results. All participants approached agreed to participate (RR 100%). 70% of patients were found to have a raised BMI. Approximately 73% of patients using the visual scale indicated that an overweight or obese BMI was ideal for them. Conclusions. Patients think they are thinner than they actually are, with obvious implications for health and health seeking behaviour. A whole of society approach is needed to change weight status perceptions and improve exercise and dietary behaviour. S. Pooransingh, K. Ramgulam, and I. Dialsingh Copyright © 2014 S. Pooransingh et al. All rights reserved. Perspectives on Employment Integration, Mental Illness and Disability, and Workplace Health Thu, 20 Nov 2014 09:35:57 +0000 This paper reviews the literature on the interplay between employment integration and retention of individuals diagnosed with mental health and related disability (MHRD). Specifically, the paper addresses the importance of an integrative approach, utilizing a social epidemiological approach to assess various factors that are related to the employment integration of individuals diagnosed with severe mental illness. Our approach to the review incorporates a research methodology that is multilayered, mixed, and contextual. The review examines the literature that aims to unpack employers’ understanding of mental illness and their attitudes, beliefs, and practices about employing workers with mental illness. Additionally we offer a conceptual framework entrenched within the social determinants of the mental health (SDOMH) literature as a way to contextualize the review conclusions. This approach contributes to a holistic understanding of workplace mental health conceptually and methodologically particularly as practitioners and policy makers alike are grappling with better ways to integrate employees who are diagnosed with mental health and disabilities into to the workplace. Nene Ernest Khalema and Janki Shankar Copyright © 2014 Nene Ernest Khalema and Janki Shankar. All rights reserved. Magnitude of Domestic Violence and Associated Factors among Pregnant Women in Hulet Ejju Enessie District, Northwest Ethiopia Mon, 10 Nov 2014 12:09:19 +0000 Introduction. Domestic violence during pregnancy is one of the barriers to achieve MDG 3 due to its adverse health consequences. Comparable population-based data on the problem are lacking as existing literatures differ in time periods explored. Such discrepancies among study findings indicate the importance of site specific studies, especially in rural parts of Ethiopia, where little is known about the problem. Objective. The aim of this study was to assess the magnitude of domestic violence and its associated factors among pregnant women in Hulet Ejju Enessie district, northwest Ethiopia. Methods and Materials. Quantitative community based cross-sectional study was carried out from January 1 to 31, 2014. A total of 425 randomly selected pregnant women were involved in the study. A standard WHO multicountry study on women’s health and domestic violence questionnaire were used for data collection. Four trained female data collectors were involved. Odds ratio with 95% CI was estimated to identify factors associated with domestic violence during pregnancy using multivariate logistic regression. Statistical significance was declared at value ≤0.05. Results. The prevalence of domestic violence during current pregnancy was 32.2%. The prevalence of psychological, sexual, and physical violence was 24.9%, 14.8%, and 11.3%, respectively. Married women at the age of ≤15 years were about four times (AOR = 4.2, 95% CI 1.9–9.0) more likely to experience domestic violence during pregnancy than their counterparts. Meanwhile, interparental exposure to domestic violence during childhood (AOR = 2.3, 95% CI 1.1–4.8), having frequently drinker partner (AOR = 3.4, 95% CI 1.6–7.4), and undesired pregnancy by partner (AOR = 6.2, 95% CI 3.2–12.1) were the main significant factors that increase risk of domestic violence during pregnancy. Conclusion and Recommendation. In this study, the prevalence of domestic violence during current pregnancy is high which may lead to a serious health consequence both on the mothers and on their foetuses. Thus, targeted efforts should be made by all concerned stakeholders to reduce the problem in the study area. Tenaw Yimer, Tesfaye Gobena, Gudina Egata, and Habtamu Mellie Copyright © 2014 Tenaw Yimer et al. All rights reserved. Perception and Barriers to Indoor Air Quality and Perceived Impact on Respiratory Health: An Assessment in Rural Honduras Mon, 13 Oct 2014 09:11:03 +0000 Objective. The aim of this study was to identify household-specific factors associated with respiratory symptoms and to study the perceived impact of indoor air pollution (IAP) as a health issue. Methods. An IRB-approved, voluntary, anonymous 23-item survey was conducted in Spanish at a medical outreach clinic in June 2012 and at the homes of survey respondents . Comparative analyses were performed to investigate relationships between specific house characteristics and respiratory complaints. Results. Seventy-nine surveys were completed. Respiratory symptoms were frequently reported by survey respondents: 42% stated that smoke in their household caused them to have watery eyes, 42% reported household members with coughs within the past two weeks, and 25% stated that there were currently household members experiencing difficulty in breathing. Stove location and kitchen roof construction material were significantly associated with frequency of respiratory symptoms. The vast majority used firewood as their major fuel type. Most respondents indicated that neither indoor air quality was a problem nor did it affect their daily life. Conclusions. Respiratory complaints are common in Yoro, Honduras. Stove location and kitchen roof construction material were significantly associated with frequency of respiratory symptoms; this may have implications for efforts to improve respiratory health in the region. Audrey Le, Gonzalo Bearman, Kakotan Sanogo, and Michael P. Stevens Copyright © 2014 Audrey Le et al. All rights reserved. Control of an Outbreak of Acinetobacter baumannii in Burn Unit in a Tertiary Care Hospital of North India Sun, 28 Sep 2014 08:08:39 +0000 Acinetobacter infection is increasing in hospitals and now it is considered as a global threat, as it can be easily transmitted and remain viable in the hospital environment for a long time due to its multidrug-resistant status, resistance to desiccation, and tendency to adhere to inanimate surfaces. Outbreaks caused by multidrug-resistant Acinetobacter baumannii (MDRAB) are difficult to control and have substantial morbidity and mortality, especially in vulnerable host. Here we are describing an outbreak of multidrug-resistant Acinetobacter baumannii in burn unit of a tertiary care hospital in India followed by its investigation and infection control measures taken to curtail the outbreak. Outbreak investigation and environmental sampling are the key factors which help in deciding the infection control strategies for control of outbreak. Implementation of contact precautions, hand hygiene, personnel protective equipment, environmental disinfection, isolation of patients, and training of health care workers are effective measures to control the outbreak of MDRAB in burn unit. Shweta Sharma, Nirmaljit Kaur, Shalini Malhotra, Preeti Madan, and Charoo Hans Copyright © 2014 Shweta Sharma et al. All rights reserved. Rural-Urban Differences in Health Care Expenditures: Empirical Data from US Households Tue, 09 Sep 2014 09:28:51 +0000 Purpose. To estimate the rural-urban differences in expenditures of outpatient care, hospital inpatient care, hospital emergency room services, medications, and total services. Methods. This cross-sectional study used data from the 2010 Medical Expenditure Panel Survey. The overall sample size for the study was 22,772. Weighted frequencies, means, or percentages were estimated to illustrate the distribution of each variable. Five two-part utilization models were then fit to determine the likelihood of having nonzero expenses and to identify how residence in a rural versus urban area affected expenditures in our five expense categories. Quantile regressions were estimated to further explore relationships between residence and each quantile of nonzero expenditure. Results. The results of two-part model suggest that rural populations spent more on medications, while urban populations spent more on emergency care. However, no rural-urban difference was found in total health expenditures. The results of quantile regressions suggest that the highest users (at the upper quantiles) of medication and total expenditure experienced the strongest positive effects of living in rural areas. Conclusions. Total health expenditures do not seem to vary significantly across urban and rural areas. However, rurality does have important effects on those who make the most use of outpatient care and prescription medications. Reviewing total health expenditures for urban and rural populations is not enough. Policymakers should monitor the effects of geographic differences, especially in the highest expenditure quantiles, for specific types of health expenditures. Differences in the influence of rurality across this distribution of health expenditures may provide important guidance for interventions. Wei-Chen Lee, Luohua Jiang, Charles D. Phillips, and Robert L. Ohsfeldt Copyright © 2014 Wei-Chen Lee et al. All rights reserved. Assessment of Knowledge, Attitude, and Practice of Risky Sexual Behavior Leading to HIV and Sexually Transmitted Infections among Egyptian Substance Abusers: A Cross-Sectional Study Mon, 25 Aug 2014 05:28:35 +0000 Background. Rapidly growing youth population with changing sexual trend in Egypt raised HIV potential. The aim of this study is to assess knowledge, attitude, and practice regarding unsafe sexual behavior among Egyptian drug abusers. Methods. This cross-sectional study was conducted in 2008 in the Freedom Drugs and HIV Program on 410 drug abusers in Egypt. Included respondents were subanalyzed by gender, age, education, and intravenous drug usage. Results. KAP average scores on safe sexual behavior were low compared to the maximum possible denoting low awareness and action of drug addicts towards avoidance of infection. Respondents with higher education had significantly better knowledge about safe sexual behavior. Significant positive correlation was shown between age and knowledge of safe sexual behavior. Older age groups were predicted to know more about safe sex, while gender; educational level and intravenous drug usage were not. Similarly, females and intravenous drug users were predicted to have higher attitude for safe sex while age and educational level did not. Conclusion. KAP of safe sexual behavior were low among drug addicts in Egypt increasing potential towards infection with STDs including HIV. The more the age and education level, the better the knowledge towards safe sexual behavior. Atef Y. Bakhoum, Max O. Bachmann, Ehab El Kharrat, and Remon Talaat Copyright © 2014 Atef Y. Bakhoum et al. All rights reserved. Awareness and Self-Reported Health Hazards of Electromagnetic Waves from Mobile Phone Towers in Dhaka, Bangladesh: A Pilot Study Wed, 20 Aug 2014 06:45:30 +0000 Background. Over the last few years there have been concerns regarding the health effects of electromagnetic waves (EMW) produced by mobile phone base transmitter stations (BTS). Data on possible health effects of EMW in developing countries are rare. This study was conducted to determine the awareness and self-reported health hazards of EMW from the mobile phone BTS in Dhaka city. Methods. A cross-sectional study was conducted among 220 respondents living around BTS in Dhaka city. Data was collected on sociodemographic characteristics, mobile phone use, BTS and EMW awareness, and self-reported health problems. Results. The majority of respondents (92.7%) reported to have seen a BTS but only 29.5% knows how it works and 74.5% had no knowledge about the EMW. 49% respondents experienced sleeping disturbances while recent episodes of headache or dizziness were reported by 47% and mood change or anxiety or depression by 41%. About 22% complained about other physical or mental symptoms. Conclusion. Awareness about the possible health hazards from EMW of BTS is low among the inhabitants of Dhaka city. A number of respondents mentioned recent health effects but the association with BTS could not be established. Sheikh Mohammed Shariful Islam Copyright © 2014 Sheikh Mohammed Shariful Islam. All rights reserved. Eating Behaviours and Body Weight Concerns among Adolescent Girls Wed, 16 Jul 2014 12:58:53 +0000 This paper presents a global review of research done on adolescent eating behaviours and food choices and the probable factors underlying it. Worldwide adolescent girls tend to develop moderate to high level of disordered eating behaviour as a result of their excessive concern with body weight or obsession with thinness. The objective of the review is to understand the concerns over body weight and the current eating patterns of adolescent girls in the developed and developing countries. Nadira Mallick, Subha Ray, and Susmita Mukhopadhyay Copyright © 2014 Nadira Mallick et al. All rights reserved. The Challenges Confronting Public Hospitals in India, Their Origins, and Possible Solutions Sun, 13 Jul 2014 08:45:58 +0000 Despite the implementation of National Rural Health Mission over a period of nine years since 2005, the public health system in the country continues to face formidable challenges. In the context of plans for rolling out “Universal Health Care” in the country, this paper analyzes the social, economic, and political origins of the major challenges facing public hospitals in India. The view taken therein holds the class nature of the ruling classes in the country and the development paradigm pursued by them as being at the root of the present problems being faced by public hospitals. The suggested solutions are in tune with these realities. Vikas Bajpai Copyright © 2014 Vikas Bajpai. All rights reserved. Reducing Colorectal Cancer Incidence and Disparities: Performance and Outcomes of a Screening Colonoscopy Program in South Carolina Mon, 23 Jun 2014 07:51:14 +0000 This study evaluated the efficiency, effectiveness, and racial disparities reduction potential of Screening Colonoscopies for People Everywhere in South Carolina (SCOPE SC), a state-funded program for indigent persons aged 50–64 years (45–64 years for African American (AA)) with a medical home in community health centers. Patients were referred to existing referral network providers, and the centers were compensated for patient navigation. Data on procedures and patient demographics were analyzed. Of 782 individuals recruited (71.2% AA), 85% (665) completed the procedure (71.1% AA). The adenoma detection rate was 27.8% (males 34.6% and females 25.1%), advanced neoplasm rate 7.7% (including 3 cancers), cecum intubation rate 98.9%, inadequate bowel preparation rate 7.9%, and adverse event rate 0.9%. All indicators met the national quality benchmarks. The adenoma rate of 26.0% among AAs aged 45–49 years was similar to that of older Whites and AAs. We found that patient navigation and a medical home setting resulted in a successful and high-quality screening program. The observed high adenoma rate among younger AAs calls for more research with larger cohorts to evaluate the appropriateness of the current screening guidelines for AAs, given that they suffer 47% higher colorectal cancer mortality than Whites. Sudha Xirasagar, Yi-Jhen Li, James B. Burch, Virginie G. Daguisé, Thomas G. Hurley, and James R. Hébert Copyright © 2014 Sudha Xirasagar et al. All rights reserved. Clinical and Microbiologic Efficacy of a Water Filter Program in a Rural Honduran Community Mon, 07 Apr 2014 06:32:58 +0000 Water purification in the rural Honduras is a focus of the nonprofit organization Honduras Outreach Medical Brigade Relief Effort (HOMBRE). We assessed water filter use and tested filter microbiologic and clinical efficacy. A 22-item questionnaire assessed water sources, obtainment/storage, purification, and incidence of gastrointestinal disease. Samples from home clay-based filters in La Hicaca were obtained and paired with surveys from the same home. We counted bacterial colonies of four bacterial classifications from each sample. Sixty-five surveys were completed. Forty-five (69%) individuals used a filter. Fifteen respondents reported diarrhea in their home in the last 30 days; this incidence was higher in homes not using a filter. Thirty-three paired water samples and surveys were available. Twenty-eight samples (85%) demonstrated bacterial growth. A control sample was obtained from the local river, the principal water source; number and bacterial colony types were innumerable within 24 hours. Access to clean water, the use of filters, and other treatment methods differed within a geographically proximal region. Although the majority of the water samples failed to achieve bacterial eradication, water filters may sufficiently reduce bacterial coliform counts to levels below infectious inoculation. Clay water filters may be sustainable water treatment measures in resource poor settings. Jaclyn Arquiette, Michael P. Stevens, Jean M. Rabb, Kakotan Sanogo, Patrick Mason, and Gonzalo M. L. Bearman Copyright © 2014 Jaclyn Arquiette et al. All rights reserved.