Advances in Public Health The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Treatment Outcomes of Tuberculosis and Associated Factors in an Ethiopian University Hospital Mon, 09 May 2016 06:14:24 +0000 Background. Tuberculosis remains a major global health problem. It causes ill-health among millions of people each year and ranks alongside the human immunodeficiency virus (HIV) as a leading cause of death worldwide. Purpose. To assess the outcome of tuberculosis treatment and to identify factors associated with tuberculosis treatment outcome. Methods. A five-year retrospective cross-sectional study was employed and data were collected through medical record review. Data were analyzed using SPSS version 16 and binary and multiple logistic regression methods were used. A value of less than 0.05 was considered as statistically significant in the final model. Results. Out of the 1584 pulmonary TB patients (882 males and 702 females) including all age group, 60.1% had successful outcome and 39.9% had unsuccessful outcome. In the final multivariate logistic model, the odds of unsuccessful treatment outcome was higher among patients of weight category 30–39.9 kg (AOR = 1.51, 95% CI: 1.102–2.065) and smear negative pulmonary TB (AOR = 3.204, 95% CI: 2.277–4.509) and extrapulmonary TB (AOR = 3.175, 95% CI: 2.201–4.581) and retreatment (AOR = 6.733, 95% CI: 3.235–14.013) and HIV positive TB patients (AOR = 1.988, 95% CI: 1.393–2.838) and unknown HIV status TB patients (AOR = 1.506, 95% CI: 1.166–1.945) as compared to their respective comparison groups. Conclusion. In this study, high proportion of unsuccessful treatment outcome was documented. Therefore emphasis has to be given for patients with high risk of unsuccessful TB treatment outcome and targeted interventions should be carried out. Minaleshewa Biruk, Belay Yimam, Hailay Abrha, Senafekesh Biruk, and Fisseha Zewdu Amdie Copyright © 2016 Minaleshewa Biruk et al. All rights reserved. Perceived Risk of HIV Infection and Associated Factors among Secondary School Students in Wakiso District, Uganda Sun, 27 Mar 2016 13:56:33 +0000 Introduction. HIV/AIDS remain a major public health problem in Uganda and 4% of individuals aged between 15 and 24 years are living with HIV. Few studies have examined HIV risk perception among adolescents in Uganda. Methods. We conducted a cross-sectional study among 379 secondary school students using multistage sampling techniques. Data were collected using an interviewer-administered questionnaire. Descriptive and logistic regression analyses were conducted. Results. One hundred ninety-one (49.6%) of the respondents perceived themselves to be at risk of contracting HIV, 174 (45.9%) had ever had sex, and 139 (80.4%) had first sexual encounter at 16 years or less. Only 49% of respondents who had sex within 12 months used a condom. Being older than 17 years, knowing someone who died of HIV, early sexual debut, and having ever had sex were associated with perceived risk of contracting HIV. After multivariate analysis, knowledge of someone who died of HIV (Adjusted Odds Ratio (AOR) 16, 95% CI 1.49–171.97) remained statistically significant. Conclusion. Many secondary school students perceived themselves to be at risk of contracting HIV; this perception is associated with knowing someone who died of HIV/AIDS. There is a need to strengthen HIV risk reduction interventions in Wakiso secondary schools. Charles Peter Osingada, Caroline Nabasirye, Sara Groves, and Tom Denis Ngabirano Copyright © 2016 Charles Peter Osingada et al. All rights reserved. Social Determinants of Immigrant Women’s Mental Health Mon, 07 Mar 2016 07:35:01 +0000 Migration is a population movement with enormous challenges for immigrant women that influence their mental health. Mental health is a social issue and its determinants need to be recognized for health policy making. This paper reviews and consolidates findings from the existing literature on social determinants of immigrant women’s mental health within a socioecological framework. Findings of this review revealed that mental health of immigrant women is an outcome of several interacting determinants at social, cultural, and health care system levels and hence calls for many different ways to promote it. Recommendations for mental health promotion of immigrant women with respect to research, education, practice, and policy are explored. Mahin Delara Copyright © 2016 Mahin Delara. All rights reserved. Assessment of Gap between Knowledge and Practices among Type 2 Diabetes Mellitus Patients at a Tertiary-Care Hospital in Bangladesh Thu, 03 Mar 2016 07:57:20 +0000 Newly diagnosed type 2 diabetes (T2 DM) patients who do not receive diabetes education (DE) have average knowledge on DM, and their practices about diabetes need to be improved. This prompted us to evaluate what happens when old diagnosed patients receive DE. The study therefore assessed the association between knowledge and practices in terms of Hemoglobin A1c (HbA1c), body mass index (BMI), and waist circumference (WC) among 500 diagnosed T2 DM using a cross-sectional design. An interviewer-administered questionnaire was used for assessing their knowledge. The mean knowledge score of the patients was 15.29 ± 3.6. A significant negative association was found between the knowledge score and the HbA1c level. Age was positively associated with HbA1c and WC. Duration of DM was positively and education was negatively associated with HbA1c. Gender was negatively associated with BMI while income was positively associated with BMI and WC. All the associations were significant. The diagnosed T2 DM patients are deficient of sufficient knowledge; the knowledge score and HbA1c have a significant negative relationship, not other actions. The risk factors for the patients’ outcome include old age, female gender, years of education, economic status, and duration of DM. Farzana Saleh, Ferdous Ara, and Fadia Afnan Copyright © 2016 Farzana Saleh et al. All rights reserved. Male Involvement in Maternal Health Planning Key to Utilization of Skilled Birth Services in Malindi Subcounty, Kenya Tue, 09 Feb 2016 08:25:21 +0000 Background. In Malindi, rural populations face challenges in accessing skilled birth services. Consequently, the majority of women deliver at home and only seek help when they have complications. This paper reports part findings from a study conducted to assess health priority setting process and its implication on availability, access, and use of emergency obstetric care services in Malindi. Methods. The study utilized qualitative methods to collect data from health personnel and maternal health stakeholders including community members. Source and method triangulation was used to strengthen the credibility of study findings. Data was categorized manually into themes around issues relating to utilization of skilled birth services discussed in this paper. Findings. Various barriers to utilization of skilled birth services were cited. However, most were linked to mwenye (the husband) who decides on the place of birth for the wife. Conclusion. Husbands are very influential in regard to decisions on skilled birth service utilization in this community. Their lack of involvement in maternal health planning may contribute as a barrier to utilization of skilled care by pregnant women. There is need to address the mwenye factor in an attempt to mitigate some of the barriers cited for nonutilization of skilled birth services. Lilian Nyamusi Nyandieka, Mercy Karimi Njeru, Zipporah Ng’ang’a, Elizabeth Echoka, and Yeri Kombe Copyright © 2016 Lilian Nyamusi Nyandieka et al. All rights reserved. NutriLive: An Integrated Nutritional Approach as a Sustainable Tool to Prevent Malnutrition in Older People and Promote Active and Healthy Ageing—The EIP-AHA Nutrition Action Group Tue, 26 Jan 2016 09:55:39 +0000 The present document describes a nutritional approach that is nested in the European Innovation Partnership for Active and Healthy Aging (EIP-AHA) and aims to provide the first common European program translating an integrated approach to nutritional frailty in terms of a multidimensional and transnational methodology. The document has been developed by the A3 Nutrition Action Area of the EIP-AHA and aims at providing a stepwise approach to malnutrition in older citizens, identifying adequate interventions based on a unified assessment and ICT-supported solutions. “NutriLive” is an integrated nutritional approach, represented by a structured Screening-Assessment-Monitoring-Action-Pyramid-Model (SAM-AP). Its core concept is the stratification of the nutritional needs, considered by the working group as the key for targeted, effective, and sustainable interventions. “NutriLive” tries to close gaps in epidemiological data within an aging population, creating a unified language to deal with the topic of nutrition and malnutrition in Europe. By assembling all the validated screening, assessment, and monitoring tools on malnutrition in a first pyramid, which is interrelated to a second intervention pyramid, the A3 Nutrition WG identifies a common, integrated vision on the nutritional approach to frailty, which applies to the various health care settings. Maddalena Illario, Angela Serena Maione, Maria Rosaria Rusciano, Edwig Goossens, Amelia Rauter, Nidia Braz, Harriet Jager-Wittenaar, Carolina Di Somma, Catherine Crola, Maria Soprano, Laura Vuolo, Pietro Campiglia, Guido Iaccarino, Helen Griffiths, Tobias Hartman, Donatella Tramontano, Annamaria Colao, and Regina Roller-Wirnsberger Copyright © 2016 Maddalena Illario et al. All rights reserved. Prediction of Optimal Daily Step Count Achievement from Segmented School Physical Activity Wed, 16 Dec 2015 12:26:53 +0000 Optimizing physical activity in childhood is needed for prevention of disease and for healthy social and psychological development. There is limited research examining how segmented school physical activity patterns relate to a child achieving optimal physical activity levels. The purpose of this study was to examine the predictive relationship between step counts during specific school segments and achieving optimal school (6,000 steps/day) and daily (12,000 steps/day) step counts in children. Participants included 1,714 school-aged children (mean age = years) recruited across six elementary schools. Physical activity was monitored for one week using pedometers. Generalized linear mixed effects models were used to determine the adjusted odds ratios (ORs) of achieving both school and daily step count standards for every 1,000 steps taken during each school segment. The school segment that related in strongest way to a student achieving 6,000 steps during school hours was afternoon recess (OR = 40.03; ) and for achieving 12,000 steps for the entire day was lunch recess (OR = 5.03; ). School segments including lunch and afternoon recess play an important role for optimizing daily physical activity in children. Ryan D. Burns, Timothy A. Brusseau, and James C. Hannon Copyright © 2015 Ryan D. Burns et al. All rights reserved. Factors Associated with Men’s Awareness of Danger Signs of Obstetric Complications and Its Effect on Men’s Involvement in Birth Preparedness Practice in Southern Ethiopia, 2014 Sun, 15 Nov 2015 08:26:43 +0000 Background. Compared to average maternal mortality ratio of 8 per 100,000 live births in industrialized countries, Ethiopia has an estimated maternal mortality ratio of 676 per 100,000 live births. Maternal deaths can be prevented partially through increasing awareness of danger signs of obstetric complications and involving husbands (male) in birth preparedness practice. Methods. Community based cross-sectional study was done. All adult males with a wife or partner who lives in the selected kebeles were our study population. Data was collected by pretested and structured questionnaires and two-stage cluster sampling procedure was used in order to collect study samples. Data was cleaned and entered into Epi Info 7 and exported to SPSS (IBM-21) for further analysis. Ordinary and hierarchical logistic regression model were used and AOR with 95% CI were used to show factors and the effect of men’s awareness of danger sign on men’s involvement in birth preparedness practice. Results. Total numbers of men interviewed were 836 making a response rate of 98.9%. 42% of men had awareness of danger sign and 9.4% (95% CI: (7.42, 11.4) of men were involved in birth preparedness practice. Respondents who live in the rural area [(AOR: 8.41; (95% CI: (4.99, 14.2)], governments employee [(AOR: 3.75; (95% CI: (1.38, 10.2)], those who belong to the highest wealth quintile [(AOR: 3.09; (95% CI: (1.51, 6.34)], and husbands whose wives gave birth in the hospital [(AOR: 2.09; (95% CI: (1.29, 3.37)], health center [(AOR: 1.99; (95% CI: (1.21, 3.28)], and health post [(AOR: 2.2; (95% CI: 2.16 (1.06, 404)] were positively associated and those who had no role in the health development army [(AOR: 0.43; (95% CI: (0.26, 0.72)] were negatively associated with men’s awareness of danger signs of obstetric complications. Conclusion. The prevalence of men awareness of danger sign was low and male involvement in birth preparedness practice was very low. Since there is a low level of awareness (17.1%) particularly in the urban area and men act as gatekeepers to women’s health, the respective organization needs to review urban health extension program and give due emphasis to husband education in order that they are able to recognize danger signs of obstetric complications in a way to increase their involvement in birth preparedness practice. Alemu Tamiso Debiso, Behailu Merdekios Gello, and Marelign Tilahun Malaju Copyright © 2015 Alemu Tamiso Debiso et al. All rights reserved. Improving Adult ART Clinic Patient Waiting Time by Implementing an Appointment System at Gondar University Teaching Hospital, Northwest Ethiopia Mon, 21 Sep 2015 14:12:13 +0000 Background. Long waiting time has been among the major factors that affect patient satisfaction and health service delivery. The aim of this study was to determine the median waiting time at the Anti-Retroviral Therapy (ART) Clinic before and after introduction of an intervention of the systematic appointment system. Methods. Patient waiting time was measured before and after the introduction of an intervention; target population of the study was all adult HIV patients/clients who have visited the outpatient ART Clinic in the study period. 173 patients were included before and after the intervention. Systematic patient appointment system and health education to patients on appointment system were provided as an intervention. The study period was from October 2011 to the end of January 2012. Data were analyzed using SPSS software version 17.0. Independent sample t-test at 95% confidence interval and 5% significance level was used to determine the significance of median waiting time difference between pre- and postintervention periods. Results and Conclusion. The total median waiting time was reduced from 274.8 minutes (IQR 180.6 minutes and 453.6 minutes) before intervention to 165 minutes (IQR 120 minutes and 377.4 minutes) after intervention (40% decrease, ). Overall, the study showed that the introduction of the new appointment system significantly reduces patient waiting time. Asmamaw Atnafu, Damen Haile Mariam, Rex Wong, Taddese Awoke, and Yitayih Wondimeneh Copyright © 2015 Asmamaw Atnafu et al. 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.