Advances in Public Health The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. Complementary Feeding Practice and Associated Factors among Mothers Having Children 6–23 Months of Age, Lasta District, Amhara Region, Northeast Ethiopia Tue, 21 Mar 2017 00:00:00 +0000 Introduction. The first two years of life are a critical window of opportunity for ensuring optimal child growth and development. Nutritional deficiencies during this period can lead to impaired cognitive development, compromised educational achievement, and low economic productivity. Improving infant and young child feeding (IYCF) practices in children aged 0–23 months is therefore critical to improved nutrition, health, and development. Objective. The aim of the study is to assess the prevalence of complementary feeding practice and its associated factors among mothers with children aged 6−23 months in Lasta District, Northeast Ethiopia, 2015. Methods. A community based cross-sectional study design was conducted among 476 mothers who had children aged 6–23 months in the study area. Simple random sampling technique was used to select the required sample. A face-to-face interview was done to collect data using structured questionnaire. Data were entered with EPI info version 3.5.1 and cleaning and analysis were done using SPSS version 16. Frequencies distribution and binary and multiple logistic regressions were done. Results. In this study only 56.5% of children aged 6–23 months received appropriate complementary feeding, considering timely introduction, minimum dietary diversity, and meal frequency. Exposure to public media [AOR = 2.50; 95% CI: ], occupation of mother [AOR = 9.50; 95% CI: ], mothers decision making role on how to use family income [AOR = 5.54; 95% CI: ], and use of postnatal care service [AOR = 5.98; 95% CI: ] were found to be independent predictors of complementary feeding practice. Conclusion and Recommendation. About 43.5% of mothers were not feeding their children complementary food appropriately, which would have negative implication on the health of infants and young children. There was a statistically significant association of inappropriate complementary feeding practices with mothers’ occupation, postnatal care service, media exposure, and mothers’ decision making role on how the money is used. Health professionals should focus on advising and counseling mothers on appropriate complementary feeding during prenatal, delivery, postnatal, and immunization services. Menberu Molla, Tadese Ejigu, and Girma Nega Copyright © 2017 Menberu Molla et al. All rights reserved. Determinants of Focused Antenatal Care Uptake among Women in Tharaka Nithi County, Kenya Mon, 02 Jan 2017 09:50:41 +0000 Background. The health status of women is an important indicator of the overall economic health and well-being of a country. Maternal health is closely linked with the survival of newborns. For every woman who dies, about thirty others suffer lifelong injuries. Focused antenatal care is one of the interventions to reduce maternal morbidity and mortality. It recommends four targeted visits during pregnancy within which essential services are offered. The aim of the study was to assess the determinants of uptake of focused antenatal care among women in Tharaka Nithi County, Kenya. Methods. This was a descriptive cross-sectional survey. Stratified sampling was used to select the health facilities while systematic sampling was used to select the respondents. Chi square, Fisher’s exact test, and logistic regression were used to analyse the data. Results. The level of uptake of focused antenatal care was slightly more than half (52%). The determinants of uptake of focused antenatal care are level of education, type of employment, household income, parity, and marital status of the pregnant women. Conclusion. Despite high attendance of at least one antenatal visit in Kenya, the uptake of focused antenatal care is proportionally low. Eliphas Gitonga Copyright © 2017 Eliphas Gitonga. All rights reserved. Study of the Injured Persons and the Injury Pattern in Road Traffic Accident in Sana’a City, Yemen Thu, 15 Dec 2016 07:03:47 +0000 Background. Fatal road traffic accidents constitute a significant public health problem. Aim. The aim of the study was to analyze road traffic accidents in Sana’a city, Yemen, during 2013–2015. Methods. The required information and data of accidents were collected, respectively, from police reported road accident statistics, Sana’a city. 11684 cases of road traffic accidents during period 2013–2015 were studied. Results. 840 people were killed and 9760 people were injured in RTAs during 2013–2015 in Sana’a city. The accident rates per 100000 of the population were 234.8 in 2013, 180.3 in 2014, and 92.2 in 2015. Mortality rates per 100000 of the population were 15.17 in 2013, 12.2 in 2014, and 8.9 in 2015. High speed was the single most important factor responsible for accidents, deaths, and injuries accounting for 38.1% of RTAs followed by drivers’ fault accounting for 18.9% of the total RTAs. The most common age group involved was ≥18 years. Males accounted for 83.1% of killed and injured persons. Most frequent victims of road traffic accidents were vehicles motor (48.9%) followed by pedestrians (38.1%). More than half of RTAs occurred on the straight road. Conclusion. RTAs are a major source of public health concern in Sana’a city, Yemen. Preventive measures to reduce the burden of mortality and morbidity due to road accidents should be introduced. Abdulhameed Ali Al-Thaifani, Nabil Ahmed Al-Rabeei, and Abdulsalam Mohammed Dallak Copyright © 2016 Abdulhameed Ali Al-Thaifani et al. All rights reserved. Magnitude of Maternal Anaemia in Rural Burkina Faso: Contribution of Nutritional Factors and Infectious Diseases Mon, 14 Nov 2016 14:15:26 +0000 Background. Maternal anaemia is a worldwide public health problem affecting particularly developing countries. In Burkina Faso, little data is available for rural areas. This study aimed to determine the prevalence of maternal anaemia and the risk factors associated with it in the rural health district of Hounde in Burkina Faso but also to define better control measures of maternal anaemia. Methods. This cross-sectional study conducted in 2010 had a sample of 3,140 pregnant women attending antenatal care in all the 18 primary health care facilities of the district. The women’s characteristics and their knowledge about contraceptives and sexually transmitted infections (STI) were collected. Also, physical and gynaecological examination, completed by vaginal, cervix, blood, and stool samplings, were collected. Results. A prevalence of 63.1% was recorded for maternal anaemia. Geophagy rate was 16.3% and vitamin A deficiency 69.3%. In addition, anaemia was independently associated with low education, low brachial perimeter, geophagy, and primigravida. But no statically significant relationship was found between maternal anaemia and infectious diseases or vitamin A deficiency. Conclusion. The magnitude of maternal anaemia was found to be higher in rural Hounde health district and should be addressed by adequate policy including education and the fight against malnutrition. Nicolas Meda, Malik Coulibaly, Yacouba Nebie, Ibrahima Diallo, Yves Traore, and Laurent T. Ouedraogo Copyright © 2016 Nicolas Meda et al. All rights reserved. Prevalence and Factors Associated with Reproductive Tract Infections in Gongolia Village, Rupandehi District, Nepal Mon, 31 Oct 2016 09:10:29 +0000 Objective. To determine the prevalence of reproductive tract infection (RTI) and its associated factors among married women of reproductive age group (15–49 yrs). Method. A cross sectional approach was employed. The study collected data of symptoms suggestive of RTI experienced in the previous six months according to World Health Organization (WHO) syndromic approach guideline. A structured interviewer administered questionnaire was used to collect data and data were entered into EPI data and transferred into SPSS (16 version) for further analysis. Chi square was used for statistical analysis. Result. Among 258 married women the prevalence of symptoms suggestive of RTI was found to be 39.9%. Low back pain, vaginal discharge, and low abdominal pains were common symptoms reported in study. Irregular menstrual cycle, sexual contact during menstruation, marriage below 19 yrs, pregnancy below 20 yrs, high parity, delivery at home, and use of temporary family planning device were significant risk factors for prevalence of RTI symptoms. Conclusion. RTI still remains neglected by married women. Training and education session needs to be carried out to identify the early symptoms of RTI. Awareness about marriage and pregnancy after 19 yrs of age, sex education, delivery at health institution by health personnel, menstrual and personnel hygiene, and use of the condom are needed for prevention of RTI. Pravina Kafle and Shiva Shankar Bhattarai Copyright © 2016 Pravina Kafle and Shiva Shankar Bhattarai. All rights reserved. The Necessity of Mobile Phone Technologies for Public Health Surveillance in Benin Tue, 25 Oct 2016 14:51:06 +0000 A cross-sectional study was conducted in March 2016 to assess the need of mobile phone technologies for health surveillance and interventions in Benin. Questionnaires were administered to 130 individuals comprising 25 medical professionals, 33 veterinarians, and 72 respondents from the public. All respondents possess cell phones and 75%, 84%, and 100% of the public, medical professionals, and veterinarians, respectively, generally use them for medical purposes. 75% of respondents including 68% of medics, 84.8% of veterinarians, and 72.2% of the public acknowledged that the current surveillance systems are ineffective and do not capture and share real-time information. More than 92% of the all respondents confirmed that mobile phones have the potential to improve health surveillance in the country. All respondents reported adhering to a nascent project of mobile phone-based health surveillance and confirmed that there is no existing similar approach in the country. The most preferred methods by all respondents for effective implementation of such platform are phone calls (96.92%) followed by SMS (49.23%) and smart phone digital forms (41.53%). This study revealed urgent needs of mobile phone technologies for health surveillance and interventions in Benin for real-time surveillance and efficient disease prevention. Yaovi M. G. Hounmanou, Murielle S. S. Agonsanou, Victorien Dougnon, Mahougnon H. B. Vodougnon, Ephraim M. Achoh, Jibril Mohammed, and Esron D. Karimuribo Copyright © 2016 Yaovi M. G. Hounmanou et al. All rights reserved. Exclusive Breastfeeding Practice and Its Associated Factors among Mothers of Infants Less Than Six Months of Age in Debre Tabor Town, Northwest Ethiopia: A Cross-Sectional Study Sun, 16 Oct 2016 11:50:01 +0000 Background. Exclusive breastfeeding for the first six months of life is recommended by the World Health Organization and United Nations Children’s Fund. However, the prevalence of exclusive breastfeeding is very low in many developing countries including Ethiopia. Objectives. The study was aimed at assessing the prevalence of exclusive breastfeeding practice and its associated factors among infants aged six months in Debre Tabor town. Methods. Community based cross-sectional study was conducted. Simple random sampling technique was employed in the selection of participants. Data were collected using pretested and structured questionnaire through face-to-face interview. Odds ratios with their 95% CI were computed and variables having value less than 0.05 in the multivariable logistic regression were considered as significantly associated with the dependent variable. Result. Of 470 mother-infant pair’s samples, 453 were included in the final analysis. The overall age appropriate rate of EBF practice was found to be 70.8%. Having an infant aged 2-3 months [AOR = 2.3 (95% CI: 1.12, 6.42)], giving birth in the health facility [AOR = 3.8 (95% CI: 2.18, 7.32)], being a house wife in occupation [AOR = 2.4 (95% CI (1.22, 6.92)], receiving counseling/advice on infant feeding [AOR = 2.1 (95% CI: 1.61, 5.41)], and colostrums feeding [AOR = 1.5 (95% CI: 1.28, 7.98)] were found to be significantly associated with EBF practice. Conclusion and Recommendations. A small proportion of infants are exclusively breastfed during the first 6 months. Promoting institutional delivery, revising the leave after birth, advice and counseling pregnant mothers about EBF, and enabling every mother to encourage colostrum feeding were recommended in order to increase the proportion of women practicing exclusive breastfeeding. Getachew Arage and Haileyesus Gedamu Copyright © 2016 Getachew Arage and Haileyesus Gedamu. All rights reserved. Utilization of Prevention of Mother-to-Child Transmission of HIV Services and Associated Factors among Antenatal Care Attending Mothers in Sebeta Town, Central Ethiopia Tue, 20 Sep 2016 08:04:06 +0000 Background. HIV transmission from mother to child continues to be the major source of HIV infection among children under the age of fifteen. Targeting pregnant women attending antenatal clinics provides a unique opportunity for implementing prevention of mother-to-child transmission (PMTCT) programs against HIV infection of newborn babies. This study assessed utilization of PMTCT service of HIV and associated factors among ANC attending mothers. Methods. An institutional based cross-sectional study was conducted from February 20 to March 30, 2015, using exit interviews with 377 ANC attendees using consecutive sampling method. In-depth interviews with service provider were conducted to complement the quantitative data. Data were entered and analysed using EpiData and SPSS, respectively. Results. The prevalence of PMTCT service utilization was 86.9% in this study. Only 8.6% of respondents attended the facility for HCT. After controlling confounders using logistic regression, PMTCT service utilization was associated with age (25–34) of respondents (AOR (95% CI) = 0.46 (0.22, 0.97)), mother’s occupational status (being merchant AOR (95% CI) = 0.31 (0.12, 0.83), government employee AOR (95% CI) = 0.05 (0.01, 0.28), student AOR (95% CI) = 0.1 (0.01, 0.44), and daily laborer AOR (95% CI) = 0.13 (0.05, 0.33)), husband’s educational status (lack of formal education (AOR (95% CI) = 3.3 (1.1, 9.9))), having discussion with husband (AOR (95% CI) = 6.1 (2.6, 14.1)), partner tested (AOR (95% CI) = 8.2 (1.9, 34.46)), and being not satisfied with the service (AOR (95% CI) = 0.46 (0.2, 0.99)). Conclusions. This study revealed that utilization of HIV counseling and testing during antenatal care was high among pregnant women in Sebeta town. It highlights that focusing on improvement of quality and coverage of health services has significant effects on PMTCT service utilization. Effective use or uptake of ARV drug among HIV-positive pregnant women should be further investigated so that utilization will be enhanced. Hailu Merga, Kifle Woldemichael, and Lamessa Dube Copyright © 2016 Hailu Merga et al. All rights reserved. Prevalence of Undernutrition and Its Associated Factors among Children below Five Years of Age in Bure Town, West Gojjam Zone, Amhara National Regional State, Northwest Ethiopia Mon, 01 Aug 2016 12:03:29 +0000 Background. Malnutrition is the major public health problem over the world. Developing countries are highly affected. Asian and Sub-Saharan African countries, including Ethiopia, contribute the highest of all. The main aim of this study was to assess the prevalence of undernutrition and its associated factors among children below five years of age. Methods. Community-based cross-sectional survey was conducted on 342 study participants. Simple random sampling technique was used to select sampling kebeles and study units. Weight and height were measured using calibrated instruments. The data were entered into EpiData version 3.1 software and calculated using SPSS version 20.0 statistical software and/or World Health Organization Anthro software with aid of Stat/Transfer. Results. Overall prevalence of undernutrition was 35.5%, of which 85 (24.9%), 38 (11.1%), and 49 (14.3%) were stunting, wasting, and underweight, respectively. Male children were more affected in both severe and moderate nutritional problems compared to female children. The finding showed that 27 (7.9%) had severe stunting, 15 (4.4%) had severe wasting, and 11 (3.2%) had severe underweight, respectively. Conclusion. Undernutrition was high in Bure town among children below five years of age. Male sex, maternal educational status, low household income, preterm babies, absence of antenatal follow-up, diarrhea, and respiratory infections within one-month duration were factors affecting undernutrition. Desalegne Amare, Ayenew Negesse, Baye Tsegaye, Birtukan Assefa, and Birehanu Ayenie Copyright © 2016 Desalegne Amare et al. All rights reserved. Adaptation of the Godin Leisure-Time Exercise Questionnaire into Turkish: The Validity and Reliability Study Sun, 31 Jul 2016 08:33:14 +0000 This study was conducted with the aim of determining whether the Turkish form of the “Leisure-Time Exercise Questionnaire” developed by Godin is a valid and reliable tool for diabetic patients in Turkey. The study was conducted as a methodological research on 300 diabetic patients in Turkey. The linguistic equivalence of the questionnaire was assessed through the back-translation method, while its content validity was assessed through obtaining expert opinions. Cronbach’s alpha value was found to assess the reliability of the questionnaire. The test-retest analysis and the correlation between independent observers were examined. The content validity index (CVI) was found to be .82 according to the expert assessments, and no statistical difference was found between them (Kendall’s , ). Cronbach’s alpha was found to be , the result of the test-retest analysis was , and the correlation between independent observers (ICC) was .98. This study found that the Turkish form of the Leisure-Time Exercise Questionnaire is a valid and reliable tool that can be used to define and assess the exercise behaviors of Turkish diabetic patients. Emine Sari and Semra Erdoğan Copyright © 2016 Emine Sari and Semra Erdoğan. All rights reserved. Accessibility to, Acceptability of, and Adherence to HIV/AIDS Prevention Services by Men Who Have Sex with Men: Challenges Encountered at Facility Level Mon, 11 Jul 2016 06:01:12 +0000 The prevalence of HIV/AIDS among men who have sex with men (MSM) in Nairobi has been reported to be 16.4% which is a public health concern. The aim of this study was to determine factors that affected accessibility to, acceptability of, and adherence to HIV/AIDS prevention services by men who have sex with men in Nairobi County, Kenya. Methods. The study used a mixed methods design, applying both quantitative and qualitative methods. Results. Over 70% of MSM reported that TB drugs, antiretroviral drugs, lubricants, condoms, and other STI treatment services were accessible. However, 31.6% of MSM reported that discrimination at the health facility level was a hindrance to accessing HIV/AIDS prevention services while 26.3% reported encountering stigma. 48.4% of MSM consumed alcohol while taking of drugs was reported, at 36.1%. Conclusion. Discrimination and stigma adversely affected MSM seeking HIV/AIDS prevention services in health facilities. MSM engaged in alcohol and substance abuse that likely affected their health seeking behavior. Although most prevention services are reported as accessible, uptake of the same needs to be considered. P. C. N. Otambo, A. Makokha, M. Karama, and M. Mwangi Copyright © 2016 P. C. N. Otambo et al. All rights reserved. Public Awareness and Identification of Counterfeit Drugs in Tanzania: A View on Antimalarial Drugs Wed, 08 Jun 2016 08:17:49 +0000 Background. The illicit trade in counterfeit antimalarial drugs is a major setback to the fight against malaria. Information on public awareness and ability to identify counterfeit drugs is scanty. Aim. Therefore, the present study aimed at assessing public awareness and the ability to identify counterfeit antimalarial drugs based on simple observations such as appearance of the drugs, packaging, labelling, and leaflets. Methodology. A cross-sectional study was conducted using interviewer administered structured questionnaire and a checklist. Respondents were required to spot the difference between genuine and counterfeit antimalarial drugs given to them. Data was analysed using SPSS version 20. Results. The majority of respondents, 163 (55.6%), were able to distinguish between genuine and counterfeit antimalarial drugs. Respondents with knowledge on health effects of counterfeit drugs were more likely to identify genuine and counterfeit drugs than their counterparts (; OR = 2.95; 95% CI: 1.47–5.65). The majority of respondents, 190 (64.8%), perceived the presence of counterfeit drugs to be a big problem to the community. Conclusions. A substantial proportion of respondents were able to distinguish between genuine and counterfeit antimalarial drugs. Public empowerment in identifying counterfeit drugs by simple observations is a major step towards discouraging the market of counterfeit drugs. Linus Mhando, Mary B. Jande, Anthony Liwa, Stanley Mwita, and Karol J. Marwa Copyright © 2016 Linus Mhando et al. 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.