Showing papers in "Universal journal of public health in 2015"

Exploring Cyber Harrassment among Women Who Use Social Media

Abstract: The number of Internet users around the word is at an all-time high. The majority of North Americans are internet users and over two-thirds participate in some kind of social network (i.e. Facebook, Twitter, etc.). Social networks and mobile technology enable individuals to connect instantaneously or asynchronously, across geographic boundaries publicly or anonymously. Few studies exploring cyber harassment have been conducted, primarily because these technologies are relatively recent. The purpose of this descriptive study was to examine U.S. women's experiences with and attitudes toward cyber harassment by way of an anonymous electronic survey. A total of 293 adult women (mean age 24.6) recruited from popular social networking sites participated in the research. The majority of participants (58.5%) reported being a student enrolled at a college or university. Close to 20% repeatedly received an unsolicited sexually obscene message and/or sexual solicitation (excluding Spam messages for all categories) on the Internet. More than 10% (11.5%, n = 33) repeatedly received pornographic messages from someone they did not know. More than a third of those who did experience some form of cyber harassment reported feeling anxious. One- fifth indicated they noticed changes in their sleeping and eating patterns as well as feeling helpless because of the harassment. Implications and recommended strategies for health education and personal safety in the online environment are provided.

'It's not as Easy as just Saying 20 Minutes a Day': Exploring Teacher and Principal Experiences Implementing a Provincial Physical Activity Policy

Abstract: In 2005, the Ontario Ministry of Education implemented the Daily Physical Activity (DPA) Policy to provide every elementary student with at least 20 minutes of sustained moderate to vigorous intensity physical activity each day. This exploratory research sought to understand the factors shaping DPA implementation in schools and classrooms, from the perspective of elementary school teachers and principals. Semi-structured interviews were conducted with Ontario grade 1-8 teachers (n=14) and elementary school principals (n=5) regarding DPA implementation, facilitators, barriers, perceived outcomes, and suggestions for change. The majority of participants stated that students were not meeting the requirements daily. However, participants shared activities and techniques for incorporating physical activity into instructional time. Facilitators and barriers to implementation were organized using the Analysis Grid for Environments Linked to Obesity (ANGELO) framework in order to identify factors acting at four environmental levels. The facilitators and barriers identified indicate that staff and resources within individual schools strongly influence implementation. Although many positive outcomes for students were identified, increased fitness was not mentioned, highlighting additional benefits above physical health. The findings suggest DPA is not being implemented as intended, as school staff are finding it difficult to meet the time and intensity requirements. Policy makers must consider the local school environment and the roles of school staff when designing school-based health policies.

Factors Associated with Male Involvement in Family Planning in West Pokot County, Kenya

Abstract: The Contraceptive Prevalence Rate for West Pokot County is estimated to be at a low of 23% compared to the national prevalence which stands at 43%. This analytic cross sectional study was aimed at establishing the male factors associated with family planning in West Pokot County, Kenya. A total of 266 married men were involved and household was the unit of analysis. The findings of this study demonstrated that 48% of the respondents were not involved at all in family planning and only 6% of men were using a family planning method. The age of respondents, educational level, number of children, and type of marriage, knowledge and ease of access to family planning services were all significantly associated with male involvement. Having no education made a man 89% less likely to be highly involved in family planning (OD 0.117; 95% CI: 0.03-0.454). The study concludes that the level of male involvement in family planning in the county is still low despite interventions both by the government and other nongovernmental organizations. Therefore, more efforts should be made to improve education standards especially for men and to reorient family planning services to make them more accessible to men.

Recognizing the Danger Signs and Health Seeking Behaviour of Mothers in Childhood Illness in Karachi, Pakistan

Abstract: Introduction: Maternal behaviour regarding child health care has been recognized as an important social and anthropological factor explaining high mortality rates among children under five years of age. Delays in seeking appropriate health care is known to be the largest risk behaviour which contribute large number of child deaths in developing countries especially in Pakistan. Mothers are mostly responsible for their child health, however, the importance of knowledge among mothers while in identifying the danger sign in their child are very imperative for preventing their illness. Method: A cross sectional study was conducted in an urban setting in Karachi city. The objective of study was to assess the knowledge of mother's regarding danger signs in their child illness and their care seeking behavior with aims to improve the neonatal and child health in Pakistan. Results: The majority of respondent mothers (81.5%) were literate, housewives (90%). Regarding child care the mothers are responsible for the immediate needs of their child. In the context of breast feeding and immunization of the infants, majority of the mothers were aware of practicing early initiation and uses of colostrum because of its importance. Although a large proportion of mothers (90.1%) sought 'appropriate' care for childhood illness, generally care was sought from private doctors (69.4%) instead of government medical practitioners. Conclusion: Study concluded that the Health seeking behviour of mothers has been found appropriate, however, their knowledge regarding the danger signs and illness of their children was reported low. It is recommended that some urgent awareness intervention by the policy makers for reducing the child death should be given to increase their knowledge on the danger sign of child diseases in Pakistan.

Determinants of Low Antenatal Care Services Utilization during the First Trimester of Pregnancy in Southern Benin Rural Setting

Abstract: Antenatal care services for pregnant women improve maternal and child health outcomes. It is recognized that antenatal care services are underutilized in developing countries. The objective of the study was to identify the determinants of low utilization of antenatal care services during the first trimester of pregnancy in southern Benin rural setting. The cross-sectional and analytical study included 301 pregnant women, 29 husbands and 21 health workers in Athieme municipality (southern Benin rural setting) and was conducted from 14 April to 14 July 2014. Data on sociodemographic and antenatal services characteristics were collected using questionnaire, semi-structured interviews and focus groups. Determinants of low utilization of antenatal care services were identified using logistic regression model. Among 301 pregnant women, only 24.6% utilized antenatal care services during the first trimester of the pregnancy. Five independent determinants of low utilization of antenatal care services were identified: low education level of pregnant women, OR= 3.3 [95%CI= (1.534:7.071)]; wrong knowledge of the required period for the first attendance to antenatal care service during pregnancy, OR=5.131 [95%CI= (1.972:13.353)]; adequate knowledge of the benefits of the antenatal care service, OR=4.031 [95%CI= (1.401:11.594)]; participation in the behavior change communication sessions, OR=0.059 [95%CI= (0.028:0.125)]; adequate patient-welcome in antenatal care services, OR= 0.162 [95%CI= (0.051:0.513)]. Sociocultural reasons were also mentioned. Pregnant women underutilize free antenatal care services in Athieme municipality. Effective interventions taking into account the identified determinants may contribute to improve the utilization of antenatal services in southern Benin rural setting.

Birth Prevalence of Overt Congenital Anomalies in Kano Metropolis: Overt Congenital Anomalies in the Kano

Abstract: Congenital anomalies are abnormalities of prenatal origin, and their prevalence varies worldwide. The objective of this study was to determine the prevalence and spectrum of overt congenital anomalies in live born neonates in selected hospitals in the Kano metropolis of North western Nigeria, as well as the associated maternal, paternal and neonatal risk factors. A descriptive study design was employed. All live born neonates in three major hospitals in Kano metropolis were prospectively studied from April 2013 to December 2013. Detailed family history and clinical data were recorded in a structured questionnaire for each child. A total of 1456 live born neonates were recruited into the study, of which 41 (28.15 per 1000 live births) had overt congenital malformations with 5 (12.20%) having multiple system involvement and 36 (87.80%) having a single system affectation. The most common system involved in neonates with isolated single system malformations were the central nervous system (10 cases) and the genitourinary system (10 cases). The consanguinity rate in the study was 17.83%. Birth weight of the neonates had a significant but negative association with the likelihood of being born with a congenital malformation (OR = 0.374; (95% CI 0.196 - 0.711) P = 0.003). Given the high frequency of potentially preventable central nervous system malformations in this study, emphasis on the primary prevention of congenital malformations by encouraging periconceptional use of folic acid containing multivitamin supplements is recommended.

Determinants of Uptake and Utilization of National Hospital Insurance Fund Medical Cover by People in the Informal Sector in Kakamega County, Kenya

Abstract: Low and middle-income countries have extended state sponsored Social Health Insurance (SHI) to people outside the formal sector to enhance access to healthcare. However, in spite of the relatively low costs of signing up and the benefits offered by SHIs, up-take rates are very low among the informal sector populations. The objective of this study was to investigate factors affecting participation of people in the informal sector in the National Hospital Insurance Fund (NHIF) scheme in Kakamega County, Kenya. This cross-sectional study was conducted in Kakamega County in Western Kenya. The study employed a mixed methods designs approach. In the first phase of the study, 400 participants were recruited using both probability and non-probability sampling methods; 400 persons engaged in informal sector activities were recruited through random sampling. In the second phase of the study, 24 key informants and 5 groups consisting of 8-12 persons were purposively selected for in-depth interviews and Focus Group Discussions respectively. The study established that people in the informal sector with higher income (> Kshs.10, 000) are more likely to enroll (odds ratio 2.21 with 95% CI: 1.07 to 4.03) compared to those with low incomes and similarly, higher level of education was significantly associated with enrolment in NHIF scheme (odds ratio 31.07 with 95% CI: 17.19 to 87.94). Rigid scheme design features create difficulties for people in informal sector to participate. In conclusion, policy decisions should focus on interventions directed at educating poor populations, people with low educational levels and those working outside formal employments on the benefits of subscribing to the NHIF scheme in Kenya. The study recommends subsidies or waivers to increase affordability of participation in the NHIF scheme, particularly for people with low monthly incomes.

"What are We Waiting for, Another Child to Die?" A Qualitative Analysis of Regulatory School Environments for Food Allergic Children

Abstract: Severe food allergy, or anaphylaxis, is an immediate and severe allergic reaction that may cause difficulty breathing, hypotension, unconsciousness, and even death. Given there is no cure, managing life-threatening reactions is limited to strict avoidance of implicated foods and provision of medication for symptomatic treatment of an adverse reaction. A key piece of this management is the regulatory frameworks used in public spaces such as schools. This paper explores the perceptions and experiences of 'school' as a safe place for students with anaphylaxis and their parents in two Canadian provinces with very different regulatory environments in order to assess the impact of alternative regulatory environments on the quality of life of affected individuals. A qualitative research design involving draw-and-tell exercises along with in-depth interviews with elementary school-aged children (n=45) and their parents in the provinces of Ontario and Quebec, Canada was used. Results indicate that these very different regulatory environments had differing impacts on kids and parents. Ontario parents found security in the Ontario legislation, while the heterogeneity of the Quebec school regulatory environments resulted in reported stress and anxiety among the parents interviewed. The kids themselves just wanted to feel normal and not be teased or bullied.

Determinants of Adherence to Recommendations of the Dietary Approach to Stop Hypertension in Adults with Hypertension Treated in a Hospital in Benin

Abstract: The dietary approach to stop hypertension (DASH) is an effective nutritional strategy to prevent and treat cardiovascular disease. Optimal benefit from dietary recommendations in management of hypertension depends on the compliance. This analytic cross sectional study aimed at establishing determinants of DASH among adults with hypertension treated at hospital in Benin. The study included 150 hypertensive adults selected during medical visit for blood pressure monitoring at hospital Saint-Luc in Cotonou from June 3rd to July 1st, 2014. Data on consumption of sodium, fruits and vegetables, alcohol, saturated and trans fat rich products were collected by questionnaire. A score of adherence to DASH was built. Determinants of adherence to DASH were identified using logistic regression model. Only 20% of subjects showed adherence to DASH. Better knowledge on hypertension OR=5.18 (95%IC 1.98-13.22) and healthy dietary habits and lifestyle prior to diagnosis of hypertension OR=4.26 (95%IC 1.67-13.18) increased the likelihood of adherence to dietary recommendations for hypertension management. Nutrition education and information of patients on hypertension and its complications during medical consultations may increase their adherence to dietary recommendations for management of the disease.

Incidence, Contributing Factors and Outcomes of Antepartum Hemorrhage in Jimma University Specialized Hospital, Southwest Ethiopia

Abstract: Background: Antepartum haemorrhage complicates three to five percent of pregnancies contributing to perinatal and maternal morbidity and mortality Timely access to quality obstetric services is the major determinant of both maternal and newborn outcomes after antepartum haemorrhage In Ethiopia, the magnitude and consequences of antepartum haemorrhage are not well studied The objective of this study was to determine the incidence, factors associated with and maternal and perinatal outcomes of antepartum haemorrhage in Jimma University Specialized Hospital Methods: A hospital-based prospective cohort study was conducted in Jimma University Specialized Hospital, from January 1 to December 31, 2013 Data were collected by reviewing medical records and interviewing mothers Cumulative incidence of antepartum hemorrhage among mothers who gave birth and odds of adverse outcomes among mothers with and without antepartum hemorrhage were calculated Odds ratio was calculated to estimate the effect of antepartum hemorrhage on maternal and new born adverse outcomes Results: Between January and December 2013, 3854 women gave birth in JUSH The incidence of antepartum hemorrhage was 51% (n=195) in 2013 The major causes of antepartum hemorrhage were abruptio placentae and placenta previa occurring in 127(651%) and 52(267%) of cases, respectively Six (31%) of the patients with antepartum hemorrhage died Of the 206 babies born, 63 (306%) were stillborn and additional 13 (63%) newborns died during the first seven days of life making perinatal mortality rate of 369% Conclusion: Antepartum hemorrhage is a common complication of pregnancy and cause of maternal and perinatal mortality in Jimma University Specialized Hospital The risk of adverse outcomes is very high compared to other countries Efforts to improve access and quality of comprehensive emergency obstetric care services are required

Strategies to Enhance Utilization of National Hospital Insurance Fund Scheme Medical Cover by Informal Sector Populations in Kakamega County, Kenya

Abstract: Social Health Insurance (SHI) has been preferred form of financing health care to reduce out of pocket expenditure on health care. Most countries are extending SHI programmes to people outside the formal sector in an effort to increase access to healthcare. However, this approach faces challenges of enrolment of sufficient numbers of people into a common risk pool and collection of contributions. The objective of this study was to evaluate strategies to enhance participation of people in the informal sector in Kakamega County in the National Hospital Insurance Fund (NHIF) Scheme for access to health care. This was a descriptive qualitative study with sample units purposively selected. Ten Focus Group Discussions were conducted and several Key informants interviewed. Data obtained was scrutinized for emerging themes. The study established that people in the informal sector in Kakamega County were aware of the value of the NHIF cover for accessing health care but lack accurate information on the insurance function of the NHIF cover. Rigid scheme design features also discourage subscription. Major recommendations included policy review of rigid scheme conditions, making the scheme attractive and increasing registration centers. Policy decisions should focus on educating people working outside formal employments on insurance functions of the NHIF cover.

Evaluation of a Service Intervention to Improve Uptake of Breast Cancer Screening in a London Borough with Many Hard to Reach Communities

Abstract: Uptake of breast cancer screening is lowest in areas of London with many hard to reach communities. This report evaluates two interventions to improve uptake of breast cancer screening in the Royal London Borough of Greenwich with many hard to reach communities. The interventions involved splitting 2,004 women eligible for screening into two groups. Group 1 who were sent letter only invites has a target group (n=1,452) and eligible women screened were (n=878). Whilst, group 2 who were sent letter invites combined with Short Message service (SMS) reminder has a target group (n=552) and eligible women screened were (n=376). The result shows a significant difference in attendance rates between the two invitation methods. The screening uptake by the women who received invitation letter only had an attendance rate of 60 percent (table1). The screening uptake by the women who received invitation letter and SMS reminder was 68 percent (table 2). This amounts to 8 percent differential rate, which translates to an additional 44 women who were screened, as a direct result of receiving an SMS reminder. Applying the achieved result to the "Letter Only" group indicates that an additional 12 women would theoretically have been screened if the 'Letter only' invites were also sent with SMS reminder. An overall 2.54 percentage point increase in screening outcome was achieved when compared the uptake in the months of the project (July to Dec 2011) with the uptake in similar months in 2010. Finally, the results prove that intervention by letter invite combined with SMS reminder is the most effective method of improving uptake of breast cancer screening in the borough with many hard to reach communities.

Assessment of Prevalence and Reasons for Termination of Pregnancy at Jimma University Teaching Hospital, Ethiopia

Abstract: Background: Increasing legal access to abortion is associated with improvement in sexual and reproductive health. Conversely, unsafe abortion and related mortality are both highest in countries with narrow grounds for legal abortion. The objective of this study was to determine the prevalence and reasons for terminations of pregnancy at Jimma university teaching hospital. Methods: A retrospective cross sectional study was conducted at JUTH from June15-28, 2015, a total of 194 cards of women who came for abortion services from January 2012-January 2014 were included by systematic random sampling with inclusion and exclusion criteria. Chi square (x2) test calculated to analyze the statistical association between abortion types and other variables, p-value less than 0.05 was considered statistically significant. Result: According to this study, of the total calculated 194 sample size from clients admitted for both spontaneous and induced abortion 125(64.4%) were spontaneous and 69(35.6%) were induced abortion. 28(14.4%) of incomplete spontaneous abortion occurs between age of 25-years.one of the most common complication in this study was sepsis 23(11.9%). This study revealed that the main reason for induced abortion was due to rape and economic problem which holds 30(15.5%) and 16(8.2%) respectively Occupation and marital status are strongly associated with types of abortion with p-value of P<0.001. Conclusion and recommendation: The study concludes that majority of abortion were spontaneous abortion which almost hold all septic abortion and majority of induced abortion were teenage, single students and most of them presented after 2nd trimester of pregnancy which increases the complication of abortion. Thus, health education on dangers of induced abortion, spontaneous abortion and utilization of contraceptive methods services to all women are highly recommended.

Factors Influencing Teenager to Initiate Smoking in South-west Bangladesh

Abstract: Long term smoking poses many health hazards that most of the teenagers know, but many do not care. Once they start smoking, struggle to cease throughout the lifespan. Peer pressure is one of the main causes of initiating smoking observed by many studies. The research was mainly carried out to explore the factors influencing the teen to initiate smoking in south-west region of Bangladesh. A number of 408 students from level 7 to 12 were interviewed using a semi-structured questionnaire during February to November, 2014. The curiosity of the teen and 'to get rid of frustration' is the two main reasons of initiating smoking. Some other acknowledged reasons are peer pressure; desire to fit with friends, fun making, copying parent or elderly, and to relief from mental stress. More than half of the teens smoke to overcome psychological stress. Some others are smoking to keep relaxed from study load, to keep away family problem as well as for outlook and personality. Many of the teen smokers used to smoke because of reasonably priced and easy to obtain. To overcome the situation, academic institutes can arrange workshop or seminar regarding the consequences of smoking on health. Health effects of smoking can also be added in the curriculum so that the teen can understand and re-think about their harmful habit.

Canadian Policy on Food Allergen Labelling: Consumers' Perspectives Regarding Unmet Needs

Abstract: It is estimated that 50% of Canadian households are directly or indirectly affected by food allergies. Since accidental exposure to food allergens can cause life-threatening reactions, the need for accurate allergen labelling is key. In Canada, new food allergen labelling guidelines were mandated in August 2012. While a substantial improvement, gaps remain. This study explored the perspectives of directly affected individuals as well as members of the general public regarding their needs and preferences for precautionary labelling, allergen symbols, and suggestions for improving labelling practices in Canada. Eight qualitative focus groups were conducted with directly affected (n=27) and general public (n=24) consumers in Vancouver, Canada. Focus groups were audio recorded and transcribed verbatim for subsequent thematic analysis using NVivo9. Although "may contain" is recommended by Health Canada, it was the least preferred precautionary statement among research participants. Both participant groups described how many consumers' purchasing habits are indirectly affected by food allergy; hence, their views should be considered in addition to those of directly affected individuals when developing allergen labelling policies. The findings identify future policy needs: 1) mandating and standardizing precautionary/allergen statements and symbols, 2) increased monitoring, and 3) increasing food allergy education and awareness among consumers and manufacturers.

Bureaucratic Barriers to Evidence-based Tobacco Control Policy: A Tasmanian Case Study

Abstract: The aim was to examine bureaucratic barriers to implementing strategies for tobacco control in Tasmania. We analysed documents provided by government agencies under Right to Information legislation; documents provided by non-government organisations (NGOs), newspaper reports, websites and Hansards relevant for the period 1997 to 2010. Responsible Tasmanian bureaucratic organisations have had a culture of avoiding responsibility for high smoking rates, their processes being excessively complex, under-resourced in expertise and funding for mass media campaigns, having poor accountability mechanisms, failed to adhere to international standards in dealings with the tobacco industry, failed to follow evidence-based public policy despite being aware of its existence, were distracted by immediate needs, experienced passive and active obstruction from other government agencies, and did not adequately inform the Parliament about measures which might reduce smoking rates. The operation and culture of the Tasmanian bureaucracy has been a significant barrier to evidence-based tobacco control public policy. This deficiency was not confined to the Department of Health and Human Services, but also included the Departments of Premier and Cabinet and Treasury. Major barriers to evidence-based tobacco control have existed within the bureaucratic systems in Tasmania in the period 1997 to 2010. They were excessively process-driven, complex structures, with lack of "evidence transfer", antipathetic in culture and had scant resources. Similar barriers exist in some other jurisdictions. All this served to undermine the effectiveness of public-health expert-driven action.

Prevent or Cure? – A New Philosophy of Health Care

Abstract: Health care systems evolve at the same time in many different ways: in area of developing technologies, the development of the medical knowledge, because of demographical changes and particularly - aging of the society. This induces modifications of the priorities of the health policy, new methods of organization and more complex funding mechanisms. Individual components of the health care system: illness prevention and health promotion, basic health care, hospital care have different contribution into the health care systems of different countries. The worlds growing awareness that for keeping and improving the population health the governments must create effective and efficient health system leads to the effective illness prevention. It shouldn't be expected that the health effects and economic efficiency of the health care system will improve, without appropriate expenditures on actions which delay or prevent illness, and also allow early diagnosis and effective (usually cheaper) treatment. In the first part of the paper there will be discussed issues connected with modern health conceptions which create the fundaments of the approach to the illness prevention. Health care is the specific public goods. This induces the choice of criteria, used by policy makers, to allocate public sources. In the second part the crucial significance is to specify the determinant of the changes of the health benefits structures financed from the public means. The last part of this elaboration, based on gathered empirical data, will discussed experiences of the selected European countries on prevention of the selected illnesses, indicating the links between expenditures and the effects of the prevention activities.

Chronic Fatigue Syndrome Prevalence and its Relation to Job Performance among Nurses

Abstract: Background and Objectives: Chronic Fatigue Syndrome (CFS) is a severe, debilitating disorder. Permanent chronic fatigue that affects the daily routine activities at least for six months and4 of the 8 patients reported symptoms associated with this disorder (problems of memory / concentration, restless sleep, joint pain, swollen lymph nodes, muscle pain, headache, sore throat, weakness due to work) and the absence of any underlying disease is the another sign of this disorder. One of the important things that are noticeable about the syndrome, is causing physical and mental disabilities in the person that will lead to approximately 50% reduction in his job performance. Methods: This study has been conducted through self-reported questionnaire and field and library studies. So the desired randomly set of 78 nurses have been selected to answer the two demographic information and symptoms questionnaires CFS (DSQ. revised)which it's reliability and validity has been verified. These questionnaires have been adjusted to the patient's preliminary data record and their symptoms. In the second stage, each individual job performance questionnaire was completed by department head. Results: The information obtained from the chronic fatigue syndrome questionnaire shows 14.1% prevalence of CFS. In discussing the relationship between CFS and indicators of job performance, it was cleared that people with the syndrome has lower job performance than those are healthy. Conclusions: In many similar studies, the effects of CFS on overall job performance in subjects were discussed and in most cases have been verified. The only differences are in subdivisions of job performance which are considered in this research

The Influence of Aerobic Fitness on the Relationship between Academic Performance and Motor Proficiency

Abstract: Purpose: To determine whether physical fitness mediates the relationship between academic performance and motor proficiency in children. Methods: The academic achievement of 1864 students (F:926, M:938, age 11.91 (SD:0.34) from the Niagara Region of Ontario was derived from the average of provincial standardized tests for reading, writing, and mathematics. The Bruininks-Oseretsky Test of Motor Performance (short-form) determined motor proficiency. Fitness (peak oxygen uptake) was established with the 20-metre shuttle run multistage test. Results: Hierarchical linear modeling identified several significant predictors of academic performance. After controlling for age (p=0.7002), gender (p<0.0001), and parental education (p<0.0001), both motor proficiency (p<0.0001) and physical fitness (p=0.0004) remained significant. The addition of physical fitness to the model reduced the point estimate of motor proficiency from 0.004 to 0.003, a reduction of 25%. However, further examination of the 95% confidence intervals suggests that this reduction is not significant. Conclusions: These results suggest that aerobic fitness does not mediate the relationship between motor proficiency and academic performance. Both physical fitness and motor proficiency have independent roles in predicting academic performance.

HIV/AIDS Scourge and Economic Growth in Sub-Sahara Africa

Abstract: This study examines the impact of HIV/ AIDS scourge on economic growth of some selected Sub-Sahara African countries. The three sub-Sahara African regions (Southern, West and Eastern) are categorized into lowest and highest HIV prevalence rate, using the global report of the UNAIDS 2012 data. In each region, the lowest and the highest HIV prevalence rate countries are selected respectively. Thus, we consider a panel of three countries in each category over a period from 1995 - 2012. We used these data to estimate the cross-country level regressions of these two categories, using panel data models. Thus, our results are in twofold: For lowest HIV prevalence rate category, the pooled OLS model was the "best" model. This pooled OLS model indicated that, for one unit increase in HIV prevalence rate, the gross domestic product per capita of countries is expected to decrease by US$23.46, holding all other variables constant. Again for highest HIV prevalence rate category, the fixed effect model was the "best" model. The fixed effect model revealed that, one unit increase in HIV prevalence rate will cause the gross domestic product per capita of countries to decrease by US$9.98, holding all other variables constant. Generally, for a unit increase in HIV prevalence rate, the impact of HIV on the economy is two-thirds larger in lowest HIV prevalence rate countries than that of the highest HIV prevalence rate countries.

What Does Not Kill Us Makes Us Stronger: Implications for Bosnian Refugees' Coping Skills during a Natural Disaster

Abstract: This study explored Bosnian refugees' attitudes and beliefs about how to cope with a potential natural disaster. A total of thirty-three Bosnian adult refugees participated in the study. Face-to-face, in-depth individual interviews were conducted. The findings indicated that Bosnian refugees developed a number of coping skills for survival and sustainability through their previous disaster experiences and emergency trainings. Their preparedness for a natural disaster can be characterized by strong leadership qualities, with more economic and social resources to draw on for coping, and close ties to local community. In case of an emergency, they would likely be calm, optimistic, and emotionally independent. Given the development of this group's coping skills, Bosnian refugees have a strong potential for serving as volunteers in disaster preparedness, response, and recovery. Particular attention should be paid, nevertheless, to these refugees' emotional and mental health needs in the aftermath of a natural disaster.

Multimorbidity and Unobserved Heterogeneity in the Study of Clinical Mortality

Abstract: In most epidemiological data sets one cannot be certain that all risk factors are measured or observed. This paper studies the risk for mortality associated with diseases and deals with heterogeneity in mortality owing to unobserved covariates. We extracted medical records of 186 hospitalized patients from an urban health facility in Ghana. Patients with at least 2 diagnoses of chronic diseases were considered multimorbid. Using age of patients at death as survival time we executed our analysis with and without incorporating frailty effect to Cox proportional hazards (PH) model. The Cox PH model with Gaussian frailty fitted the data better when compared to the standard Cox PH model and Cox PH model with gamma frailty. On average patients were aged 62.315.3 years, with 66.1% being multimorbid. Varying degrees of mortality risks were found for different diseases, with the highest associated with having pulmonary valve disorders (HR 7.99, 95% CI 1.45-44.0). Heterogeneity in mortality resulting from unmeasured factors was insignifi- cant. This study demonstrates that patients share similar risk with respect to unobserved factors, but varying risk when conditioned on observables.

Understanding Motivations: Exploring Adolescents Perceptions and Experiences of Physical Activity-Nutrition Program

Abstract: The increasing rate of obesity among children and youth is a major health concern for the Canadian population Although exercise-based intervention programs have shown significant improvements in clinical markers, maintenance and management of these improvements are often stunted or reversed due to barriers relating to negative attitudes and lack of motivation towards exercise The Self-Determination Theory suggests a shift in motivation towards physical activity, from lack thereof to autonomous, can occur within supportive environments It is thus crucial to explore the perceptions and experiences of overweight adolescents enrolled in fitness-nutrition programs This research attempts to go beyond the biophysical markers of health to provide insight on individual experiences that affect attitudes towards exercise and making healthy choices In-depth interviews were conducted with adolescents (aged 12-16years) to discuss their experience(s) in a referral-based fitness-nutrition program Results from this study revealed that participants' attitude and perception of exercise shifted from apprehension to full engagement/enjoyment and were associated with individuals gaining self-confidence These attitudes further translated to individual lifestyle changes outside of the program, illustrating the shift in motivation from external to internal These results suggest that a potential key to enhancing physical activity and making healthy choice among overweight adolescents lie in shifting individual attitudes from a motivation to autonomous motivation in pressure-free supportive environments

Health Services Consumers Perceptions on Task Shifting of Primary Healthcare Functions to Community Health Workers in Rural Butere Sub County, Western Kenya

Abstract: Background: Attaining universal access to primary healthcare services require radical changes in human resource and retention strategies. Hence, the task shifting is introduced. This is a process of delegation whereby tasks are moved to the most appropriate but less specialized level of Community Health Workers (CHWs). Effective planning to enhance scaling up of this strategy however, needs evidence which according to many researchers is vital but lacking. Methodology: This study provides such data for evidence based health policy decision making through the health services consumers' perceptions on task shifting in relation to CHWs current roles and responsibilities. The study was qualitative with fifteen focus group discussions held with health service consumers linked to the CHWs services. Ethical approval was gained through the Moi University and Great Lakes University of Kisumu Ethical Review Board and Committee respectively. Results: Short duration training programs, with mostly promotional, preventive and some curative tasks were suggested to be shifted to CHWs with a relatively strong monitoring and supervision mechanism. Consumers agreed that task shifting had significantly increased access to health services and improved health outcomes. Conclusion: Task shifting if well implemented could play a major role in improving access to, and equity in provision of primary healthcare services. However, there is the need to recognize, and carefully plan and implement task shifting. Failure to do so could result in it becoming a parallel health system competing with the formal healthcare system but with compromised quality. Hence, the Ministry of Health and other relevant stakeholders need to institute quality assurance frameworks, including standardized training, supervision, certification and regular assessments for effective task shifting models.

The Association between Sleep Loss and Women's Wellness Decisions

Abstract: Sleep loss is an important determinant of health status owing to its relationships with molecular, immune, and neural changes; these changes, in turn, are important etiological mechanisms for the development of cardiovascular, metabolic diseases and increased risk of accident related injuries. While the association between sleep loss and risk of weight gain is established, studies on the association between sleep loss and nutrition and physical activity are limited. The purpose of this research was to determine if there are significant associations between reported sleep variations and nutrition and physical activity level while recognizing the association between body mass index (BMI) and sleep loss. Data from the 2011 sleep-related questions captured by the Centers for Disease Control and Prevention's (CDC) Behavioral Risk Factor Surveillance System (BRFSS) was used to identify possible behavioral indicators related to sleep loss in women. Multiple logistic regression was used to assess the hypothesized associations between sleep loss and fruit and vegetable consumption and physical activity levels. The odds ratios for the association between fruit/vegetable intake and sleep loss and that of BMI and sleep loss were (OR =0.761, 95% CI =0.651, 0.889) and (OR = 1.108, 95% CI =0.972, 1.262), respectively. The odds ratio for the association between physical exercise and sleep loss was (OR = 0.991, 95% CI =0.864, 1.137). Having adjusted for relevant covariates, consumption of fruits and vegetables was significantly associated with sleep loss; physical activity was not significantly associated with sleep loss.

Assessment of the Potential for Spread of Deadly Ebola Virus across International Borders by Returnee Travelers and Humanitarian Health Workers from West Africa

Abstract: The recent Ebola Virus Disease (EVD) outbreak in West Africa is so far the largest and deadliest in recorded history. The rapid spread of the disease in the region and its potential for international spread prompted the World Health Organization to declare the outbreak a public health emergency of international concern. (1) This paper assesses the potential for the spread of the disease across international borders by returnee travelers and humanitarian health workers, given that the disease spreads through physical contact. The surveillance data published by both the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) were reviewed to identify the EVD epidemiological situation in West Africa from March 2014 to September 2014. The risk assessment data published by Public Health England (PHE) and CDC travel updates were reviewed to identify travel group(s) most at risk of transmitting EVD across international borders. Studies focusing on West African cultural practices were also reviewed to identify aspects that carry risk of EVD transmission. The study found that the risk of travelers transmitting EVD across international borders is low and would remain so on two conditions. First, all travelers must avoid direct physical contact with a sick or d ead person or animal infected with EVD. Second, international humanitarian health workers in affected areas of West Africa who will eventually return to their home countries must work in safe environments with adequate protective equipment. The risk of travelers acquiring EVD is considered very low, yet there is serious concern that the disease may spread further within West Africa and across international borders. Local burial practices exacerbate the disease spread while poor working environments and inadequate supply of equipment increase risk of exposure to EVD of humanitarian workers. This researcher recommends addressing the issues through local awareness, pre-travel advice and capacity investment in the healthcare infrastructure in the EVD affected areas.

The Impact of Cigarette Type on Consumers' Perception of Health Risks of Smoking

Abstract: Background: Smoking prevalence in Singapore has increased from 12.6 % in 2006 to 14.3% in 2011 despite restrictions on tobacco advertising and promotion act, largely due to the strategies of the tobacco industry such as cigarette packaging suggesting lower tar content to target the young and the health conscious. Objectives: To review the perception of health risks of different types of cigarettes across smoking status, age-group and gender, and to determine if smokers perceive differences in health risks based on the taste of cigarettes alone. Method: 240 smokers and 240 non-smokers were presented with cigarette boxes a pair each time and were asked a series of questions on perception of tar content, taste and perceived health risk. Participants who identified themselves as smokers were blindfolded and asked to take 2 puffs of each cigarette type and asked to rate for 'Presence of tar', 'Smoothness of taste' and 'Health risk'. Results: A significant majority of the participants selected 'regular' cigarettes as delivering more tar than 'light' and 'menthol' cigarettes, while 'lights' and 'menthol' cigarettes were perceived as smoother-tasting and being able to reduce health risks. Non-smokers were more susceptible to perceive 'lights' cigarettes as a 'healthier' choice, compared to smokers, but not females or adolescents. Smokers, based on taste alone, rated regular cigarettes to be higher in health risks compared to both 'lights' and 'menthol' cigarettes, which were similarly rated. Discussion: The perception of health risks across different types of cigarettes are affected by the deceptive descriptors on the packaging, but the local increase in prevalence of youth and female smoking cannot be explained by their susceptibility to packaging influences. Taste of cigarettes seems to affect smokers' perception of health-risks as well; hence bans on deceptive descriptors on cigarette packaging may not totally eliminate differences in perception of health risks of different types of cigarettes.

The Perceptions of Community Change through Promoting Positive Sexual Health: A Teenage Pregnancy Program Evaluation

Abstract: Teenage pregnancy is associated with adverse social, economic and health outcomes for both mother and child. The factors frequently associated with teenage pregnancy or related sexual health issues include teenagers' knowledge, attitudes, and beliefs about sex and other social-economic factors such as levels of poverty, academic success or failure, and parents' education. This paper reports on the evaluation of a teenage pregnancy program conducted in the Southern and North Western regions of Tasmania to address the high levels of teenage pregnancy and sexually transmitted infection (STIs) in these regions. The aim of the study was to examine the effectiveness of the Teenage Pregnancy Programs by examining any evidence for a community change in attitudes and behaviours, and any changes in youth awareness about sexual health. The study adopted a qualitative approach and data were collected from a total of 25 participants (17 who were interviewed and eight who participated in focus groups) residing in the target regions. Data were analysed using thematic analysis using Nvivo 9.0. The study results indicated that the program was well managed and delivered. There were reported changes in the awareness, attitudes and behaviours regarding sexual health within the target communities, which were considered necessary for young people to make well informed choices. The evaluation of the program provides valuable knowledge regarding the processes and outcomes that may have application in future community based sexual health initiatives may be delivered into regional communities.

Clearance Failure Rates of Plasmodium falciparum after Treatment among Children (6-11 years) in Kisumu East Sub County

Abstract: Plasmodium falciparum is said to be yet sensitive to artemether-lumefantrine (AL) among all age groups in Kisumu County, despites report of its isolated strain with reduced sensitivity in Kilifi and reported reduced sensitivity to artemisinins in South East Asia. This trial intended to compare Plasmodium falciparum clearance failure rates among children (6-11 years) with uncomplicated falciparum malaria randomly allocated to artesunate-mefloquine or generic artemether-lumefantrine. We conducted a two arms open label randomized controlled trial with a fourteen day follow up and a sample size of 130 children with uncomplicated falciparum malaria in government primary schools of Kisumu East Sub County. This study showed Plasmodium falciparum clearance failure rates significantly higher (P = 0.02) with generic artemether-lumefantrine than with artesunate-mefloquine on day one of treatment. However, no significant difference (P = 0.999) was observed between the two arms on day seven and day fourteen of treatment. Thus, Plasmodium falciparum was less likely to fail to clear as it responded to artesunate-mefloquine than to generic artemether-lumefantrine on day one of treatment. Nevertheless, it was unlikely to fail to clear as it responded to both artesunate-mefloquine and generic artemether-lumefantrine on day seven and day fourteen of treatment.

Using Waist Circumference Measurements to Enhance the Public's Understanding of Childhood Obesity: Accounting for Health Literacy

Abstract: This study examined the extent to which the measurement of waist circumference (WC) can categorize overweight/obesity status similarly to BMI in children. Height and weight were measured and BMI was calculated for participants' age 9 to 11 years old. Children were classified as either normal-weight, overweight, or obese. WC was measured twice and the average of these measures recorded. Receiver-operator characteristic curves were computed for each age and gender for both overweight and obese using BMI as the standard. For each analysis the area under the curve was used as an overall indicator of agreement between the two measures. WC achieved very strong sensitivity for both overweight and obesity for both genders, ranging from .90 to .93. Specificity for obesity for both genders was very strong, ranging from .89 to .93 for girls and from .90 to .93 for boys. While specificity for obese remains high for both genders (.89 - .93) across all three years, the specificity for overweight fell to .68 to .84 for boys and to .66 to .74 for girls. Due to low levels of health literacy in the population, using WC may provide an easy to understand measure of obese or overweight status.