Methods

The study uses information from the Understanding the Lives of Adolescents and Young Adults (UDAYA) project survey conducted in Uttar Pradesh and Bihar in 2016. The study sample consisted of 14,625 adolescent girls aged 10–19 years. The study sample was selected using a multi-stage systematic sampling design. Multilevel logistic regression (MLR) was used to identify the individual and community level factors associated with the use of sanitary napkins.

Results

The results revealed a wide variation in sanitary napkins’ use across the socio-economic and demographic factors. The use of sanitary napkins was significantly higher among girls with 8–9 (53.2%) and 10 and more (75.4%) years of schooling compared to those who had no formal education (26.4%). The use of sanitary napkins was higher among adolescent girls who were not engaged in paid work (54.7%) than those who did any paid job (40.8%). Adolescent girls reporting frequent exposure to mass media (OR = 2.10), belonging to the richest wealth quintile (OR = 3.76), and whose mothers had 10 or more years of education (OR = 2.29) had a higher propensity to use sanitary napkins than their counterparts. We did not find a significant role of community-level education of mothers on the menstrual hygiene practices of adolescents.

Conclusion

Ensuring that adolescent girls have access to hygienic means to manage their menses is critical from a public health perspective and in enabling them to realize their full potential. Programs to enhance menstrual hygiene are warranted. These programs should involve mothers, who are an important source of knowledge about menstrual hygiene. Facilitating girls’ access to education may also produce tangible menstrual hygiene benefits.

Methods

We conducted 6 in-depth interviews, 70 key informant interviews, and 13 focus group discussions among purposively selected community groups, experts, and lactating mothers between November- 2017 and January- 2018. Audio records of all interviews and focus group discussions were transcribed verbatim (word-to-word) and translated into English. Then, translated data were analyzed thematically using qualitative data analysis software Atlas ti-version 7.4.

Results

The participants in this study perceived that lactating mothers in their study area are not properly utilizing available and recommended nutrition interventions, and as a result, their nutrient intake was reported as inadequate. Participants identified inadequate accessibility and availability of foods, feeding practices, cultural and religious influences, focus on agricultural production and productivity, barriers related to health services and poor access to water, sanitation and hygiene as major barriers hindering the uptake of nutrition interventions by lactating women in Tigray, northern Ethiopia.

Conclusion

The uptake of nutrition intervention services was low among lactating mothers and was hindered by multiple socio-cultural and health service related factors requiring problem-specific interventions at community, health facility, and administrative levels to improve the nutritional status of lactating mothers in the study area.

Methods

We utilised a mixed methods approach. A difference-in-difference approach was used to quantify the average impact of the model with Kajiado as the intervention County and Mandera, Marsabit and Wajir as control counties. The approach relied on secondary data analysis of the Kenya Demographic and Health Survey (KDHS) 2003, 2008–2009 and 2014. A qualitative approach involving focus group discussions, in-depth interviews and key informant interviews were conducted with various respondents and community stakeholders to document experiences, attitude and practices towards FGM/C.

Results

The CLARP has contributed to: 1) decline in FGM/C prevalence, CEFM rates and TP rates among girls by 24.2% (p<0.10), 4.9% (p<0.01) and 6.3% (p<0.01) respectively. 2) increase in girls schooling years by 2.5 years (p<0.05). Perceived CLARP benefits to girls included: reduction in teenage marriages and childbirth; increased school retention and completion; teenage pregnancies reduction and decline in FGM/C prevalence. Community stakeholders in Kajiado believe that CLARP has been embraced in the community because of its impacts in the lives of its beneficiaries and their families.

Conclusion

This study demonstrated that CLARP has been positively received by the Maasai community and has played a significant role in attenuating FGM/C, CEFM and TP in Kajiado, while contributing to increasing girls’ schooling years. CLARP is replicable as it is currently being implemented in Tanzania. We recommend scaling it up for adoption by stakeholders implementing in other counties that practice FGM/C as a rite of passage in Kenya and across other sub Saharan Africa countries.

Methodology/Principal findings

Here, we report the sequences of 59 SARS-CoV-2 samples from inhabitants of the Colombian Amazonas department. The viral genomes were distributed in two robust clusters within the distinct GISAID clades GH and G. Spatial-temporal analyses revealed two independent introductions of SARS-CoV-2 in the region, one around April 1, 2020 associated with a local transmission, and one around April 2, 2020 associated with other South American genomes (Uruguay and Brazil). We also identified ten lineages circulating in the Amazonas department including the P.1 variant of concern (VOC).

Conclusions/Significance

This study represents the first genomic epidemiology investigation of SARS-CoV-2 in one of the territories with the highest report of indigenous communities of the country. Such findings are essential to decipher viral transmission, inform on global spread and to direct implementation of infection prevention and control measures for these vulnerable populations, especially, due to the recent circulation of one of the variants of concern (P.1) associated with major transmissibility and possible reinfections.

Methods

Descriptive analytic cross-sectional study was conducted from Dec 2019 –May 2020 at the King Khalid University Hospital (KKUH); a teaching facility with general and subspecialty medical services in King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia. Data were collected using a structured pretested questionnaire and analyzed using SPSS version 23.0. Descriptive statistics and Chi square tests were used. Multivariate logistic regression analysis was used to find significant predictors for EC awareness and use. A p value < 0.05 was considered statistically significant.

Results

A total of 461 participants completed the questionnaire (response rate 86%). The majority (82%) of the participants were unaware of EC; with only 18% having some knowledge. Knowledgeable men had positive attitudes (73.5%) about EC as compared to non- knowledgeable ones (55.0%). Factors found to be associated with less knowledge of EC were cultural [0.46, 95%CI 0.22. 0.96] and religious unacceptability [OR 0.51, 95%CI 0.29, 0.89)]. Higher level of education [OR 1.83, 95%CI 0.94, 3.53] was associated with more knowledge regarding EC. The study showed that correct information about using contraceptives within 3 days of unprotected sex [OR 4.96, 95%CI 1.81, 13.60]; availability without prescription [OR 5.06, 95%CI 1.68, 15.30], EC advertisement [OR 4.84, 95%CI 0.96, 24.27] and receipt of information from family/friends [OR 18.50, 95%CI 5.19, 65.93] were factors that contributed to men using EC.

Conclusion

The current knowledge of EC among men is limited. Social determinants affect these levels of knowledge, as well as the usage of EC. Factors that were associated with the use of ECPs were correct knowledge, advertisement, availability and receipt of information from family/friends. The findings highlight the need to educate men on this important topic to avoid unintended pregnancy, keeping in view cultural and social values. Future qualitative studies are needed to understand the male perspective.

Objective

To investigate the awareness regarding risk factors and determinants of cancers among Bahir Dar city residents, northwest, 2019

Methods

A community-based cross-sectional study was employed. A systematic random sampling technique was carried out to select 845 study participants from May 1 to June 30, 2019. A validated structured cancer awareness measuring tool was used to collect the data. The data were entered into the Epi-data version 3.1 and analyzed using SPSS version 21 software. A simple logistic regression was run, and AOR (adjusted odds ratio) at a 95% confidence interval was used to identify the determinants of awareness regarding risk factors of cancers.

Results

Nearly twenty percent of the respondents had a good awareness regarding risk factors of cancers. An orthodox Christian (AOR = 3. 2; 95%CI: 1.8, 5.6), college graduated (AOR = 2. 3; 95%CI:1.1, 4.9), a family member with cancer (AOR = 2. 0; 95%CI: 1.3, 3.3), and living in a rental house (AOR = 0. 6; 95%CI: 0.4, 0.9) were significantly associated with awareness regarding risk factors of cancers.

Conclusion

The study revealed that awareness regarding risk factors of cancers was very low in the study area. Being Orthodox Christian, college graduated, a family member with cancer, and living in the rental house were the determinants of awareness regarding risk factors of cancers.

Methods

A rapid program evaluation using a qualitative study approach was conducted in three home-based palliative care programs in Addis Ababa and Yirgalem town, Ethiopia. Female patients enrolled in the programs, and their primary caregivers were interviewed on palliative care needs, preferences and service provision. We explored the views of purposely selected stakeholders on the organization of palliative care and its challenges. Audio-taped data was transcribed verbatim and translated into English and an inductive thematic analysis was applied. Descriptive analyses were used to label physical signs and symptoms using palliative outcome scale score.

Results

A total of 77 interviews (34 patients, 12 primary caregivers, 15 voluntary caregivers, 16 stakeholders) were conducted. The main physical complaints were moderate to severe pain (70.6%), followed by anorexia (50.0%), insomnia, nausea and vomiting (41.2%). Social interaction and daily activities were hampered by the patients’ condition. Both patients and caregivers reported that programs focus most on treatment of symptoms, with limited psychosocial, emotional, spiritual and economic support. Lack of organizational structures and policy directions limit the collaboration between stakeholders and the availability of holistic home-based palliative care services.

Conclusions

Although female patients and caregivers appreciated the palliative care and support provided, the existing services did not cover all needs. Pain management and all other needed supports were lacking. Multi-sectorial collaboration with active involvement of community-based structures is needed to improve quality of care and access to holistic palliative care services.

Methods

A cluster-randomised controlled study was conducted between 2016 and 2019. Of the 18 Local Government Areas (LGA) in Cross River State, eight (four urban and four rural LGAs) were randomized into the intervention and control study arms. A multi-component intervention involving the training of traditional and religious leaders was implemented in the four intervention LGAs. Baseline, midline and endline surveys collected information on children aged 0–23 months. The effect of the intervention on outcomes including the proportion fully up-to-date with vaccination, timely vaccination for pentavalent and measles vaccines, and pentavalent 1–3 dropout rates were estimated using logistic regression models using random effects to account for the clustered data.

Results

A total of 2598 children at baseline, 2570 at midline, and 2550 at endline were included. The intervention was effective in increasing the proportion with at least one vaccine (OR 12.13 95% CI 6.03–24.41p<0.001). However, there was no evidence of an impact on the proportion of children up-to-date with vaccination (p = 0.69). It was effective in improving timeliness of Pentavalent 3 (OR 1.55; 95% CI: 1.14, 2.12; p = 0.005) and Measles (OR 2.81; 96% CI: 1.93–4.1; p<0.001) vaccination. The odds of completing Pentavalent vaccination increased (OR = 1.66 95% CI: 1.08,2.55).

Conclusion

Informal training to enhance the traditional and religious leaders’ knowledge of vaccination and their leadership role can empower them to be good influencers for childhood vaccination. They constitute untapped resources in the community to boost routine immunisation.

Pan African Clinical Trial Registry (PACTR) PACTR202008784222254.

Methodology

We used a quasi-experimental, before-after study design with a mixed methods approach. The 10-week family-based intervention was designed to strengthen the resilience of individuals and families by enhancing their protective abilities and capacity to overcome adversity. The study was conducted in two sites, urban areas in Telangana state, and in rural areas in Odisha state, India. Persons affected and their family members were included using purposive sampling. Two questionnaires were used pre-and post-intervention: the Connor-Davidson Resilience Scale (CD-RISC, maximum score 100, with high scores reflecting greater resilience) and the WHOQOL-BREF (maximum score of 130, with higher scores reflecting higher quality of life). In addition, semi-structured interviews were conducted post-intervention. Data were collected at baseline, a few weeks after completion of the intervention, and in the Odisha cohort again at six months after completion. Paired t-tests measured differences pre- and post- intervention. Qualitative data were thematically analysed.

Findings

Eighty participants across 20 families were included in the study (23 persons affected and 57 family members). We found a significant increase in CD-RISC scores for persons affected and family members from Odisha state (baseline 46.5, first follow-up 77.0, second follow-up 70.0), this improvement was maintained at six-month follow-up. There was no increase in CD-RISC scores post-intervention among participants from Telangana state. WHOQOL-BREF scores were significantly higher at follow-up for persons affected in both states, and for family members in Odisha state. No families dropped out of the study. In the qualitative feedback, all participants described drawing benefit from the programme. Participants especially appreciated the social dimensions of the intervention.

Conclusion

This pilot study showed that the 10-week family-based intervention to strengthen resilience among persons affected by leprosy and their family members was feasible, and has the potential to improve resilience and quality of life. A large-scale efficacy trial is necessary to determine the effectiveness and long-term sustainability of the intervention.

Methods

Data from the GoActive study were used for these analyses. Participants were adolescents (n = 1765, mean age±SD 13.2±0.4y) from the East of England, UK. Change in longitudinal accelerometer assessed moderate-to-vigorous physical activity (MVPA) was the outcome. School policy, social and physical environment features (n = 267) were exposures. The least absolute shrinkage and selection operator variable selection method (LASSO) was used to determine exposures most relevant to the outcome. Exposures selected by the LASSO were added to a multiple linear regression model with estimates of change in min/day of MVPA per 1-unit change in each exposure reported. Post-hoc analyses, exploring associations between change in variables selected by the LASSO and change in MVPA, were undertaken to further explain findings.

Findings

No school policy or physical environment features were selected by the LASSO as predictors of change in MVPA. The LASSO selected two school social environment variables (participants asking a friend to do physical activity; friend asking a participant to do physical activity) as potential predictors of change in MVPA but no significant associations were found in subsequent linear regression models for all participants (β [95%CI] -1.01 [-2.73;0.71] and 0.65 [-2.17;0.87] min/day respectively). In the post-hoc analyses, for every unit increase in change in participants asking a friend to do PA and change in a friend asking participants to do PA, an increase in MVPA of 2.78 (1.55;4.02) and 1.80 (0.48;3.11) min/day was predicted respectively.

Conclusions

The school social environment is associated with PA during adolescence. Further exploration of how friendships during adolescence may be leveraged to support effective PA promotion in schools is warranted.

Materials and methods

The study utilised data from the women’s file of the 2014 Ghana Demographic and Health Survey (GDHS) and sampled 1,678 women aged 15–49 who had complete data on EPNC. Descriptive computation of EPNC was done. Since EPNC (which is the main outcome variable for the study) was dichotomous, the binary logistic regression was used to determine factors influencing utilisation of EPNC at 95% two-tailed confidence interval. The results were presented as adjusted odds ratio (AOR). Stata version 14.0 was used for all the analyses.

Results

Descriptively, the results indicated that 31% of women aged 15–49 sought EPNC. At the inferential level, women aged 40–44 were more likely to seek EPNC compared to those aged 15–19 [AOR = 3.66, CI = 1.25–10.67]. Islam women had higher odds of EPNC as compared with Christians [AOR = 1.70, CI = 1.23–2.35]. Comparatively, women of Mande ethnic group had higher propensity to seek EPNC than the Akan [AOR = 3.22, CI = 1.20–8.69]. Residents of the Greater Accra region were over 11 times probable to utilise EPNC compared with the residents of Western region.

Conclusion

The key determinants of EPNC were age, religion, ethnicity, marital status and region. Therefore, the Health Promotion and Education Unit and Reproductive and Child Health Department of the Ghana Health Service need to scale up EPNC sensitisation programmes and should target women aged 15–19, Christians and other category of women with less likelihood of EPNC in order to offset the disparities.

Methods

DLCO and TLC values were assessed and compared between Indigenous Australians and Australian Caucasians matched for age, sex and body mass index, with normal chest radiology.

Results

Of the 1350 and 5634 pulmonary function tests assessed in Indigenous Australian and Australian Caucasian adults respectively, a total of 129 Indigenous Australians and 197 Australian Caucasians met the inclusion criteria. Absolute DLCO and TLC values for Indigenous Australians were a mean 4.3 ml/min/mmHg (95% CI 2.86, 5.74) and 1.03 L (95% CI 0.78, 1.27) lower than Australian Caucasians (p<0.01). Percentage predicted values were 15.38 (95% CI 11.59, 19.17) and 16.63 (95% CI 13.59, 19.68) points lower for DLCO and TLC, respectively. Lower limit of normal (LLN) values did not significantly differ between groups, however a significantly greater proportion of Indigenous Australians recorded values below the LLN in comparison to Australian Caucasians for DLCO (64 vs. 25%, p<0.01) and TLC (66 vs. 21%, p<0.01). Significant differences for the interaction of sex on DLCO and TLC were noted in Australian Caucasians, with reduced or absent sex differentiation among Indigenous Australians.

Conclusions

There are significant differences in DLCO and TLC parameters between Indigenous Australian compared to Australian Caucasians. Appropriate DLCO and TLC norms need to be established for Indigenous Australians.

Methodology/Principal findings

Based on a mixed methods study combining a qualitative strand with a quantitative survey, we found that epilepsy was perceived to have had an epidemic emergence in the past and was still considered an important health issue in the study area. Socio-economic status, availability and accessibility of drugs and practitioners, as well as perceived aetiology shaped therapeutic itineraries for epilepsy, which included frequenting (in)formal biomedical health care providers, indigenous and/or faith healing practitioners. Ivermectin uptake for onchocerciasis was generally well known and well regarded. The CDTI faced structural and logistical bottlenecks undermining equal access and optimal adherence to the drug.

Conclusions/Significance

Locally accessible, uninterrupted, sustainable and comprehensive health-service delivery is essential to help alleviate the epilepsy burden on afflicted households. Addressing structural challenges of CDTI and communicating the potential link with epilepsy to local populations at risk could optimize the uptake of this potentially significant tool in OAE prevention.

Methods

This study was based on pooled data from 1992–93, 1998–99, 2005–06 and 2015–16 India’s DHS (NFHS) surveys. The outcome variable of the study was different types of contraceptive methods used. Multinomial logistic model has been applied to examine the relationship between the dependent variable and the explanatory variables. The software STATA version14 has been used for the entire analysis.

Result

The result of this study clearly demonstrates the evidence of continuing sterilization dominance in the India’s family planning program. The choice of different types of contraceptive methods is influenced by the longstanding heterogeneity of population associated with religion and the caste system. Reliance over female sterilization was observed in almost all parts of the country with southern India being the leading zone. Women in the lowest wealth quintile, uneducated, higher parity, and less exposed to media were more likely to use sterilization as a method of birth control.

Conclusion

The study was successful in identifying the factors behind the excessive dependency on female sterilization and also highlights the weakness of family planning program to promote other useful modern methods over the past two decades.

Methods

A mixed-methods approach was deployed in October 2019 in the Sylhet division of Bangladesh which involved a cross-sectional survey among 400 indigenous older adults (200 males, 200 females) from 8 tea gardens using a pre-tested semi-structured questionnaire. Ten in-depth interviews were also conducted with providers of the tea garden health facilities. Descriptive analysis, multiple logistic and multi-nominal linear regression were performed to explore associated factors around health and quality of life.

Results

Of the total respondents, the majority (79.5%) had chronic diseases, with visual difficulty being predominant (74%) among the conditions. Almost all (94%) of the respondents experienced delays in receiving treatment and poverty was identified by most (85%) as the primary cause of those delays. Extreme age, being male, living alone and low family income were significantly associated with suffering from chronic conditions. Furthermore, having a chronic condition and extreme age were found to be significantly associated with a low quality of life. Health service providers identified lack of logistical support in the health facilities, the economic crisis and lack of awareness as the major causes of poor health status and poor health seeking behaviour of the indigenous older adults.

Conclusion

Indigenous older men in extreme old age are more vulnerable to adverse health conditions and poor quality of life. Health literacy and health seeking behaviour is poor among indigenous older adults generally and there is a huge gap in the health services and social supports available to them.

Methods

The study utilized data from Understanding the Lives of Adolescents and Young Adults (UDAYA) project survey, which was conducted in two Indian states Uttar Pradesh and Bihar, in 2016 by Population Council under the guidance of Ministry of Health and Family Welfare, Government of India. Utilizing information on 20,594 adolescents aged 10–19 years (adolescent boys-5,969 and adolescent girls-14,625), the study examined three outcome variables, i.e., thinness, stunting, and co-existence of both. The study used descriptive and bivariate analysis. Furthermore, the study examined income-related inequality in stunting and thinness through concentration index. At last, the study used Wagstaff decomposition analysis to decompose the concentration index.

Results

The prevalence of thinness was higher among adolescent boys as compared to girls (25.8 per cent vs. 13.1 per cent). However, stunting was more prevalent among girls (25.6 per cent) than in boys (39.3 per cent). The odds of stunting were higher among late adolescents [Boys- OR:1.79; CI: 1.39, 2.30] and [Girls- OR: 2.25; CI: 1.90,2.67], uneducated adolescents [Boys- OR:2.90; CI: 1.67, 5.05] and [Girls- OR: 1.82; CI: 1.44,2.30], and poorest adolescents [Boys- OR:2.54; CI: 1.80, 3.58] and [Girls- OR: 1.79; CI: 1.38,2.32]. Similarly age, educational status, working status and wealth index were significantly associated with thinness among adolescent boys and girls. Media exposure [Boys- OR: 11.8% and Girls- 58.1%] and Wealth index [Boys: 80.1% and Girls: 66.2%] contributed significantly to the inequality in the prevalence of thinness among adolescents. Similarly, wealth index [Boys: 85.2% and Girls: 84.1%] was the only significant contributor to the inequality in the prevalence of stunting among adolescents.

Conclusion

The study provides an understanding that stunting and thinness is a significant public health concern among adolescents, and there is a need to tackle the issue comprehensively. By tackling the issue comprehensively, we mean that the state government of Uttar Pradesh and Bihar shall screen, assess, and monitor the nutritional status of adolescent boys and girls. The interventions shall focus towards both boys as well as girl adolescents, and particular emphasis should be given to adolescents who belonged to poor households. Also, efforts should be taken by stakeholders to increase family wealth status.

Material and methods

In this cross-sectional, correlational study, we used mailed questionnaires to collect data from four geographical areas and three hospital levels in Taiwan from June 6 to August 31, 2018. Two thousand and thirty-three clinical nurses participated in this study.

Results

Participants’ mean age was 34.47 years, and 95.7% were women. Of them, 78.3% were willing to donate their organs and 20.6% had registered for organ donation after death. The results of logistic regression showed that in the personal domain, higher age (odds ratio (OR) = 1.03, p < 0.001), better knowledge of organ donation (OR = 1.09, p < 0.001), and a positive attitude toward organ donation (OR = 2.91, p < 0.001) were positively associated with organ donation registration, while cultural myths (OR = 0.69, p < 0.001) were negatively correlated. In the policy domain, the convenience of the registration procedure (OR = 1.45, p < 0.001) was positively associated with registration. A gap between willingness to donate and actual registration was observed.

Conclusions

Personal factors played an important role in organ donation registration. Therefore, efforts to improve knowledge and inculcate positive cultural beliefs about organ donation among clinical nurses are recommended. There is also a need to cooperate with government policies to provide appropriate in-service training and policy incentives and establish an efficient registration process.

Methods

A secondary data analysis was conducted based on the 2016 Ethiopian Demographic and Health Survey data. A total weighted sample of 11022 reproductive-age women who gave birth within five years preceding the survey was included for analysis. To identify the predictors, the Gompertz gamma shared frailty model was fitted. The theta value, Akakie Information Criteria (AIC), Bayesian Information Criteria (BIC), and deviance was used for model selection. Variables with a p-value of less than 0.2 in the bi-variable analysis were considered for the multivariable analysis. In the multivariable Gompertz gamma shared frailty analysis, the Adjusted Hazard Ratio (AHR) with a 95% Confidence Interval (CI) was reported to show the strength and statistical significance of the association.

Results

The median inter-birth interval in Ethiopia was 38 months (95% CI: 37.58, 38.42). Being living in Addis Ababa (AHR = 0.15, 95% CI: 0.03, 0.70), being rural resident (AHR = 1.13, 95% CI: 1.01, 1.23), being Muslim religious follower (AHR = 6.53, 95% CI: 2.35, 18.18), having three birth (AHR = 0.51, 95% CI: 0.10, 0.83), having four birth (AHR = 0.30, 95% CI: 0.09, 0.74), five and above births (AHR = 0.10, 95% CI: 0.02, 0.41), and using contraceptive (AHR = 2.35, 95% CI: 1.16, 4.77) were found significant predictors of duration of birth interval.

Conclusion

The length of the inter-birth interval was consistent with the World Health Organization recommendation. Therefore, health care interventions that enhance modern contraceptive utilization among women in rural areas and Muslim religious followers would be helpful to optimize birth interval.

Methods

This study used the 2016 Ethiopian Demographic and Health Survey data (EDHS) as data sources. According to the 2016 EDHS data, all the regions were stratified into urban and rural areas. The variable “size of child” measured according to the report of mothers before two weeks of the EDHS takes placed. The study sample refined from EDHS data and used for this further analysis were 7919 children. A logistic regression model was used to assess the association of proximate low birth weight and potential determinates of proximate low birth weight. But, the data were tested to model fitness and were fitted to Hosmer-Lemeshow-goodness of fit.

Results

The prevalence of proximate low birth weight in Ethiopia was 26.9% (2132), (95%CI = 25.4, 27.9). Of the prevalence of child size in year from 2011 to 2016, 17.1% was very small, and 9.8% was small. In the final multivariate logistic regression model, region (AOR = xx), (955%CI = xx), Afar (AOR = 2.44), (95%CI = 1.82, 3.27), Somalia (AOR = 0.73), (95%CI = 0.55, 0.97), Benishangul-Gumz (AOR = 0.48), (95%CI = 0.35, 0.67), SNNPR (AOR = 0.67), (95%CI = 0.48, 0.93), religion, Protestant (AOR = 0.76), (95%CI = 0.60, 0.95), residence, rural (AOR = 1.39), (95%CI = 1.07, 1.81), child sex, female (AOR = 1.43), (95%CI = 1.29, 1.59), birth type, multiple birth during first parity (AOR = 2.18), (95%CI = 1.41, 3.37), multiple birth during second parity (AOR = 2.92), (95%CI = 1.86, 4.58), preparedness for birth, wanted latter child (AOR = 1.26), (95%CI = 1.09, 1.47), fast and rapid breathing (AOR = 1.22), (95%CI = 1.02, 1.45), maternal education, unable to read and write (AOR = 1.46), (95%CI = 1.56, 2.17), and maternal age, 15–19 years old (AOR = 1.86), (95%CI = 1.19, 2.92) associated with proximate low birth weight.

Conclusions

The proximate LBW prevalence as indicated by small child size is high. Region, religion, residence, birth type, preparedness for birth, fast and rapid breathing, maternal education, and maternal age were associated with proximate low birth weight. Health institutions should mitigating measures on low birth weight with a special emphasis on factors identified in this study.

Objective

This study assessed changes in SRH behaviours of unmarried young people aged 15–24 and associated factors over a ten-year period in Nigeria.

Data and method

We analysed datasets from Nigeria Demographic and Health Surveys of 2008, 2013 and 2018 to assess changes in inconsistent condom use, non-use of modern contraceptives; multiple sexual partnership; and early sexual debut. Using binary logistic regression, we assessed the association of selected variables with the SRH behaviours.

Results

Over four-fifths of unmarried young people (15–24) in Nigeria engaged in at least one risky sexual behaviour in each survey year. The pattern of changes in the four risky SRH behaviours was consistent over the 10-year period, with the highest rates of each behaviour occurring in 2018 while the lowest rates were in 2013, thus indicating an increase in the proportion of respondents engaging in risky sexual behaviours over the study period. Comprehensive HIV/AIDS knowledge, male gender, older age category (20–24), residence in south-west Nigeria, urban residence, higher socio-economic status, secondary/higher education were mostly protective against the four SRH variables analysed across the different data waves.

Conclusion

Addressing the high and increasing level of risky SRH behaviours among young people in Nigeria is imperative to improve overall national health status and to ensure progress towards achieving SDG target 3.7 focusing on SRH.

Methods

Nationwide latest demography and health survey data from six South Asian countries, including Bangladesh (2014), Pakistan (2017–2018), Nepal (2016), Afghanistan (2015), Maldives (2016–2017) and India (2015–2016) were pooled for the present study. Multivariate analysis was performed to explore the association between unintended pregnancy and its associated factors.

Results

Amongst the total women (n = 41,689), overall, 19.1% pregnancies were reported as unintended (ranging from 11.9% in India to 28.4% in Bangladesh). The logistic regression model showed that younger women (15–19 years) had 1.42 times higher chance of unintended pregnancies. The odds of unintended pregnancies was 1.24 times higher for poorest women and 1.19 times higher for poorer women. Further, urban women (aOR = 0.70, 95% CI = 0.50–0.80), women having no children (aOR = 0.10, 95% CI = 0.09–0.12), smaller (≤4) family (aOR = 0.72, 95% CI = 0.67–0.78), those who intent to use contraceptive (aOR = 0.72, 95% CI = 0.60–0.86), currently living with partner (aOR = 0.90, 95% CI = 0.81–0.99), first cohabitation in teenage (≤19 years) (aOR = 0.85, 95% CI = 0.78–0.92) were less likely to report unintended pregnancies.

Conclusions

This study has showed that women’s age, wealth index, place of residence, number of children, family size, the intention of contraceptive use, living with a partner, and first cohabitation age are essential determinants of unintended pregnancy. These factors should be considered when trying to reduce unintended pregnancy in six South Asian countries. However, there is a need to improve health education, counselling, skills-building, sex education, modern contraceptive use and its access in this region. Intervention programs regarding reproductive health and policies are warranted to reduce rates of unintended pregnancy in South Asian countries.

Principle findings

A cross-sectional mixed-methods design was used. Persons affected by leprosy, their close contacts, community members and health workers were included. Through interview-administered questionnaires we assessed knowledge, attitudes, practices and fears with the KAP measure, EMIC-CSS and SDS. In addition, semi-structured interviews and focus group discussions were conducted. The quantitative data were analysed using stepwise multivariate regression. Determinants of knowledge and stigma that were examined included age, gender, participant type, education, occupation, knowing someone affected by leprosy and district. The qualitative data were analysed using open, inductive coding and content analysis.

We administered questionnaires to 2344 participants (46% from India, 54% from Indonesia) as an interview. In addition, 110 participants were interviewed in-depth and 60 participants were included in focus group discussions. Knowledge levels were low in both countries: 88% of the participants in India and 90% of the participants in Indonesia had inadequate knowledge of leprosy. In both countries, cause, mode of transmission, early symptoms and contagiousness of leprosy was least known, and treatment and treatability of leprosy was best known. In both countries, health workers had the highest leprosy knowledge levels and community members the highest stigma levels (a mean score of up to 17.4 on the EMIC-CSS and 9.1 on the SDS). Data from the interviews indicated that people were afraid of being infected by leprosy. Local beliefs and misconceptions differed, for instance that leprosy is in the family for seven generations (Indonesia) or that leprosy is a result of karma (India). The determinants of leprosy knowledge and stigma explained 10–29% of the variability in level of knowledge and 3–10% of the variability in level of stigma.

Conclusion

Our findings show the importance of investigating the perceptions regarding leprosy prior to educational interventions in communities: even though knowledge levels were similar, local beliefs and misconceptions differed per setting. The potential determinants we included in our study explained very little of the variability in level of knowledge and stigma and should be explored further. Detailed knowledge of local knowledge gaps, beliefs and fears can help tailor health education to local circumstances.

Methods

A community-based cross-sectional study was conducted among 7,543 pregnant women in Ethiopia using the Ethiopian Demographic Health Survey (EDHS), 2016 data. A two-stage stratified cluster sampling was employed. The Kaplan-Meier (KM) method was used to estimate time to first antenatal care visit. Cox-gamma shared frailty model was applied to determine predictors. Adjusted Hazard Ratio (AHR) with 95% confidence interval was reported as the effect size. Model adequacy was assessed by using the Cox-Snell residual plot. Statistical significance was considered at p value <0.05. For data management and analysis Stata 14 was used.

Results

The median time to first ANC was 5 months with IQR (3,-). The independent predictors of time to first ANC visit were primary education [AHR: 1.24 (95%CI, 1.13–1.35)], secondary education [AHR: 1.28(95% CI, 1.11–1.47)], higher education [AHR: 1.43 (1.19–1.72)] as compared to women with no formal education. Having media exposure [AHR: 1.13 (95% CI, 1.03–1.24)], early initiation of ANC increases by 25% [AHR: 1.25 (95% CI, 1.12–1.40)] in poorer, 32% [AHR: 1.32 (95% CI, 1.17–1.49)] in middle, 37% [AHR: 1.37 (95% CI, 1.20–1.56)] in richer and 41% [AHR: 1.41 (95%CI, 1.1.19–1.67)] in richest households as compared to poorest household wealth index. Living in city administration, media exposure and community women literacy were also enabler factors, while, long distance from health facility and nomadic region residency were hindering factors of early ANC visit.

Conclusions

The current study revealed that women’s time to first antenatal care visit was by far late in Ethiopia as compared to the world health organization recommendation (WHO). The predictors of time to first ANC visit were education status of women, having media exposure, level of household wealth index, community women literacy ad distance to health facility. It is vital that maternal and child health policies and strategies better to be directed at women development and also designing and applying interventions that intended to increase timely initiation ANC among pregnant-women. Researchers also recommended conducting studies using a stronger design like a cohort to establish temporality and reduce biases.

Methods

A retrospective study of individuals living with RHD in Far North Queensland (FNQ), Australia between 1997 and 2017. Patients were identified using the Queensland state RHD register. The Socio-Economic Indexes for Areas (SEIFA) Score–a measure of socioeconomic disadvantage–was correlated with RHD prevalence, disease severity and measures of RHD care.

Results

Of the 686 individuals, 622 (90.7%) were Indigenous Australians. RHD incidence increased in the region from 4.7/100,000/year in 1997 to 49.4/100,000/year in 2017 (p<0.001). In 2017, the prevalence of RHD was 12/1000 in the Indigenous population and 2/1000 in the non-Indigenous population (p<0.001). There was an inverse correlation between an area’s SEIFA score and its RHD prevalence (rho = -0.77, p = 0.005).

249 (36.2%) individuals in the cohort had 593 RHD-related hospitalisations; the number of RHD-related hospitalisations increased during the study period (p<0.001). In 2017, 293 (42.7%) patients met criteria for secondary prophylaxis, but only 73 (24.9%) had good adherence. Overall, 119/686 (17.3%) required valve surgery; the number of individuals having surgery increased over the study period (p = 0.02).

During the study 39/686 (5.7%) died. Non-Indigenous patients were more likely to die than Indigenous patients (9/64 (14%) versus 30/622 (5%), p = 0.002), but Indigenous patients died at a younger age (median (IQR): 52 (35–67) versus 73 (62–77) p = 0.013). RHD-related deaths occurred at a younger age in Indigenous individuals than non-Indigenous individuals (median (IQR) age: 29 (12–58) versus 77 (64–78), p = 0.007).

Conclusions

The incidence of RHD, RHD-related hospitalisations and RHD-related surgery continues to rise in FNQ. Whilst this is partly explained by increased disease recognition and improved delivery of care, the burden of RHD remains unacceptably high and is disproportionately borne by the socioeconomically disadvantaged Indigenous population.

Methods

CT data for 214 modern crania of Asian, African and European ancestry were compared using 3D geometric morphometrics and multivariate statistics, including principal component analysis, Hotelling’s T² test, multivariate regression, ANOVA, and MANCOVA.

Results

Sex differences in average occipital morphology are only observed in Europeans, with males exhibiting a pronounced inion. Significant ancestral differences are observed among all samples and are shared by males and females. Asian and African crania have smaller biasterionic breadths and flatter clivus angles compared to Europeans. Asian and European crania are similar in their nuchal and occipital plane proportions, nuchal and occipital angles, and lower inion positions compared to Africans. Centroid size significantly differs between sexes and among populations. The overall allometry, while significant, explains little of the shape variation. Larger occipital bones were associated with a more curved occipital plane, a pronounced inion, a narrower biasterionic breadth, a more flexed clivus, and a lower and relatively smaller foramen magnum.

Conclusions

Although significant shape differences were observed among populations, it is not recommended to use occipital morphology in sex or population estimation as both factors explained little of the observed variance. Other factors, relating to function and the environment, are suggested to be greater contributors to occipital variation. For the same reason, it is also not recommended to use the occiput in phylogenetic studies.

Objective

To determine molecular epidemiology of clinical isolates of Mycobacterium tuberculosis circulating in an indigenous population through Spoligotyping and 24-loci MIRU-VNTR.

Methodology

A descriptive cross-sectional study was conducted in 23 indigenous communities of Puerto Nariño-Amazonas, Colombia. Recovered clinical isolates were genotyped. For genotyping analyzes global SITVIT2 database and the MIRU-VNTRplus web portal were used.

Results

74 clinical isolates were recovered. Genotyping of clinical isolates by spoligotyping determined 5 different genotypes, all of them belonged to Euro-American lineage. By MIRU-VNTR typing, a total of 14 different genotypes were recorded. Furthermore, polyclonal infection was found in two patients from the same community. The combination of the two methodologies determined the presence of 19 genotypes, 8 formed clusters with 63 clinical isolates in total. Based on epidemiological information, it was possible to establish a potential chain of active transmission in 10/63 (15.9%) patients.

Conclusions

High genomic homogeneity was determined in the indigenous population suggesting possible chains of active transmission. The results obtained showed that specific genotypes circulating among the indigenous population of Colombia are significantly different from those found in the general population.

Methods

We deployed walkthroughs, simulations, and ethnography to identify important safety gaps in care delivery processes on the Unit. These interventions were undertaken using interdisciplinary theories of implementation that combined systems-level HF perspectives, ethnographic approaches, and individual-level IPC perspectives. Timely recommendations were developed and delivered to Unit staff for feedback and implementation.

Results

We describe three interventions on the Unit: 1) the de-cluttering and re-organization of personal protective equipment (PPE); 2) the reconfiguring of designated ‘dirty’ tray tables and supplies; and 3) the redesign of handling pathways for ‘dirty’ linens and laundry. Each of these interventions was implemented to varying degrees, but all contributed to discussions of safety and IPC implementation that extended beyond the Unit and into the operations of the broader hospital.

Conclusions

Leveraging our team’s interdisciplinary expertise and blended approaches to implementation, the interventions assisted in the Unit’s rapid conversion towards providing COVID-19-specific care. The deployment and implementation of the interventions highlight the potential of collaboration between HF, ethnography, and IPC experts to support frontline healthcare delivery under pandemic conditions in an effort to minimize nosocomial transmission potential in the acute healthcare setting.

Methods

The study is an analytic cross-sectional survey with questionnaires administered to the general population including Health Care Workers (HCW) in Kano, Nigeria. Participants were recruited by convenience sampling following informed consent. The percentage of KAP scores were categorized as good and poor. Independent predictors of good knowledge of COVID 19 were ascertained using a binary logistic regression model.

Results

The questionnaire was administered among urban 32.8%, peri-urban dwellers 32.4%, and to online participants 34.8%. The peri-urban and urban participants were given paper questionnaires. There were 886 study participants with mean age 28.58yrs [SD:10.25] (Interquartile range [IQR]:22yrs–32yrs), males 55.4% with 57.3% having had or were in tertiary education. Most participants were students 40% and civil servants 20%. The overall mean [standard deviation (SD)] for knowledge, attitude and practice scores expressed in percentage was 65.38%[SD15.90], 71.45% [SD14.10], and 65.04% [SD17.02] respectively. Out of the respondents, 270(30.47%) had good knowledge (GK), 158(17.8%) had good attitude (GA), and 230(25.96%) had good practice (GP) using cut-off scores of 75%, 86.5%, and 75% respectively. Over 48% did not agree COVID-19 originated from animals while 60% perceived the pandemic to be due to God’s punishment. Also, 36% thought it was a man-made virus. When rating fear, most respondents [63.5%] had marked fear i.e. ≥ 7 out of 10 and 56% admitted to modifying their habits recently in fear of contracting the virus. As regards attitude to religious norms, 77.77% agreed on cancellation of the lesser pilgrimage as a measure to curb the spread of the disease while 23.64% admitted that greater pilgrimage (Hajj) should proceed despite the persistence of the ongoing pandemic. About 50% of the respondents insisted on attending Friday congregational prayers despite social distancing. One in four people still harbored stigma towards a person who has recovered from the virus. 28% felt some races are more at risk of the disease though 66% mentioned always practicing social distancing from persons coughing or sneezing. Almost 70% of respondents said they were willing to accept a vaccine with 39% saying they would be willing to pay for it if not publicly funded. In univariate analysis increasing age and having been ever married were associated with GK while tertiary education was associated with GA [Odds Ratio; 95% Confidence Interval] 2.66(1.79–3.95). Independent positive predictors of GK were those who were or had ever been married, those who had marked fear of COVID-19, and had modified their habits in the last three months. Those who had non-tertiary education and had the questionnaire administered as paper rather than online version had GK but age was not a predictor.

Conclusion

Knowledge of transmission and preventive measures should be improved in the general population cognizant of cultural norms and Islamic practices. The study highlights the importance of considering belief systems and perception in developing control measures against COVID-19.

Methods

Community-based cross-sectional study design was employed. A total of 683 respondents were interviewed using a structured and pre-tested questionnaire. The data were collected by using a mobile-based application called “Google form.” Logistic regression was performed to analyze the data. Estimates were reported in adjusted odds ratios with 95% confidence intervals (CI) and a significant association was declared at p-value of less than 0.05.

Result

The overall adherence level of the community towards the recommended safety measures of COVID-19 was 44.1%. Self-efficacy (AOR = 0.23; 95% 0.14, 0.36), perceived benefits (AOR = 0.35; 95% 0.23, 0.56), perceived barriers (AOR = 3.36; 95% 2.23, 5.10), and perceived susceptibility of COVID-19 (AOR = 1.60; 95% 1.06, 2.39) were important predictors that influenced the adherence of the community to COVID-19 preventive behaviors.

Conclusions

In this study, the overall adherence level of the community towards the recommended safety measures of COVID-19 was relatively low. It is vital to consider the communities’ self-efficacy, perceived benefits, perceived barriers and perceived susceptibility of COVID-19 in order to improve the adherence of the community towards the recommended safety measures of COVID-19.

Material & methods

A community based matched case control study was carried from September 2019 to February 2020 among under five children of Satar community residing in Jhapa district. Multistage random sampling technique was used to select 50 cases and 100 controls in the ratio of 1:2. Information was collected through personal interview with the parents and anthropometric measurement of the children was measured. Bivariate and multivariate conditional logistic regression analysis was used to explore the determinants of severe acute malnutrition.

Results

A total of 664 children between the age group of 6–59 months were screened for SAM. The prevalence of SAM was found 7.53%. Factors like, low economic status, birth interval less than 2 years, frequency of breast feeding <8 times/day and household food insecurity were found to be significant determinants of SAM. Multivariate logistic regression documented low economic status (AOR: 11.14, 95% CI 1.42 to 87.46); and frequency of breast feeding <8 times/day (AOR: 2.09, 95% CI 1.00 to 4.37) as determinants of SAM.

Conclusion

Low economic status and frequency of breast feeding less than 8times/day were major determinants of SAM among children under 5yrs of age. Ending malnutrition will require greater efforts and integrated approaches to eradicate extreme poverty. Multi-sector approaches have been conducting for SAM in Nepal but there are no specific approaches for marginalized community.

Aim

To understand factors that may impact MITS acceptability and inform introduction of the procedure to ascertain CoD among children with acute illness or malnutrition who die during hospitalization in Malawi.

Methods

We conducted eight focus group discussions with key hospital staff and community members (religious leaders and parents of children under 5) to explore attitudes towards MITS and inform consent processes prior to commencing the MITS in Malawi study. We used thematic content analysis drawing on a conceptual framework developed from emergent themes and MITS acceptability literature.

Results

Feelings of power over decision-making within the hospital and household, trust in health systems, and open and respectful health worker communication with parents were important dimensions of MITS acceptability. Other facilitating factors included the potential for MITS to add CoD information to aid sense-making of death and contribute to medical knowledge and new interventions. Potential barriers to acceptability included fears of organ and blood harvesting, disfigurement to the body, and disruption to transportation and burial plans.

Conclusion

Social relationships and power dynamics within healthcare systems and households are a critical component of MITS acceptability, especially given the sensitivity of death and autopsy.

Methods

A multi-stage random sampling approach was used to recruit 650 people from Beni-Suef City in South Egypt. All participants were interviewed using the Arabic version of the Public Opinion Survey of Human Attributes-Stuttering (POSHA-S) after getting their informed consent. This instrument assesses people’s Beliefs and Self Reactions towards PWS in addition to their sociodemographic characteristics.

Results

The Beliefs and Self Reactions subscores in addition to the Overall Stuttering Score of the Egyptian sample were remarkably lower than the median values of the reference database (12 versus 34), (-4 versus 2), and (4 versus 18), respectively. TV, radio, and films were the main sources of knowledge about stuttering. Egyptian participants who reported average to high income were more likely to have a positive attitude (≥50% of Overall Stuttering Score) towards PWS than their counterparts with low income (Odds Ratio = 1.57, 95% Confidence Interval: 1.08–2.28).

Conclusion

People in South Egypt showed a less positive attitude towards PWS compared with other populations worldwide. Further studies should focus on changing the public attitudes towards PWS through awareness programs that consider the cultural perspectives of the society.

Methods

This exploratory qualitative study in Delhi (India) included in-depth interviews with parents (50 mothers and 49 fathers), who had stillbirth or child death, their family members (n = 41) and community representatives (n = 12). Eight focus group discussions were done with community members (n = 72). Inductive data analysis included thematic content analysis. Perinatal Grief Scale was used to document the mother’s grief severity after 6–9 months of loss.

Results

The four themes emerged were grief anticipation and expression, impact of the bereavement, coping mechanism, and sociocultural norms and practices. The parents suffered from disbelief, severe pain and helplessness. Mothers expressed severe grief openly and some fainted. Fathers also had severe grief, but didn’t express openly. Some parents shared self-guilt and blamed the hospital/healthcare providers, themselves or family. Majority had no/positive change in couple relationship, but few faced marital disharmony. Majority experienced sleep, eating and psychological disturbances for several weeks. Mothers coped through engaging in household work, caring other child(ren) and spiritual activities. Fathers coped through avoiding discussion and work and professional engagement. Fathers resumed work after 5–20 days and mothers took 2–6 weeks to resume household chores. Unanticipated loss, limited family support and financial strain affected the severity and duration of grief. 57.5% of all mothers and 80% mothers with stillbirth had severe grief after 6–9 months.

Conclusions

Stillbirth and child death have lasting psychosomatic, social and economic impacts on parents, which are usually ignored. Sociocultural and religion appropriate bereavement support for the parents are needed to reduce the impacts.

Methods

Data used in this study were obtained from the 2014 Ghana Demographic and Health Survey. The survey was nationally representative and provides estimates for population and health indicators across the former ten regions of Ghana, including rural and urban areas. Data were analyzed with Stata/SE version 16.

Results

We found that 32% of young women and 19% of young men accepted wife-beating. Among young women, acceptance of wife-beating was significantly influenced by younger age, wealth index, low educational status, religion, the region of residence, ethnicity, frequency of reading newspaper and frequency of listening to radio (p < 0.05). Among young men, acceptance of wife-beating was significantly influenced by wealth index, the region of residence and frequency of reading newspaper (p < 0.05).

Conclusion

This study demonstrates that a substantial proportion of young people in Ghana accept wife-beating. Young women were more likely to accept wife-beating compared to young men. Acceptance of wife-beating was influenced by socio-demographic and behavioral factors. Efforts to end violence against women and girls in Ghana should focus on promoting girl education, economic empowerment of women and public education on laws that prohibit Intimate Partner Violence.

Materials and methods

Data on 223,184 children under five were extracted from Demographic and Health Surveys of 29 sub-Saharan African countries, conducted between 2010 and 2018. The outcome variable for the study was healthcare seeking for childhood illnesses. The data were analyzed using Stata version 14.2 for windows. Chi-square test of independence and a two-level multivariable multilevel modelling were carried out to generate the results. Statistical significance was pegged at p<0.05. We relied on ‘Strengthening the Reporting of Observational Studies in Epidemiology’ (STROBE) statement in writing the manuscript.

Results

Eighty-five percent (85.5%) of women in SSA sought healthcare for childhood illnesses, with the highest and lowest prevalence in Gabon (75.0%) and Zambia (92.6%) respectively. In terms of the barriers to healthcare access, we found that women who perceived getting money for medical care for self as a big problem [AOR = 0.81 CI = 0.78–0.83] and considered going for medical care alone as a big problem [AOR = 0.94, CI = 0.91–0.97] had lower odds of seeking healthcare for their children, compared to those who considered these as not a big problem. Other factors that predicted healthcare seeking for childhood illnesses were size of the child at birth, birth order, age, level of community literacy, community socio-economic status, place of residence, household head, and decision-maker for healthcare.

Conclusion

The study revealed a relationship between barriers to healthcare access and healthcare seeking for childhood illnesses in sub-Saharan Africa. Other individual and community level factors also predicted healthcare seeking for childhood illnesses in sub-Saharan Africa. This suggests that interventions aimed at improving child healthcare in sub-Saharan Africa need to focus on these factors.

Objectives

To identify beliefs and practices associated with the use of alternative treatments for hypertension and type 2 diabetes mellitus among patients.

Methods

A mixed-methods study including an investigator-administered survey and focus group discussion sessions using convenience sampling was conducted among patients aged ≥18 years during May to August 2018. Descriptive statistics were used to describe and compare demographic characteristics among groups of survey participants using JMP Pro 14.0. Thematic analysis was conducted to analyze the qualitative data using NVivo.

Results

Most study participants (87–90%) were on prescription medication for their condition. Of survey participants, 69% reported taking their medication as prescribed and 70% felt that prescription medicine was controlling their condition. Almost all participants (98%) reported using alternative treatments, mainly herbal medications, and 73–80% felt that herbal medicines controlled their conditions. One-third believed that herbal medicines are the most effective form of treatment and should always be used instead of prescription medication. However, most participants (85%) did not believe that prescription and herbal treatments should be used simultaneously. Most (76–90%) did not discuss herbal treatments with their healthcare providers. Four themes emerged from the focus group sessions: 1) Simultaneous use of herbal and prescription medicine was perceived to be harmful, 2) Patients did not divulge their use of herbal medicine to healthcare providers, 3) Alternative medicines were perceived to be highly effective, and 4) Religiosity and family elders played key roles in herbal use.

Conclusions

This study provides useful insights into perceptions and use of alternative treatments by patients that can be used by healthcare providers in developing appropriate interventions to encourage proper use of prescription medicines and alternative medicines resulting in improved management of these chronic diseases.

Methods

We used the 2016 Ethiopia demographic and health survey data for this analysis. The survey was a community-based cross-sectional study conducted from January 18 to June 27, 2016. The survey employed a two-stage stratified cluster sampling technique. A total of 11,646 ever-married women were included in the analysis. Bivariate and multivariable logistics regression was done to identify the determinants of divorce from the first marriage. A p-value < 0.05 was used to declare statistical significance.

Results

About 25% (95%CI: 23.4% - 26.6%) ever-married women were divorced from their first marital relationship. Women who were married at age < 15 years (AOR = 1.34; 95%CI: 1.07–1.68), urban women (AOR = 1.69; 95%CI: 1.22–2.35), women who did not attend formal education (AOR = 4.36; 95%CI: 3.14–6.05), women who were employed (AOR = 1.51; 95%CI: 1.31–1.73), and being childless (AOR = 1.34; 95%CI: 1.07–1.69) had higher odds of experiencing a divorce. Similarly, women who experienced partner violence, women with no house ownership, and women in the Amhara region had higher odds of divorce from their first marital union. Conversely, women in Oromia, SNNPR, the metropolis, and the pastoral regions had lower odds of divorce from their first marital union.

Conclusion

Divorce from the first marriage is high in Ethiopia. Preventing early marriage and partner violence and promoting girls’ education would reduce the divorce rate in Ethiopia.

Method

A multiple response predictive model for testing positive for HIV and having sufficient HIV knowledge is modeled to 2009 and 2018 survey data with the use of Bayes estimates. These data are obtained through a hierarchical data structure. The model allows one to address the change in the response to HIV, as it relates to morbidity and to HIV knowledge in Mozambique in the fight against the disease in the last decade.

Results

A more affluent resident is more likely to test positive, more likely to be more knowledgeable about the disease. Whereas, individuals practicing the Islam faith are less likely to test positive but also less likely to be knowledgeable about the disease. Education, while still a factor, has declined in its impact on testing positive for HIV or being knowledgeable about HIV. Females are more likely to test positive but more likely to be knowledgeable about the disease than men. The rate of impact of affluence on knowledge has increased in the past decade. Marital status (cohabitating or married) showed no impact on the knowledge of the disease. Age had no impact on knowledge suggesting that the message is getting to resident.

Conclusions

A joint Bayes modeling of correlated binary (testing positive and knowledge about the disease) responses, while accounting for the hierarchy of the data collection, presents an opportunity to extract the extra variation before allocating the variation on the responses as the due of the covariates. The fight against HIV in Mozambique seems to be succeeding. Some knowledge is common among all ages, and Islam religion has a positive effect. While education still shows an influence on the binary responses, it has declined over the last decade.

Methods

Using a cross-sectional design three Indigenous groups in Khagrachari district, CHT, Bangladesh were surveyed between September 2017 and February 2018. Indigenous women within 36 months of delivery were asked about attending ANC services and the number who attended was used to estimate prevalence. Socio-demographic and obstetric characteristics were used to determine factors associated with knowledge and attendance using multivariable logistic regression techniques adjusted for clustering by village; results are presented as odds ratios (OR), adjusted OR, and 95% confidence intervals (CI).

Results

Of 494 indigenous women who met the inclusion criteria in two upazilas, 438 participated (89% response rate) in the study, 75% were aged 16–29 years. Sixty-nine percent were aware of ANC services and the prevalence of attending ANC services was 53% (n = 232, 95%CI 0.48–0.58). Half (52%; n = 121) attended private facilities. Independent factors associated with knowledge about ANC were age ≥30 years (OR 2.2, 95%CI 1.1–4.6), monthly household income greater than 20,000 Bangladeshi Taka (OR 3.4, 95%CI 1.4–8.6); knowledge of pregnancy-related complications (OR 3.6, 95%CI 1.6–8.1), knowledge about nearest health facilities (OR 4.3, 95%CI 2.1–8.8); and attending secondary school or above (OR 4.8, 95%CI 2.1–11). Independent factors associated with attending ANC services were having prior knowledge of ANC benefits (OR 7.7, 95%CI 3.6–16), Indigenous women residing in Khagrachhari Sadar subdistrict (OR 6.5, 95%CI 1.7–25); and monthly household income of 20,000 Bangladeshi Taka or above (OR 2.8, 95%CI 1.1–7.4).

Conclusion

Approximately half of Indigenous women from Chittagong Hill Tracts Bangladesh attended ANC services at least once. Better awareness and education may improve ANC attendance for Indigenous women. Cultural factors influencing attendance need to be explored.

Methods

Between March and June 2019, a cross-sectional descriptive study was conducted, and 799 nursing students from three vocational colleges completed the Source of Meaning in Life Scale, General Self-Efficacy Scale and Prosocial Behaviours Scale. Data were analyzed using structural equation modelling and statistical analysis by SPSS (version 23.0, IBM).

Results

The average SML, general self-efficacy and prosocial behaviours scores of the 799 nursing students were 6.43±0.83, 2.48±0.59 and 3.69±0.62, respectively. Correlation analysis showed that SML, general self-efficacy and prosocial behaviours were positively correlated (P<0.01). General self-efficacy partially mediated the relationship between SML and prosocial behaviours (P<0.01); this mediating effect contributed 22.97% of the total effect and explained 17.6% of the variance in the dependent variable.

Conclusions

Educators should focus on cultivating nursing students’ cognition and experience of meaning in life and their efficacy in life, study and work, which can improve students’ “people-oriented” service and prosocial behaviour and the quality of nursing services.

Objectives

This study aimed to assess the prevalence and correlates of job loss among schizophrenia outpatient units in Addis Ababa, Ethiopia.

Methods

Institutional based cross-sectional study was conducted at Saint Amanuel Mental Specialized Hospital among schizophrenia outpatient units in Addis Ababa from May to June 2018. A total of 421 study subjects were interviewed using Positive and Negative Syndrome Scale and Perceived devaluation and discrimination scale. Out of the total study participants, female populations were slightly higher (50.4%) and the majorities (38.6%) were orthodox religion followers. Study characteristics was summarized using descriptive statistics and bi-variable and multivariable analysis was performed using Statistical Package for Social Science version 24. Furthermore, those factors at p value ≤ 0.05 were considered as statistically significant.

Results

The prevalence of job loss among patients with schizophrenia was 37.3%. Factors including unmarried [AOR = 2.42:95% CI (1.28, 4.54)], divorced [AOR = 2.34: 95% CI (1.16, 4.71)], severe positive symptoms [AOR = 2.03: 95% CI (1.15, 3.60)], severe general psychopathology [AOR = 1.76: 95% CI (1.01, 3.08)], and poor level of social and occupational functioning [AOR = 5.05: 95% CI (2.81, 9.09)] were significantly associated with job loss among schizophrenia people.

Conclusion

This study suggested that job loss among schizophrenia outpatients was high. There was significant association among people with unmarried, divorced, severe positive symptoms, poor functionality and higher general psychopathology. Therefore, clinical and psychosocial factors were responsible for job loss which warrant further attention and investigation.

Materials and methods

Data for this study was obtained from the 2014 Ghana Demographic and Health Survey. We used data of 1,441 women who gave birth in the 5 years preceding the survey and were dwelling in urban areas. By the use of Stata version 14.2, we conducted both descriptive and multivariable logistic regression analyses.

Results

We found that 7.9% of women in urban areas in Ghana delivered at home. The study revealed that, compared to women who lived in the Northern region, women who lived in the Brong Ahafo region [AOR = 0.38, CI = 0.17–0.84] were less likely to deliver at home. The likelihood of home delivery was high among women in the poorest wealth quintile [AOR = 2.02, CI = 1.06–3.86], women who professed other religions [AOR = 3.45; CI = 1.53–7.81], and those who had no antenatal care visits [AOR = 7.17; 1.64–31.3]. Conversely, the likelihood of home delivery was lower among women who had attained secondary/higher education [AOR = 0.30; 0.17–0.53], compared to those with no formal education.

Conclusion

The study identified region of residence, wealth quintile, religion, antenatal care visits, and level of education as factors associated with home delivery among urban residents in Ghana. Therefore, health promotion programs targeted at home delivery need to focus on these factors. We also recommend that a qualitative study should be conducted to investigate the factors responsible for the differences in home delivery in terms of region, as the present study could not do so.

Methods and principal findings

Crusted scabies became a formally notifiable disease in the Northern Territory of Australia in 2016. We conducted a 2-year prospective study of crusted scabies cases notified between March 2016 and February 2018, with subsequent follow up for 22 months. Demographics, clinical and laboratory data, treatment and outcomes were analysed, with cases classified by severity of disease.

Over the 2-year study period, 80 patients had 92 episodes of crusted scabies; 35 (38%) were Grade 1 crusted scabies, 36 (39%) Grade 2 and 21 (23%) Grade 3. Median age was 47 years, 47 (59%) were female, 76 (95%) Indigenous Australians and 57 (71%) from remote Indigenous communities. Half the patients were diabetic and 18 (23%) were on dialysis for end-stage kidney failure. Thirteen (16%) patients had no comorbidities, and these were more likely to have Grade 3 disease. Eosinophilia was present in 60% and high immunoglobulin E in 94%. Bacteremia occurred in 11 episodes resulting in one fatality with methicillin-susceptible Staphylococcus aureus bacteremia. Two other deaths occurred during admission and 10 others died subsequent to discharge consequent to comorbidities. Treatment generally followed the recommended guidelines, with 3, 5 or 7 doses of oral ivermectin depending on the documented grade of crusted scabies, together with daily alternating topical scabicides and topical keratolytic cream. While response to this therapy was usually excellent, there were 33 episodes of recurrent crusted scabies with the majority attributed to new infection subsequent to return to a scabies-endemic community.

Conclusions

Crusted scabies can be successfully treated with aggressive guideline-based therapy, but high mortality remains from underlying comorbidities. Reinfection on return to community is common while scabies remains endemic.

Aim

The aim of the study was to assess CKD patients’ willingness to pay for kidney transplantation as a treatment option for end stage renal disease in Ghana.

Methods

A facility based cross-sectional study conducted at the Renal Outpatient clinic and Dialysis Unit of Korle-Bu Teaching Hospital among 342 CKD patients 18 years and above including those receiving haemodialysis. A consecutive sampling approach was used to recruit patients. Structured questionnaires were administered to obtain information on demographic, socio-economic, knowledge about transplant, perception of transplantation and willingness to pay for transplant. In addition, the INSPIRIT questionnaire was used to assess patients’ level of religiosity and spirituality. Contingent valuation method (CVM) method was used to assess willingness to pay (WTP) for kidney transplantation. Logistic regression model was used to determine the significant predictors of WTP.

Results

The average age of respondents was 50.2 ± 17.1 years with most (56.7% (194/342) being male. Overall, 90 out of the 342 study participants (26.3%, 95%CI: 21.7–31.3%) were willing to pay for a kidney transplant at the current going price (≥ $ 17,550) or more. The median amount participants were willing to pay below the current price was $986 (IQR: $197 –$1972). Among those willing to accept (67.3%, 230/342), 29.1% (67/230) were willing to pay for kidney transplant at the prevailing price. Wealth quintile, social support in terms of number of family friends one could talk to about personal issues and number of family members one can call on for help were the only factors identified to be significantly predictive of willingness to pay (p-value < 0.05).

Conclusion

The overall willingness to pay for kidney transplant is low among chronic kidney disease patients attending Korle-Bu Teaching Hospital. Patients with higher socio-economic status and those with more family members one can call on for help were more likely to pay for kidney transplantation. The study’s findings give policy makers an understanding of CKD patients circumstances regarding affordability of the medical management of CKD including kidney transplantation. This can help develop pricing models to attain an ideal poise between a cost effective but sustainable kidney transplant programme and improve patient access to this ultimate treatment option.

Methods and materials

Through a qualitative design, including 19 single interviews, 3 dyad interviews and 16 focus groups with older immigrants, relatives of immigrants with dementia, and health personnel, we explored experiences and perceptions related to receive and provide care for people with immigrant backgrounds living with dementia in Norway. The analysis were conducted inspired by Kvale and Brinkmann’s three contexts of interpretations.

Results

Challenges related to language and communication were emphasized as the most fundamental barrier to provide adjusted care; exemplified through cases of isolation and agitation among patients not able to communicate. Care services framed by the majority culture creates feelings of alienation and exclusion. Not having access to specific types of food and the possibility to listen to songs, music, literature or TV programs representing a familiar and homely context may prevent use of public dementia care. Findings also point to differences in moral views regarding life-prolonging treatment in advanced stages of dementia.

Conclusion

This study argues that to be able to address challenges related to migration-driven diversity one needs holistic care services that addresses individual as well as socio-cultural needs. A linguistically and culturally diverse workforce may represent an important resource, potentially reducing some of the problems related to communication. On a structural level, it seems necessary to allocate more time and resources, including the use of interpreters, when assessing and getting to know persons with dementia with another linguistic and cultural background. However, shared language does not guarantee understanding. Rather, one needs to become familiar with each person’s way of being ill, on a cultural and individual level, including changes occurring living with progressive dementia. Getting to know a person and his/her family will also facilitate the possibility to ensure a more familiar and homely context. Thus, continuity in relation to language and culture is important, but continuity in relations may be equally important ensuring that people with dementia receive equitable care.