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Sztuka dawna i współczesna, muzea i kolekcje

Metodologia nauk, Matematyka, Filozofia, Miary i wagi, Pomiary

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Antropologia kulturowa Socjologia Psychologia Zdrowie i medycyna

Przewidywania Kosmologia Religie Ideologia Polityka

Geologia, geofizyka, geochemia, środowisko przyrodnicze

Biologia, biologia molekularna i genetyka

Technologia cyberprzestrzeni, cyberkultura, media i komunikacja

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Budownictwo, energetyka, transport, wytwarzanie, technologie informacyjne

Journal of Public Health in Africa

The therapeutic impact of inappropriate prescribing of antibiotics is debatable, particularly in situations where infections are treated empirically with multiply prescribed antibiotics. Prescribers may remain under the illusion that such prescriptions are appropriate on the basis of any observed positive treatment outcomes, even though an antibiotic prescribed in such combination therapy may actually be infective against infecting pathogens. This, inevitably, promotes inappropriate antibiotic prescribing. Prescribers may be motivated to make more conscious attempts to prescribe antibiotics appropriately if it is proven that judicious prescribing of antibiotics has positive impacts on treatment outcomes. The objective of this study was to determine the impact of appropriate prescribing of antibiotics on treatment outcomes, days of patient hospitalization and costs related to antibiotic treatment. Observational data on antibiotic treatment were collected for a onemonth period from case notes of all inpatients (n=307) and outpatients (n=865) at five government and mission hospitals in Lesotho. Prescriptions were classified into categories of appropriateness based on extents to which antibiotics were prescribed according to principles. Treatment success rates, mean days of hospitalization and costs of antibiotic treatments of inpatients treated with specified prescription categories were determined. Appropriate prescribing of antibiotics for inpatients had positive impacts on treatment outcomes, patients’ days of hospitalization for infections and costs of antibiotic treatments. In outpatient settings, appropriate prescribing of antibiotics failed to show any significant impact on costs of antibiotics. Appropriate prescribing of antibiotics had a positive impact on patients’ recovery and costs of antibiotic treatments in inpatient settings. 2013/07/02 - 21:57

Measuring variations and gaps in health and wellbeing across individuals, social groups and societies is a critical issue confronting social scientists in their quest to explain why gaps in health between the rich and the poor persist within and across societies. This article provides a systematic review of the measurement of inequalities and their implications on rural and remote health. A comprehensive literature review was conducted using online databases and other collections of published research on measuring health gaps between the rich and the poor in order to trace the development of this field of inquiry. Despite the enormous information on the subject area, it is not always easy to disentangle the independent effects of social class or socio-economic status (SES) on health inequalities from genetic or biological differences when analyzing racial/ethnic, gender or age gaps in mortality and morbidity. The meaning of SES or social class also varies from one culture to the other. Despite decades of work in this field, it is not clear what it is about SES or social class that is associated with inequalities in health. Is it simply a question of access to resources? And on the issue of measurement, studies from various disciplines have shown that it is important to employ a raft of measures in order to measure and present the distributions fully from various angles and value judgments. In the rural African context, tackling vertical and horizontal inequalities in health requires tackling the root causes of poverty and promoting social policies that empower individuals and communities. Hence, the review discusses recent methodological developments that hold promise for addressing the knowledge gap that remain. We hope that researchers will reflect on the dynamics in measures of inequalities discussed in this paper as they continue to assess the status of health in Africa’s contemporary and largely dominated rural population. 2013/07/02 - 21:57

Africa has been losing professionally trained health workers who are the core of the health system of this continent for many years. Faced with an increased burden of disease and coupled by a massive exodus of the health workforce, the health systems of many African nations are risking complete paralysis. Several studies have suggested policy options to reduce brain drain from Africa. The purpose of this paper is to review possible policies, which can stem the impact of health professional brain drain from Africa. A systemic literature review was conducted. Cinahl, Science Direct and PubMed databases were searched with the following terms: health professional brain drain from Africa and policies for reducing impact of brain drain from Africa. References were also browsed for relevant articles. A total of 425 articles were available for the study but only 23 articles met the inclusion criteria. The review identified nine policy options, which were being implemented in Africa, but the most common was task shifting which had success in several African countries. This review has demonstrated that there is considerable consensus on task shifting as the most appropriate and sustainable policy option for reducing the impact of health professional brain drain from Africa. 2013/06/29 - 14:13

Background: Africa has been losing professionally trained health workers who are the core of the health system of this continent for many years. Faced with an increased burden of disease and coupled by a massive exodus of the health workforce, the health systems of many African nations are risking complete paralysis. Several studies have suggested policy options to reduce brain drain from Africa. The purpose of this paper is to review possible policies which can stem the impact of health professional brain drain from Africa. Methods: A systemic literature review was conducted. Cinahl, Science Direct and PubMed databases were searched with the following terms: ‘health professional brain drain from Africa’ and ‘policies for reducing impact of brain drain from Africa’. References were also browsed for relevant articles. Results: A total of 425 articles were available for the study but only 23 articles met the inclusion criteria. The review identified nine policy options which were being implemented in Africa, but the most common was task shifting which had success in several African countries. Conclusion: This review has demonstrated that there is considerable consensus on task shifting as the most appropriate and sustainable policy option for reducing the impact of health professional brain drain from Africa. 2013/06/26 - 08:06

In developing countries, few data are available on healthcare-associated infections. In Burkina Faso, there has been a failure to take into account risk management and patient safety in the quality assurance program. The main objective of our study was to carry out an assessment of healthcare-associated infection in a first level hospital. We conducted a crosssectional study in June 2011 in the care units of Ziniaré District Hospital (Ziniaré, Burkina Faso). The hospital has been divided in three components: i) hospital population (care providers, in-patients and patients’ guardians); ii) healthcare and services organization; iii) hospital environment. We included: care providers of the clinical services, hospital inpatients and patients’ guardians, hospitalization infrastructure and nursing units, and all the documents relating to standards and protocols. Data collection has been done by direct observation, interviews and biological samples taken at different settings. In hospital population, care providers and patients’ guardians represented a high source of infection: adherence to hygiene practice on the part of care providers was low (12/19), and no patients’ guardian experienced good conditions of staying in the hospital. In healthcare and services organization, healthcare waste management represented a high-risk source of infection. In hospital environment, hygiene level of the infrastructure in the hospital rooms was low (6.67%). Prevalence of isolated bacteria was 71.8%. Urinary-tract catheters infections were the most significant in our sample, followed by surgical-site infections. In total, 56.26% (9/19) of germs were -Lactamase producers (ESBL). They were represented by Escherichia coli and Klebsiella pneumoniae. Our analysis identified clearly healthcare-associated infection as a problem in Ziniaré district hospital. Hence, a national program of quality assurance in the hospitals should now integrate the risk infectious management of healthcare-associated infections. 2012/12/18 - 14:14

The specific objectives are: i) to determine the level of awareness of pesticide residue in locally available food among food sellers in Ile Ife area of Osun state, Nigeria; ii) to identify the demographic and socio-economic characteristics of food sellers who use pesticides, natural means in preserving their foodstuff from getting spoilt; iii) to determine the level of understanding of food sellers who use pesticides about the likely health implications that could result. The design of the study is cross sectional. Structured open-ended questionnaires were administered to 98 randomly selected food sellers in Ile Ife area Osun state, Nigeria. This includes males and female. The inference from the study shows that majority of the food sellers were between ages 21 and 30 years, suggesting that more of the young people are involved in the selling of foodstuff in the area of study. Most of the food sellers used phostozin, an organophosphate compound as preservatives for cereals. The majority of those that were aware of the health hazards associated with the usage of pesticides as preservative were literate school leavers. Among respondents to the questionnaire, it was expected that many of those food sellers likely to demonstrate caution in the usage of pesticide would be the literate school leavers. This is because they are more aware of the possible associated health hazards than their fellow food sellers who are not literate. The level of awareness of health implications associated with use of pesticides on consumable food items is higher among school certificate holders who are food sellers. Phostozin, an organophosphate, is a common preservative pesticide used on cereals foodstuff (e.g., bean, rice, maize) in the area of study, especially among the age group between 21 and 30 years. 2012/10/25 - 18:48

We sought to determine the knowledge and attitude of public health workers (PHWs) with respect to emerging and re-emerging zoonotic diseases and the practice of one health approach in the surveillance of zoonoses in the community. A cross-sectional study was conducted in 12 randomly selected districts of Nyanza province, Kenya. One hundred and ten randomly-selected PHWs were assessed using a structured questionnaire. Data were collected on their knowledge, attitudes and practices about common zoonotic diseases. Eighty-nine (81%) questionnaires were received back. Eighty-seven (98%) said they discuss zoonotic diseases with the local villagers during their community health work. The most commonly discussed disease was rabies (n=39). Seventy-six (85%) respondents reported ever discussing zoonoses with their veterinary colleagues. Over 85% of the PHWs asked for refresher training on H1N1, and 51% require training on highly pathogenic avian influenza (H5N1). Despite fair knowledge of rabies among the PHWs in Nyanza province, there is need for improving their attitude of the emerging and reemerging zoonoses. There is also need to improve their practice in terms of collaboration with the veterinarians in zoonoses surveillance in the community. 2012/10/25 - 18:48

Few studies have systematically characterized drug-prescribing patterns, particularly at the primary care level in Nigeria, a country disproportionately burdened with disease. The aim of this study was to assess the disease profiles and drug-prescribing pattern in two health care facilities in Edo State, Nigeria. The medical records of 495 patients who attended a primary or secondary health care facility in Owan-East Local Government Area of Edo State, Nigeria, between June and November 2009 were reviewed. Disease profiles and drug prescribing patterns were assessed. Data were analyzed based on the World Health Organization Anatomic Therapeutic Chemical classification system, and core drug prescribing indicators. Five hundred and twelve clinical conditions were identified. Infectious disease was most prevalent (38.3%), followed by disorder of the alimentary tract (16.4%). Malaria was responsible for 55.6% of the infectious diseases seen, and 21.3% (109/512) of the total clinical conditions managed at the two health facilities during the study period. Consequently, anti-infective medications were the most frequently prescribed medicines (21.5%), followed by vitamins (18.2%). Use of artesunate monotherapy at both facilities (15.7%), and chloroquine at the primary health facility (24.9%) were common. Paracetamol (41.8%) and non-steroidal anti-inflammatory drugs (24.9%) were the most frequently used analgesic/antipyretic. At the primary health care facility, dipyrone was used in 21.6% of cases. The core drug prescribing use indicators showed inappropriate prescribing, indicating poly-pharmacy, overuse of antibiotics and injectio. Inappropriate drug use patterns were identified at both health care facilities, especially with regard to the use of ineffective antimalarial drugs and the use of dipyrone. 2012/10/23 - 21:13

In many regions, some of the most formidable enemies of health are joining forces with the allies of poverty to impose a double burden of disease, disability and premature death. This paper looks at the main financial sources households use to finance healthcare in Ghana. It examines the spatial and socio-economic dynamics and the challenges these pose to health and development. Analysis of the 2003 Ghana World Health Survey data indicates that approximately 41% of households depend on more than one financial source with 88% depending on household income to finance healthcare expenditure. The high dependency on household income will erode gains in the economic and health sector in the midst of the recent global economic recession. Comprehensive national health insurance programs that cover emerging disease conditions will mitigate the double burden of disease on households in emerging economies. 2012/10/23 - 01:03

In resource-limited developing nations, such as Cameroon, the expense of modern water-quality monitoring techniques is prohibitive to frequent water testing, as is done in the developed world. Inexpensive, shelf-stable 3M™ Petrifilm™ Escherichia coli/Coliform Count Plates potentially can provide significant opportunity for routine water-quality monitoring in the absence of infrastructure for state-of-the-art testing. We used shelf-stable E. coli/coliform culture plates to assess the water quality at twenty sampling sites in Kumbo, Cameroon. Culture results from treated and untreated sources were compared to modern bacterial DNA pyrosequencing methods using established bioinformatics and statistical tools. Petrifilms were reproducible between replicates and sampling dates. Additionally, cultivation on Petrifilms suggests that treatment by the Kumbo Water Authority (KWA) greatly improves water quality as compared with untreated river and rainwater. The majority of sequences detected were representative of common water and soil microbes, with a minority of sequences (<40%) identified as belonging to genera common in fecal matter and/or causes of human disease. Water sources had variable DNA sequence counts that correlated significantly with the culture count data and may therefore be a proxy for bacterial load. Although the KWA does not meet Western standards for water quality (less than one coliform per 100 mL), KWA piped water is safer than locally available alternative water sources such as river and rainwater. The culture-based technology described is easily transferrable to resource-limited areas and provides local water authorities with valuable microbiological safety information with potential to protect public health in developing nations. 2012/10/23 - 01:03

Sub-Saharan Africa is most heavily affected by human immunodeficiency virus (HIV) infection worldwide. The infection is more commonly observed amongst vulnerable populations. The objective was to determine the profile of seropositive acceptors of HIV voluntary counseling and testing in Niger-Delta, Nigeria. Medical records of voluntary counseling and testing (VCT) acceptors at the Sacred Heart Hospital Obudu, Cross-River State, Nigeria, from January to July 2010 were reviewed. HIV antibody screening was done using two rapid ELISA tests. A total of 1269 VCT acceptors were screened for HIV antibodies out of which 134 (10.6%) tested positive. The age group 20-29 year old was more affected (41.0%). Average age of seropositive acceptors was however 31.21±8.8 years. Most of them 80 (59.7%) were females, married 61 (45.5%) and either had none or low level of formal education (61.2%). Traders constituted 25.4%, students 24.6%, farmers 20.9% among others. More females were married than the males (50.0% vs 38.9%) (P>0.05). There were more educated females than males (P>0.05). Those who had formal education were more likely to be either gainfully employed or seeking for one (P<0.001). HIV positivity was observed mostly among married, female adolescence/ young adult with either none or low level of formal education and engaged in commercial activities. Sustaining efforts towards women education, economic empowerment, and gender equity, modification of risky social lifestyle and VCT for HIV will be helpful in reducing HIV infection among the vulnerable groups. 2012/10/23 - 01:03

Human immunodeficiency syndrome (HIV) whose full-blown period is called acquired immunity deficiency syndrome (AIDS) is today a terminal disease. While one weakens the body hormones, the other comes to claim the life with its accompanying opportunistic diseases. Several factors have been reviewed to be causing the infection and its prevalence as well as its socio-economic, scientific and cultural dimensions. The cost implication of this ailment is enormous when considered from individual, national or global perspective, especially when the cost of treatment and the cost of the disability adjusted life years (DALYs) lost to incapacitation from HIV/AIDS is considered. This study has investigated the financial implications of treatment and the DALYs lost to HIV/AIDS from the perspective of sub-Saharan Africa covering thirty-five countries. Infected population of age 15-49 years were considered, being the active life year age group. Applying Morrow’s DALYs measurement, and Ainsworth’s per capita general rule method of costing HIV/AIDS, it was found that the cost of treatment of HIV/AIDS in any country depends on her economic strength on the one hand and the size of the infected population on the other, to the extent that no country spends or loses less than 3 percent of her national income on treatment and to DALYs. To any country, the financial cost of the DALYs lost to HIV/AIDS is much more than the cost of treatment per episode, mostly huge enough to develop a sector of the country’s economy. However, a single recommendation could be difficult as individual countries experience different effect, but different countries must pursue long-run anti-prevalence policies individually and as economic region or bloc. 2012/10/23 - 01:03

The paper assesses the options for additional innovative financing that could be considered in South Africa, covering both raising new funds and linking funds to results. New funds could come from: i) the private sector, including the mining and mobile phone industry; ii) from voluntary sources, through charities and foundations; iii) and through further expanding health (sin) levies on products such as tobacco, alcohol and unhealthy food and drinks. As in other countries, South Africa could earmark some of these additional sources for investment in interventions and research to reduce unhealthy behaviors and influence the determinants of health. South Africa could also expand innovative linking of funds to improve overall performance of the health sector, including mitigating the risks for non-state investment and exploring different forms of financial incentives for providers and patients. All such innovations would require rigorous monitoring and evaluation to assess whether intended benefits are achieved and to look for unintended consequences. 2012/10/23 - 01:03

The Rift Valley fever (RVF) epidemic in the Horn of Africa region in 2007 resulted in significant mortality on a background of protracted political instability, famine, food insecurity and internal population displacement. Com - municable diseases such as RVF are difficult to contain in such a context with protracted civil war, statelessness, poor governance and constant population movement. A literature review was conducted to assess i) contributing factors to the latest RVF crisis and ii) emergency response. Within the review, the challenges and opportunities for future management were also identified. A range of geopolitical, socioeconomic and environmental barriers impeded the public health response, notably the lack of regional epidemic management guidelines. The Horn of Africa nations did not have localized response plans despite the presence and assistance of multinational organizations with epidemic containment strategies. Traversing borders and boundaries, RVF could wreak devastating outcomes once more unless stringent local and regional public health collaborations are established. It is therefore necessary to empower livestock owners and instate them in national and regional early detection, as part of a strengthened detection and response mechanism. 2012/10/23 - 01:03

This study examines the effects of socioeconomic and maternal variables on the probability of neonatal deaths. An understanding of the factors related to neonatal mortality is important in guiding the development of focused and evidence-based health interventions to prevent neonatal deaths. The data source for the analysis was the 2006-07 Swaziland Demographic and Health Survey from which survival information on 1727 infants born within the 3 years preceding the survey. Design based logistic regression incorporating survey weights was performed to analyze the associated factors. Compared to infants born at home, the odds of dying were significantly lower for infants born in a private facility (OR=0.37, 95% CI: 0.15-0.90). Neonates born in public facilities and those born at home had similar odds of dying. For newborns, whose birth size according to the mother was smaller than average, the odds of dying were more than 4 times the odds for large-sized babies (OR=4.72, 95% CI: 1.66-13.36). 2012/10/23 - 01:03

Considerations as to the feasibility with which child survival interventions can be delivered at high levels of population coverage, have been described as a central criterion of interventions intended to reduce child mortality... 2012/10/23 - 01:03

At least two distinct approaches to pandemic preparedness have arisen in response to the threats posed by pandemic influenza: a traditional public health approach and an increasingly securitised one. Traditional public health focuses on the population and their living conditions. In contrast, public health strategies informed by concerns with security focus on the resilience of critical infrastructure, such as electricity and communication, and on the ensuring good connections between different layers of government and any private bodies likely to be central to the response. Pandemic plans can be informed by one or a mix of both approaches. The securitised approach is more prevalent in the World Health Organization (WHO)’s plans and Western countries’ plans. In contrast, the WHO-AFRO Regional Pandemic Influenza Preparedness Plan 2009 utilises the existing Integrated Diseases Surveillance and Response framework as its starting point. It is informed by both rationales. Will African preparedness efforts develop in the direction of those already more informed by concerns about security? This paper examines how a securitised approach glosses over the differences between existing and threatened diseases. This is a particular problem in the African context with a high burden of infectious disease and underfunded health systems. Rather than a diversion of resources into a securitised approach, we suggest that the preparedness needs of the African continent are best served by focussing political will, international aid, financial and technical resources on the development of the health sector, including the integrated diseases surveillance and response framework. By tracing the distinct rationales at work in preparedness plans, it becomes apparent that an emphasis on the population will better position the continent for the future pandemics. 2012/10/23 - 01:03

Little is known about the distribution of eye and vision conditions among school children in Qatar. The aim of the study was to examine the effects of excessive internet use and television viewing on low vision and its prevalence with socio-demographic characteristics. This is a cross-sectional study which was carried out in the public and private schools of the Ministry of Education and Higher Education of the State of Qatar from September 2009 to April 2010. A total of 3200 students aged 6-18 years were invited to take part of whom 2586 (80.8%) agreed. A questionnaire, that included questions about socio-demographic factors, internet use, and television viewing and computer games, co-morbid factors, and family history and vision assessment, was designed to collect information from the students. This was distributed by the school authorities. Of the school children studied (n=2586), 52.8% were girls and 47.2% boys. The overall prevalence of low vision was 15.2%. The prevalence of low vision was significantly higher in the age group 6-10 years (17.1%; P=0.05). Low vision was more prevalent among television viewers (17.2%) than in infrequent viewers (14.0%). The proportion of children wearing glasses was higher in frequent internet users and television viewers (21.3%). Also, low vision without aid was higher in frequent viewers. The study findings revealed a greater prevalence of low vision among frequent internet users and television viewers. The proportion of children wearing glasses was higher among frequent viewers. The prevalence of low vision decreased with increasing age. 2012/06/01 - 21:05

HIV and AIDS are major public health problems in Cameroon where the HIV prevalence is 5.5%. Candidiasis is the leading opportunistic mycosis in HIV and AIDS patients. The objective of this study was to determine the in vitro antifungal susceptibility pattern of Candida albicans in HIV and AIDS patients to eight antifungal agents in the Nylon Health District of Douala in Cameroon. Three hundred and four HIV and AIDS patients were recruited between March and August 2007 to participate in a cross-sectional study. All subjects who fulfilled the inclusion criteria were enrolled. Informed consent was obtained from all subjects before samples were collected. Three samples comprising oral swabs, vagina/urethra swabs and a mid-stream urine were collected from each subject. Specimens were cultured on sabouraud dextrose agar and C. albicans isolates were identified using the germ tube technique. The disk diffusion method was used for antifungal susceptibility testing using eight antifungal agents. The prevalence of candidiasis in the study population was 67.8% (95% CI: 62.5-73.1%) and that of C. albicans was 42.8% (95% CI: 37.2-48.4%). Oral swabs had the highest prevalence of C. albicans followed by vaginal/urethral samples (52.6% vs. 29.7% respectively). Forty (30.8%) subjects had C. albicans infection at more than one collection site. There was a statistically significant difference in the infectivity of C. albicans with age, sex and site of infection (P<0.05). C. albicans isolates were most sensitive to ketoconazole (80%) followed by econazole (64.6%) while fluconazole and 5-flurocytosin recorded the poorest sensitivities (22.9% vs 24.6%, respectively). There was a statistically significant difference in the sensitivity pattern of antifungal agents with respect to the site of isolation of the organism (P<0.05). Ketoconazole is the drug of choice for the treatment of C. albicans infection in HIV and AIDS patients in the Nylon Health District of Douala, Cameroon. 2012/05/11 - 04:43

This paper investigated the belief of the news of impending earthquake from any source in the context of the Cry Wolf hypothesis as well as the belief of the news of any other imminent disaster from any source. We were also interested in the correlation between preparedness, risk perception and antecedents. This explorative study consisted of interviews, literature and Internet reviews. Sampling was of a simple random nature. Stratification was carried out by sex and residence type. The sample size of (N=400), consisted of 195 males and 205 Females. Further stratification was based on residential classification used by the municipalities. The study revealed that a person would believe news of an impending earthquake from any source, (64.4%) and a model significance of (P=0.000). It also showed that a person would believe news of any other impending disaster from any source, (73.1%) and a significance of (P=0.003). There is association between background, risk perception and preparedness. Emergency preparedness is weak. Earthquake awareness needs to be re-enforced. There is a critical need for public education of earthquake preparedness. The authors recommend developing emergency response program for earthquakes, standard operating procedures for a national risk communication through all media including instant bulk messaging. 2012/04/27 - 19:08

Rapid expansion of antiretroviral therapy (ART) and a shortage of health care workers (HCWs) required the implementation of a peer educator (PE) model as part of a task-shifting strategy in Lusaka District clinics. The purpose of this study was to evaluate patient and staff perceptions regarding whether the PE program: a) relieved the workload on professional HCWs; and b) delivered services of acceptable quality. Qualitative and quantitative data were gathered from five primary care clinics delivering ART in Lusaka, Zambia. Closed surveys were conducted with 148 patients receiving ART, 29 PEs, and 53 HCWs. Data was imported into Microsoft Excel to calculate descriptive statistics. Six focus group discussions and eight key informant (KI) interviews were conducted, recorded, transcribed, and coded to extract relevant data. Survey results demonstrated that 50 of 53 (96.1%) HCWs agreed PEs reduced the amount of counseling duties required of HCWs. HCWs felt that PEs performed as well as HCWs in counseling patients (48 of 53; 90.6%) and that having PEs conduct counseling enabled clinical staff to see more patients (44 of 53; 83%). A majority of patients (141 of 148; 95.2%) agreed or strongly agreed that PEs were knowledgeable about ART, and 89 of 144 (61.8%) expressed a high level of confidence with PEs performing counseling and related tasks. Focus group and KI interviews supported these findings. PEs helped ease the work burden of HCWs and provided effective counseling, education talks, and adherence support to patients in HIV care. Consideration should be given to formalizing their role in the public health sector. 2012/03/08 - 09:23

There is limited availability of mental health services in Nigeria, and indeed most of Africa. Available services are also often under-utilized because of widespread ignorance and supernatural beliefs about the etiology of mental illnesses. The consequence, therefore, is a long and tedious pathway to care for the mentally ill, especially children and adolescents. This was a study of all new patients, aged 18 years and below, presenting over a 6 month period in 2009 (January – June) at the outpatient clinic of a tertiary psychiatric facility in northern Nigeria. A socio-demographic questionnaire was utilized, along with a record of the clinician’s assessment of diagnosis for 242 patients. Subjects who had been withdrawn from school, or any previously engaged-in activity for longer than 4 weeks on account of the illness, were recorded as having disability from the illness. The children were aged 1-18 years (mean=12.3; SD=5.2) with males accounting for 51.7% (125) while 14.5% of the females (n=117) were married. Two thirds (64.5%) of the patients had been ill for longer than 6 months prior to presentation. One hundred and forty four subjects (59.5%) had received no care at all, while 36.4% had received treatment from traditional/religious healers prior to presentation. The most disabling conditions were ADHD (80%), mental retardation (77.8%), epilepsy (64.1%) and psychotic disorders (50%). There is urgent need for extending mental health services into the community in order to improve access to care and increase awareness about effective and affordable treatments. 2012/03/08 - 09:23

Drug abuse is reported to be on the increase among young persons using illicit substances but little is known about the frequency with which they occur, the symptoms on presentation to health institutions, and the different substances abused. To establish this, we reviewed patient data collected at Al-Amal Hospital in Jeddah Kingdom of Saudi Arabia on young persons who are refered to the hospital for problems related to drug abuse. Data on 69 adolescent drug users were reviewed and analyzed using the Composite International Diagnostic Interview - Substance Abuse Model (CIDI-SAM) to assess dependence on substances including amphetamines, cannabis, cocaine, and opioids. Furthermore, we assessed the adolescents’ data on history of delusions and hallucinations in the context of use of, or withdrawal from, these specific substances. Our analysis shows that 10 to 79.6% of users of amphetamines, cannabis, cocaine, and opiates met DSM-III-R dependence criteria for each specific substance. The prevalence of psychotic symptoms associated with each specific substance ranged from users with no diagnosis to users with severe dependence as follows: amphetamines (3-100%), cannabis (7- 60.0%), cocaine (5-70.7%), and opiates (4- 88%). The risk of psychotic symptoms increased for respondents who abused (OR=7.2) or had mild (OR=8.1), moderate (OR=20.0), or severe dependence (OR=14.0) on cocaine when compared to those who were users with no diagnosis. A similar pattern was evident in cannabis, opiate, and amphetamine users. In conclusion, most adolescent drug users in Saudi Arabia who are dependent on illicit substances experience psychotic symptoms in the context of use of, or withdrawal from, these substances. Psychotic symptoms increased with the severity of the disorders associated with use of all four substances. These findings underscore the importance of developing services to target this population; a population at risk of developing psychotic symptoms. 2012/03/08 - 09:23

Supplementation of conventional medicines with herbs is increasing globally, including among people infected with HIV. Yet there is little data systematically describing the prevalence and patterns of this supplementation and on which counseling scripts can be based. Moringa oleifera is an herb found in the tropics and sub-tropics commonly used for medicinal and nutritional purposes. This survey determined the prevalence and patterns of use of M. oleifera among HIV positive patients. The study was a cross-sectional survey. HIV-infected adults were enrolled from an opportunistic infections clinic of a referral hospital. Using a previously piloted researcher administered questionnaire; patients who reported to the clinic over three months were interviewed about their use of herbal medicines. The focus was on M. oleifera use, and included plant part, dosage, prescribers and the associated medical conditions. Sixty-eight percent (68%) of the study participants consumed M. oleifera. Of these, 81% had commenced antiretroviral drugs. Friends or relatives were the most common source of a recommendation for use of the herb (69%). Most (80%) consumed M. oleifera to boost the immune system. The leaf powder was mainly used, either alone or in combination with the root and/or bark. M. oleifera supplementation is common among HIV positive people. Because it is frequently prescribed by non-professionals and taken concomitantly with conventional medicine, it poses a potential risk for herb-drug interactions. Further experimental investigations into its effect on drug metabolism and transport would be useful in improving clinical outcome of HIV positive patients. 2012/03/08 - 09:23

Although the world has progressed in the area of water and sanitation, more than 2.3 billion people still live without access to sanitation facilities and some are unable to practice basic hygiene. Access to water and basic sanitation has deteriorated in Chitungwiza and children are at risk of developing illness and missing school due to the deterioration. We sought to investigate the predisposing, enabling and reinforcing factors that are causally related to water- and sanitation- related hygiene practices among school going children. A random sample of 400 primary school children (196 males, 204 females) in four schools in Chitungwiza town, Zimbabwe was interviewed. Behavioural factors were assessed through cross examination of the PROCEED PRECEDE Model. The respondents had been stratified through the random sampling where strata were classes. A structured observation checklist was also administered to assess hygiene enabling facilities for each school. Children’s knowledge and perceptions were inconsistent with hygienic behaviour. The family institution seemed to play a more important role in life skills training and positive reinforcement compared to the school (50% vs 27.3%). There was no association between a child’s sex, age and parents’ occupation with any of the factors assessed (P=0.646). Schools did not provide a hygiene enabling environment as there were no learning materials, policy and resources on hygiene and health. The challenges lay in the provision of hygiene enabling facilities, particularly, the lack of access to sanitation for the maturing girl child and a school curriculum that provides positive reinforcement and practical life skills training approach. 2012/03/08 - 09:23

Prevention and management of obesity largely depends on patient motivation and education and these, in turn, can be greatly facilitated by adequate baseline data on the knowledge, attitude and practice (KAP) of patients. The aim of this study is to assess KAP on obesity among Bangladeshi type 2 diabetics. Under a cross-sectional design 160 type 2 diabetics were selected from outpatient department of Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine & Metabolic Disorders. A standard questionnaire was constructed in local language and interview was administrated. Age and body mass index (BMI) of the respondents were 45.17±5.68 years and 25.6 ±4 kg/m2 respectively. Among them 45% were male, 38% had primary education, 25% belonged to normal weight, 1/2 of them were overweight and rest were obese. KAP score of the respondents was [mean ±SD(%)] 60.03±13.82, 79.30±8.27, 55.50±19.21 respectively. Majority were unaware about ideal body weight, energy requirement and the weight measurement techniques. A substantial proportion of the respondents considered fast food, soft drinks, mayonnaise as healthier food. Majority of them positively agreed on willingness to follow proper diet, maintaining ideal body weight, dietary management and exercise. More than half of the normal weight and overweight respondents did exercise >45 min, while 1/3 obese did not do exercise (35%). KAP score were significantly associated with respondents’ level of education (P=0.0001, P=0.007, P=0.05 respectively) practice score was significantly associated with sex (P=0.0001), occupation (P=0.003) and BMI (P=0.0001). There is a need for increased effort towards developing and making education programs focusing on empowering the persons to transform their knowledge and attitude into practice. 2012/03/08 - 09:23

Nigerian youth currently bear a disproportionate burden of the HIV epidemic. This paper presents findings on the occurrence of HIVrelated discrimination among youth with HIV accessing care in Ibadan, Nigeria. A cross-sectional study was conducted and information on history of discrimination experienced by 170 youth with HIV was obtained. About 80% of respondents had disclosed their HIV status. The majority had informed their spouses (66.3%), mothers (47.1%), fathers (39.1%) and siblings (37.7%). Sixteen (11.5%) respondents [15 (93.8%) females and one (6.2%) male] had suffered discrimination since disclosure of their status. Of these, 25.0% respondents were sent out of their matrimonial homes by their husbands, 25.0% were abandoned by their spouses and 12.5% indicated their fiancé broke up their relationship. A higher proportion of females (12.9%) than males (4.3%) had suffered discrimination. In addition, a significant proportion of respondents who were separated/divorced (73.3%) had been victims of discrimination compared with those who were widowed (10.5%) or single (5.9%) (P<0.05). The study confirmed that young people living with HIV/AIDS, especially women experience extreme forms of discrimination. More efforts aimed at addressing HIV/AIDS-related discrimination are required especially as it is a known barrier to HIV prevention and treatment efforts. 2012/03/08 - 09:23

Contextual influence on health outcomes is increasingly becoming an important area of research. Analytical techniques such as spatial analysis help explain the variations and dynamics in health inequalities across different context and among different population groups. This paper explores spatial clustering in body mass index among Ghanaian women by analysing data from the 2008 Ghana Demographic and Health Survey using exploratory spatial data analysis techniques. Overweight was a more common occurrence in urban areas than in rural areas. Close to a quarter of the clusters in Ghana, mostly those in the southern sector contained women who were overweight. Women who lived in clusters where the women were overweight were more likely to live around other clusters where the women were also overweight. The results suggest that the urban environment could be a potential contributing factor to the high levels of obesity in urban areas of Ghana. There is the need for researchers to include a spatial dimension to obesity research in Ghana paying particular attention the urban environment. 2012/03/08 - 09:23

Zimbabwe’s HIV epidemic is amongst the worst in the world, and disproportionately effects poorer rural areas. Access to almost all health services in Zimbabwe includes some form of cost to the client. In recent years, the socio-economic and employment status of many Zimbabweans has suffered a serious decline, creating additional barriers to HIV treatment and care. We aimed to assess the impact of i) socio-economic status (SES) and ii) employment status on the utilization of health services in rural Zimbabwe. Data were collected from a random probability sample household survey conducted in the Mutoko district of north-western Zimbabwe in 2005. We selected variables that described the economic status of the respondent, including: being paid to work, employment status, and SES by assets. Respondents were also asked about where they most often utilized healthcare when they or their family was sick or hurt. Of 2,874 respondents, all forms of healthcare tended to be utilized by those of high or medium-high SES (65%), including private (65%), church-based (61%), traditional (67%), and other providers (66%) (P=0.009). Most respondents of low SES utilized government providers (74%) (P=0.009). Seventy-one percent of respondents utilizing health services were employed. Government (71%), private (72%), church (71%), community-based (78%) and other (64%) health services tended to be utilized by employed respondents (P=0.000). Only traditional health services were equally utilized by unemployed respondents (50%) (P=0.000). A wide range of health providers are utilized in rural Zimbabwe. Utilization is strongly associated with SES and employment status, particularly for services with user fees, which may act as a barrier to HIV treatment and care access. Efforts to improve access in low-SES, high HIVprevalence settings may benefit from the subsidization of the health care payment system, efforts to improve SES levels, political reform, and the involvement of traditional providers. 2012/03/08 - 09:23

The growing rate of sexual risk-taking among young people contributes significantly to the spread of the HIV/AIDS epidemic in Nigeria. This study, explores the influence of socio-demographic, HIV/AIDS awareness and female empowerment on the sexual risk behaviors of unmarried Nigerian women aged 15-24. The data presented in this paper was drawn from the 2003 Nigeria National Demographic and Health Survey. The sample consisted of unmarried women aged 15-24 in the dataset. Data was collected through a structured and interviewer administered questionnaire. Multivariate logistic regression models were used to identify the most important predictors of sexual risk behaviors. Sexual risk-taking is relatively high among unmarried young women. Among those who are sexually active, 80% indicated that they did not use a condom during their first sexual encounter. Regression analysis revealed that younger age, lower HIV/AIDS prevention and transmission knowledge, lower knowledge of where to obtain condoms, lower material standard of living and greater intimate partner violence were significantly associated with sexual risk-taking in this population. Findings revealed that the sexual behavior of unmarried Nigerian women aged 15-24 is influenced by a complex matrix of factors. Identifying specific processes and contexts that promote the concentration of risk among sub-sections of young unmarried women aged 15-24 years in Nigeria should be a research and intervention priority. 2012/03/08 - 09:23

Developing countries are devising various strategies and mechanisms to accelerate their speed towards the Millennium Development Goals (MDGs) by 2015. In Nigeria, different approaches have been used to address the tackling of health-related MDGs. One creative approach has been the implementation of the NHIS Maternal and Child Health (NHIS-MCH) Project. The project aims to speed up the achievement of MDGs 4 and 5 (reducing child mortality and improving maternal health) in the country. Little is known about the NHISMCH Project’s design and health insurance coverage activities. Project planning and monitoring could be hampered by lack of technical and managerial skills of health insurance most especially at middle and local levels. Challenging debates continue to emanate on the project’s sustainability. 2012/03/08 - 09:23

Studies worldwide have established a close link between higher socioeconomic status (SES) and demographic outcomes such as lower infant and child survival. This relationship has often been studied by utilizing information on ownership of household assets. Recently, we examined the effect of a proxy for SES on child survival in Malawi using the 1987 and 1998 census data. Results showed that in 1987 there was an increase in mortality for children belonging to poor households; in 1998 results were reversed: child mortality was higher among rich households and also among middle-aged women. Parallel analysis of the 1992 and 2000 Demographic and Health Surveys (DHS) data showed similar results. We replicate our earlier analyses and assess whether the results persist in the 2004 DHS. Results show that child mortality is higher in richer households but at lower levels than those observed earlier owing to modest improvement in the living standards of people. 2012/03/08 - 09:23

A significant proportion of vulnerable people in sub-Saharan Africa (SSA) remain at risk for contracting diarrhoeal diseases due to the presence of many risk factors facilitating their transmission. A systematic review of published articles from the SSA region was done to determine the prevalence and types of diarrhoeal pathogens in circulation, based on a search of databases, including EBSCO host, PubMed, Scopus, Science Direct, Google scholar and Web of Science was done between September 2009 and December 2010. Data were summarized from 27 studies, with pooled data analysed and reported. Pathogens were isolated from between 26.8-65.6% of cases, with an overall isolation rate of 55.7% (95% CI, 48.2-62.9%). Isolation rates were highest amongst adult cases followed by children, and the odds of isolating a pathogen was greater in diarrhoeal cases (Odds Ratio 4.93 (95% CI, 1.99 to 12.23), than in asymptomatic controls. Overall isolation ranged from 8% to 99%; and heterogeneity testing suggests differences between age groups (Q=5.806; df=2, P=0. 055). Mixed E. coli spp., (29.95%), Cryptosporidium (21.52%), Cyclospora (18%), Entamoeba, (13.8%), Shigella spp. (10.49%), Salmonella spp. (8.36%), and Campylobacter spp. (8.33%), were most commonly reported, and rotavirus was the most common virus isolated. This is the first review to look at the range of enteric pathogens circulating in SSA, and has confirmed high rates of isolation of pathogens from diarrhoeal cases. Public health practitioners can use this information to understanding the challenges related to diarrhoeal illness and set priorities for their prevention and control. 2011/09/05 - 11:39

Since 1957, there has been major reorganization of health care services in Malaysia. This article assesses the changes and challenges in health care delivery in Malaysia and how the management in health care processes has evolved over the years including equitable health care and health care financing. The health care service in Malaysia is changing towards wellness service as opposed to illness service. The Malaysian Ministry of Health (MOH), being the main provider of health services, may need to manage and mobilize better health care services by providing better health care financing mechanisms. It is recommended that partnership between public and private sectors with the extension of traditional medicine complementing western medicine in medical therapy continues in the delivery of health care. 2011/09/05 - 11:39

Few studies have investigated the interplay of multiple factors affecting the prevalence of tuberculosis in developing countries. The compositional and contextual factors that affect health and disease patterns must be fully understood to successfully control tuberculosis. Experience with tuberculosis in South Africa was examined at the household level (overcrowding, a leaky roof, social capital, unemployment, income) and at the neighbourhood level (Gini coefficient of inequality, unemployment rate, headcount poverty rate). A hierarchical random-effects model was used to assess household-level and neighbourhood-level effects on self-reported tuberculosis experience. Every tenth household in each of the 20 Rhini neighbourhoods was selected for inclusion in the sample. Eligible respondents were at least 18 years of age and had been residents of Rhini for at least six months of the previous year. A Kish grid was used to select one respondent from each targeted household, to ensure that all eligible persons in the household stood an equal chance of being included in the survey. We included 1020 households within 20 neighbourhoods of Rhini, a suburb of Grahamstown in the Eastern Cape, South Africa. About one-third of respondents (n=329; 32%) reported that there had been a tuberculosis case within the household. Analyses revealed that overcrowding (P≤0.05) and roof leakage (P≤ 0.05) contributed significantly to the probability of a household TB experience, whereas higher social capital (P≤0.01) significantly reduced this probability. Overcrowding, roof leakage and the social environment affected tuberculosis prevalence in this economically disadvantaged community. Policy makers should consider the possible benefits of programs that deal with housing and social environments when addressing the spread of tuberculosis in economically poor districts. 2011/09/05 - 11:39

About 400 million school-age children are infected with roundworm, whipworm and hookworm worldwide. This study aims to assess prevalence of parasitic infections among rural primary school pupils at Minia Governorate, Egypt, and to identify relevant predisposing factors of the school and pupils to intestinal parasitic infections. A total of 264 pupils out of 1053, aged 6-12 years, were randomly selected for parasitological investigation and the school was inspected on site for sanitary facilities and conditions of hygiene, as well as the conditions of hygiene of the pupils. The pupils were examined for ova, cysts and/or larvae of intestinal parasites using direct wet mount and formal-ether concentration techniques. Inspection of sanitary facilities and the conditions of hygiene of the school, as well pupil's conditions of hygiene, were carried out through observation checklists. Findings revealed the following intestinal parasites: Entamoeba coli (in 19.3% of pupils), Ascaris lumbricoides (3.8%), Hymenolepiasis nana (12.5%), Enterobious vermicularis (5.7%) and Giardia lamblia (12.5%), with varying percentages between male and female pupils, and a highly statistical association between pupil sex and type of parasites (P<0.001). Unapproved sanitary facilities and conditions of hygiene of the school and pupils were observed. Many intestinal parasitic infections among the primary school pupils were found. Unapproved and low inventory school sanitary facilities were observed, in addition to poor conditions of hygiene of pupils which may play a crucial role in these infections. The school facilities and sanitary conditions, especially the quality of water in the toilets, should be improved. Pupils and school personnel have a real need for health education about modes of transmission and preventive methods of intestinal parasitic infections. 2011/09/05 - 11:39

Despite over two decades of extensive research showing that male circumcision protects against heterosexual acquisition of HIV in men, and that includes findings from large randomized controlled trials leading to acceptance by the WHO/UNAIDS and the Cochrane Committee, opponents of circumcision continue to generate specious arguments to the contrary. In a recent issue of the Journal of Public Health in Africa, Van Howe and Storms claim that male circumcision will increase HIV infections in Africa. Here we review the statements they use in support of their thesis and show that there is no scientific basis to such an assertion. We also evaluate the statistics used and show that when these data are properly analyzed the results lead to a contrary conclusion affirming the major role of male circumcision in protecting against HIV infection in Africa. Researchers, policy makers and the wider community should rely on balanced scholarship when assessing scientific evidence. We trust that our assessment may help refute the claims by Van Howe and Storms, and provide reassurance on the importance of circumcision for HIV prevention. 2011/09/05 - 11:39

Half of the 10 million children who die annually in the world are from Sub-Saharan Africa (SSA). The reasons are known, but lack of will and resources avoid the development of sustainable policies. Associated factors to the high infant mortality rate (IMR) in SSA have been investigated in this research. An ecological multi-group study was designed comparing rates within SSA. The dependent variable is the IMR and health services, economic and development indicators are the independent variables. Information and data sources were WHO, World Bank, UNICEF and UNDP (1997-2007). IMR mean value is 92.2 (per 1000 live births) and a relationship with several of the factors could be observed. In the bi-variate analysis direct relationship was observed with maternal mortality rate and an inverse relationship was observed with prenatal care coverage, births assisted by skilled health personnel, gross national income per capita, per capita government expenditure on health, social security expenditure, adult literacy rate, net primary school enrolment rate, population with access to safe drinking water (in urban and rural areas) and with population with access to basic sanitation in rural areas. In the multi-variate analysis IMR had an inverse relationship with children under 5 years with diarrhoea who receive oral re-hydration, with social security expenditure as percentage of general government expenditure on health and with per capita government expenditure on health. The situation in SSA would change if their inhabitants received education and information to demand more equitable polices and better investments from their governments. 2011/09/05 - 11:39

With only four years left for the Millennium Development Goal’s 2015 deadline for reducing poor maternal health outcomes, developing countries are still bearing a huge burden of maternal morbidity worldwide. Estimates show that over 2 million women worldwide are suffering from obstetric fistula, the majority of which live in sub-Saharan Africa, Southeast Asia, and the Arab region. The purpose of this study is to shed a light on obstetric fistula by examining risk factors associated with this morbidity in Uganda. Descriptive and multivariate analyses were conducted using data from the 2006 Uganda Demographic and Health Survey. Older age at first sexual intercourse was significantly associated with a lower risk of obstetric fistula (OR=0.302) compared to younger age at first intercourse (7-14 years). Lack of autonomy was negatively associated with the risk of obstetric fistula; women who have problems securing permission from their husband to go seek care (OR=1.658) were more likely to suffer from this morbidity. Significant differentials in obstetric fistula have also been observed based on the region of residence: women living in Central (OR=4.923), East Central (OR=3.603), West Nile (OR=2.049), and Southwest (1.846) more likely to suffer from obstetric fistula than women living in North Central. Findings demonstrate the importance of improving geographical accessibility to maternal health care services, and emphasize the need to reinforce intervention programs, which seek to address gender inequalities. 2011/09/05 - 11:39

Experience suggests that the incorporation of gender approaches into family planning (FP) and reproductive health (RH) programs may increase their impact and sustainability, but further work is needed to examine the interactions between gender norms and family planning and to incorporate this understanding into behavior change communication (BCC) in specific social contexts. We conducted open-ended, in-depth interviews with 30 young currently married men, 30 young married women and 12 older people who influenced FP decisions. Six focus group interviews were also conducted. The interviews focused on the role of gender norms in reproductive decision-making and contraceptive use among young married men and women in Tanzania. The findings suggest that gender factors, such as men’s dominance in decision-making do function as barriers to the use of modern contraceptives, but that fear of side effects, by both men and women, may be even more important deterrents. Results from this research will inform the development of BCC interventions to be tested in a subsequent intervention study in which gender factors and poor information about contraceptive methods will be addressed. 2011/09/05 - 11:39