المؤلفون: Alice F. Yan, Patricia E. Stevens, Susan Cotts Watkins, Lucy Mkandawire-Valhmu, Katarina M. Grande, Thokozani Ng’ombe Mwenyekonde, Emmanuel M. Ngui, Loren W. Galvao, Lindsay Emer, Lance S. Weinhardt

المصدر: AIDS and Behavior

مصطلحات موضوعية: Male, Rural Population, Malawi, Economic growth, Non-Randomized Controlled Trials as Topic, Economics, Vulnerability, HIV Infections, Food Supply, Health Risk Behaviors, 0302 clinical medicine, Outcome Assessment, Health Care, 030212 general & internal medicine, Aged, 80 and over, 2. Zero hunger, Food security, Sustainable agriculture, 1. No poverty, Agriculture, Middle Aged, 3. Good health, Health psychology, Models, Economic, Infectious Diseases, Female, 0305 other medical science, Risk assessment, Quasi-experiment, Adult, medicine.medical_specialty, Adolescent, Social Psychology, Developing country, Microfinance, Structural intervention, Risk Assessment, Young Adult, 03 medical and health sciences, Environmental health, Intervention (counseling), medicine, Humans, Developing Countries, Aged, Original Paper, 030505 public health, business.industry, Public health, Farmer field schools, Health Plan Implementation, Public Health, Environmental and Occupational Health, HIV, business

الوصف: The objective of the Savings, Agriculture, Governance, and Empowerment for Health (SAGE4Health) study was to evaluate the impact of a large-scale multi-level economic and food security intervention on health outcomes and HIV vulnerability in rural Malawi. The study employed a quasi-experimental non-equivalent control group design to compare intervention participants (n = 598) with people participating in unrelated programs in distinct but similar geographical areas (control, n = 301). We conducted participant interviews at baseline, 18–, and 36–months on HIV vulnerability and related health outcomes, food security, and economic vulnerability. Randomly selected households (n = 1002) were interviewed in the intervention and control areas at baseline and 36 months. Compared to the control group, the intervention led to increased HIV testing (OR 1.90; 95 % CI 1.29–2.78) and HIV case finding (OR = 2.13; 95 % CI 1.07–4.22); decreased food insecurity (OR = 0.74; 95 % CI 0.63–0.87), increased nutritional diversity, and improved economic resilience to shocks. Most effects were sustained over a 3-year period. Further, no significant differences in change were found over the 3-year study period on surveys of randomly selected households in the intervention and control areas. Although there were general trends toward improvement in the study area, only intervention participants’ outcomes were significantly better. Results indicate the intervention can improve economic and food security and HIV vulnerability through increased testing and case finding. Leveraging the resources of economic development NGOs to deliver locally-developed programs with scientific funding to conduct controlled evaluations has the potential to accelerate the scientific evidence base for the effects of economic development programs on health.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::4a94615ccd2d358900ca0cadb6d139abTest

المؤلفون: Lenka Benova, Hania Sholkamy, Oona M. R. Campbell, George B. Ploubidis

المصدر: International Journal for Equity in Health

مصطلحات موضوعية: Adult, Rural Population, Health Knowledge, Attitudes, Practice, medicine.medical_specialty, Health Behavior, Population, Psychological intervention, Private Practice, Young Adult, 03 medical and health sciences, 0302 clinical medicine, 5. Gender equality, Pregnancy, Environmental health, medicine, Humans, Maternal Health Services, 030212 general & internal medicine, Healthcare Disparities, 10. No inequality, education, Poverty, Socioeconomic status, Facility delivery, Health policy, education.field_of_study, business.industry, Research, 030503 health policy & services, Public health, Health Policy, 1. No poverty, Health services research, Public Health, Environmental and Occupational Health, Health-seeking behaviour, Middle Aged, 3. Good health, Cross-Sectional Studies, Logistic Models, Ante-natal care, Socioeconomic Factors, Egypt, Female, Maternal health, Rural area, 0305 other medical science, business

الوصف: INTRODUCTION: Socio-economic inequalities in basic maternal health interventions exist in Egypt, yet little is known about health-seeking of poor households. This paper assesses levels of maternal health-seeking behaviours in women living in poor households in rural Upper Egypt, and compares these to national averages. Secondly, we construct innovative measures of socio-economic resourcefulness among the rural poor in order to examine the association between the resulting variables and the four dimensions of maternal health-seeking behaviour. METHODS: We analysed a cross-sectional survey conducted in Assiut and Sohag governorates in 2010-2011 of 2,242 women in households below the poverty line in 65 poorest villages in Egypt. The associations between four latent socio-economic constructs (socio-cultural resourcefulness, economic resourcefulness, dwelling quality and woman's status) and receipt of any antenatal care (ANC), regular ANC (four or more visits), facility delivery and private sector delivery for women's most recent pregnancy in five years preceding survey were assessed using multivariate logistic regression. RESULTS: In the sample, 58.5% of women reported using any ANC and 51.1% facility delivery, lower than national coverage (74.2% and 72.4%, respectively). The proportion of ANC users receiving regular ANC was lower (67%) than nationally (91%). Among women delivering in facilities, 18% of women in the poor Upper Egypt sample used private providers (63% nationally). In multivariate analysis, higher economic resourcefulness was associated with higher odds of receiving ANC but with lower odds of facility delivery. Socio-cultural resourcefulness was positively associated with receiving any ANC, regular ANC and facility delivery, whereas it was not associated with private delivery care. Dwelling quality was positively associated with private delivery facility use. Woman's status was not independently associated with any of the four behaviours. CONCLUSIONS: Coverage of basic maternal health interventions and utilisation of private providers are lower among rural poor women in Upper Egypt than nationally. Variables capturing socio-cultural resourcefulness and economic resourcefulness were useful predictors of ANC and facility delivery. Further understanding of issues surrounding availability, affordability and quality of maternal health services among the poor is crucial to eliminating inequalities in maternal health coverage in Egypt.

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المؤلفون: Heiner Grosskurth, David Katende, Kathy Baisley, Fiona Vanobberghen, Bazil Kavishe, Robert N. Peck, Eric Ikoona, Gerald Mutungi, Paula Munderi, Janneth Mghamba, Liam Smeeth, Edmund Kisanga, Jonathan Levin, Richard J. Hayes, Maria Assumpció Bou Monclús, Samuel Biraro, Saidi Kapiga

المصدر: BMC Medicine

مصطلحات موضوعية: Male, Pathology, Cross-sectional study, heart failure, HIV Infections, 030204 cardiovascular system & hematology, Overweight, Logistic regression, Tanzania, 0302 clinical medicine, Risk Factors, Prevalence, Medicine, Uganda, 030212 general & internal medicine, NCD risk factors, Medicine(all), education.field_of_study, Alcohol Use Disorders Identification Test, biology, Smoking, 1. No poverty, General Medicine, Middle Aged, 3. Good health, Alcoholism, obstructive pulmonary disease, Female, medicine.symptom, Needs Assessment, Research Article, Adult, medicine.medical_specialty, hypertension, Adolescent, Population, Communicable Diseases, 03 medical and health sciences, Environmental health, Diabetes Mellitus, Humans, Non-communicable diseases, education, Aged, Health Services Needs and Demand, business.industry, HIV infection, biology.organism_classification, Confidence interval, WHO STEPS survey, Cross-Sectional Studies, Logistic Models, Africa, Chronic Disease, Rural area, business

الوصف: Background The burden of non-communicable diseases (NCDs) is increasing in sub-Saharan Africa, but data available for intervention planning are inadequate. We determined the prevalence of selected NCDs and HIV infection, and NCD risk factors in northwestern Tanzania and southern Uganda. Methods A population-based cross-sectional survey was conducted, enrolling households using multistage sampling with five strata per country (one municipality, two towns, two rural areas). Consenting adults (≥18 years) were interviewed using the WHO STEPS survey instrument, examined, and tested for HIV and diabetes mellitus (DM). Adjusting for survey design, we estimated population prevalences of hypertension, DM, obstructive pulmonary disease, cardiac failure, epilepsy and HIV, and investigated factors associated with hypertension using logistic regression. Results Across strata, hypertension prevalence ranged from 16 % (95 % confidence interval (CI): 12 % to 22 %) to 17 % (CI: 14 % to 22 %) in Tanzania, and from 19 % (CI: 14 % to 26 %) to 26 % (CI: 23 % to 30 %) in Uganda. It was high in both urban and rural areas, affecting many young participants. The prevalence of DM (1 % to 4 %) and other NCDs was generally low. HIV prevalence ranged from 6 % to 10 % in Tanzania, and 6 % to 12 % in Uganda. Current smoking was reported by 12 % to 23 % of men in different strata, and 1 % to 3 % of women. Problem drinking (defined by Alcohol Use Disorder Identification Test criteria) affected 6 % to 15 % men and 1 % to 6 % women. Up to 46 % of participants were overweight, affecting women more than men and urban more than rural areas. Most patients with hypertension and other NCDs were unaware of their condition, and hypertension in treated patients was mostly uncontrolled. Hypertension was associated with older age, male sex, being divorced/widowed, lower education, higher BMI and, inversely, with smoking. Conclusions The high prevalence of NCD risk factors and unrecognized and untreated hypertension represent major problems. The low prevalence of DM and other preventable NCDs provides an opportunity for prevention. HIV prevalence was in line with national data. In Tanzania, Uganda and probably elsewhere in Africa, major efforts are needed to strengthen health services for the PREVENTION, early detection and treatment of chronic diseases. Electronic supplementary material The online version of this article (doi:10.1186/s12916-015-0357-9) contains supplementary material, which is available to authorized users.

وصف الملف: application/pdf

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المؤلفون: Ramon Durazo-Arvizu, Amy Luke, Jacob Plange-Rhule, David A. Shoham, Pascal Bovet, Richard S. Cooper, Ulf Ekelund, Dale A. Schoeller, Lara R. Dugas, Terrence Forrester, Soren Brage, Estelle V. Lambert

المساهمون: Department of Human Biology, Faculty of Health Sciences

المصدر: BMC Public Health
Bmc Public Health, vol. 15, no. 173, pp. 1-10

مصطلحات موضوعية: Adult, Male, Jamaica, African Continental Ancestry Group/statistics & numerical data, Automobiles/statistics & numerical data, Epidemiologic Studies, Exercise, Female, Ghana, Humans, Income, Middle Aged, Ownership, Prevalence, Seychelles, Socioeconomic Factors, South Africa, Developing country, Poison control, Black People, Socioeconomic development, Environmental health, Medicine, African American, Socioeconomic status, health care economics and organizations, Car ownership, business.industry, 1. No poverty, Public Health, Environmental and Occupational Health, Physical Activity, Socioeconomic Status, Epidemiological transition, African Populations, Automobile Ownership, Household income, Biostatistics, business, Automobiles, human activities, Research Article

الوصف: Background: Variations in physical activity (PA) across nations may be driven by socioeconomic position. As national incomes increase, car ownership becomes within reach of more individuals. This report characterizes associations between car ownership and PA in African-origin populations across 5 sites at different levels of economic development and with different transportation infrastructures: US, Seychelles, Jamaica, South Africa, and Ghana. Methods: Twenty-five hundred adults, ages 25–45, were enrolled in the study. A total of 2,101 subjects had valid accelerometer-based PA measures (reported as average daily duration of moderate to vigorous PA, MVPA) and complete socioeconomic information. Our primary exposure of interest was whether the household owned a car. We adjusted for socioeconomic position using household income and ownership of common goods. Results: Overall, PA levels did not vary largely between sites, with highest levels in South Africa, lowest in the US. Across all sites, greater PA was consistently associated with male gender, fewer years of education, manual occupations, lower income, and owning fewer material goods. We found heterogeneity across sites in car ownership: after adjustment for confounders, car owners in the US had 24.3 fewer minutes of MVPA compared to non-car owners in the US (20.7 vs. 45.1 minutes/day of MVPA); in the non-US sites, car-owners had an average of 9.7 fewer minutes of MVPA than non-car owners (24.9 vs. 34.6 minutes/day of MVPA). Conclusions: PA levels are similar across all study sites except Jamaica, despite very different levels of socioeconomic development. Not owning a car in the US is associated with especially high levels of MVPA. As car ownership becomes prevalent in the developing world, strategies to promote alternative forms of active transit may become important.

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المؤلفون: Jacob Etches, Kristin Aronson, Cameron Mustard, Benjamin C. Amick, Peter M. Smith, Amber Bielecky, Russell Wilkins, Michael Tjepkema

المصدر: BMC Public Health

مصطلحات موضوعية: Adult, Male, Canada, Population, Poison control, Risk Assessment, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Environmental health, Cause of Death, Risk of mortality, Medicine, Humans, 030212 general & internal medicine, Mortality, education, Cause of death, Aged, Proportional Hazards Models, education.field_of_study, 030505 public health, Occupational health, business.industry, Proportional hazards model, Hazard ratio, 1. No poverty, Public Health, Environmental and Occupational Health, Middle Aged, 3. Good health, Unemployment, 8. Economic growth, Cohort, Female, 0305 other medical science, business, Cohort study, Research Article

الوصف: Background This study describes the association between unemployment and cause-specific mortality for a cohort of working-age Canadians. Methods We conducted a cohort study over an 11-year period among a broadly representative 15% sample of the non-institutionalized population of Canada aged 30–69 at cohort inception in 1991 (888,000 men and 711,600 women who were occupationally active). We used cox proportional hazard models, for six cause of death categories, two consecutive multi-year periods and four age groups, to estimate mortality hazard ratios comparing unemployed to employed men and women. Results For persons unemployed at cohort inception, the age-adjusted hazard ratio for all-cause mortality was 1.37 for men (95% confidence interval (CI): 1.32-1.41) and 1.27 for women (95% CI: 1.20-1.35). The age-adjusted hazard ratio for unemployed men and women was elevated for all six causes of death: malignant neoplasms, circulatory diseases, respiratory diseases, alcohol-related diseases, accidents and violence, and all other causes. For unemployed men and women, hazard ratios for all-cause mortality were equivalently elevated in 1991–1996 and 1997–2001. For both men and women, the mortality hazard ratio associated with unemployment attenuated with age. Conclusions Consistent with results reported from other long-duration cohort studies, unemployed men and women in this cohort had an elevated risk of mortality for accidents and violence, as well as for chronic diseases. The persistence of elevated mortality risks over two consecutive multi-year periods suggests that exposure to unemployment in 1991 may have marked persons at risk of cumulative socioeconomic hardship.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::697fa4d15c9eb84a7cb732bd20054ddaTest

المؤلفون: Richard G. Wamai, John E. Sidle, Burke Gao, Benson N. Gakinya, Debra A. Klein, Rebecca K. Papas, Omar Galárraga

المصدر: BMC Health Services Research
BMC Health Services Research, Vol 17, Iss 1, Pp 1-16 (2017)

مصطلحات موضوعية: Adult, medicine.medical_specialty, Alcohol Drinking, Total cost, Cost-Benefit Analysis, Allied Health Personnel, Psychological intervention, CBT, Developing country, HIV Infections, 03 medical and health sciences, 0302 clinical medicine, Acquired immunodeficiency syndrome (AIDS), Risk Factors, Environmental health, Return on investment, medicine, Humans, 030212 general & internal medicine, Economic impact analysis, Psychiatry, Cost-benefit-analysis, health care economics and organizations, 030505 public health, Cognitive Behavioral Therapy, Sub-Saharan Africa, Cost–benefit analysis, business.industry, lcsh:Public aspects of medicine, Incidence, Cognitive-behavioral-therapy, Public health, Health Policy, 1. No poverty, HIV, lcsh:RA1-1270, medicine.disease, Kenya, Task-shifting, 3. Good health, AIDS, Alcoholism, Alcohol, 0305 other medical science, business, Research Article

الوصف: Among HIV+ patients, alcohol use is a highly prevalent risk factor for both HIV transmission and poor adherence to HIV treatment. The large-scale implementation of effective interventions for treating alcohol problems remains a challenge in low-income countries with generalized HIV epidemics. It is essential to consider an intervention’s cost-effectiveness in dollars-per-health-outcome, and the long-term economic impact —or “return on investment” in monetary terms. We conducted a cost-benefit analysis, measuring economic return on investment, of a task-shifted cognitive-behavioral therapy (CBT) intervention delivered by paraprofessionals to reduce alcohol use in a modeled cohort of 13,440 outpatients in Kenya. In our base-case, we estimated the costs and economic benefits from a societal perspective across a six-year time horizon, with a 3% annual discount rate. Costs included all costs associated with training and administering task-shifted CBT therapy. Benefits included the economic impact of lowered HIV incidence as well as the improvements in household and labor-force productivity. We conducted univariate and multivariate probabilistic sensitivity analyses to test the robustness of our results. Under the base case, total costs for CBT rollout was $554,000, the value of benefits were $628,000, and the benefit-to-cost ratio was 1.13. Sensitivity analyses showed that under most assumptions, the benefit-to-cost ratio remained above unity indicating that the intervention was cost-saving (i.e., had positive return on investment). The duration of the treatment effect most effected the results in sensitivity analyses. CBT can be effectively and economically task-shifted to paraprofessionals in Kenya. The intervention can generate not only reductions in morbidity and mortality, but also economic savings for the health system in the medium and long term. The findings have implications for other countries with generalized HIV epidemics, high prevalence of alcohol consumption, and shortages of mental health professionals. This paper uses data derived from “Cognitive Behavioral Treatment to Reduce Alcohol Use Among HIV-Infected Kenyans (KHBS)” with ClinicalTrials.gov registration NCT00792519 on 11/17/2008; and preliminary data from “A Stage 2 Cognitive-behavioral Trial: Reduce Alcohol First in Kenya Intervention” ( NCT01503255 , registered on 12/16/2011).

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::d5f522545ec4c28d9c68e5afaf062066Test

المؤلفون: Jean-Christophe Fotso, Elizabeth W. Kimani-Murage, Nelly Yatich, Martin K. Mutua, Nyovani Madise, Catherine Kyobutungi, Tabither Gitau

المصدر: BMC Public Health
BMC Public Health, Vol 11, Iss 1, p 396 (2011)

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Urban Population, 030309 nutrition & dietetics, Population, Decision Making, Breastfeeding, Guidelines as Topic, Breast milk, World Health Organization, Interviews as Topic, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Nursing, Environmental health, Poverty Areas, Medicine, Humans, 030212 general & internal medicine, Longitudinal Studies, education, Infant Nutritional Physiological Phenomena, Proportional Hazards Models, 2. Zero hunger, 0303 health sciences, education.field_of_study, business.industry, lcsh:Public aspects of medicine, Public health, 1. No poverty, Infant, Newborn, Public Health, Environmental and Occupational Health, lcsh:RA1-1270, Kenya, 3. Good health, Breast Feeding, Family planning, Marital status, Health education, Female, business, Breast feeding, Research Article

الوصف: Background The World Health Organisation (WHO) recommends exclusive breastfeeding during the first six months of life for optimal growth, development and health. Breastfeeding should continue up to two years or more and nutritionally adequate, safe, and appropriately-fed complementary foods should be introduced at the age of six months to meet the evolving needs of the growing infant. Little evidence exists on breastfeeding and infant feeding practices in urban slums in sub-Saharan Africa. Our aim was to assess breastfeeding and infant feeding practices in Nairobi slums with reference to WHO recommendations. Methods Data from a longitudinal study conducted in two Nairobi slums are used. The study used information on the first year of life of 4299 children born between September 2006 and January 2010. All women who gave birth during this period were interviewed on breastfeeding and complementary feeding practices at recruitment and this information was updated twice, at four-monthly intervals. Cox proportional hazard analysis was used to determine factors associated with cessation of breastfeeding in infancy and early introduction of complementary foods. Results There was universal breastfeeding with almost all children (99%) having ever been breastfed. However, more than a third (37%) were not breastfed in the first hour following delivery, and 40% were given something to drink other than the mothers' breast milk within 3 days after delivery. About 85% of infants were still breastfeeding by the end of the 11th month. Exclusive breastfeeding for the first six months was rare as only about 2% of infants were exclusively breastfed for six months. Factors associated with sub-optimal infant breastfeeding and feeding practices in these settings include child's sex; perceived size at birth; mother's marital status, ethnicity; education level; family planning (pregnancy desirability); health seeking behaviour (place of delivery) and; neighbourhood (slum of residence). Conclusions The study indicates poor adherence to WHO recommendations for breastfeeding and infant feeding practices. Interventions and further research should pay attention to factors such as cultural practices, access to and utilization of health care facilities, child feeding education, and family planning.

وصف الملف: text

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::2014102776f65072d61fd6c5b6a26524Test

المؤلفون: Dimple Kondal, Hassan Khan, Carla J. Berg, Rajendra Pradeepa, Vamadevan S. Ajay, Mohammed K. Ali, Zafar Fatmi, Muhammad Masood Kadir, K.M. Venkat Narayan, Nikhil Tandon, Roopa Shivashankar, Dorairaj Prabhakaran, Viswanathan Mohan, Deepa Mohan

المصدر: BMC Public Health

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Adolescent, Alcohol Drinking, Cross-sectional study, Health Status, Population studies, MEDLINE, India, Comorbidity, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Environmental health, Epidemiology, medicine, Prevalence, Humans, Pakistan, 030212 general & internal medicine, Tobacco Use Epidemiology, Sex Distribution, Poverty, health care economics and organizations, business.industry, Public health, 1. No poverty, Secondhand smoke exposure, Public Health, Environmental and Occupational Health, Tobacco Use Disorder, Middle Aged, medicine.disease, Southeast Asia, 3. Good health, Tobacco use, Cross-Sectional Studies, population characteristics, Female, Biostatistics, business, geographic locations, Research Article

الوصف: Background Tobacco burdens in India and Pakistan require continued efforts to quantify tobacco use and its impacts. We examined the prevalence and sociodemographic and health-related correlates of tobacco use in Delhi, Chennai (India), and Karachi (Pakistan). Methods Analysis of representative surveys of 11,260 participants (selected through multistage cluster random sampling; stratified by gender and age) in 2011 measured socio-demographics, tobacco use history, comorbid health conditions, and salivary cotinine. We used bivariate and multivariate regression analyses to examine factors associated with tobacco use. Results Overall, 51.8 % were females, and 61.6 % were below the age of 45 years. Lifetime (ever) tobacco use prevalence (standardized for world population) was 45.0 %, 41.3 %, and 42.5 % among males, and 7.6 %, 8.5 %, and 19.7 % among females in Chennai, Delhi, and Karachi, respectively. Past 6 month tobacco use prevalence (standardized for world population) was 38.6 %, 36.1 %, and 39.1 % among males, and 7.3 %, 7.1 %, and 18.6 % among females in Chennai, Delhi, and Karachi, respectively. In multivariable regression analyses, residing in Delhi or Karachi versus Chennai; older age; lower education; earning less income; lower BMI; were each associated with tobacco use in both sexes. In addition, semi-skilled occupation versus not working and alcohol use were associated with tobacco use in males, and having newly diagnosed dyslipidemia was associated with lower odds of tobacco use among females. Mean salivary cotinine levels were higher among tobacco users versus nonusers (235.4; CI: 187.0-283.8 vs. 29.7; CI: 4.2, 55.2, respectively). Conclusion High prevalence of tobacco use in the South Asian region, particularly among men, highlights the urgency to address this serious public health problem. Our analyses suggest targeted prevention and cessation interventions focused on lower socioeconomic groups may be particularly important. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1817-z) contains supplementary material, which is available to authorized users.

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المؤلفون: Matthew Chersich, Mags Beksinska, Balthazar Candrinho, Wim Delva, Yves Lafort, Letitia Greener, Jenni Smit, Faustino Lessitala, Ross Greener

المصدر: BMC Public Health
BMC PUBLIC HEALTH
BMC Public Health, Vol 16, Iss 1, Pp 1-8 (2016)

مصطلحات موضوعية: Mixed methods, Sexual and reproductive health, HIV Infections, Ambulatory Care Facilities, Health Services Accessibility, 0302 clinical medicine, Health facility, Pregnancy, Surveys and Questionnaires, Medicine and Health Sciences, Medicine, 030212 general & internal medicine, 10. No inequality, Care seeking, Contraception Behavior, Mozambique, Reproductive health, RISK, Female sex workers, education.field_of_study, lcsh:Public aspects of medicine, 1. No poverty, virus diseases, Focus Groups, care seeking, female sex workers, HIV, mixed methods, sexual and reproductive health, Pregnancy, Unwanted, 3. Good health, Family planning, POPULATIONS, Female, BURDEN, 0305 other medical science, Research Article, AFRICA, COUNTRIES, Adult, medicine.medical_specialty, Sexual Behavior, Population, Sexually Transmitted Diseases, COTE-DIVOIRE, Context (language use), Young Adult, 03 medical and health sciences, Environmental health, Humans, education, Sex Workers, 030505 public health, business.industry, Public health, Sex Offenses, Public Health, Environmental and Occupational Health, lcsh:RA1-1270, SERVICES, Patient Acceptance of Health Care, Focus group, Cross-Sectional Studies, Reproductive Health Services, Sex offense, business

الوصف: Background: In the context of an operational research project in Tete, Mozambique, use of, and barriers to, HIV and sexual and reproductive health (HIV/SRH) commodities and services for female sex workers (FSWs) were assessed as part of a baseline situational analysis. Methods: In a cross-sectional survey 311 FSWs were recruited using respondent driven sampling and interviewed face-to-face, and three focus group discussions were held with respectively 6 full-time Mozambican, 7 occasional Mozambican and 9 full-time Zimbabwean FSWs, to investigate use of, and barriers to, HIV/SRH care. Results: The cross-sectional survey showed that 71 % of FSWs used non-barrier contraception, 78 % sought care for their last sexually transmitted infection episode, 51 % of HIV-negative FSWs was tested for HIV in the last 6 months, 83 % of HIV-positive FSWs were in HIV care, 55 % sought help at a health facility for their last unwanted pregnancy and 48 % after sexual assault, and none was ever screened for cervical cancer. Local public health facilities were by far the most common place where care was sought, followed by an NGO-operated clinic targeting FSWs, and places outside the Tete area. In the focus group discussions, FSWs expressed dissatisfaction with the public health services, as a result of being asked for bribes, being badly attended by some care providers, stigmatisation and breaches of confidentiality. The service most lacking was said to be termination of unwanted pregnancies. Conclusions: The use of most HIV and SRH services is insufficient in this FSW population. The public health sector is the main provider, but access is hampered by several barriers. The reach of a FSW-specific NGO clinic is limited. Access to, and use of, HIV and SRH services should be improved by reducing barriers at public health facilities, broadening the range of services and expanding the reach of the targeted NGO clinic. The research leading to these results has received funding from the International Department Flanders (DIV) under agreement A11/TT/0382 and the European Union Seventh Framework Programme under grant agreement number Health-F3-2011-282542.

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المؤلفون: Majid Ezzati, Joshua A. Salomon, Roland Pongou

المصدر: BMC Public Health, Vol 6, Iss 1, p 98 (2006)
BMC Public Health

مصطلحات موضوعية: Male, 030309 nutrition & dietetics, Social Environment, 0302 clinical medicine, Cameroon, 030212 general & internal medicine, Child, 2. Zero hunger, Family Characteristics, 0303 health sciences, education.field_of_study, lcsh:Public aspects of medicine, 1. No poverty, Middle Aged, 3. Good health, Child, Preschool, Income, Female, Child Nutritional Physiological Phenomena, Research Article, Adult, medicine.medical_specialty, Adolescent, Population, Mothers, Developing country, Social class, 03 medical and health sciences, Environmental health, medicine, Humans, education, Socioeconomic status, Analysis of Variance, business.industry, Public health, Body Weight, Public Health, Environmental and Occupational Health, Infant, lcsh:RA1-1270, Patient Acceptance of Health Care, medicine.disease, Health Surveys, Body Height, Child mortality, Malnutrition, Social Class, Socioeconomic Factors, business

الوصف: BackgroundUndernutrition is a leading cause of child mortality in developing countries, especially in sub-Saharan Africa. We examine the household and community level socioeconomic and environmental factors associated with child nutritional status in Cameroon, and changes in the effects of these factors during the 1990s economic crisis. We further consider age-specific effects of household economic status on child nutrition.MethodsChild nutritional status was measured by weight-for-age (WAZ) and height-for-age (HAZ) z-scores. Data were from Demographic and Health Surveys conducted in 1991 and 1998. We used analysis of variance to assess the bivariate association between the explanatory factors and nutritional status. Multivariate, multilevel analyses were undertaken to estimate the net effects of both household and community factors.ResultsAverage WAZ and HAZ declined respectively from -0.70 standard deviations (SD), i.e. 0.70 SDbelowthe reference median, to -0.83 SD (p = 0.006) and from -1.03 SD to -1.14 SD (p = 0.026) between 1991 and 1998. These declines occurred mostly among boys, children over 12 months of age, and those of low socioeconomic status. Maternal education and maternal health seeking behavior were associated with better child nutrition. Household economic status had an overall positive effect that increased during the crisis, but it had little effect in children under 6 months of age. Improved household (water, sanitation and cooking fuel) and community environment had positive effects. Children living in the driest regions of the country were consistently worst off, and those in the largest cities were best off.ConclusionBoth household and community factors have significant impact on child health in Cameroon. Understanding these relationships can facilitate design of age- and community-specific intervention programs.

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