Physical accessibility and utilization of health services in Yemen.

BACKGROUND: Assessment of physical access to health services is extremely important for planning. Complex methods that incorporate data inputs from road networks and transport systems are used to assess physical access to healthcare in industrialised countries. However, such data inputs hardly exist in many developing countries. Straight-line distances between the service provider and resident population are easily obtained but their relationship with driving distance and travel time is unclear. This study aimed to investigate the relationship between different measures of physical access, including straight-line distances, road distances and travel time and the impact of these measures on the vaccination of children in Yemen. METHODS: Coordinates of houses and health facilities were determined by GPS machine in Urban and rural areas in Taiz province, Yemen. Road distances were measured by an odometer of a vehicle driven from participants' houses to the nearest health centre. Driving time was measured using a stop-watch. Data on children's vaccination were collected by personal interview and verified by inspecting vaccination cards. RESULTS: There was a strong correlation between straight-line distances, driving distances and driving time (straight line distances vs. driving distance r = 0.92, p < 0.001, straight line distances vs. driving time r = 0.75; p < 0.001, driving distance vs. driving time r = 0.83, p < 0.001). Each measure of physical accessibility showed strong association with vaccination of children after adjusting for socio-economic status. CONCLUSION: Straight-line distances, driving distances and driving time are strongly linked and associated with vaccination uptake. Straight-line distances can be used to assess physical access to health services where data inputs on road networks and transport are lacking. Impact of physical access is clear in Yemen, highlighting the need for efforts to target vaccination and other preventive healthcare measures to children who live away from health facilities

Can online distance learning improve access to learning in conflict zones? The Oxford Psychiatry in Iraq (OxPIQ) experience

Psychiatry trainees in Iraq face many challenges that limit their immediate access to training opportunities. These include limited opportunities to attend international conferences due to visa restrictions, reduced access to evidence-based practice and guidelines and less experience in conducting quality improvement projects and audits. There are also issues related to their training programmes, including lack of regular meetings with supervisors and fewer opportunities for case-based discussions. Clinical Psychiatry is thus a potential key affected clinical domain due to the above factors. Technological advances in the field of e-learning created concepts such as Technology-enhanced or Web-based learning (TEL or WBL). These developments enabled the formation of “virtual teams” using an online platform. These teams overcome logistical geographical and other barriers to enable professionals to connect and learn from each other. This paper includes an appraisal of the TEL, looking at its advantages and challenges in meeting the needs of learners and educators. Also, we describe how we incorporated evidence-based and good practice guidelines on TEL use in these circumstances to the design, delivery and early evaluation of the distance learning programme. In our conclusion, we add to these and draw attention to the use of established online platforms (Medicine Africa in this case) and the importance of involving Iraqi Training leads, trainees and institutions in identifying trainee learning needs and supporting existing training provisions

Trends in Stunting, Underweight and Overweight Among Children Aged \u3c 5 Years in Kuwait: Findings From Kuwait Nutritional Surveillance System (2007-2019)

Background: There is a paucity of data on the secular trends of stunting and overweight among children aged \u3c 5 years in oil-rich countries in the Middle East. Aims: To examine the secular trends of stunting, underweight and overweight in children aged \u3c 5 years in Kuwait between 2007 and 2019. Methods: We used large individual data records (n=48 108) from the Kuwait Nutritional Surveillance System (KNSS) to calculate height/length-for-age z score (HAZ), weight-for-age z score and body mass index (BMI)-for-age z score using World Health Organization growth references. Stunting and underweight were defined as less than -2 standard deviation (SD) and overweight (including obesity) as ≥ 2 SD. Trends of stunting, underweight and overweight were investigated using logistic regression models. Results: The prevalence of stunting, underweight and overweight was 5.15%, 2.33% and 10.78%, respectively. Stunting increased during the study period, among children aged \u3c 2 years. There was no increasing trend in overweight during the study period. These findings were corroborated by the distribution of HAZ and BMI-for-age z scores. Current prevalence of combined stunting and overweight was 1.53% in boys and 1.98% in girls. Conclusion: Current prevalence of stunting and underweight is low in Kuwait indicating that undernutrition is no longer a major public health issue. There is a tendency for stunting to increase in children aged less than 2 years, highlighting the need to investigate early causes of stunting such as maternal and pregnancy-related factors

Impact of Treating Maternal Periodontal Disease on the Risk of Preterm Birth and Low Birth Weight: An Umbrella Review of Systematic Reviews

Pregnancy involves complex physical and hormonal changes that significantly impact almost every organ system, including the oral cavity. The presence of oral disease in women has consequences for both their child and their health. The two main oral conditions linked to pregnancy are gingivitis and periodontal disease. Several studies have demonstrated that there is a positive association between periodontal disease and adverse pregnancy outcomes such as preterm birth (PTB) and low birth weight (LBW). PTB and LBW are among the leading causes of perinatal mortality and morbidity. It has been hypothesized that periodontal disease may cause PTB and/or LBW either directly through the presence of gram-negative anaerobic bacteremia originating in the gingival biofilm or indirectly through the production of pro-inflammatory markers which enter the bloodstream from the gingival submucosa. The ultimate result of both pathogenic pathways is the same, the development of an immune inflammatory response and/or the local suppression of growth factors in the fetal–placental unit (including the myometrium, membranes, amniotic fluid, placenta, circulation, and fetal tissues), which in turn shortens gestational age and triggers labor. Overall, the impact of treating maternal periodontitis on the risk of PTB or LBW remains unclear despite numerous observational studies reporting that periodontal disease is positively associated with adverse birth outcomes. Despite that umbrella reviews of systematic reviews have been published on this topic, recent high-quality systematic reviews have been published and thus, there is a need for updated umbrella reviews that includes evidence from multiple sources. In the present umbrella review, we aim to review the evidence of the impact of treating maternal periodontitis on the risk of PTB and LBW, which is a prerequisite to formulating guidelines regarding this issue.https://digitalcommons.odu.edu/gradposters2023_healthsciences/1015/thumbnail.jp

The effect of distance to health-care facilities on childhood mortality in rural Burkina Faso.

This study aims to investigate the relation between distance to health facilities, measured as continuous travel time, and mortality among infants and children younger than 5 years of age in rural Burkina Faso, an area with low health facility density. The study included 24,555 children born between 1993 and 2005 in the Nouna Health and Demographic Surveillance System. The average walking time from each village to the closest health facility was obtained for both the dry and the rainy season, and its effect on infant (<1 year), child (1-4 years), and under-5 mortality overall was analyzed by Cox regression. The authors observed 3,426 childhood deaths, corresponding to a 5-year survival of 85%. Walking distance was significantly related to both infant and child mortality, although the shape of this effect varied distinctly between the 2 age groups. Overall, under-5 mortality, adjusted for confounding, was more than 50% higher at a distance of 4 hours compared with having a health facility in the village (P < 0.0001, 2 sided). The region of residence was an additional determinant for under-5 mortality. The findings of this study emphasize the importance of geographic accessibility of health care for child survival in sub-Saharan Africa and demonstrate the need to improve health-care access to achieve the Millennium Development Goals

Spectrophotometric Studies of the Behaviour of Multidentate Schiff Base Ligands with Copper(II) in Methanol Solution

Four formation reaction complexes of polydentate Schiff base ligands derived from condensation of ethylenediamine with salicylaldehyde (L1) and 2-pyridinecarboxaldehyde (L2) and of diethylenetriamine with salicylaldehyde (L3) and 2-hydroxy-1-naphthaldehyde (L4) as electron donors with copper (II) chloride as an electron acceptor in methanol were studied spectrophotometrically at 301 K. The absorption band wavelengths of the electron donors, the electron acceptor and their complexes were measured and studied. Parameters such as the molar absorptivities, eAD, of these complexes and the equilibrium constants, KAD, of their formation reactions obtained from the Benesi-Hildebrand equation were established and discussed. The absorption band energies of the complexes, E, the ionization potentials of the Schiff base ligands, ID, and the Gibbs energy changes of the above reactions, &Delta;G, were calculated. Finally, kinetic parameters such as the orders of the reactions, and the rate constants of the forward and reverse reactions, k1 and k-1, were determined. Key Words: UV-Visible,Spectrophotometry,Schiff base ligand,Transition metal complexes,Copper(II) chloride,Methanol,Benesi-Hildebrand South African Journal of Chemistry Vol.57 2004: 33-3

Exposure to Household Secondhand Smoke Among Adolescents in Kuwait: Results From Two School-Based Cross-Sectional Studies

INTRODUCTION: Detrimental effects of secondhand smoke (SHS) exposure are well established; however, data on SHS exposure among adolescents in Kuwait are lacking. Hence, this study sought to estimate the prevalence of household SHS exposure among two samples of adolescents in Kuwait and assess its variation by socioeconomic status and parental education level. METHODS: Data from two large school-based cross-sectional studies were analyzed. Adolescents attending public middle (n=3864; aged 11-14 years) and high (n=1959; aged 14-19 years) schools throughout Kuwait were enrolled in 2016-2017, and parental self-reported household SHS exposure was ascertained. Associations were assessed using Poisson regression with robust variance estimation, and adjusted prevalence ratios (APRs) and 95% confidence intervals (CIs) were estimated. RESULTS: Overall, 45.8% (1755/3836; 95% CI: 44.2-47.3%) of the enrolled middle school students and 51.6% (998/1936; 95% CI: 49.3-53.8%) of the enrolled high school students were exposed to household SHS. Among middle and high school students, the prevalence of household SHS exposure increased as maternal/paternal education level and family income decreased. Among middle school students, paternal educational attainment of middle school or less compared to bachelor\u27s degree or higher was associated with 1.60 times (95% CI: 1.44-1.79) higher household SHS exposure. Similarly, in the sample of middle school students, the prevalence of household SHS exposure significantly increased from 35.8% among children from families reporting the highest household income to 50.5% among children from families with the lowest reported household income (p-trend\u3c0.001). CONCLUSIONS: Household SHS exposure is substantially high among adolescents in Kuwait. Enrolled adolescents from families with low socioeconomic status or with low parental education level have the highest household SHS exposure. These findings highlight the need for national comprehensive tobacco control policies and increasing parental awareness of the impact of SHS exposure on children

Anemia And It\u27s Associated Factors Among Adolescents in Kuwait

We estimated the prevalence of anemia among school children and investigated factors associated with this problem in Kuwait. A cross-sectional study was conducted on 1415 adolescents randomly selected from middle schools in Kuwait. Hemoglobin, iron, ferritin, folate and vitamin B-12, in addition to many other laboratory indicators, were measured in a venous blood sample. Data on risk factors for anemia were collected from parents and adolescents. Multiple logistic regression was used to investigate factors associated with anemia. The prevalence of anemia was 8.06% (95% CI: 6.69-9.60%), which was significantly higher among females compared to males (10.96% vs. 5.04%; p \u3c 0.001). Mean (SD) Hb level was 133.7 (9.89) g/L and 130.00 (10.48) g/L among males and females, respectively (p \u3c 0.001). The prevalence of mild, moderate and severe anemia was 5.94%, 1.91% and 0.21%, respectively. Gender, age, iron concentration and ferritin were associated with anemia in multivariable analysis. These data indicate that anemia among school children in Kuwait is of mild public health significance. Further reduction in anemia in school girls should focus on correcting iron deficiency. Surveillance systems for anemia may consider using a cut-off point that is specific for the method of blood sampling and the method of Hb measurement

Season of Birth and Sugary Beverages Are Predictors of Raven\u27s Standard Progressive Matrices Scores in Adolescents

To investigate factors associated with cognitive functioning in healthy adolescents, a school-based cross-sectional study was conducted on 1370 adolescents aged 11-16 years that were randomly selected from all governorates of Kuwait. Raven\u27s Standard Progressive Matrices (SPM), a non-verbal test of intelligence, was used to measure cognitive functioning of the study participants. Data on predictors of cognitive functioning were collected from parents and adolescents. Weight and height of the participants were measured in a standardized manner and blood samples were tested in an accredited laboratory under strict measures of quality control. In multivariable linear regression analysis, factors that showed significant association with the SPM score were gender (p=0.002), season of birth (p=0.009), place of residence (p\u3c0.001), father\u27s (p\u3c0.001) and mother\u27s (p=0.025) educational level, type of housing (p\u3c0.001), passive smoking at home (p=0.031), sleeping hours during weekends (p=0.017), students\u27 educational level (p\u3c0.001) and the frequency of consumption of sugary drinks (p\u3c0.001). The link between cognitive functioning and season of birth seems to be robust in various geographical locations including the Middle East. The association between sugary drinks and cognitive functioning highlights the importance of diet independently of obesity and support efforts to reduce consumption of sugary drinks among children

Predictors of Acne Vulgaris Among Adolescents in Kuwait

Objectives: The prevalence of acne vulgaris (AV) among adolescents in Kuwait has remained mostly unknown. This study aimed to estimate the prevalence of AV and its predictors among adolescents in Kuwait. Subjects and Methods: A cross-sectional study was conducted on 714 participants who were randomly selected from public schools using multistage cluster random sampling. The presence or absence of AV, as well as severity of AV, were assessed using the Global Acne Grading Scale. Data on risk factors and potential confounders were collected from the parents through a self-administered questionnaire, and from the adolescents by face-to-face interview. Weight and height were measured in a standardized manner. Results: Of 714 participants, 320 (44.8%; 95% CI 41.1–48.6%) self-reported AV. By clinical examination, AV was found among 479 (67.1%; 95% CI 63.5–70.5%) participants. Factors that were found to be significantly associated with AV in multivariable analysis were age, gender, nationality, and BMI categories. Females compared to males (adjusted prevalence ratio [APR] 1.16 [95% CI 1.05–1.25]; p = 0.006) and overweight or obese adolescents compared to normal weight (APR 1.15 [95% CI 1.02–1.26] and 1.14 [95% CI 1.02–1.23], respectively; p = 0.026) were more likely to have AV. None of the food items studied showed an association with AV in multivariable analysis. Conclusion: The prevalence of self-reported AV seems to be lower than that reported in other settings, while the prevalence of AV by clinical examination resembles that reported in many other countries. BMI was the only modifiable risk factor associated with AV in multivariable analysis, and none of the food items studied was related to the presence or absence of AV in multivariable analysis