Impact of health concepts on healthcare-seeking practices of low-income population in South Coast of Bahia, Brazil / Impacto dos conceitos de saúde nas práticas de busca de atenção à saúde da população de baixa renda no litoral sul da Bahia, Brasil

Objective: By using geospatial and social perspectives, this paper aimed to show the most prevalent health self-concepts among inhabitants living near a specific community health centre in South Bahia, Brazil, in order to investigate the importance of social determinants and the association between health concepts and self-care habits. Methodology: A descriptive research based on the quantitative approach of using qualitative variables was carried out by using Chi-square and Cramer's V tests. A semi-structured questionnaire was administered to participants (N= 501) with geographic coordinates recorded for geospatial analysis. Results: The most prevalent health concepts were the positive and the most addressed care habits were of those in the ‘common sense’ category (p = 0.01). The associations with health concepts were considered statistically significant in terms of age (p = 0.001), level of education (p = 0.0004), and household income (p = 0.0125), and an additional criterion of presence or absence of any disease (p = 0.001). The majority of participants (n=323, CI 122–460 p<0.001) reported they have known the precise location of the community healthcare unit. However, those who lived a greater distance from the unit were unaware of its location. Conclusions: Our results on geospatial analysis corroborate the importance of space planning as an additional social framework for measuring the performance of health policy. Our findings suggest that a more structured and better planning based on health self-concepts and of health service promotion could drive effective strategies that would promote health outcomes in the low- and middle-income communities

Town Of Huntington, Massachusetts Annual Report 2010

BACKGROUND:Rabies is a fatal encephalitis caused by lyssaviruses, with most human cases worldwide resulting from rabid dog bites. Although effective animal and human vaccines have been available for over 100 years, control efforts have not been adequately implemented on the global scale and rabies remains one of the greatest global zoonotic threats to human health. We conducted a knowledge, attitudes and practices survey in Northern Cameroon to describe dog ownership characteristics, rates of dog bites, and post-bite healthcare seeking behaviors. METHODS:The survey was performed in four rural Cameroonian communities. A structured community-based questionnaire was conducted over a 20-day period in April 2010, and focused on socio-economic factors correlated with gaps in rabies knowledge. Information pertaining to socio-demographics, as well as attitudes and practices with regard to animal bites and bite treatment practices were recorded. Characteristics of dog ownership such as dog confinement, resources provided to dogs, and dog vaccination status were examined. Human to dog ratios were compared on a linear scale to poverty scores by community. When applicable, 2-tailed Chi-square tests or Fisher's exact tests were calculated to determine relationships between variables. We also used One-way Analysis of Variance (ANOVA) to identify associations between rabies knowledge and wealth with dog ownership, dog vaccination, and human healthcare seeking behaviors. Independent variables were evaluated using multivariate logistic regression analysis. RESULTS:A total of 208 households were enrolled. Respondents were predominantly male (68.3%), with a median age of 43.6 years. Eighty-four households (39.9%) reported owning a total of 141 dogs (human dog ratio 10.4:1). The majority of dogs (61%) were allowed to roam freely. A history of rabies vaccination was reported for 30.8% of owned dogs. Respondents reported 11 bites during the two years preceding the survey (annual bite incidence was 2.6% [95% CI 1.4%- 4.6%]). Only one person (9.1%) received rabies post-exposure prophylaxis (PEP), and none described symptoms of clinical illness consistent with rabies. Respondents who indicated that they would seek medical care and PEP after a dog bite had higher average wealth and rabies knowledge index scores (p = 0.01 and 0.04, respectively). Respondents who indicated that they would seek care from a traditional healer had significantly lower wealth scores, but not significantly different knowledge scores (p < 0.01 and p = 0.49, respectively). CONCLUSIONS:In the communities evaluated, the majority of dogs were allowed to roam freely and had no history of rabies vaccination; factors that favor enzootic transmission of canine rabies virus. We also identified a strong relationship between poverty and dog ownership. Bite events were relatively common among respondents, and very few victims reported utilizing health services to treat wounds. Increased wealth and knowledge were significantly associated with increased likelihood that a respondent would seek medical care and post-exposure prophylaxis. These findings indicate the need for educational outreach to raise awareness of dog rabies and proper prevention measures

The potential effect of improved provision of rabies post-exposure prophylaxis in Gavi-eligible countries: a modelling study

Background: Tens of thousands of people die from dog-mediated rabies annually. Deaths can be prevented through post-exposure prophylaxis for people who have been bitten, and the disease eliminated through dog vaccination. Current post-exposure prophylaxis use saves many lives, but availability remains poor in many rabies-endemic countries due to high costs, poor access, and supply. Methods: We developed epidemiological and economic models to investigate the effect of an investment in post-exposure prophylaxis by Gavi, the Vaccine Alliance. We modelled post-exposure prophylaxis use according to the status quo, with improved access using WHO-recommended intradermal vaccination, with and without rabies immunoglobulin, and with and without dog vaccination. We took the health provider perspective, including only direct costs. Findings: We predict more than 1 million deaths will occur in the 67 rabies-endemic countries considered from 2020 to 2035, under the status quo. Current post-exposure prophylaxis use prevents approximately 56 000 deaths annually. Expanded access to, and free provision of, post-exposure prophylaxis would prevent an additional 489 000 deaths between 2020 and 2035. Under this switch to efficient intradermal post-exposure prophylaxis regimens, total projected vaccine needs remain similar (about 73 million vials) yet 17·4 million more people are vaccinated, making this an extremely cost-effective method, with costs of US$635 per death averted and$33 per disability-adjusted life-years averted. Scaling up dog vaccination programmes could eliminate dog-mediated rabies over this time period; improved post-exposure prophylaxis access remains cost-effective under this scenario, especially in combination with patient risk assessments to reduce unnecessary post-exposure prophylaxis use. Interpretation: Investing in post-exposure vaccines would be an extremely cost-effective intervention that could substantially reduce disease burden and catalyse dog vaccination efforts to eliminate dog-mediated rabies. Funding: World Health Organization

High Incidence of Congenital Syphilis after Implementation of the Brazilian Ministry of Health Ordinances Related to Maternal Diagnostics

The increasing rates of maternal and congenital syphilis (CS) infections are public health concerns and need further investigation in order to provide better assistance in epidemiological surveillance and new strategies for the assistance and prevention of CS. In December 2011, the Brazilian Ministry of Health (BMH) implemented ordinance number 3.242, reinforced in 2012 by ordinance number 77, aiming to improve the quality of the syphilis diagnosis system using rapid tests. Here, we evaluate the incidence, lethality, and possible factors associated with CS in Salvador, Bahia, in the pre-resolution period (2007 to 2011) and post-resolution (2012 to 2016). An observational, ecological time-series study is conducted using secondary data collected from the National Notifiable Diseases Information System (SINAN). Linear regression analysis to estimate increases or reductions in the mean incidence over time is also performed. A total of 5470 CS cases are analyzed. The incidence ranges from 2.1 cases per 1000 live births in 2007 to 17.1 cases per 1000 live births in 2019, showing a progressive increase in incidence over the years and reduction of lethality in the post-resolution period. The number of CS cases reported prior to the implementation of the ordinances (2007–2011) does not reveal a significant increase in the incidence. However, in the post-ordinances period (2012–2019), there is an average increase of the number of CS cases by three times over the years, with an average increase of 1.8 new cases annually. Our findings highlight the importance of diagnosis and support information in strategies for CS prevention. Furthermore, these data show a positive impact of resolutions on the diagnosis and evolution of the disease

Attitudes and practices towards bite events among community members, Cameroon, 2010.

<p>Attitudes and practices towards bite events among community members, Cameroon, 2010.</p

Characteristics associated with individuals who consulted a traditional healer by multivariate logistic regression, Cameroon, 2010.

<p>Characteristics associated with individuals who consulted a traditional healer by multivariate logistic regression, Cameroon, 2010.</p

An open street map overview of imagery detailing the four communities surveyed in this study.

<p>Approximate population for the communities are: Mayo-Oulo 1,031 inhabitants, Sanguéré-Paul 377 inhabitants, Gaschiga 3,066 inhabitants, and Ngong 9,037 inhabitants.</p

Characteristics associated with individuals who actively sought medical care by multivariate logistic regression, Cameroon, 2010.

<p>Characteristics associated with individuals who actively sought medical care by multivariate logistic regression, Cameroon, 2010.</p

Analysis of wealth score and its association with practices towards bite events among community members, Cameroon, 2010.

<p>The horizontal midline of each vertical bar represents the mean index score; upper and lower confidence intervals are depicted respectively at either end. P-value was calculated by using T-test.</p

Construction of the knowledge score.

<p>As indicated on the table below, all respondents were assigned a total of 10 points for correct answers in each of the 4 questions used to assess the knowledge about rabies. The knowledge questions were focused on: 1) severity of the disease; 2) transmission and reservoirs; and 3) attitudes regarding rabies exposure. For all questions, respondents were also deducted a total of -10 points for incorrect answers.</p