Analysis of 137 obstetric fistula cases seen at three fistula centres in northwest Nigeria

Objectives: To determine the contributory factors to development of obstetric fistula and to determine the knowledge and practice of modern contraception among fistula patients.Design: Descriptive hospital cross-sectional study.Setting: Three fistula centres in north west Nigeria.Subjects: All obstetric fistula patients that met the inclusion criteria.Results: Of 137 cases of obstetric fistula patients that satisfied the inclusion criteria, 88% had only Vesico-vaginal fistula, while 10% and 2% had recto-vaginal fistula, and combined vesico vaginal fistula and recto-vaginal fistula respectively. All the patients had early marriage (before age 20 years) with median ages at first marriage of 15 years and at presentation in hospital of 16 years. Majority (93.4%) of the patients developed fistula during the first delivery. Approximately two-third of the patients had no form of education. Only 42.3% of the patients received antenatal care and 86% delivered at home. Only 28% of the patients was aware of modern contraception and 2% had used modern contraceptive before developing fistula. All the patients expressed willingness to use modern contraception after fistula repair.Conclusion: This study shows that child marriage, low education, unskilled birth attendance and low contraceptive uptake are common among the obstetric fistula patients in north west Nigeria. Public advocacy and formulation of laws and policies to protect girls from early marriage, girl child education to secondary school level be encouraged, public education on the importance of and utilisation of maternity and modern family planning services

Depression among secondary school students: a comparison between urban and rural populations

Introduction: Childhood depression is a debilitating psychiatric illness and has frequently been under-diagnosed. It is crucial to identify the condition early, as undetected cases may lead to detrimental psychosocial consequences in adulthood. Objective: The prevalence of depression among school children in Selangor and to compare it between urban and rural schools. Also to identify factors associated with depression in secondary school children. Method: 2 urban and 3 rural secondary schools were selected by 2-staged stratified random sampling to represent the population of secondary school children in the state of Selangor, Malaysia. A total of 2,048 school children were enrolled and the level of depression was measured by a self-rated scale, the Children’s Depression Inventory. Results: This study found that the prevalence of possible depressive students in Selangor was 10.3%. There was no difference in the prevalence of depression between rural and urban population. Factors associated with depression were being female, Chinese, parents with low educational level, and high number of siblings, smoking and alcohol abuse. Depression contributed significantly to suicidal tendencies. Conclusions: A sizable proportion of the secondary school children in this population potentially suffer from depression. Psychological interventions are needed to ease this psychological burden and ensure their well being. Key words: Depression, secondary school students, factors associated

Pilot study on depression among secondary school students in Selangor

A cross sectional descriptive study of 2048 subjects was conducted to determine the prevalence of depression and factors influencing depression among students in secondary school from urban and rural areas in the state of Selangor. Malaysia. The children's depression inventory (COl) developed by Maria Kovacs was used in this study. Students who participated in this study come from two urban schools and three rural schools. It was found that in the yield for scores for five factors were 9.2% have negative mood. 5% have interpersonal problems. 8.3% have ineffectiveness. 9.8% have anhedonia and 10.6% have negative self esteem. Following the interpretive guidelines for the T-scores. it was found that 10.3% of the students were much above average in the depression scale. This study also found that: 1% of students were smoking. 1.6% of students were gum sniffling. 0.9% took drugs. 4.1 % took alcohol and 9.9% took things from other people. Females were more depressed than males. The Chinese students were more depressed compared to Indian students. Students whose parents had no formal education or had only primary education were more depressed than students whose parents had secondary. college or university education. Depression increased with increasing number of siblings. Depression contributed to the habit of drug abuse. gum sniffing and stealing but not to smoking and alcohol abuse. Suicidal tendencies were more likely among the depressed students. It is imperative that not only caregivers but also teachers have to be equipped with the knowledge. attitude and skills to assist secondary school children cope with their emotions. handle conflicts and manage stress early so that a more productive society will develop in the future

An individually-tailored multifactorial intervention program for older fallers in a middle-income developing country: Malaysian Falls Assessment and Intevention Trial (MyFAIT)

Background: In line with a rapidly ageing global population, the rise in the frequency of falls will lead to increased healthcare and social care costs. This study will be one of the few randomized controlled trials evaluating a multifaceted falls intervention in a low-middle income, culturally-diverse older Asian community. The primary objective of our paper is to evaluate whether individually tailored multifactorial interventions will successfully reduce the number of falls among older adults. Methods: Three hundred community-dwelling older Malaysian adults with a history of (i) two or more falls, or (ii) one injurious fall in the past 12 months will be recruited. Baseline assessment will include cardiovascular, frailty, fracture risk, psychological factors, gait and balance, activities of daily living and visual assessments. Fallers will be randomized into 2 groups: to receive tailored multifactorial interventions (intervention group); or given lifestyle advice with continued conventional care (control group). Multifactorial interventions will target 6 specific risk factors. All participants will be re-assessed after 12 months. The primary outcome measure will be fall recurrence, measured with monthly falls diaries. Secondary outcomes include falls risk factors; and psychological measures including fear of falling, and quality of life.Previous studies evaluating multifactorial interventions in falls have reported variable outcomes. Given likely cultural, personal, lifestyle and health service differences in Asian countries, it is vital that individually-tailored multifaceted interventions are evaluated in an Asian population to determine applicability of these interventions in our setting. If successful, these approaches have the potential for widespread application in geriatric healthcare services, will reduce the projected escalation of falls and fall-related injuries, and improve the quality of life of our older community

Missense mutation of Brain Derived Neurotrophic Factor (BDNF) alters neurocognitive performance in patients with mild traumatic brain injury: a longitudinal study

The predictability of neurocognitive outcomes in patients with traumatic brain injury is not straightforward. The extent and nature of recovery in patients with mild traumatic brain injury (mTBI) are usually heterogeneous and not substantially explained by the commonly known demographic and injury-related prognostic factors despite having sustained similar injuries or injury severity. Hence, this study evaluated the effects and association of the Brain Derived Neurotrophic Factor (BDNF) missense mutations in relation to neurocognitive performance among patients with mTBI. 48 patients with mTBI were prospectively recruited and MRI scans of the brain were performed within an average 10.1 (SD 4.2) hours post trauma with assessment of their neuropsychological performance post full Glasgow Coma Scale (GCS) recovery. Neurocognitive assessments were repeated again at 6 months follow-up. The paired t-test, Cohen’s d effect size and repeated measure ANOVA were performed to delineate statistically significant differences between the groups [wildtype G allele (Val homozygotes) vs. minor A allele (Met carriers)] and their neuropsychological performance across the time point (T1 = baseline/ admission vs. T2 = 6th month follow-up). Minor A allele carriers in this study generally performed more poorly on neuropsychological testing in comparison wildtype G allele group at both time points. Significant mean differences were observed among the wildtype group in the domains of memory (M = -11.44, SD = 10.0, p = .01, d = 1.22), executive function (M = -11.56, SD = 11.7, p = .02, d = 1.05) and overall performance (M = -6.89 SD = 5.3, p = .00, d = 1.39), while the minor A allele carriers showed significant mean differences in the domains of attention (M = -11.0, SD = 13.1, p = .00, d = .86) and overall cognitive performance (M = -5.25, SD = 8.1, p = .01, d = .66).The minor A allele carriers in comparison to the wildtype G allele group, showed considerably lower scores at admission and remained impaired in most domains across the timepoints, although delayed signs of recovery were noted to be significant in the domains attention and overall cognition. In conclusion, the current study has demonstrated the role of the BDNF rs6265 Val66Met polymorphism in influencing specific neurocognitive outcomes in patients with mTBI. Findings were more detrimentally profound among Met allele carriers

Incidence and Determinants of Acute Diarrhoea in Malaysia: A Population-based Study

Acute diarrhoea is a major health problem in many parts of the world, contributing to about 1.8 million deaths globally. The objectives of the study were to assess the incidence, determinants, and severity of acute diarrhoea in the population. A nation-wide cross-sectional survey involving about 57,000 respondents was conducted via face-to-face interview among eligible respondents of all ages. An acute diarrhoeal episode was defined as having three or more episodes of loose stools in any 24-hour period within the past four weeks before the interview. The severity was measured by duration of acute diarrhoea and associated symptoms. The variables tested as determinants were age, sex, ethnicity, the highest educational level, total monthly household income, and locality. Univariate, bivariate and multivariate procedures meant for complex study design were used in the analyses. The four-week incidence of acute diarrhoea was 5% [95% confidence interval (CI) 4.8-5.2]. The incidence of acute diarrhoea among the estimated population was the highest among young adults aged 20-29 years, Other Bumiputras (the pre-dominant ethnic group in East Malaysia), those with tertiary-level of education, those earning a monthly household income of less than RM 400, and rural dwellers. Only age, ethnicity, the highest level of education attained, and locality were significantly associated with acute diarrhoea in bivariate analysis. In multivariate analysis, these four variables were found to be the determinants of acute diarrhoea. Sex and monthly household income were excluded from the model. The mean duration of acute diarrhoea was 2.0 days (standard deviation 1.3). Forty-six percent of the respondents reported stomach cramps as an associated symptom. The findings revealed that acute diarrhoea is still a major public-health concern in Malaysia and grossly undernotified. There is a need for intensification of public-health intervention efforts to reduce the incidence of acute diarrhoea while improving surveillance and notification of the disease