Ascertainment of childhood vaccination histories in northern Malawi

OBJECTIVE: To assess factors related to recorded vaccine uptake, which may confound the evaluation of vaccine impact.METHODS: Analysis of documented vaccination histories of children under 5 years and demographic and socio-economic characteristics collected by a demographic surveillance system in Karonga District, Malawi. Associations between deviations from the standard vaccination schedule and characteristics that are likely to be associated with increased mortality were determined by multivariate logistic regression.RESULTS: Approximately 78% of children aged 6-23 months had a vaccination document, declining to <50% by 5 years of age. Living closer to an under-5 clinic, having a better educated father, and both parents being alive were associated with having a vaccination document. For a small percentage of children, vaccination records were incomplete and/or faulty. Vaccination uptake was high overall, but delayed among children living further from the nearest under-5 clinic or from poorer socio-economic backgrounds. Approximately 9% of children had received their last dose of DPT with or after measles vaccine. These children were from relatively less educated parents, and were more likely to have been born outside the health services.CONCLUSIONS: Though overall coverage in this community was high and variation in coverage according to child or parental characteristics small, there was strong evidence of more timely coverage among children from better socio-economic conditions and among those who lived closer to health facilities. These factors are likely to be strong confounders in the association of vaccinations with mortality, and may offer an alternative explanation for the non-specific mortality impact of vaccines described by other studies

A Population-based policy and systems change approach to prevent and control hypertension

"Hypertension is one of the leading causes of death in the United States, affecting nearly one in three Americans. It is prevalent in adults and endemic in the older adult population. Hypertension is a major contributor to cardiovascular morbidity and disability. Although there is a simple test to diagnose hypertension and relatively inexpensive drugs to treat it, the disease is often undiagnosed and uncontrolled. A Population-Based Policy and Systems Change Approach to the Prevention and Control Hypertension identifies a small set of high-priority areas in which public health officials can focus their efforts to accelerate progress in hypertension reduction and control. It offers several recommendations that embody a population-based approach grounded in the principles of measurement, system change, and accountability. The recommendations are designed to shift current hypertension reduction strategies from an individual-based approach to a population-based approach. They are also designed to improve the quality of care provided to individuals with hypertension and to strengthen the Center for Disease Control and Prevention's leadership in seeking a reduction in the sodium intake in the American diet to meet dietary guidelines. The book is an important resource for federal public health officials and organizations, especially the Center for Disease Control and Prevention, as well as medical professionals and community health workers."--resource home page.Hypertension is one of the leading causes of death in the United States, affecting nearly one in three Americans. It is prevalent in adults and endemic in the older adult population. Hypertension is a major contributor to cardiovascular morbidity and disability. Although there is a simple test to diagnose hypertension and relatively inexpensive drugs to treat it, the disease is often undiagnosed and uncontrolled. A Population-Based Policy and Systems Change Approach to the Prevention and Control Hypertension identifies a small set of high-priority areas in which public health officials can focus their efforts to accelerate progress in hypertension reduction and control. It offers several recommendations that embody a population-based approach grounded in the principles of measurement, system change, and accountability. The recommendations are designed to shift current hypertension reduction strategies from an individual-based approach to a population-based approach. They are also designed to improve the quality of care provided to individuals with hypertension and to strengthen the Center for Disease Control and Prevention's leadership in seeking a reduction in the sodium intake in the American diet to meet dietary guidelines.Public health importance of hypertension -- The role of the Division for Heart Disease and Stroke Prevention in the prevention and control of hypertension -- Interventions directed at the general population -- Interventions directed at individuals with hypertension -- Implementing a population-based policy and systems approach to the prevention and control of hypertension.Committee on Public Health Priorities to Reduce and Control Hypertension in the U.S. Population, Board on Population Health and Public Health Practice, Institute of Medicine of the National Academies.Title from resource title page (National Academies Press, viewed July 15, 2010)"This report was made possible by the support of the Division of Heart Disease and Stroke Prevention of the Centers for Disease Control and Prevention." - p. xIncludes bibliographical references

Uneven progress in reducing exposure to violence at home for New Zealand adolescents 2001–2012: a nationally representative cross‐sectional survey series

Objective: To explore trends, and identify risk factors, that may explain changes in adolescent exposure to family violence over time.Methods: Data for this study was drawn from the Youth 2000 series of cross‐sectional surveys, carried out with New Zealand high school students in 2001, 2007 and 2012. Latent class analysis was used to understand different patterns of exposure to multiple risks for witnessing violence at home among adolescents.Results: Across all time periods, there was no change in witnessing emotional violence and a slight decline in witnessing physical violence at home. However, significant differences were noted between 2001 and 2007, and 2007 and 2012, in the proportion of adolescents who reported witnessing emotional and physical violence. Four latent classes were identified in the study sample; these were characterised by respondents' ethnicity, concerns about family relationships, food security and alcohol consumption. For two groups (characterised by food security, positive relationships and lower exposure to physical violence), there was a reduction in the proportion of respondents who witnessed physical violence but an increase in the proportion who witnessed emotional violence between 2001 and 2012. For the two groups characterised by poorer food security and higher exposure to physical violence, there were no changes in witnessing of physical violence in the home.Implications for public health: In addition to strategies directly aimed at violence, policies are needed to address key predictors of violence exposure such as social disparities, financial stress and alcohol use. These social determinants of health cannot be ignored

Circulating 250HD, dietary vitamin D, PTH, and calcium associations with incident cardiovascular disease and mortality: The MIDSPAN Family Study

<p>Context: Observational studies relating circulating 25-hydroxyvitamin D (25OHD) and dietary vitamin D intake to cardiovascular disease (CVD) have reported conflicting results.</p> <p>Objective: Our objective was to investigate the association of 25OHD, dietary vitamin D, PTH, and adjusted calcium with CVD and mortality in a Scottish cohort.</p> <p>Design and Setting: TheMIDSPAN Family Study is a prospective study of 1040 men and 1298 women from the West of Scotland recruited in 1996 and followed up for a median 14.4 yr. Participants: Locally resident adult offspring of a general population cohort were recruited from 1972–1976.</p> <p>Main Outcome Measures: CVD events (n = 416) and all-cause mortality (n=100) were evaluated.</p> <p>Results: 25OHD was measured using liquid chromatography-tandem mass spectrometry in available plasma (n=2081). Median plasma 25OHD was 18.6 ng/ml, and median vitamin D intake was 3.2 µ g/d (128 IU/d). Vitamin D deficiency (25OHD<15 ng/ml) was present in 689 participants (33.1%). There was no evidence that dietary vitamin D intake, PTH, or adjusted calcium were associated with CVD events or with mortality. Vitamin D deficiency was not associated with CVD (fully adjusted hazard ratio=1.00; 95% confidence interval=0.77–1.31). Results were similar after excluding patients who reported an activity-limiting longstanding illness at baseline (18.8%) and those taking any vitamin supplements (21.7%). However, there was some evidence vitamin D deficiency was associated with all-cause mortality (fully adjusted hazard ratio=2.02; 95% confidence interval=1.17–3.51).</p> <p>Conclusion: Vitamin D deficiency was not associated with risk of CVD in this cohort with very low 25OHD. Future trials of vitamin D supplementation in middle-aged cohorts should be powered to detect differences inmortality outcomes as well as CVD.(J Clin EndocrinolMetab97: 0000 –0000, 2012)</p&gt

The Political Economy of India's Malnutrition Puzzle

Child malnutrition in India is shockingly high and is falling unusually slowly in a period of large gains in aggregate prosperity. Yet technical solutions to malnutrition are known. This article suggests the disjunction is a consequence of institutional features of India, in which rent?creation and rent?sharing in an unequal society are central. Economic reforms partially altered relations between the state and business, helping spur growth, but growth is much weaker in rural areas and poorer states. And service delivery remains enmeshed in patronage and populism. This is acutely misaligned with required action on malnutrition that involves provision of complementary public goods, by different agencies, with a key role for front?line workers. Systemic institutional change is going to be a long haul; in the meantime, public action needs to be designed around existing political and organisational realities. Otherwise increased nutrition?related spending will be like pushing on a string

Ten commandments for the future of ageing research in the UK: a vision for action

Increases in longevity resulting from improvements in health care and living conditions together with a decrease in fertility rates have contributed to a shift towards an aged population profile. For the first time the UK has more people over age 60 than below 16 years of age. The increase in longevity has not been accompanied by an increase in disease-free life expectancy and research into ageing is required to improve the health and quality of life of older people. However, as the House of Lords reported, ageing research in the UK is not adequately structured and a clear vision and plan are urgently required. Hence, with the aim of setting a common vision for action in ageing research in the UK, a 'Spark Workshop' was organised. International experts from different disciplines related to ageing research gathered to share their perspectives and to evaluate the present status of ageing research in the UK. A detailed assessment of potential improvements was conducted and the prospective secondary gains were considered, which were subsequently distilled into a list of 'ten commandments'. We believe that these commandments, if followed, will help to bring about the necessary implementation of an action plan for ageing research in the UK, commensurate with the scale of the challenge, which is to transform the manifold opportunities of increased longevity into actual delivery of a society living not only for longer, but also healthier, wealthier and happier

Promoting reproductive options for HIV-affected couples in sub-Saharan Africa

HIV-affected couples have unique challenges that require access to information and reproductive services which prevent HIV transmission to the uninfected partner and offspring while allowing couples to fulfill their reproductive goals. In high HIV prevalent regions of sub-Saharan Africa, HIV-affected couples require multipurpose prevention technologies (MPTs) to enhance their reproductive healthcare options beyond contraception and prevention of HIV/sexually transmitted infections (STIs) to include assistance in childbearing. The unique characteristics of the condom and its accepted use in conjunction with safer conception interventions allow HIV-serodiscordant couples an opportunity to maintain reproductive health, prevent HIV/STI transmission, and achieve their reproductive goals while timing conception. Rethinking the traditional view of the condom and incorporating a broader reproductive health perspective of HIV-affected couples into MPT methodologies will impact demand, acceptability, and uptake of these future technologies

Relationship between household wealth inequality and chronic childhood under-nutrition in Bangladesh

BACKGROUND: Household food insecurity and under-nutrition remain critically important in developing countries struggling to emerge from the scourge of poverty, where historically, improvements in economic conditions have benefited only certain privileged groups, causing growing inequality in health and healthcare among the population. METHODS: Utilizing information from 5,977 children aged 0-59 months included in the 2004 Bangladesh Demographic and Health Survey , this study examined the relationship between household wealth inequality and chronic childhood under-nutrition. A child is defined as being chronically undernourished or whose growth rate is adversely stunted, if his or her z-score of height-for-age is more than two standard deviations below the median of international reference. Household wealth status is measured by an established index based on household ownership of durable assets. This study utilized multivariate logistic regressions to estimate the effect of household wealth status on adverse childhood growth rate. RESULTS: The results indicate that children in the poorest 20% of households are more than three time as likely to suffer from adverse growth rate stunting as children from the wealthiest 20% of households (OR=3.6; 95% CI: 3.0, 4.3). The effect of household wealth status remain significantly large when the analysis was adjusted for a child's multiple birth status, age, gender, antenatal care, delivery assistance, birth order, and duration that the child was breastfed; mother's age at childbirth, nutritional status, education; household access to safe drinking water, arsenic in drinking water, access to a hygienic toilet facility, cooking fuel cleanliness, residence, and geographic location (OR=2.4; 95% CI: 1.8, 3.2). CONCLUSION: This study concludes that household wealth inequality is strongly associated with childhood adverse growth rate stunting. Reducing poverty and making services more available and accessible to the poor are essential to improving overall childhood health and nutritional status in Bangladesh