Changing poor mothers' care-seeking behaviors in response to childhood illness: findings from a cross-sectional study in Granada, Nicaragua

BACKGROUND: In 2008, approximately 8.8 million children under 5 years of age died worldwide. Most of these deaths occurred in developing countries, but little is known about poor mothers' care-seeking behaviors for their children. We examined poor mothers' care-seeking behaviors in response to childhood illness, and identified factors affecting their choices. We also assessed mothers' perception of the medical services and their confidence in the health care available for their children. METHODS: We carried out a community-based cross-sectional study with structured questionnaires. Participants were 756 mothers and their young children (0-23 months) in Nandaime municipality, Granada province, Nicaragua. We took the children's anthropometric measurements and we assessed the mothers according to their income. We divided them into 3 global absolute poverty categories (income: <1 USD/day, 1-2 USD/day, >2 USD/day), and 4 quintile. RESULTS: When a child showed symptoms of illness, most mothers (>75%) selected public health facilities as their first choice. More than half (>58%) were satisfied with the medical services, but the poorest mothers expressed more dissatisfaction (p = 0.003), when we divided the participants into 4 quintiles groups according to their income. In the poorest group, the main reasons for dissatisfaction were cost (46.6%), and distance to the facilities (25.8%). Almost half (41.3%) of mothers lacked confidence in the health care offered to their child, while most of the wealthiest mothers (75.7%) did have confidence in it (p = 0.001). The poorest mothers showed greater interest in health education than the wealthiest (86.2% vs. 77.8%) (p = 0.015). We found that poor mothers (≤2 USD/day) changed their second choice for care in a positive direction. Factors affecting the change in second choice were the child having symptoms of respiratory disease (AOR, 2.51; 95% CI, 1.28-4.90, p = 0.007), visiting health post as the first choice (AOR, 2.11; 95% CI, 1.26-3.53, p = 0.005), and experiencing a child death in the past (AOR, 2.05; 95% CI, 1.15-3.68, p = 0.016). Child stunting, mother's level of education, and past participation in health education programs did not affect. CONCLUSIONS: Determination of the severity of a childhood disease is a difficult task for mothers. The national rural health system was functioning, yet the services were often limited. We should consider the feasibility of providing a more effective primary care system for the poor. To encourage mothers' care-seeking behaviors in poor settings, the referral system and the social safety net need to be strengthened. Poor mothers need further education about the danger signs of childhood illness

Quality of Life and Mental Health Status of Arsenic-affected Patients in a Bangladeshi Population

Contamination of groundwater by inorganic arsenic is one of the major public-health problems in Bangladesh. This cross-sectional study was conducted (a) to evaluate the quality of life (QOL) and mental health status of arsenic-affected patients and (b) to identify the factors associated with the QOL. Of 1,456 individuals, 521 (35.78%) were selected as case and control participants, using a systematic random-sampling method. The selection criteria for cases (n=259) included presence of at least one of the following: melanosis, leucomelanosis on at least 10% of the body, or keratosis on the hands or feet. Control (nonpatient) participants (n=262) were selected from the same villages by matching age (\ub15 years) and gender. The Bangladeshi version of the WHOQOL-BREF was used for assessing the QOL, and the self-reporting questionnaire (SRQ) was used for assessing the general mental health status. Data were analyzed using Student's t-test and analysis of covariance (ANCOVA), and the WHOQOL-BREF and SRQ scores between the patients and the non-patients were compared. The mean scores of QOL were significantly lower in the patients than those in the non-patients of both the sexes. Moreover, the mental health status of the arsenic-affected patients (mean score for males=8.4 and females=10.3) showed greater disturbances than those of the non-patients (mean score for males=5.2 and females=6.1) of both the sexes. The results of multiple regression analysis revealed that the factors potentially contributing to the lower QOL scores included: being an arsenic-affected patient, having lower age, and having lower annual income. Based on the findings, it is concluded that the QOL and mental health status of the arsenic-affected patients were significantly lower than those of the non-patients in Bangladesh. Appropriate interventions are necessary to improve the well-being of the patients

Social capital and life satisfaction: a cross-sectional study on persons with musculoskeletal impairments in Hanoi, Vietnam

BackgroundSocial capital has been recognized as a major social determinant of health, but less attention has been given to social capital of persons with musculoskeletal impairments. The present study aimed to explore the associations between social capital and life satisfaction of persons with musculoskeletal impairments in Hanoi, Vietnam.MethodsA cross-sectional study was conducted in Hanoi, Vietnam. From June to July 2008, we collected data from 136 persons with musculoskeletal impairments who belonged to disabled people\u27s groups. Social capital was measured using a short version of the Adapted Social Capital Assessment Tool that included group membership, support from groups, support from individuals, citizenship activities, and cognitive social capital. Life satisfaction was measured using the Satisfaction with Life Scale. As possible confounding factors, we measured socio-economic factors and disability-related factors such as activities of daily living.ResultsAfter controlling for confounding effects, group membership remained significantly associated with the level of life satisfaction reported by the persons with musculoskeletal impairments. In particular, being an active member of two or more groups was associated with higher life satisfaction. In contrast, other components of social capital such as citizenship activities and cognitive social capital were not significant in the multiple regression analysis of this study.ConclusionsThe findings suggest the importance of considering an active participation in multiple groups toward the enhancement of the life satisfaction among persons with musculoskeletal impairments. To encourage persons with musculoskeletal impairments to have multiple active memberships, their access to groups should be facilitated and enhanced

Identification of high risk groups with shorter survival times after onset of the main reason for suicide: findings from interviews with the bereaved in Japan

Abstract Objectives We sought to (1) measure survival lengths after the onset of the main reason for the target’s suicide, (2) identify the highest-risk groups and the contributors to early death, in Japan, and (3) clarify peculiar traditional Japanese values concerning suicide. Results Data for 523 deceased individuals (median age 43.0 years) were collected from bereaved persons. Average survival time from the onset of the main reason for suicide was 1956 days (5.4 years). After controlling for confounding factors, being middle-aged, male, self-employed, and a founding company president were identified as the highest-risk groups. Half of the self-employed founding presidents died within 2 years. Many of the bereaved had observed some signs of the suicide 2 weeks ago. The traditional Japanese idea is that one means of compensating for a serious mistake is to commit suicide, and we observed that many Japanese people still regard suicide as a respectable death, even among the interviewed. The possible intervention time is quite limited; however, those who have contact with the high-risk groups should be alert to behavioral changes or signals of impending suicide

Primary Health Care Must Go Beyond WHO

We were pleased to hear Margaret Chan\u27s strong commitment to primary health care 30 years after the Alma-Ata Declaration. In your Editorial on her statement (May 31, p 1811),1 you mention that the challenge in revitalising primary health care lies in tying together the ever-increasing number of global initiatives

High Rate of Unintended Pregnancies After Knowing of HIV Infection Among HIV Positive Women Under Antiretroviral Treatment in Kigali, Rwanda

More than 90% of pediatric AIDS results from the transmission of the virus through HIV positive pregnant mothers to their children. However, little has been known about factors associated with unintended pregnancies after knowing their HIV seropositive status, or contraceptive use among HIV positive women under antiretroviral treatment (ART). We investigated thus factors associated with unintended pregnancies after knowing seropositive status, and also factors associated with the non-use of contraceptives among HIV positive women under ART. We carried out a cross-sectional study in Kigali, Rwanda in 2007. A total of 565 HIV positive women under ART were interviewed. We examined the associated factors of unintended pregnancies or non-use of contraceptives using logistic regression analysis. Among all the respondents (n = 565), 132 women became pregnant after knowing their HIV seropositive status. Among them, 82 (62.7%) got pregnant unintentionally. Those who had two or more children (adjusted OR, 3.83) were more likely to get pregnant unintentionally. Meanwhile, among all, 263 had sexual intercourse during the last three months. Of them, 85 women did not use any contraceptives. Those who did not agree that \u27HIV positive children can survive as long as HIV negative children\u27 (adjusted OR, 2.28), and those who \u27can always ask partner to use a condom\u27 (adjusted OR, 9.83), were more likely to use contraceptives. This study suggests that HIV positive women under ART need special support to avoid unintended pregnancies especially those who have two or more children. Moreover, interventions are also needed to improve women\u27s understanding of the prognosis of pediatric AIDS, and condom-use negotiation skills

Examination of Cluster Groups of Risk Behaviors and Beliefs Associated with Non-Communicable Diseases with Latent Class Analysis: A Cross-Sectional Study in Rural Bangladesh

This cross-sectional observational study examined the cluster groups of risk behaviors and beliefs associated with non-communicable diseases (NCDs) and the demographic factors that influence these cluster groups. The questionnaire survey was conducted in Lohagara Upazila in Narail District, Bangladesh and included basic demographics and items associated with NCDs. The inclusion criteria for the participants in this study included those who were aged between 20 and 80 years and both sexes. The survey items were based on risk behavior, belief, and improvement behavior. To identify the several cluster groups based on NCD-related behavior and belief patterns, a log-likelihood latent class analysis was conducted. Then, a multinomial regression analysis was performed to identify the factor associated with each cluster group. Of the 600 participants, 231 (38.5%) had hypertension, 87 (14.5%) had diabetes, and 209 (34.8%) had a body mass index of 25 or more. Finally, risk behaviors and beliefs associated with NCDs were classified into three cluster groups: (1) very high-risk group (n = 58); (2) high-risk group (n = 270); and (3) moderate-risk group (n = 272). The very high-risk group was significantly associated with female gender, older age, fewer years spent in education, and the absence of daily medication compared to the moderate-risk group. Educational interventions in rural Bangladesh should be immediately implemented to improve the risk behaviors and beliefs associated with NCDs