Children not receiving adequate immunization in Ibadan, Nigeria: What reasons and beliefs do their mothers have?

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Risk factors associated with mental illness in Oyo State, Nigeria: A Community based study

BACKGROUND: The main objective of this study was to determine the prevalence and factors associated with mental illness in Oyo State at community level using the general health questionnaire as a screening tool. METHOD: This cross-sectional, community- based survey was carried out among adults in three randomly selected LGAs using multi-stage sampling technique. RESULTS: A total of 1105 respondents were assessed in all. The overall prevalence of psychiatric morbidity in Oyo state Nigeria was found to be 21.9%, (18.4% in the urban areas and 28.4% in the rural areas, p = 0.005). Young age ≤ 19 yrs (X(2 )= 20.41, p = 0.00013), Unemployment (X(2 )= 11.86 p = 0.0005), living condition below average (X(2 )= 12.21, p = 0.00047), physical health (X(2 )= 6.07, p = 0.014), and large family size (X(2 )= 14.09 p = 0.00017) were associated with increase risk for psychiatric morbidity. Following logistic regression analysis, Unemployment (C.I = 1.18–3.70, OR -2.1) and living conditions perceived to be above average (C.I = 1.99–5.50, OR-3.3) were significant predictors of mental illness while family size less than 6 (C.I = 0.86–0.97, OR-0.91) was protective. CONCLUSION: The teenagers and the rural populations are in greater need of mental health promotional services. Family planning should be made freely available in order to reduce the family size and hence incidence of mental illness in the African population

Health status of children aged under two years cared for in day-care centres and the home environment in Ibadan, Nigeria

Background: As a result of the increasing numbers of Nigerian women in the labour force and also the gradual disintegration of the extended family system, a demand for alternative means of caring for children is being created. Day-care as an alternative source of childcare has now become a necessity rather than an option. Objectives: To assess and compare the health status of two groups of children under two years old cared for in two different rearing environments, home environment and day-care centres. Methods: A descriptive comparative study design was used. Two groups of children from comparable low socio-economic backgrounds were recruited into the study. Using simple random sampling, 91 under two-year old children attending day-care centres in a middle-high density area of Ibadan and 91 under two-year old children cared for in the home environment in a settlement in the junior staff quarters of the University of Ibadan were enrolled in the study. Anthropometric data, immunisation status and morbidity patterns for various childhood illnesses were obtained for children in both groups in the study. Results: Statistically insignificant higher percentages of children cared for in the day-care centres were underweight and wasted, while significantly more children cared for at home were stunted {Relative risk RR=1.46, (95% Confidence Limit CL = 1.10-1.93), p=0.018}. Except for measles immunisation coverage which was lower in the day-care group, there was comparability in the immunisation status of children in both groups. Day-care attendance was found to be a significant risk factor associated with the occurrence of diarrhoea (RR=1.74, (95% CL =1.34-2.26), p=0.0016) and upper respiratory tract infections (RR=2.31, (95% CL = 1.62-3.30), p=0.0000004) in these children. Measles occurred only in children attending day-care centres and there was an outbreak during the study period. Conclusions: Given the higher risk of infections among children cared for in day-care centres, strategies should be put in place to train the child minders and ensure regular supervision of the Keywords: day-care, home environment, health status immunisation status, morbidity pattern, under two-year old childJournal of Community Medicine and Primary Health Care 2005, 17(1): 33-3

The effect of maternal anthropometric characteristics and social factors on gestational age and birth weight in Sudanese newborn infants

<p>Abstract</p> <p>Background</p> <p>In Africa low birth weight (LBW) (<2500 g), is the strongest determinant of infant morbidity and mortality. The aim of this study was to quantify the effect of maternal anthropometry, education and socio-economic status on gestational age and birth weight.</p> <p>Methods</p> <p>In 1000 Sudanese mothers with singleton births, anthropometric measurements (weight, height, mid-arm circumference) and newborn birth weight were taken within 24 hours of delivery. Furthermore, maternal education and socio-economic status were recorded. The effect of these maternal variables on gestational age and birth weight was investigated by receiver operating characteristic (ROC) curves and by multivariate logistic regression analysis.</p> <p>Results</p> <p>Although maternal height was significantly correlated (p = 0.002) with gestational age, we did not find maternal characteristics of value in determining the risk for preterm birth. Birth order was the strongest determinant of birth weight compared to other maternal characteristics. The LBW rate of first born babies of 12.2% was nearly twice that of infants of multiparous mothers. Maternal age and all maternal anthropometric measurements were positively correlated (p < 0.001) with birth weight. A maternal height of <156 cm, a maternal weight of <66 kg, a maternal mid arm circumference of <27 cm and years of education of ≤ 8 years were found to increase the relative risk of LBW but this was statistically significant only in the case of maternal height. Maternal age and BMI had no statistically significant effect on determining the risk for LBW. The social class did not affect the birth weight, while the number of years of education was positively correlated with birth weight (p = 0.01). The LBW rate decreased from 9.2% for ≤ 8 years of education to 6.0% for >12 years of education.</p> <p>Conclusion</p> <p>Birth order and maternal height were found to be the most important maternal parameters which influences birth weight and the risk for LBW. The duration of maternal education and not social class was found to significantly affect the risk for LBW.</p

Endemic and epidemic dynamics of cholera: the role of the aquatic reservoir

BACKGROUND: In the last decades, attention to cholera epidemiology increased, as cholera epidemics became a worldwide health problem. Detailed investigation of V. cholerae interactions with its host and with other organisms in the environment suggests that cholera dynamics is much more complex than previously thought. Here, I formulate a mathematical model of cholera epidemiology that incorporates an environmental reservoir of V. cholerae. The objective is to explore the role of the aquatic reservoir on the persistence of endemic cholera as well as to define minimum conditions for the development of epidemic and endemic cholera. RESULTS: The reproduction rate of cholera in a community is defined by the product of social and environmental factors. The importance of the aquatic reservoir depends on the sanitary conditions of the community. Seasonal variations of contact rates force a cyclical pattern of cholera outbreaks, as observed in some cholera-endemic communities. CONCLUSIONS: Further development on cholera modeling requires a better understanding of V. cholerae ecology and epidemiology. We need estimates of the prevalence of V. cholerae infection in endemic populations as well as a better description of the relationship between dose and virulence

Predictors for neonatal death in the rural areas of Shaanxi Province of Northwestern China: a cross-sectional study

Background Almost all (99%) neonatal deaths arise in low-income and middle-income countries. Approximately 450 new-born children die every hour, which is mainly from preventable causes. There has been increased recognition of the need for these countries to implement public health interventions that specifically target neonatal deaths. The purpose of this paper is to identify the predictors of neonatal death in Type 4 rural (poorest) counties in Shaanxi Province of northwestern China. Methods A cross-sectional study was conducted in Shaanxi Province, China. A single-stage survey design was identified to estimate standard errors. Because of concern about the complex sample design, the data were analysed using multivariate logistic regression analysis. Socioeconomic and maternal health service utilization factors were added into the model. Results During the study period, a total of 4750 women who delivered in the past three years were randomly selected for interview in the five counties. There were 4880 live births and 54 neonatal deaths identified. In the multiple logistic regression, the odds of neonatal death was significantly higher for multiparous women (OR = 2.77; 95% CI: 1.34, 5.70) and women who did not receive antennal health care in the first trimester of pregnancy (OR = 2.49; 95% CI: 1.41, 4.40). Women who gave birth in a county-level hospital (OR = 0.18; 95% CI: 0.04, 0.86) and had junior high school or higher education level (OR = 0.20; 95% CI: 0.05, 0.84) were significantly protected from neonatal death. Conclusions Public health interventions directed at reducing neonatal death should address the socioeconomic factors and maternal health service utilization, which significantly influence neonatal mortality in rural China. Multipara, low educational level of the women, availability of prenatal visits in the first trimester of pregnancy and hospital delivery should be considered when planning the interventions to reduce the neonatal mortality in rural areas

High HIV Incidence and Sexual Behavior Change among Pregnant Women in Lilongwe, Malawi: Implications for the Risk of HIV Acquisition

HIV incidence is higher among pregnant women than their non-pregnant counterparts in some sub-Saharan African settings. Our aims were (1) to estimate HIV incidence during pregnancy and (2) to compare sexual activity between pregnant, postpartum, and non-pregnant women.We examined a retrospective cohort of 1087 women to identify seroconverters using antenatal and labor ward HIV test results. We also conducted a cross-sectional survey, including a quantitative questionnaire (n = 200) and in-depth interviews (n = 20) among women in early pregnancy, late pregnancy, postpartum, and non-pregnancy. Outcomes included measures of sexual activity, reported spouse's risky behavior, and beliefs about abstinence.11 of 1087 women seroconverted during pregnancy yielding a 1% seroconversion risk and an incidence rate of 4.0/100 person years (95% CI 2.2-7.2). The reported sexual activity of the early pregnancy and non-pregnancy groups was similar, but significantly higher than the late pregnancy and postpartum groups (p<0.001). During pregnancy, sex acts decreased as gestation increased (p = 0.001). There was no reported difference in the spouse's risky behavior. Most women believed that sex should cease between the 6(th) and 8(th) month of pregnancy and should not resume until 6 months postpartum. Some talked about conflict between their cultural obligation to abstain and fear of HIV infection if their spouses find other partners.HIV incidence is high among pregnant women in Malawi, and sexual activity decreases during pregnancy and postpartum. Pregnant women need to be informed of their increased risk for HIV and the importance of using condoms throughout pregnancy and the postpartum period

Socio-economic factors associated with delivery assisted by traditional birth attendants in Iraq, 2000

<p>Abstract</p> <p>Background</p> <p>Traditional birth attendants (TBAs) are likely to deliver lower quality maternity care compared to professional health workers. It is important to characterize women who are assisted by TBAs in order to design interventions specific to such groups. We thus conducted a study to assess if socio-economic status and demographic factors are associated with having childbirth supervised by traditional birth attendants in Iraq.</p> <p>Methods</p> <p>Iraqi Multiple Indicator Cluster Survey (MICS) data for 2000 were used. We estimated frequencies and proportions of having been delivered by a traditional birth attendant and other social characteristics. Logistic regression analysis was used to assess the association between having been delivered by a TBA and wealth, area of residence (urban versus rural), parity, maternal education and age.</p> <p>Results</p> <p>Altogether 22,980 women participated in the survey, and of these women, 2873 had delivery information and whether they were assisted by traditional birth attendants (TBAs) or not during delivery. About 1 in 5 women (26.9%) had been assisted by TBAs. Compared to women of age 35 years or more, women of age 25–34 years were 22% (AOR = 1.22, 95%CI [1.08, 1.39]) more likely to be assisted by TBAs during delivery. Women who had no formal education were 42% (AOR = 1.42, 95%CI [1.22, 1.65]) more likely to be delivered by TBAs compared to those who had attained secondary or higher level of education. Women in the poorest wealth quintile were 2.52 (AOR = 2.52, 95%CI [2.14, 2.98]) more likely to be delivered by TBAs compared to those in the richest quintile. Compared to women who had 7 or more children, those who had 1 or 2 were 28% (AOR = 0.72, 95%CI [0.59, 0.87]) less likely to be delivered by TBAs.</p> <p>Conclusion</p> <p>Findings from this study indicate that having delivery supervised by traditional birth attendants was associated with young maternal age, low education, and being poor. Meanwhile women having 1 or 2 children were less likely to be delivered by TBAs. These factors should be considered in the design of interventions to reduce the rate of deliveries assisted by TBAs in favour of professional midwives, and consequently reduce maternal and neonatal mortality rates and other adverse events.</p