Vaginal discharge: perceptions and health seeking behavior among Nepalese women

Objectives: To understand women\u27s perceptions and health seeking behavior and the association between vaginal discharge, clinical signs and laboratory findings as a presentation of sexually transmitted diseases (STD).Methods: We conducted five focus group discussions with women attending the outpatient department in a large public hospital in Katmandu, Nepal, during May-June 1997. We also interviewed seventy women presenting with vaginal discharge to the same hospital, through structured questionnaire. Women presenting with discharge were also examined and investigated for six common sexually transmitted diseases and reproductive tract infections.Results: In the focus groups vaginal discharge was identified as a common disease distinct from STDs, for which women can seek treatment. STDs were considered as social diseases transmitted to women through multiple sexual partners and not from husband. Patients with vaginal discharge preferred traditional healers and pharmacist. Clinical signs were inconclusive for type of infection. Simple laboratory tests identified etiologic agent in 64 (91%) patients and the three commonest infections were Moniliasis (78%), Bacterial Vaginosis (25%) and Trichomoniasis (17%).CONCLUSION: Vaginal discharge may be used as a risk marker for identification of STDs by Primary Health Workers. Low cost investigations should be made available at the secondary care level for identification of most common Reproductive Tract Infections. Communication campaigns should target the misconceptions that exist in the communities local context related to the prevention, treatment and control of vaginal discharge and STDs

The Pathway to Publishing: A Guide to Quantitative Writing in the Health Sciences

Writing manuscripts is central to the advance of scientific knowledge. For an early career aspiring scientist, writing first author manuscripts is an opportunity to develop critical skills and to credential their expertise. Writing manuscripts, however, is difficult, doubly so for scientists who use English as a second language. Many science students intentionally avoid a writing-intensive curriculum. Careful, thorough reviews of draft manuscripts are difficult to secure, and experienced scientific supervisors face more demands on their time than they have time available. Weak draft manuscripts discourage supervising scientists investing the time to coach revisions. It is easier for experienced scientists to ignore the request, or to simply rewrite the article. Early career scientists are motivated to address these barriers but specific advice is difficult to find, and much of this advice is behind a pay wall. This essential, open access text presents writing lessons organized as common errors, providing students and early-career researchers with an efficient way to learn, and mentors with a quick-reference guide to reviewing. Error descriptions include specific examples drawn from real-world experiences of other early-career writers, and suggestions for how to successfully address and avoid these in the future. Versions of this book have been used by Stanford University, UC Davis, Johns Hopkins, and numerous international institutions and organizations for over a decade.

Hygiene: new hopes, new horizons.

Although promotion of safe hygiene is the single most cost-effective means of preventing infectious disease, investment in hygiene is low both in the health and in the water and sanitation sectors. Evidence shows the benefit of improved hygiene, especially for improved handwashing and safe stool disposal. A growing understanding of what drives hygiene behaviour and creative partnerships are providing fresh approaches to change behaviour. However, some important gaps in our knowledge exist. For example, almost no trials of the effectiveness of interventions to improve food hygiene in developing countries are available. We also need to figure out how best to make safe hygiene practices matters of daily routine that are sustained by social norms on a mass scale. Full and active involvement of the health sector in getting safe hygiene to all homes, schools, and institutions will bring major gains to public health

The risk of misclassifying subjects within principal component based asset index.

The asset index is often used as a measure of socioeconomic status in empirical research as an explanatory variable or to control confounding. Principal component analysis (PCA) is frequently used to create the asset index. We conducted a simulation study to explore how accurately the principal component based asset index reflects the study subjects' actual poverty level, when the actual poverty level is generated by a simple factor analytic model. In the simulation study using the PC-based asset index, only 1% to 4% of subjects preserved their real position in a quintile scale of assets; between 44% to 82% of subjects were misclassified into the wrong asset quintile. If the PC-based asset index explained less than 30% of the total variance in the component variables, then we consistently observed more than 50% misclassification across quintiles of the index. The frequency of misclassification suggests that the PC-based asset index may not provide a valid measure of poverty level and should be used cautiously as a measure of socioeconomic status

Inequalities in Care-seeking for Febrile Illness of Under-five Children in Urban Dhaka, Bangladesh

Fever is an easily-recognizable primary sign for many serious childhood infections. In Bangladesh, 31% of children aged less than five years (under-five children) die from serious infections, excluding confirmed acute respiratory infections or diarrhoea. Understanding healthcare-seeking behaviour for children with fever could provide insights on how to reduce this high rate of mortality. Data from a cross-sectional survey in the catchment areas of two tertiary-level paediatric hospitals in Dhaka, Bangladesh, were analyzed to identify the factors associated with the uptake of services from trained healthcare providers for under-five children with reported febrile illness. Health and demographic data were collected in a larger study of 7,865 children using structured questionnaires. Data were selected from 1,290 of these under-five children who were taken to any healthcare provider for febrile illness within two months preceding the date of visit by the study team. Certified doctors were categorized as ‘trained’, and other healthcare providers were categorized as ‘untrained’. Healthcare-seeking behaviours were analyzed in relation to these groups. A wealth index was constructed using principal component analysis to classify the households into socioeconomic groups. The odds ratios for factors associated with healthcare-seeking behaviours were estimated using logistic regression with adjustment for clustering. Forty-one percent of caregivers (n=529) did not seek healthcare from trained healthcare providers. Children from the highest wealth quintile were significantly more likely [odds ratio (OR)=5.6, 95% confidence interval (CI) 3.4-9.2] to be taken to trained healthcare providers compared to the poorest group. Young infants were more likely to be taken to trained healthcare providers compared to the age-group of 4-<5 years (OR=1.6, 95% CI 1.1-2.4). Male children were also more likely to be taken to trained healthcare providers (OR=1.5, 95% CI 1.2-1.9) as were children with decreased level of consciousness (OR=5.3, 95% CI 2.0-14.2). Disparities across socioeconomic groups and gender persisted in seeking quality healthcare for under-five children with febrile illness in urban Dhaka. Girls from poor families were less likely to access qualified medical care. To reduce child mortality in the short term, health education and behaviour-change communication interventions should target low-income caregivers to improve their recognition of danger-signs; reducing societal inequalities remains an important long-term goal

Clinical diagnosis of Plasmodium falciparum among children with history of fever, Sindh, Pakistan

Objective: To identify clinical predictors for malaria and develop a clinical algorithm to more accurately identify malaria from non-malaria cases.Methods: Four hundred thirty eight children aged 6-120 months attending the rural health center between August 15 and October 5, 1997, in Jhangara town of district Dadu, Sindh were recruited. A standard questionnaire was used to record symptoms and duration of child\u27s illness. Each child was physically examined, had their axillary temperature measured, and blood samples were collected from which Giemsa stained thick and thin blood films were prepared and examined for presence of Plasmodium parasites. The sensitivity and specificity of several candidate algorithms for parasitemia were evaluated using various combinations of identified predictors.Results: Twenty-six of 438 children (6%) were slide positive for malaria. An algorithm comprised of fever 3 days duration and (absence of cough or having rigors) had 100% sensitivity and 63% specificity for detecting P. falciparum.CONCLUSION: In this low malaria prevalence region, restricting the diagnosis of malaria to persons who had \u3e3 days of fever and absence of cough or rigors, remained highly sensitive but was more specific than current practice. If validated prospectively, this algorithm could reduce misdiagnosis and mis-treatment

Estimating the Effect of Recurrent Infectious Diseases on Nutritional Status: Sampling Frequency, Sample-size, and Bias

There is an ongoing interest in studying the effect of common recurrent infections and conditions, such as diarrhoea, respiratory infections, and fever, on the nutritional status of children at risk of malnutrition. Epidemiological studies exploring this association need to measure infections with sufficient accuracy to minimize bias in the effect estimates. A versatile model of common recurrent infections was used for exploring how many repeated measurements of disease are required to maximize the power and logistical efficiency of studies investigating the effect of infectious diseases on malnutrition without compromising the validity of the estimates. Depending on the prevalence and distribution of disease within a population, 15-30 repeat measurements per child over one year should be sufficient to provide unbiased estimates of the association between infections and nutritional status. Less-frequent measurements lead to a bias in the effect size towards zero, especially if disease is rare. In contrast, recall error can lead to exaggerated effect sizes. Recall periods of three days or shorter may be preferable compared to longer recall periods. The results showed that accurate estimation of the association between recurrent infections and nutritional status required closer follow-up of study participants than studies using recurrent infections as an outcome measure. The findings of the study provide guidance for choosing an appropriate sampling strategy to explore this association

Long-term improvement in unsafe injection practices following community intervention

Background: A study in 1994 identified frequent unsafe injections as the cause of widespread hepatitis C virus infection in Hafizabad, Pakistan. A simple low cost community education program was assessed to see if it improved injection safety.Methods: A local health organization developed educational materials on hepatitis C including advice on how to avoid unnecessary injections and, when injections were necessary, to use a new syringe and needle. Beginning in 1995, this advice was communicated through multiple channels including health education meetings, announcements in mosques, and via pamphlets. In 1998 study workers revisited controls from the 1994 case-control study (along with three of their neighbors of a similar age) to collect information on injection practices in the previous 12 months.Results: Thirty-three percent of the study\u27s participants in 1998 received \u3eor=5 injections in the preceding 12 months compared to 40% of the hepatitis C virus negative controls reported in the year prior to the 1994 study (p=0.85). In 1998 52 persons (34%) brought their own syringe for their most recent injection, a practice that was unreported in 1994. Overall, in 1998 59% of patients received their most recent injection with a new syringe and needle compared to 24% in 1994 (p=0.003).CONCLUSIONS: Following this low cost health communication effort, community members took steps to protect themselves from unsafe injections