Hypertension, its correlates and differences in access to healthcare services by gender among rural Zambian residents: a cross-sectional study

[Objectives] To examine the prevalence of hypertension and access to related healthcare services among rural residents of Mumbwa district in Zambia. [Design] Cross-sectional study with probability cluster sampling. [Setting] Rural Zambia. [Participants] We recruited 690 residents from Mumbwa district aged 25–64 years who had been living in the study area for ≥6 months and had adopted the lifestyle of the study area. Pregnant women and women who had given birth in the past 6 months were excluded. The data collection—questionnaire survey and anthropometric and biological measurements—was conducted between May and July 2016. [Results] In the overall sample, 39.7% and 33.5% of the men and women had hypertension (systolic blood pressure (BP)≥140 or diastolic BP ≥90 mm Hg), respectively. Among the participants without a previous diagnosis of hypertension, 30.3% presented with hypertension at the time of measurement. In the multivariable analysis, alcohol intake and urban residence in men, and older age group, higher education and body mass index ≥25 kg/m2 in women were significantly associated with hypertension. Among the 21.8% who never had their BP measured, 83.8% were men; among these men, older age (adjusted OR (AOR), 0.43; 95% CI 0.25 to 0.73) and HIV positive status (AOR, 0.37; 95% CI 0.14 to 0.97) were negatively associated, while current smoker status (AOR, 2.09; 95% CI 1.19 to 3.66) was positively associated with the lack of BP measurements. [Conclusion] We found that hypertension is prevalent in the target rural area. However, many were not aware of their hypertension status and many never had their BP measured, indicating a serious gap in cardiovascular disease prevention services in Zambia. There is an urgent need for health promotion and screening for hypertension, especially in the primary health services of rural Zambia. Issues related to healthcare accessibility in men require particular attention

Food insecurity is associated with increased risk of non-adherence to antiretroviral therapy among HIV-infected adults in the Democratic Republic of Congo: a cross-sectional study.

BACKGROUND: Food insecurity is increasingly reported as an important barrier of patient adherence to antiretroviral therapy (ART) in both resource-poor and rich settings. However, unlike in resource rich-settings, very few quantitative studies to date have investigated the association of food insecurity with patient adherence to ART in Sub-Saharan Africa. The current study examines the association between food insecurity and adherence to ART among HIV-infected adults in the Democratic Republic of Congo (DRC). METHODS AND FINDINGS: This is a cross-sectional quantitative study of patients receiving ART at three private and one public health facilities in Kinshasa, DRC. Participants were consecutively recruited into the study between April and November 2012. Adherence was measured using a combined method coupling pharmacy refill and self-reported adherence. Food insecurity was the primary predictor, and was assessed using the Household Food Insecurity Access Scale (HFIAS). Of the 898 participants recruited into the study, 512 (57%) were food insecure, and 188 (20.9%) were not adherent to ART. Food insecurity was significantly associated with non-adherence to ART (AOR, 2.06; CI, 1.38-3.09). We also found that perceived harmfulness of ART and psychological distress were associated respectively with increased (AOR, 1.95; CI, 1.15-3.32) and decreased (AOR, 0.31; CI, 0.11-0.83) odds of non-adherence to ART. CONCLUSION: Food insecurity is prevalent and a significant risk factor for non-adherence to ART among HIV-infected individuals in the DRC. Our findings highlight the urgent need for strategies to improve food access among HIV-infected on ART in order to ensure patient adherence to ART and ultimately the long-term success of HIV treatment in Sub-Saharan Africa

Latin American immigrants have limited access to health insurance in Japan: a cross sectional study

<p>Abstract</p> <p>Background</p> <p>Japan provides universal health insurance to all legal residents. Prior research has suggested that immigrants to Japan disproportionately lack health insurance coverage, but no prior study has used rigorous methodology to examine this issue among Latin American immigrants in Japan. The aim of our study, therefore, was to assess the pattern of health insurance coverage and predictors of uninsurance among documented Latin American immigrants in Japan.</p> <p>Methods</p> <p>We used a cross sectional, mixed method approach using a probability proportional to estimated size sampling procedure. Of 1052 eligible Latin American residents mapped through extensive fieldwork in selected clusters, 400 immigrant residents living in Nagahama City, Japan were randomly selected for our study. Data were collected through face-to-face interviews using a structured questionnaire developed from qualitative interviews.</p> <p>Results</p> <p>Our response rate was 70.5% (n = 282). Respondents were mainly from Brazil (69.9%), under 40 years of age (64.5%) and had lived in Japan for 9.45 years (SE 0.44; median, 8.00). We found a high prevalence of uninsurance (19.8%) among our sample compared with the estimated national average of 1.3% in the general population. Among the insured full time workers (n = 209), 55.5% were not covered by the Employee's Health Insurance. Many immigrants cited financial trade-offs as the main reasons for uninsurance. Lacking of knowledge that health insurance is mandatory in Japan, not having a chronic disease, and having one or no children were strong predictors of uninsurance.</p> <p>Conclusions</p> <p>Lack of health insurance for immigrants in Japan is a serious concern for this population as well as for the Japanese health care system. Appropriate measures should be taken to facilitate access to health insurance for this vulnerable population.</p

Investigation of the key factors that influence the girls to enter into child marriage: A meta-synthesis of qualitative evidence.

In this study, we synthesized findings from qualitative studies to identify the key factors that influence child marriage. We used a meta-ethnographic approach coupled with thematic synthesis. We searched literature from nine databases, which were in English language, covering areas in public health, psychology, and social science between 2008 and 2018. Twelve studies were included in the synthesis. We identified six main themes: human insecurity and conflict; legal issues; family values and circumstances; religious beliefs; individual circumstances, beliefs, and knowledge; and social norms. Our findings highlight the impact of human insecurity and conflict, as well as legal issues. In spite of global progress scaling up legislation against child marriage, the legal framework is insufficiently enforced in many settings. Most of the included studies were from the Middle East, Africa, and South Asia. Studies from other parts of the world such as Latin America and Southeast Asia, which have the highest rates of child marriage, are needed

Grit is associated with lower level of depression and anxiety among university students in Chiang Mai, Thailand: A cross-sectional study.

BACKGROUND:Depression and anxiety symptoms are prevalent among university students in both developed and developing settings. Recently, grit, defined as perseverance and passion for long-term goals, has emerged as an indicator of success and well-being. However, the relationship between grit and poor mental health outcomes among university students is largely unknown. The current study investigates the relationship of grit with depression and anxiety among university students in Chiang Mai, Thailand. METHODS:This cross-sectional study was conducted from January to March 2018 among university students aged 18-24 years from Chiang Mai University, the first largest university in Chiang Mai Province. Depression and anxiety were assessed with the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder (GAD-7) Scales, respectively. Grit was measured using the 8-item Short Grit Scale (GRIT-S). Grit scores were grouped into three categories: low (below the 25th percentile); average (from the 25th to the 75th percentiles); and high (above the 75th percentile). The other covariates included variables such self-esteem and socio-demographic variables. RESULTS:Of the 800 participants included in the study, 405 (50.6%) were female and 395 (49.4%) were male. Respectively 21.4% and 7.8% of the participants had depression and clinical symptoms of GAD. Increasing levels of grit negatively correlated with PHQ-9 and GAD-7 scores. Participants with high level of grit scored respectively 1.69 points (P <0.001) and 1.71 points (P < 0.001) lower on the PHQ-9 scale and GAD-7 scores. Similarly, self-esteem was negatively associated with PHQ-9 and GAD-7 scores. CONCLUSION:Our findings highlight the negative correlation of grit with poor mental health outcomes, particularly depression and anxiety. Interventions designed to improve grit could play an essential role in the prevention of adverse mental health outcomes among university students

Association of excessive smartphone use with psychological well-being among university students in Chiang Mai, Thailand.

BackgroundDespite the pervasive use of smartphones among university students, there is still a dearth of research examining the association between smartphone use and psychological well-being among this population. The current study addresses this research gap by investigating the relationship between smartphone use and psychological well-being among university students in Thailand.MethodsThis cross-sectional study was conducted from January to March 2018 among university students aged 18-24 years from the largest university in Chiang Mai, Thailand. The primary outcome was psychological well-being, and was assessed using the Flourishing Scale. Smartphone use, the primary independent variable, was measured by five items which had been adapted from the eight-item Young Diagnostic Questionnaire for Internet Addiction. All scores above the median value were defined as being indicative of excessive smartphone use.ResultsOut of the 800 respondents, 405 (50.6%) were women. In all, 366 (45.8%) students were categorized as being excessive users of smartphones. Students with excessive use of smartphones had lower scores the psychological well-being than those who did not use smartphone excessively (B = -1.60; P ConclusionThis study provides some of the first insights into the negative association between excessive smartphone use and the psychological well-being of university students. Strategies designed to promote healthy smartphone use could positively impact the psychological well-being of students

Factors associated with smartphone addiction: A comparative study between Japanese and Thai high school students.

BackgroundSmartphone addiction is a growing social problem with adverse health outcomes. There are few comparative studies in Asia that examine factors associated with smartphone addiction. The current study aimed to address this research gap by presenting a comparative analysis of factors associated with smartphone addiction in Japan and Thailand, two countries heterogeneous in both their level of economic development and culture.MethodsParticipant data were collected using two population-based surveys. Participants were high school students in grade 11, aged 16-17 years old, and were selected using quota sampling in Japan in 2014 and random sampling in Thailand in 2016. The outcome of interest was smartphone addiction, measured using a modified version of the Young Diagnostic Questionnaire for Internet Addiction. Multiple logistic regression analysis was performed to determine factors associated with smartphone addiction (gender; nationality; family connectedness; and average time spent on smartphone per day).ResultsThis study included a total of 7694 students, 6585 students from Japan and 1109 students from Thailand. The prevalence of smartphone addiction was 35.9% among Thai students and 12% among Japanese students. Thai students were more likely to have smartphone addiction than Japanese students (AOR 2.76; 95% CI: 2.37-3.30). Being female was associated with increased odds of smartphone addiction in both Japanese (AOR 1.53; 95% CI: 1.32-1.78) and Thai students (AOR 1.34; 95% CI: 1.01-1.78). The parental connectedness variables "my parents noticed when I was unhappy" (AOR 0.77; 95% CI: 0.62-0.96) and "my parents noticed when I did something good" (AOR 0.78, 95% CI: 0.61-0.99) were associated with lower odds of smartphone addiction among Japanese students.ConclusionSmartphone addiction was more prevalent among Thai adolescents than Japanese adolescents, and more prevalent among females than males in both countries. Interventions for reducing smartphone addiction should take into account both context and gender, and should leverage the protective effect of parental connectedness

"When I first saw a condom, I was frightened": A qualitative study of sexual behavior, love and life of young cross-border migrants in urban Chiang Mai, Thailand.

Many young migrant workers move across the border to Chiang Mai, a major city in Northern Thailand, in search of work opportunities. This study describes their sexual behavior, lifestyles, relationships and experiences with youth-friendly sexual and reproductive health (SRH) services.This is the qualitative arm of a mixed methods study using focus group discussions (FGDs) among young MWs aged 15-24 years in urban Chiang Mai. We conducted 6 FGDs with 84 participants (43 males, 41 females) organized in groups of 10-15 people, including 3 groups of males, 2 groups of females, and 1 group of both males and females.We found that the lack of parental control, pressure to assimilate into Thai society, access to social media and modern communication technologies, and limited knowledge and access to sexual and reproductive health (SRH) services interplayed to shape lifestyle and sexual behaviors, including low condom use among young migrants.The present study helped discern the vulnerability of young migrants to adverse SRH outcomes. This particular group of youth needs urgent intervention to improve their knowledge on SRH and access to a youth-friendly clinic to help them personalize risk of HIV and other adverse SRH outcomes

Prevalence and Correlates of HIV Testing among Young People Enrolled in Non-Formal Education Centers in Urban Chiang Mai, Thailand: A Cross-Sectional Study.

BACKGROUND:HIV testing is the gateway to HIV prevention, treatment, and care. Despite the established vulnerability of young Thai people to HIV infection, studies examining the prevalence and correlates of HIV testing among the general population of Thai youth are still very limited. This study investigates socio-demographic, behavioral, and psychosocial factors associated with HIV testing among young Thai people enrolled in Non-formal Education Centers (NFEC) in urban Chiang Mai, Northern Thailand. METHODS:This was a cross-sectional quantitative study conducted among young unmarried Thai youth--between the ages of 15 and 24--who were enrolled in NFEC in urban Chiang Mai. Multiple logistic regressions were used to identify correlates of "ever tested for HIV" among the sexually active participants. FINDINGS:Of the 295 sexually active participants, 27.3% reported "ever tested for HIV;" 65.4% "did not consistently use condom;" and 61.7% "had at least 2 lifetime partners." We found that "self-efficacy" (AOR, 4.92; CI, 1.22-19.73); "perception that it is easy to find a location nearby to test for HIV" (AOR, 4.67; CI, 1.21-18.06); "having at least 2 lifetime sexual partners" (AOR, 2.05; CI, 1.09-3.85); and "ever been pregnant or made someone pregnant" (AOR, 4.06; CI, 2.69-9.15); were associated with increased odds of having ever been tested. On the other hand, "fear of HIV test results" (AOR, 0.21; CI, 0.08-0.57) was associated with lower odds of ever having been tested for HIV. CONCLUSION:The main finding is that a substantially high proportion of Thai youth is engaged in risky sexual behaviors--yet reports low rates of ever having been tested for HIV. This highlights an urgent need to develop appropriate interventions--based on the identified correlates of HIV testing. There is also an urgent need to enhance HIV testing and to promote safer sexual behaviors among young Thai people--particularly those who are out-of-school

Dietary habits, body image, and health service access related to cardiovascular diseases in rural Zambia: A qualitative study.

BackgroundCardiovascular diseases are among the leading causes of mortality and morbidity in sub-Saharan Africa, including Zambia, where cardiovascular diseases account for 8% of the mortality rates. Despite an increasing number of cardiovascular disease-related studies in Zambia, qualitative studies exploring how cardiovascular diseases and their risk factors are understood in the socioeconomic and cultural contexts are still few. This study, therefore, aimed to analyze the beliefs, perceptions, and behaviors related to cardiovascular diseases and their risk factors among the local residents of Zambia.MethodsThis qualitative study was conducted from August to September 2014 among healthy residents aged 40 years and above in a rural community in Mumbwa District. We investigated the beliefs, perceptions, and behaviors related to cardiovascular diseases and their potential risk factors in the sociocultural context of Zambia by conducting in-depth interviews and focus group interviews. Audio-recorded interviews were transcribed and analyzed using thematic analysis with investigator triangulation.ResultsWe conducted 34 in-depth interviews and 6 focus group interviews with 27 males and 40 females. Most participants were aware of the prevalence of cardiovascular diseases around them and correctly identified hypertension, excessive salt, sugar, and cooking oil intakes, poor quality cooking oil, consumption of meat or vegetables contaminated with chemicals, obesity, stress ["thinking too much"], lack of physical exercise, and heredity as potential risk factors of cardiovascular diseases, while smoking and alcohol were mentioned by only a few participants. However, they claimed that many of these risk factors were difficult to avoid due to ingrained taste preferences for high salt and sugar, increasingly busy lives that force them to use cooking oil to reduce preparation time, cultural preference for big body size or fatness, especially for women, stigmatized body image attached to HIV, stressful life or life events related to poverty, and financial barriers to affording quality foods and healthcare services. Limited health screening opportunities and the negative impact of HIV-related stigma on health-seeking behavior also emerged as important risk factors for cardiovascular diseases.ConclusionsThis study revealed that participants are relatively well aware of cardiovascular diseases and their risk factors. However, they engage in high-risk health behaviors, due to ingrained taste preferences, limited knowledge, and unavoidable socioeconomic and cultural circumstances. Results suggest that prevention interventions addressing cardiovascular diseases in rural Zambia should target gaps in knowledge and socioeconomic and cultural barriers