Journal of Health, Population, and Nutrition

Permanent URI for this collection

https://imsear.searo.who.int/handle/123456789/8

ISSN: 1606-0997 (Print)

Frequency: Quarterly

Language: English

Published by ICDDR,B: Centre for Health and Population Research

Peer-reviewed open access journal indexed in Index Medicus

Web site: https://www.banglajol.info/index.php/JHPN/

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Neglected Value of Small Population-based Surveys: A Comparison with Demographic and Health Survey Data.
(2015-03) Langston, Anne C; Prosnitz, Debra M; Sarriot, Eric G
We believe that global health practice and evaluation operate with misleading assumptions about lack of reliability of small population-based health surveys (district level and below), leading managers and decision- makers to under-use this valuable information and programmatic tool and to rely on health information from large national surveys when neither timing nor available data meet their needs. This paper uses a unique opportunity for comparison between a knowledge, practice, and coverage (KPC) household survey and Rwanda Demographic and Health Survey (RDHS) carried out in overlapping timeframes to disprove these enduring suspicions. Our analysis shows that the KPC provides coverage estimates consistent with the RDHS estimates for the same geographic areas. We discuss cases of divergence between estimates. Application of the Lives Saved Tool to the KPC results also yields child mortality estimates comparable with DHSmeasured mortality. We draw three main lessons from the study and conclude with recommendations for challenging unfounded assumptions against the value of small household coverage surveys, which can be a key resource in the arsenal of local health programmers.
Infant Formula Crisis in China: A Cohort Study in Sichuan Province.
(2015-03) Tang, Li; Binns, Colin W; Lee, Andy H
China has become the largest market of infant formula in the world. The consumption of infant formula is widespread across the country. This study investigated the opinions of Chinese mothers on infant formula. A prospective cohort study (n=695) was undertaken in 2011 in Sichuan province of China two years after the melamine scandal. Infant-feeding practices and mothers’ opinions on infant formula-use were documented in detail. A total of 674 mothers (97%) had initiated breastfeeding by discharge. Of the 21 mothers who did not commence breastfeeding, 13 made a decision to exclusively feed their babies with infant formula because of hepatitis B virus infection. Nearly 70% of newborns received infant formula as their first feed, and the prevalence increased to 88% within one month. Having insufficient breastmilk was perceived by the majority (77%) of mothers as the reason behind infant formula feeding. About half (46%) of the mothers agreed with or were ambivalent that infant formula feeding does not reduce their breastmilk production. More than one-third (38%) of women thought that formulafed infants sleep longer at night than those who are breastfed. In addition, this perception was positively associated with the use of formula within one month postpartum (p=0.003). In conclusion, mothers’ opinions appear to influence the use of infant formula in China. There is a need for further education on breastfeeding and infant-feeding options to maintain and improve breastfeeding outcomes in China.
Barriers to Infant and Child-feeding Practices: A Qualitative Study of Primary Caregivers in Rural Uganda.
(2015-03) Nankumbi, Joyce; Muliira, Joshua K
The purpose of this study was to explore the barriers to the use of appropriate infant and young childfeeding practices by primary caregivers living in a rural Ugandan district. A community-based qualitative design and focus group discussions were used for collecting data from primary caregivers of children aged 0 to 24 month(s). On an average, each of the four focus group discussions had 11 participants. The focus group discussions were conducted using a structured interview guide and were tape-recorded. The recorded data were later transcribed and analyzed using qualitative thematic analysis techniques. All the participants were females, and the majority had low levels of education and at least one child in the age-group of 0-24 month(s) in their household. The findings show that the main barriers to the use of appropriate infant and young child-feeding practices fall under four themes: caregiver’s knowledge about breastfeeding, caregiver’s knowledge about complimentary feeding, influence of culture custodians on the caregivers, and patterns and burden of other responsibilities the caregivers have in the household. The four categories of barriers imply that there are various missed opportunities to implement hospital and community-based interventions to improve infant and young child-feeding practices, which is one way of preventing malnutrition. Therefore, in rural areas of Uganda, the major factors responsible for the high prevalence of malnutrition among infants and children are still those related to knowledge, culture, and social status of the primary caregivers.
Dual Burden of Underweight and Overweight among Women in Bangladesh: Patterns, Prevalence, and Sociodemographic Correlates.
(2015-03) Kamal, S M Mostafa; Hassan, Che Hashim; Alam, Gazi Mahabubul
The discourse of dual burden caused through underweight and overweight is well-documented globally but this issue and its connection with women’s health in Bangladesh is yet to be explored widely. To enrich the current debate, this study, in the context of Bangladesh, examines the patterns, prevalence, and socioeconomic factors influencing the ever-married women of being underweight and overweight over normal weight. Data used in this study have been extracted from the most recent 2011 Bangladesh Demographic and Health Survey. To achieve results connected with the research objectives, both bivariate and multivariate statistical analyses have been employed. In bivariate analysis, we used seven categories of BMI cutoff points for Asian countries as prescribed by World Health Organization (WHO). Multinomial logistic regression model was constructed to investigate the net effect of socioeconomic factors on underweight, pre-overweight, and overweight over normal weight. The results confirm the co-existence of underweight and overweight among women as we found the prevalence of underweight, normal weight, pre-overweight, overweight, and obesity to be 24.1%, 46.7%, 12.8%, 13.5%, and 2.9% respectively. Compared to the richest, the women from the poorest households were significantly (p<0.001) most likely to be underweight (OR=2.75, 95% CI 2.27-3.35) and least likely to be overweight (OR=0.15, 95% CI 0.12-0.19) over normal weight. The urban women, compared to their rural counterparts, were significantly (p<0.001) less likely to be underweight (OR=0.80, 95% CI 0.71-0.91) and more likely to be overweight (OR=1.33, 95% CI 1.18-1.51) than normal weight. The other socioeconomic grades that were most marked to be underweight and overweight are age, women’s education, marital status, age at first childbirth, parity, number of children aged ≤5 years at the household, and food security. The findings confirm the dual burden of both under- and overweight. Systematic and regular monitoring and surveillance of the social trajectory of nutritional status of women and men in Bangladesh is crucial to develop apposite strategy that addresses the persistent and chronic problem of underweight and the emerging problem of overweight. The dual existence of both types of malnutrition among women in Bangladesh must be taken into consideration so that public health interventions may be adopted through appropriate policy.
Healthy Eating Habits among the Population of Serbia: Gender and Age Differences.
(2015-03) Jovičić, Ana Đ
The purpose of the study is to examine healthy eating habits of the population of Serbia through three dimensions: knowledge, problems, and feelings as well as to determine whether there are any differences between genders and among different age-groups. The research instrument was an Eating Habits Questionnaire (EHQ) which consisted of 35 items. There were 382 respondents involved in the study. The reliability and factor structure of the questionnaire were verified by using factor analysis. The results of MANOVA showed that there is a significant difference in the habits concerning healthy eating between men and women [F (3,378)=4.26, p=0.006; Wilks’ Lambda=0.97]. When the results for the dependent variables (knowledge, problems, and feelings) were considered separately, it was determined that there is no significant difference between men and women, which confirms the results of the t-test. The effect of age on the three dimensions of healthy eating habits was examined within three age-groups, by using ANOVA. The results showed that knowledge about healthy eating increases with age [F (2,379)=6.14, p=0.002] as well as positive feelings which occur as a result of healthy eating [F (2,379)=3.66, p=0.027]. Unlike ANOVA, MANOVA showed difference among the age-groups only when it came to the ‘knowledge’ variable. This study is important as it shows the current state of awareness on healthy eating habits in the researched populace and may be the basis for further research in this field in Serbia.
Predictors of Dietary Supplement Usage among Medical Interns of Tehran University of Medical Sciences.
(2015-03) Sotoudeh, Gity; Kabiri, Sanaz; Yeganeh, Haleh Sadrzadeh; Koohdani, Fariba; Khajehnasiri, Farahnaz; Khosravi, Shahla
This study aimed to determine the prevalence of dietary supplement-use and its relationship with demographics and lifestyle of medical interns. The study sample comprised 356 interns aged 23 to 25 years. Participants completed a questionnaire on dietary supplement-use during the month preceding the study, information on demographic characteristics and lifestyle was also obtained. Univariable and multivariable logistic regression were employed to assess the correlates of dietary supplement-use. The prevalence of dietary supplement-use was about 33% (males 20.4% and females 43.2%, p<0.001). The most commonly-used dietary supplement was multivitamin/multivitamin-mineral (90.6% in males and 52.3% in females). Approximately 30% of supplements were used regularly (≥5 days/week) by all subjects. The most-frequently reported reasons for supplement-use in males were: enhancing daily energy/stamina (51.1%), poor food intake (13.3%) and, in females, were: improving health and nutritional status (39.3%) and reducing hair loss (23.4%). The decision to use dietary supplement was mostly driven by the interns themselves (56% in males, 61% in females). In the univariable analysis, men who exercised once or twice a week were less likely to use supplements compared to those who reported doing exercise more than twice weekly (OR=0.35, 95% CI 0.12-0.98). Females who reported their health status to be ‘excellent’ were more likely to use supplements compared to those who described their health status as ‘moderate/poor/very poor’ (OR=2.53, 95% CI 1.15-5.56) as were women who mentioned their breakfast consumption status as ‘always’ (OR=2.69, 95% CI 1.47-4.92). In the multivariable analysis, only breakfast consumption was significantly related with dietary supplement-use in females (OR=2.20, 95% CI 1.11-4.38). In conclusion, dietary supplement-use among medical interns, especially among females, was relatively very common. Dietary supplement-use was related to a healthier lifestyle.
Sensory Evaluation of Locally-grown Fruit Purees and Inulin Fibre on Probiotic Yogurt in Mwanza, Tanzania and the Microbial Analysis of Probiotic Yogurt Fortified with Moringa oleifera.
(2015-03) Hekmat, Sharareh; Morgan, Kathryn; Soltani, Mohammad; Gough, Robert
The purpose of this study was to establish new food products that increase the nutritional value and health benefits of the probiotic yogurt currently used in the Western Heads East (WHE) Project in Mwanza, Tanzania. The probiotic yogurt has established health benefits, and product development through fortification must not adversely affect the acceptability of yogurt or the viability of the probiotics. Both sensory testing and microbial analysis testing were conducted. The products tested were yogurt fortified with locally-grown fruit purees with inulin and Moringa oleifera. The results of the sensory evaluation showed that all yogurts were not rated significantly different from the control, except for appearance. The avocado puree without inulin rated significantly lower in all categories. The microbial analysis showed that Moringa oleifera did not negatively affect the growth of Lactobacillus rhamnosus GR-1 in MRS, milk or yogurt, although a significant decrease was found after 5 weeks of storage at 4 oC.
Validity and Reproducibility of a Revised Semiquantitative Food Frequency Questionnaire (SQFFQ) for Women of Age-group 12-44 Years in Chengdu.
(2015-03) Tang, Ying; Liu, Ying; Xu, Liangzhi; Jia, Yujian; Shan, Dan; Li, Wenjuan; Pan, Xin; Kang, Deying; Huang, Chengyu; Li, Xiaosong; Zhang, Jing; Hu, Ying; Konglin, Lingli; Zhuang, Jing
To find a credible nutritional screening tool for evaluating relationship between nutritional status and diseases in Chengdu female residents, the reliability and validity of a revised semi-quantitative food frequency questionnaire (SQFFQ) were tested. The validity was assessed by comparing the SQFFQ with the ‘standard’ method of 3 days’ dietary recall, and the reliability was assessed by comparing the first SQFFQ with the second SQFFQ at 4 weeks interval. Correlation analysis showed that, for reliability, the average correlation coefficient (CC) of 22 kinds of nutrients was 0.66 and reduced to 0.60 after adjusting for energy; the average of intra-class correlation coefficients (ICC) was 0.65. For validity, the average CC was 0.35 and remained stable after adjusting for CC of energy or nutrients. Validity of 17 nutrients in SQFFQ survey had correlation with result of 3 days’ dietary recall. The results showed that the revised SQFFQ can be used for investigating the role of nutrients in development of disease in Chengdu female residents.
Dietary Patterns and Risk of Gallbladder Disease: A Hospital-based Case-Control Study in Adult Women.
(2015-03) Jessri, Mahsa; Rashidkhani, Bahram
Gallbladder disease is one of the most prevalent gastrointestinal disorders that may result from a complex interaction of genetic and environmental factors. This study examined the association of dietary patterns with gallstone disease among Iranian women. This case-control study was conducted in general teaching hospitals in Tehran, Iran. Participants were 101 female cases and 204 female controls aged 40-65 years who were admitted for problems other than GBD. Dietary patterns were identified using principal components analysis based on food frequency questionnaire. Compared to the control group, cases were less educated, less physically active, and consumed more total energy (p<0.02). Having ≥3 livebirths increased the risk of gallstone by more than 5 times, followed by having rapid weight loss, being single, having familial history of gallstone, and consuming high total energy. Two distinct dietary patterns were identified in women (healthy and unhealthy). After adjustment for several confounding variables, healthy dietary pattern was associated with a decreased risk of gallstone disease (OR=0.14, 95% CI 0.048-0.4) while unhealthy dietary pattern was associated with an increased risk (OR=3.77, 95% CI 1.52-9.36). These findings confirm that dietary pattern approach provides potentially useful and relevant information on the relationship between diet and disease. Identifying risk factors will provide an opportunity for prevention of gallbladder disease in developing countries facing an increased risk of obesity.
Unmet Need for Family Planning: Implication for Under-five Mortality in Nigeria.
(2015-03) Adedini, Sunday Adepoju; Odimegwu, Clifford; Imasiku, Eunice Ntwala; Ononokpono, Dorothy Ngozi
There are gaps in evidence on whether unmet need for family planning has any implication for under-five mortality in Nigeria.This study utilized 2008 Nigeria Demographic and Health Survey data to examine the effect of unmet need on under-five mortality. Cox regression analysis was performed on 28,647 children born by a nationally-representative sample of 18,028 women within the five years preceding the survey. Findings indicated elevated risks of under-five death for children whose mothers had unmet need for spacing [Hazard ratio (HR): 1.60, confidence interval (CI) 1.37-1.86, p<0.001] and children whose mothers had unmet need for limiting (HR: 1.78, CI 1.48-2.15, p<0.001) compared to children whose mothers had met need. These findings were consistent after adjusting for the effects of factors that could confound the association. Findings of this study underscore the need to address the present level of unmet need for family planning in Nigeria, if the country would achieve meaningful reduction in under-five mortality.
Primary Health Centres: Preferred Option for Birthing Care in Tamilnadu, India, from Users’ Perspectives.
(2015-03) Jayanthi, T P; Suresh, Saradha; Padmanaban, P
Tamilnadu state of India witnessed an increasing trend of institutional deliveries since the beginning of 1990s, with decline of domiciliary deliveries to nearly zero now. Among the institutional deliveries, a shift has been observed since 2006 wherein primary health centres (PHC) have shown a four-fold increase in the number of deliveries while other public and private health facilities showed a decline, despite equal access by people to all categories of health facilities. A qualitative study was designed to explore the determinants that led to increased preference of PHCs for birthing care. In-depth interviews and FGDs were conducted with recently-delivering women and their spouses. User-friendly ambience, courteous attitude and behaviour of staff, good infrastructure, availability of qualified staff, and relative absence of informal payments have contributed to increased preference for birthing care in PHCs. Barriers to seeking care from secondary and tertiary-level public hospitals and private hospitals have also made women prefer PHCs.
Relationship between Sociodemographics, Dietary Intake, and Physical Activity with Gestational Weight Gain among Pregnant Women in Rafsanjan City, Iran.
(2015-03) Ebrahimi, Fatemeh; Shariff, Zalilah Mohd; Tabatabaei, Seyed Zia; Fathollahi, Mahmood Sheikh; Mun, Chan Yoke; Nazari, Mozhgan
Gestational weight gain (GWG) is a determinant of health and nutrition of mothers and offspring. However, many factors associated with GWG are not completely understood. The present study assessed the relationship between sociodemographics, dietary intake, and physical activity with GWG in 308 Iranian pregnant women attending government healthcare centres in Rafsanjan city, Iran. Women gained an average of 12.87±3.57 kg during pregnancy while 54% did not gain weight within the Institute of Medicine (IOM)-recommended range. Univariate logistic models showed that gestaional weight gain was related to age, pre-pregnancy body mass index (BMI), energy intake, and sitting time. Cumulative logit model showed positive relationship between age (p=0.0137) and pre-pregnancy BMI (p<0.0001) with GWG. All pregnant women should be counselled on achieving the reccomended GWG to prevent adverse maternal and prenatal outcomes. Pre-pregnancy and gestational nutritional status and physical activity should be emphasized in antenatal care.
Protective Effect of Breastfeeding against Overweight Can Be Detected as Early as the Second Year of Life: A Study of Children from One of the Most Socially-deprived Areas of Brazil.
(2015-03) Assunção, Monica L; Ferreira, Haroldo S; Coutinho, Sônia B; Santos, Leonor M P; Horta, Bernardo L
Millions of children live in Brazil’s semi-arid region, one of the most socially-deprived areas of the country, where undernutrition co-exists with obesity as a consequence of the nutrition transition. There is evidence that childhood obesity predisposes adult obesity and, thus, that obesity should be prevented as early as possible. Some studies have shown that breastfeeding is a protective factor against overweight and obesity while other studies have not found this association. There have been few studies on this association in developing countries and of children below two years of age. The present study aimed to investigate whether children exposed to exclusive breastfeeding for ≥6 months showed a lower prevalence of overweight in the second year of life, based on a probability sample of 2,209 children (aged 12 to 24 months). The dependent variable was overweight, defined as weight-for-length z-scores of >2, based on the WHO 2006 standard while the independent variable was exclusive breastfeeding (≥6 months). The prevalence ratio (PR) and its 95% CI were estimated using Poisson regression with robust adjustment of variance. After adjusting for potential confounding factors (socioeconomic, demographic and health-related variables), children on exclusive breastfeeding for ≥6 months showed a lower prevalence of overweight (5.7% vs 9.1%, PR 0.62, 95% CI 0.45-0.89). It was found that exclusive breastfeeding for six months or more is a protective factor against overweight in children in the second year of life living in the Brazilian semi-arid region.
Cholera Outbreak Linked with Lack of Safe Water Supply Following a Tropical Cyclone in Pondicherry, India, 2012.
(2015-03) Fredrick, Tony; Ponnaiah, Manickam; Murhekar, Manoj V; Jayaraman, Yuvaraj; David, Joseph K; Vadivoo, Selvaraj; Joshua, Vasna
In the aftermath of a severe cyclonic storm on 7 January 2012, a cluster of acute diarrhoea cases was reported from two localities in Pondicherry, Southern India. We investigated the outbreak to identify causes and recommend control measures. We defined a case as occurrence of diarrhoea of more than three loose stools per day with or without vomiting in a resident of affected areas during 6-18 January 2012. We used active (door-to-door survey) and stimulated passive (healthy facility-based) surveillance to identify cases. We described the outbreak by time, place, and person. We compared the case-patients with up to three controls without any apparent signs and symptoms of diarrhoea and matched for age, gender, and neighbourhood. We calculated matched odds ratio (MOR), 95% confidence intervals (CI), and population attributable fractions (PAF). We collected rectal swabs and water samples for laboratory diagnosis and tested water samples for microbiological quality. We identified 921 cases and one death among 8,367 residents (attack rate: 11%, case-fatality: 0.1%). The attack rate was the highest among persons of 50 years and above (14%) and females (12%). The outbreak started on 6 January and peaked on the 9th and lasted till 14 January. Cases were clustered around two major leakages in water supply system. Nine of the 16 stool samples yielded V. cholerae O1 Ogawa. We identified that consumption of water from the public distribution system (MOR=37, 95% CI 4.9-285, PAF: 97%), drinking unboiled water (MOR=35, 95% CI 4.5-269, PAF: 97%), and a common latrine used by two or more households (MOR=2.7, 95% CI 1.3-5.6) were independently associated with cholera. Epidemiological evidence suggested that this outbreak was due to ingestion of water contaminated by drainage following rains during cyclone. We recommended repair of the water supply lines, cleaning-up of the drains, handwashing, and drinking of boiled water.
Knowledge, Perception, and Management Skills of Mothers with Under-five Children about Diarrhoeal Disease in Indigenous and Resettlement Communities in Assosa District, Western Ethiopia.
(2015-03) Merga, Nigatu; Alemayehu, Tadesse
As primary caregiver to under-five children in Ethiopia, mothers’ knowledge, perception, and management skills are important to minimize the effects of morbidity and mortality associated with diarrhoeal diseases. A community-based comparative cross-sectional study was conducted in Abramo and Megele 37 kebeles (the last administration division) in Assosa district of western Ethiopia in July 2010. Quantitative data were obtained by a structured questionnaire from 232 randomly-selected mothers having children aged less than five years regarding their knowledge, perception, and management. Qualitative data were also collected by arranging four focus group discussions involving mothers from the two communities. The prevalence of diarrhoeal diseases among under-five children was 33.2%, and the knowledge of mothers about the causes, transmission, and prevention of diarrhoea in the study area was 37.5%. The prevalence of diarrhoeal disease was higher in the settlement area whereas mothers’ knowledge was better in the indigenous community; 62.9% of mothers were categorized as having good attitude on causes, transmission, and prevention of diarrhoeal disease. Community water source, water storage container, and knowledge of mothers remained a strong predictor of diarrhoeal morbidity after conducting logistic regression analysis (OR=8.4, CI 3.59-31.85; OR=2.2, CI 1.02-4.89; and OR=3.62, CI 1.23-4.71 respectively). Diarrhoeal morbidity was high in the study areas. On the contrary, knowledge and attitude of mothers, recognizing the danger sign of dehydration due to diarrhoea, and the prevention and management of childhood diarrhoeal diseases were not adequate. Information, education and communication strategy may help increase the knowledge and create positive attitude among mothers regarding the cause, prevention, and management of diarrhoea.
Promotion of Zinc Tablets with ORS through Child Health Weeks Improves Caregiver Knowledge, Attitudes, and Practice on Treatment of Diarrhoea in Nigeria.
(2015-03) Kung'u, Jacqueline K; Owolabi, Olumuyiwa; Essien, Grace; Aminu, Francis T; Ngnie-Teta, Ismael; Neufeld, Lynnette M
We examined whether the Maternal, Newborn and Child Health Weeks (MNCHW) in Nigeria would present an opportunity to raise awareness of and demand for the use of zinc and ORS in the treatment for diarrhoea, guided by a conceptual framework designed to assess three theoretical underpinnings (characteristics and performance standard of the health workers, potential reach, and intensity of the intervention), along the impact pathway. Zinc and ORS with education for their appropriate use during the next diarrhoeal episode were delivered as part of the November 2010 and May 2011 MNCHW. On the day of but before participating in MNCHW activities, semi-structured interviews were used for collecting information on knowledge, attitudes, and practice (KAP) relating to diarrhoea from 602 caregivers with children aged less than five years. Forty-eight health workers were also interviewed. Nearly all health workers (98%) correctly mentioned the dosage of zinc while only 58% correctly stated the preparation of ORS. The proportion of caregivers with knowledge on the treatment for diarrhoea increased from 46.4% in November 2010 pre-MNCHW to 71.3% in May 2011 pre-MNCHW interviews (p<0.001). More caregivers correctly mentioned the dosage of zinc (80.9%) and stated the preparation of ORS (88.8%) in the November 2010 exit interview immediately after the MNCHW encounter compared to the levels a few months later in the home follow-up visit (53.1% and 37.4% respectively). After attending both rounds of November 2010 and May 2011 MNCHW, caregivers’ knowledge on the treatment of diarrhoea increased seven times compared to the caregivers who attended the May 2011 MNCHW only (OR=7.0, p<0.001). Additionally, caregivers were 40% less likely to seek advice outside the home in the treatment for diarrhoea if they had attended both the MNCHWs than if they had attended the May 2011 MNCHW only (OR=0.6, p<0.029). We conclude that providing opportunities for caregivers to receive a sample of zinc and ORS and to learn about its use in the treatment for diarrhoea, from trained health workers during MNCHW, has the potential to increase KAP relating to the use of zinc and ORS in the treatment for diarrhoea and for future diarrhoeal episodes.
Predictors of Acute Diarrhoea among Hospitalized Children in Gaza Governorates: A Case-Control Study.
(2015-03) Alnawajha, Samer Khader; Bakry, Ghadeer Abdo; Aljeesh, Yousef Ibrahim
This study aims to determine the predictors of acute diarrhoea among hospitalized children in the Gaza Governorates. The case-control design included 140 children (70 cases and 70 controls) in a stratified cluster sample from Naser Medical Complex and Alnasser Pediatric Hospital. An interview questionnaire was used, and face and content validations were performed. Multiple logistic regression was used for the multivariate analysis of risk factors of diarrhoea in children aged less than five years. Results showed a significant association between diarrhoea and family income, residence, complementary feeding, and age of weaning (p<0.05). Children living in villages had lower odds of having diarrhoea by 53.2% than children living in cities. Children of families with incomes between US$ 485 and 620 had lower odds of having diarrhoea by 80.8% than children of families with incomes less than US$ 485. Moreover, children who did not receive complementary feeding had lower odds of having diarrhoea by 59.0%. We found that, for one month increase in weaning age, the odds of diarrhoea decreased by 1.06 times (adjusted OR=1.05, 95% CI 1.0180- 1.100). The study concludes that urban residence, lower family income, complementary feeding, and lower age of weaning are risk factors of diarrhoea among children aged less than five years in the Gaza Strip. The results of the study suggest that children of low-income families and those who were not naturally breastfed may warrant more attention for prevention and/or treatment of diarrhoea.
A Model Immunization Programme to Control Japanese Encephalitis in Viet Nam.
(2015-03) Yen, Nguyen Thu; Liu, Wei; Hanh, Hoang Duc; Chang, Na Yoon; Duong, Tran Nhu; Gibbons, Robert V; Marks, Florian; Thu, Nghiem Anh; Hong, Nguyen Minh; Park, Jin Kyung; Tuan, Pham Anh; Nisalak, Ananda; Clemens, John D; Xu, Zhi-yi
In Viet Nam, an inactivated, mouse brain-derived vaccine for Japanese encephalitis (JE) has been given exclusively to ≤5 years old children in 3 paediatric doses since 1997. However, JE incidence remained high, especially among children aged 5-9 years. We conducted a model JE immunization programme to assess the feasibility and impact of JE vaccine administered to 1-9 year(s) children in 3 standard-dose regimen: paediatric doses for children aged <3 years and adult doses for those aged ≥3 years. Of the targeted children, 96.2% were immunized with ≥2 doses of the vaccine. Compared to the national immunization programme, JE incidence rate declined sharply in districts with the model programme (11.32 to 0.87 per 100,000 in pre- versus post-vaccination period). The rate of reduction was most significant in the 5-9 years age-group. We recommend a policy change to include 5-9 years old children in the catch-up immunization campaign and administer a 4th dose to those aged 5-9 years, who had received 3 doses of the vaccine during the first 2-3 years of life.
Assessment of ‘Accredited Social Health Activists’—A National Community Health Volunteer Scheme in Karnataka State, India.
(2015-03) Fathima, Farah N; Raju, Mohan; Varadharajan, Kiruba S; Krishnamurthy, Aditi; Ananthkumar, S R; Mony, Prem K
About 700,000 Accredited Social Health Activists (ASHA) have been deployed as community health volunteers throughout India over the last few years. The objective of our study was to assess adherence to selection criteria in the recruitment of ASHA workers and to assess their performance against their job descriptions in Karnataka state, India. A cross-sectional survey, using a combination of quantitative and qualitative methods, was undertaken in 2012. Three districts, 12 taluks (subdistricts), and 300 villages were selected through a sequential sampling scheme. For the quantitative survey, 300 ASHAs and 1,800 mothers were interviewed using sets of structured questionnaire. For the qualitative study, programme officers were interviewed via in-depth interviews and focus group discussions. Mean±SD age of ASHAs was 30.3±5.0 years, and about 90% (261/294) were currently married, with eight years of schooling. ASHAs were predominantly (>80%) involved in certain tasks: home-visits, antenatal counselling, delivery escort services, breastfeeding advice, and immunization advice. Performance was moderate (40-60%) for: drug provision for tuberculosis, caring of children with diarrhoea or pneumonia, and organizing village meetings for health action. Performance was low (<25%) for advice on: contraceptive-use, obstetric danger sign assessment, and neonatal care. This was self-reported by ASHAs and corroborated by mothers. In conclusion, ASHA workers were largely recruited as per preset selection criteria with regard to age, education, family status, income, and residence. The ASHA workers were found to be functional in some areas with scope for improvement in others. The role of an ASHA worker was perceived to be more of a link-worker/facilitator rather than a community health worker or a social activist.
Association of Insulin Resistance with Lipid Profile, Metabolic Syndrome, and Hormonal Aberrations in Overweight or Obese Women with Polycystic Ovary Syndrome.
(2015-03) Ebrahimi-Mamaghani, Mehranghiz; Saghafi-Asl, Maryam; Pirouzpanah, Saeed; Aliasgharzadeh, Akbar; Aliashrafi, Soudabeh; Rezayi, Niloufar; Mehrzad-Sadaghiani, Mahzad
This cross-sectional study was aimed to better clarify the associations of insulin resistance (IR) with endocrinometabolic parameters in polycystic ovary syndrome (PCOS). Anthropometric measurements, endocrine and metabolic profiles, and the presence of IR and metabolic syndrome (MetS) were assessed in 63 overweight or obese PCOS patients subdivided into insulin-resistant (IR) and insulin-sensitive (IS) groups. Fasting insulin concentration and HOMA-IR were higher (p<0.001), and quantitative insulin check index (QUICKI), glucose-to-insulin ratio (p<0.001), and high-density lipoprotein cholesterol (HDL-C) (p=0.012) were lower in IR group. MetS (p=0.034) and obesity (p=0.038) were more prevalent in IR group. For all PCOS patients, significant correlations of total cholesterol (TC) with dehydroepiandrosterone sulphate (DHEAS) (r=-0.27, p=0.031), HDL-C with QUICKI (r=0.26, p=0.036) were found. Partial correlations also showed significant associations between TG and BS2h (r=0.30, p=0.026) as well as TC and LH/FSH ratio (r=0.30, p=0.032). When the patients were divided into IR and IS groups, significant correlations of lowdensity lipoprotein cholesterol (LDL-C) with luteinizing hormone (LH) (r=0.50, p=0.017) as well as TC (r=0.42, p=0.043) and LDL-C (r=0.50, p=0.016) with LH/FSH ratio were observed in IR group. However, partial correlation suggested significant associations of HDL-C with testosterone (r=-0.35, p=0.049) as well as serum LDL-C (r=0.38, p=0.033), HDL-C (r=-0.32, p=0.047), and TC (r=0.34, p=0.056) with progesterone level only in the IS group. The findings of this study indicated that lipid abnormalities may occur in PCOS, irrespective of IR.

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