Complete Primary Education Research Articles

Determinants of Acute Watery Diarrhea in Children Under Five Years: A Comprehensive Analysis

Background: Acute watery diarrhea (AWD), which has a sudden onset and is associated with a risk of severe dehydration, is primarily spread through unsafe water, poor sanitation, and inadequate hygiene. Socioeconomic factors, like low parental education and poverty, further increase risks. WHO-recommended interventions, including oral rehydration therapy, zinc supplementation, and rotavirus vaccinations, have reduced diarrhea-related deaths globally. Aim of the study: This study aims to explore the socio-demographic, environmental, and behavioral factors associated with childhood watery diarrhea, particularly in high-risk regions. Methods: This prospective observational study was conducted at the Department of Pediatric, 250 Bedded General Hospital, Khulna, Bangladesh, with 210 children aged 0–60 months presenting acute watery diarrhea, enrolled over one year July 2023 to June 2024. Eligible children met specific inclusion criteria, while exclusion was applied to cases of chronic diarrhea or unrelated pre-existing conditions. Data confidentiality was maintained, with ethical approval granted. The analysis involved descriptive statistics in SPSS (version 26) for comprehensive result interpretation. Result: The study included 210 children under five, with a mean age of 14.51±5.34 months; most were aged 7-12 months (38.10%), and 54.29% were male. Caregivers were predominantly aged 28.39±4.11 years, with 73.81% having completed primary education. Key findings included high MMR vaccination rates (62.38%), significant exclusive breastfeeding for six months (58.57%), and recent diarrhea reports among 20.95% of caregivers. In terms of WASH practices, 60.48% used piped water, 57.62% stored drinking water separately, and 95.71% had toilet facilities. Notably, 67.14% used water only for handwashing, and 45.24% washed hands with soap post-toilet use. Conclusion: Safe water, sanitation, and handwashing practices are essential to reducing acute watery diarrhea in children under five. Children in households with untreated water and inconsistent caregiver handwashing face higher risks. Targeted public health initiatives to improve water treatment and hygiene could greatly reduce diarrhea incidence and improve child health outcomes.

P033 HYPERTENSION AND SOCIAL DETERMINANTS OF HEALTH IN A POPULATION OF YOUNG ADULTS REGISTERED IN A PRIMARY CARE UNIT IN RIO DE JANEIRO

Background: New cardiovascular (CV) risk factors have been studied (including social determinants of health - SDHs) that seems to influence the incidence of CV events, life expectancy and mortality rate. Objective: To evaluate the SDHs associated with high blood pressure (BP) in young adults living in the area of a primary care unit in Rio de Janeiro. Methods: Cross-sectional population study to assess the CV risk of adults aged between 20 and 50 years old. Sociodemographic characteristics, anthropometric measurements and CV risk factors were recorded. Pressure and HBPM were recorded. The race was self-declared. Low education was defined as having completed primary education or less. Those with formal or informal employment were considered to have a job. Results: 483 individuals, 299 (62%) female with an average age of 37 ± 9 years. Non-whites people comprised 52% of the sample. 108 individuals (21%) have low education and 98 (20%) do not have a job. Sedentary lifestyle (44%), dyslipidemia (43%), obesity (26%) and hypertension (26%) were the most prevalent risk factors. Abdominal obesity was more prevalent among women (45% vs 26%) and high BP (33% vs 21%) and smoking (18% vs 9%) among men. Black people are older and have less education (24% vs 18%), but race had no relationship with BP levels. Lack of employment was more common among women (79% vs 58%) and in logistic regression it practically doubled the risk of hypertension (OR 1.76, 95%CI 1.02-3.04, p=0.042). Low education was prevalent among older men and logistic regression showed that it doubled the risk of smoking (OR 2.17: 95%CI 1.15-4.08, p=0.016) and high BP (OR 1. 82, 95%CI 1.10-3.03, p=0.021). Lack of employment was more common among women and was not associated with CV risk factors. Conclusion: Low education and lack of employment were the main social determinants of health associated with high BP.

Understanding the awareness of antimicrobial resistance amongst commercial poultry farmers in northwestern Nigeria

The emergence of antimicrobial resistance (AMR) in both humans and animals is a growing health threat worldwide. Significant quantities of antibiotics are used in the livestock production sector, particularly in poultry farming to enhance growth and productivity. A cross-sectional study was conducted in three states of northwestern Nigeria to understand the level of knowledge, attitude, and practice of commercial poultry farmers on antimicrobial resistance. A total of 247 poultry farmers enrolled in the study comprising 100 (40.5 %) from Sokoto, 68 from Kebbi (27.5 %) and 79 (32.0 %) from Zamfara States. A significant number of the farmers have good knowledge of antimicrobial use (94.74 %), and the potential emergence of antimicrobial resistant bacteria due to irrational administration of antibiotics (83.0 %). Kruskal-Wallis test showed a significant difference in farmers’ knowledge of AMR based on their educational qualification (p < 0.001) as farmers with bachelor’s degree (BSc) being more knowledgeable than those with Ordinary National Diploma (OND) and those who only completed primary or secondary education. A statistically significant difference was also observed in the attitude of the participants based on State (p < 0.001) and educational qualification (p = 0.013). The study provided valuable insight into the understanding of antimicrobial resistance amongst commercial poultry farmers in the region. The findings necessitate the need for educational interventions and initiatives through enlightenment campaigns and deployment of extension workers to reach farmers with low level of education to further improve their attitudes and practice towards responsible use of antibiotics.

Collaborative Action Research As an Approach to School Improvement to Develop Inclusive Education in Pakistan

ABSTRACT Education in Pakistan continues to be underfunded and only one in three children complete primary education. Children with special needs face further barriers to access good quality education, with an estimated less than one in ten disabled children attending any school. In this situation, mainstream schools struggle to provide an inclusive education environment. Given these multiple challenges, Collaborative Action Research (CAR) was used to attempt to improve educational services, by facilitating teachers, school management, and families and parents to work together to promote inclusion. A research team consisting of occupational therapists and teachers worked with five local primary schools, using the Action Research cycles of plan-act-observe-reflect to develop practical strategies, materials, and inclusive lesson plans to facilitate the participation of all children in all school-based occupations. Support from school management as well as interdisciplinary collaboration were crucial factors for implementing Action Research and the innovations resulting from this process. Resulting strategies were found to benefit all children in class, leading to enhanced engagement and attainment of children with special needs as well as their peers. Both occupational therapists and teachers discovered the value of interprofessional collaboration through this process. A Resource Guide has been produced and is freely available.

The Vicious Worm education tool improves the knowledge of community health workers on Taenia solium cysticercosis in Rwanda.

The pork tapeworm Taenia solium causes human taeniasis and cysticercosis when ingested as viable cysts and eggs, respectively. Despite its high health burden in low-income countries, knowledge of the parasite in endemic areas such as Rwanda is often limited. Here, we assess whether The Vicious Worm education software can increase knowledge in endemic areas of Rwanda. A cross-sectional mixed-methods study was conducted to evaluate knowledge about T. solium among community health workers trained using the Vicious Worm education software. Knowledge was assessed before, immediately after, and four weeks after the training. The health workers perceptions of the software were analysed thematically. A total of 207 community health workers were recruited from Nyamagabe district in Southern Province, Rwanda. Participants were composed of males (33.5%) and females (66.5%), aged between 22 and 68 years, and most (71%) had only completed primary education. Knowledge of cysticercosis at baseline was low, particularly knowledge of human cysticercosis and neurocysticercosis. The overall knowledge score increased significantly after training and was maintained four weeks after the training. Overall, insufficient knowledge was associated with neurocysticercosis-related questions, which after the training, remained relatively lower compared to questions of other categories. Participants reported the software to be user-friendly and educational. Digital illiteracy and the lack of smartphones were among the critical challenges highlighted in responses. This study has shown gaps in knowledge regarding T. solium infections within rural Rwanda, particularly neurocysticercosis. Health education using the Vicious Worm education software should be considered in integrated control programs.

ANALISA FAKTOR INDIVIDU TERHADAP PENYEBAB KEMISKINAN EKSTRIM DI KABUPATEN TANGERANG

This research was conducted with the main aim of examining individual factors that contribute to extreme poverty in the Tangerang Regency, especially in 12 villages located across four district regions: Pakuhaji District, Rajeg District, Solear District, and Sindang Jaya District. By gaining a deeper understanding of the factors driving extreme poverty, it's hoped that poverty alleviation efforts in this area can be more effective and targeted. The research utilized a qualitative descriptive method as the primary approach. Findings indicate that individual factors, particularly in education and employment aspects, significantly contribute to extreme poverty in this region. Analysis reveals that the majority of the population in these 12 villages have low educational attainment, with most having only completed primary or lower secondary education. Additionally, livelihoods are predominantly in the agricultural sector, manual labor, odd jobs, and other informal occupations, showcasing limited job options available. Possible steps to address this include raising awareness about the importance of education through community and private sector participation, enhancing the knowledge and skills of the workforce, improving educational infrastructure, providing job training and internships within local companies, creating new labor-intensive job opportunities, boosting economic infrastructure, and improving access to financing while providing support for community-driven initiatives

Factors associated with family planning use among refugee and host populations in Adjumani district, West Nile, Uganda: a comparative study

IntroductionUganda currently hosts an estimated 1.5 million refugees. The refugees have challenges in accessing family planning (FP) services in the host country. The study aimed to investigate factors associated with FP use among host and refugee populations in Adjumani district, Uganda.MethodsA comparative cross-sectional study was conducted in May 2021 in three refugee settlements and their host communities in Adjumani district. A total of 1,310 respondents, (664 refugees and 646 host) were randomly selected using multistage cluster sampling and interviewed. Quantitative data were collected using structured questionnaires and analyzed using STATA V.15. Descriptive and Multivariate analysis performed.ResultsWe found that modern Contraceptive Prevalence Rate (mCPR) was 30.2% (32.2% for host and 28.2% for refugees). Multivariate analysis showed that women who live singly (AOR = 2.25, 95%, CI: 1.56 -3.84), completed primary education [AOR = 1.65, 95% CI: 1.27–2.16], acquired skills [AOR = 2.28, 95% CI: 2.11–2.47], have the desire for another child [AOR = 3.73, 95% CI: 1.45- 9.60], have stayed in the study area between 3–5 years [AOR = 2.24, 95% CI: 1.46–3.42] were statistically significantly associated with FP use among both refugee and host populations. The key barrier to FP use by host was harassment of women and separation/divorce for not consulting the family members. Whereas amongst the refugees, they do not want to use FP methods.ConclusionOur findings revealed low FP use amongst both populations in Adjumani district. The main factors associated with FP use amongst refugee populations included marital status, level of education, type of occupation, and duration of stay in the study area whereas amongst the host is the marital status. Main reasons for not using FP methods included fear of side effects by hosts and not wanting to use FP by refugees. There is need to sensitize both communities about the benefits of FP at community level.

Narratives of homeless people with ostomies treated at the Adult Rehabilitation Center in a state in Northeastern Brazil

The objective was to analyze the narratives of homeless people with ostomies in a state in northeastern Brazil. This is a qualitative study in which data were produced in two moments: documentary research and interviews guided by the thematic oral history approach. The interviews were inserted into the Atlas.ti 7 software to organize and process the data, which were analyzed using thematic content analysis. From the analysis of interview data, 34 subcategories emerged in total. The results showed that the group of participants is mostly under 40 years old, male, mixed race, complete primary education and between 5 and 10 years living on the streets. It was reported that having a colostomy bag is limiting, either due to the lack of information on where to seek specialized services, or stigma and prejudice.

Tampa Scale for Kinesiophobia in chronic neck pain patients (TSK-neck): structural and construct validity and reliability in a Brazilian population

BackgroundTo date, there are no studies in the literature that define the internal structure of the Tampa Scale for Kinesiophobia (TSK) in patients with chronic neck pain based on factorial analysis. As such, we aimed to verify and identify the best structure of the Brazilian version of the TSK in patients with chronic neck pain.MethodsWe included Brazilian participants aged ≥18 years, both sexes, with self-reported neck pain for more than 3 months and pain intensity ≥3 on the Numerical Pain Rating Scale (NPRS). Dimensionality and number of TSK items were assessed using confirmatory factor analysis (CFA). We tested the following internal structures: structure 1 (1 domain and 17 items), structure 2 (1 domain and 11 items), structure 3 (2 domains and 11 items), and structure 4 (2 domains and 9 items). We used the Pain-Related Catastrophizing Thoughts Scale (PCTS) and the NPRS for construct validity. In addition, we assessed test-retest reliability for the seven-day interval using intraclass correlation coefficient (ICC2,1), Cronbach’s alpha to assess internal consistency, and ceiling and floor effects.ResultsThe study sample included of 335 patients. Most were women (77.6%), young adults (~ 34 years), single (48.4%), with complete primary education (57.3%), physically inactive (66.6%), with a mean pain duration of 46 months and a mean pain intensity of ~ 5 points on the NPRS. Redundancy was found in the following items: item 1 with item 2 (modification indices = 21.419) and item 13 with item 15 (modification indices = 13.641). Subsequently, based on these paired analyses, the items with the lowest factor loadings (items 2 and 15) were excluded. As such, TSK structure 4 was composed of two domains (“somatic focus” and “activity avoidance”) and 9 items, which showed adequate fit indices and lower AIC and SABIC values. We observed significant values (p < 0.05) with a correlation magnitude greater than 0.142 to 0.657 between the two domains of the TSK-neck and the other instruments (PCTS and NPRS). We found excellent reliability (ICC2,1 ≥ 0.96) and adequate internal consistency (Cronbach’s alpha ≥0.98) of the TSK-neck. Finally, ceiling and floor effects were not observed.ConclusionThe TSK-neck structure with two domains (somatic focus and activity avoidance) and nine items is the most appropriate for patients with chronic neck pain.

Awareness About Maternal and Child Health among the Tribal Women in Two Villages of North Bengal, West Bengal

Despite the implementation of various national programs in India, maternal and neonatal mortality and morbidity remain persistently high in tribal areas, primarily due to a lack of awareness about Maternal and Child Health (MCH) services among tribal women. This study was strategically designed to evaluate the knowledge levels of married tribal women in the reproductive age group regarding MCH services. The focus of this investigation is to understand the awareness about mother and child health services among tribal women in the reproductive age group in two villages, Shikarpur of Jalpaiguri and Hatighisa of Darjeeling district in West Bengal. A total of 100 (50 from each village) married women of reproductive age group were selected. All the participants were interviewed using a survey schedule. Among 100 respondents, 68% completed primary education. A significant proportion of child-birth/deliveries (81%) occur at home, prompting the need for safer institutional deliveries. Prenatal and postnatal care practices vary, with 68% receiving two Tetanus Toxoid doses. Healthcare consultations during sickness show diversity and 57 individuals did not seek any. Breastfeeding initiation within 24 hours was observed. Introducing complementary foods occurred mostly between 0-6 months. The study underscores the necessity for targeted interventions to improve vaccination coverage and healthcare-seeking behaviors, and emphasizes promoting exclusive breastfeeding for enhanced maternal and child well-being.

Empowering the community through financial planning to increase family economic independence in South Tangerang

Rukun Tetangga 03 and 02 in Rukun Warga 01, Rempoa Village, East Ciputat District, South Tangerang City, are geographically suburban areas near Jakarta. The environment is characterized by urban villages, with most residents having completed primary education. The majority of residents fall into the middle to lower-class economic category. Facing post-pandemic economic challenges, residents often opt for cooperative loans. Limited financial knowledge leads to inadequate attention to sound financial management. In response to these challenges, this service program focuses on educating residents about family financial planning and management. The stages of the activity include problem identification, program implementation, and evaluation. The results of the educational activities demonstrate an increase in knowledge related to family financial planning and management.

Development of a multivariate predictive model for dapsone adverse drug events in people with leprosy under standard WHO multidrug therapy.

The occurrence of adverse drug events (ADEs) during dapsone (DDS) treatment in patients with leprosy can constitute a significant barrier to the successful completion of the standardized therapeutic regimen for this disease. Well-known DDS-ADEs are hemolytic anemia, methemoglobinemia, hepatotoxicity, agranulocytosis, and hypersensitivity reactions. Identifying risk factors for ADEs before starting World Health Organization recommended standard multidrug therapy (WHO/MDT) can guide therapeutic planning for the patient. The objective of this study was to develop a predictive model for DDS-ADEs in patients with leprosy receiving standard WHO/MDT. This is a case-control study that involved the review of medical records of adult (≥18 years) patients registered at a Leprosy Reference Center in Rio de Janeiro, Brazil. The cohort included individuals that received standard WHO/MDT between January 2000 to December 2021. A prediction nomogram was developed by means of multivariable logistic regression (LR) using variables. The Hosmer-Lemeshow test was used to determine the model fit. Odds ratios (ORs) and their respective 95% confidence intervals (CIs) were estimated. The predictive ability of the LRM was assessed by the area under the receiver operating characteristic curve (AUC). A total of 329 medical records were assessed, comprising 120 cases and 209 controls. Based on the final LRM analysis, female sex (OR = 3.61; 95% CI: 2.03-6.59), multibacillary classification (OR = 2.5; 95% CI: 1.39-4.66), and higher education level (completed primary education) (OR = 1.97; 95% CI: 1.14-3.47) were considered factors to predict ADEs that caused standard WHO/MDT discontinuation. The prediction model developed had an AUC of 0.7208, that is 72% capable of predicting DDS-ADEs. We propose a clinical model that could become a helpful tool for physicians in predicting ADEs in DDS-treated leprosy patients.

How do socioeconomic determinants of health affect the likelihood of living with HTLV-1 globally? A systematic review with meta-analysis.

Human T Lymphotropic Virus type 1 (HTLV-1) is a neglected retrovirus associated with many clinical disorders, most notably Adult T-cell Leukemia/Lymphoma and HTLV-1-Associated Myelopathy (HAM). Found in endemic clusters across the world, high prevalence has been reported in minoritized groups who suffer from health inequities. This study investigates the association between HTLV-1 prevalence and the following socioeconomic determinants of health: education, income, and employment, which are markers of health inequity. A systematic review was conducted by searching the following databases: Ovid/Medline, Embase, Global Health Database, Web of Science, LILACS and SciELO. Primary studies in English, Spanish and Portuguese mentioning HTLV-1 and one of education, income and/or employment were included. A random-effects meta-analysis was performed, and odds ratios (OR) were calculated to determine the association between these socioeconomic determinants of health and HTLV-1 prevalence. 42 studies were included. The likelihood of having HTLV-1 was higher in individuals with less than completed primary education compared to those who completed primary education (OR 1.86 [95% CI 1.34-2.57]; p < 0.01). This may be because individuals with low education have reduced access to and understanding of health information, thus increasing the prevalence of risk factors associated with HTLV-1 infection. No other determinants were found to be statistically significant. Fewer years of schooling are associated with increased likelihood of contracting HTLV-1. Therefore, health promotion materials and public health policies regarding HTLV-1 must consider those with lower educational levels to effectively reduce disease transmission. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=335004, identifier (CRD42022335004).

The influence of demographic and socio-economic factors on non-vaccination, under-vaccination and missed opportunities for vaccination amongst children 0-23 months in Kenya for the period 2003-2014.

Vaccination is crucial in reducing child mortality and the prevalence of Vaccine-Preventable-Diseases (VPD), especially in low-and-middle-income countries like Kenya. However, non-vaccination, under-vaccination, and missed opportunities for vaccination (MOV) pose significant challenges to these efforts. This study aimed to analyze the impact of demographic and socio-economic factors on non-vaccination, under-vaccination, and MOV among children aged 0-23 months in Kenya from 2003 to 2014. A secondary data analysis of data from the Kenya Demographic Health Surveys (KDHS) conducted during this period was conducted, with a total of 11,997 participants, using a two-stage, multi-stage, and stratified sampling technique. The study examined factors such as child's sex, residence, mother's age, marital status, religion, birth order, maternal education, wealth quintile, province, child's birth order, parity, number of children in the household, place of delivery, and mother's occupation. Binary logistic regression was employed to identify the determinants of non-vaccination, under-vaccination, and MOV, and multivariable logistic regression analysis to report odds ratios (OR) and their corresponding 95% confidence intervals (CI). In 2003, the likelihood of non-vaccination decreased with higher maternal education levels: mothers who did not complete primary education (AOR = 0.55, 95% CI = 0.37-0.81), completed primary education (AOR = 0.34, 95% CI = 0.21-0.56), and had secondary education or higher (AOR = 0.26, 95% CI = 0.14-0.50) exhibited decreasing probabilities. In 2008/09, divorced/separated/widowed mothers (AOR = 0.22, 95% CI = 0.07-0.65) and those with no religion (AOR = 0.37, 95% CI = 0.17-0.81) showed lower odds of non-vaccination, while lower wealth quintiles were associated with higher odds. In 2014, non-vaccination was higher among younger mothers aged 15-19 years (AOR = 12.53, 95% CI = 1.59-98.73), in North Eastern Province (AOR = 7.15, 95% CI = 2.02-25.30), in families with more than 5 children (AOR = 4.19, 95% CI = 1.09-16.18), and in children born at home (AOR = 4.47, 95% CI = 1.32-15.17). Similar patterns were observed for under-vaccination and MOV. This information can inform strategies for bridging the gaps in immunization coverage and promoting equitable vaccination practices in Kenya.

Spatial distribution of pregnancy and early motherhood among late adolescent girls in Ethiopia using data from the Ethiopia Demographics and Health Survey 2019: Spatial and multilevel analyses.

Various governmental and non-governmental organizations in Ethiopia are striving to decrease adolescent pregnancy by enacting laws against early marriage, developing a national youth and adolescent reproductive health strategy, legalizing abortion, and developing an HIV/AIDS policy for youth; however, the issue of teenage pregnancy& early motherhood remains a major concern. Data were obtained from the Ethiopian Demographics and Health Survey (EDHS) in 2019. A total sample of 2210 adolescents was included in our study. Spatial autocorrelation, hotspot analysis, and spatial interpolation were used to observe significant spatial variation and clustering and to predict the prevalence of pregnancy in an unsampled area among adolescent girls in Ethiopia; a multilevel binary logistic regression model was fitted to identify factors associated with the outcome variable. The adjusted odds ratio was calculated with a 95% confidence interval, and the variables with a p-value 0.05 in the multivariable multilevel logistic regression were determined to be statistically significant. Global spatial autocorrelation analyses showed that the spatial distribution of late-adolescent pregnancy and early motherhood varied across Ethiopia (the Global Moran's Index I value showed GMI = 0.014, P 0.001). The spatial distribution revealed a high cluster (hot spot) of late-adolescent pregnancy and early motherhood in most parts of Gambella, Afar, Benishangul-Gumuz, the eastern part of Oromia, and Somalia. In the multivariable multilevel analysis, being 17 years old (AOR = 3.43; 95% CI: 1.54-7.59), 18 years old (AOR = 14.92; 95% CI: 6.78-32.8), and 19 years old (AOR = 8.44; 95% CI: 4.06, 17.56), married (AOR = 25.38; 95% CI: 15.33, 42.02), having completed primary, secondary, and higher education (AOR = 0.45; 95% CI: 0.21-0.95), and being at Gambela (AOR = 3.64; 95% CI: 1.04, 12.75) were significant predictors of late adolescent pregnancy and early motherhood. Overall, the prevalence of late-adolescent pregnancy and early motherhood was found to be high. At the individual level, marital status, educational attainment, and age of adolescents were significant predictors of pregnancy and early motherhood, and regions were found at a community level associated with pregnancy and early motherhood among late adolescents. Therefore, late-adolescent girls should be educated about menstruation, sexual intercourse, pregnancy, and contraceptives before they reach early adolescence.

Physical and psychological changes of the COVID-19 infodemic by the older adult population.

to analyze the physical and psychological changes of the COVID-19 infodemic for the older adult population of Rio de Janeiro. a cross-sectional, web-based survey to find out about access to news and information about COVID-19 among older adult in Rio de Janeiro, between July and December 2020. Univariate analysis and bivariate analysis were carried out using non-parametric statistical methods. 390 older adults took part, predominantly female (75.1%), aged between 66 and 75 (35.4%), married (51.0%), white (60.3%), owning their own home (81.8%), located in urban areas (91%), with complete or incomplete primary education (31.8%) and retired or pensioners (79.2%). Younger people were significantly affected both physically and psychologically by social networks when compared to television (<0.001). Physical and psychological changes from exposure to information about COVID-19 have affected the lives of the older adult, having an impact on this population.

Understanding the Role of Social Support in the Adherence to the Hypertension Continuum of Care in Cambodia

Introduction: Hypertension (HTN) is a major public health problem and a leading cause of cardiovascular diseases and deaths globally. A continuum of HTN care is necessary for people living with HTN since this chronic disease requires comprehensive life-long healthcare management. Several studies have examined the factors influencing the adherence to HTN care. Socio-demographic and economic characteristics are commonly studied as influencing factors of each step of the cascade of HTN care, yet little is known about the effect of social support on the cascade of HTN care. Therefore, our study aims to assess the role of social support on the cascade of HTN care in Cambodia.&#x0D; Method: We performed a population-based survey (5070 individuals aged over 40 and over) to generate a cascade of care for HTN and assess the levels of social support in Cambodia. The cascade shows the patients’ flow in the health system and where they are lost (dropped) along all steps of the cascade from (i) prevalence, (ii) screening, (iii) diagnosis, (iv) treatment in the last 12 months, (v) treatment in the last 3 months, (vi) to being under control. Social support was assessed using the 8-item Medical Outcomes Study Social Support Survey. Multivariate logistic regression was used to determine the effect of social support (from a family member) on each step of the cascade.&#x0D; Results: Among people living with HTN, 22.4%, 27.0%, 21.6% and 28.9% reported receiving low, medium, high and very high levels of social support respectively. Higher levels of social support were found in female adults, married adults, adults aged over 60, as well as those living in a household of 4 to 5 members and those receiving some or having completed primary education. Participants who received medium and very high levels of social support had two times the odds of receiving treatment for HTN as participants with low levels of support both in the last 12 months and the last 3 months. While, participants who had high level of social support had five times the odds of receiving treatment for HTN (both in the last 12 and 3 months) as participants with low levels of social support. &#x0D; Conclusion: Social support from a family member is strongly associated with treatment compliance in the HTN cascade of care in Cambodia. Our findings suggest an exploration of using social support as a tool to promote adherence to treatment programs for HTN care.&#x0D; Implication for applicability/transferability &#x0D; Families are a potential source of social support for hypertensive patients to overcome social barriers and execute disease management tasks especially for treatment compliance. Promoting social support through a social intervention could be a viable path to improve care for hypertensive patients since chronic illness care poses challenges for isolated patients, but could be made easier with the assistance from family.

Prevalence and determinants of poor glycaemic control in individuals aged between 18-60 years, at a regional hospital in KwaZulu-Natal Province, South Africa- a cross sectional study.

Achieving optimal blood glucose control is imperative for preventing diabetes related complications and negative socio-economic consequences associated with them. The aim of the study was to determine the prevalence and determinants of poor glycaemic control amongst type II diabetic outpatients presenting at a regional semi-rural hospital in eThekwini district, Kwa-Zulu Natal. An observational, analytic cross-sectional study was conducted amongst 384 systematically sampled type 2 diabetes patients. Data were collected by an interviewer administered questionnaire, clinical record review and anthropometric measurements. Bivariate and multivariate analyses were performed. Ninety one percent of the study population (349/384) had poorly controlled diabetes. Amongst uncontrolled diabetics, 80% (n=281) were older than 35 years' age group; 58% (n= 203) were male; 85% (n=295) completed primary school education and 93% (n=324) were overweight. Patients that were 35 years and older, female, employed, had a high body mass index, were on oral hypoglycaemic and/or insulin in combination, and receiving treatment longer than 3 years, had an increased odd of uncontrolled diabetes. Being female and receiving oral hypoglycaemic and/or insulin were significantly associated with poor blood glucose control. Patient that were female overweight, having a lower level of education, and greater than three-year duration of medication and on oral hypoglycaemic agent and/or insulin were more likely to have poor blood glucose control. These factors should serve as early identifiers of potential poor control and an alert clinician to adopt a more active approach to optimize treatment.

Trends and Determinants of Intergenerational Educational Inequality in Sub-Saharan Africa for Birth Cohorts 1974 to 2003

This article expands the scope of comparative social stratification research in education to rapidly developing, largely low-income sub-Saharan Africa. First, we investigate trends in the association between parental socioeconomic status (SES) and children’s chances to attend and complete primary education, exploring whether and where educational expansion of the early twenty-first century led to equalization of educational opportunities. Drawing on data from 153 Demographic and Health Surveys and Multiple Indicator Cluster Surveys (1990–2017) from 40 countries, findings indicate that inequality in attendance declined, but inequality in completing six grades largely persisted. Cross-country analyses reveal a large variation in inequality levels and trends. We explore the role of national contextual factors and find that underweight prevalence, fertility rates, school fees, public spending on education, and the ratio of pupils to teaching staff systematically explain variation in SES gaps across countries and cohorts. Findings underline the importance of absolute material deprivation and school teaching resources in the stratification of educational opportunities in this region.

Occurrence and predictors of delirium in critically ill older patients: a prospective cohort study.

This study aims to analyze the occurrence of delirium in critically ill older patients and to identify predictors of delirium. This prospective study included critically ill older patients admitted into level II units of Intensive Care Medicine Department of a University Hospital. Patients with Glasgow Coma Scale score ≤11, traumatic brain injury, terminal disease, history of psychosis, blindness/deafness, or inability to understanding/speaking Portuguese were excluded. The Confusion Assessment Method-Short Form (CAM-4) was used to assess the presence of delirium. The final sample (n = 105) had a median age of 80 years, most being female (56.2%), widowed (49.5%), and with complete primary education (53%). Through CAM-4, 36.2% of the patients had delirium. The delirium group was more likely to have previous cognitive decline (48.6% vs 19.6%, P = .04) and severe dependency in instrumental activities of daily living (34.3% vs 14.8%, P = .032), comparing with patients without delirium. The final multiple logistic regression model explained that patients with previous cognitive decline presented a higher risk for delirium (odds ratio: 4.663, 95% confidence Interval: 1.055-20.599, P = .042). These findings corroborate previous studies, showing that cognitive decline is an independent predictor for delirium in older patients. This study is an important contribution for the knowledge regarding the predictors of delirium. The recognition of these factors will help to identify patients who are at high risk for this syndrome and implement early screening and prevention strategies. However, further studies with larger samples, recruited from other clinical settings as well as analyzing other potential factors for delirium, will be needed.